[Quality in the appraisal of head and neck sonography results in university hospitals-a random sample]. / Qualität in der Befundung von Kopf- und Halssonographien an Universitätskliniken ­ eine Stichprobe.

BACKGROUND: Ultrasound diagnostics are widely used and are standard for radiologists, otolaryngologists, and oral and maxillofacial surgeons in the diagnostic work-up of various pathologies. There is agreement that digital documentation is urgently needed at present to improve and standardize the quality of sonographic documentation. There are more and more publications on the implementation of standardized documentation of findings in imaging diagnostics, including head and neck sonography. OBJECTIVE: The present work aims to determine the quality of routine head and neck sonography findings on a random basis, according to the criteria of the Bavarian Association of Statutory Health Insurance Physicians (KVB) at a selection of German university otolaryngology departments (ENT). MATERIALS AND METHODS: A total of 70 randomly selected anonymized written findings including image documentation from seven ENT departments were retrospectively analyzed by an experienced KVB examiner concerning fulfilment of KVB criteria. The data were evaluated descriptively. RESULTS: Of the 70 reports, 69 were eligible for evaluation. The average documentation completeness was 80.6%. A total of 9 findings were correctly documented in full (13%). The documentation completeness of the individual departments was sorted in ascending order from 68.1% to 93%. With 88.5% vs. 75%, the hospitals with a structured report showed a higher level of completeness. In 75% of the cases the hospitals with structured reports also had digital solutions for reporting and image archiving. CONCLUSION: In general, there is potential for optimization regarding the completeness and quality of routinely prepared head and neck sonography findings at the selected university ENT departments. The implementation of structured reporting masks and the conversion of analogue documentation into digital solutions as well as digital networking with the hospital information systems, picture archiving and communication systems should be promoted. Supervision by senior doctors is required to ensure the quality of findings of inexperienced colleagues and to help to achieve standards in reporting.

Effect of thirst challenge on ADH levels in patients with bilateral Menière's disease.

The aim of the study was to investigate plasma ADH levels and plasma/urine osmolality in patients suffering from bilateral Menière's disease since a disturbance in the water household after thirst challenge is a suspected pathogenic factor in the development of this disease. In this study the plasma ADH levels and plasma/urine osmolality of bilateral Menière's disease patients under thirst challenge were investigated to show whether the water balance is affected. 9 patients with bilateral Menière's disease and 9 healthy controls skipped water intake for 12 h. Plasma ADH, plasma/urine osmolality, and electrolytes were measured after this thirst period as well as 8 h later after food and fluid intake. During food and fluid intake the patients demonstrated a slightly higher plasma ADH level and plasma osmolality than controls, whereas at the end of the thirst period patients and the controls showed no significant change. Instead the urine osmolality differed significantly (p<0.001): showing a high urine osmolality in controls and an almost stable urine osmolality in patients after thirst challenge. This indicates that the water balance in patients is likely different from that of controls. These observations point to ADH and its target aquaporine 2 as keyplayers in the pathophysiological events leading to the development of Menière's disease.

Semicircular canal dehiscence in HR multislice computed tomography: distribution, frequency, and clinical relevance.

The literature about bony defects in the semicircular canal system is highly inconsistent. Therefore, we analyzed a series of 700 high-resolution multislice CT examinations of the temporal bone for semicircular canal dehiscencies. An unselected group of ENT patients with different clinical symptoms and variable age was chosen. We found semicircular canal dehiscence in 9.6% of temporal bones, superior semicircular canal was affected mostly (8%), less common posterior semicircular canal (1.2%); only in 3 cases (0.4%), lateral semicircular canal showed dehiscence. In 60% of SSC dehiscence, we registered bilateral manifestation. The so-called "third mobile window" in semicircular canal dehiscence causes a great variety of clinical symptoms like vertigo, nystagmus, oscillopsies, hearing loss, tinnitus and autophonia. Comparison with anatomic studies shows that CT examination implies the risk of considerable overestimation; this fact emphasizes the important role of clinical and neurophysiological testing.

[Traffic medicine expert opinions in otorhinolaryngology: current aspects]. / Verkehrsmedizinische Begutachtung in der HNO-Heilkunde : Aktuelle Aspekte.

According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (> or = 60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

[Vestibular compensation : basic principles and clinical significance]. / Vestibuläre Kompensation : Grundlagen und klinische Bedeutung.

The vestibular system has the ability to repair deficits due to functional lesions, which is known as vestibular compensation. For successful function the performance of different receptors is less important than the bilateral balance of neuronal activity between the vestibular nuclei complexes. In this review based on data from animal experiments and clinical observations, the mechanisms of vestibular compensation, its time course and its clinical significance are described. Most of the clinical features can be explained by neuronal operations known from animal experiments. It must be emphasized that vestibular compensation is not a static phenomenon but a fluctuating process which can be influenced by therapeutic procedures. Vestibular compensation for static phenomena can be almost completely carried out, but for dynamic features only incompletely. These factors should be taken in account for diagnosis, therapy and assessment of vestibular disturbances.

[Skull vibration induced nystagmus test]. / Le test vibratoire osseux vestibulaire.

OBJECTIVES: To establish during a consensus meeting the fundamental basis, the validity criteria, the main indications and results of the skull vibration induced nystagmus test (SVINT) which explores the vestibule high frequencies. MATERIAL AND METHODS: The SVINT is applied on the mastoid process (right and left sides) at 100 Hz during 10 seconds on a sitting upright subject. Total unilateral peripheral lesions (tUVL: operated vestibular shwannomas, vestibular neurectomies) and partial unilateral peripheral lesions (pUVL: preoperative neuromas, Meniere's disease, vestibular neuritis, chemical labyrinthectomies) were studied. Thirty-six patients had brainstem lesions and 173 normal subjects were used as controls. RESULTS: The SVINT is considered positive when the application of the vibrator produces a reproducible sustained nystagmus always beating in the same direction following several trials in various stimulation topographies (on the right and left mastoid). The skull vibratory nystagmus (SVN) begins and ends with the stimulation; the direction of the nystagmus has no secondary reversal. The slow phase velocity (SPV) is>2 degrees /second. In tUVL the SVINT always reveals a lesional nystagmus beating toward the safe side at all frequencies. The mean SVN SPV is 10.8 degrees /s+/-7.5 SD (N=45). The mastoid site was more efficient than the cervical or vertex sites. Mastoïd stimulation efficiency is not correlated with the side of stimulation. The SVN SPV is correlated with the total caloric efficiency on the healthy ear. In pUVL the SVINT is positive in 71 to 76% of cases; the mean SVN. SPV (6.7 degrees /s+/-4.7 SD)(N=30) is significantly lower than in tUVL (P=0.0004). SVINT is positive in 6 to 10% of the normal population, 31% of brain stem lesions and negative in total bilateral vestibular peripheral lesions. CONCLUSIONS: SVINT is an effective, rapid and non invasive test used to detect vestibular asymmetry between 20 to 150 Hz stimulation. This test used in important cohorts of patients during the ten last years has demonstrated no observable adverse effect. SVINT complements other tests which evaluate lower frequencies (caloric test: 0,003 Hz) and the medium frequencies (Head-Shaking-Test (HST): 2 Hz; the head impulse test (HIT): 6 Hz). SVINT is useful in the diagnosis of labyrinthine hydrops or detection of acoustic neuromas. It is useful when the caloric test can not be practised because of middle ear problems. SVINT has its limits: in pUVL, the nystagmus direction is not always specific of the pathologic side and can change with the stimulus frequency. This test does not precisely point out the level of the lesion on the vestibular pathway.

[Special ginkgo extract in cases of vertigo: a systematic review of randomised, double-blind, placebo controlled clinical examinations]. / Ginkgo-Spezialextrakt bei Schwindel: Ein systematischer Review randomisierter, doppelblinder, placebokontrollierter klinischer Prüfungen.

BACKGROUND: The concept for the medical treatment of vertigo has changed over the last 30 years due to recognition of the dependence of the vertiginous sensation on vestibular compensation and the dependence of vestibular compensation on the state of vigilance. METHODS: In this systematic review, experimental studies of the influence of the special ginkgo extract EGb 761 on vestibular compensation in animals and randomized, double-blind clinical studies of EGb 761 in vestibular and non-vestibular vertigo are described and critically evaluated. RESULTS: The beneficial effect of EGb 761 on vestibular compensation has been demonstrated in preclinical and clinical studies. CONCLUSION: Evidence of the efficacy of EGb 761 for the treatment of vertiginous syndromes is presented in the available studies.

[Vestibular evoked myogenic potentials]. / Vestibulär evozierte myogene Potenziale.

The recording of vestibular evoked myogenic potentials is a relatively new neuro-otologic method which gives specific information about the function of the sacculus and the inferior vestibular nerve on each side separately. The main indications for this method are vestibular schwannoma and fistula of the labyrinth, involvement of the sacculus or the inferior vestibular nerve in Menière's disease and vestibular neuritis, vertigo of unknown etiology, and forensic questions.

[Acute peripheral vestibular lesions. Monocular subjective visual vertical and cyclodeviation]. / Akute periphere vestibuläre Läsionen. Monokulare subjektive visuelle Vertikale und Zykloduktionsstellung.

BACKGROUND: A deviation of the subjective visual vertical (svv) is often found in patients with unilateral peripheral vestibular lesions and in most cases the deviation is transitory and easy to compensate. The purpose of the study was to find out if there is a correlation between deviation of the svv and objective cyclodeviation of the retina. PATIENTS AND METHODS: A total of 20 patients (10 females and 10 males aged between 16 and 78 years) with acute vestibular disease were enrolled. Only patients with a binocular deviation of the svv of more than 2 degrees and/or a difference between the monocular deviation of more than 1.5 degrees were included. The svv was examined monocular in a darkened room and after pupil dilatation, fundus photography was performed on each eye. The angle between papilla and macula was measured manually. RESULTS: We found a good qualitative correlation between svv (mean 7.9 degrees) and objective cyclodeviation (mean 10.6 degrees). CONCLUSION: In contrast to the binocular measurement of the svv, we found good correlation between the monocular svv and the objective cyclorotation measured with fundus photography. It is not yet clear which part of the vestibular system is responsible for cyclodeviation. Because of our results we recommend monocular measurement of the svv in clinical examinations.

Vibration-induced nystagmus - A sign of unilateral vestibular deficit.

Vibrations of 60 Hz and 100 Hz were applied on the mastoid of healthy subjects, patients with unilateral peripheral vestibular lesions, with central lesions of different localizations, and patients with benign paroxysmal positioning vertigo (BPPV). In patients with unilateral peripheral deficit a horizontal nystagmus with a small torsional component beating generally to the not affected side could be observed. This nystagmus did not show adaptation during 40 s. The occurrence was more frequent using 60-Hz stimulations. This vibration-induced nystagmus did never occur in healthy subjects, seldom in patients with central vertigo, and only exceptionally in patients with BPPV. It is concluded that the finding of a vibration-induced nystagmus reflects a side difference of peripheral vestibular excitability.

Long-term deficits in otolith, canal and optokinetic ocular reflexes of pigmented rats after unilateral vestibular nerve section.

Static and dynamic otolith, horizontal vestibular and optokinetic ocular reflexes were investigated in pigmented rats 1-6 and more months after unilateral vestibular nerve (UVN) section. Evoked responses were compared with published data from control rats studied under identical conditions. Static lateral tilt of UVN rats in the light evoked a vertical deviation in static eye position that was as large as in controls. In darkness, the evoked responses in UVN rats 6 months after the lesion were consistently smaller than in controls. Linear horizontal acceleration in darkness evoked vertical and torsional response components in UVN rats that were parallel-shifted towards lower gains and larger phase lags. Off-vertical axis rotation on a platform provoked responses that differed markedly from those recorded in intact rats with respect to the bias velocity component. These results suggest a permanent deficiency in the static and dynamic otolith-ocular reflex performance of UVN rats. Ocular responses to horizontal table velocity steps in darkness exhibited a direction-specific asymmetry in UVN rats. Step responses evoked by acceleration towards the intact side were larger in gain and longer in duration than responses evoked by acceleration towards the operated side. When compared with control data, responses to either side were reduced in UVN rats and the velocity store mechanism was barely activated by velocity steps towards the operated side. Responses evoked by horizontal optokinetic stimulation with constant pattern velocities were below control values in either direction. Slow-phase eye velocity saturated at much lower values than in intact rats, particularly during pattern motion towards the intact side. The duration of the optokinetic afternystagmus was asymmetrically reduced with respect to control data. Practically identical reductions in duration were found for vestibulo-ocular responses in the opposite directions. Behaving animals exhibited no obvious impairment in their spontaneous locomotory or exploratory activities. However, each UVN rat was impaired, even 2 years after the lesion, in its postural reaction to being lifted by the tail in the air. This observation suggests the presence of a permanent deficit in static and dynamic otolith-spinal reflexes that may be substituted on the ground by proprioceptive inputs.

[Therapy of isolated acute laryngitis with fusafungin. A phase IV study]. / Therapie der isolierten akuten Laryngitis mit Fusafungin. Eine Phase-IV-Studie.

Four-hundred and eighty-four patients with acute laryngitis were examined before and after treatment with fusafungin under phase IV conditions. After one week of therapy such complaints as hoarseness, sore throat and difficulties in swallowing were improved in about 90% of the patients, while the leading complaint of "hoarseness" had disappeared in 60%. Inflammatory findings, documented by a physician, showed comparable results. An analysis of subgroups (ineffectively treated patients and patients with long-lasting symptoms and complaints) shows that fusafungin was effective therapeutically for treating for acute laryngitis. This study also shows that the generally accepted high rate of spontaneous recovery does not exist.

[Therapy of vestibular vertigo]. / Therapie des vestibulären Schwindels.

The non-surgical treatment of vestibular disorders must be based on current knowledge of vestibular pathophysiology. It is generally accepted that after vestibular lesions a self-repair mechanism exists that allows a more or less complete recovery. In cases of persisting vestibular complaints the physician's duty consists in stimulation of these pre-existing mechanisms. This can be done by physical exercises, as has been recommended since the work of Cawthorne and Cooksey in 1946. This concept is meanwhile supported by modern neurophysiological research. This article describes a short training program consisting of exercises for fixation during rotations, smooth pursuit, optokinetic nystagmus and motor learning mechanisms. Physical exercises can be reinforced by nootropic drugs.

[Ultrasonics in the diagnosis and follow-up of tumors of the inner nose and paranasal sinuses]. / Ultraschall in der Diagnostik und Nachsorge von Tumoren der inneren Nase und der Nebenhöhlen.

Ultrasound diagnosis is not applicable in diagnostics and monitoring of tumors of the inner nose; the B-mode can be used only if the lumen of the nose is completely filled out by the tumor. In case of the paranasal sinuses the A-mode imaging furnishes a pattern containing back wall echoes and intermediate echoes which necessitates further diagnostic measures. Thanks to the B-mode imaging it is possible to determine the tumor extent and an eventual infiltration into the surrounding tissues. The pre- and posttherapeutic diagnosis of tumors of the inner nose and the paranasal sinuses contains also an investigation of the neck in order to detect possible metastases.