In patients with various otoneurological diseases like hearing loss, neuronitis vestibularis, Ménière's disease and Bell's palsy, analyses concerning the immunoregulation and immunogenetics were done. For analysing the immunoregulation the T-helper (CD4) T-suppressor (CD8) ratio was determined. In contrast to patients with hearing loss caused by otobasal fractures and a healty control group, this ratio was elevated in 50% of the patients suffering from hearing loss. The elevation of the CD4/CD8 ratio was mainly caused by a reduction of CD8 positive cytotoxic-suppressor T-lymphocytes. The CD4/CD8 ratio may be of prognostic value, since an elevated ratio was found more often in patients with relapse of hearing loss, fluctuations, persistence of tinnitus or vestibular symptoms. An elevated ratio could also be detected in 48% of the patients with neuronitis vestibularis, in 50% of the patients with Ménière's disease and in 39% of the patients with Bell's palsy. A normal value was found in paralysis of the facial nerve of known origin like a state after trauma or after herpes zoster oticus paralysis. Immunogenetics was tested by HLA-DR typing. In patients with hearing loss HLA-DR4 antigen was distinctly increased, the relative risk was 2.8. The presence of the HLA-DR4 antigen proved to be an unfavourable sign, since in 44% of the patients presenting these antigens we found no improvement of the hearing. In patients with neuronitis vestibularis we found a relative risk of 3.12 and in patients with Ménière's disease a relative risk of 3.64, both for HLA-DR4.(ABSTRACT TRUNCATED AT 250 WORDS)

Total saliva and secretions from parotid and submandibular glands of patients with carcinomas in the oral cavity, oropharynx or larynx and a control group of healthy individuals were analyzed for concentrations of glycosidically bound sugars and free N-acetylneuraminic acid as well as for sialidase activity. When compared to the data obtained for normal donors, the relative amounts of the individual monosaccharides fucose, galactose, mannose, N-acetylgalactosamine, and N-acetylglucosamine as components of glycoconjugates showed variable differences to the group of tumor patients depending on the type of secretion and the location of the tumor. The percentage of glycosidically linked N-acetylneuraminic acid, however, was always higher for the healthy donors. A significant difference was found in the amount of free sialic acid, with the exception of submandibular gland secretion from a patient with an oropharyngeal carcinoma, and sialidase activity which were increased for tumor patients, independent of the type of secretion and the location of the tumor. From these results it is concluded that free sialic acid and sialidase activity may be considered as markers for carcinomas in the upper aerodigestive tract.

Bei den HNO-Jahreskongressen 1989 und 1990 wurde bereits über die Neuentwicklung einer muzinhaltigen Speichelersatzlösung gegen Xerostomie berichtet.

Zur Therapie der Rhinitis sicca wird als Ersatz des fehlenden Nasensekretes das Zuführen von Flüssigkeiten oder Ersatzlösungen von außen angewendet. Dabei sind bisher schon Lösungen der verschiedensten Zusammensetzung benützt worden. Deren gravierender Mangel ist, daß der Feuchtigkeitsgewinn zu kurzfristig ist. Ursache dafür ist die kurze Haftzeit von Flüssigkeiten auf Schleimhäuten. Dies trifft auch für Inhalationen zu. Bei den nasalen Schleimhäuten kommt erschwerend hinzu, daß der mucoziliare Transport für einen schnellen Abtransport der Flüssigkeit sorgt.

A method has been developed making it possible to look around intubation obstacles with the aid of rigid angular-lens systems. A glottis that is not or is only partly visible in direct laryngoscopy can be visualized endoscopically. The normal intubation technique is retained. A rigid endoscope is additionally introduced into the oropharynx, the glottis located endoscopically, and the endoscope secured to the laryngoscope in the position. The free hand can then be used to advance the tube through the glottis into the trachea under endoscopic control. This endoscopic method is intended to augment the physician's instrumental repertoire.

A method has been developed making it possible to look around intubation obstacles with the aid of rigid angular-lens systems. A glottis that is not or is only partly visible in direct laryngoscopy can be visualized endoscopically. The normal intubation technique is retained. A rigid endoscope is additionally introduced into the oropharynx, the glottis located endoscopically, and the endoscope secured to the laryngoscope in the position. The free hand can then be used to advance the tube through the glottis into the trachea under endoscopic control. This endoscopic method is intended to augment the physician's instrumental repertoire.

Auf dem letztjährigen HNO-Kongreß in Kiel 1989 wurde ein neuer Speichel- und Schleimersatz för die oberen Luft- und Speisewege vorgestellt. Dieser besteht aus zwei Lösungen; Lösung 1 enthält Calciumsalze, Lösung 2 Natriumalginat. Sie werden hintereinander auf die Schleimhaut appliziert.

In patients with various otoneurological diseases like hearing loss, neuronitis vestibularis, Ménière's disease and Bell's palsy, analyses concerning the immunoregulation and immunogenetics were done. For analysing the immunoregulation the T-helper (CD4) T-suppressor (CD8) ratio was determined. In contrast to patients with hearing loss caused by otobasal fractures and a healty control group, this ratio was elevated in 50% of the patients suffering from hearing loss. The elevation of the CD4/CD8 ratio was mainly caused by a reduction of CD8 positive cytotoxic-suppressor T-lymphocytes. The CD4/CD8 ratio may be of prognostic value, since an elevated ratio was found more often in patients with relapse of hearing loss, fluctuations, persistence of tinnitus or vestibular symptoms. An elevated ratio could also be detected in 48% of the patients with neuronitis vestibularis, in 50% of the patients with Ménière's disease and in 39% of the patients with Bell's palsy. A normal value was found in paralysis of the facial nerve of known origin like a state after trauma or after herpes zoster oticus paralysis. Immunogenetics was tested by HLA-DR typing. In patients with hearing loss HLA-DR4 antigen was distinctly increased, the relative risk was 2.8. The presence of the HLA-DR4 antigen proved to be an unfavourable sign, since in 44% of the patients presenting these antigens we found no improvement of the hearing. In patients with neuronitis vestibularis we found a relative risk of 3.12 and in patients with Ménière's disease a relative risk of 3.64, both for HLA-DR4.(ABSTRACT TRUNCATED AT 250 WORDS)

Numerous and various immunological tests have been made in the last few years for researching and diagnosing immunological diseases of the labyrinth. In spite of the different possibilities for immunological testing, Veldmann [8] is right in talking of the diagnostic dilemma of recognizing supposed immuno-otological diseases. This is also true to the same degree for the facial nerve.

Für das Nasenflügelansaugphänomen gibt es verschiedene Ursachen. Deshalb ist eine exakte rhinologische Diagnostik erforderlich.

Bei der Entwicklung eines wirksamen SpeichelSchleimersatzes müssen die physiologischen Besonderheiten des Schleimes berücksichtigt werden, der das Epithel des Aerodigestivtraktes bedeckt. Von großer biologischer Bedeutung ist die elektronegative Ladung der Neuraminsäure, die für die protektive Funktion der Muzine verantwortlich ist. Dadurch erhält das Epithel ein elektronegatives Ladungsschild, das es gegenüber der Umgebung schützt (Abb. 1). Als Neuraminsäureersatz wurde aus der Gruppe der Uronsäuren die Alginsäure ausgewählt.

Die Antwort auf die Frage, ob eine Antibiotikaprophylaxe oder -therapie in der Chirurgie sinnvoll ist oder nicht, richtet sich nach Art und Ort des Eingriffes und nach der vermuteten Infektionsrate. Letztere hängt jedoch wiederum von den individuellen Gegebenheiten einer Klinik und den Operateuren ab. Nach einer Standardklassifizierung werden chirurgische Wunden im Hinblick auf das zu erwartende postoperative Infektionsrisiko in 4 Kategorien eingeteilt, und zwar in sauber, sauber-kontaminiert, kontaminiert und schmutzig. Der Begriff „saubere“ Wunden gibt es lediglich in der gezielten, also elektiven Chirurgie, d. h. es liegt keine Entzündung vor und die Sterilität während des Eingriffes wurde nicht durchbrochen. Die bei derartigen Maßnahmen zu erwartende Infektionsrate liegt unter 5%.

Bei den Ohrmuschelmißbildungen I. und II. Grades sind die Strukturen eines normalen Ohres zum Teil noch erhalten.

Thymus lymphocytes-subpopulations (T-helper T4 and T-suppressorcells T8) were determined in inner ear diseases (e.g. sudden hearing loss, neuronitis vestibularis, Morbus Menière, Bell's Palsy) by specific monoclonal antibodies. T-cell subset ratio (T4/T8) was elevated (less than 3) in about 50% of all patients. DR-typifying was performed because of the well-known control of the immunoregulation through the class II HLA-DR antigens. There was a relative risk of 5.2 in peripheral vestibular lesion (neuronitis vestibularis). The relative risk of autoimmune diseases is found at this level.