[Otologic diagnosis: powder technique]. / Otodiagnostik: Pudertechnik.

The otologic diagnostic powder test with grape - sugar simple will be performed with a powder - blower. It permits a good differentiation between dry squamous epithelium and wet mucosa. In our opinion this test therefore is unrenouncable in microscopic differentiation between mucosa in central perforations on one hand and atrophic scars, retraction pockets or adhesive epithelium of the drum or complete atelectasis of the tympanic cavity on the other hand.

[Soft palate stabilization with cartilage in snoring and OSAS]. / Gaumen-Knorpel-Stabilisierung bei Schnarchen und mildem bis mittelschwerem obstruktivem Schlaf-Apnoe-Syndrom.

Soft palate stabilization with cartilage represents a new and innovative surgical concept in snoring and OSAS using nasal septum cartilage or concha cartilage.

[Cleaning and disinfection of endoscopes in general practice and ambulatory care]. / Reinigung und Desinfektion von Endoskopen in Praxis und Ambulanz.

The legal conditions in Germany for cleaning and disinfection of endoscopes depend on the terms of reference of the "Bundesgesundheitsamt (BGA)" and the "Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM)" and the "Unfallverhütungsvorschrift (UVV) der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege". The different regulations and the resulting practical consequences for manual and mechanical cleaning and disinfection of rigid and flexible endoscopes are described. Particularly the HBV-HIV-problems as well as the respective inactivation times resulting there from, standby times and concentrations of different solutions for disinfection are discussed. Presentation of the practicability of the different steps in daily ENT-practice and ambulance.

Penetration of ofloxacin into nasal tissues.

The average concentration in 75 female/male patients was 1.90 +/- 1.10/1.55 +/- 0.62 mg/l in serum, 0.81 +/- 0.42/0.74 +/- 0.48 mg/kg in bone, 2.40 +/- 1.16/1.94 +/- 0.87 mg/kg in cartilage, and 2.35 +/- 1.28/1.99 +/- 1.02 mg/kg in mucosa. In each case the highest serum or tissue concentrations were observed 2 hours after the last ofloxacin administration (serum 2.60 +/- 0.41 mg/l, bone 1.10 +/- 0.75 mg/kg, cartilage 3.40 +/- 0.86 mg/kg, mucosa 3.50 +/- 1.05 mg/kg), but even 8 hours after the last dose the levels still exceeded the MIC 90% of e.g. Pseudomonas aeruginosa, Staphylococcus aureus or Haemophilus influenzae. The clinical investigations carried out show that ofloxacin represents a new oral therapeutic agent of significant value in otorhinolaryngology, particularly in the treatment of problematic infections. As the investigations show, the level in healthy tissue is definitely within the therapeutic region for a period of 8 hours. In ENT (nasal and paranasal) infections, ofloxacin should be given for defined indications, e.g. for oral therapy of problematic infections due to P. aeruginosa, and if possible after identification of the pathogen.

Tissue and serum concentrations of ofloxacin in the ear region following a single daily oral dose of 400 mg.

Even after a single daily dose of 400 mg, the concentrations of ofloxacin in infected middle ear tissues are within the therapeutic range. Even 20 h after a single dose of 400 mg ofloxacin, the tissue concentrations in cartilage and cholesteatomatous matrix are in excess of the minimal inhibitory concentration for a number of pathogens, such as Staphylococcus aureus and Haemophilus influenzae. The especially high concentrations in middle ear mucosa, auricular cartilage and cholesteatomatous matrix are striking. No complications or side effects were observed during ofloxacin treatment in this study. The study demonstrates that a dose of 400 mg ofloxacin per day is an effective and patient orientated therapeutic regime for the treatment of ENT infections, particularly of ear infections.

Concentrations of ofloxacin in ear and nasal tissues.

The results of two kinetic studies examining soft tissue, cartilage and bone after uptake of oral ofloxacin [administered as 200 mg twice daily (study I/nose) or 400 mg once daily (study II/ear)] show that antibiotic concentrations lie within the therapeutic range. Findings demonstrate that 400 mg ofloxacin daily is a compliance-enhancing and effective approach to the treatment of ENT-related infections, in particular those caused by problem organisms such as Pseudomonas aeruginosa.

[Endonasal paranasal sinus surgery with the binocular magnifier]. / Endonasale Nasennebenhöhlenchirurgie unter Lupenbrillenkontrolle.

The Keeler panoramic magnifiers can be worn in connection with a well-focussed head lamp system and permit stereoscopic surgery of the paranasal sinuses with 3 x 0 magnification. Operations under panoramic magnifier control are time-sparing and economical. Operations on the paranasal sinuses under binocular magnifiers are a useful alternative to microscopic surgery.

[A new cartilage crushing instrument for rhinoseptoplasty]. / Eine neue Knorpel-Quetsche für die Rhinoseptoplastik.

The method of so called "Cartilage Crushing" is used for bone or cartilage which is temporarily removed from the nasal septum during surgery in order to straighten it, remove tension and then to replant it. Basically the pieces to be treated are placed between two metal blocks which are pressed together on impact by a hammer. The newly developed instrument presented here is not joined together in the form of an axle. The new instrument has a larger circular formed area with a diameter of 4 cm. The anvil has a rounded surface enclosed by cylindrical walls, while the pressure pestle functions as a piston within the cylindrical walls. This system allows the bone cartilage on the surface to receive an even impact on the whole section through the piston-like action of the pressure pestle, thus making it possible for the crushed cartilage to be evenly extended in all directions.

[Amalgam tattoo--an important differential diagnosis from malignant melanoma of the mouth mucosa]. / Die Amalgamtätowierung--eine wichtige Differentialdiagnose zum malignen Melanom der Mundschleimhaut.

Amalgam tattoos develop as an amalgam deposit often as a result of continuous contact between an amalgam filling and the gingiva or amalgam fragments embedded in the oral tissue during dental filling or surgical operations. Sometimes fragments of amalgam restorations are broken off during extraction and embed in the adjacent soft tissue. In our case a small piece of amalgam had broken off during an extraction after retrograde filling up this tooth some years before following a resection of the dental root. Embedded in the depth of the bony resection cavity the piece of amalgam had produced the amalgam tattoo 13 years later.

[DNA cytometric studies of cholesteatoma of the middle ear]. / DNA-zytometrische Untersuchungen von Cholesteatomen des Mittelohrs.

Thirteen smears of middle ear cholesteatomas were investigated by the recently developed interactive DNA cytometry. The demonstration of DNA aneuploidy in 9 of the 13 cholesteatomas possibly indicates that these lesions are neoplasms.

[Hemostasis in the nose with bipolar suction and a coagulation probe under endoscopic control]. / Blutungsstillung in der Nase mit bipolarer Saug- und Koagulationssondeunter endoskopischer Kontrolle.

To stop nasal bleeding we use a manually operated combined bipolar suction and coagulation instrument under microscopic or endoscopic control, managed by one hand. As a result of the simultaneous suctioning of blood, the bleeding source can be coagulated even during the most effussive bleeding. Since the instrument is a combination of suction tube and bipolar coagulation sound, it can perform three functions at the same time: inspection of the source of bleeding, sucking off the blood, and coagulation. This does away with the need of nasal tamponade which most patients find highly disagreable.

[Practical pointers on the use of Plastipore middle ear implants (TORP, PORP)]. / Praktische Hinweise zur Anwendung von Mittelohr-Implantaten aus Plastipore (TORP, PORP).

"Plastipore" prostheses (TORP, PORP) in the middle ear have established themselves in recent years for the restoration of optimal transformation of air pressure in partial or total loss of the ossicular chain, provided that certain conditions are observed. A good protector between the tympanic membrane or the tympanic membrane graft, and a prosthetic screen is essential. For this we use a transplant composed of perichondrium and cartilage from the tragal cartilage cut in a certain manner, which also functions ideally as a tympanic membrane graft. The technique and the results are described.

[Osteomyelitis of the turbinates and its significance in chronic sinusitis]. / Die Osteomyelitis des Os conchale und ihre Bedeutung bei der chronischen Sinusitis.

We described the treatment of hyperplasia of the turbinate by sub-mucous resection of the inferior turbinate in 1981. The conchal bones removed were examined, and a histological study is now presented. In most cases we found a nonbacterial inflammation of the bone marrow of the inferior turbinate. The bearing of this and other changes in the bone marrow on the increase in size of the bone causing reduced ventilation of the nose and the paranasal sinuses, leading to sinusitis are discussed.

[Tympanoplasty with tragus cartilage transplant: "cartilage cover plasty"]. / Tympanoplastik mit Tragusknorpel-Transplantat: "Knorpeldeckel-Plastik".

Transplants composed in three layers of tragus cartilage and perichondrium are ideally suited for eardrum transplants. They are easily prepared, well-nourished, stable and withstand retraction tendencies due to negative middle ear pressure. One overlapping perichondrium layer forms, so to speak, the live rail for the eardrum epithelium. To this perichondrium layer the cartilage disk is safely attached. The cartilage disk attached to its outer perichondrium layer--also covered by the perichondrium towards the middle ear--is thus fastened like a circular tape in the eardrum frame similar to the foot plate of the stapes. The eardrum seal is safe; in 87 operations we observed only one case of the edge coming away which was due to the transplant being too small. This type of transplant has proved its worth especially when reconstructing the ossicle chain with column protheses (TORP, PORP). The excellent hearing results may be explained by the optimum transformation of air pressure from the large cartilage via the medium-sized prosthesis screen, which is attached to the surface, to the small foot plate of the stapes. The "tragus" transplant can also be used in case of a Type III interposition of incus.

[Operations of nasal concha in special consideration of the submucous turbinectomy (author's transl)]. / Eingriffe an den Nasenmuscheln unter besonderer Berücksichtigung der subperiostalen Conchektomie.

The importance of anatomy and physiology of the nasal turbinates is emphasized, specially the importance of an intact surface epithelium. The surgical principle of submucous resection of the turbinal bone is demonstrated and various modifications represented. An attempt of pre- and postoperative rhinomanometric evaluation is done.

[Iontophoresis - local anesthesia at the ear canal and tympanic membrane (author's transl)]. / Iontophorese - Lokalanästhesie an Gehörgang und Trommelfell.

Operations to the external ear canal and tympanic membrane necessitate sufficient local anesthesia. General sedation followed by infiltration anestesia, is rather time-consumming, can be painful due to the injection, and is not particularly satisfactory for the treatment of outpatients. The iontophorese-technique, however, of local anesthesia, is applicable particularly for the treatment of outpatients. Principally, the local anesthetic is transported in ionisised form to the nerve membrane, by means of calvanic currents through the healthy surface epithelial tissue of the external ear canal or the eardrum. The technique described for the first time in 1911 no longer shows toxic sides-effects since the introduction of improved electrodes and more modern local anesthetic. The anatomic, pharmacological, chemical and physical basics of the technique will be described. The lecture will be based on personal experience of the method, taken from large groups of patients over a period of more than two years, using equipment specially designed for this purpose.