K Hörmann

Universität Mannheim, Mannheim, Baden-Württemberg, Germany

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Publications (522)526.41 Total impact

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    ABSTRACT: Stromal cell-derived factor-1α (SDF-1α), also known as CXCL12, has variable effects on a plurality of cells. It is known to have selective effects on cell migration, morphology, survival and cell homing. As such the SDF-1-CXCR4 axis is postulated to be a crucial key pathway in the interaction between (cancer) stem cells and their surrounding supportive cells, the so-called (cancer) stem cell niche. We evaluated the expression of CD44 as a cancer stem cell (CSC) marker and the expression of CXCR4 in the head and neck squamous cell carcinoma (HNSCC) cell line UM-SCC 11A. In addition, we monitored proliferation, formation of podia and migration of UM-SCC 11A cells under the influence of SDF-1α. Whereas SDF-1α induced the formation of podia of CD44+ CXCR4+ UM-SCC 11A cells in a dose-dependent manner and the maximum number of cells exhibiting the formation of podia was observed under the influence of 10 ng/ml SDF-1α (P=5.3x10-6), the highest number of migrating cells was noted using a concentration of 100 ng/ml (P=0.027). Proliferation and survival were not affected by SDF-1α. We showed that UM-SCC 11A cells could be a target for SDF-1α by CXCR4 expression and these cells also showed characteristics of HNSCC CSCs via CD44 expression. We demonstrated that SDF-1α is a chemoattractant for UM-SCC 11A cells, and a maximum directed migration was achieved under the influence of 100 ng/ml SDF-1α. Changes in cell morphology by presenting filopodia or a prominent uropod were noted following treatment of 10 ng/ml SDF-1α. The SDF-CXCR4 axis may play a crucial role in the interaction between CSCs and their supportive cells in the CSC niche. Understanding these interactions may help to gain further insight into the pathophysiology of the progression and recurrence of malignant diseases and thus help to develop novel strategies for therapy.
    Oncology Reports 12/2012; · 2.30 Impact Factor
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    ABSTRACT: Head and neck squamous cell carcinoma (HNSCC) is an aggressive epithelial malignancy. It is known to be the most common neoplasm appearing in the upper aerodigestive tract. The poor 5‑year survival rate has remained unchanged in the last decades even though improved techniques in surgery, radiation and chemotherapy have been established. In contrast to the overall decreasing incidence of head and neck cancer in the US, the incidence of HPV-associated oropharyngeal cancer is increasing, indicating the importance of viral etiology. Furthermore, growth and invasion of HNSCC are strongly influenced by the extracellular matrix (ECM). Matrix metalloproteinases (MMP) have been shown to play key roles in the remodeling of the ECM. Imatinib (STI 571) was originally designed to inhibit the BCR-ABL tyrosine kinase in chronic myeloid leukaemia. But it also has an inhibitory impact, e.g., on the protein-tyrosine-kinase (PTK) receptor c-kit and on its PTK activity in HNSCC. In this study, we incubated the HNSCC cell lines HNSCC 11A and 14C and the p16-positive SCC line CERV196 with increasing concentrations of imatinib or carboplatin. After an incubation time of up to 10 days, we evaluated MMP-2 and -14 expression by ELISA techniques and immunohistochemistry. MMP-2 and -14 expression was demonstrated in all incubated tumor cell lines. Especially incubation with imatinib resulted in a significant decrease in MMP expression in incubated cell lines. Our results indicate that the expression of MMP-2 and -14 is suppressed in the presence of imatinib. Thus, imatinib may exert in part its inhibitory effect on malignant cell growth via the blockage of the signal transduction of PTK receptors. Further studies are warranted, especially keeping in mind the moderate toxicity of imatinib.
    Oncology Reports 07/2012; 28(1):172-8. · 2.30 Impact Factor
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    ABSTRACT: Speech audiometry studies do not deliver structured testimony of patients as to the actual benefit of hearing aids based on individual daily life experiences. This deficiency can be resolved by applying structured inventory questionnaires. The APHAB (German version) is an evaluated inventory questionnaire consisting of six questions put to patients with hearing deficiencies with and without hearing aids in four different hearing situations. We collected the APHAB data of 560 patients before and after fitting hearing aids. We also gathered personal data as to age, prior experience with hearing aids, duration of daily use of the hearing aid and degree of hearing loss. The average age of the patients was a little under 70 years, 84% had just received their first hearing aid, and 83% exhibited moderate or severe hearing loss. The APHAB results were classified in percentile and contingency tables. The latter allow one to determine conditional probabilities of the potential success of fitting a hearing aid to a new patient for each APHAB scale. The APHAB can be applied regularly to measure the benefit of fitting a hearing aid to a patient in particular in problematic hearing situations. By registering the personal view of the patients, it expands the scope of the standard methods (e.g., speech audiometry) so that the quality of diagnostics and therapy can be improved. It qualitatively records the success of hearing aid fitting, predicts potential problem areas and thereby may reduce the number of unused hearing aids.
    HNO 07/2012; 60(7):626-36. · 0.42 Impact Factor
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    ABSTRACT: The objective of the study was to assess the short-term efficacy of radiofrequency volumetric tissue reduction (RFVTR) of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy. The study is a prospective, randomized, single-blinded, placebo-controlled, crossover trial. A total of 22 patients (age range 21-72 years; median age 41 years) were randomized into two treatment arms. Using a bipolar radiofrequency system, the first group (VP-group) received RFVTR (verum = V) first (at t1) followed by a placebo treatment (P) 6-8 weeks later (at t2). The PV-group was treated with placebo first at t1 and received RFVTR at t2. Subjects in both groups underwent identical procedures in an office-based setting. Delivery of radiofrequency energy was the only difference between the two groups. The outcome measures assessed were rhinomanometry, physician's evaluation of the degree of hypertrophy of the inferior turbinates and patients' estimation of nasal obstruction. Physician and patient evaluations were documented using a score ranging from 0 = none to 4 = severe. Evaluation was performed 6-8 weeks after every intervention. No intraoperative or postoperative complications occurred. Inferior turbinate hypertrophy improved significantly in both groups after RFVTR was performed (VP-group: p < 0.001; PV-group: p = 0.002). Nasal obstruction also decreased only after RFVTR (VP-group: p = 0.004, PV-group: p = 0.002). This study confirmed the safety of bipolar RFVTR as an office-based treatment of nasal obstruction due to inferior turbinate hypertrophy. We could prove that RFVTR is superior to placebo for reduction in turbinate hypertrophy and subjective improvement in nasal obstruction. To our knowledge, this is the first level I study proving the short-term efficacy of a bipolar radiofrequency system. Level of evidence 1b.
    Archives of Oto-Rhino-Laryngology 06/2012; · 1.29 Impact Factor
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    ABSTRACT: A 73-year old man presented with a lesion inferior to his left medial canthus with discharge and headache. Fifteen years previously, the patient had undergone reduction of an orbital fracture and reconstruction of the orbit with silicone. An orbitocutaneous fistula was found to originate from the implant which was displaced in the ethmoid, obstructing frontal sinus outflow. Symptoms disappeared after explantation of the implant, reconstruction of the orbit with a titanium plate and frontal sinus surgery. Although the use of silicone in facial trauma has declined, complications have to be expected even years after implantation.
    HNO 06/2012; · 0.42 Impact Factor
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    ABSTRACT: To perform functional magnetic resonance imaging (fMRI) studies with olfactory stimulation, the stimulation device requires special properties including those of being non-conductive and non-magnetic. It should also be easily portable and should be small enough to be stored easily when not in use. However, presently only a limited number of devices fulfill these criteria; additionally, they are typically associated with high costs. The aim of the study was to investigate whether a newly developed and relatively simple and inexpensive stimulation device would be suitable for fMRI measurements. Our stimulation device was made of standard industrial and laboratory components, has open-source software and consists of 3 core compartments namely: 'the air inlet, control and distribution section', 'the odorant-section', and 'the delivery-section'. The device was tested in an fMRI study using 21 healthy normosmic subjects who were stimulated with two odors, d-limonene and terpinen-4-ol. Results from this trial suggest that the stimulation device is capable of creating adequate stimulation suitable for fMRI sequences. In general we describe how all sections of the olfactometer are optimized for the needs of fMRI studies.
    Journal of neuroscience methods 06/2012; 209(1):189-94. · 2.30 Impact Factor
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    ABSTRACT: Urticaria describes a heterogeneous group of diseases, whose cardinal symptoms are itching wheals. With a high life time prevalence of 25%, this disease is of major relevance, and the ENT specialist should be familiar with this disease. The most common type is spontaneous Urticaria in which the wheals seem to arise without provocation. Its subtypes are acute and chronic. The mechanism of wheal formation is the activation and degranulation of mast cells. However, the etiology of the wheals is multifaceted. In case of acute spontaneous urticaria, the underlying cause does not have to be verified. It is treated symptomatically by its self-limiting course of disease. The chronic spontaneous, less frequent form of urticaria is treated curatively by identification and elimination of underlying causes, such as autoimmune processes, intolerance to food additives and chronic infections. The chronic subtype can persist for years and thus has an extensive socioeconomic impact. This article overviews the clinical symptoms, diagnostic methods and therapeutic options for both acute spontaneous and chronic spontaneous urticaria, and refers to the current international EAACI/WAO and German DGAKI/DDG S3 guidelines.
    HNO 05/2012; 60(5):457-65; quiz 466. · 0.42 Impact Factor
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    ABSTRACT: The pathophysiology of chronic rhinosinusitis (CRS) is unknown, but the majority of patients suffer from eosinophilic infiltration. We hypothesised that doxycycline might alter the eosinophil-associated expression of interleukin-5 (IL-5) and eotaxin-3 in CRS and also the expression of matrix metalloproteinase 9 (MMP-9), being involved in the tissue-remodelling in CRS. After obtaining samples from 10 CRS patients with and without nasal-polyposis undergoing functional endoscopic sinus surgery and two healthy individuals, the expression of IL-5, eotaxin-3 and MMP-9 were evaluated by an ELISA technique. The tested agent was doxycycline at 0.1 or 1 mg/ml. IL-5 levels remained unchanged, but eotaxin-3 levels actually increased under doxycycline treatment. The only marker showing a slight drop was MMP-9, albeit not significant. As first clinical trials with doxycycline in the treatment of CRS produced reasonable results we could demonstrate that the underlying pathology is more complex, and doxycycline affects only a part of the factors believed to support the chronic infection of the respiratory mucosa.
    In vivo (Athens, Greece) 05/2012; 26(3):369-74. · 1.22 Impact Factor
  • K. Hörmann, K. Hirth
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    ABSTRACT: Die Autoren der im Journal of the American Medical Association (JAMA) veröffentlichten Studie kommen zu dem Schluss, dass sowohl die Adenotomie (AT) als auch die Adenotonsillektomie (TEAT) lediglich im ersten postoperativen Jahr zu einer Reduktion der Häufigkeit der Otitiden führt, dieser Effekt in den nachfolgenden Jahren jedoch nicht mehr gesehen wird. Die Autoren folgern daraus, dass aufgrund der Operationsmorbidität sowie Komplikationsrate und nicht zuletzt auch der Kosten auf eine operative Therapie zugunsten einer gezielten Antibiotikatherapie sowie ggf. der Einlage von Paukenröhrchen verzichtet werden sollte. Diese Betrachtungsweise erscheint einseitig und soll im nachfolgenden Beitrag diskutiert werden.
    HNO 04/2012; 48(9):637-638. · 0.42 Impact Factor
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    ABSTRACT: The need for surgical treatment alternatives for obstructive sleep apnea is unchanged. However, recommendations regarding these treatments can often only be given with caution as there are only a limited number of controlled studies available. To perform controlled trials and even more so placebo controlled trials in the field of sleep surgery is challenging, especially in comparison to studies evaluating conservative approaches. Nevertheless, these studies can be carried out also in the field of sleep surgery. In this review we present recent concepts and high-quality surgical trials with innovative study designs. A Medline search revealed 310 studies regarding surgical treatment of sleep apnea. These studies were assessed regarding quality, execution and number of subjects. A total of 12 randomized controlled studies were identified addressing palatal implants, radio-frequency surgery, nasal surgery, maxillomandibular advancement and laser-assisted uvulopalatoplasty (LAUP). Furthermore this review addresses the limitations of surgical studies and the differences compared to trials dealing with conservative approaches. The studies presented in this review demonstrate that high-quality trials regarding surgical treatment of obstructive sleep apnea are feasible and can lead to recommendations with high evidence levels.
    HNO 04/2012; 60(4):294-9. · 0.42 Impact Factor
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    ABSTRACT: In a former study, taste disturbances after tonsillectomy seemed to be more frequent than expected. Eight percent of patients reported subjective taste disorders 6 months after tonsillectomy. Fifteen patients from the initial trial, who reported taste disorders after tonsillectomy, were contacted again for this long-term follow-up. A telephone interview using the same questionnaire addressing the current self-estimate of taste function was performed. At 32 ± 10 months following surgery, two (0.9%) patients still reported suffering from taste disturbance. This long-term follow-up study shows that dysgeusia following tonsillectomy occurs in approximately 1% of patients. These data should be considered when patients are informed about complications after tonsillectomy.
    The Laryngoscope 03/2012; 122(6):1265-6. · 1.98 Impact Factor
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    ABSTRACT: The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic facilities, HNSCC still represents a multidisciplinary challenge. One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome prediction in patients with HNSCC. This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRT are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning.
    Laryngo-Rhino-Otologie 03/2012; 91 Suppl 1:S27-47. · 0.82 Impact Factor
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    ABSTRACT: Perturbation of semicircular canal function may result in a pathological angular vestibulo-ocular reflex (aVOR). The resulting impairment in gaze stabilization is perceived as "vertigo" or "dizziness" and may occur following receptor function impairment of all three semicircular canals. The head impulse test reveals hidden (covert-catchup) or visible (overt-catchup) saccades in disturbances of semicircular function. Most peripheral vestibular disorders can be treated conservatively. There are surgical treatment options for some diseases, such as intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence. Vestibular training promotes central reorganization of the VOR. Impaired semicircular receptor function, in particular bilateral vestibulopathy, may affect spatial orientation and cognitive processes. Balance prostheses could serve as a replacement for receptors in the future.
    HNO 03/2012; 60(3):249-59; quiz 260-1. · 0.42 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of a phytotherapeutic nasal spray containing Cyclamen europaeum (CE) in the treatment of acute rhinosinusitis (ARS). We performed a randomized, double-blind, placebo-controlled trial of CE nasal spray once daily for 15 days in 99 adult patients with moderate-to-severe ARS who also received amoxicillin 500 mg three times daily for the first 8 days. The primary endpoint was the change in mean total symptom scores (TSS) on day 7. Secondary endpoints included individual symptom scores (nasal congestion, mucus secretion, facial pain, impairment of smell) and endoscopic findings on days 7 and 15 and others. No statistically significant difference in TSS was noted for CE versus placebo on day 7. Moreover, the individual scores were not statistically different between the groups for the ITT-population on day 7. However, both a reduction in facial pain and an improvement in endoscopically-assessed mucosal obstruction significantly favoured CE on day 7. The most common adverse events were nasal burning and mild epistaxis, but no severe adverse events were documented. In summary, this is the first randomized controlled trial on phytotherapy in patients with moderate-to-severe ARS demonstrating clinical safety and some encouraging effects of CE which merit to investigate phytotherapeutic products in further large-scale clinical trials.
    Rhinology 03/2012; 50(1):37-44. · 1.72 Impact Factor
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    ABSTRACT: Complementary and alternative medicine (CAM) represents a wide range of treatment modalities. CAM products may interact with enzymes, transport proteins, and may therefore influence drug metabolism. The prevalence and patterns of CAM usage among patients with head and neck carcinoma (HNC) are largely unknown. This cross-sectional study was designed to document pattern of CAM consumption in patients with HNC. Statistical differences in a significantly higher prevalence of CAM consumption between tumor patients (n = 107) and the control group (n = 112) could be detected. Concerning the frequency of CAM usage, we could document a significant increased consumption of CAM among tumor patients (42.8% vs. 62.6%) especially for herbal teas (P < 0.05), phytotherapy (P < 0.001), supplement products (P < 0.05), and "other" supplements (P < 0.005) comparing the controls. Furthermore a significant influence of female gender and an increased CAM usage could be illustrated. Concerning the knowledge of potential interactions of CAM consumption, only 6.25% of the controls and 19.6% of tumor patients know about possible side effects but only 1.7% of the controls and 6.5% of the tumor patients informed their physician about the CAM usage. The frequency of CAM in head and neck tumor patients seems to be relevant in the supervision of anticancer therapies.
    Nutrition and Cancer 02/2012; 64(3):377-85. · 2.70 Impact Factor
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    ABSTRACT: PURPOSE: Success rates of non-ventilation therapies for sleep disordered breathing (SDB) remain hardly acceptable. Drug-induced sleep endoscopy (DISE) tends to show the level and mechanism of obstruction and helps to specify therapy individually. Therefore, increasing success rates are expected. The objective of this study is to detect whether locations of treatment recommendations given after DISE are different to those made after clinical basic ENT (ear, nose, throat) examination (CBE). METHODS: This study included patients with obstructive sleep apnea (OSA) and primary snoring who wish or require an alternative therapy to the gold standard, continuous positive airway pressure (CPAP). After CBE, a theoretical treatment recommendation was given comprising surgery (possible surgical target: soft palate, tonsils, tongue base, epiglottis) and mandibular advancement splints (MAS) or both. A second ENT specialist conducted a DISE and independently recommended a second therapy concept without knowing the first one. A third person compared both theoretical locations of treatment recommendations (CBE vs. DISE). RESULTS: A total of 97 patients (eight female and 89 male, age 30-85 years, AHI 1.9-88.6/h, body mass index [BMI] 20.3-36.3 kg/m²) received two therapy recommendations. Regarding surgical options only, 63.9% of the examined patients got a different recommendation in at least one of four levels. If MAS was included, a change was found in 78.4% of the patients. Subdivided into each type of intervention, the following changes were found in the therapy concept: 24.7% (n = 24/97) soft palate, 12.4% (n = 12/97) tonsils, 33.0% (n = 32/97) tongue base, 27.8% (n = 27/97) epiglottis, 38.1% (n = 37/97) MAS. CONCLUSIONS: DISE shows a relevant influence on the location of treatment recommendation. Thus, a change in success rates of non-CPAP therapy in OSA and snoring appears possible.
    Sleep And Breathing 01/2012; · 2.26 Impact Factor
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    ABSTRACT: Palatal implants have been used to treat snoring and mild to moderate obstructive sleep apnea (OSA). Two previous controlled trials have published conflicting results regarding the effects of palatal implants on objective outcome measures, although they both could demonstrate superiority over placebo. The aim of the present study was to assess the effects of palatal implants in patients with mild to moderate sleep apnea in a randomised, placebo-controlled trial. Twenty-two patients with mild to moderate OSA (AHI 18 ± 5, BMI 28 ± 3, age 51 ± 13 years) due to palatal obstruction were enrolled in this randomised, double-blind, placebo-controlled trial. Respiratory parameters and sleep efficiency (evaluated by polysomnography), snoring (evaluated by the bed partner), and daytime sleepiness (evaluated by ESS) were assessed before and 90 days after surgery. One patient in each group did not show up for follow-up. The AHI, HI and LSAT showed statistically significant improvement in the treatment group (p < 0.05). Snoring as rated by bed partners also showed statistically significant improvement within the treatment group (p = 0.025). There was no statistical difference when comparing the means of the treatment group with the placebo group. There were no peri- or post-operative complications and no extrusions during the follow-up period. The study supports the idea that palatal implants lead to a reduction in respiratory events in patients with mild to moderate OSA, although a statistically significant superiority of palatal implants over placebo could not be demonstrated in this trial.
    Archives of Oto-Rhino-Laryngology 01/2012; 269(7):1851-6. · 1.29 Impact Factor
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    ABSTRACT: The most common neoplasm arising in the upper aerodigestive tract is head and neck squamous cell carcinoma (HNSCC). Tumor growth, invasion and systemic dissemination is a multistep process of dysregulated cellular signaling pathways and an altered cell-cell and cell-matrix interaction. Aberrant Wnt/β-catenin signaling is linked to tumor development and dissemination in several tumor entities. β-catenin is a multifunctional protein within the canonical Wnt pathway, which is an important factor for reducing cell-cell adhesion in malignant tissue and for triggering cell cycle progression and unscheduled proliferation. Another pivotal factor in carcinogenesis is the tyrosine kinase receptor c-kit, which in the case of dysregulated expression is associated with neoplastic transformation in epithelial tissue. This study evaluates the expression pattern of secreted and nuclear β-catenin and c-kit in p16-positive and HPV-negative squamous cell carcinomas (SCC) and the vulnerability of therapy with the tyrosine kinase inhibitor imatinib as a potential targeted treatment modality compared to platinum-based chemotherapeutic drugs. The different squamous tumor cell lines were incubated with increasing concentrations of carboplatin (3 or 7.5 µmol/ml) and imatinib (18 or 30 µmol/ml). ELISA and immunohistochemical methods were carried out after 48, 72, 120, 192 and 240 h. We detected a reliable trend towards significantly decreased cytosolic and nuclear β-catenin and c-kit expression levels in p16-positive SCC and non-HPV HNSCC cells induced by imatinib exposure for an extended incubation period, whereas platinum-based agents had no or, at best, a slight influence. Virus-transformed squamous cell carcinoma (CERV196) cells were characterized by a reduced susceptibility to an imatinib-altered β-catenin expression. Further studies are planned to investigate this observance in HPV-positive HNSCC in vitro. The implementation of a selective molecular therapy in established chemotherapeutic regimes may enhance the efficacy of platinum-based chemotherapy without increased toxicity and could thus improve the clinical outcome in HNSCC, irrespective of the HPV status.
    Oncology Reports 01/2012; 27(1):270-80. · 2.30 Impact Factor
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    ABSTRACT: The perception and conversion of motion stimuli by the vestibular receptors, unimpaired postural control and intact visual acuity are essential for spatial orientation. Disturbances in these three sensory systems can manifest as "vertigo", "dizziness" or "imbalance". The integrity of peripheral receptor function, especially of the three semicircular canals, plays a superficial role. They are sensitive to acceleration stimuli, which they transmit via reflexes to the eye muscles. The stabilization of a visual target is via vestibulo-ocular reflexes, which have a very short latency and thus ensure a permanently stable image on the retina. Modern lateral-specific testing procedures are available to diagnose the receptor function of the peripheral vestibular system. The function of the semicircular canals can be analyzed using a head impulse test (HIT) and, more recently, by means of video-HIT as well as on the basis of a caloric test. Using these techniques, all three semicircular canals can be assessed in a side- and receptor-specific manner.
    HNO 01/2012; 60(1):75-87; quiz 88. · 0.42 Impact Factor
  • HNO 12/2011; 60(2):141-62. · 0.42 Impact Factor

Publication Stats

3k Citations
526.41 Total Impact Points

Institutions

  • 1996–2014
    • Universität Mannheim
      Mannheim, Baden-Württemberg, Germany
  • 1995–2014
    • Universität Heidelberg
      • • Faculty of Medicine Mannheim and Clinic Mannheim
      • • Institute of Hygiene
      Heidelburg, Baden-Württemberg, Germany
  • 2013
    • Technische Universität München
      München, Bavaria, Germany
  • 2000–2013
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 2012
    • HELIOS Klinikum Berlin-Buch
      Berlín, Berlin, Germany
  • 2009–2012
    • Universitätsmedizin Mannheim
      Mannheim, Baden-Württemberg, Germany
    • Central Institute of Mental Health
      Mannheim, Baden-Württemberg, Germany
  • 2011
    • University of Cologne
      • Faculty of Medicine
      Köln, North Rhine-Westphalia, Germany
  • 1997–2010
    • Westpfalz-Klinikum GmbH
      Kaiserlautern, Rheinland-Pfalz, Germany
    • Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
  • 2008–2009
    • Asklepios Klinik Harburg
      Hamburg, Hamburg, Germany
  • 2005–2008
    • Universitätsklinikum Münster
      Muenster, North Rhine-Westphalia, Germany
  • 2007
    • University of Münster
      Muenster, North Rhine-Westphalia, Germany
  • 2003
    • Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.
      München, Bavaria, Germany
  • 2001
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
  • 1993–1996
    • Technische Universität Kaiserslautern
      • Department of Physics
      Kaiserlautern, Rheinland-Pfalz, Germany
  • 1987
    • University of Hamburg
      Hamburg, Hamburg, Germany