Medical care and treatment of allergic rhinitis: a population-based cohort study based on routine healthcare utilization data.

BACKGROUND: Health services research on medical care and treatment of allergic rhinitis (AR) is scarce. OBJECTIVES: To investigate the prevalence, incidence, comorbidities, and treatment of AR in a realistic setting. METHODS: A cohort of 1 811 094 German National Health Insurance beneficiaries in 2005 was followed until 2011. To avoid misclassification, the ICD-10 code for AR (J30) had to be documented at least twice to classify patients as having AR. Descriptive statistics and logistic regression models were used to describe the burden, comorbidities, and treatment of AR. RESULTS: A total of 111 394 patients (6.2%) had prevalent AR in 2005/2006. In another 60 145 individuals (3.3%), AR was newly diagnosed in 2007 to 2011 (incident cases). Patients with prevalent AR were three times more likely to develop asthma compared to patients without AR (age and sex-adjusted risk ratio (RR) 3.04; 95% confidence interval (95%CI) 2.98-3.10). Newly diagnosed recurrent depressive disorder (RR 1.61; 95%CI 1.55-1.68), anxiety disorder (RR 1.52; 95%CI 1.48-1.56), and ADHD (RR 1.21; 95%CI 1.13-1.29) were also related to prevalent AR. Approximately 20% of children and 36% of adults with AR were exclusively treated by general practitioners. Allergy immunotherapy (AIT) was prescribed for 16.4% of patients with AR. Subcutaneous immunotherapy was most frequently used (80% of AIT). CONCLUSIONS: This study highlights the significant burden of AR. Despite the established benefits of AIT to treat AR and prevent asthma, this study suggests significant undertreatment. Future research is necessary to develop and implement adequate measures to increase guideline adherence.

[Bilateral nasal remission spectroscopy allows the side separated continuous measurement of changes in swelling of the nasal mucosa]. / Schwellungsänderungen in der Nase: Die bilaterale nasale Remissionsspektroskopie zum seitengetrennten Echtzeit-Monitoring.

INTRODUCTION: In earlier studies optical transmission spectroscopy showed that continuous monitoring of changes in the swelling of the nasal mucosa is possible. However, independent measurement in both sides of the nose cannot be achieved by this method. With the aim of achieving real-time monitoring of endonasal swelling separately for both nostrils we developed the new method of bilateral nasal remission spectroscopy for this pilot study. MATERIALS AND METHODS: In nasal remission spectroscopy, light at a wavelength of 790 nm (close to the isobestic point of hemoglobin) is beamed into each side of the nose, and the light that is backscattered by the internal nasal tissue is measured continuously on the same nasal side. To evaluate the principle of this new method a pilot study was conducted in five healthy probands subjected to a one-sided (unilateral) nasal histamine provocation test (0.14 ml, 2 mg/ml). RESULTS: In each proband single-sided nasal histamine provocation led to an increase in light extinction on the provoked side by an average of 0.18 optical densities (OD). In four of the five probands a slight increase (0.04 OD) in light extinction was observed on the other side of the nose. CONCLUSION: Nasal remission spectroscopy seems to allow single-side, continuous monitoring on both sides of the nose. Therefore, the method could also be suitable for use in studies of the nasal cycle, as well as for objectivisation of nasal allergen provocation tests.

[Documentation of endonasal changes in blood volume using optical rhinometry]. / Dokumentation von endonasalen Blutvolumenänderungen mittels optischer Rhinometrie.

BACKGROUND: In optical rhinometry, the nose is transilluminated with light and the light absorption by the nasal tissue is measured continuously. Using this method, a real time documentation of changes in nasal blood volume is possible. The method has been evaluated using the nasal allergen provocation test. In this study, the ability of optical rhinometry to detect changes in the nasal blood volume due to various posture changes is examined. METHODS: Optical rhinometry was tested on ten healthy probands, with several examinations being performed on each. RESULTS: By bending the neck, lying down or stopping breathing, stronger light extinction was found. Standing up quickly caused a sudden but short decrease in light extinction. A small amount of exercise, such as making a fist several times, decreased light extinction. Harder exercise on an ergometer led to a stronger decrease in light extinction. In the Valsalva maneuver, an increase in light extinction for the duration of the maneuver was observed. Changes in breathing through the nose or mouth or counting from 1 to 100 had no influence. CONCLUSIONS: Using the new method of optical rhinometry, it is possible to detect changes in endonasal blood volume caused by changes of intrathoracic pressure, changes in posture or physical exercise, non-invasively and in real time. This technique can therefore be used for further research on the regulation of the nasal blood flow.

[Endocranial complications in otitis media: what you need to remember]. / Kopfschmerz, Schwindel, Meningismus, Krampfanfall. Steckt vielleicht eine Otitis media dahinter?

Thanks to the potency of antibiotics, life-threatening complications of otitis media are rare. In many cases, however, the symptomatology is veiled, and the course of the disease tends to be protracted. Secondary symptoms may preponderate and often mask those associated with the ear itself. If a case of otitis media fails to clear up, or mastoiditis develops, or sensorineural deafness, vertigo, headaches, seizures, or meningism occur, the possibility of an otogenous complication must immediately be considered and the patient submitted to diagnostic imaging without delay, so as to ensure early surgical treatment of a possible lesion in the ear.

Optical measurement of nasal swellings.

We introduce a new optical method to noninvasively and continuously measure the swelling process of the nasal mucosa whereby we use light of different wavelengths in the red and near-infrared range which is transilluminated through the nasal tissue and whose extinction is recorded as a function of time. From the temporal and spectral extinction data, we are able to extract characteristic parameters that describe the swelling process quantitatively by means of a regression-type parameter estimation algorithm. The method has been applied to the nasal allergen provocation test and verified on a limited number of volunteers.

Titanium clip prosthesis.

OBJECTIVE: Prostheses for the reconstruction of a defective ossicular chain should be stable and firmly anchored to the ossicular remnants. This will prevent a defective connection from causing diminished sound transmission efficiency and will keep the prosthesis from tilting or even losing contact, which would result in a sound transmission block. Through temporal bone experimentation, we have consequently developed a very lightweight titanium prosthesis, which is fastened onto the stapes head with a clip mechanism. METHODS: When temporal bone experiments using laser Doppler vibrometry confirmed that the prosthesis functioned well acoustically and when luxation experiments proved that it could be safely used without the risk of stapes dislocation, the prosthesis was used in a clinical application within an observational study. The University of Dresden Otorhinolaryngological Hospital as well as seven surgeons from five other hospitals participated in the study. RESULTS: The results of 133 operations showed that, in over 90% of the cases, the prosthesis could be implemented without problems and with good mechanical stability. The first acoustical results obtained during the first year from 49 patients showed a sound transmission improvement range from 12 dB to 14 dB. CONCLUSION: With the clip prosthesis, it seems possible to further improve defective middle ear function, which would allow the patient to regain social hearing after middle ear reconstruction. The reliability of the fastening is an innovation. Revision operations showed a stable prosthesis-stapes complex in the middle of a recurring cholesteatoma and the prosthesis could always be easily pulled from the stapedial suprastructure.

[Optical Rhinometry. Continuous, direct measurement of swelling of the nasal mucosa with allergen provocation. Real-time monitoring of the nasal provocation test using optical rhinometry]. / Die optische Rhinometrie. Kontinuierliche, direkte Messung der Schwellung der Nasenschleimhaut bei Allergenprovokation.

BACKGROUND: Various methods exist for measuring swelling of the nasal mucosa. This is necessary in order to make the nasal provocation test objective. With the new method of optical rhinometry, it is possible to measure swelling of the mucosa directly from outside of the nose in real-time. The measurement is carried out with monochromatic near-infrared light of different wavelengths, the intensity change of which are recorded and displayed during the swelling. MATERIALS AND METHODS: With the help of a specially developed prototype of an optical rhinometer, we carried out measurements on 15 subjects having positive nasal provocation tests with histamine and allergens, negative provocation tests with allergens in non-allergics, negative provocation tests with control solution, and decongestion with xylometazoline. RESULTS: We found significant differences between positive and negative provocation tests ( P<0.01). Decongestion was different from all other groups ( P<0.01). Nasal congestion subjectively reported by the subject always correlated with the optical rhinometry findings. CONCLUSION: The objective assessment of nasal swelling using optical rhinometry seems reliable. The course of the endonasal swelling can thereby be monitored in real-time. The measurement is largely independent of the cooperation of the patient. The swelling is measured directly and not indirectly via air flow resistance.

[Normal sense of smell in Kallmann syndrome. A case report]. / Normosmie bei Kallmann-Syndrom Ein Fallbericht.

BACKGROUND: Kallmann's syndrome (KS) was first mentioned in 1944 as an association of anosmia and hypogonadotropic hypogonadism. Causes are multiple genetic defects the most common of which is the x-linked KS appearing mostly in men. However, autosomal dominant and autosomal recessive forms have also been described. PATIENT: We present a case of KS with normosmia (male, 39 years of age). All symptoms of hypogonadotropic hypogonadism were present. RESULTS: Psychophysical olfactory testing revealed left-sided anosmia with right-sided normosmia which was confirmed by electrophysiological measures of olfactory function. Magnetic resonance imaging indicated aplasia of the left olfactory tract and bulb, whereas the right-sided structures appeared to be normal. CONCLUSIONS: As indicated in this case with lateralized anosmia and contralateral normosmia, overall olfactory function strongly depends on the "best" nostril. Therefore, in many clinical situations, lateralized olfactory testing appears to be extremely important.

[Necrotizing lymphadenitis (Kikuchi-Fujimoto disease) as a rare cause of cervical lymphadenopathies. Diagnosis and differential diagnosis]. / Nekrotisierende Lymphadenitis (M. Kikuchi-Fujimoto) als seltene Ursache zervikaler Lymphadenopathien. Diagnose und Differentialdiagnose.

BACKGROUND: The ENT specialist is often confronted with the inquiry as to the cause of lymph node enlargements. Common causes include inflammations, neoplastic, or autoimmune diseases. We report on three cases of Kikuchi-Fujimoto disease as a benign self-limiting lymphadenopathy of unknown etiology, which is usually found in young women between 20 and 30 years of age. Main symptoms are indolent or light tender, enlarged lymph nodes in the neck area. The correct diagnosis requires the histologic examination of the lymph node. Even for the experienced pathologist the differential diagnosis of malignant systemic disorders can be difficult. PATIENTS: Three female patients suffering from Kikuchi-Fujimoto disease were treated in our department between September 1997 and March 1998. RESULTS: All patients showed indolent and enlarged lymph nodes in the neck. In one case we were able to diagnose an acute cytomegalovirus infection; in another case an acute Epstein-Barr virus infection. After 3-5 months the symptoms disappeared spontaneously in all patients. In two of the three cases, histologic lymph node examination revealed T-cell lymphoma and Hodgkin's disease and in one case led to initial chemotherapeutic treatment. As a result of a second histologic examination, both diagnoses were reviewed and Kikuchi-Fujimoto disease was diagnosed. Chemotherapy was discontinued. CONCLUSIONS: Kikuchi-Fujimoto disease is a benign, self-limiting lymphadenopathy which is usually diagnosed in young women. Distinguishing Kikuchi-Fujimoto disease from malignant systemic disorders may even be difficult for pathologists using histological examination techniques and requires close cooperation between the ENT specialist and the pathologist. In order to minimize the risk of misdiagnosis and incorrect treatment, the ENT specialist should inform the pathologist about the differential diagnosis of Kikuchi-Fujimoto disease in such cases.