Universitats Klinik

Würzburg, Germany

Universitats Klinik

Würzburg, Germany
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Skevas T.,University of Trier | Klingmann C.,University of Gottingen | Plinkert P.K.,Universitats Klinik | Baumann I.,Universitats Klinik
HNO | Year: 2012

Background: Until now, no validated instrument to measure disease-specific, health-related quality of life (HR-QOL) in adults with chronic tonsillitis (CTO) exists. Material and methods: After an item reduction of the alpha-version of the Tonsillectomy Outcome Inventory (TOI), the TOI-14 resulted. In addition to the total score, it includes the subscales throat problems, overall health, resources, and social-psychological restrictions. In phase 2, the TOI-14 was prospectively validated on 108 adults with CTO, who had undergone a tonsillectomy. Results: The TOI-14 had, on average, good reliability. It included all important aspects of the HR-QOL. Patients with CTO can be distinguished with high sensitivity from healthy subjects. All scores showed moderate to good correlation with the subjective limitation in quality of life. The sensitivity of the questionnaire demonstrated major effects postoperatively. Conclusion: The TOI-14 constitutes the first worldwide-validated, disease-specific instrument to measure HR-QOL in adults with CTO. Due to its ease of use, it can be utilized both in the outcome research and in clinical routine. © 2012 Springer-Verlag.

Baumann I.,Universitats Klinik
Laryngo- Rhino- Otologie | Year: 2010

Septoplasty is one of the most frequently performed otorhinolaryngological procedures which might be very challenging for the surgeon. An accurate preoperative diagnosis of pathologies of the septum in the context of the nasal cavity is essential for the success of surgery. Intraoperative visualization through microscope or endoscope is very helpful for the surgeon and for the training of the residents. The modern technique of septoplasty with the phases of approach, mobilization, resection/repositioning and reconstruction/fixation is presented. Furthermore, the extracorporeal septoplasty in extreme deviations of the septum and alternative techniques for use in cases with limited pathologies as well as aspects of septoplasty in children are discussed. As particularly pathologies of the caudal septum are responsible for failures of septal surgery, some special problems of this region such as the vertical fracture of the caudal septum, the lack of caudal septum or anterior convexities of the cartilaginous septum are argued. Finally, advices for the management of intra-and postoperative complications are given.

Muhler R.,Otto Von Guericke University of Magdeburg | Hoth S.,Universitats Klinik
HNO | Year: 2014

Objective methods based on the measurement of otoacoustic emissions (OAE) and auditory evoked potentials (AEP) are indispensable in pediatric audiology especially for the early detection and therapy of congenital hearing impairment. The correct and efficient use requires knowledge and skills which are beyond the basic equipment of many users and require continuous updating. In the present review many aspects relevant for the safe handling of the methods and interpretation of the results are addressed. The presentation does not focus on the methods themselves but on the core problem of the practical daily routine, namely the qualitative and quantitative description of hearing loss in terms of its extent, the frequency range affected and the identity with respect to the type and site of the lesion. The certainty of the diagnosis can be optimized by observing few and simple rules. Central importance is attached to the thorough discussion of the interrelated parameters residual noise, signal-to-noise ratio and reproducibility in order to promote their correct use. Further subjects of this article are the recognition of pitfalls, the description of new developments, such as chirp and auditory steady-state responses (ASSR) and finally the consideration of the extraordinarily important aspect of maturation. © 2014, Springer-Verlag Berlin Heidelberg.

Stuck B.A.,Universitats Klinik
Somnologie | Year: 2011

Comparatively little is known about chemosensory processing during sleep. Earlier studies with significant methodological limitations investigated whether olfactory stimulation is processed during sleep at all. The scantness of available data is explained by physiological aspects and methodological difficulties (e.g. rapid adaptation, co-stimulation, etc.). Chemosensory processing during sleep can be assessed by means of event-related potentials, induced arousals or awakenings or by assessing effects on psychological functions. Chemosensory event-related potentials could be demonstrated in 2006. Recent studies with improved methodology have shown that isolated olfactory stimulation does not lead to arousals or awakenings. Finally, the impact of nocturnal olfactory stimulation on learning and emotional dream content could be described. © Springer-Verlag 2010.

Stuck B.A.,Universitats Klinik | Heller T.,Universitats Klinik
HNO | Year: 2011

The material used for osteosynthesis plays a crucial role in the management of facial fractures. Plates need to be flexible enough to be bent and should not be palpable through the skin, while ensuring stable fixation und adequate biocompatibility. Although stainless steel was initially the material of choice, titanium has become the standard material due to its superior biocompatibility. While the explantation of titanium plates and screws appears unnecessary in general, it should be considered in cases of dislocation, cosmetic concerns, pain and infection. Due to their limited initial stability and a potential increase in local complications, resorbable materials based on polymeric lactose are used with caution in midfacial fractures in adults. Our own retrospective study comparing the postoperative complications after fixation of lateral midfacial fractures with titanium and resorbable systems demonstrated a low complication rate for both systems (7-8%) and no statistically significant difference between the two. The appropriate material for fixation should be selected based on the localization and severity of the fracture, the experience of the surgeon as well as on the age and overall condition of the patient. © 2011 Springer-Verlag.

Traditional Transcutaneous Approaches In Head & Neck Surgery The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing. In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool. In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise. © Georg Thieme Verlag KG Stuttgart · New York.

Background: Patients suffering from obstructive sleep apnea syndrome (OSAS) and obesity have an elevated risk of postoperative complications independent of each other. Within the framework of expert opinions for courts the question arose whether postoperative prolonged intubation or tracheotomy are standard routine approaches which are to be carried out in the normal course of operations on patients with OSAS. Material and methods: A search of the literature was performed using PubMed, Web of Science, Scopus, EMBASE, the Cochrane database of systematic reviews and the Cochrane central register of controlled trials. Furthermore, 78 German otorhinolaryngology (ENT) departments participated in a nationwide survey. Results: The results of the survey showed that after normal complication-free surgery planned postoperative prolonged intubation is not performed in the majority of ENT departments and no department performs a tracheotomy. In contrast, the standard approach for patients with OSAS and obesity who undergo two-level surgery is intubation and subsequent monitoring without ventilation for the first postoperative day. In the literature no evidence of a scientific basis for carrying out prolonged intubation or a tracheotomy could be found. Conclusion: Neither tracheotomy nor prolonged intubation are standard procedures for OSAS patients with obesity after complication-free surgery. © 2014, Springer-Verlag Berlin Heidelberg.

Keck T.,University of Graz | Lindemann J.,Universitats Klinik | Lindemann J.,Oberarzt der Universitats Klinik Ulm
Laryngo- Rhino- Otologie | Year: 2010

Simulation and Air-conditioning in the Nose Heating and humidification of the respiratory air are the main functions of the nasal airways in addition to cleansing and olfaction. Optimal nasal air conditioning is mandatory for an ideal pulmonary gas exchange in order to avoid dessication and adhesion of the alveolar capillary bed. The complex three-dimensional anatomical structure of the nose makes it impossible to perform detailed in vivo studies on intranasal heating and humidification within the entire nasal airways applying various technical set-ups. The main problem of in vivo temperature and humidity measurements is a poor spatial and time resolution. Therefore, in vivo measurements are feasible to a restricted extent, only providing single temperature values as the complete nose is not entirely accessible. Therefore, data on the overall performance of the nose are only based on one single measurement within each nasal segment. In vivo measurements within the entire nose are not feasible. These serious technical issues concerning in vivo measurements led to a large number of numerical simulation projects in the last few years providing novel information about the complex functions of the nasal airways. In general, numerical simulations only calculate predictions in a computational model, e.g. realistic nose model, depending on the setting of the boundary conditions. Therefore, numerical simulations achieve only approximations of a possible real situation. The aim of this report is the synopsis of the technical expertise on the field of in vivo nasal air conditioning, the novel information of numerical simulations and the current state of knowledge on the influence of nasal and sinus surgery on nasal air conditioning. © Georg Thieme Verlag KG Stuttgart New York.

The surgical treatment of snoring and obstructive sleep apnea is still under debate. This can explained at least in part by the lack of sufficient scientific data for the majority of the current procedures, especially with regard to controlled clinical trials. Controlled trials are of particular importance especially in the field of sleep medicine. The following review will discuss the possibilities of controlled clinical trials in the field of sleep disordered breathing and its surgical treatment and most recent controlled trials will be discussed to demonstrate the progress that has been made in the scientific evaluation of surgical treatments in this field. This will demonstrate that the scientific basis of surgical treatment options is continuously improving, which will enable the sleep physician to better assess their value in the future. With regard to the comparison of surgical and non-surgical treatment the fundamental differences in compliance needs to be addressed. Recent approaches to address these aspects will be described. As surgical treatment is currently considered to be a second-line alternative to conservative approaches, the direct comparison between surgical and non-surgical interventions becomes less important. Finally, the principles in indicating and selecting surgical options will be discussed for snoring and obstructive sleep apnea. The most relevant surgical interventions will be presented with regard to current guidelines in this field. This review shall enable the reader to critically evaluate the limits and potentials for surgical treatment of snoring and obstructive sleep apnea. © 2011 Dustri-Verlag Dr. Karl Feistle.

Reiter R.,Universitats Klinik | Pickhard A.,TU Munich | Brosch S.,Universitats Klinik
Laryngo- Rhino- Otologie | Year: 2012

A child has the first 4 years of life in which to develop speech. The first 8-10 months see the ability to distinguish sounds; later comes further linguistic ability. A hearing impairment more than 25 dB in the better ear in the speech frequencies (500-4 000 Hz) for more than 3 months has clear consequences, especially in the first 4 years of life. Therefore early diagnosis and treatment with rehabilitation of hearing loss is important for proper speech development. Copyright © 2012 by Thieme Medical Publishers, Inc.

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