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Würzburg, Germany

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. Source

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. Source

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. Source

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. Source

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. Source

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