[Decompression of the optic nerve after fractures of the rhino-basal skull with computer-assisted surgery]. / Dekompression des Nervus opticus nach Frakturen des Riechschädels mit Hilfe von CAS (Computer Assisted Surgery).

Referring to 22 cases of surgery after frontobasal fractures of different origin with loss of vision, the surgical procedure is discussed with special consideration of the approach, technique and timing of the operation. We conclude that the external rhinological approach through the ethmoid sinus is the best and easiest access in cases of loss of vision with verified fracture or haematoma. A number of patients were operated using CAS (Computer Assisted Surgery)-Systems, a CT-based tool for three-dimensional orientation. It proved to be very useful for the surgeon, saving time and reducing the risk of additional damage. According to our experience and the results of other authors we believe that surgical intervention should be performed as early as possible.

[Peritonsillar abscess in the ultrasonic image]. / Der Peritonsillarabszess im Ultraschallbild.

A prospective study was carried out to evaluate the sensitivity of ultrasonography in diagnosis of peritonsillar abscess (Quinsy). In 1986 through 1989 all cases of doubtful peritonsillitis were subjected to B-mode ultrasonography of tonsils before tonsillectomy was carried out. 36 patients were included in this clinical study. In cases of clinically uncertain peritonsillar abscesses the sensitivity of the method was 82%. However, only four false positive cases ("abscess in the scan but no pus during surgery") occurred.

[A pragmatic assessment of sense of smell]. / Eine pragmatische Geruchsprüfung.

A new clinical odour test was developed and validated in a clinical trial including 50 healthy volunteers as well as 35 patients suffering from smell disorders. The aromas were incorporated in an inert gas under disclosure from oxygen, avoiding impairment caused by oxidative transformation. Conventional smell test by Elsberg bottles was used as standard. The spray test proved to be equally effective in discriminating subjects suffering from smell disorders as the standard procedure. Moreover the spray test is feasible and long term constance of the substances is guaranteed.

[Administration of terfenadine in a single dose: comparison to standard treatment, as a double blind study, in patients presenting with allergic rhinitis]. / Administration de la terfénadine en prise unique: comparaison au traitement standard, en double aveugle, chez des patients présentant une rhinite allergique.

This double-blind, randomized multicentre study was designed to compare efficacy and tolerability of 120 mg terfenadine taken once daily (in the morning) with the established regimen of 60 mg terfenadine taken twice daily in the treatment of seasonal rhinitis. Two comparable groups, a total of 191 hay fever patients, were treated for 1 week. Symptom severity was assessed by the investigators before and at the end of the treatment (visual analogue scale), and daily by the patient (four-point rating scale). All symptoms improved to a similar degree in both groups. Differences between the two groups were not statistically significant, except for nasal symptoms in three cases as assessed by the visual analogue scale in one centre (better relief in the group given 120 mg terfenadine once daily). Tolerability was good and similar in both groups. The data presented show that in the treatment of hay fever 120 mg terfenadine given once daily is an effective, convenient and well tolerated alternative to the regimen of 60 mg terfenadine given twice daily.

Multi-centre double-blind comparison of terfenadine once daily versus twice daily in patients with hay fever.

This double-blind, randomized multi-centre study was designed to compare efficacy and tolerability of 120 mg terfenadine taken once daily (in the morning) with the established regimen of 60 mg terfenadine taken twice daily in the treatment of seasonal rhinitis. Two comparable groups, a total of 191 hay fever patients, were treated for 1 week. Symptom severity was assessed by the investigators before and at the end of the treatment (visual analogue scale), and daily by the patient (four-point rating scale). All symptoms improved to a similar degree in both groups. Differences between the two groups were not statistically significant, except for nasal symptoms in three cases as assessed by the visual analogue scale in one centre (better relief in the group given 120 mg terfenadine once daily). Tolerability was good and similar in both groups. The data presented show that in the treatment of hay fever 120 mg terfenadine given once daily is an effective, convenient and well tolerated alternative to the regimen of 60 mg terfenadine given twice daily.

[Does human fibrin glue improve results in tympanoplasty?]. / Verbessert Human-Fibrinkleber die Ergebnisse der Tympanoplastik?

Human fibrin tissue adhesive diminishes the rate of recurrent perforations in tympanoplastic on a statistical base (n = 1051). The postoperative air-bone gap (1000 cps) was not influenced in a substantial amount by using tissue adhesive. The reconstruction of the lateral attic wall by endogenous conchal cartilage was facilitated by the application of fibrin tissue adhesive. In animal experiments with guinea pigs ("attic" of bulla tympanica) human fibrin tissue adhesive is superior to free muscle transplants in reconstruction of the bony bulla wall. Fibrin adhesive induces scar formation, therefore a very sparing use is necessary.

[Osteosynthesis treatment of periorbital fractures with the mandibular mesh system]. / Osteosynthetische Versorgung von periorbitalen Frakturen mit dem Mandibular-Mesh-System.

We report about 11 patients with periorbital fracture. Blow-out fracture and patients with fracture of the anterior wall of the frontal sinus. Treatment was operative osteosynthesis. We used for that the Mandibular Mesh System of 3M Company, Germany. We usually observed the patients for one year and got a firm unification of the fragments, as well a good cosmetic success from the beginning. We had not seen any complications caused by the osteosynthesis material. The author consider the most important advantages of this system to be the considerably smaller measurements, the possibility to form the osteosynthetical sheets out of a lattice, the higher solidity of Titanium and the good formability.

[A caloric vestibular test with increased positive evidence (author's transl)]. / Vergleich der typischen kalorischen Vestibularisprüfung mit einem Vestibularistest mit erhöhter Aussagekraft.

A decrease of the variance of a caloric test would increase the importance of the statement of this test. An important source of variance are the differences concerning the timecourse of the induced heat wave, determined by the different anatomic conditions in the petrous bone, particularly the pneumatisation. A constant temperature gradient is obtained by the irigation in a pessimum position with the head flexed 30 degrees to the front. This temperature gradient evokes immediately a constant maximum vestibular stimulus after having reflected the head 90 degrees to the back. Comparing this new method with the traditional irrigation, one can state an important reduction of variance. The dependence of the nystagumus response on caloric irrigation of the petrous bone demands a X-ray-examination according to the technique of Schüller before starting with the caloric examination. In case of differences between the right and left sides the described test would be necessary in our opinion.

[A caloric vestibular test with increased positive evidence (author's transl)]. / Ein kalorischer Vestibularistest mit erhöhter Aussagekraft.

The positive evidence of the caloric test increases, when the time-course of the induced heat wave in the petrous bone was eliminated, which differs from man to man. This is possible by changing head position during calorisation, so that a nearly rectangular stimulus results.

[Comparison of different nystagmus-parameters with the measured so-called maximal velocity of the slow phase in connexion with caloric vestibular examination (author's transl)]. / Vergleich verschiedener Nystagmusparameter mit der gemessenen sog. maximalen Winkelgeschwindigkeit bei der thermischen Erregbarkeitsprüfung.

The adequate stimulus of the semicircular canals by a rotatory acceleration is producing a nystagmus, whose graph of the postrotatorius I is adequate to a decreasing e-function. The constants of the function are calculabe, the variance is very small. The inadequate stimulus of the semicircular canals by caloric stimulation effects a nystagmus, which shows an intensive changing course of the graph with a large variance. Only smoothings and standardisations by counting of an individual coefficient of the reaction-intensity lead to a graph, which is nearly adequate to an increasing and decreasing e-function. The variance of the single nystagmus-parameters grows with its range of reaction. The velocity of the slow phase shows the largest variance. Each experimental arrangement, which enlarges the nystagmus-intensity, is enlarging the variance coincident. The experimental conditions are neither to form by illumination of the eyes nor by increasing of the mental activity in such a uniform way that the variance would be reduced. The valuation of the singular nystagmus-parameters for the clinic is only to confirm by the examination of otoneurologic syndroms.