[The audioanalysator. A bridge between audiometry and psychoacoustics]. / Audioanalysator: Eine Brücke zwischen Audiometrie und Psychoakustik.

An analyser with a system of continous sweeping frequencies and a spectrum of strongly different control signals is described here. Including the active participation of the patient and his impaired hearing a much more accurate finding of symptoms is possible than with the standard methods of audiometry. The major factors mentioned include the continuous fine testing of the sounds heard in an unlimitated choice of frequencies ranging between 20 Hz. and 20 000 Hz. with an automated search unit as well as a test for the highest tones. After brief instruction the tests are determined by the patient himself according to choice monaurally and/or binaurally depending on comparisons and corrections right/left. This leads to highly differentiated statements on the sounds heard and to comparable qualities of tone which until today have been unknown in this wide extent of variety to audiometry and audiology and which presents totally new aspects. One of the main purposes of the audioanalyser is to detect the role played by the transients in discrimination. Obviously also the highest tones influence the character of the transients. They are apt to be easily lost e.g. by infections any kind. A vigilant patient will become aware of this loss.

[Operative tasks with regard to the cranial base in otorhinolaryngology. III]. / Die operativen Aufgaben in der Basis Kranii für die HNO-Heilkunde. Teil III.

The decisive influence of the os sphenoidale in its different parts on the malformations and diseases of the oto- and rhinobasis. Congenital epidermoid (so called cholesteatoma) and entodermal cyst of the os petrosum. Malformations of the middle ear. Hyper- and hypoteleroismus, their surgery. The osteodystrophies. Are slow changes during lifetime of the petrous bone the cause of otospongiosis (A. Sercer, J. Krmpotic)? Surgical prevention of the effect of this tension of the cortex of the petrous pyramid on the capsule of cochlea? Anomalies and aneurysma of the carotid arterie inside of the temporal bone. The diseases of the surface of the temporal and sphenoidal bone in the basicranium and infratemporal. The effect on the Eustachian tube.

[Surgery on the cranial base. Guidelines for otorhinolaryngology. I]. / Die operativen Aufgaben in der Basis Kranii. Für die HNO-Heilkunde Teil I.

This presentation carries two goals: 1. Not to consider one particular aspect of a specified disease as a topic but rather an area of topography to which in general only a serving function is ascribed. For the vast multitude of pathogenetic processes taking place in this region our total understanding is required. 2. To find out the contradiction that exists between the array of diseases and their clinical consequences during the first postwar period which still experienced the then "biologically natural circumstances" of that time up until today, i.e. the changes over the past 35 years. H. Marx, director of the ENT University department in Würzburg until 1947, published in that year a "Short Manual of Otology". We have added on to this clinical opinions and experiences. At the same time G. Shambaugh jr. developed the long sought after fenestration of the semicircular canal to an advanced stage for improvement of hearing in case of otosclerosis. Around this time it was allowed to administer penicillin not only to the military but also to the civilians. The technique to use a milling cutter (not a drill) according to J. Lempert extended widely into the entire region of otology and into the whole neuro- and viscerocranium. Out of a few improvised microscopes an entire industry evolved. In H. Marx' 850 page textbook the complications of the acute and chronic otitis media alone make up for more than 20% of the text.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesteatoma. Etiology, nosology and tympanoplasty.

After more than 25 years of tympanoplasty for cholesteatomata, it is time to reconsider the origin of this pathological finding. The pathogenesis has not changed, it is the aspects of the disease which have shifted. There are two reasons for this: (a) much improved conditions of living, housing, nutrition and epidemiology, especially during childhood, and (b) discontinuation of the indication for radical surgery, only in the case of threatening complications is tympanoplasty used as a prophylactic operation. In the meantime a new and numerously large group of cholesteatomata has come up which was previously unknown, namely the so-called 'iatrogenic cholesteatomata'. Under these aspects the nomenclature of the cholesteatomata has to be newly defined, according to its etiology and form of disease.

A method for refixation of the multifractured respiratory cranium.

So-called Tantalum-Visors are used to refixate the multifractured facial skeleton, torn off the base of the skull by trauma, in a three dimensional way to avoid dishface and pseudotelorismus. These visors are kept in storage: a small model--glabella visor, and a large one--zygomatic visor. Of both types, a bigger one is for the head of a male, a smaller for a female and still smaller for youth, because it is impossible to make an individual mold immediately following an accident.

Tympanoplasty: the fundamentals of the concept.

The development of tympanoplasty based on a fundamental understanding of the mechanisms of the middle ear in health and disease is described as it evolved. As a consequence of problems arising from the creation of an open cavity further developments led to the concept of a 'closed' operation which in turn has its own disadvantages. These are principally concerned with aeration of the tubotympanic cleft. The most recent phase of tympanoplasty is concerned with limiting the extent of the procedure to what is required to expose the disease process and re-establish function.

[Paralayrinthine cholesteatoma and tympanoplasty (author's transl)]. / Das paralabyrinthäre Cholesteatom und die Tympanoplastik.

Closed tympanoplasty techniques greatly increase the risk of recurrent cholesteatoma. This is obvious as many surgeons using these methods insist on a necessary obligatory control operation as a "second look". In this paper cholesteatomata are classified according to their tendency to extend within the petrous pyramid and the subsequent danger of invading semicircular canals, cochlea or cranial fossae. The predisposition to this type of growth is present in the well defined "medial" type of epitympanic cholesteatoma, and more in the anteriorly than the posteriorly placed ones. As infection becomes less prominent in countries with advanced medical services, especially otology, the cholesteatoma hidden behind a small dry epitympanic perforation and those even with no perforation termed "hidden primary cholesteatoma" become more frequent. They cause their own special symptomatology, not infrequently a slowly progressive facial palsy. Every cholesteatoma requires mandatory prophylactic surgery. This means the complete exposure of the danger area, the epitympanum, and nowadays the possibility of the syncronous complete reconstruction of a normal middle ear and external canal, i.e. osteoplastic epitympanotomy.

[Tympanoplasty of today (author's transl)]. / Tympanoplastik heute

The author explains why he developed the access to the meso-hypotympanum via the angle between the facial nerve and the chorda tympani in 1953 which he then demonstrated at many occasions. The value of this access--later used by other ear surgeons and named mastoidectomy with intact canal wall technique or posterior tympanotomy--for chronic otitis media was always denied by the author. These methods do not give sufficient way to the main focus of pathology in the epitympanum mainly to the pretympanic recess in front of the head of the malleus; The danger of deep penetrating cholesteatoma in the petrous bone is too great. Only complete opening combined with complete reconstruction serves really eradicating the pathology completely as well as full reconstruction of the middle ear and the external canal; this means osteoplastic epitympanotomy. With the help of this operation it is possible to continue in the same stage with complete mastoidectomy and complete sinus operation.