[Treatment of allergic rhinitis: update 2005]. / Therapie der allergischen Rhinitis. Mannschaftsaufstellung für die Allergiesaison 2005.

Potential approaches to the treatment of allergic rhinitis are the avoidance of allergens and medication with chromone compounds, antihistaminics and glucocorticosteroids. The sole causally effective treatment is specific immunotherapy. Leukotriene receptor antagonists, anti-IgE antibodies and monoclonal CD-4-molecules, as also soluble cytokine receptors are potential therapeutic options, the value of which currently remains unknown.

[Topical comments on chronic rhinosinusitis]. / Chronische Rhinosinusitis. Was tun, wenn Ihr Patient die Nase voll hat?

Chronic rhinosinusitis (CRS) is defined as a group of illnesses that is characterized by inflammation of the nose and paranasal sinus mucous membranes that lasts at least twelve weeks. In Europe and the U.S.A., CRS is one of the most widespread illnesses, with incidence and prevalence on the increase. There are various potential causes and triggering factors for CRS; likewise, the symptoms from individual to individual can be very different. Up until now, there has been a dearth of evidence-based studies on conservative drug treatments for CRS. For many patients with years of recurring inflammation attacks, the operative correction is often the only therapeutic option. The minimally invasive functional paranasal sinus surgery has achieved good and, also, long term therapeutic responses.

[Treatment of allergic rhinitis]. / Therapiemodalitäten der allergischen Rhinitis. Kommen Sie dem "Etagenwechsel" zuvor.

The allergic rhinitis is the most common allergic condition. The causes of allergic rhinitis are still much debated, but there is now a consensus on the need to initiate treatment as early as possible in order to avoid the spreading of the infection to the bronchi. In addition to allergy prevention, the aim of treatment is medical control of the allergic inflammatory reaction and thus improvement of the clinical symptoms. Depending on the severity of the disease and the predominant symptoms, this can be achieved with mast cell stabilizers, local and systemic H1 antagonists, local steroids and anticholinergic drugs. The WHO also recommends hyposensitization, which may be subcutaneous (SIT) or sublingual (SLIT).

[Allergic rhinitis to be diagnosed and treated correctly. Tips for a runny nose]. / Allergische Rhinitis richtig diagnostizieren und behandeln. Tipps für Triefnasen.

Two types of allergic rhinitis are differentiated: seasonal rhinitis caused in particular by pollen allergens, and the perennial form caused by such year-round allergens as house dust (mites), moulds and animal hair. The diagnosis is based on a comprehensive history (family/occupation/environment), clinical symptoms, a rhinoscopic examination, and testing for allergens, e.g. conjunctival tests, prick test or nasal provocative test. The treatment of choice is elimination of the allergens as completely as possible. An additional causal therapeutic option is specific immune therapy (SIT) which, however, is contraindicated in the presence of intercurrent infections, use of beta blockers and immunodeficiency. Available medications include mast cell stabilizers, antihistaminic agents and corticosteroids, which are applied in stepped fashion, depending upon severity. In addition, adjuvant surgical measures may improve obstructive symptoms.

[Rhinosinusitis. Current diagnostic and therapeutic aspects]. / Sinusitis unbedingt abklären und lege artis behandeln. So verhindern Sie die Chronifizierung.

Over the past years, the incidence of acute and chronic forms of rhinosinusitis has been increasing, and between 10 and 15% of the population of Central Europe are affected annually. Accordingly, the economic significance of rhinosinusitis is considerable. This makes the need for appropriate diagnostic and therapeutic strategies all the more urgent. In addition to case history and a physical examination, a helpful diagnostic strategy also includes rhinoendoscopy and--in particular in preparation for surgery--a CT scan. A plain radiograph does not suffice to confirm chronic sinusitis. The major therapeutic pillar in the treatment of acute rhinosinusitis is medication in conformity with accepted guidelines (proof of efficacy!). In the majority of cases chronic courses can be managed by minimally invasive surgery.

[Complications of rhinosinusitis]. / Vom Orbitaödem bis zum Hirnabszess. Das sind die Folgen einer vernachlässigten Sinusitis!

Rhinogenous complications may manifest in the region of the orbits, bone or soft parts of the wall of the frontal sinus, or endocranially. With regard to orbital complications, a differentiation is made between edema, periostitis, subperiosteal abscess and phlegmon--depending on severity and extent. A possible sequela of frontal sinusitis may be osteomyelitis. If the frontal bone is involved, there is a danger that the infection may spread to the endocranium via medullary spaces and blood vessels. The diagnostic basis for deciding appropriate treatment is CT or MRI. While orbital edema and periostitis usually respond to conservative treatment, subperiosteal abscess, orbital phlegmon and abscess of the brain require immediate operative treatment under antibiotic cover. The treatment of choice for osteomyelitis of the frontal bone is the liberal removal of affected bone, also under antibiotic cover.

[Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates]. / Die Laserkonchotomie mit Ho:YAG- und Dioden-Laser zur Behandlung von hyperplastischen Nasenmuscheln.

BACKGROUND: Since the early 80's, chronic nasal obstruction due to hyperplastic turbinates is treated by laser light. Comparative clinical studies were performed to assess the clinical outcome of laser assisted endonasal turbinate surgery in longterm. METHODS: By means of a pulsed Ho:YAG laser emitting light at lambda = 2100 nm (0.8 - 1.2 J/pulse, 4 - 8 Hz), 69 patients suffering from nasal obstruction due to allergic rhinitis (46 %) and vasomotor rhinitis (54 %) were treated under local anesthesia. Furthermore, 50 patients (52 % with allergic rhinitis and 48 % with vasomotor rhinitis) were treated by means of a GaAlAs-diode laser (c. w., lambda = 940 nm, 8 - 10 W). The treatment time took 3 - 10 min/turbinate and nasal packing was not necessary after the laser procedure. The study was conducted by a standardized questionnaire, photo documentation, allergy test, mucociliar function test, rhinomanometry, and acoustic rhinometry. RESULTS: Within 4 weeks after laser treatment, an improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined in more than 80 % of the patients. Rhinomanometry revealed a significant improvement of the nasal airflow 6 months and 1 year after the laser treatment compared to the preoperative data. Side effects like nasal dryness and pain were rare (< 5 %). Diode laser treatment revealed more effective results than Ho:YAG laser treatment, however there was no significant difference between the two investigated groups. Patients suffering from vasomotor rhinitis showed far better results in long term in comparison to allergic rhinitis patients. CONCLUSIONS: Ho:YAG and diode laser treatment can be performed as an outpatient procedure under local anesthesia in a short treatment time with promising results. It could become a time and cost effective treatment modality in endonasal laser surgery.

[CAS of the paranasal sinuses--technology and clinical experience with the Vector-Vision-Compact-System in 102 patients]. / Computerassistierte Chirurgie der Nasennebenhöhlen--Technologie und klinische Erfahrungen mit dem Vector-Vision-Compact-System an 102 Patienten.

INTRODUCTION: Functional endonasal sinus surgery has gained significant importance in the treatment of chronic inflammatory sinus disease over the past 20 years. Still, the risk of jeopardizing adjacent structures, i. e. the anterior skull base, optic nerve or carotid artery, is increased, especially in revision cases. Several attempts have been made in the past to reduce the risk of iatrogenic injuries due to this kind of surgery and to increase the safety of the procedure, one of them being the introduction and clinical application of image guided and computer assisted surgery (CAS) respectively. A new method of patient registration for the CAS is the non-contact laser registration (z-touch trade mark laser). The main advantage of the laser registration device, is that it is no longer necessary to equip the patient with special markers or with a headset for the registration scan, therefore additional CT scans can be avoided. MATERIAL AND METHODS: In this study we summarize our experience with the Vector Vision compact navigation system. The study population contained 102 patient, treated over a period of 18 months (Sept. 2000 - Dez. 2001). The indications for the CAS were mainly revision operations of recurrent nasal polyps, mucoceles or other chronic rhino-sinus diseases, especially of the frontal sinus. In 35 cases the headset registration was applied, in all other cases we used the z-touch trade mark laser registration. RESULTS: The preoperative planning time was significantly lower for z-touch trade mark laser registration ( 5,2 min) compared to the headset registration ( 20,2 min), the set-up-time in the operation room was nearly the same, 7 min for z-touch trade mark laser registration and 6 min for headset registration. The most important criterion for CAS, of course, is accuracy during surgery; here we also observed an increased accuracy for the z-touch trade mark laser registration. CONCLUSIONS: Our data confirm earlier observations indicating that CAS enhances safety during endoscopic sinus surgery especially in revision cases. In addition it might be a helpful adjunct for the beginner and even advanced surgeon during routine sinus procedures. Nevertheless, CAS should not be misinterpreted as a substitute for thorough and meticulous studying of this delicate area including cadaver studies. Our results further demonstrate that the faster and simple registration method allows us to use the system more frequently, thereby increasing the number of navigated cases. The accuracy we can achieve varies between 0.9 and 2.4 mm, with a mean value of 1,3 in the x- and y-axis and 1,4 in the z-axis. In addition it is also possible to use imaging data sets obtained prior to the intent to operate. This not only reduces the cost for imaging studies, but also minimizes the manpower needed to place the fiducials, organize and perform additional acquisition of images.

[Dilated pneumosinus of the frontal sinus]. / Pneumosinus dilatans der Stirnhöhle.

Pneumosinus dilatans is a rare disorder of the frontal sinus most commonly found in 20- to 40-year-old males. The deformity is caused by an abnormal enlargement of the frontal sinus by hyperpneumatization. A valve mechanism raising the pressure inside the sinus is regarded to be responsible for this condition. The diagnostic and surgical approach is presented in a 25-year-old male. A preoperative computed tomography (CT) scan in three planes illustrates the anatomical conditions and possible etiologic mechanisms. The surgical procedure is supposed to correct the esthetic deformity and the cause of the disorder. A bicoronal incision allows the best exposition of the frontal sinus. The osteoplastic correction is stabilized by titanium micro-osteosynthesis plates, which do not have to be removed. Functional endoscopic sinus surgery should be performed concomitantly in order to remove the cause of pneumosinus dilatans.

[Value of secondary coronal reconstructions in computed tomography of the paranasal sinuses]. / Zur Aussagefähigkeit koronarer Sekundärrekonstruktionen computertomographischer Sequenzen der Nasennebenhöhlen.

INTRODUCTION: Before sinus surgery, computed tomography (CT) of the paranasal sinuses and anterior skull base is a standard procedure in the diagnostic evaluation. However, coronal sections necessary for the analysis of the complex anatomy of this region are often not applicable in multiple injured or elderly patients due to the impossibility to maintain the required position for the coronal scans. Secondary coronal reconstruction of primary axially acquired scans could help to overcome this problem. This technique was, however, hampered so far by an insufficient resolution in case of conventional CT. We therefore compared the quality of primary coronally acquired conventional CT images with the resolution of multiplanar reformatted coronal images of primary axially acquired scans by means of a new CT generation, the Multidetector Computed Tomography (MDCT). MATERIAL AND METHODS: 10 patients were each examined with conventional CT or MDCT respectively. The quality of primary coronally acquired conventional scans (CT) versus secondary coronal reconstructions (MDCT) was compared by evaluating typical anatomic landmarks. RESULTS: As compared to conventional CT, the coronal reconstruction of primary axially acquired scans by means of MDCT revealed an equal resolution and additionally no essential impairment by amalgam artefacts. CONCLUSION: Our results demonstrate the excellent quality of secondary coronal reconstructions by means of MDCT in the CT evaluation of the paranasal sinuses and the anterior skull base as compared to primary coronally acquired images via conventional CT.

Dermoid cyst of the floor of the mouth--a case report.

We report a case of a 30-year-old, previously healthy man who presented at our clinic with complaints of increasing dysphagia and globus sensation for about 2 years. In addition, he noticed an increasing submental swelling. On examination, the patient revealed a massive swelling of the floor of the mouth, which had displaced the tongue cranially. MRI imaging showed the lesion to be a homogeneous, cystic lesion, clearly at a distance from the surrounding mucous tissue. Surgery was performed, and the tumor was resected completely. Histologic examination of the resected tissue was consistent with a dermoid cyst located in the floor of the mouth. Although dermoid cysts are rarely located in the oral cavity, it should be included in differential diagnosis. Surgery is the treatment of choice.