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ABSTRACT: Malignant melanomas are the most frequent skin tumors and, due to the early tendency to metastasize, are linked with an unfavorable prognosis. In the early stage of illness surgical resection is the treatment of choice. This case shows that even large exulcerated tumors of the neck can originate from a dermal tumor.
HNO 10/2012; 60(10):908-12. · 0.40 Impact Factor
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ABSTRACT: HintergrundDie vorgestellte Arbeit erhebt den aktuellen Stand der Lehrsituation an deutschen HNO-Universitätskliniken 5Jahre nach Inkrafttreten
der neuen ärztlichen Approbationsordnung (AO).
MethodeEs wurde ein aus 31Items bestehender Fragebogen an alle HNO-Universitätskliniken deutscher Hochschulen geschickt.
ErgebnisseAn der Umfrage nahmen 31HNO-Lehrstühle (86%) teil. Den Forderungen nach mehr Praxisnähe und Vermittlung sozialer Kompetenz
wurde weitestgehend Rechnung getragen. Dennoch bleiben auf inhaltlicher Ebene, insbesondere hinsichtlich der Qualität schriftlicher
und praktischer Prüfungen sowie der stärkeren Gewichtung des praktischen Jahrs, noch einige Probleme offen. Noch 20–33% der
Lehrveranstaltungen sind nicht an speziellen Lernzielkatalogen orientiert, und die Qualität schriftlicher Prüfungen wird nur
in knapp der Hälfte aller Fälle durch ein „Peer-review“-Verfahren sowie statistische Auswertungen sichergestellt.
SchlussfolgerungDie deutschen HNO-Universitätskliniken können bisher die Forderungen der neuen AO nicht vollständig umsetzen. Hierfür wären
eine stärkere Gewichtung der Lehre und eine intensivere didaktische Ausbildung der Hochschullehrer nötig. Hilfreich würden
sich die Erarbeitung eines bundesweiten Lernzielkatalogs auf Fachgesellschaftsebene sowie die Ressourcenbündelung bei der
Erstellung und Durchführung von schriftlichen „Multiple-choice“- (MC-)Prüfungen auswirken.
BackgroundIn 2003 new regulations for the licensing of German physicians came into effect. The aim of this study was to survey the present
status of realization in German otorhinolaryngology (ORL) university departments.
MethodsA questionnaire containing 31 items was sent to all German ORL university departments.
ResultsA total of 31 (86%) ORL departments responded to the questionnaire. Most faculties reacted correctly in the practical realization
of the new regulation demands. Regarding the quality of written and practical examinations, some changes have to be considered
in order to maintain high quality standards.
ConclusionThe demands of the new licensing regulations have not yet been fully implemented. Therefore, medical education must gain importance
in the daily clinical routine. Establishment of nationwide learning objectives and resources pooling for written examinations
would be helpful.
SchlüsselwörterÄrztliche Approbationsordnung-Medizinische Ausbildung-Lernziele-Lehrevaluation-„Objective structured clinical examination“
KeywordsNew regulations for the licensing of physicians-Medical education-Learning evaluation-Learning objectives-Objective structured clinical examination
HNO 05/2012; 58(3):255-262. · 0.40 Impact Factor
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ABSTRACT: Eine 65-jährige Patientin stellte sich mit rezidivierenden wässrig-schleimigen Rhinorrhoen beiderseits mit zeitweiligen Blutbeimengungen
vor. Klinisch imponierte ein grau-glasiger Polyp im hinteren Siebbeinbereich rechts, der sich histologisch als Hämangioperizytom
vom sinunasalen Typ darstellte. Nach erfolgreicher Operation und vollständiger Resektion des Tumors ist die Patientin rezidiv-
und beschwerdefrei. Die Prognose dieser Tumorentität wird entscheidend von Tumorgröße und -ausdehnung bei Erstdiagnose und
dem initialen Resektionsstatus bestimmt.
A 65-year-old female was admitted to hospital for evaluation of recurrent, right-sided sometimes ensanguined, rhinorrhea and
epistaxis. Clinical examination revealed a right-sidedunilateral polypoid nasal mass. After endoscopic sinus surgery a sinunasal
hemangiopericytoma (SNHPC) was diagnosed. Revision surgery was performed without any residual tumor. To date the patient is
free of recurrence. SNHPCs are uncommon neoplasms of vascular origin. The prognosis is mainly determined by initial tumor
size and expansion as well as primary complete resection.
SchlüsselwörterHämangioperizytom vom sinunasalen Typ-Polyposis nasi-Glomangioperizytom-Literaturübersicht
KeywordsSinunasal hemangiopericytoma-Glomangiopericytoma-Nasal polyp-Literature review
HNO 05/2012; 58(10):1053-1056. · 0.40 Impact Factor
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ABSTRACT: Aufgrund des vermehrten Einsatzes der Sonographie im Kopf-Hals-Bereich und der Weiterentwicklung der Ultraschalltechnik werden
zunehmend Tumoren in der Regio thyroidea diagnostiziert. Anhand eines sonographisch diagnostizierten intrathyreoidalen Schilddrüsennodus
und zweier dorsal der Schilddrüse gelegener Nodi auf der Gegenseite wird die seltene Differenzialdiagnose einer multiplen
endokrinen Neoplasie Typ1 an einem Fallbeispiel vorgestellt.
Owing to the growing use of ultrasound in the head and neck and to technical progress, the number of tumours diagnosed in
the thyroid region is increasing. The rare differential diagnosis of multiple endocrine neoplasm type1 in a case with a unilateral
intrathyroidal lump and two lumps located dorsal to the contralateral thyroid is discussed.
HNO 05/2012; 55(11):880-884. · 0.40 Impact Factor
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ABSTRACT: Anatomical information of the middle and inner ear is becoming increasingly important in post-operative evaluation especially after stapesplasty with unsuccessful improvement of the air-bone gap (ABG). So far computed tomography (CT) has been the first choice for detection of reasons for recurrent hearing loss. CT has the disadvantage of metal-induced artefacts after insertion of middle ear implants and of a relatively high irradiation dose.
Flat panel CT (fpCT) was performed in three temporal bone specimen after experimental insertion of different stapes prostheses, aiming to validate the accuracy of fpCT of the middle and inner ear. Additionally, 28 consecutive patients, supplied with different stapes prostheses underwent post-operative fpCT to compare the pre- and post-operative hearing results with the determined prosthesis position in the middle and inner ear.
In all cases, fpCT showed a statistically significant correlation between hearing improvement and prosthesis position. This technique provided detailed post-operative information of the implant position in patients and temporal bone specimen.
The new imaging technique of fpCT allows the immediate and almost artefact-free evaluation of surgical results following stapesplasty. Further benefits are a lower irradiation dose and higher isovolumetric resolution compared with standard CT.
Flat panel computed tomography (fpCT) helps otosurgeons design precise stapes protheses. fpCT allows a prediction of the postoperative hearing outcome in patients. fpCT is an adequate imaging technique for immediate postoperative quality control. Postoperative management of patients with prosthesis-related complications is more appropriate.
European Radiology 12/2011; 22(4):837-44. · 3.22 Impact Factor
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ABSTRACT: The training of microsurgical motor skills is essentiell for surgical education if the interests of the patient are to be safeguarded. In otosurgery the complex anatomy of the temporal bone and variations necessitate a special training before performing surgery on a patient. We therefore developed and evaluated a simplified middle ear model for acquiring first microsurgical skills in tympanoplasty.The simplified tympanoplasty model consists of the outer ear canal and a tympanic cavity. A stapes model is placed in projection of the upper posterior tympanic membrane quadrant at the medial wall of the simulated tympanic cavity. To imitate the annular ligament flexibility the stapes is fixed on a soft plastic pad. 41 subjects evaluated the model´s anatomical analogy, the comparability to the real surgical situation and the general model properties the using a special questionnaire.The tympanoplasty model was very well evaluated by all participants. It is a reasonably priced model and a useful tool in microsurgical skills training. Thereby, it closes the gap between theoretical training and real operation conditions.
Laryngo-Rhino-Otologie 11/2011; 90(11):672-6. · 0.97 Impact Factor
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ABSTRACT: Patients with birch pollen allergy may suffer from severe anaphylactic reactions after ingestion of foodstuffs containing soya. The reason for this is similarities in protein structure between a major birch pollen allergen (bet v 1) and Gly m 4, a pollen-related protein in soya. A 65-year-old patient allergic to birch pollen developed an adverse systemic reaction after consumption of a soya-containing drink. The diagnosis could be confirmed by in vitro and skin testing methods. Patients who suffer from birch pollen allergy should strictly avoid the intake of soya-containing foodstuffs.
HNO 10/2011; 60(2):117-9. · 0.40 Impact Factor
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T Zahnert
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ABSTRACT: Today the middle ear can be reconstructed in various ways: without any ossicular chain reconstruction, with reconstruction using autologous ossicles, with reconstruction using passive alloplastic implants or by using active implants. In recent decades, reconstruction with passive middle ear implants has increased for several reasons. It has been demonstrated that in the case of inflamed mucosa the resorption rate of autologous ossicles is around 15%. Modern alloplastic implants can be considered more resistant to inflammatory processes with high biocompatibility. Furthermore, modern alloplastic implants are low-weight with high rigidity. The greatest advantage lies in better coupling possibilities to the residual ossicular chain because of the introduction of coupling elements and also functional elements which are integrated into the prostheses. Due to the wide variety of passive implants this paper is intended to provide an overview of the best reconstruction solutions for the most typical ossicular chain defects using passive middle ear implants. Particular attention is paid to the use of alloplastic prosthesis compared to the use of autologous ossicles.
HNO 09/2011; 59(10):964-73. · 0.40 Impact Factor
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ABSTRACT: Olfactory dysfunction is a common symptom in patients with inflammation of the nasal mucosa. Among numerous drugs, so far only the use of steroids has been shown to have a positive effect on olfactory function. Therefore the aim of the present study was to investigate whether patients with sinonasal disease would benefit in terms of olfactory function from oral treatment with a herbal drug (combination of primrose, gentian root, vervain, elder flowers, and sorrel: Sinupret(r)) which is commonly used in sinusitis. Olfactory function was tested using a standardised olfactory test kit (`sniffin` sticks`). The drug was applied in a double-blind fashion: after an initial therapy of 7 days of oral prednisolone for all participants with a sinonasal olfactory disease, participants were divided into a placebo- and a verum-group; tests were performed before and after treatment over a 2 months period. Statistical analysis did not reveal any major differences in olfactory function in relation to treatment. Considering that its benefit for the inflammatory component of sinusitis has been shown, the herbal drug may exhibit positive effects on olfactory function in a different setting, e.g., when applied without preceding administration of prednisolone, or when used in patients with certain degrees of rhinosinusitis.
Rhinology 09/2011; 49(3):342-6. · 1.32 Impact Factor
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ABSTRACT: Standardized procedures support learning of complex psychomotoric activities. We standardized the clinical otolaryngology examination to provide an objective basis for its operationalization. The Impact of the standardization on the objective measureable learning success and the student's evaluation were determined.During their 1-week ENT internship 166 medical students learned the standardized clinical otolaryngology examination. At the end of this week they absolved an objective structured clinical examination (OSCE). The students evaluated both, the teaching (standardization) and examination method (OSCE) with 2 questionnaires.All students passed the exam with mean score of 60.3±3.5 (max. 65) points. By using the OSCE checklist 2 independent examiners appraised nearly identical examination performances. In both evaluations the students rated the teaching and examination design positive. All students greatly appreciated the standardized clinical examinations and considered it as are very important for learning practical skills.The standardization of clinical otolaryngology examination permits objective and reliable tests for learning progress and success. Furthermore transparency, process reliability and test quality are considerably improved. The student's evaluation clearly reflects the mentioned advantages.
Laryngo-Rhino-Otologie 07/2011; 90(9):537-42. · 0.97 Impact Factor
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ABSTRACT: A 65-year-old female was admitted to hospital for evaluation of recurrent, right-sided sometimes ensanguined, rhinorrhea and epistaxis. Clinical examination revealed a right-sidedunilateral polypoid nasal mass. After endoscopic sinus surgery a sinunasal hemangiopericytoma (SNHPC) was diagnosed. Revision surgery was performed without any residual tumor. To date the patient is free of recurrence. SNHPCs are uncommon neoplasms of vascular origin. The prognosis is mainly determined by initial tumor size and expansion as well as primary complete resection.
HNO 10/2010; 58(10):1053-6. · 0.40 Impact Factor
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ABSTRACT: In 2003 new regulations for the licensing of German physicians came into effect. The aim of this study was to survey the present status of realization in German otorhinolaryngology (ORL) university departments.
A questionnaire containing 31 items was sent to all German ORL university departments.
A total of 31 (86%) ORL departments responded to the questionnaire. Most faculties reacted correctly in the practical realization of the new regulation demands. Regarding the quality of written and practical examinations, some changes have to be considered in order to maintain high quality standards.
The demands of the new licensing regulations have not yet been fully implemented. Therefore, medical education must gain importance in the daily clinical routine. Establishment of nationwide learning objectives and resources pooling for written examinations would be helpful.
HNO 03/2010; 58(3):255-62. · 0.40 Impact Factor
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ABSTRACT: Today a large variety of different imaging techniques are available for middle ear investigation. However, imaging is not suitable to give essential information in every case on the surgical strategy to be chosen. This article discusses the most frequent indications for preoperative imaging and the relevant techniques. CT scanning, MRI and rotational tomography are taken into consideration as well as traditional X-ray investigations like e.g. 'Schüller's view'. In general, preoperative imaging should only be performed in a patient if certain specific questions can be answered. The experience of the investigator to interpret the images may influence the choice of imaging as well as the equipment he has access to.
ORL 01/2010; 72(3):159-67; discussion 167. · 0.91 Impact Factor
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ABSTRACT: Although the function of active middle ear implants in cases of intact ossicular chains and ventilated middle ears is well known, information about sound transfer function to the inner ear in cases of chronic middle ear effusion and defective middle ear structures is needed. A temporal bone model was developed to measure (1) the coupling of the active middle ear implant Vibrant Soundbridge in cases of nonventilated radical cavities, and (2) the effect of effusion and cartilage shielding.
Three fresh human temporal bone specimens were studied. After preparation of a radical cavity, the floating mass transducer was coupled to the stapes footplate. The transducer was stimulated with 50 mV multisinus signals and inner ear fluid vibration was measured using a microphone in the round window niche. Several coupling conditions were simulated with mass and stiffness variations and cartilage shielding.
Coupling modality and prestress have the most influence on the sound transfer function to the inner ear. Cartilage shielding may ensure better coupling of the FMT to the footplate. The effect of middle ear effusion is negligible.
The Vibrant Soundbridge provides good sound transfer to the inner ear not only in cases of coupling onto an intact ossicular chain in a ventilated middle ear but also in cases of coupling to the stapes footplate in non-ventilated radical cavities.
Advances in oto-rhino-laryngology 01/2010; 69:32-7.
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ABSTRACT: Some patients with chronic middle ear disease and multiple failed revisions, who also need a hearing aid, may benefit from an active middle ear implant. An advantage of an active middle ear implant is that the ear canal is unoccluded.
Following extensive experimental development in temporal bones and investigations of various locations and attachments of a Vibrant Soundbridge transducer, a new titanium clip holder for the vibrant floating mass transducer was developed. This assembly is a total ossicular replacement prosthesis (TORP) that is placed on the stapes footplate. Six patients were implanted with this device.
Acoustic results demonstrate significantly improved gain, especially in the high frequencies, which is typically unobtainable by conventional hearing aids.
The simple procedure of placing an active TORP assembly on the stapes footplate, similar to the implantation of a passive TORP prosthesis during tympanoplasty, offers promising treatment for cases of incurable middle ear disease.
Advances in oto-rhino-laryngology 01/2010; 69:27-31.
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T Zahnert
HNO 09/2009; 57(10):998. · 0.40 Impact Factor
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ABSTRACT: An intact olfactory system affects all areas of life including the creation of new life, partner selection, daily hygiene, food intake, and the perception of danger from gas and smoke. The olfactory system is most effective from adolescence to middle age. With advancing age the regeneration of olfactory receptor cells decreases, often resulting in an increasing loss of smell. Functional anosmia affects 5% of the general population and 10% of those over 65. Therefore, olfactory dysfunctions are not uncommon. The following provides an overview of the physiology of smell, olfactory testing, special olfactory dysfunctions as well as treatment and general recommendations.
Laryngo-Rhino-Otologie 10/2008; 87(9):657-68; quiz 669-72. · 0.97 Impact Factor
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ABSTRACT: The successful introduction of Doppler and Color-Coded Doppler Sonography (CCDS) in the field of Otorhinolaryngology has improved the diagnostic sonographic value for several diseases of the head and neck region, e. g. in hemangiomas and vascular malformations. The diagnostic value of CCDS for examination of the extracranial brain supplying vessels in combination with neuro-otologic disorders is still under controversial discussion.
We investigated the diagnostic CCDS findings for 215 patients suffering from different neuro-otologic disorders. All patients were classified into 4 groups according to the different disorder entity (sudden deafness, tinnitus, vestibular neuropathy, combined diagnosis). The frequency of pathologic CCDS findings was correlated with the different groups using sonographic parameters such as atherosclerosis, stenosis and intima-media thickness.
Classification of the disorder entities led to the following distribution: Sudden deafness group (85 patients; 40 %), Tinnitus group (44 patients; 20 %), Vestibular neuropathy group (41 patients; 19 %), Combined diagnosis group (45 patients; 21 %). Sonographic evaluation of atherosclerosis was possible in 76 cases (35 %), changes of the intima-media thickness were observed in 43 cases (20 %) while proof of stenoses was identified in 15 cases (7 %). The evaluation of plaque formation (atherosclerosis) in the sudden deafness group was significantly higher (p < 0.01) than in all other groups although the combined diagnosis group demonstrated certain tendencies (p < 0.08) without significant correlation.
Our results reinforce the hypothesis of a vascular genesis of sudden deafness and seem to offer the possibility of sonographic differentiation between neuro-otologic disorder entities by use of CCDS. In contrast, it seems that the role of CCDS is negligible for individual diagnostic purposes.
Ultraschall in der Medizin 02/2008; 29(6):627-32. · 2.40 Impact Factor
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ABSTRACT: The primary goal in chronic otitis media is the creation of a dry, safe ear with hearing preservation and reconstruction. This study was designed to evaluate the authors' experience using autologous bone pate and conchal cartilage for mastoid obliteration in canal wall down tympanomastoidectomy.
A retrospective long-term review in 2003 of thirty-nine ears was performed, which underwent mastoid obliteration in canal wall down tympanomastoidectomy between 1993 and 2002 performed by the senior author. Data included questionnaire results, clinical observation as well as pre- and postoperative audiometry.
Long-term follow-up shows, that 38 out of 39 ears maintained a small, dry, healthy mastoid cavity. Recurrent cholesteatoma occurred in a single patient. A self-cleaning mastoid bowl was achieved in 90 %, resulting in reduced follow-up visits. Postoperative vertigo in canal wall down revision surgery is clearly diminished due to the mastoid obliteration. Overall, 92 % of patients are satisfied with the surgical result.
Obliteration of a canal wall down mastoid cavity by autologous bone pate and conchal cartilage is a reliable and effective technique that results in a dry, trouble free mastoid cavity in 90 % of the patients with chronic otitis media.
Laryngo-Rhino-Otologie 01/2008; 86(12):861-6. · 0.97 Impact Factor
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ABSTRACT: Owing to the growing use of ultrasound in the head and neck and to technical progress, the number of tumours diagnosed in the thyroid region is increasing. The rare differential diagnosis of multiple endocrine neoplasm type 1 in a case with a unilateral intrathyroidal lump and two lumps located dorsal to the contralateral thyroid is discussed.
HNO 12/2007; 55(11):880-4. · 0.40 Impact Factor
