A study was conducted to compare the new MED-EL TEMPO+ ear-level speech processor with the CIS PRO+ body-worn processor in the COMBI 40/COMBI 40+ implant system. Speech tests were performed in 46 experienced subjects in two test sessions approximately 4 weeks apart. Subjects were switched over from the CIS PRO+ to the TEMPO+ in the first session and used only the TEMPO+ in the time between the two sessions. Speech tests included monosyllabic word tests and sentence tests via the telephone. An adaptive noise method was used to adjust each subject’s scores to approximately 50%. Additionally, subjects had to complete a questionnaire based on their 4 weeks of experience with the TEMPO+. The speech test results showed a statistically significant improvement in the monosyllabic word scores with the TEMPO+. In addition, in the second session, subjects showed a significant improvement when using the telephone with the TEMPO+, indicating some learning in this task. In the questionnaire, the vast majority of subjects found that the TEMPO+ allows equal or better speech understanding and rated the sound quality of the TEMPO+ higher. All these objective and subjective results indicate the superiority of the TEMPO+ and are mainly attributed to a new coding strategy called CIS+ and its implementation in the TEMPO+. In other words, based on the results of this study, it appears that after switching over from the CIS PRO+ to the TEMPO+, subjects are able to maintain or even improve their own speech understanding capability.

The present multicentric clinical study involves 19 centres, 16 of them in German-speaking countries, 1 British, 1 Polish and 1 Hungarian. 60 postlingually deafened adults with a mean age of 47.5 years (20-70) and mean duration of deafness of 5.3 years (0.5-20) have been evaluated with the MED-EL COMBI 40 cochlear implant which implements a high-rate continuous-interleaved-sampling strategy with 8 channels. Safety and effectiveness data have been collected. Speech perception tests include a 16-consonant, an 8-vowel, a sentence and a monosyllabic-word test in all languages and a 2-digit figure test in all languages but English. Test intervals are 1, 3, 6 months and 1 year after first fitting. 41 of the 60 postlingually deafened adult study patients have completed their 6-month evaluation. While their pre-operative monosyllabic-word score was 0%, their mean monosyllabic-word score 6 months after first fitting was 48% (8-90) with a median of 50%. The mean sentence understanding was 84% (24-100) with a median of 90%. The respective values for the 1-year evaluations with 25 patients are a mean of 50% (5-85), with a median of 60% for the monosyllables and a mean of 89% (30-100), with a median of 97%, for the sentences.

The authors present a case of a young woman with a diabetic ketoacidosis and rhinoorbital mucormycosis, successfully treated by resection of necrotic areas without orbital exenteration. The favorable outcome was attributed to early diagnosis and immediate commencement of the adequate therapy, which included correction of diabetic ketoacidosis, debridement of devitalized tissue, daily irrigation of the involved areas with amphotericin B solution and application of intravenous amphotericin B.

The human septal cartilage is of ectodermal origin and contributes to midfacial growth and development. Acromegaly is an endocrine disease due to growth hormone (Gh) excess originating from a somatotrophic adenoma of the pituitary gland. Excessive Gh levels lead to high insulin-like growth factor I (IGF I) concentrations, which are known to stimulate cartilage growth in vivo and in vitro. One of the salient clinical pictures is coarsening of the midface and enlargement of the septal cartilage. Septal cartilage was obtained from 8 acromegalic patients during transnasal hypophysectomy and from 10 healthy adults during septoplasty to analyse the following aspects of cartilage biochemistry, metabolism and growth. 1. Intracellular glycogen, the major source of energy of chondrocytes, was determined enzymatically and found to be drastically reduced in acromegaly. 2. Several intracellular enzymes, related to biomatrix degradation, showed a strict local pattern of distribution. Cathepsin B activity, a neutral proteinase degrading both the helical and nonhelical region of the collagen molecule was significantly increased in acromegaly, whereas alkaline phosphatase activity, an enzyme related to mineralization of the cartilage at the chondroosseous junction was depressed in acromegaly. 3. The cell density in some areas of the septal cartilage was increased in acromegaly, whereas the clonal proliferation rate of its chondrocytes in response to serum and growth factors was decreased. Chondrocytes both of healthy adults and acromegalic patients could be effectively stimulated by insulin-like growth factor I and II and to a lesser extent by epidermal growth factor.

Two rhinomanometers (the NR 6 manufactured by Mercury, Scotland and the Rhino-Comp manufactured by Cintec, Sweden) were tested and compared in five subjects. Both instruments are suitable for clinical use and produced equal measurements of nasal airway resistance. The Rhino-Comp device is easier to handle. Technical improvements would be desirable in both machines.

The influence of indoor climate on goblet cells and intraepithelial glands of nasal mucosa was analysed. A cold and heat adapted group of twenty rats were compared with a neutral adapted group after eight weeks of climatic exposure. There was a decrease of density of the goblet cells and the intrapeithelial glands in cold adapted rats. It is suggested that the adaptive changes of the mucous membranes of the rats may be correlated with the increased ventilation rate in the cold.

Despite various methods of investigation, there are few reports as to the normal values of nasal airway resistance. A total of 56 adult subjects free of any nasal disease underwent nasal airway resistance measurement using active anterior rhinomanometry according to the guidelines of the international committee on standardization of rhinomanometry. Inspiratory and expiratory resistance was measured before and after application of a topical decongestant spray. This test was reproducible in that 46 of the subjects underwent a second study with resistance values quite close to that of the initial measurement. The upper range of the total inspiratory nasal airway resistance was 0.45 Pa s/cm3 before and 0.3 Pa s/cm3 after decongestant administration. There was no statistically significant difference between the inspiratory and expiratory resistance measurements. No correlation could be made between nasal airway resistance, age, sex, height or weight.

Septal cartilage was obtained during septoplasty from healthy adults or during transnasal hypophysectomy from acromegalic patients. Small strips of cartilage were excised from five different areas of the septum: the anterior free end, the suprapremaxillary area, the central area, the posterior area, and the caudal prolongation of the septum. Five different enzymatic pathways were analyzed in these areas. Cathepsin D, an acid proteinase, did not show a specific local activity pattern and was not influenced by the augmented growth hormone level in acromegaly, whereas cathepsin B, a neutral proteinase, showed its highest activity in the caudal prolongation and the posterior area and was significantly increased in all areas in acromegaly. Beta-hexosaminidase activity was highest in the central and posterior area and caudal prolongation of the septum. In acromegaly, a significant increase of its activity was found in the suprapremaxillary and posterior area. Acid phosphatase activity was highest in the caudal prolongation of the septum, but its activity was significantly increased in all tested areas in acromegaly. Alkaline phosphatase activity could only be found in the posterior area and the caudal prolongation in healthy adults. However, in acromegaly this enzyme could be detected in the central area and the posterior end of the suprapremaxillary area suggesting an altered process of mineralization. A distinct local pattern of enzymes related to intercellular substance metabolism and mineralization can be demonstrated in the septal cartilage of healthy adults and acromegalic patients.

Growth activity in different areas of human septal cartilage was measured by in vitro incorporation of 35 S-labelled sulfate and 3 H-labelled thymidine in 6 acromegalic patients. Septal cartilage was obtained during transnasal hypophysectomy. The growth activities in the posterior area, which is situated anterior to the septo-ethmoidal junction were significantly enhanced compared to a control group of hormonally normal adults. Growth activities of the septal cartilage in the anterior free end and the suprapremaxillary area were not different in both groups. This indicates that growth hormone excess in acromegaly enhances human septal growth by stimulation of growth activities in the posterior area and not at the anterior free end and suprapremaxillary area.

Der operative Verschluß von Septumperforationen (S.P.) ist auch heute noch nicht problemlos. Grundsätzlich sollten nur Patienten mit Beschwerden wie Bluten, Krusten, Pfeifen und Kopfschmerzen behandelt werden. Von 61 operierten S. P. waren mehr als ⅔ iatrogener Art. Der vollständige Verschluß der Perforation ist für die Beseitigung der Beschwerden nicht absolut erforderlich. Wichtiger erscheint die Protektion des Hinterrandes der S.P. Bei kleinen S.P. (bis zu 5 mm ∅) läßt sich eine Faszieninterposition kombiniert mit einem Verschiebelappen gut durchführen. Bei mittleren S.P. (bis zu 15 mm ∅) wird eine zweizeitige Deckung mit einem Vestibulum-Conchalappen empfohlen, der in 80% der operierten Fälle befriedigende Resultate brachte. Bei großen S. P. (> 15 mm ∅) ist die Versorgung mit einem Obturator vorzuziehen.

There are still some problems of the surgical treatment of septal perforations (s.p.). Only patients with s.p. having complaints i.e. bleeding, crusting, whistling and headache should be treated. More than 60% of 61 operated patients had an iatrogenic perforation. The complete closure of the s.p. is not abosulutely necessary. More important seems to be the protection of the posterior circumference of the s.p. In small perforations (up to 5 mm) an interposition of fascia combined with a rotating mucosa flap is a safe technique. In middle size s. p. (up to 15 mm) a two stage technique is recommended by using a vestibular-conchal flap which gives satisfactory results in 80% of the operated patients. In great s. p. (more than 15 mm) a septal button is preferred.

To find an explanation for tumor-recurrences around the tracheostoma, in 59 cases of squamous cell cancer of larynx, hypopharynx, oropharynx and tongue the ipsilateral hemithyreoidectomy was included into the tumorexstirpation and radical neck dissection. This histological work up of the thyroid showed no evidence of metastases within the gland. However in cases of extended metastasis or difficult surgical approach to the prae- and paratracheal areas the hemithyreoidectomy is advised.

The revascularization of ossicle trans- and implants in the middle ear of rabbits has been studied over a period of 5 months. For transplants the autogenetic incus, for implants the allogenetic or xenogenetic incus or malleus preserved in 1:5000 CialitTM, deep frozen (at -20° C and -196° C) or lyophilized and ?-sterilized, respectively, have been used. The following observations have been made:1.In case of autogenetic transplantation, should necrosis have taken place, the development of new Havers' vessels within the Havers' canals could be seen.2.The same could be observed after allogenetic implantation when the ossicula had been preserved by CialitTM or deep freezing. In addition one found resorptive granulation tissue rich in vessels within enlarging Havers' canals.3.Havers' vessels did rather seldom develop in allogenetic implants preserved by lyophilization and ?-rays.4.Havers' vessels could no longer be found in the later period in xenogenetic implants preserved by lyophilization and ?-rays. Instead granulative tissue and single thick walled capillaries with obliterated lumina had developed.

A histological study is presented on 18 cartilage grafts, conserved in Merthiolat TM, which had been implanted for reconstruction of the caudal border of the nose for time periods of 1 month up to 11 years. These cartilage graft preparations were compared to non graft cartilage from patients died in an age of 37, 51 and 53 years respectively. Our findings show that cartilage grafts are eroded from the edge by resorption granulations of the host. Besides resorption one case showed purulent chondritis and another one osteoneogenesis. The extent of the erosion and the resorption rate seem to depend strongly on the original quality of the cartilage graft. This is possibly due to degenerative focuses which could be found in all of the natural cartilage preparations. After our opinion these focuses regarded like "loci minoris resistentiae". Therefore cartilage material to be used for rhinoplasty ought to be checked for such degenerative focuses.