[Diagnosis and treatment of dysphagia]. / Diagnostik und Therapie der Dysphagie.

Most swallowing problems can be treated, although the treatment depends on the type of dysphagia. A multidisciplinary team of surgeons, phoniatrists, and speech-language therapists is necessary to develop the appropriate treatment strategy. A thorough medical history, clinical investigation of the swallowing muscles, and fiberoptic endoscopic evaluation of swallowing with foods of different consistencies help to decide whether swallowing exercises alone are sufficient, or whether an additional pharmacologic or surgical treatment is needed to prevent aspiration, malnutrition, and dehydration.

[The physiologic and the pathologic swallowing process]. / Der physiologische und der pathologische Schluckvorgang.

It is estimated that 5 million people in Germany currently suffer from swallowing disorders. Due to increasing life expectancy and the good outcome of very premature infants, this number is expected to increase. Swallowing normally occurs in four phases, and for each phase there are diagnostic tools to assess whether the problem is anatomic-organic or functional. A detailed case history is followed by clinical examination of the cranial nerves, the orofacial region, the swallowing reflex, and pharyngeal and esophageal transit. Attention is also paid to age-related changes in the swallowing process, nasal regurgitation, retention at the base of the tongue or in the hypopharynx, and signs of aspiration.

[Detection of hearing loss in dementia patients : pilot study and literature survey]. / Detektion von Schwerhörigkeiten bei dementen Menschen : Pilotstudie und Literaturübersicht.

There is a higher incidence of dementia among people with hearing loss, although the complex interrelation is not yet understood. The potential influence of hearing rehabilitation is also unclear. A previously published retrospective study on this topic throws doubt on the ability of dementia patients to accomplish audiometric tests. Therefore, we conducted a pilot study to analyse the feasibility of applying conventional speech and pure tone audiometry in patients with dementia. In contrast to previously published data, we were able to achieve reproducible results in almost all patients. The difficulty associated with audiometric testing in dementia patients does thus not seem to lie in the application of pure tone and speech audiometry. On the basis of evidence indicating the importance of central hearing loss in the elderly, these tests alone do not appear sufficient. It is of greater interest to ascertain whether central hearing loss is relevant in patients suffering from dementia and whether corresponding audiometric tests are feasible.

[Dementia and otorhinolaryngologic practice]. / Der demente Patient in der HNO-Praxis.

The interaction between sensorial registration of peripheral stimuli and their central cognitive processing is not yet understood. The role of sensory deficits such as olfactory deterioration or hearing loss in the development of dementia is currently a focus of concern, with hopes of finding new diagnostic aspects and therapeutic options for multimodal treatment concepts in patients with dementia. The expertise of ENT specialists in the diagnostic and therapeutic fields of dysphagia, vestibular dysfunction and olfactory or hearing loss could make an important contribution to the development of future strategies for dealing with dementia. In this report we present up-to-date basic knowledge and ENT-specific aspects relating to the diagnostics and treatment of dementia.

[Hearing function and hearing loss in the elderly]. / Hörfähigkeit und Schwerhörigkeit alter Menschen.

Statistically, hearing function decreases with advancing age, but not all people are affected to the same extent. Environmental influences, such as noise exposure in particular, also play an important role in the development of hearing loss. Since the functional capacity of parts of the central auditory processing system can also diminish with age, these should also be evaluated in diagnostic procedures. Rehabilitative treatment of older people with hearing aids in particular, has to be improved. Audiotherapy can enhance the acceptance of hearing aids and optimize central auditory processing.

[Pharmacotherapy of acute and chronic hearing loss]. / Zur Pharmakotherapie des akuten und chronischen Tinnitus.

The aetiology of acute hearing loss is mostly idiopathic like sudden sensorineural hearing loss and rarely infectious or vascular. Several studies and meta-analyses of pharmacotherapy are reviewed: In chronic tinnitus there is no indication for pharmacotherapy; sometimes a possible psychosomatic comorbidity has to be treated with psychopharmaceutical agents. Despite a low level of evidence treatment with steroids and initially plasma expanding infusions is recommended for acute tinnitus if there is no spontaneous remission. Intratympanic steroid therapy can be used as an alternative if there is severe hearing loss together with tinnitus.

[Orbital and periorbital complications in acute sinusitis]. / Orbitale und periorbitale Komplikationen bei akuter Sinusitis.

BACKGROUND: Orbital and periorbital complications due to acute paranasal sinusitis can be treated surgically or conservatively. In many cases the type of treatment depends on the ophthalmological findings. In the context of this clinical analysis we explored whether a conservative rather than an surgical therapy should be chosen for specific otorhinolaryngological or ophthalmological findings. METHODS: 32 patients were treated conservatively, whereas 4 patients had to be operated. Before therapy and after completion of the treatment otorhinolaryngologistical and ophthalmological findings were recorded and these findings as well as the two therapy options were compared with each other. RESULTS: In the cases of the 32 conservatively treated patients plus the 4 patients, who were treated surgically, a complete restitutio ad integrum could be observed at the end of the treatment period. DISCUSSION: A conservative therapy is obsolete in cases with specific ophthalmological findings such as reduction of vision, significant increase of exophthalmos, extreme limitation of motility. In all other cases, a conservative attempt can be made first, because the results of this therapy are as good as the results of surgical intervention but with less exposure for the patient. So the choice of therapy depends the ophthalmological findings.

[DPOAE and lateral inhibition in chronic tinnitus]. / DPOAE und laterale Inhibition bei chronischem Tinnitus.

INTRODUCTION: According to our audiological data, 90% of tinnitus patients have deficits in inner ear function as a generator of tinnitus, mainly in the outer hair cells (OHC). This can be verified by registration of distortion products of otoacoustic emissions (DPOAE). Thus, the main origin of tinnitus is peripheral, and most patients suffer from accompanying hearing loss, even though it is sometimes mild or subjectively not even felt. Whether or not the tinnitus is disturbing, however, is determined through further auditory processing of the "signal" tinnitus and its psychological validation. With almost 50% of our tinnitus and hyperacusis patients, we find hyperfunctioning of the OHC, possibly originating from reduced or ineffective efferent control in the auditory pathway. Efferent activity can be measured by acoustic stimulation of the contralateral ear, which normally reduces the DPOAE amplitudes via efferent inhibition. METHOD AND PATIENTS: DPOAE were recorded with 67 tinnitus patients (127 ears) with and without contralateral acoustic stimulation. Twenty-one persons (41 ears) served as controls. RESULTS: With 64% of the tinnitus patients, DPOAE amplitudes were not reduced significantly, compared with 34% of the controls. The medium amplitude reduction for controls was 1.76 dB, whereas for the tinnitus patients it was significantly less (0.91 dB). CONCLUSION: For a considerable number of tinnitus patients, efferent control of OHC activity is restricted, but this seems to be confined to a certain type of tinnitus only.

[Reversible hearing loss in acute salicylate intoxication]. / Reversible Hörminderung bei akuter Salizylatintoxikation.

Acetylic acid, such as aspirin, is one of the most commonly used medication in Western societies. Aspirin overdosage causes ototoxic side effects in some patients, such as bilateral mild to moderate sensorineural hearing loss and tinnitus. Recent literature describes, that salicylates act as competitive inhibitors of Cl- anions at the anion-binding site of prestin, the motor protein of the outer hair cell. This molecular mechanism correlates well with the clinical audiological mainstays of aspirin-induced hearing loss, dose dependency, cochlear site of hearing loss and reversibility. We report about a young man with an acute moderate aspirin intoxication resulting in asymmetric hearing loss of 50 dB HL and tinnitus for five days. Otoacoustic emissions were absent on the first day of intoxication but could be measured again on the fifth day after the intoxication. As the ototoxic side effects resolve with in two or three days, no specific treatment is necessary for ototoxicity. Medical treatment of acute or chronic aspirin intoxications aims to decrease further drug absorption by gastrointestinal decontamination and to accelerate elimination by alkaline diuresis. Only in severe intoxications hemodialysis may be considered to treat neurologic, pulmonal, renal or cardial complications.

[Zenker's diverticulum. The endoscopic-microscopic, staple-assisted esophagodiverticulostomy]. / Zenker-Divertikel. Endoskopisch-mikroskopische, staplerassistierte Schwellenspaltung.

BACKGROUND: The endoscopic-microscopic staple-assisted esophagodivertikulostomy of Zenker's diverticulum is a new modification of endoscopic operation techniques which minimizes complications and is able to speed up the patient's convalescence. PATIENTS AND METHODS: A total of 22 out of 32 patients with Zenker's diverticulum underwent surgery. The operation involves cutting the wall between the diverticular sac and the oesophagus and, at the same time, closing the mucosal wound edges using the "closed" surgery method. RESULTS: All operations were effective and uncomplicated. A total of 28 operations were performed on 22 patients. The operations due to relapse were predominantly necessary among younger patients, of whom three were operated endoscopically and three through the cricopharyngeal myotomy. CONCLUSIONS: The "closed" endoscopic-microscopic staple-assisted esophagodivertikulostomy of Zenker's diverticulum avoids opening the retropharyngeal and retrooesophageal areas and allows a quick convalescence in the mostly elderly patients. This technique is effective, safe and has no major complications.

[Oncocytic adenocarcinoma of the submandibular gland]. / Onkozytäres Adenokarzinom der Glandula submandibularis.

BACKGROUND: Malignant oncocytic tumors rarely occur in major salivary glands and generally account for < 1% of all salivary tumors. There is no difference of both sexes and appearing mainly between 50 and 60 years of age. They comprise oncocytes, which are epithelial cells with abnormally formed cytoplasm and acidophilic granular cytoplasma. In the process of the malignant transformation the coexistence from oncocytic rests and untypical oncocytic carcinoma portions can be seen. The tumors show no capsule and an infiltrative local growth with perineural and vascular expansions. PATIENT AND METHOD: A rare case of a 59-year-old man with malignant oncocytoma is presented. The tumor was found in the left submandibular gland with one enlarged lymph node near by. RESULT AND CONCLUSIONS: A general overview of the available literature and the histological classification of oncocytomas is given. Therapy consists of surgical resection and radiotherapy. Close clinical controls are necessary.

[Myositis proliferans. Differential cervical space-occupying lesion diagnosis]. / Myositis proliferans. Eine Differenzialdiagnose zervikaler Raumforderungen.

Myositis proliferans is a rare and benign pseudosarcomatous tumour of soft tissue. In most cases it is found in the region of the shoulder and arm and its occurrence in the region of the neck is described in literature in 16 cases in all. For the ear, nose and throat specialist it is an important differential diagnosis in contrast to malignant tumours. In this report we present the cases of two patients, who were suffering from painful cervical swelling that had been increasing for some days. The problems inherent in the diagnosis of this illness are discussed. Due to its rapid growth the tumour is generally falsely diagnosed and radically removed. Therefore, in appropriate case history, this possibility should be considered and excluded in order to prevent the patient from unnecessary radical operation. In addition to clinical symptoms, imaging and trial excision are suitable.

[Acoustic neurinoma with preserved inner ear function. Interesting audiologic constellation of findings]. / Akustikusneurinom mit erhaltener Innenohrfunktion. Interessante audiologische Befundkonstellation.

Neurofibromatosis (NF) is a syndrome with multiple neuromas. With the central form or NF2 very often bilateral acoustic neuromas are found. Tumours derive from Schwann cells of the eighth cranial nerve; symptoms are tinnitus, hearing loss and vertigo. Therapy is surgical, if possible with the protection of remaining hearing function. We report the case of a 28 year old female patient with neurofibromatosis type 2. After complete resection of the left AN and partial resection of the right AN the patient suffered from bilateral complete deafness, although almost normal DPOAE can be recorded on one side. Therefore we find the classical neural deafness with intact function of outer haircells (OHC).

[Intensive inpatient therapy of auditory processing and perceptual disorders in childhood]. / Die stationäre Intensivtherapie bei auditiven Verarbeitungs- und Wahrnehmungsstörungen im Kindesalter.

UNLABELLED: PRELIMINARY REMARKS: The prevalence of central auditory processing disorders (CAPD) is supposed to be 2-3% of all children. Given the number of affected children and restricted resources in the public health there is a need for an effective and evaluated therapeutic approaches. On the other hand the number of outcome studies is remarkably small. PATIENTS AND METHODS: The presented study reports strategies and pitfalls in outcome measurements of 34 children with CAPD, based upon a 3-weeks indoor therapeutic intervention. Diagnostic criteria of auditory processing and perception were recorded before and after therapy. RESULTS: The data shows a highly significant improvement of certain perceptive abilities, including audiological parameters (dichotic testing, discrimination, loudness scaling) and awareness, psycholinguistic development and orthographic tests. CONCLUSION: The study demonstrates that an effective therapy of CAPD in children is possible and scientifically proven. Long term surveillance however seems to be necessary. It also has to be studied whether intensive indoor treatment is superior or equal to out clinic therapy.

[Chronic complex tinnitus: therapeutic results of inpatient treatment in a tinnitus clinic]. / Ergebnisse stationärer Therapie bei Patienten mit chronisch komplexem Tinnitus.

BACKGROUND: In-patient treatment of patients with chronic tinnitus is necessary only when these patients have a severe psychosomatic co-morbidity and suffer severely. However this therapeutic approach has to be supervised and evaluated properly. METHODS: We present data and results of 1841 patients suffering from chronic tinnitus. Due to the severity of the symptom and psycho-neurotic side effects in-patient treatment was necessary. Therapy lasted 5 - 6 weeks, the main aspect was an intensive psychotherapeutic evaluation and stabilisation next to retraining and habituation programmes. Relaxation techniques were taught. Patients suffered from their tinnitus more than six month; 95 % further suffered from hearing-loss, mainly in high frequencies. The study evaluates results of patients from October 1994 until June 2000. Basis of the study was the evaluation of a specific tinnitus-questionnaire (TQ), published by Hallam in the UK and translated by Goebel and Hiller in Germany. Data was recorded at registration in our clinic, 4 - 6 months later during admission and at the end of the therapy. Final data was gained during a special meeting or questioning 6 months after dismissal from the clinic. RESULTS: Patients that suffered most showed the greatest improvement; directly after therapy there was a highly significant improvement in the TQ for an average of 13.01 points. Highly significant improvements were found in all the TQ-subscales respectively. Only 10 % of the patients did not show any improvement at all. CONCLUSION: Therapy of most severe cases of chronic tinnitus is possible, using an integrated concept of otologic and psychosomatic treatments. With large numbers of patients and sufficient data a thorough and necessary evaluation of this therapy can be achieved.

[Is recurrent loss of low frequency tone perception--without vertigo--a precursor of Meniere disease?]. / Sind rezidivierende Tieftonhörverluste--ohne Schwindel--die Vorstufe eines Morbus Menière?

PURPOSE: Recurrent low-frequency sensory hearing loss is one characteristic sign of Meniere's disease. It is therefore often assumed to be a prodromal sign of Meniere's disease. METHODS: We report on 81 patients with recurrent low-frequency sensory hearing loss who did not previously suffer from vertigo. All patients underwent a follow-up examination after at least 1 year up to more than 10 years after the onset of the disease [average: 64.65 months (SD 56.33)]. CONCLUSIONS: Only 3.7% of these patients developed the typical signs of Meniere's disease with labyrinthine vertigo, whereas 25.9% suffered from recurrent hearing loss and an unspecific vertigo, which could be diagnosed and treated as psychogenic vertigo; 3.7% showed a typical benign positional vertigo. We can thus conclude that although almost every patient with Meniere's disease suffers from recurrent hearing loss, only a few patients with recurrent hearing loss will develop Meniere's disease. However, many patients with low-frequency sensory hearing loss develop anxiety and psychogenic dizziness in expectation of "imminent" Meniere's disease. Therefore, it is important to counsel the patients carefully that the probability of this occurring is not very high.

[Schwannoma of the tongue]. / Das Schwannom der Zunge.

BACKGROUND: Schwannoma, in the English literature mostly called neurilemmoma, are well known in the ear-nose-and-throat-medicine as benign tumors of the nerve-sheath, for example as neuroma of the acoustic nerve. They are seldom found at other peripheral nerves of the head. The localisation in the tongue has so far only been described in some individual cases. CASE REPORT: We present a case of a 28-year-old woman with a schwannoma of the tongue, measuring 4.0 x 2.2 x 3.2 cm. The case history and the radiological investigations suggested a malignant tumor. During the operation the lump revealed itself as being encapsulated. Under the histological examination it was discovered to be a Schwannoma. CONCLUSIONS: We would like to add a further case of a schwannoma of the tongue to the so far published cases, thus allowing this possibility to be considered in general diagnosis.

[Ear dysfunction due to air bag detonation?]. / Funktionsstörungen des Hörorgans nach Airbagdetonationen?

Air bags are among the latest developments in extensive automobile safety systems. They successfully have saved the lives of car occupants in road accidents. Many additional injuries caused by air bags from minor to severe have been reported. With the help of two acceleration sensors, the electronic tuner amplifier records the vehicle's deceleration. This is the adequate trigger for air bag deployment, which creates an intense noise of up to 170 dB sound pressure level. This noise level can cause cochlear damage. We present two patients with otologic symptoms after spontaneous air bag deployment.