ABSTRACT
The universal use of computed tomography (CT) has opened up new possibilities in the noninvasive examination of human mummies, and particularly the detailed study of the fine structures of the temporal bone. The aim of this study was to describe the morphological changes, as seen on CT, found in the right temporal bone of Djed-Hor, an around 2300 year old Heidelberg's Egyptian mummy, and to discuss their possible causal relation to his death. Here we showed the presence of a compress on the auricle, and of probable pus in the mastoid, middle ear, and external ear with erosion of the tegmen tympani probably related to a fatal acute mastoiditis. These typical morphological changes of such a disease were demonstrated in the same way as in living patients of today. This would be the first depiction of a compress on an auricle associated with pus in the ear of an Egyptian mummy.
Subject(s)
Mastoiditis , Mummies , Humans , Mastoiditis/diagnostic imaging , Mummies/diagnostic imaging , Egypt , Ear, Middle/diagnostic imaging , SuppurationABSTRACT
BACKGROUND: The Blakesley fenestrated ethmoid forceps, eponymously named after Theodore Seward Blakesley, belong today in every set of endonasal surgical instruments. This study aimed to go back to Blakesley's original description, and to follow its introduction, variations and acceptation by rhinosurgeons. METHOD: Historical review of literature. RESULTS: In 1915, Blakesley described two nasal instruments: a submucous septum resection instrument and an ethmoid instrument. The history of the ethmoid instrument is in close relationship to another quite similar one described by Moriz Weil. The difference between the Weil and the Blakesley ethmoid forceps lies essentially in the base of the cutting jaws, which are narrower in Weil's instrument. CONCLUSION: Blakesley's eponym must only be used for the instrument without the narrower base of the cutting jaws.
Subject(s)
Ethmoid Sinus/surgery , Otolaryngology/history , Surgical Instruments/history , History, 19th Century , History, 20th CenturyABSTRACT
A 6-week-old girl suffered from a growing and recurrently bleeding mass of unrecognizable origin, obstructing the left nose. Using low-dose Multislice-CT the exact diagnostic localization could be found within one minute in the sleeping baby without sedation or general anesthesia. The result of this imaging enabled the successful complete microscopic removal of a hemangioma from the left inferior turbinate. Follow-up after 15 months showed normal nasal finds.
Subject(s)
Hemangioma/diagnostic imaging , Multidetector Computed Tomography/methods , Nose Neoplasms/diagnostic imaging , Turbinates/diagnostic imaging , Female , Hemangioma/surgery , Humans , Infant , Nose Neoplasms/surgery , Otolaryngology , Radiation DosageABSTRACT
The German Society of Otorhinolaryngology, Head and Neck Surgery recently has released the abbreviated version of its scientific guideline "ENT-specific therapy of obstructive sleep apnoea (OSA) in adults", which has been updated in 2015 and can be found online at the Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). A summary of the main recommendations is provided in this revised English version. All recommendations are based on a systematic literature research of articles published up until March 2014. Literature research followed the Cochrane Handbook for Systematic Literature Research to create Guidelines published by the German Cochrane Centre. Studies were evaluated with respect to their scientific value according to the recommendations of the Oxford Centre for Evidence-based Medicine, and grades of recommendation are provided regarding each intervention.
Subject(s)
Interdisciplinary Communication , Intersectoral Collaboration , Otolaryngology , Otorhinolaryngologic Diseases/therapy , Sleep Apnea, Obstructive/therapy , Adult , Germany , Humans , Otorhinolaryngologic Diseases/diagnosis , Sleep Apnea, Obstructive/diagnosisABSTRACT
The present S2e-guideline is an update of the former S2e-guideline "treatment of obstructive sleep apnea in adults". The update was performed on behalf of the German Society for Otorhinolaryngology, Head and Neck Surgery by its Sleep Medicine Task Force. The long version of the guideline is valid from 5.9.2015 to 5.9.2020 and has been available (guideline No. 017-069) since November 2015 on the official AWMF website.The subsequently presented short version of the guideline summarizes the essentials in a legible way. For further information, please refer to the long version.
Subject(s)
Otolaryngology/standards , Otorhinolaryngologic Surgical Procedures/standards , Practice Guidelines as Topic , Sleep Apnea, Obstructive/therapy , Sleep Medicine Specialty/standards , Adult , Evidence-Based Medicine , Germany , Humans , Sleep Apnea, Obstructive/diagnosis , Treatment OutcomeABSTRACT
This historical sketch follows the traces of a mirror, once used to test the last breath of a dying woman. It was found on the fresco of a tomb in Paestum dated about 320 BC. In 1889, Hendrik Zwaardemaker (Utrecht) was the first to present a hygrometric functional test using a cold mirror placed under the nose to estimate the degree of airflow obstruction during exhalation. In 1901, Ernst Glatzel (Berlin) modified Zwaardemaker's concept by engraving a series of equidistant arcs into his metallic mirror to further quantify the amounts of condensed vapour in the expired air. The Glatzel-mirror was used in Germany until after the Second World War.
Subject(s)
Breath Tests , Death , Exhalation , Steam , Female , Germany , History, 19th Century , History, 20th Century , History, Ancient , Humans , Italy , NetherlandsABSTRACT
Due to the frequency of this phenomenon and the often considerable distress caused to the affected person, competent advice, diagnosis and treatment of snoring in adults is of particular importance. The aim of this guideline is to promote high-quality medical care for patients affected by this problem. According to the three-level concept of the AWMF, it corresponds to an S1 guideline. Prior to any therapeutic intervention, relevant sleep medical history, clinical examination, as well as a mandatory objective diagnostic measure are performed. Snoring is only treated if the patient asks for it. In general, invasive methods should be viewed critically and the patient should be advised correspondingly. In the case of surgical therapy, minimally invasive techniques are preferred. Reducing body weight (in the case of overweight snorers), abstinence from alcohol, nicotine and sleep medication, as well as maintaining a healthy sleep-wake cycle can be recommended from a sleep-medicine perspective, although convincing clinical studies are not yet available. Since evidence for the effectiveness of muscle stimulation or various methods for toning and training of the muscles of the floor of mouth is not available, these methods are not recommended. Snoring can be successfully treated with the use of an intraoral device; however, careful patient selection is important. Avoiding a supine position during sleep can be helpful in some cases. Only limited data is available on the success rates of the surgical approaches and long term data is often lacking, and not all techniques have been sufficiently evaluated from a scientific point of view. Nasal surgery is only indicated if the patient suffers from nasal obstruction. Extensive data supports the effectiveness of laser-assisted resection of excessive soft palate tissue (laser-assisted uvuloplasty, LAUP). In principle, however, such resections can be performed using other techniques. Placebo-controlled studies were able to prove the effectiveness of radiofrequency surgery of the soft palate. A reduction in snoring could also be achieved in many cases by means of soft palate implants with minimal post-operative morbidity. The indication for tonsillectomy and uvulopalatopharyngoplasty should be made cautiously due to the comparatively high morbidity associated with these procedures.
Subject(s)
Otolaryngology/standards , Snoring/diagnosis , Snoring/prevention & control , Adult , Germany , HumansABSTRACT
The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.
Subject(s)
Evidence-Based Medicine , Sleep Apnea, Obstructive/therapy , Adult , Case-Control Studies , Cohort Studies , Germany , Humans , Randomized Controlled Trials as Topic , Sleep Apnea, Obstructive/diagnosisABSTRACT
Sleep-related breathing disorders (SBAS) affect approximately 8% of the population of middle aged adults. At the age of 20 years, approximately 10% of the population snore, while at the age of 60 about 50% of men snore. Some 9% of middle aged women and 24% of middle aged men have an apnea hypopnea index (AHI) of >5 (number of nocturnal apnea and hypopnea per hour of sleep). Sleep apnea hypopnea syndrome is found in 2% of the women and 4% of the men, i.e. they have an AHI>5 associated with daytime sleepiness. Forms, check lists, summaries and patient-readable questionnaires have proved helpful in the evaluation of SBAS.
Subject(s)
Sleep Apnea Syndromes/diagnosis , Surveys and Questionnaires , Adult , Age Factors , Aged , Airway Obstruction/complications , Airway Obstruction/diagnosis , Comorbidity , Cross-Sectional Studies , Female , Germany , Humans , Incidence , Male , Middle Aged , Polysomnography , Practice Guidelines as Topic , Sex Factors , Sleep Apnea Syndromes/epidemiology , Sleep Apnea Syndromes/etiology , Snoring/etiologyABSTRACT
A still-born male fetus from the 19th century, fixed in formalin and presenting as diprosopia triophthalmica, was analysed by helical computer tomography and virtually reconstructed without damage. This rare, incomplete, symmetrical duplication of the face on a single head with three eyes, two noses and two mouths develops in the first 3 weeks of gestation and is a subset of the category of conjoined twins with unknown underlying etiology. Spiral computer tomography of fixed tissue demonstrated in the more than 100 year old specimen that virtual reconstruction can be performed in nearly the same way as in patients (contrast medium application not possible). The radiological reconstruction of the Munich fetus, here confined to head and neck data, is the basis for comparison with a number of imaging procedures of the last 3000 years. Starting with some Neolithic Mesoamerican ceramics, the "Pretty Ladies of Tlatilco", diprosopia triophthalmica was also depicted on engravings of the 16th and 17th century A.D. by artists as well as by the anatomist Soemmering and his engraver Berndt in the 18th century. Our modern spiral computer tomography confirms the ability of our ancestors to depict diprosopia triophthalmica in paintings and sculptures with a high level of natural precision.
Subject(s)
Craniofacial Abnormalities/diagnostic imaging , Craniofacial Abnormalities/history , Medical Illustration/history , Medicine in the Arts , Sculpture/history , Twins, Conjoined , Europe , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, Ancient , History, Medieval , Humans , Radiographic Image Interpretation, Computer-Assisted , Tomography, X-Ray Computed/historyABSTRACT
BACKGROUND: Recent technical developments in metered pump systems allow the production and use of preservative-free nasal products. The aim of the current study is to compare the tolerability of a preservative-free dexpanthenol (5%) nasal spray with that of the established dexpanthenol (5%) nasal ointment, also without preservatives. The main outcome measure was in vivo mucociliary clearance. METHOD: Mucociliary clearance was assessed by saccharin migration time in 20 volunteers. Wash-out phases were 7 days and the spray or ointment was always applied 20 min before the saccharin test. The study was designed to test for non-inferiority. RESULTS: Saccharin migration time was slightly longer after ointment administration, however, these were not significantly different to nasal spray. The saccharin migration time showed a significant correlation with the age of the volunteers. The upper confidence limit of dexpanthenol nasal spray was markedly less than that of the ointment. Therefore, dexpanthenol nasal spray is at least equal to if not better than dexpanthenol nasal ointment. CONCLUSIONS: Due to its ease of administration, preservative-free dexpanthenol nasal spray offers a valuable therapeutic alternative.
Subject(s)
Mucociliary Clearance/drug effects , Pantothenic Acid/analogs & derivatives , Pantothenic Acid/administration & dosage , Rhinitis/drug therapy , Adult , Aerosols , Cross-Over Studies , Female , Humans , Male , Middle Aged , Ointments , Pantothenic Acid/adverse effects , Preservatives, Pharmaceutical , Prospective StudiesSubject(s)
Deafness/history , Hearing Aids/history , Language Development Disorders/history , Surgical Instruments/history , Adult , Child , Child, Preschool , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, Ancient , History, Medieval , Humans , Infant , Infant, Newborn , Medical IllustrationABSTRACT
BACKGROUND: It is rare to find anything written about hearing loss or its treatment in either representative art or in a medical-historical context in ear, nose and throat journals. METHODS: Examples dating back over the past 4000 years found in medical-historical, philosophical, and literary documents are presented and commented on. RESULTS: The ancient Egyptians and Greeks attempted to explain deafness and sought remedies,making use not only of empiric rational means but also magic and religion. Later, in the Middle Ages, examples from Christian iconography are found demonstrating miracle healing of deafness. Education of the deaf was not considered possible from the time of Aristotle to the sixteenth century, but from then on was organized on a large scale utilizing speech with gestures.
Subject(s)
Christianity , Deafness/history , Education, Special/history , Magic/history , Religion and Medicine , Egypt , Europe , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, Ancient , History, Medieval , History, Modern 1601- , HumansABSTRACT
BACKGROUND: It is rare to find anything written about hearing loss or its treatment in either representative art or in a medicalhistorical context in ear, nose and throat journals. METHODS: Examples dating back over the past 4000 years found in medical-historical, philosophical, and literary documents are presented and commented on. RESULTS: The ancient Egyptians and Greeks attempted to explain deafness and sought remedies,making use not only of empiric rational means but also magic and religion. Later, in the Middle Ages, examples from Christian iconography are found demonstrating miracle healing of deafness.Education of the deaf was not considered possible from the time of Aristotle to the sixteenth century, but from then on was organized on a large scale utilizing speech with gestures.
ABSTRACT
BACKGROUND: Patients with severe obstructive sleep apnea (OSA) treated by nasal continuous positive airway pressure (CPAP) often undergo rhinosurgery to improve nasal ventilation and comply with CPAP therapy. The use of nasal packing postoperatively may worsen the severity of their sleep-related breathing disorders, even leading to death. For this reason, postoperative surveillance with CPAP ventilation is recommended. An oral connection piece offers the possibility to continue CPAP therapy. PATIENTS AND METHOD: Five patients with OSA were enrolled in this pilot study. All patients underwent a septorhinoplasty with nasal packing for 2 days. CPAP ventilation was guaranteed postoperatively by using an oral connection piece. The object of the study was to evaluate the feasibility, effectiveness, and acceptance of CPAP ventilation with this oral connection piece in patients with nasal packing. Therefore, the blood oxygenation of the patients was observed by pulse oximetry pre- and postoperatively. RESULTS: None of the patients with nasal packing showed apneas or hypopneas with arterial blood oxygen saturation below 92%. Application of oxygen was not necessary. Cardiorespiratory or neurological complications were not observed. CONCLUSION: The oral connection piece offers a feasible and effective opportunity to continue CPAP ventilation therapy after rhinosurgery in patients with OSA. The acceptance of the method is satisfactory.
Subject(s)
Postoperative Care , Rhinoplasty , Sleep Apnea, Obstructive/surgery , Adult , Feasibility Studies , Female , Humans , Male , Middle Aged , Oximetry , Patient Acceptance of Health Care , Pilot Projects , Positive-Pressure Respiration , Postoperative Complications/etiology , Postoperative Complications/therapySubject(s)
Hyperthermia, Induced , Sleep Apnea Syndromes/therapy , Tongue , Humans , Treatment OutcomeABSTRACT
The phenomenon of stuttering from Biblical times is covered from a historical and cultural point of view. Theories of its origin and the methods by which it was treated in former times including the surgical procedures of the 18th and 19th century are examined. Since the Renaissance, examples of stutterers in the performing arts have been found.
Subject(s)
Culture , Stuttering/history , Attitude to Health , Famous Persons , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, Ancient , History, Medieval , Humans , Medicine in the Arts , Stuttering/therapy , Surgical Instruments/history , Tongue/surgeryABSTRACT
Paintings and drawings by Lucas Moser, Leonardo da Vinci, Albrecht Dürer, and Jacob Cornelisz van Oostsanen suggest that they employed people who had had cleft lips operated on as models for their works of art. Created between 1431 and 1520, the portraits show diagnostic facial profiles with a curved nasal dorsum, short columella, maxillary retrusion, and pseudoprogenia. The first medical illustration of cleft lip surgery was published in 1564 by Ambroise Paré. It was therefore late Gothic and Renaissance artists who depicted the conspicuous signs of surgically treated patients with cleft lip more than 130 years before the surgeons.
