[Emergencies in ear, nose and throat medicine]. / Notfälle in der Hals-, Nasen- und Ohrenheilkunde.

Emergencies in ear, nose and throat medicine in the preclinical setting are common. Due to the narrow anatomical conditions, relocation or bleeding in this area can quickly lead to an emergency situation. In this article, the most important causes of bleeding, shortness of breath and trauma are to be presented and the corresponding treatment briefly outlined.

Comparison of Clinical Examination and Various Imaging Modalities in the Diagnosis of Head and Neck Cancer.

Introduction Squamous cell Carcinoma of the Head and Neck (HNSCC) is the most common tumor entity of malignant processes in the head and neck area. Due to the metastasizing behavior of these tumors, the staging is indispensable for the treatment planning and requires imaging techniques, which are sensitive, specific, and as far as possible cost-effective, to benefit ultimately the patient and to ensure optimal care. Objectives The aim of the present study is to compare the clinical examination including palpation, ultrasound and computed tomography (CT)/magnetic resonance imaging (MRI) for the diagnosis of neck metastases to make the correct indication for a neck dissection. Methods Data from 286 patients with HNSCC were analyzed for neck metastases to determine which diagnostic tool is the best to answer the question if a neck dissection is necessary or not. Each study method was examined retrospectively by comparing sensitivity, specificity, the positive/negative predictive value, the positive likelihood ratio and the diagnostic accuracy. Results The ultrasound showed a sensitivity of 91.52%, a specificity of 61.67%, a positive/negative predictive value of 76.65%/84.09%, a positive likelihood ratio of 2.39 and a diagnostic accuracy of 78.95%. The clinical examination showed a sensitivity of 75.76%, a specificity of 66.12%, a positive/negative predictive value of 75.30%/66.67%, a positive likelihood ratio of 2.24 and a diagnostic accuracy of 71.68%. The CT/MRI showed a sensitivity of 78.66%, a specificity of 62.50%, a positive/negative predictive value of 74.14%/68.18%, a positive likelihood ratio of 2.10 and a diagnostic accuracy of 71.83%. Radiographically, ultrasound, as well as the clinical examination, could be judged to be free from radiation load and side effects from the contrast medium. The high dependence on the investigator when using ultrasound made reproducibility of the results difficult. Conclusions It could be shown that ultrasound was the diagnostic tool with the highest sensitivity, positive/negative predictive value, positive likelihood ratio and diagnostic accuracy by detecting and interpreting metastases in the head and neck region correctly. Whether a neck dissection should be performed depends to a large extent on the ultrasound findings.

Comparison of Clinical Examination and Various Imaging Modalities in the Diagnosis of Head and Neck Cancer

Abstract Introduction Squamous cell Carcinoma of the Head and Neck (HNSCC) is the most common tumor entity of malignant processes in the head and neck area. Due to the metastasizing behavior of these tumors, the staging is indispensable for the treatment planning and requires imaging techniques, which are sensitive, specific, and as far as possible cost-effective, to benefit ultimately the patient and to ensure optimal care. Objectives The aim of the present study is to compare the clinical examination including palpation, ultrasound and computed tomography (CT)/magnetic resonance imaging (MRI) for the diagnosis of neck metastases to make the correct indication for a neck dissection. Methods Data from 286 patients with HNSCC were analyzed for neck metastases to determine which diagnostic tool is the best to answer the question if a neck dissection is necessary or not. Each study method was examined retrospectively by comparing sensitivity, specificity, the positive/negative predictive value, the positive likelihood ratio and the diagnostic accuracy. Results The ultrasound showed a sensitivity of 91.52%, a specificity of 61.67%, a positive/negative predictive value of 76.65%/84.09%, a positive likelihood ratio of 2.39 and a diagnostic accuracy of 78.95%. The clinical examination showed a sensitivity of 75.76%, a specificity of 66.12%, a positive/negative predictive value of 75.30%/66.67%, a positive likelihood ratio of 2.24 and a diagnostic accuracy of 71.68%. The CT/MRI showed a sensitivity of 78.66%, a specificity of 62.50%, a positive/negative predictive value of 74.14%/68.18%, a positive likelihood ratio of 2.10 and a diagnostic accuracy of 71.83%. Radiographically, ultrasound, as well as the clinical examination, could be judged to be free from radiation load and side effects from the contrast medium. The high dependence on the investigator when using ultrasound made reproducibility of the results difficult. Conclusions It could be shown that ultrasound was the diagnostic tool with the highest sensitivity, positive/negative predictive value, positive likelihood ratio and diagnostic accuracy by detecting and interpreting metastases in the head and neck region correctly. Whether a neck dissection should be performed depends to a large extent on the ultrasound findings.

Aspirin sensitivity and chronic rhinosinusitis with polyps: a fatal combination.

Aspirin-exacerbated respiratory disease (AERD) refers to aspirin sensitivity, chronic rhinosinusitis (CRS), nasal polyposis, asthma, eosinophil inflammation in the upper and lower airways, urticaria, angioedema, and anaphylaxis following the ingestion of NSAIDs. Epidemiologic and pathophysiological links between these diseases are established. The precise pathogenesis remains less defined, even though there is some progress in the understanding of several molecular mechanisms. Nevertheless, these combinations of diseases in patients classified by AERD constitute a fatal combination and may be difficult to treat with standard medical and surgical interventions. This paper reviews in brief the epidemiology, clinical features, diagnosis, molecular pathogenesis, and specific therapies of patients classified by AERD and postulates future attempts to gain new insights into this disease.

Sleep apnoea in patients after treatment of head neck cancer.

CONCLUSIONS: The prevalence of sleep apnoea among patients following treatment of head and neck carcinomas seems to be slightly higher than in the normal population. The possible importance of tumour treatment features, especially transient tracheostoma, needs further assessment. OBJECTIVES: The epidemiology of sleep apnoea in patients following the treatment of head and neck cancer remains unclear. This study was undertaken to assess the prevalence of sleep apnoea in head and neck cancer patients by characterizing their clinical, anatomical and tumour treatment features. PATIENTS AND METHODS: Our study examined 31 patients in a prospective non-controlled study using a standardized questionnaire that included the Epworth Sleepiness Scale (ESS) and a polygraph. RESULTS: Six of the 31 patients showed a pathologic AHI > or = 20/h. Subjects positive for sleep apnoea more often had a tumour of the hypopharynx or larynx and more often had a transient tracheostoma during cancer therapy. Radiotherapy had no clear impact on the prevalence of sleep apnoea.

Inflammatory pseudotumor of the hypopharynx: clinical diagnosis, immunohistochemical findings and treatment of this rare disease.

Inflammatory pseudotumor (IPT) is a rare benign lesion, often imitating a malignant disease. An IPT was found in the sinus piriformis of a 40-year-old male who suffered from dysphagia, globus feeling and a weight loss of 5 kilograms in six months. Neither common infections previously described in combination with IPT such as human herpes virus (HHV) 8, human immunodeficiency virus (HIV) or acute Epstein Barr virus (EBV), nor evidence of manifestation of a systemic mastocytosis or a malignant disease were found. The primary therapy for IPT in locations other than the orbita is complete resection, if this is not applicable or recurrence occurs then cyclosporine, chlorambucil, indometacin or radiation have been used as alternative treatments. A transoral laser-assisted resection was performed in the case described here, resulting in a complete and lasting cure.

Analysis of plasmacytoid and myeloid dendritic cells in nasal epithelium.

The role of plasmacytoid dendritic cells (PDC), the major producers of alpha interferon upon viral infection, in the nasal mucosa is largely unknown. Here we examined the presence of PDC together with myeloid dendritic cells (MDC) in the nasal epithelia of healthy individuals, of asymptomatic patients with chronic nasal allergy, of patients undergoing steroid therapy, and of patients with infectious rhinitis or rhinosinusitis. Considerable numbers of PDC and MDC could be detected in the nasal epithelium. Furthermore, we demonstrate the expression of SDF-1, the major chemoattractant for PDC, in the nasal epithelium. PDC levels were significantly lower for patients with allergies than for healthy individuals. Interestingly, PDC and MDC were almost absent from patients who received treatment with glucocorticoids, while very high numbers of PDC were found for patients with recent upper respiratory tract infections. Our results demonstrate for the first time a quantitative analysis of PDC and MDC in the healthy nasal epithelium and in nasal epithelia from patients with different pathological conditions. With the identification of PDC, the major target cell for CpG DNA or immunostimulatory RNA, in the nasal epithelium, this study forms the basis for a local nasal application of such oligonucleotides for the treatment of viral infection and allergy.

Isolation of human myeloid dendritic cells from tumor tissue and peripheral blood.

BACKGROUND: Human myeloid dendritic cells (MDC) have been identified in human solid tumor tissue of head and neck squamous cell carcinoma (HNSCC), their cellular functions being strongly affected in this environment. The characterization of MDC differentiation and functions requires the establishment of highly efficient isolation procedures. MATERIALS AND METHODS: Human MDC were isolated from peripheral blood and solid HNSCC using density gradient centrifugation or preparation of single cell suspensions, respectively. The cells were isolated by "magnetic bead separation" using magnetically-labelled antibodies and were analyzed by flow cytometry. RESULTS: The isolation of human MDC from peripheral blood or solid HNSCC tissue resulted in highly enriched cell populations and revealed cell purities of about 90%. CONCLUSION: The scale of molecular investigations on human myeloid dendritic cells is restricted by the limited proportion of this cell type. Thus, highly efficient and gentle MDC isolation procedures are essential to characterize in vivo matured MDC.

Generation of an autologous cell system for immunotherapy of squamous cell carcinoma of the head and neck.

BACKGROUND: To date, there is no tumor antigen known to be sufficiently specific for diagnosis, therapy monitoring and immunotherapy of squamous cell carcinoma of the head and neck (SCCHN). The aim of our study was to generate an autologous immune response against SCCHN in vitro for further characterization of SCCHN-specific tumor markers and adoptive immunotherapy. MATERIALS AND METHODS: As sources for tumor antigens (Ags) for the restimulation of autologous immune cells, cell lines from solid SCCHN were established and characterized. Forty-five percent of 40 tumors of different SCCHN specimens were maintained for more than 20 cell generations in culture. RESULTS: One primary cell line, SCCHN-GHD, newly established from a hypopharynx carcinoma, was further characterized as a telomerase-positive, immortalized cell line with epithelial cell characteristics. It was found to be tumorigenic in SCID mice. CONCLUSION: This new SCCHN-GHD cell line is competent as a target for lysis by autologous immune cells and for the restimulation of autologous tumor-specific immune cells. Subsequent characterization of tumor antigens will be performed.

Sensitive and specific photometric determination of mannitol in human serum.

Mannitol is an osmotically active polyalcohol often present in fluids used for irrigation of exposed tissue during minimal invasive surgery. Since this polyol normally is not detected in human plasma to any significant extent, it may be used as a laboratory marker of absorption of mannitol-containing irrigative fluids during surgery. For this aim, we developed a photometric assay of mannitol in human blood or serum that may be performed in a near-patient setting. Following deproteinization of the sample with trichloroacetic acid, the supernatant is mixed with NAD+ and a commercially available preparation of mannitol 2-dehydrogenase and is incubated at pH 7.8 and at 37 degrees C for 30 to 60 minutes. At the end of the incubation period the solution is appropriately diluted and the concentration of NADH formed by oxidation of mannitol is determined photometrically at 340 nm. The limit of detection of serum mannitol with this assay is 0.05 mmol/l, the linear range of measurement extends to about 3 mmol/l. At analyte concentrations of 0.48, 1.38 and 3.48 mmol/l, coefficients of inter-assay variation of 12.1, 6.7 and 4.9%, respectively, were obtained. The analytical recovery of mannitol added to serum samples was close to 100%. Of 27 polyalcohols, monosaccharides and oligosaccharides tested, none exhibited a measurable substrate activity and only D-fructose significantly inhibited the oxidation of mannitol at sample concentrations above 10 mmol/l; the enzymatic reaction, however, was strongly affected by EDTA. The suitability of the assay as a routine diagnostic tool for detection and quantification of intraoperatively absorbed irrigation fluid was demonstrated by analyzing mannitol in serum samples obtained from 24 patients undergoing transurethral prostatectomy.