OBJECTIVE:Peritonsillar abscess (PTA) is a common problem in otorhinolaryngology. The pathogenesis, supporting factors and optimal therapy are matter of numerous investigations. We studied retrospectively smoking habits, preoperative coagulation screening and the applied therapy of PTA.MATERIAL AND METHODS:Data from 460 patients who underwent treatment for PTA between 2000 and 2009 at Dessau Medical Center were retrospectively analysed.RESULTS:The highest incidence of PTA was found in young men, the prevalence of nicotine consumption was clearly increased in relation to the general population. The therapy of first choice was abscess tonsillectomy. Even with preoperative pathological coagulation-parameters no increased risk of secondary bleeding was shown.CONCLUSIONS:The part of smokers of patients with PTA is increased in comparison to the correspondent population of same age. A routine preoperative coagulation screening has a low benefit relating to the prediction of the risk of secondary bleeding. Abscess tonsillectomy is a safe method and has proved itself in clinical daily routine.

Peritonsillarabszesse (PTA) sind eine häufige, aber schwere Komplikation der aktuen exsudativen Tonsillitis. Es wurde untersucht, ob Antibiotika nach chirurgischer Sanierung des PTA erforderlich sind.

Histiocytosis X (Langerhans cells) is a rare disease with different forms of manifestation in the head and neck, which mostly occurs in children. We report the case of a 52-year-old male patient from Saudi Arabia who presented in the out-patient department of the University Hospital Charite Berlin with therapy-resistant otitis externa. ENT examination additionally showed nasal polyps. A paranasal computed tomography scan revealed as an incidental finding a mass forming tumor in both mastoids with osseous destruction of the posterior cranial fossa. Histological evaluation of the suspected tissue revealed histiocytosis X in both mastoids. After exclusion of a systemic disease local low-dose radiotherapy with 9 Gy (3x3 Gy) of the mastoid cavities was administered.

INTRODUCTION:Foreign bodies in the oesophagus represent a frequent emergency situation in ENT medicine. Usually the cases involve lumps of meat, bones, shards of glass, bottle tops, batteries or dentures. We would like to report about an unusual foreign body found in the oesophagus.PATIENT:A 45-year-old patient presented himself in our interdisciplinary casualty department where he claimed to have swallowed a butter-knife that morning as a bet. The ENT examination showed no abnormal findings. The thorax X-Ray revealed a 14 cm-long foreign body in projection to the oesophagus, which matched the knife. Following consultation with the thorax surgeon, a rigid oesophagoscopy was conducted under endotracheal intubation and the knife was easily removed using tongs. Archive searches conducted in the meantime showed that foreign bodies had been removed from the patient on numerous occasions by fellow surgeons either laparoscopically or via open surgery. As a result, the patient was transferred to the psychiatric ward with unimpeded swallowing reflex with a suspected self-harming syndrome.DISCUSSION:As an ENT emergency, a foreign body in the oesophagus generally requires intervention because of the risk of complications such as perforation or pressure-induced necrosis of the oesophagus wall with resulting mediastinitis. Suitable instruments are the flexible oesophagoscope, the rigid oesophagoscope under anaesthesia or transcervical/transthoracic removal. The choice of procedure crucially depends on the type and localisation of the foreign body in the oesophagus. Particularly in cases of unusual foreign objects or repeated foreign object ingestion, it should be considered whether a psychological illness could be the cause and whether the introduction of appropriate therapy could be expedient.

Peritonsillar abscess (PTA) is a common and serious complication of acute exudative tonsillitis. We wanted to answer the following question: Are postoperative antibiotics mandatory after abscess tonsillectomy? In an epidemiological observational study, 283 patients (98 females and 185 males, age range 2-72 years) were treated with abscess tonsillectomy for PTA. For a prospective randomized multicenter study, 105 patients were divided into two groups; one group was treated postoperatively with benzylpenicillin, and antibiotics were omitted in the control group. We evaluated postoperative pain scores, swallowing disorders, and well-being. Additionally, laboratory parameters such as C-reactive protein, leukocytes, and antistreptolysin titer were measured, and blood cultures were collected. Male patients in the 2nd-4th decades of life were predominantly affected, mostly in the summer. For the patients in the two groups, we assessed no significant differences in either the subjective or the laboratory parameters. The blood cultures showed no evidence of bacteremia. We conclude that immediately performed abscess tonsillectomy is an effective and safe treatment for PTA. No higher complication rate was found when additional antibiotic treatment was not used. Because of the small number of cases, the results can be regarded only as a tendency, not as a general recommendation.

Nasal hyperreactivity is one of the most important underlying mechanisms in both allergic (AR) and idiopathic rhinitis (IR). In order to study the pathomorphological changes in this entity, tissue samples from patients with AR, IR, and from patients without chronic inflammation were taken during nasal surgery. Primary antibodies against Substance P (SP), calcitonin gene-related peptide (CGRP), and endothelial nitric oxide synthases (NOS III) were applied and the immunocomplexes were visualized by immunocytochemistry. The nasal mucosa of patients with AR and IR showed similarities on the ultrastructural level. Neurogenic inflammation was indicated by a strong innervation pattern with sensory nerve fibers containing SP and CGRP. We could show that extensive edema and cellular infiltration might be characteristic for AR. On other hand there was no evidence of eosinophilic or NO involvement in IR. Finally, on the ultrastructural level, AR and IR showed many similarities. Based on these findings anti-inflammatory therapy modalities could be recommended for both types of rhinitis.

BACKGROUND Investigations into the MRI compatibility of middle ear implants made from titanium alloys with 1.5 and 3.0 tesla MRI systems which are frequently used for imaging diagnostics. METHOD 17 different middle ear (ME) implants (ossicular replacement prosthesis (ORP) and ventilation tubes) made from titanium were tested in vitro. Potential warming was determined via an MRI-compatible fibre optic temperature sensor under the influence of sequences with high-level high frequency impulses. An assessment of the attractive force of the implants was carried out placed on a Petri dish under vibration and floating on rubber-sponge (RS) in a water bath. RESULTS No significant warming of the implants was observed with any of the used sequences at either 3 or 1.5 Tesla field strength (TF). With 3 TF, all 17 implants changed their position on the surface of the water and moved at a slow speed (0.0004-0.0014 m/s) towards the magnetic field. With 1.5 TF, the tested ME implants moved at a maximum speed of 0.0002 m/s and in the case of the ventilation tubes at 0.0005 m/s. CONCLUSION No warming occurred in any of the tested middle ear implants at either 1.5 or 3 TF. The attractive forces exerted through the static magnetic field were overall low at 1.5 and 3 TF, indicating that no dislocation is to be expected if intraoperative anchoring is correctly conducted. Nevertheless, the indication for examination at 3 TF should be carefully considered due to the anatomically sensitive region.

Die Pathophysiologie der allergischen (AR) und idiopathischen Rhinitis (IR) ist bis heute nicht vollständig geklärt. Die AR und die IR sind gekennzeichnet durch eine zugrunde liegende nasale Hyperreaktivität. Ziel der Untersuchung war die Suche nach pathomorphologischen Veränderungen der Nasenschleimhaut bei diesen verschiedenen Rhinitisformen.

The advent of bone-anchored hearing aids with titanium implants has markedly improved patient management. There are two systems on the market for performing the requisite osseointegration. The aim of our study was to evaluate the Ti-Epiplating system, since no data have been published on this in the literature thus far. Between November 2002 and March 2005, we anchored the BAHA snap coupling via the Ti-Epiplating system in 8 patients in a single session. The patients were followed-up at regular intervals to assess clinical and audiometric results and subjective satisfaction. The postoperative hearing threshold with the BAHA was in the former bone conduction range. In the Freiburg speech test, a significant improvement was found for monosyllables (free-field), and the hearing loss for numbers showed a mean reduction from 75 to 30 dB. There has been no implant loss in our collective thus far. Good to very good results were evaluated for the quality of life in the "International Inventory of evaluation of hearing aids" (IIEH). Clinics that use Medicon's osteosynthesis system can safely and reliably achieve inexpensive and audiometrically successful BAHA management by a comparatively simple surgical procedure.

INTRODUCTION:For the surgical therapy of lagophthalmos rigid gold implants were used. There are a lot of studies using rigid gold implants with widely different complications. In the primary study the small amount of patients is often a problem. The aim of our study was to survey the postoperative results and complications after insertion of rigid gold implants and to statistically compare the results with a meta-analysis.MATERIAL AND METHODS:38 publications on 1000 rigid gold implants were analyzed in the context of a meta-analysis of the postoperative results.RESULTS:Complete lid closure can be obtained in 84.5 % with the rigid gold implants. The postoperative complication rates were 13.4 % for bulging, 6.4 % for migration, 6.8 % for extrusion, 11.5 % for corneal astigmatism and 7.0 % postoperative infections.DISCUSSION:Lidloading is a very simple and reversible procedure for the surgical treatment of lagophthalmos. The statistical analysis in using rigid gold implants showed a significant rate of postoperative complications. To increase the effectivity of the treatment method these results should be taken into account for alternative implants.

Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage.We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life.

Background: Parotid gland malignancies are primarily treated by surgery.Particularly extensive tumor recurrences mostly require very large-scale and cosmetically unfavorable interventions.Unclear anatomic conditions often restrict the intraoperative orientation.This case report demonstrates the markedly improved quality of life achieved despite the complexity of the intervention.Patient: A 62-year-old male patient presented to our emergency room with acute bleeding from a parotid tumor.The clinical examination revealed a 5 cm massively bleeding necrotic tumor crater colonized with fly maggots in the right preauricular region.The patient also had a complete peripheral facial palsy of House-Brackmann Grade VI.Primary irradiation had been performed for a parotid mucoepidermoid carcinoma one and a half years ago.Clinical Course: First, the bleeding was stopped by embolizing the anterior auricular branch of the superficial temporal artery.Restaging yielded a tumor status of kT4 kN2b M0.The subsequent tumor resection included a hemimandibulectomy, a resection of the auricle with the auditory canal and middle ear, a mastoidectomy with microsurgical facial nerve reconstruction, and a modified radical neck dissection on the right side.We used a pectoralis major myocutaneous flap to close the defect after achieving tumor-free resection margins.The lagophthalmos was treated by pretarsal implantation of a platinum chain.Wound healing was uneventful.The histological examination showed the R0 resection of the previously diagnosed mucoepidermoid carcinoma.The patient was discharged in good general condition and is undergoing shortinterval follow-ups in our tumor dispensary.After the tumor resection and primary healing, the patient received an adhesive ear epithesis to improve the aesthetic results. Conclusion:Even patients with tumor recurrence after primary radiation therapy can profit by extensive surgical treatment.The quality of life can thus be markedly improved even in a palliative situation.The option of complex interventions for extensive tumor recurrences should be integrated in an effective overall concept and discussed with the patients.

Background: The causes of keratoconjunctivitis sicca are multifarious. Major causes include eyelid anomalies, Sjogren's disease, injuries, radiation or mucin deficiency. In our case, nasal positive airway pressure due to muscular dystrophy is described as another possible cause.Patient: A 32-year-old male patient with advanced Duchenne muscular dystrophy requires nasal continuous positive airway pressure ventilation due to loss of the auxiliary respiratory muscles. The patient presented because permanent air flow from the lower right lacrimal point resulted in epiphora and keratoconjunctivitis sicca on the right side.Therapy: We reversibly occluded the lower lacrimal duct with a punctum plug flow regulator. The lacrimal flow regulator is available in two sizes, 0.8 and 0.9 mm, and is designed to be inserted into the punctal aperture. The soft silicone plug is delivered with a disposable dilator and can be used on an outpatient basis. It is actually used for punctal occlusion in patients with chronic dry eye syndrome and regulates the flow of lacrimal fluid. After insertion of a 0.9 mm punctal plug, the patient reported marked improvement of the findings, which was confirmed in a follow-up after 4 and 8 weeks. On a visual analog scale of 1 to 10, the subjective status was given a rating of 8.Conclusion: By occluding the right lower lacrimal point with a punctal plug, we were able to markedly reduce the unpleasant retrograde air flow and the subjective complaints of the patient with nasal continuous positive airway pressure ventilation.

By occluding the right lower lacrimal point with a punctal plug, we were able to markedly reduce the unpleasant retrograde air flow and the subjective complaints of the patient with nasal continuous positive airway pressure ventilation.

BACKGROUND The presurgical diagnostic for measurement of skull thickness for implantations of epithesis or bone anchored hearing aids is limited on computed tomography (CT) of petrosal bone up to now. Testing of ultrasound for measurement of skull thickness is the aim of our study . MATERIAL AND METHODS 20 patients has been included, which had got a computed tomography of nasal sinus, skull or petrosal bone. The potential localisations of implantations have been measured by 3D-reconstruction of computed tomography. The results have been statistical compared by sonographic investigations (7.5 MHz Soundhead) at the same localisation. RESULTS The mean skull thickness has been 5,2 mm in computed tomography. Comparison has described a mean skull thickness of 4,2 mm in sonography. Statistical comparison has shown that ultrasound has been measured statistical significant too small. CONCLUSIONS The skull thickness can be described and measured by sonography. However mean skull thickness has been measured statistical significant too small. In spite of this, conclusions relating to presurgical diagnostic, for instance for the implantation of epithesis and bone anchored hearing aids, can be drawn by sonographic data.

Background: Septoplasty is often combined with surgery of the inferior turbinate. To avoid complications like serious bleeding and hematoma nasal splints and several kinds of nasal packing is used. The splints have to be fixed, which can leed to infections around the suture and at the edge of the splints. The removal of the packings and the splints mostly done at different days, is a very unpleasent procedure.

The therapeutic options of a lipoma of the cerebellopontine angel depend on the clinical symptoms and a radiologic confirmed progression of size. Because of the received data until today an operative therapy is only indicated when symptoms clinically can not be treated or the leason seems to be a well differentiated liposarcoma.

The rare multiple lentigines ( LEOPARD) syndrome rep resents a complex of skin, cardiac, skel e tal, inner ear and other mal formations. There is marked variability in expression of the syndrome. We re port on a 20 year old man, showing typical lentiginosis, a retardation of growth, tachycardiac conduction abnormality, ophthalmologic manifestations and a sensorineural hearing loss. Pathogenesis, clinical and differential diagnostic aspects are discussed in this case re port. The early diagnosis of a senosorineural hearing loss is useful in order to pro vide appropriate rehabilitation. When lentiginosis is diagnosed, it is important to consider further abnormalities such as cardiomyopathy, which can be associated with a high mortality.

BACKGROUND:Treatment of paralytic lagophthalmos involves surgical repair, requiring exact knowledge of eyelid anatomy. While there are extensive studies on anatomical eyelid measurements in healthy eyes, no data exist on the changes in the functional anatomy of the upper eyelid in paralytic lagophthalmos. The aim of this study, was to examine by ultrasound the upper lid tarsus during changes in the patient's line of vision, and to answer the question of whether there are changes in the curvature radius of the tarsus, caused by facial paralysis with resultant lagophthalmos.MATERIAL AND METHODS:Two groups were formed. The first group consisted of 50 subjects with healthy eyes, and the second contained 47 patients with paralytic lagophthalmos. The upper lid tarsal radius, when looking straight ahead and in the abducted position, was determined by ultrasound with a 7.5 MHz scanner in the non-contact mode, and then compared statistically.RESULTS:Both groups showed a highly significant difference in the tarsus curvature, when looking straight ahead and in the abduction position. While there was no significant difference between both groups in the abduction position, they differed significantly when looking straight ahead. Also, a significant difference was noted, between the eyes of healthy subjects and the healthy eye in patients with facial palsy.CONCLUSION:The changes in curvature of the tarsal plate, when looking straight ahead, can be explained by the loss of tone in the paralyzed Orbicularis Occuli muscle. This means, that in addition to the lagophthalmos resulting from facial paralysis, changes occur in the functional anatomy of the upper eyelid, which must be considered during surgical correction. Additionally, the physiological loss of tone of the upper eyelid tarsal plate, which comes with age, has a certain influence.