["Ultrasound tonsillectomy" in comparison with conventional tonsillectomy]. / Die "Ultraschalltonsillektomie" im Vergleich zur konventionellen Tonsillektomie.

BACKGROUND AND OBJECTIVE: The postoperative convalescence after tonsillectomy is difficult because of a high rate of secondary hemorrhages and severe pain. The Ultracision Harmonic Scalpel cuts in the longitudinal direction and coagulates simultaneously by means of a 55.500 Hz vibrating blade. A randomized prospective simple blind study was conceived to compare the advantages and disadvantages of the "Ultrasound Tonsillectomy" with the conventional method. PATIENTS: Between 8/1999 and 3/2000 25 tonsillectomies were performed with the Ultracision (TEuc-group) and 25 with conventional methods (TEkonv-group). The age of the patients was between 18 and 65 years. RESULTS: The median intraoperative blood loss in the TEuc-group was significantly lower than the TEkonv-group (19.0 g/176.0 g), the pain symptoms were comparatively less. On the other hand postoperative blood losses of the TEuc-group were clearly higher (7/25 vs. 3/25), wounds healed more slowly, the development of the wound covering and the swelling of the uvula were significantly larger. CONCLUSIONS: Based on the results of the study the ultrasound technique is not superior to the conventional tonsillectomy.

[Functional and esthetic results of osteoplastic frontal sinus operations and profile reconstruction with bitemporal coronal incision]. / Funktionelle und ästhetische Ergebnisse nach osteoplastischen Stirnhöhlenoperationen und Profilplastiken über bitemporalen Bügelschnitt.

BACKGROUND AND OBJECTIVE: The majority of inflammatory frontal sinus diseases requiring operative intervention can now be managed successfully by endonasal surgery. In problematic cases, however, optimal exposure of the entire frontal sinus and possibly complete mucous membrane removal combined with sinus obliteration must be achieved. In these cases, external frontal sinus surgery is indicated. PATIENTS/METHODS: The operative approach and findings of 35 osteoplastic sinusotomy operations and 5 forehead reconstruction operations with porous polyethylene are reviewed. Median follow-up was 3.7 years, ranging from 1 to 7 years. Indications for surgery were trauma (12), infections (8), tumors (11), muco- or pyoceles (4), and frontal deformities (5). RESULTS: The overall functional and esthetic result was excellent. No recurrent infection was noted. None of the patients have required revision surgery so far, and no serious complications occurred. Abnormal forehead sensation was reported by 12 patients (30%). Temporary double vision was described in 3 cases (7.5%). CONCLUSIONS: Due to optimal sinus exposure and advantageous incision, osteoplastic frontal sinusotomy leads to excellent functional and esthetic results. Porous polyethylene demonstrates superior material properties and seems to be, in comparison with other implants, the current material of choice in frontal reconstruction.

[Small abnormality of the middle ear--a genetically-induced defect?]. / Die kleine Fehlbildung des Mittelohres--ein genetisch bedingter Defekt?

Conductive and sensorineural hearing losses are of genetic origin in 20% to 60% of cases. In general, genetic abnormalities are more often expressed as a sensorineural hearing loss than as a conductive hearing loss. At present several genes for sensorineural hearing loss have been isolated. The most common genetically transmitted forms for isolated conductive hearing losses are otosclerosis and small malformations of the ossicles. To date no genes responsible for these deformations have been isolated. We present a family with four siblings having conductive hearing losses caused by ossification of the stapedial tendon. This finding is suggestive of an autosomal recessive inheritance. The early diagnosis of an hereditary conductive hearing loss contains the possibility for permitting normal development of speech.

Possible autosomal recessive inheritance of progressive hearing loss with stapes fixation.

Four sibs with progressive, bilateral conductive hearing loss are presented. Symmetrical hearing loss averaging 30-60 dB (0.125-8 kHz) became apparent between 8 and 24 years of age. Tympanotomy showed a fixed stapes either through ossified stapedius tendon or through ossified stapedius tendon or through a bony bridge from the stapes to the pyramidal eminence in all patients. After surgical removal of the bony tendon hearing was normal. Both parents, four other sibs, and all grandparents had normal hearing. This family and a further published case suggest a possibly recessive inheritance of this form of conductive hearing loss.

[Our concept of the formation and closure of a tracheostoma]. / Unser Konzept bei Anlage und Wiederverschluss eines Tracheostoma.

Better functional and cosmetic results are achieved after the closure of an epithelialized tracheostomy if a method suited to the closure technique is selected when the stoma is first created. We choose a horizontal skin incision which also allows an incision running along the tension lines of the neck to be used when closing the tracheostomy. The flap from the anterior tracheal wall reported by Björk is of functional value and for closure of the stoma also. When the skin has been previously damaged, we suggest covering the defect in patients with tracheal fistulae by a bridge flap from the neck skin, avoiding the use of distant flaps which are cosmetically less favourable.

Porous polyethylene and proplast: their behavior in a bony implant bed.

A comparative animal study showed that, after implantation in skull defects in guinea pigs, porous high-density polyethylene (PHDPE) was substantially better anchored in the bone than Proplast, and had greater stability of form and structure. In Proplast, ingrowth of fibrous tissue caused partial structural dilatation and fragmentation, which could limit its suitability for use in reconstructive surgery.

[Porous synthetic materials in external ear reconstruction]. / Poröse Kunststoffe für die Ohrmuschelplastik.

An investigation was done on the suitability of four porous synthetic materials--Dacron, porous polyethylene, Proplast II and Teflon--for use as a framework in external ear reconstruction. For this purpose, folded implants up to 1,8 mm thick were implanted under the abdominal skin of rats to create a standing skin fold. The fibrin glue proved useful. After 10 months the most convincing of the synthetic materials was porous polyethylene, which offered advantages over the other materials in handling, and retained a lasting form. This synthetic was also used in clinical reconstruction of the external ear.

Dependence of noise-induced hearing loss upon perilymph magnesium concentration.

Noise-induced hearing loss (NIHL) is significantly greater in rats fed a magnesium-deficient diet than in rats on a magnesium-rich diet. The hearing loss was found to be negatively correlated with the magnesium concentration of the perilymph. It is suggested that also in man, the magnesium concentration in the perilymph may be of importance in determining susceptibility to NIHL.

[Rupture of the round window - a cause of sudden hearing loss (author's transl)]. / Die Rupture der runden Fenstermembran - eine Ursache des akuten Hörsturzes.

Rupture of the round window has been mostly described as an occasional lesion with sudden deafness and vertigo after diving, flying and physical stress, usually according to the patient's history. It also seems to be the cause of sudden progressive hearing loss of so-called idiopathic origin as shown by the findings in 6 out of 9 patients with perilymphatic fistulas. Therefore, transtympanic endoscopic evaluation of the round window is performed in the author's clinic as a routine measure in patients with sudden complete deafness or severe progressive loss of hearing even without any pointer to a possible trauma.

Increased noise trauma in guinea pigs through magnesium deficiency.

Mg-deficient guinea pigs developed significantly increased hearing loss during 4 weeks of noise exposure [95 dB(A)] as compared to animals fed a Mg-rich diet. The hearing loss was negatively correlated to the Mg content of the perilymph (r = -0.86). Besides this auditory effect, there was a decrease of intracellular Mg and an increase of collagen in the myocardium, both of which were correlated to the hearing loss and caused by Mg deficiency and noise stress.

The influence of the effect system on adaptation, temporary and permanent threshold shift.

As it was still not possible to elucidate sufficiently the function of the efferent acoustic system or the tractus olivocochlearis (OCB), and as it is still not known whether this system possibly has the function of providing protection against noise-induced trauma, the vestibular nerve was severed in the guinea pig, and the threshold shift was compared with that of a control group. On day 8 after exposure to noise, both the temporary threshold shift (TTS) and the permanent threshold shift (PTS) were significantly lower in the control group than in the group with severed OCB. Thus, it does indeed seem possible to ascribe a protective function to the efferent system.

[The differential diagnosis of chronic tympanic effusion (author's transl)]. / Zur Differentialdiagnose des chronischen Paukenergusses.

Three patients are reported in whom sound-conduction deafness was caused by malignant tumors in the tubal-tympanic area of the middle ear. In all patients, physical examination (inclusive of the ear and nasopharynx) had essentially been normal for a long time. In each patient, the tympanogram obtained indicated a tympanic effusion which, however, proved to be therapy-resistant. The first patient was found to have a malignant melanoma of the auditory tube while the second patient had an adenoid cystic carcinoma of the middle ear. The last patient had a primary carcinoma which at first showed only peritubal and submucosal growth.

["Sudden binaural deafness" after acute heroin intoxication (author's transl)]. / "Hörsturz beidseits" nach akuter Heroinintoxikation.

After intoxication by an overdose of intravenously applied heroin, a 20 year old man developed a nearly symmetrical, tub-shaped sensorineural deafness of max. 50-60 dB at the frequencies 1000-4000 Hz, which receded completely within 3 days. In addition, a short survey is given of hitherto known neurological complications after heroin intoxication.

The applicability of porous polyethylene for tympanoplasty; an animal experimental study.

The problem of a replacement material for the reconstruction of the posterior wall of the auditory canal, as well as for the obliteration of the radical cavity has not been solved satisfactor;ly so far. In order to examine the possible applicability of porous plastics, the posterior wall of the auditory canal of guinea pigs was first removed and then reconstructed using porous polyethylene and filling the bulla tympanica with fine polyethylene chips. One third of the animals had an infected middle ear at the time of implantation. Histologic assessments were made until 24 weeks after implantation. In 80% of the animals the implant settled well, even in cases where the middle ears had been originally infected. By proliferation of vessels and connective tissue, the polyethylene had almost been completely integrated into the surrounding tissue after one week. Extent and frequency of metaplastic osseous growth was greater inthe chip-filled bulla than in the reconstructedposterior wall(Fig. 9). After four weeks, the new osteoid substance was firmly connected with the regional bone (Fig. 4). According to these results, it would seem possible to use porous polyethylene even for the nonaseptic implant bed as it is found in the chronically infected middle ear.

[Reaction pattern of the cochlea in cases of experimentally induced sudden hearing loss (author's transl)]. / Die Reaktionsform der Kochlea beim experimentell induzierten Hörsturz.

Acute auditory damage is produced in 127 guinea pigs. In one group (n = 68), sound damage is effected (140 dB SPL white noise for 5 min.). In a second group (n = 59), the cochlea is damaged with a cryoprobe (-196 degrees C, 1 min.). Both methods produce a middle-grade hearing impairment. With the aid of indwelling cathodes, the input-output curves are determined before and after the damage as well as up to the 16th postoperative day. Statistical comparison of the results shows that the reaction of the cochlea to the same irritation can be very different. This must be taken into consideration especially in evaluating the effect of pharmaca.

[The significance of IgE in the differential diagnosis of vasomotoric rhinopathy (author's transl)]. / Zur Bedeutung des IgE bei der Differentialdiagnose der Rhinopathia vasomotorica

In 94 patients with allergic and non-allergic rhinopathy, we performed quantitative IgE-determinations in the serum as well as in the nasal secretion. 34 patients had a vasomotor rhinitis, 40 patients a pollinosis and 20 a perennial allergic rhinitis. Statistically, the IgE-values were in pollinosis and in perennial alllergic rhinitis-in the serum as well as in the nasal secretion-significantly higher than in vasomotor rhinitis. Due to the great range of variation of the values in all groups of patients examined, an assignment ot a certain group of diseases was not possible individually. As in some patients the secretion concentrations were higher than the corresponding serum values, we presume that IgE is produced-at least to some extent-also in the mucosa.