mRNA Induction and Cytokine Release of Inflammatory Mediators During In Vitro Exposure of Human Nasal Respiratory Epithelia to Acetaldehyde

Acetaldehyde has been shown to be cytotoxic and carcinogenic to the upper respiratory tract epithelium of rodents following long-term exposure. Most animal studies have concentrated on carcinogenicity and DNA-protein cross-link formation, while less is known about potential dose- and time-dependent induction of aldehyde-induced rhinitis in humans. In this in vitro study, 22 primary cell cultures established from inferior turbinate tissue of healthy individuals were exposed to acetaldehyde concentrations of 50 (German MAK value) or 500 ppm for 4 or 24 h. mRNA expression and protein levels of cytokines and other inflammatory mediators were quantified at the end of the 4- and 24-h exposures. C…

Acoustic Rhinometry-Predictive Value in Septal and Turbinate Surgery

Survivin’s Dual Role: An Export’s View

Survivin is proposed to function as a mitotic regulator and an apoptosis inhibitor during development and pathogenesis. As such, survivin has aroused keen interest in disparate areas of basic and translational research. Survivin acts as a subunit of the chromosomal passenger complex (CPC), composed of the mitotic kinase Aurora-B, Borealin and INCENP, and is essential for proper chromosome segregation and cytokinesis. Our recent findings indicate that the nuclear export receptor Crm1 is critically involved in tethering the CPC to the centromere by interacting with a leucine-rich nuclear export signal (NES), evolutionary conserved in all mammalian survivin proteins. In addition, the survivin/…

Der Einsatz eines optischen Navigationssystem in der Nasennebenh�hlenchirurgie

Hintergrund. Fur die moderne Nasennebenhohlenchirurgie stehen heute verschiedene CAS-Systeme zur Verfugung.Das Vector-Vision-Compact®-System stellt erstmals ein speziell fur Nasennebenhohleneingriffe konzipiertes optisches Gerat dar.Seine Praktikabilitat und Zuverlassigkeit wurde in der Nasennebenhohlenchirurgie uberpruft. Patienten und Methode. Das System wurde bei 60 Patienten mit polyposer Pansinusitis verwendet.Die Bestimmung der Systemgenauigkeit erfolgte visuell und wurde mit etablierten Systemen verglichen.Fehlerquellen sowie systembedingte Komplikationen wurden uberpruft. Ergebnisse. Die Systemgenauigkeit betrug 1,9 mm und war anderen Navigationssystemen gleichwertig. In 83,3% aller…

Recurrence of pleomorphic adenoma of the parotid gland-predictive value of cadherin-11 and fascin

The predictive value of cadherin-11, tenascin, fascin, and mucin-1 as markers for the likelihood of recurrence in pleomorphic adenoma of the parotid gland was examined. In this retrospective study we analysed 20 tumours from16 patients by immunohistochemistry. Staining intensities were measured using a semiquantitative scoring approach; localisation (tumour centre vs border) as well as clinical data were analysed and correlated with follow-up. Cadherin-11 was increased in recurrent tumours. However, no changes of fascin, tenascin or mucin-1 were observed. Cadherin-11 and fascin were increased in primary tumours of patients with later recurrence, with fascin upregulation restricted to the tu…

Influence of different approaches to the cerebellopontine angle on the function of the intermediate nerve

Object Surgery in the cerebellopontine angle (CPA) is a standard procedure at many centers. Outcome is focused mainly on preservation of hearing and facial function postoperatively. The nonmotor part of the facial nerve, the intermediate nerve, is nearly neglected nowadays. Methods A retrospective study was designed, including a questionnaire that was sent to 178 patients who had undergone surgery between 2000 and 2004. Data were obtained in 156 cases. The questionnaire was divided into five parts assessing the presence of increased tearing, reduced tearing, salivation disturbances, increased nasal secretions, and abnormalities in taste. Finally, a self-assessment of patient symptoms was a…

Alteration of the Calcium Content in Inner Hair Cells of the Cochlea of the Guinea Pig after Acute Noise Trauma with and without Application of the Organic Calcium Channel Blocker Diltiazem

Calcium ions are known to be important to the process of signal transduction across the apical and basal sides of the inner hair cells. Calcium channel antagonists have been demonstrated by light microscopy to provide protection against acoustic trauma. To evaluate the protective effect of calcium channel blocker on the inner ear cells to noise exposure, the amount of the histochemical reaction products formed in the cytoplasm of the inner hair cells of the guinea pig after application of pyroantimonate was measured by an image processing system connected to an energy-filtering transmission electron microscope (EFTEM). Compared to untreated control specimens (experimental animal group I) th…

Epidural hematoma after cochlear implantation in a 2.5-year-old boy.

OBJECTIVE Report a case of an epidural hematoma after cochlear implantation in a 2.5-year-old boy, the diagnostic and therapeutical emergency management, as well as the postinterventional course and rehabilitation of the child. STUDY DESIGN Retrospective case review. PATIENT Two and a half-year-old boy, suffering from early onset, profound sensorineural hearing loss had been diagnosed at an age of 1.5 years, which had been more severe on the right side initially, but had progressed to bilateral deafness. INTERVENTION AND COMPLICATION: Cochlear implantation on the left side, followed up by an extensive epidural hematoma, causing intracranial compression with a midline shift of 15 mm to the r…

Intratympanic gentamicin treatment after endolymphatic sac surgery.

Interval treatment with up to three intratympanic gentamicin injections once weekly effectively controlled vertigo while preserving hearing in patients with Ménière's disease and recurrent or resistant vertigo after saccotomy.Recurrent or resistant incapacitating vertigo may occur after endolymphatic sac surgery (saccotomy) in patients with Ménière's disease. In these patients, revision saccotomy, vestibular nerve section or labyrinthectomy are the established treatment options. We advocate a once-weekly application of intratympanic gentamicin (12 mg) as an effective alternative in this group of patients.Five patients (age range 39-65 years) with definite Ménière's disease according to the …

Virtual endoscopy of the inner ear and the auditory canal.

To assess the role of virtual endoscopy (VE) in the examination of intracisternal structures and of the inner ear, we studied the anatomy of the labyrinth and internal auditory canal using the original CT slices and VE on the unaffected side in three female and three male patients, age range 3–46 years, with contralateral retrocochlear hearing loss. We also examined seven patients with different pathological findings. VE was performed using an advanced postprocessing program with high- resolution 3D data sets of CT (1–1.5 mm thickness, pitch 1.25) and MRI-CISS-3D (constructive interference in steady state) images of the basal cisterns (1.5 T, slice thickness 0.7–1 mm). VE provides an endosc…

Possible Ca 2+ -dependent mechanism of apical outer hair cell modulation within the cochlea of the guinea pig

Calcium ions were precipitated with potassium antimonate after injection of the inorganic calcium channel blocker MnCl2 or the inorganic potassium channel blockers BaCl2 or CsCl into the perilymph of the scala vestibuli of the guinea pig. The spatial distribution of the formed histochemical reaction products within the organ of Corti was studied by energy-filtering transmission-electron microscopy. Compared with untreated control ears, the number of the formed precipitates drastically increased at the extracellular side of the lamina reticularis after application of the various inorganic channel blockers. The apical side of the outer hair cells and the intervening Deiter cells were covered …

Ultrasonography for the diagnosis of Lyme disease in cases of acute facial paralysis.

Ultrasonography of the parotid gland was introduced in 1989 as part of the diagnostic protocol of every patient treated in our clinics with acute facial paralysis. Ten of 50 patients so tested were found to have unilateral nonpalpable enlarged lymph nodes in the caudal portion of the parotid gland around the stylomastoid foramen. All 10 patients were eventually diagnosed as having Lyme disease. It is suggested that in patients with acute facial paralysis, ultrasonography is an inexpensive tool to improve diagnosis of Lyme disease and may have a more useful purpose in monitoring therapy.

Frequent chromosomal gains in recurrent juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor, mostly affecting adolescent males. Some patients develop recurrences after surgery independently of completeness of removal. Only very limited data concerning underlying chromosomal changes are available. We therefore analyzed samples of 22 JNAs, including six recurrences, with comparative genomic hybridization (CGH). Additionally, quantitative image cytometry was used for measurement of DNA aneuploidy in representative samples. Of the 13 primary JNAs without later recurrence, DNA gains were identified on autosomes in only two samples. Four patients with one or two recurrences were included in the study; for one of these, no…

Steroid and vasoactive treatment for acute deafness after attempted hearing preservation acoustic neuroma surgery.

<i>Objective:</i> To investigate whether intravenous steroid and vasoactive therapy in the acute postoperative period improves hearing outcome in patients who develop acute deafness after attempted hearing preservation surgery for acoustic neuroma (AN) through a retrosigmoid or a middle cranial fossa approach. <i>Study Design and Setting:</i> Retrospective controlled study in a tertiary care center. Thirty-six patients who had developed acute deafness after hearing preservation surgery for treatment of an AN were reviewed. Preoperative AAOHNS hearing class was A in 2, B in 2 and D in 32 patients. Twenty-seven patients were treated with prednisolone, hydroxyethyl star…

Vascular endothelial growth factor expression in nasal polyps of aspirin-intolerant patients.

Objective To study differences between aspirin-tolerant patients and aspirin-intolerant patients concerning vascular endothelial growth factor (VEGF) expression. Recent publications strongly suggest the involvement of VEGF and its receptors in the pathophysiologic process of nasal polyps. Design We subjected 43 polyp specimens to semiquantitative immunohistochemical analysis. We quantified VEGF and its receptors (Flk, Flt, and neuropilin) in all samples. To gain insight into potential VEGF-mediated cellular responses, we determined proliferative (Ki67) and apoptotic (caspase 3) indices. Patients Polyp samples were obtained from 22 aspirin-intolerant patients and from 21 aspirin-tolerant pat…

Intratympanale Intervalltherapie des Morbus Meni�re mit Gentamicin unter Erhalt der Kochleafunktion

Patienten und Methode Zwischen 1997 und 2000 haben wir 57 Patienten intratympanal einseitig mit Gentamicininjektionen (jeweils 0,3 ml = 12 mg) therapiert. Eine Therapieserie bestand maximal aus je einer Injektion an Tag 1, 8 und 15. Intratympanal injiziertes Gentamicin akkumuliert langsam (Durchschnitt unseres Krankenguts: 4,6 Tage) im Innenohr. Die Intervalltherapie vermeidet uberhohte Gentamicinkonzentrationen. Sobald Zeichen einer Innenohrreaktion auftreten (Nystagmus, Unsicherheit, Schwindel), hat die Therapie gewirkt und darf keinesfalls weitergefuhrt werden.

DPOAE‐Grams in Patients with Acute Tonal Tinnitus

To investigate cochlear outer hair cell function in patients with acute tonal tinnitus and normal or near-normal hearing threshold.Prospective controlled study in an academic tertiary health center. Distortion products of otoacoustic emissions (DPOAE)-grams of 32 ears with acute tonal tinnitus and normal hearing or minimal hearing loss were compared with those of 17 healthy nontinnitus ears.Tinnitus ears exhibited relatively increased amplitudes of DPOAE at high frequencies (4-6.3 kHz) when compared with the group of healthy ears and relatively decreased DPOAE amplitudes at middle frequencies (1650-2400 Hz). Statistically significant ( P0.01) increased mean values of DPOAE amplitudes were o…

Ascorbic acid reduces noise-induced nitric oxide production in the guinea pig ear.

Objectives: Noise-induced hearing loss can be caused, among other causes, by increased nitric oxide (NO) production in the inner ear leading to nitroactive stress and cell destruction. Some studies in the literature suggest that the degree of hearing loss (HL) could be reduced in an animal model through ascorbic acid supplementation. To identify the effect of ascorbic acid on tissue-dependent NO content in the inner ear of the guinea pig, we determined the local NO production in the organ of Corti and the lateral wall separately 6 hours after noise exposure. Study Design: Prospective animal study in guinea pigs. Methods: Over a period of 7 days, male guinea pigs were supplied with minimum (…

Zur Notwendigkeit der zweikanaligen 24-h-pH-Metrie in der Diagnostik des laryngopharyngealen Reflux

Der laryngopharyngeale Reflux (LPR) kann Ursache zahlreicher Erkrankungen sein, mit denen der HNO-Arzt taglich konfrontiert wird. Da sich der LPR vom gastroosophagealen Reflux (GOR) unterscheidet, muss vor Therapiebeginn die Langzeit-pH-Messung direkt am Kehlkopf erfolgen. Dies ist durch ein neues Messsystem moglich. Mit dem pH-RESPONSE® wurde der pH-Wert 24 h hinter dem Larynx und im distalen Osophagusdrittel bei 20 Patienten gemessen und an beiden Messpunkten miteinander verglichen. Ferner wurde der De-Meester-Index als Mas fur den GOR bestimmt. Das Messsystem wurde von 19/20 Patienten gut toleriert. Die Zahl der Refluxereignisse am Larynx betrug1/3 derer im Osophagus und die durchschnitt…

Orbital Decompression for Endocrine Ophthalmopathy: The Endonasal Approach

A surgical endonasal procedure is described to perform orbital decompression in patients suffering from ophthalmopathy in Grave's disease. The decompression technique employs removal of the lamina papyracea as an exclusive modality or in conjunction with a transmaxillary or lateral decompression approach. This present series contain 23 patients who underwent decompression over a 3-year period and were followed for at least 6 months postoperative. The results of decompression were assessed by measuring reduction in proptosis and visual acuity. All patients demonstrated improved visual acuity. Measuring retroplacement of the globe, the endonasal approach proved to equal the results obtained …

Effects of the Breathe Right Nasal Strips on Nasal Ventilation

The Breathe Right nasal strips are more and more commonly used, mainly by athletes, who hope to enhance their physical performance in competition and training. The effect of the device in such situations is uncertain and perhaps somewhat controversial. To investigate the effects of the nasal strips on nasal ventilation, 20 Caucasian individuals were objectively assessed using anterior rhinomanometry and acoustic rhinometry. The results showed a significant increase in all subjects of transnasal airflow and in the average cross-sectional area of the nasal cavity that quantifies objectively the subjective impression of improved nasal breathing. In such patients where an improvement in nasal …

Ultrasonography for evaluation of the carotid artery in head and neck cancer.

The dynamic relationship of lymph node metastases to surrounding vascular structures in the neck is important for preoperative patient assessment. When carotid artery involvement is suspected, this relationship often determines whether or not to operate. In the case of adhesive neck metastases along the internal jugular vein, it becomes possible to predict preoperatively if the integrity of this vein may be preserved. Ultrasonography has the ability to differentiate subtle from gross adherence, or simple compression from vascular invasion. This is done by manually palpating the tumor mass and asking the patient to perform various maneuvers while observing on a monitor the relationship of th…

Localization of the two constitutively expressed nitric oxide synthase isoforms (nNOS and eNOS) in the same cell types in the saccule maculae of the frog Rana pipiens by immunoelectron microscopy: evidence for a back-up system?

There is growing evidence for a nitric oxide/cyclic GMP pathway of signal transduction in the vestibular system. Recently, two isoforms of nitric oxide (NO) synthase (nNOS and eNOS) and NO itself have been identified at the light microscopic level in the vestibulocochlear system of mice using specific antibodies and a new fluorescence indicator. In order to acquire more information about signal transduction and tissue modulation in this neuroepithelium at the cellular and subcellular levels, ultrathin sections of London Resin White-embedded saccule maculae of the frog Rana pipiens were incubated with various concentrations of commercially available antibodies to nNOS and eNOS. The immunorea…

Acute effects of an exposure to 100 ppm 1-methoxypropanol-2 on the upper airways of human subjects.

Abstract The German MAK value of 1-methoxypropanol-2 has been fixed at 100 ppm. The aim of this study was to evaluate possible acute effects of an exposure to 100 ppm 1-methoxypropanol-2 on the upper airways of human subjects. Twenty subjects were exposed in a crossover design to 100 ppm 1-methoxypropanol-2 and to air in an exposure chamber for 4 h. Subjective symptoms were assessed by questionnaire. Olfactory thresholds for n-butanol and mucociliary transport time were measured before and after exposure. Concentrations of interleukin 1β and interleukin 8 were determined in nasal secretions taken after exposure. mRNA levels of interleukins 1β, 6 and 8, tumor necrosis factor α, granulocyte-m…

Adenoids of patients with mucopolysaccharidoses demonstrate typical alterations.

Abstract Objective Tonsillar hypertrophy caused by the progressive accumulation of partially degraded glycosaminoglycans (GAGs) within the cells is a typical symptom in patients with mucopolysaccharidoses (MPS). We studied the tissue of adenoids and tonsils of patients suffering from MPS with special regard to characteristic morphological features serving as possible markers for diagnosis. Methods Adenoids of 87 patients and tonsils of 4 patients with MPS (2 patients with MPS I, 7 MPS II, 5 MPS IV and 10 MPS VI and 63 controls) and controls were examined. Examinations were repeated in a blinded manner by two pathologists. Results The key feature observed was a subepithelial “clearing” on sc…

Comparison of subjective olfaction ratings in patients with and without olfactory disorders

AbstractObjective:Olfactory dysfunction is common. The reliability of self-assessment tools for smell testing is still controversial. This study aimed to provide new data about the accuracy of olfactory self-assessment compared with a standardised smell test.Design:Prospective, controlled, cohort study of patients with olfactory disorders and healthy controls.Subjects:Ninety-six patients with a smell deficit and 71 controls were asked to rate their sense of smell on a visual analogue scale. Their olfactory abilities were also evaluated with the Sniffin' Sticks tests.Results:The whole cohort showed a significant correlation between visual analogue scale smell scores and Sniffin' Sticks total…

Fehlerquellen der Navigation in der lateralen Sch�delbasischirurgie

Die Identifikation moglicher Storfaktoren navigationsunterstutzter Eingriffe an der lateralen Schadelbasis ermoglichen dem Anwender die Vermeidung und Behebung dieser Fehler. Anhand unserer Erfahrungen von 85 navigationsunterstutzten Eingriffen im Bereich der lateralen Schadelbasis werden Fehler der Hard- und Software, der Bildgebung und des -transfers, der Patientenregistrierung, durch den Anwender und solche strategischer Art analysiert. Bei optischen CAS-Systemen fuhrt eine Blockade des Sichtfelds der Kameras zu Funktionsbeschrankungen, wahrend elektromagnetische Systeme durch ferromagnetisch aktive Materialien beeinflusst werden konnen. Die bisherigen Verfahren der Patientenregistrierun…

Multikinase inhibitors sorafenib and sunitinib as radiosensitizers in head and neck cancer cell lines

Background Radioresistance is a common feature of head and neck squamous cell carcinoma (HNSCC). We previously showed that the irradiation- activated vascular endothelial growth factor (VEGF)-extracellular signal-regulated kinase (ERK)-axis is fundamental for the survival of resistant tumors. In this study, we examined if treatment with potent multikinase (MK) inhibitors, sorafenib and sunitinib, could radiosensitize tumor cells. Methods Cultured HNSCC cell lines were treated with inhibitors and subsequently irradiated. Radiosensitizing effects were functionally assessed by annexin-V apoptosis and clonogenic assays and confirmed by Western blot. Additionally, we surveyed human HNSCC tissue …

Vestibular Function after Acoustic Neuroma Removal with Preservation of One Branch of the Vestibular Nerve

Background Vestibular compensation after acoustic neuroma surgery is affected by many parameters. Apart from surgical approach, age of the patient, and comorbidity, the use of rehabilitative vestibular training and the degree of preoperative vestibular compensation play their respective roles. Objective To examine whether and how surgical preservation of one branch of the vestibular nerve affects the compensation process in patients after acoustic neuroma removal. Study design Prospective study involving 29 patients with acoustic neuromas. In 15 patients operated on by the middle fossa or retrosigmoid approach, one branch of the vestibular nerve could be preserved intraoperatively, and the …

Zur Pr�valenz der obstruktiven Schlafapnoe (OSA) bei Patienten mit H�rsturz

Obstruktives Schnarchen und Schlafapnoe wurden als wesentliche Risikofaktoren fur schlafgebundene zerebrale Ischamien identifiziert und 25–50% der Schlaganfallpatienten leiden an schlafbezogenen Atmungsstorungen mit einem "respiratory disturbance index" (RDI) >10. Wahrend schlafgebundener Apnoephasen sinkt die Sauerstoffsattigung (pO2) des Blutes, und der Kohlendioxidpartialdruck (pCO2) steigt an. Fur den pCO2 wurde eine entscheidende Rolle in der Regulation der Flussgeschwindigkeit des Blutes in den grosen Hirnarterien nachgewiesen. Die Genese des Horsturzes wird in einer Mikrozirkulationsstorung der Endstrohmbahn der Innenohrgefase vermutet. Ob die Schlafapnoe die Entstehung eines Horstur…

Intratympanic Dexamethasone/Hyaluronic Acid Mix as an Adjunct to Intravenous Steroid and Vasoactive Treatment in Patients With Severe Idiopathic Sudden Sensorineural Hearing Loss

To evaluate differences in effectiveness (hearing recovery rates) between idiopathic sudden sensorineural hearing loss (ISSNHL) patients treated with intravenous therapy alone and patients treated with a combination of intravenous and intratympanic therapy.Retrospective case review.Tertiary referral hospital center.Ninety-four patients with moderate ISSNHL treated with an intravenous steroid and vasoactive regimen (duration of therapy, 9 ± 2.76 d) and 76 patients with severe ISSNHL treated with a combination regimen of intravenous and intratympanic therapy (duration of therapy, 10 ± 2.71 d) were reviewed. In the latter patients' group, a series of 3 intratympanic injections of a dexamethaso…

The effect of short-term immunotherapy with molecular standardized grass and rye allergens on eosinophil cationic protein and tryptase in nasal secretions.

Activation of mast cells and eosinophils under pollen exposure can be inhibited by specific immunotherapy.The effect of short-term immunotherapy with 7 preseasonal injections of molecular standardized allergens from grass and rye pollen on eosinophil cationic protein (ECP) and tryptase levels in nasal secretions has been compared with symptomatic drug treatment in an open, randomized study with 48 patients.Nasal reactivity and mediator levels in nasal secretions were measured at baseline, before season, in season, and after season.Symptom scores in the immunotherapy group were 134.5 (95% CI, 65 to 336) versus 386. 0 (95% CI, 185 to 563), significantly lower as in the drug-treated group. ECP…

mRNA-induction and cytokine release during in vitro exposure of human nasal respiratory epithelia to methyl methacrylate

Abstract Background Methyl methacrylate (MMA) has been reported to cause histopathological changes in rodent nasal epithelium after inhalation challenges. Data in humans are lacking. Methods In this in vitro design 22 primary cell cultures taken from inferior turbinate tissue of healthy individuals were exposed to MMA concentrations of 50 ppm (German MAK-value) and 200 ppm. mRNA expression and cytokine release of inflammatory mediators were quantified after 4 h and after 24 h. Controls were exposed to synthetic air. Q-PCR analysis was performed for TNF-α, IL-1β, IL-6, IL-8, MCP-1, GMCSF, Cox-1 and Cox-2. ELISA assays were performed from culture supernatants for TNF-α, IL-1β, IL-6, IL-8, MCP…

Transient evoked otoacoustic emissions in vestibular neuritis.

Objectives: Partial or total degeneration of the vestibulocochlear anastomosis at its takeoff from the saccular ganglion and regenerating efferent neural buds under the cochlear outer hair cells (OHCs) have been found in the temporal bones of human patients with a history of vestibular neuritis (VN). We sought to test whether VN has any functional impact on the ipsilateral OHCs by means of transient evoked otoacoustic emission (TEOAE) testing. Methods: We retrospectively analyzed prospectively collected TEOAE data of 28 patients (19 female, 9 male; age range, 21 to 60 years; median age, 42.5 years). The pure tone air conduction hearing thresholds at each standard audiometric frequency (0.12…

Subacute effects of ozone exposure on cultivated human respiratory mucosa.

This study was designed to investigate subacute effects of long-term exposure of both healthy and chronically inflamed human respiratory mucosa to ozone. Functional and metabolic effects on ciliary beat frequency (CBF), release of interleukin 8 (IL-8), interleukin 4 (IL-4), and γ interferon (g-INF), as well as cellular viability and cytotoxicity, were monitored. Cell cultures of 60 specimens (healthy mucosa: n = 30, inflamed mucosa: n = 30) were exposed to synthetic air and to ozone-enriched synthetic air in different concentrations of WO, 500, and WOO μg/m3. Continuous expositions were performed using an air/liquid interface cell culture technique for a period of 4 weeks. CBF was monitore…

Comparison of electronystagmography results with dynamic posturography findings in patients with vestibular schwannoma.

Condition-5-score (C5S) and condition-6-score (C6S) of computerized dynamic platform posturography (CDPP) can detect the presence of a functional deficit of the lateral semicircular canal (and the superior vestibular nerve), irrespective of the central vestibular compensatory status, in vestibular schwannoma (VS) patients.To test whether CDPP findings differ between VS patients with and without asymmetry on caloric and/or rotational ENG studies.This was a retrospective review of 216 consecutive patients with VS. C5S and C6S of CDPP (Equitest) were compared among patients with normal caloric and rotational studies, patients with asymmetry on caloric studies and normal rotational studies, and…

Tracheal Ceramic Rings for Tracheomalacia: A Review After 17 Years

Background: Despite different support techniques, the surgical management of tracheomalacia is still a challenging problem. Satisfactory results after internal stenting are above 80%, whereas, when performing external stenting using biocompatible ceramic rings, results are reported at over 90%. Objective: The purpose of this study was to examine the efficiency of surgical treatment in patients with segmentary tracheomalacia using external ceramic ring grafts. Methods: In this retrospective study, we collected data from 12 patients who underwent surgery during the last 17 years for symptomatic segmentary tracheomalacia by use of biocompatible aluminum-oxide ceramic rings. All except one pati…

Psychological and physical well-being in hearing-impaired children

Summary Objectives The purpose of this study was to evaluate the psychological and physical well-being in 6–11-year-old hearing-impaired children. Methods The cohort consisted of 70 boys and 61 girls who either attended a special school for deaf children ( n  = 78) or a mainstream school ( n  = 53). We used the FKSI (Frankfurt Self-Concept Scales for Children). Results Children in special schools saw themselves in a less favourable light than children in mainstream schools. They were less confident and less assertive. They reached lower scores in making friends, and were more anxious and sad. Children attending mainstream schools were found to be more self-confident the more pronounced the …

Olfactory function after microscopic endonasal surgery in patients with nasal polyps.

A controlled prospective study on 31 patients with nasal polyps was performed to evaluate the time course of olfactory function after endonasal surgery. A modified Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory function test was used to measure olfactory threshold, odor identification ability, and odor discrimination ability. The test was performed in all patients 1–3 days before surgery (V1), 7–10 days after surgery (V2), and after 1 (V3), 2 (V4), 3 (V5), and 6 (V6) months. Mean olfactory threshold in the CCCRC butanol test was 4.19 at V1 (= moderate hyposmia). At V2, it decreased to 3.46 (= severe hyposmia), before increasing to 5.16 at V3 and 5.22 at V4 (= mild hypo…

Radiofrequency tissue volume reduction for treatment of auricle keloids

Objectives/Hypothesis: Keloids are often refractive to treatment, and recurrences occur quite frequently. Radiofrequency tissue volume reduction (RFTVR) is a surgical technology that induces extensive fibrosis at the target tissues. Methods: We applied RFTVR in 14 patients (19 auricles, 5 patients treated bilaterally; 9 female, 5 male; range, 10–66 years) with keloids of the auricle. Keloids were located at the earlobe in 4 patients (5 auricles), helix in 9 patients (12 auricles), and at both earlobe and helix in 1 patient (2 auricles). In 6 patients (8 auricles) RFTVR was the sole treatment modality applied, and in 7 patients (10 auricles) intralesional steroid injection was also performed…

Olfaction in chemotherapy for head and neck malignancies

Abstract Objective Systemic chemotherapy for different malignancies occurs alongside various side effects, including reduced sensory function. To date, little is known about the effect of chemotherapeutic agents on olfaction. The aim of this study was to provide new data about changes in sense of smell during chemotherapy among patients with advanced squamous cell carcinomas of the head and neck region. Methods In a prospective, controlled cohort study of patients undergoing up to three courses of chemotherapy (cis- or carboplatin, 5-fluorouracil and docetaxel), olfaction was evaluated prior to and directly following completing a cycle, as well as 3 weeks later with the beginning of the nex…

Long-Term Results after Interval Therapy with Intratympanic Gentamicin for Meni??re???s Disease

Objectives The new single-shot and interval treatment for Meniere's disease with gentamicin was designed to avoid cochlear damage during treatment with gentamicin. Methods To date, 90 patients were treated with the single-shot or interval gentamicin therapy. Fifty-seven cases of Meniere's disease were followed up prospectively between 2 and 4 years. During one treatment series, a maximum of three intratympanic gentamicin injections within 15 days were applied, each consisting of 0.3 mL (12 mg) of gentamicin (days 1, 8, and 15). Thirty of these 57 patients (53%) needed only one injection to be controlled (single-shot treatment). Results Vertigo attacks were completely controlled in 95% and p…

Malignant and benign sinonasal paragangliomas

Objectives/Hypothesis To report on the clinical course and management of sinonasal paragangliomas (PGLs). Study Design and Methods Retrospective chart review of six patients with PGLs of the nasal cavity and paranasal sinuses. Results Three patients had tumors with malignant clinical behavior with cerebral metastases or infiltration of brain and local recurrence, despite surgery and/or radiotherapy, while three patients demonstrated a benign course. Conclusion Sinonasal paragangliomas are frequently malignant. If malignant, they are very aggressive, with rapid local spread as well as high metastatic potential despite surgical resection; and they have a poor prognosis. Malignancy cannot be d…

Influence of nerve of origin and tumor size of vestibular schwannoma on dynamic posturography findings.

Condition 5-score (C5S) and vestibular ratio (VER) correlate, but condition-6-score (C6S) and mean overall balance score (MOBS) do not, with the size of an inferior vestibular nerve (IVN) vestibular schwannoma (VS). In IVN VS patients the visual system plays a major role in the maintenance of postural stability.To test whether the size of a superior vestibular nerve (SVN) or IVN VS, as measured on MRI scans, correlates with computerized dynamic platform posturography (CDPP) findings and whether CDPP findings could preoperatively predict the nerve of origin of the VS.This was a retrospective study. Seventy-five consecutive VS patients were evaluated. C5S, C6S, VER, and MOBS were evaluated. S…

Proliferative Activity and Cytometric Characteristics in Polyps of the Nasal Cavity and Paranasal Sinuses

Although several investigations have revealed the influence of cytokines, allergy, and environmental factors in polyp development, the etiology of nasal polyps is still unknown. To estimate the biology of this common disease the operative specimens of 50 patients who underwent surgery for polyps of the nasal cavity and the paranasal sinuses were examined; of these, 10 patients had recurrent disease and 23 patients had an allergy. The investigations included routine histology and quantitative DNA measurements, along with immunohistochemical identification of proliferation markers (i.e., MIB-1; proliferating cell nuclear antigen, PCNA). Histologically, most polyps revealed an infiltration wi…

Current Concepts in Therapy of Chronic Rhinosinusitis and Nasal Polyposis

The exact pathophysiological mechanisms leading to chronic rhinosinusitis (CRS) still to a large extent remain obscure. However, recently there has been some progress in elucidating the etiology of nasal polyposis, especially regarding tissue eosinophilia as well as the role of aspirin intolerance and eicosanoid mediators. Endonasal sinus surgery has evolved to be the treatment of choice in CRS and nasal polyposis in all cases where conservative treatment has failed or resulted in only a partial or temporary relief. Today, state of the art in surgical technique includes the ability to combine microscopic and endoscopic procedures. Regardless of technical advances like powered instrumentatio…

Reanimation of the Paralyzed Human Larynx With an Implantable Electrical Stimulation Device

Objectives/Hypothesis Electrical stimulation of the posterior cricoarytenoid muscle, when paced with inspiration, offers a physiological approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment. Study Design A prospective study of six patients. Methods The patients were successfully implanted with an Itrel II stimulator (Medtronic, Inc). In postoperative sessions, stimulated vocal fold abduction, patient ventilation, and voice were assessed and compared with preoperative values. Results The optimum stimulus paradigm was a 1- to 2-second train of 1-millisecond pulses delivered at a frequency of 30 to 40 Hz and am…

Possible roles of nitric oxide in the physiology and pathophysiology of the guinea pig cochlea.

Two nitric oxide synthase isoforms (NOS-I and NOS-III) are present in the mammalian cochlea, and many regulatory functions of the inner ear could be mediated by NO. In this study, cochlear potentials and immunohistochemical measures were analyzed by changing the concentration of NO in the guinea pig during intracochlear and intravenous application of an NOS inhibitor and an NO donor. In anesthetized guinea pigs the NOS inhibitor NG-nitro-L-arginine-methylester (L-NAME) was applied by intracochlear perfusion or intravenously. The cochlear potentials and blood pressure were measured during and after the application. Cochleae were removed and prepared for morphological and immunohistochemical …

Objective measures of nasal function

Numerous techniques to objectively measure nasal function are available to the rhinologic surgeon. Rhinomanometry, acoustic rhinometry, laser Doppler flowmetry, saccharin transport time, determination of ciliary beat frequency, and olfactory and trigeminal event-related potentials are all techniques in current use. Rhinomanometry is the standard clinical tool used to indicate those patients complaining of nasal obstruction who are likely to benefit from septal and turbinate surgery. Acoustic rhinometry permits the precise localization of nasal stenoses and is the best predictor of a patient's postoperative satisfaction. It is, in addition, more sensitive than rhinomanometry in recording cha…

Comparison of Conventional Instruments and Mechanical Debriders for Surgery of Patients with Chronic Sinusitis

Background This article compares the use of the microdebrider as a form of powered instrumentation designed to decrease mucosal trauma with traditional surgical instruments for endonasal sinus surgery. Methods Surgery was performed with the shaver or conventional instruments using an endonasal approach in 24 patients with bilateral chronic rhinosinusitis. Each patient served as his/her own control, meaning that one side was operated on with conventional instruments and the opposite side was operated on with the microdebrider to evaluate postoperative recovery, healing, and incidence of complications. They were stratified preoperatively and reassessed during 3- and 6-month follow-up and long…

Three-dimensional ultrasound evaluation in the head and neck.

We evaluated the use of a novel three-dimensional ultrasound imaging device in patients with various head and neck lesions. The investigated system was found to be a valuable adjunct to conventional ultrasound in head and neck evaluations. A disadvantage of the three-dimensional system was the need for expensive technical equipment.

Increased amplitudes of distortion product otoacoustic emissions in patients with unilateral acoustic neuroma.

We present a case series of 4 patients with a unilateral acoustic neuroma and increased amplitudes of the distortion products of otoacoustic emissions (DPOAEs) at the low- and middle- frequency bandwidth on the involved side compared to the uninvolved side despite a 28-dB hearing level (HL) worse (compared to the uninvolved side) pure-tone hearing threshold average for standard audiometric frequencies between 1 and 6 kHz at the involved side. In 3 of these patients, 2 with an inferior vestibular nerve origin of the acoustic neuroma and one in whom the nerve of origin could not be unequivocally defined, the tumor was extending extrameatally. One patient had a purely intrameatal acoustic neur…

Diagnosis and therapy of vestibular schwannoma.

MRI studies are of paramount importance for diagnosis and follow-up measurements during conservative and postinterventional management of vestibular schwannomas (VS). MRI findings that convey important information for hearing-preservation VS surgery are: length of tumor-cochlear nerve contact, involvement of the internal auditory canal, incomplete filling of internal auditory canal, tumor size less than 15 mm and the intralabyrinthine signal intensity on 3DFT-CISS gradient-echo images. Functional neuro-otologic studies of facial nerve function, hearing and vestibular/balance function provide a valuable means of assessment of the actual impairment of the functional status of the VS patient. …

Immunoelectron-microscopic localization of synaptophysin in the organ of Corti of the guinea pig.

Synaptophysin has been localized previously in the mammalian cochlea at the light-microscopic level and in few reports by electron microscopy using either a preincubation procedure or the avidin-biotin reaction. Here we present results of the electron-microscopic analysis for postembedding immunoreactivity of synaptophysin in the cochlea of the guinea pig of LR-White-embedded samples. Strong synaptophysin immunoreactivity is located in the cytoplasm of the efferent nerve endings at the base of inner and outer hair cells. Besides this, some antibodies to synaptophysin were also identified in the cytoplasm of outer hair cells. To get more information about the cellular content of synaptophysi…

Intratympanic Dexamethasone and Hyaluronic Acid in Patients with Low-Frequency and Ménière's-Associated Sudden Sensorineural Hearing Loss

Steroids are widely used for the treatment of cochleovestibular disorders. Direct steroid application in the middle ear cavity, when combined with a round window membrane permeability-modulating substance, increases the level of the steroid reaching the target cells. We measured hearing in patients with idiopathic isolated low-frequency sensorineural hearing loss and in patients with sudden sensorineural hearing loss and a history of Ménière's disease. Contradictory reports about effectiveness of intratympanic steroid therapy on vertigo control and hearing improvement in patients with Ménière's disease exist in the literature.Eighteen patients with isolated low-frequency idiopathic sudden s…

Recurrence of a laryngeal spindle cell sarcoma with a transformation into a higher grade of malignancy.

Primary malignant mesenchymal neoplasms of the larynx are rare. Sarcomas of the larynx account for <1% of all malignant laryngeal mesenchymal neoplasms. This report examines a case of a recurring laryngeal, initial benign-appearing mesenchymal tumour, which first changed its clinical phenotype without any histological signs of malignancy and later also its histological appearance with signs of malignancy. Finally, it even underwent a transformation into a higher grade of malignancy. In addition to this, the difficulties of allocating this tumour to the correct sarcoma subentity are shown.

Aspirin Intolerance in Patients with Chronic Sinusitis

Aspirin intolerance in patients with chronic sinusitis is often a cause of early recurrence of symptoms after surgical treatment. This study assesses 84 patients who were tested for acetylsalicylic acid intolerance after presenting with symptoms like chronic rhinosinusitis, sometimes bronchial asthma, coexisting allergies or a history of aspirin sensitivity. Nasal polyposis was found in a majority of cases, often recurrent after previous surgery. The levels of eicosanoids such as peptido-leukotrienes and prostaglandin E&lt;sub&gt;2&lt;/sub&gt; were analyzed in isolated blood cells and compared with a healthy control group. Aspirin-intolerant patients showed elevated basal levels of peptido-…

Dynamic survivin in head and neck cancer: Molecular mechanism and therapeutic potential

Although disease management of head and neck squamous cell carcinomas (HNSCC) has improved significantly, therapy resistance leading to tumor recurrence still counteracts improvement of long-term survival. Consequently, identification of molecular markers that signal increased risk of treatment failure or, which can be exploited by targeted therapy, is urgently needed. Survivin is strongly expressed in HNSCC, and its proposed dual role as an apoptosis inhibitor and a mitotic effector positioned survivin in the front line of cancer research. Notably, survivin is detected as a cytoplasmic and as a nuclear protein in HNSCC patients, which stimulated numerous studies to investigate and to specu…

A Targeted Problem and Its Solution

Comparison of olfactory function in patients with seasonal and perennial allergic rhinitis

Hyposmia is a common symptom in allergic rhinitis. However, little is known about differences in the olfactory function of patients with seasonal or perennial allergy. A prospective controlled study was performed on 28 patients with allergic rhinitis to grass pollen and on 47 patients with allergic rhinitis to mites. Sixty-six healthy volunteers served as a control. Olfactory function was evaluated by a modified Connecticut Chemosensory Clinical Research Center testing procedure for threshold, identification, and discrimination. The grass pollen-allergic patients were tested preseasonally and after 3 weeks of intraseasonal grass pollen exposure; the mite-allergic patients and the volunteers…

Cancer-associated fibroblasts do not respond to combined irradiation and kinase inhibitor treatment

The emergence of radioresistance is a significant issue in the treatment of squamous cell carcinoma. We recently demonstrated that post-radiogenic extracellular signal-regulated kinase (ERK) signaling might decrease radiosensitivity in this cancer type. To further elucidate how tumor-organizing cell types respond to irradiation and ERK pathway inhibition, we analyzed one oral squamous cell carcinoma and one lung cancer cell line (HNSCCUM-02T, A549), fibroblasts (NIH3T3), primary normal and cancer-associated fibroblasts (CAFs) in vitro. Irradiated cells treated with mitogen-activated protein kinase (MAPK) inhibitor U0126 were screened for pERK levels. Post-radiogenic cellular responses were …

Acute effects of 1,1,1-trichloroethane on human olfactory functioning.

Background Animal experiments indicate that 1,1,1-trichloroethane can cause degeneration of the olfactory epithelium. The effects of 1,1,1-trichloroethane on human odor perception still have not been investigated. The goal of this study was to learn more about acute effects of 1,1,1-trichloroethane. Methods Twelve healthy, nonsmoking students were exposed to 200 and 20 ppm (control) 1,1,1-trichloroethane in an exposure chamber for 4 hours according to a crossover design. Olfactory functioning was investigated with the Sniffin’ Sticks. The test includes the determination of the detection threshold for n-butanol and an odor identification test. Results After 1 hour of exposure to 200 ppm 1,1,…

No evidence for a correlation of glutathione S-tranferase polymorphisms and chronic rhinosinusitis.

OBJECTIVE: Cellular detoxification mechanisms are mandatory for cellular protection against oxidative stress and reactive oxygen species. One major group of antioxidative active enzymes involved in cellular detoxification are the Glutathione S-Transferases (GST). Multiple subtypes like GSTM1, GSTP1, and GSTT1 and variants of them are known, arising from allelic variations of the GST loci. Moreover, functional variants occur in high percentages and have been associated with diseases like bronchial asthma and bronchial hyperresponsiveness. The interplay of oxidative stress, detoxifying genes like GSTs and the genesis of respiratory tract illness is under contradictory debate. In this study, w…

Expression, Localization, and Significance of Vascular Permeability/Vascular Endothelial Growth Factor in Nasal Polyps

Background The exact etiologic mechanisms leading to the formation of nasal polyps have remained largely obscure. A key phenomenon of this specific type of chronic inflammatory disease in nasal respiratory mucosa is remarkable edema. Vascular permeability/vascular endothelial growth factor (VPF/VEGF) plays an important role in inducing angiogenesis and modulating capillary permeability. Objective To study the expression and localization of VPF/VEGF as a putative key factor in nasal polyp development. Methods Specimens of nasal polyps (n = 12) were harvested during endonasal sinus surgery in patients with polypous chronic rhinosinusitis. Specimens of healthy nasal respiratory mucosa (n = 12)…

Immuno-electron microscopic localization of the alpha(1) and beta(1)-subunits of soluble guanylyl cyclase in the guinea pig organ of corti.

Guanylyl cyclases (GC) catalyze the formation of the intracellular signal molecule cyclic GMP from GTP. For some years it has been known that the heme-containing soluble guanylyl cyclase (sGC) is stimulated by NO and NO-containing compounds. The sGC enzyme consists of two subunits (alpha(1) and beta(1)). In the present study, the alpha(1) and beta(1)-subunits were identified in the guinea pig cochlea at the electron microscopic level using a post-embedding immuno-labeling procedure. Ultrathin sections of LR White embedded specimens were incubated with various concentrations of two rabbit polyclonal antibodies to the alpha(1)- and beta(1)-subunit, respectively. The immunoreactivity was visua…

Quantitative DNA measurements in malignant and benign lesions of the upper aerodigestive tract.

Thirty-six patients underwent biopsy of clinically suspicious lesions of the mucosa of the upper aerodigestive tract. The biopsy material was evaluated histologically and cytologic smears out of the same lesion underwent quantitative DNA analysis using a numerical index derived from the single cell DNA content. In 30 patients, histologically diagnosed squamous cell cancer was confirmed by DNA analysis with the malignancy grade correlating with the morphologic differentiation of the tumor. Six lesions were histologically benign: i.e. dysplasia (n = 3), hyperplasia (n = 2) and chronic inflammation (n = 1). DNA analysis confirmed the benign nature in 4 cases, but in 2 cases of dysplasia, a dia…

Activation of mitogen-activated protein kinase extracellular signal-related kinase in head and neck squamous cell carcinomas after irradiation as part of a rescue mechanism

Background. Irradiation plays a pivotal role in head and neck squamous cell carcinoma (HNSCC) treatment. However, especially recurrent tumors frequently show increased radioresistance. We analyzed irradiation-stimulated mitogen-activated protein kinase (MAPK) signaling pathways to define cellular rescue mechanisms. Methods. Irradiated HNSCC cells were screened for MAPK activation and results were confirmed and refined by functional analyses. Extracellular signal-regulated kinase (ERK) inhibitor U0126 application enabled us to specify postradiogenic cellu- lar responses. Vascular endothelial growth factor (VEGF) levels were analyzed additionally. Results. We observed a pronounced and time-de…

Controlled trial for long-term low-dose erythromycin after sinus surgery for chronic rhinosinusitis

Objectives/Hypothesis The efficacy of macrolides in chronic rhinosinusitis (CRS) is still under controversy. To date, only two double-blind, placebo-controlled studies have been published with differing results. None of these studies investigated the possible benefit of macrolides in the postoperative period. We conducted an investigator-initiated clinical trial using 250-mg erythromycin once a day over a period of 3 months, beginning the administration of either erythromycin or placebo 2 weeks after a surgical intervention for CRS. Study Design Randomized double-blind, placebo-controlled trial. Methods The concentrations of eosinophilic cationic protein (ECP) and myeloperoxidase in nasal s…

Farbduplexsonographische Messung der Lymphknotenperfusion: Ein Beitrag zur Diagnostik der zervikalen Metastasierung*

The objective of this study was to find additional sonomorphological criteria for determining the status of enlarged lymph nodes. By using colour-coded duplex sonography the perfusion of 63 lymph nodes in the neck was analysed. The status was confirmed either histologically or clinically (29 metastases from squamous cell carcinomas and 34 acute or chronic inflammatory nodal diseases). A quantitative evaluation of the pulsatility measured in 51 lymph nodes by computing the Pourcelot-Ratio and the Mean Pulsatility Index yielded significant differences between the two groups. By definition of a limiting value of the Pourcelot-Ratio (0.75) for the prediction of benignity, the specificity and th…

[Treatment of sensorineural hearing loss in acute viral otitis media with intratympanic dexamethasone and hyaluronic acid in comparison with intravenous therapy].

Background: Intratympanic dexamethasone with hyaluronic acid has shown to be an effective treatment of the inner ear damage in sudden hearing loss and Meniere's disease. It is not known yet if the same applies to the toxic inner ear damage in acute viral otitis media. Patients: Retrospectively, 26 patients who suffered from acute viral otitis media with sensorineural hearing loss were examined with regard to the improvement of their inner ear hearing loss. Twelve patients were treated with intravenous therapy only, consisting of hydroxyethylstarch, pentoxifylline and prednisolone. Fourteen patients additionally received intratympanic injections, consisting of dexamethasone and hyaluronic ac…

Evaluation of the efficacy of the ‘nasal airflow-inducing manoeuvre’ for smell rehabilitation in laryngectomees by means of the Sniffin′ Sticks test

Clin. Otolaryngol. 2011, 36, 17–23 Objective:  To determine the efficacy of the nasal airflow-inducing manoeuvre (NAIM) as a method for olfactory rehabilitation in laryngectomees by the means of the Sniffin′ Sticks test. Study design:  Prospective open interventional trial. Setting:  Tertiary academic hospital. Participants:  Thirty-seven patients after laryngectomy have been screened and 25 patients have been included into the study. The participant’s sense of smell was tested with the Sniffin′ Sticks test before and after learning the nasal airflow inducing manoeuvre. The individual level of threshold, discrimination and identification (TDI) was determined and the individual threshold, di…

Microscopic Endonasal Surgery for Repair of CSF Leaks

This manuscript will detail our experience using a microscopic endonasal surgery (MES) approach in the repair of spontaneous, traumatic, and/or iatrogenic cerebrospinal fluid (CSF) fistula into the ethmoid and sphenoid sinuses. The location of the fistula in 22 patients was determined by a direct endoscopic or microscopic visualization, intrathecal fluorescein, or computed tomography (CT) with metrizamide. Several of these patients had been treated unsuccessfully with previous neurosurgical, intracranial, and extracranial approaches to stop the leak. The CSF fistulas in all these patients were repaired with a MES approach, packing the leak with either a septal mucosal graft, or abdominal f…

Influence of nerve branch of origin and extracanalicular extension of the tumor on hearing after middle fossa removal of vestibular schwannoma

Neither nerve branch of origin nor extracanalicular (up to 1 cm) extension of a vestibular schwannoma (VS) influence the postoperative hearing outcome in patients operated via a middle cranial fossa (MCF) approach.To test whether the nerve branch of tumor origin and an extracanalicular, up to 1 cm, tumor extension influences hearing outcome after MCF VS surgery.This was a retrospective case review of 50 patients with postoperative pure-tone audiogram (PTA) performed later than 90 days after surgery. Twenty patients had a superior vestibular nerve (SVN) tumor and 27 patients had an inferior vestibular nerve (IVN) tumor. In three patients the nerve branch of origin of the VS could not be uneq…

Microsurgical treatment of midfacial tumours involving the skull base

Various approaches to the base of the skull for the treatment of cranial base tumours are described in detail. Advantages and disadvantages of the particular approaches are discussed. This clinical experience is based on 303 neoplasms involving the base of the skull, operated on by the authors. Retrospective survival studies are presented and a review of the literature on the subject is discussed. Utilizing microsurgical techniques the 2-, 3- and 5-year survival rates were significantly improved. The functional and aesthetic outcomes were also dramatically superior compared with standard ablative procedures. Reconstructive postoperative strategies are suggested.

Evaluation of inflammatory reactions and genotoxic effects after exposure of nasal respiratory epithelia to benzene.

&lt;i&gt;Background:&lt;/i&gt; The aim of this study was to identify inflammatory changes as well as genotoxic effects in cultivated human respiratory epithelial cells after in vitro exposure to benzene. &lt;i&gt;Methods:&lt;/i&gt; Primary cell cultures of nasal respiratory mucosa were exposed to synthetic air enriched with 5,000 µg/m&lt;sup&gt;3&lt;/sup&gt; of benzene at an air/liquid interface over 8 h and then to synthetic air only over the following 24 h. Controls were continuously exposed to synthetic air over 32 h. To detect inflammatory reactions, release of prostaglandin E&lt;sub&gt;2&lt;/sub&gt; was quantified using a competitive enzyme immunoassay. The Comet Assay was used to quan…

Head and neck paragangliomas: Report of 175 patients (1989-2010)

Attention of the otorhinolaryngologist needs to be drawn to the versatile aspects of head and neck paragangliomas (PGLs).This study is a retrospective, nonrandomized clinical study of all 175 individuals with PGLs treated in our department between 1989 and 2010. A genetic analysis was performed on 86 patients.The 175 patients presented 224 head and neck PGLs as well as 2 thyroid papillary carcinomas. Genetic analysis resulted in 1 patient positive for a von Hippel-Lindau (VHL) gene mutation and 34 for succinate dehydrogenase (SDH) gene mutations (22 SDHD, 7 SDHC, and 5 SDHB), 12 of the latter carrying a novel mutation. Thirty-three patients (18.9%) had multiple PGLs and 11 patients (6.3%) h…

COX-2 expression in the guinea pig cochlea is partly altered by moderate sound exposure.

The cyclooxygenase-2 isoform (COX-2) was found recently to be constitutively expressed in the guinea pig inner ear. To gain knowledge about its role in sound perception, alterations in the COX-2 level of moderate noise-stimulated cochleae were determined. Staining intensities were quantified in different regions using an immunohistochemical staining procedure and computer-assisted system. After 70 dB and 90 dB noise exposure for 1 h at 8000 Hz, COX-2 downregulation was observed in the organ of Corti, which was most prominent in Deiters' cells near Hensen cells and outer hair cells. In pillar cells, COX-2 levels were only slightly reduced after 70 dB but strongly diminished after 90 dB expos…

Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea.

Objectives/hypothesis The concept of two-level pharyngeal collapse in patients with obstructive sleep apnea is too simplified. Aggressive multilevel surgeries addressing several airway segments, including skeletal surgery, demonstrate improved success rates. Study design The study aimed to evaluate the safety and efficacy of multilevel radiofrequency application to soft palate, tonsils, and base of tongue in 16 white patients (mean age, 56.9 +/- 11.1 y; mean body mass index, 27.3 +/- 2.6 kg/m2) with obstructive sleep apnea. There was one dropout. Therapeutic effects after one treatment session were assessed 20.6 +/- 12.6 weeks postoperatively. Treatment outcome measurements were based on Ep…

Cholesteatoma of the hypotympanum in a patient with Treacher Collins syndrome

In the present article we report a cholesteatoma of the hypotympanum extending to the jugular foramen in a 16-year-old male with Treacher Collins syndrome. Preoperative imaging excluded jugular paraganglioma and set the diagnosis of cholesteatoma. We discuss the operative treatment via a large hypotympanotomy and creation of an open hypotympanic cavity. To the authors' knowledge this is the first description of hypotympanal cholesteatoma with such an extension, being treated through this approach.

Ultracytochemical localization of Ca2(+)-ATPase activity in the middle ear mucosa of the guinea pig.

Ca2(+)-ATPase activity was studied ultra-cytochemically in the middle ear mucosa of the guinea pig. On electron microscopic examination, the most intense reaction was found on the microvilli. Reaction products were also observed on the cilia and around and between the secretory granules on the apical side of the cells in their secretory phase. The basolateral membranes contained few reaction products, while very little or no activity was found on the basal membrane.

Gentamicin alters nitric oxide production in semicircular canals and otolith organs.

Objectives/Hypothesis: Intratympanic application of gentamicin is an important therapeutic option to control vertigo spells in Meniere's disease. Low doses eliminate the function of semicircular canal ampullae (SCCA) and saccule in most patients, although utricular function is maintained in many cases. Local alteration in free radical production might be responsible for these differences. Therefore, the gentamicin-induced nitric oxide (NO) production was determined in an animal model using separate organ cultures of SCCA, saccule, and utricle. Study Design: Prospective pilot study in male guinea pigs. Methods: SCCA, saccule, and utricle of 28 guinea pigs were isolated and incubated separate…

Analysis of differentially expressed proteins in oral squamous cell carcinoma by MALDI-TOF MS

J Oral Pathol Med (2010) 40: 369–379 Purpose:  To explore the presence of differentially expressed proteins in OSCC for discrimination of tumour and normal mucosa to establish potential biomarkers and therapeutic targets. Experimental Design:  Paired protein samples of 12 individuals (tongue cancer and non-cancerous mucosa) were separated by two-dimensional polyacrylamid gel electrophoresis. The protein patterns were compared pairwise and protein spots were quantified. We identified about 70 regulated proteins which we subsequently identified by MALDI-TOF mass spectrometry. Results:  Cancerous and non-cancerous tissues could be most precisely distinguished by a panel of proteins. They inclu…

Vergleich der perkutanen Dilatationstracheotomie versus konventioneller Tracheotomie - Eine retrospektive Studie

BACKGROUND In this retrospective study we compared endoscopically controlled percutaneous dilatative tracheostomies (PDT) with conventional surgical tracheostomies as a bedside procedure and in the operating theatre. PATIENTS Between 1998 and 2000 we performed 360 tracheostomies electively, 152 in PDT-technique (42 %) and 208 (58 %) with the conventional procedure. Referring to the PDT-technique 74 % (n = 112) were performed at the bedside and 26 % in the operating theatre. The conventional tracheostomies took place at bedside in 53 % (n = 110) and in the operating theatre in 47 % (n = 98) of the cases. The complications were divided in 5 groups with special interest if the operation took p…

Dysregulated Survivin Expression in Nasal Polyps of Individuals with Aspirin Exacerbated Respiratory Disease

Background A derailed balance of cell proliferation and apoptosis is presumed to result in cell hyperplasia as a typical feature of nasal polyps. Survivin, a protein of the inhibitors of the apoptosis family is proposed to promote polyp formation. However, studies concerning survivin expression in chronic rhinosinusitis (CRS) with nasal polyps are rare and the specificity of the survivin expression in nasal polyps from individuals with aspirin-exacerbated respiratory disease (AERD) has not been investigated. Methods Immunohistochemical survivin expression analysis was performed. Samples were taken from the ethmoid sinus of individuals with CRS with nasal polyps with and without AERD during …

Demethylation treatment restores hic1 expression and impairs aggressiveness of head and neck squamous cell carcinoma.

Promoter hypermethylation of tumor suppressor genes is a common feature of primary cancer cells. However, at date the somatic epigenetic events that occur in head and neck squamous cell carcinoma (HNSCC) tumorigenesis are not yet been well defined. In the present study we analysed the methylation status of the gene hypermethylated in cancer-1 (hic1), a gene located on chromosome 17p13.3, a region frequently lost in HNSCC. We analysed 22 HNSCC samples and three cell lines using methylation specific PCR (MSP). We found hic1 methylated in 21 out of 22 samples and in all three cell lines. Treatment of the cell lines with the demethylating agent 5-Azacytidin (5-Aza) resulted in the demethylation…

The VEGF/VEGF-R Axis in Sporadic Vestibular Schwannomas Correlates with Irradiation and Disease Recurrence

&lt;b&gt;&lt;i&gt;Background/Aims:&lt;/i&gt;&lt;/b&gt; The molecular mechanisms downstream of mutated neurofibromatosis type 2 (NF2) gene resulting in the growth and development of vestibular schwannoma (VS) are controversial. Several lines of evidence suggest the involvement of the vascular endothelial growth factor (VEGF) pathway in VS development. Given that recent studies of VEGF blockade in patients with NF2-associated VS showed positive effects on VS growth control, we initiated this comprehensive study of the VEGF pathway in sporadic VS. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; A tissue microarray analysis of 182 sporadic VS was conducted. The expression of VEGF and its recepto…

Immunohistochemical localization of cyclooxygenase isoforms in the organ of Corti and the spiral ganglion cells of guinea pig cochlea.

Prostaglandins have been used in experimental models and clinical studies for the therapy of sudden hearing loss and tinnitus with conflicting results. However, little is known about the rate-limiting enzymes of prostaglandin synthesis in the inner ear, the generally constitutively expressed cyclooxygenase 1 (COX-1) and the distress-inducible cycloxygenase 2 (COX-2). To extend our knowledge concerning the physiological expression and localization of these two enzymes, immunohistochemical stainings of the guinea pig cochlea were performed. Light microscopical analysis revealed a homogenous distribution of COX-1 within nearly all cell types of the organ of Corti, but no COX-1 expression in th…

Indications for Computer-Assisted Surgery in Otorhinolaryngology

Indications for the use of computer-assisted surgery (CAS) in otorhinolaryngology can be grouped into several domains including the following: difficult cases involving the anterior, middle, and posterior skull base, especially the rhinobasis or laterobasis, and diseases of the petrous bone, the infratemporal fossa, the retromaxillar space, and the orbit; extended paranasal sinus surgery and revision cases with surgically altered anatomic landmarks; and use for educational purposes where CAS can provide better instruction in surgical anatomy by relating the surgical field to radiological sectional images. A new field for CAS is surgery of the inferior neck soft tissues or pathologic process…

Endoscope‐microscope combination for endonasal sinus surgery

Localization of Congenital Tegmen Tympani Defects

Objective: This study sets out to demonstrate the normal developmental steps of the tegmen tympani and thus explains the typical localization of congenital tegmental defects. Specimens: For this study, 79 macerated and formalin-fixed human temporal bones from 14th fetal week to adults were observed and prepared. Intervention: Macroscopic and microscopic examination of the prenatal and postnatal changes of the tegmen tympani during its development. Main Outcome Measure: Temporal bones from 14th fetal week to adults underwent descriptive anatomic studies to understand the normal development of the tegmen tympani and to find a possible cause of its congenital defects. Results: The medial part …

Lateralized and Bilateral Olfactory Function in Patients With Chronic Sinusitis Compared With Healthy Control Subjects

Results of this study demonstrated that a new olfactory test, the "Sniffin' Sticks," can be used to distinguish hyposmic patients with chronic sinusitis (n = 63) from control subjects. Dirhinic testing yielded improved olfactory sensitivity compared with monorhinic testing. However, dirhinic results were not significantly different from results obtained for the best nostril.

Fungal DNA is present in tissue specimens of patients with chronic rhinosinusitis.

Background It has been postulated that fungal organisms might represent the immunologic target initiating and maintaining the disease process in patients with chronic rhinosinusitis (CRS). The presence of fungi in nasal mucus has been established by different groups, but so far it has not been shown how the immune system could even recognize such extramucosal—extracorporal—fungal targets. The aim of this study was to determine whether fungal DNA is present in tissue specimens taken from patients with polypoid CRS. Methods Twenty-seven surgical specimens were collected from patients suffering from CRS. Fifteen surgical specimens from healthy ethmoidal mucosa served as controls. A second set …

Benign paroxysmal positioning vertigo: diagnosis and therapy using video-oculographic control.

In this prospective study, 82 patients (40 males, 42 females, aged between 15 and 80 years) with benign paroxysmal positioning vertigo (BPPV) were treated with different positioning manoeuvres using video-oculographic control. The maximum age for females and males was 31 and 40 years respectively. After an interview about the special history related to vertigo imbalance symptoms and using video-oculographic control, we diagnosed 79 patients with BPPV of the posterior semicircular canal and 3 of the horizontal semicircular canal. The Dix-Hallpike and Cawthorne manoeuvres were used for the diagnosis of BPPV of the posterior semicircular canal and the McClure manoeuvre for the diagnosis of BPP…

Low-dose aspirin desensitization in individuals with aspirin-exacerbated respiratory disease

Background Nasal polyposis frequently occurs within the clinical picture of aspirin-exacerbated respiratory disease (AERD). A derailed arachidonic acid metabolism is regarded to be part of the pathophysiology of AERD, and aspirin desensitization is the only causal therapeutic option, so far. The optimal maintenance dose of aspirin desensitization to prevent nasal polyp recurrence on the one hand and to minimize aspirin-related side-effects, on the other hand, is still a matter of debate. The aim of this trial was to investigate the efficacy and safety of a low-dose aspirin desensitization protocol. Methods After sinus surgery, 70 individuals with AERD were randomly allocated to a prospectiv…

The Use of Acoustic Rhinometry in Predicting Outcomes after Sinonasal Surgery

Today's healthcare environment demands objective assessment of surgical outcomes. The recent otolaryngologic literature has established acoustic rhinometry (AR) as a valid instrument to objectively document nasal patency. The purpose of this article is to evaluate the utility of AR in predicting outcomes after sinonasal surgery. All patients scheduled for sinonasal surgery at the Tulane University and University of Mainz Departments of Otolaryngology between 10/1/98 and 12/15/98 were enrolled. All subjects underwent AR and completed a sinonasal outcome survey (SNOT-20) one day before and two months after their surgical procedure. Thirty-one patients were enrolled. The SNOT-20 raw scores im…

Increased radioresistance via G12S K-Ras by compensatory upregulation of MAPK and PI3K pathways in epithelial cancer

Background Irradiation-induced signaling via the 2 pathways, Raf-MEK-ERK and PI3K-Akt, is known to be closely associated with a limited response to radiotherapy. In the present study we analyzed the relevance of constitutively active K-Ras for postradiogenic pathway stimulation and the option of coordinated inhibition to overcome these rescue mechanisms. Methods We used 2 epithelial tumor cell lines as a model system, one of them harboring a G12S K-Ras mutation. Cells were irradiated and the effect of combined treatment with ionizing radiation and inhibitors on the expression of pERK and pAkt was determined by Western blotting. Additionally, clonogenic assays were performed to functionally …

An Assessment of Radiologic Discrepancies in Patients with Paranasal Sinus Disease

The importance of computerized tomographic (CT) imaging of the paranasal sinuses in patients with chronic or recurring sinusitis is well documented. Nevertheless, the accuracy and reliability of this examination is not absolute. In this study of 80 cases, a considerable percentage of CT scans (57.5%) failed to detail accurately the extent of pathology in the sinus cavities. In 39 cases the extent of disease was underestimated using CT, and in seven cases it was overestimated. Discrepancies in pathology were encountered most commonly in the posterior ethmoid sinus. In our opinion, the primary role of CT in the assessment of patients with paranasal sinus disease is to detail precisely the co…

Intraoperative Navigation in der Chirurgie der Nasennebenhöhlen und der vorderen Schädelbasis

Hintergrund und Fragestellung. Beim Einsatz der computerassistierten Chirurgie im Bereich der Nasennebenhohlen und vorderen Schadelbasis sind einige Fehlerquellen zu beachten, die durch physikalische Gesetze, den technischen Entwicklungs- und individuellen Kenntnisstand des Anwenders bedingt sind. Patienten/Methodik. Anhand unserer Erfahrungen von 436 navigationsunterstutzten Eingriffen werden Hard- und Softwarefehler, Fehler der Bildgebung und des -transfers, Fehler der Patientenregistrierung, Anwenderfehler und strategische Fehler analysiert. Ergebnisse. Bei optischen CAS-Systemen fuhrt die Blockade des Sichtfeldes der Kamera zu Funktionseinschrankungen, wahrend elektromagnetische Systeme…

Fascin upregulation in primary head and neck squamous cell carcinoma is associated with lymphatic metastasis

Fascin is an actin-bundling protein that is associated with cellular motility and cancer-cell invasion. The present study aimed to examine the expression of fascin in head and neck squamous cell carcinoma (HNSCC) and its potential use as a biomarker. In a prospective study with a median follow-up time of 48.8 months, tumor tissues, adjacent healthy tissues and cervical lymph node metastases were collected from 25 patients and analyzed by immunohistochemistry. The specimens were scored according to the intensity of fascin staining and the percentage of tumor cells stained using a semi-quantitative scoring approach; the data were analyzed and correlated with clinical follow-up observations. A…

Is there a relationship between the degree of preoperative motility impairment or the muscle thickness and the outcome of strabismus surgery in patients with graves' orbitopathy after decompression surgery?

There is considerable controversy regarding the performance of strabismus surgery in patients with Graves' orbitopathy (GO). The spectrum of recommendations extends from variable dose-effect correlations for these procedures (Esser, 1994; Mourits et al., 1990; Nguyen et al., 2002) to individualized approaches such as passive intraoperative motility testing and postoperative adjustment of sutures (Lueder et al., 1992; Nguyen et al., 2002), and to local anesthesia for intraoperative assessment of active motility (Kalpadakis et al., 2004). Furthermore, prior decompression surgery is known to contribute to an unpredictable outcome (Eckstein and Esser, 2003; Esser, 1994). We retrospectively anal…

Relocation of an infected tracheostoma: anterior mediastinal tracheostomy as Mission:Impossible

Abstract Infected tracheostomas are frequently associated with high morbidity and mortality rates—especially in patients after neck-oncological surgery with subsequent radiochemotherapy. A 59-year-old male patient with a history of hypopharynx carcinoma, successive laryngectomy and adjuvant radiochemotherapy developed an oesophagotracheal fistula with massive inflammation and periodical bleedings, uncontrollable by regular stent alternations. In a multidisciplinary setting, the decision was made to treat the patient with an anterior mediastinal tracheostomy. Extending usual anterior mediastinal tracheostomy indications, we present an ultimate treatment option for infected tracheostomas and …

Radiofrequency volumetric tissue reduction (RFVTR) of inferior turbinates: a new method in the treatment of chronic nasal obstruction.

Twenty-two Caucasians (16 male and 6 female) with chronic bilateral nasal obstruction due to hypertrophic inferior turbinates were followed up over a three-month period. They were assessed by clinical examination, as active anterior rhinometry, and acoustic rhinometry before and after topical decongestion, preoperatively and three months after surgery. All patients were treated by application of radiofrequency-volumetric-tissue reduction (RFVTR, or somnoplasty) to both inferior turbinates. Initial postoperative edematous response disappeared during the first week after RFVTR. Three months postoperatively 20 of 22 patients (91%) reported subjective improvement of nasal patency. The average …

Promoter methylation of MGMT, MLH1 and RASSF1A tumor suppressor genes in head and neck squamous cell carcinoma: Pharmacological genome demethylation reduces proliferation of head and neck squamous carcinoma cells

Promoter hypermethylation of tumor suppressor genes (TSGs) is a common feature of primary cancer cells. However, to date the somatic epigenetic events that occur in head and neck squamous cell carcinoma (HNSCC) tumorigenesis have not been well-defined. In the present study, we analyzed the promoter methylation status of the genes mutL homolog 1 (MLH1), Ras-association domain family member 1 (RASSF1A) and O-6-methylguanine-DNA methyltransferase (MGMT) in 23 HNSCC samples, three control tissues and one HNSCC cell line (UM-SCC 33) using methylation-specific PCR (MSP). The expression of the three proteins was quantified by semi-quantitative immunohistochemical analysis. The cell line was treate…

Effekt der kontralateralen Stimulation auf evozierte otoakustische Emissionen bei akutem Hörverlust*

23 patients with unilateral hearing loss and presence of TEOAE on both ears were examined with regard to the association between contralateral acoustic stimulation and evoked otoacoustic emissions. Contralateral white noise of 40 dB HL, 50 dB HL and 60 dB HL decreases the amplitude of TEOAE both at the ear with and without hearing loss. In comparison with a group of subjects with normal hearing, the decrease in the amplitude of TEOAE was less in the group of patients with hearing loss. Two paradoxical cases were found with an increase in the TEOAE amplitude in the ear with hearing loss during contralateral stimulation. It is assumed that impairment of the efferent synapses on the outer hair…

Analysis of Fifty-Six Cochlear Implant Device Failures

&lt;i&gt;Objective:&lt;/i&gt; Our aim was to present a failure analysis after cochlear implant revision surgery in a large series of children and adults and to assess the outcome and audiologic performance. &lt;i&gt;Methods:&lt;/i&gt; Fifty-six cochlear implant failures that occurred in 422 devices implanted between 1990 and 2007 at the Department of Otolaryngology, Head and Neck Surgery at the University of Mainz, Germany, were retrospectively analyzed. The causes of failure were reviewed evaluating the individual history, telemetric and intraoperative findings and manufacturer’s investigation reports. &lt;i&gt;Results:&lt;/i&gt; We performed 56 surgical revisions in a series of 422 consec…

A Passive-Marker-Based Optical System for Computer-Aided Surgery in Otorhinolaryngology: Development and First Clinical Experiences

Objectives: To develop a new type of optical computer-aided surgery (CAS) device that overcomes some of the restrictions of common systems and to examine its accuracy and usability under laboratory and intraoperative conditions. Study Design: Prospective study using laboratory experiments and intraoperative data collection. Methods: An optical CAS system applying passive optical markers for coordinate determination was developed. Laboratory accuracy measurements were obtained on a Plexiglas model with known coordinates of fiducial markers, before and after predefined table movements. Intraoperative accuracy measurements were recorded from 24 patients undergoing endonasal surgery of the para…

Endonasal Approach for Nasal and Paranasal Sinus Tumor Removal

Patients with benign (53) and malignant (22) tumors of the nose and paranasal sinuses were treated for tumor removal via an endonasal approach. Patient selection was based on tumor location (centrally) rather than histology. Tumors attainable by the endonasal approach were located in the nasal cavity, the ethmoid sinus, the sphenoid sinus and the medial wall of the maxillary sinus. Endonasal microscopic techniques including endonasal orbital decompression and endonasal closure of CSF-leaks were combined with surgical navigation tools in selected cases. Surgical trauma and morbidity could be minimized without compromising radicality of tumor removal. Postoperative hospitalization was compara…

17β-Estradiol Reduces Nitric Oxide Production in the Guinea Pig Cochlea

Intense noise exposure and the application of ototoxic substances result in increased levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS), such as nitric oxide (NO). In order to reduce the free NO concentration in the inner ear under pathological conditions, the use of natural cytoprotective substances such as 17β-estradiol is a promising therapeutic concept. In male guinea pigs the organ of Corti and the lateral wall were isolated from the cochlea and afterwards incubated for 6 h in cell-culture medium. 17β-Estradiol was adjusted in 2 concentrations to organ cultures of the right ears (12 animals per concentration). The left ears were used as controls. The NO produc…

Prognostic indicators for squamous cell carcinoma of the oral cavity: a clinicopathologic correlation.

Fifty-three patients with T1 squamous cell cancer of the floor of mouth and ventral surface of the tongue with a known clinical outcome were retrospectively analyzed and arbitrarily divided into "aggressive" and "nonaggressive" groups based on their clinical behavior. Various host and tumor factors were then evaluated in an attempt to determine whether the tumor behavior could have been predicted. The paraffin-embedded tumor specimens were evaluated for tumor differentiation, tumor thickness and tumor invasion, microvessel density, and p53 expression. In addition, a composite morphologic grading score was obtained by combining cell differentiation, nuclear polymorphism, mitosis activity, de…

Endothelial nitric oxide synthase upregulation in the guinea pig organ of Corti after acute noise trauma.

Endothelial nitric oxide synthase (eNOS) upregulation was identified 60 h after acute noise trauma in morphologically intact cells of the reticular lamina in the organ of Corti of the guinea pig in the second turn of the cochlea. Using gold-coupled anti-eNOS antibodies and electron microscopy, it was shown that eNOS expression was upregulated in all cell areas and cell types except inner hair cells. Furthermore, eNOS was found in the organelle-free cytoplasm and in mitochondria of various cell types. The density of eNOS in mitochondria was considerably higher compared with the surrounding cytoplasm. Since eNOS activity is regulated by calcium, the eNOS detection was combined with calcium pr…

Pharmacological genome demethylation increases radiosensitivity of head and neck squamous carcinoma cells

Aberrant inactivation of tumor suppressor genes by promoter hypermethylation has been recognized as a crucial step of tumor development and is related to aggressiveness and therapy resistance. To identify potential novel treatment strategies, we evaluated pharmacological genome demethylation for the increase of irradiation treatment effectiveness in head and neck squamous cell carcinoma (HNSCC) in this in vitro study. HNSCC cells were cultured with 2 different concentrations of 5-azacytidine (5-Aza) for 72 h, followed by a single fraction irradiation with 4 or 50 Gy, respectively. To show successful genome demethylation, the methylation status of the tumor suppressor gene hic1 (hypermethyla…

Verbesserte Orts- und Kontrastauflösung in der Ultraschalldiagnostik durch Nutzung Harmonischer Frequenzen

Background: The aim of new techniques in head and neck sonography is to increase the sensitivity and the specificity of the examination, With tissue harmonic imaging (THI) and contrast harmonic imaging (CHI) new techniques are available which allow increased contrast and resolution in head and neck sonography as well as a better detection of small blood vessels. Methods: We studied whether these techniques improve sonographic detection of head and neck lymph nodes and primary tumours of the upper aerodigestive tract. Results: The results indicate that THI allows a better detection of cervical lymph nodes. Furthermore, intranodal structures and the borders of the lymph node can be better det…

Long-Term Functional Outcome after Unilateral Cordectomy

&lt;i&gt;Purpose of the Study:&lt;/i&gt; Our aim was to longitudinally analyze the vocal outcome after endoscopic CO&lt;sub&gt;2&lt;/sub&gt; laser resection of early glottic carcinoma. &lt;i&gt;Procedures:&lt;/i&gt; Sixteen patients treated with laser surgery for T1 or T2 tumors of the vocal cords received voice therapy and were examined 1, 2, 3, 4.5, 6 and 12 months postoperatively. Besides videolaryngostroboscopy, each examination included history, phonetogram of the speaking and the singing voice, language-specific hoarseness diagram and a questionnaire (Voice Handicap Index 12 in German). &lt;i&gt;Results:&lt;/i&gt; Objective parameters demonstrated a broad variability with a slight ten…

Diltiazem for Prevention of Acoustical Trauma during Otologic Surgery

100 patients were tested in a prospective, randomized, double-blinded study to assess the perioperative efficacy of a calcium channel blocker (diltiazem) in preventing acoustical trauma during otologic surgery. The patients were randomly divided into a therapy group (diltiazem) and a control group (placebo). Bone conduction hearing thresholds were examined preoperatively and again 1 day and 3 months postoperatively. Frequency-dependent changes in postoperative bone conduction and the number of patients with various degrees of postoperative hearing loss in both groups were statistically analyzed. The results indicated only a small postoperative hearing loss after ear surgery in both groups. …

Neurinoma of the jugular foramen.

The complementary predications of modern imaging techniques, CT, MRI and intraarterial digital subtraction angiography (i.a. DSA), in the differential diagnosis of a neurinoma of the jugular foramen are described.

Stentgraft-Implantation for Treatment of Internal Carotid Artery Injury during Endonasal Sinus Surgery

Background Damage of the internal carotid artery (ICA) is very rare but can be a dramatic complication of endonasal sinus surgery. In the literature only a few cases are reported, some of them with fatal results. Methods We present two cases with massive bleeding of the ICA caused by endonasal sinus surgery. Results In both cases bleeding could be stopped sufficiently by implanting a stentgraft. Conclusion The lumen of the artery could be preserved and no neurological deficits were observed.

DNA measurements for monitoring chemotherapy in advanced head and neck carcinomas

Background. Quantitative DNA measurements have demonstrated prognostic relevance in various malignancies, including head and neck cancer. The application of DNA measurements in monitoring and predicting the outcome of chemotherapy in treating patients with head and neck cancer was investigated. Methods. Twenty-five patients with advanced squamous cell carcinomas of the head and neck who underwent primary chemotherapy with three courses of cisplatin and 5-fluorouracil (5-FU) were examined in this study. Cytologic smears from the tumor site, as well as from normal mucosa, were taken before and 1 week after each course of chemotherapy. Quantitative DNA measurements were performed using an auto…

The Candy Smell Test in Clinical Routine

Background The “Candy Smell Test” (CST) has been introduced as a new testing method for the evaluation of the human sense of smell. In contrast to other established orthonasal smell tests, the CST addresses the retronasal application of odors, typical for food aroma effects during mastication and swallowing. The aim of this study was to evaluate the CST in a clinical setting in patients with olfactory dysfunction and normal controls against the Sniffin’ Sticks test. Furthermore, cutoff points for normal and pathological results in the CST should be determined. Methods The olfactory performance of 96 patients presenting with olfactory disorders and 71 healthy controls was evaluated with the …

Yamik Sinus Catheter in the Topical Treatment of Patients with Acute Rhinosinusitis after Previous Sinus Surgery

Background The Yamik sinus catheter was designed as a new device for the topical treatment of rhinosinusitis. It creates intermittent positive and negative intranasal pressure after sealing the ipsilateral nostril and choana with two inflatable cuffs. Affecting the nasal cavity and all paranasal sinuses of one side at a time, it is used to evacuate mucous and secretions as well as and to introduce antiseptic, antibacterial, or antifungal solutions. Methods This study was designed to evaluate the effectiveness of the Yamik catheter in cases of acute purulent rhinosinusitis in patients who previously underwent endonasal sinus surgery for chronic rhinosinusitis. Twenty patients were treated at…

Quality of Life in Sporadic Vestibular Schwannoma: A Review

Quality of life (QoL) measures are increasingly used as outcome measures in the assessment of different treatment options in clinical practice and as endpoints in clinical trials. Methods and questionnaires currently used for QoL assessment in vestibular schwannoma (VS) patients, studies evaluating QoL before and after treatment, studies on patients managed conservatively and studies evaluating facial-nerve-function-related QoL in VS patients are reviewed. Current methodological controversial issues in QoL studies on VS patients include the lack of a planned prospective comparison between QoL values before and after treatment, a need for the inclusion of additional questions along with stan…

Characteristics of recurrent chronic rhinosinusitis after previous surgical therapy.

Our findings emphasize the role of a thorough diagnostic evaluation preoperatively and a targeted long-term medical therapy following any sinonasal surgery for inflammatory disease. Early onset of long-term aspirin desensitization can address a very predominant inflammatory stimulus in a large number of our patients in an effort to prevent recurrent chronic rhinosinusitis (CRS) after successful surgical therapy.Postoperative recurrence of CRS, regardless of the ongoing evolution of diagnostic and surgical techniques, still poses an unsolved problem.This investigation was designed to further characterize the role of aspirin intolerance (AI) and inhalant allergies as persistent inflammatory s…

Doxycycline reduces nitric oxide production in guinea pig inner ears.

Abstract Objective Gentamicin application is an important therapeutic option to control vertigo spells in Meniere's disease. However, even in the case of low-dose intratympanic application, gentamicin might contribute to a pathological NO-increase leading to cochlear damage and hearing impairment. The study was performed to evaluate the nitric oxide (NO) reducing capacity of doxycycline in the inner ear after NO-induction by gentamicin. Methods In a prospective animal study, a single dose of gentamicin (10 mg/kg body weight) was injected intratympanically into male guinea pigs (n = 48). The auditory brainstem responses (ABRs) were recorded prior to application and 3, 5 and 7 days afterwards…

Lack of neurofibromatosis type 2 gene promoter methylation in sporadic vestibular schwannomas.

&lt;i&gt;Background:&lt;/i&gt; Vestibular schwannomas (VS) are benign tumors of the nervous system that are usually sporadic but also occur in the inherited disorder neurofibromatosis type 2 (NF2). In VS, losses of chromosomal material and mutations of the NF2 gene have been established to be causative. For a subset of VS without detectable gene alterations, promoter inactivation by hypermethylation has been suggested. However, published data are very limited and contradictory. &lt;i&gt;Methods:&lt;/i&gt; We analyzed NF2 gene promoter methylation in 35 sporadic VS by methylation-specific PCR. &lt;i&gt;Results:&lt;/i&gt; Twenty-three of the tumors were informative, showing no promoter methyl…

The supracondylar approach to the jugular tubercle and hypoglossal canal.

BACKGROUND Circumscribed lesions of the hypoglossal canal and of the jugular tubercle still remain a surgical challenge. So far, transpetrosal, transcondylar suboccipital, and extreme lateral approaches have been used to access this region. These surgical procedures bear a high risk for neurological deficits. Therefore, we introduce a new minimally invasive extradural approach to the hypoglossal canal that also allows access to the lateral aspects of the jugular tubercle. METHODS After a paramedian retromastoid skin incision, a basal suboccipital craniectomy lateral to the foramen magnum toward the jugular tubercle is performed. With this approach the occipital condyle and the lateral osseo…

Nuclear and Cytoplasmic Survivin: Molecular Mechanism, Prognostic, and Therapeutic Potential.

Abstract Survivin's proposed dual role as an apoptosis inhibitor and a mitotic effector positioned it in the front line of cancer research. Notably, survivin is detected as a cytoplasmic and nuclear protein in cancer patients, which stimulated numerous studies to investigate and to speculate on the functional and prognostic significance of its dynamic localization. Recent evidence shows that the direct interaction of survivin with the nuclear export receptor Crm1 is critically involved in its intracellular localization and cancer-relevant functions. Here, we review our current understanding of the Crm1/survivin interface and discuss its potential prognostic and therapeutic relevance. [Cance…

Management of head and neck paragangliomas: review of 120 patients.

Head and neck paragangliomas (PGL) are rare, mostly benign tumors. About 10% to 15% of PGL are caused by mutations in the succinate dehydrogenase genes B, C, or D and may appear multifocally.A retrospective review of 120 patients with 146 head and neck PGL, including 46 carotid body tumors (CBT), 13 vagal tumors, 55 jugulotympanic tumors (JTT), 25 tympanic tumors (TT) and 7 tumors in other locations are included. The internal carotid artery was preserved in 97.5% of CBT resections. Preservation of hearing was achieved in 92% of JTT and 88% of TT resections.According to our experience, the treatment of PGL must be individualized, taking into account the patient's age, medical condition, tumo…

New Immunohistologic Findings on the Differential Role of Cyclooxygenase 1 and Cyclooxygenase 2 in Nasal Polyposis

Background Cyclooxygenase 1 (Cox-1) plays a key role in arachidonic acid metabolism and in the pathophysiology and immunology of nasal polyposis in patients suffering from aspirin intolerance. We hypothesize that Cox-2 also might be relevant in the etiology of nasal polyps of aspirin-tolerant patients by their effects on inflammatory mediators as well as on microvascular permeability. Methods Fifty-two surgical specimens were immunohistochemically labeled for Cox-1 and Cox-2. Specimens were taken from chronically inflamed mucosa (n = 19) and from nasal polyps (n = 19) during endonasal sinus surgery. Controls were obtained from healthy nasal respiratory mucosa (n = 14), harvested during turb…

Malignant paraganglioma caused by a novel germline mutation of the succinate dehydrogenase D-gene--a case report.

Background Paragangliomas of the head and neck are rare, mostly benign tumors. Approximately 10% to 15% of paragangliomas are caused by mutations in the succinate dehydrogenase (SDH) genes B, C, or D. These are often multifocal as part of paraganglioma syndromes and hormone secreting, and malignant particularly associated with mutations in SDHB. Methods and Results A 29-year-old man was seen with recurrent paraganglioma. The patient's father reportedly suffered from bilateral carotid body tumors. Imaging studies showed metastases in both lungs and the liver. There was no increased hormone production by the tumor. Sequence analysis of the SDH genes revealed a novel C to T nonsense mutation i…

Nanoparticle Size Is a Critical Physicochemical Determinant of the Human Blood Plasma Corona: A Comprehensive Quantitative Proteomic Analysis

In biological fluids, proteins associate with nanoparticles, leading to a protein "corona" defining the biological identity of the particle. However, a comprehensive knowledge of particle-guided protein fingerprints and their dependence on nanomaterial properties is incomplete. We studied the long-lived ("hard") blood plasma derived corona on monodispersed amorphous silica nanoparticles differing in size (20, 30, and 100 nm). Employing label-free liquid chromatography mass spectrometry, one- and two-dimensional gel electrophoresis, and immunoblotting the composition of the protein corona was analyzed not only qualitatively but also quantitatively. Detected proteins were bioinformatically cl…

Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis.

Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, snee…

Early stress response of human nasal respiratory epithelia after exposure to 1-methoxypropanol-2

To evaluate the impact of 1-methoxypropanol-2 (MEP) for the stimulation of an inflammatory response in human respiratory mucosa, we exposed 22 primary cell cultures of nasal respiratory epithelia of healthy individuals to MEP concentrations at the level of the German MAK-value (100 ppm) and to the 10-fold concentration (1000 ppm). After 4 and 24h we analyzed the transcription of TNF-alpha, IL-1beta, IL-6, IL-8, MCP-1, GMCSF, Cox-1 and Cox-2 by quantitative PCR as well as the release of the respective cytokines by ELISA. At both MEP concentrations we observed a significant increase of TNF-alpha-, IL-1beta-, IL-6- and Cox-2-transcripts after 4h. After 24h cytokine transcription of TNF-alpha, …

Epiphora Secondary to Blockage of the Lacrimal System: The Role of Endonasal Dacryocystorhinostomy

Stenosis of the lacrimal system may occur secondary to tumor, infection, trauma, and congenital etiologies. Attempts to remedy this problem often include irrigation and probing. However, if these fail, external or internal dacryocystorhinostomy (DCR) with or without stenting may be performed. The purpose of this article is to detail our experience with a microscopic endonasal approach to DCR utilized in 23 patients. This is a modification of an older accepted procedure which utilizes the modern techniques of endonasal sinus surgery. This approach has allowed for immediate restoration of drainage in 22 of 23 cases. In one case, the procedure was repeated because of restenosis at the level o…

Increased basic fibroblast growth factor release and proliferation in xenotransplanted squamous cell carcinoma after combined irradiation/anti-vascular endothelial growth factor treatment.

Novel strategies of cancer therapy combine irradiation and anti-angiogenic active compounds. However, little is known concerning the undesired cellular and molecular effects caused by this novel treatment concept. We used a mouse squamous cell carcinoma (SCC) xenotransplantation model to evaluate the potential undesired effects which compromise the success of this therapeutic combination. SCCs were subcutanously implanted in nude mice. Animals were treated with a fractionated irradiation scheme (5x4 Gy) alone or in combination with daily injections of anti-vascular endothelial growth factor (VEGF) antibodies. Controls remained untreated. Before and after treatment, resonance imaging (MRI), …

Endonasal Sinus Surgery: Extended versus Limited Approach

Background This study was designed to investigate whether two different surgical approaches in endonasal sinus surgery lead to different postoperative results in patients with chronic rhinosinusitis. Methods Sixty-five patients suffering from chronic rhinosinusitis were operated on with either a limited approach or an extended approach. They were examined preoperatively and reassessed during 3 months, 6 months, and long-term follow-up visits that included endoscopy, saccharin transport time, and the assessment of symptoms. Results The concept of this study was prospective, randomized, and multicenter (Mainz, Germany, and Moscow, Russia). The results of the two different surgical approaches …

Orbital complications of pediatric sinusitis: treatment of periorbital abscess.

Twenty-six children requiring surgical intervention for orbital complications of acute sinusitis were treated at our institutions between 1985 and 1995. Twenty patients were successfully treated surgically utilizing endoscopic/microscopic endonasal surgery, or traditional external ethmoidectomy. However, six patients failed to respond to initial surgical attempts and ultimately required a revision. In one of these six patients the development of an intracranial abscess also necessitated a craniotomy for surgical drainage. Analysis of these six failures was performed with special attention given to the reasons for initial surgical failure and possible means for preventing revision surgeries…

Multifocal adult rhabdomyoma of the head and neck: a case report and literature review.

Adult rhabdomyoma is a rare, usually solitary, primary tumour of striated muscle origin that almost exclusively presents in the head and neck region with predilection for male. We herein present a rare case of a multifocal adult rhabdomyoma in a 72-year-old woman. The lesions were located, the first one in the area of the left aryepiglottic fold and the second one right cervical arising from oesophagus. The diagnosis of the cervical mass was obtained prior to resection through cytological examination (FNAC). We discuss the clinical, cytological and histological findings and we provide a brief review of the literature on this entity.

Polysomnography and ApneaGraph in patients with sleep-related breathing disorders.

&lt;i&gt;Purpose:&lt;/i&gt; To evaluate whether ApneaGraph (AG) and polysomnography (PSG) deliver comparable results in patients with sleep-related breathing disorders. &lt;i&gt;Procedures:&lt;/i&gt; A prospective study was performed, which included 14 patients with obstructive sleep apnea syndrome. Apnea-hypopnea index (AHI), hypopnea index (HI), apnea index (AI), obstructive, central and mixed apnea, oxygen saturation (SaO&lt;sub&gt;2&lt;/sub&gt;), pulse and body position were simultaneously assessed by PSG and AG in each individual. &lt;i&gt;Results:&lt;/i&gt; There was a good correlation between measurements of AG and PSG for AHI, pulse, SaO&lt;sub&gt;2&lt;/sub&gt;, body position and ce…

Die Bedeutung eosinophiler Granulozyten in Beziehung zu Allergie und Aspirin-Intoleranz bei Patienten mit Sinusitis polyposa

BACKGROUND The development of nasal polyps might be influenced by different factors such as mucosal inflammation. Infiltration with eosinophils is a common finding, although in largely different quantitis. PATIENTS AND METHODS We investigated 58 patients suffering from nasal polyps who were assigned for endonasal sinus surgery based on endoscopic and CT findings. Out of these patients, 52% have already had sinus surgery and had recurrent polyps. All patients were subjected to both, allergy testing and a functional in vitro test for aspirin intolerance. During surgery, tissue samples were gained and send for histological examination with special respect to eosinophil infiltration. RESULTS Eo…

Dynamic intracellular survivin in oral squamous cell carcinoma: underlying molecular mechanism and potential as an early prognostic marker

Survivin functions as an apoptosis inhibitor and a regulator of cell division in many tumours. The intracellular localization of survivin in tumours has been suggested as a prognostic marker. However, current reports are inconsistent and the underlying molecular mechanisms are not understood. The present study has examined the localization and prognostic value of nuclear and cytoplasmic survivin in the pre-therapeutic biopsies from 71 oral and oropharyngeal squamous carcinoma (OSCC) patients. Statistical analysis indicated that preferential nuclear versus cytoplasmic survivin correlated with favourable versus unfavourable disease outcome. Uni- and multi-variate analysis showed that in contr…

Dynamic posturography findings predict balance status in vestibular schwannoma patients.

OBJECTIVE To test whether condition 5 score (C5S) and condition 6 score (C6S) of the sensory organization test of computerized dynamic platform posturography (CDPP) differ between vestibular schwannoma (VS) patients with and without vestibular symptoms. STUDY DESIGN Retrospective review of prospectively collected data. SETTING Tertiary academic referral center. PATIENTS Two hundred and sixteen consecutive patients with a histological diagnosis of a VS (103 women; 113 men; age range, 18-78 years; median, 54 years) who had been preoperatively evaluated by CDPP. A hundred and twelve patients had a history of vertigo, dizziness, and/or imbalance, and 104 patients had neither present nor past ve…

The Drainage System of the Paranasal Sinuses: A Review with Possible Implications for Balloon Catheter Dilation

Background Intersinus connections and accessory ostia of the maxillary sinus are well known to rhinologic surgeons but are less known for the remaining paranasal sinuses. Probing and dilatation of the natural ostia of diseased sinuses is being popularized currently by the clinical value of balloon catheter dilation (BCD). Although short-term high success rates with treatment of the dilated ostia/duct have been reported with this technique, the potential impact of fractures of adjacent bony septae on accessory sinus ostia, on mucosally lined surfaces, and on intersinus drainage pathways still has not been considered. The aim of this study was to review the literature on accessory sinus ostia…

Technical Note: Minimal Access Surgery for Cochlear Implantation with MED-EL Devices

&lt;i&gt;Background:&lt;/i&gt; Minimally invasive techniques have been described for cochlear implant surgery, but so far this had not been the case for Med-EL devices. &lt;i&gt;Objective:&lt;/i&gt; To describe a newly developed minimal access approach for the implantation of Med-EL devices and report our results after up to 1 year of follow-up in 52 patients. &lt;i&gt;Discussion:&lt;/i&gt; The use of a minimally invasive approach without raising a flap or extensive drilling of a bony well was feasible in all 52 patients of this series. It shortened the surgical time to an average of 45 min and there were no specific postoperative complications. The average follow-up of 8.4 months was uneve…

Inducible NO synthase confers chemoresistance in head and neck cancer by modulating survivin

The dual role of the inducible NO synthase (iNOS) and NO signaling in head and neck squamous cell carcinoma (HNSCC) is a complex and can both promote or inhibit tumor progression. However, the underlying molecular mechanisms are not yet resolved in detail. We show for the first time that conditions, favoring low NO levels conferred resistance against cisplatin/taxol-induced apoptosis in HNSCC cell lines. Cytoprotection was mediated by survivin, because we observed its upregulation subsequent to low doses of the NO donors S-nitroso-N-acetyl-penicillamine (SNAP) and sodium nitroprusside (SNP) or ectopic expression of physiologic amounts of iNOS. Also, RNAi-mediated depletion of survivin block…

Hearing results after hypotympanotomy for glomus tympanicum tumors.

We postulate, that glomus tympanicum tumors (GTTs) may be safely removed without interference with the ossicular chain via a hypotympanotomy approach.Prospective, nonrandomized anatomic and clinical study.Tertiary referral center.All 17 patients between 1989 and 2009 with GTTs without involvement of the lumen of the jugular bulb.We used a modified hypotympanotomy approach. Our technique is a modification of the one first published by Shambaugh (1955). Pure-tone audiograms were performed in all patients. Preoperative and postoperative audiograms were modeled in a linear mixed model evaluating hearing threshold for air and bone conduction and air-bone gap at 500, 1,000, 2,000, and 3,000 Hz. I…

Topical Antibiotic, Antifungal, and Antiseptic Solutions Decrease Ciliary Activity in Nasal Respiratory Cells

This study was designed to investigate whether topical solutions, as they are used in the treatment of selected cases of rhinosinusitis, influence nasal mucociliary clearance. The objective of this study was to evaluate the effects of the following topical solutions on the ciliary beat frequency (CBF) of nasal respiratory cells: ofloxacin as an antibiotic; Betadine and hydrogen peroxide (H2O2) as antiseptic; and amphotericin B, itraconazole, and clotrimazole as antifungal solutions. Differences are described between effects of each of these substances and we clarify whether ciliotoxic effects are dose dependent and if they can be reduced or eliminated by diluting the concentration of the a…

Breathe Right Nasal Strips and the Respiratory Disturbance Index in Sleep Related Breathing Disorders

This investigation assesses the effects of Breathe Right nasal strips on the respiratory disturbance index (RDI) measured by polysomnography in patients suffering from obstructive sleep apnea and snoring. The positive effect of these strips on nasal ventilation was shown in earlier studies. Twenty-six patients with an RDI higher than 10 in an initial measurement underwent a second preoperative polysomnography with Breathe Right nasal strips in place. Nineteen of these 26 patients showed reduction of RDI during the second night of polysomnography using the nasal strips, indicating that nasal obstruction seems to be a predominant factor in the etiology of snoring and apnea in these individua…

Evidence for a possible NOS back-up system in the organ of Corti of the guinea pig

Recently, the two Ca(2+)/calmodulin-regulated nitric oxide synthase isoforms, nNOS and eNOS, and NO itself have been identified in the cochlea of vertebrates using specific antibodies and a new fluorescence indicator. In order to acquire more information about the quantitative and spatial distribution of these two constitutively expressed NOS isoforms (cNOS) in the organ of Corti at the cellular and subcelluar levels, ultrathin sections of London resin (LR) White-embedded cochleae of the guinea pig were incubated with various concentrations of commercially available antibodies to nNOS and eNOS. The immunoreactivity was visualized by a gold-labeled secondary antibody and the amount of the im…

Measurement of Pharyngeal Pressure in Patients using Nasal CPAP

In patients with obstructive sleep apnea syndrome (OSAS), nasal continuous positive airway pressure (nCPAP) prevents pharyngeal collapse by applying positive pressure transnasally. Currently there are not objective criteria to determine whether surgical improvement of nasal resistance is necessary in patients undergoing nCPAP treatment. In 16 patients with documented OSAS, inspiratory and expiratory pressures in the pharynx were measured during nCPAP with pressures ranging from 5 to 20 mbar. Identical studies were performed in 12 patients with severe nasal obstruction without OSAS and in eight normal patients. The results of each group were compared to the nasal resistance as measured by a…

Spontaneous cerebrospinal fluid rhinorrhea: A clinical and anatomical study

Objectives/Hypothesis: Spontaneous nasal cerebrospinal fluid (CSF) fistula represents a rare clinical entity. The possible etiology and the localization of the rhinorrhea remain an ongoing clinical challenge. The purpose of this study was to evaluate the localization of spontaneous CSF fistula and to correlate it with anatomical studies. Study Design: Retrospective clinical study, prospective anatomical study. Methods: Twenty-nine patients with spontaneous CSF rhinorrhea were retrospectively studied, 10 males and 19 females. Ages ranged from 10 to 92 years (mean, 50 years). In addition, 48 human skulls from newborns to adults were examined for the postnatal development of the anterior and m…

Low SPINK5 expression in chronic rhinosinusitis

Objectives/Hypothesis: Chronic rhinosinusitis (CRS) is a multifactorial disease that probably arises as a result of genetic diversity and environmental factors. SPINK5 is a serine protease inhibitor, which is supposed to be an important regulator of epithelial barrier maintenance. The role of SPINK5 polymorphisms and expression in CRS, especially in individuals with aspirin intolerance, is unclear. Study Design: SPINK5 single-nucleotide polymorphisms (SNPs) and SPINK5 expression levels were correlated with CRS without (CRSsNP) and with nasal polyps (CRSwNP), aspirin intolerance, asthma, and allergies. Methods: One hundred four nasal tissue samples, 15 from patients with CRSsNP, 59 from pati…

Ultrastructural evidence for protection of the outer hair cells of the inner ear during intense noise exposure by application of the organic calcium channel blocker diltiazem.

Outer hair cells could be protected during intense noise exposure by the application of the calcium channel blocker diltiazem given before and after noise treatment. After various experimental approaches, the ultrastructural morphology was analysed for the different animal populations in the basal part of the second turn of the cochlea, which was the most destroyed area after an acute noise trauma caused by a gun shot (sound pressure at the ear drum 156 dB, frequency maximum between 4 and 6 kHz). Compared to untreated control specimens (experimental animal group I), the outer hair cells in the basal part of the second turn of the cochlea were mostly destroyed without any diltiazem applicati…

Investigations for fine mapping of amplifications in chromosome 3q26.3-28 frequently occurring in squamous cell carcinomas of the head and neck.

&lt;i&gt;Objective:&lt;/i&gt; Overrepresentations of chromosomal material on the long arm of chromosome 3 frequently occur in squamous cell carcinoma of the head and neck. This experimental study was conducted for further fine mapping of these overrepresentations by interphase fluorescence in situ hybridization (FISH) of tumor cells in cell lines. &lt;i&gt;Methods:&lt;/i&gt; Seven cell lines derived from squamous cell carcinomas of the head and neck were investigated by comparative genomic hybridization to analyze unbalanced chromosomal aberrations. Overrepresentations of chromosomal material on the telomeric part of the long arm of chromsome 3 were further analyzed by interphase FISH using…

Die Rolle der Farbduplexsonographie bei Diagnose und Differentialdiagnose von Glomus-caroticum-Tumoren*

BACKGROUND Currently the diagnosis of tumorous lesions of the carotid bifurcation is the domain of magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). So far, colour Doppler imaging (CDI) has not been playing an important part in this field. The aim of this study was to define the diagnostic value of CDI in the evaluation of these tumours related to the big arteries and to compare the different imaging techniques. PATIENTS AND METHODS 6 female patients with suspected tumours of the carotid bifurcation were examined with CDI. Additionally 5 MRI examinations and 3 preoperative diagnostic DSA examinations were performed in the same patients. Pathologically, there were 4…

Cochlear origin of early hearing loss in vestibular schwannoma.

Objective: To test whether early hearing loss (HL) is cochlear in origin in patients with vestibular schwannoma (VS). Study Design: Retrospective case review in an academic tertiary referral center. Methods: A group of 19 VS patients with normal/symmetrical hearing and a group of 20 VS patients with mild HL (threshold at any tested frequency better than 45 dB HL) on the tumor ear side. Differences of the amplitudes of the distortion products of otoacoustic emissions (DPOAEs) between the tumor ear and the nontumor ear were studied at frequencies of 1, 1.4, 2, 2.8, and 4 kHz. The Wilcoxon test was used to compare the ears for both groups and to test for possible differences in tumor size betw…

Reactive oxygen species activation of MAPK pathway results in VEGF upregulation as an undesired irradiation response

Background Radioresistance limits the effectiveness of radiotherapy in head and neck squamous cell carcinoma. We previously demonstrated post-radiogenic mitogen-activated protein kinase (MAPK) pathway activation and vascular endothelial growth factor (VEGF) release resulting in reduced tumor cell response. Here, we examined the association of this mechanism with the induction of reactive oxygen species (ROS) under irradiation (IR). Methods Intracellular ROS after IR were measured. We modeled radiation-induced ROS by exposure of two SCC lines to H2O2 and evaluated the impact of irradiation and ROS on ERK phosphorylation by Western blot, immunohistochemistry, and ELISA. Results We found eleva…

Gentamicin increases nitric oxide production and induces hearing loss in guinea pigs.

Objectives/Hypothesis: Gentamicin application is an important therapeutic option for Meniere's disease. However, even if given at intervals, a destruction of the cochlea was often observed in various animal models together with an increased content of nitric oxide (NO) and reactive oxygen species. The present study was undertaken to identify the correlation between hearing threshold alteration and the NO production in the lateral wall and organ of Corti of the guinea pig in response to gentamicin application. Study Design: Prospective animal study in guinea pigs. Methods: A single dose of gentamicin (10 mg/kg body weight) was injected intratympanally into male guinea pigs and the auditory b…

Prostaglandin E2 activates the ciliary beat frequency of cultured human nasal mucosa via the second messenger cyclic adenosine monophosphate.

Prostaglandins influence the ciliary beat frequency (CBF) of ciliated nasal epithelial cells and a stimulatory effect has been described for prostaglandin E2 (PGE2). Until now, it is not known whether PGE2 has direct ciliostimulatory properties or acts through a second messenger. In this study we investigated whether cyclic adenosine monophosphate (cAMP) is implicated in the signal transduction pathway of PGE2-induced activation of CBF. Ciliated cells of the nasal mucosa were cultured for up to 5 days whereafter the culture medium was removed and the cells were incubated with different concentrations of test solutions. The ciliated cells were recorded under a phase-contrast microscope and v…

Intermittent Dyspnea and Cyanosis in a Newborn Caused by a Hairy Polyp

Non-pheochromocytoma (PCC)/paraganglioma (PGL) tumors in patients with succinate dehydrogenase-related PCC-PGL syndromes: a clinicopathological and molecular analysis

ObjectiveAlthough the succinate dehydrogenase (SDH)-related tumor spectrum has been recently expanded, there are only rare reports of non-pheochromocytoma/paraganglioma tumors in SDHx-mutated patients. Therefore, questions still remain unresolved concerning the aforementioned tumors with regard to their pathogenesis, clinicopathological phenotype, and even causal relatedness to SDHx mutations. Absence of SDHB expression in tumors derived from tissues susceptible to SDH deficiency is not fully elucidated.Design and methodsThree unrelated SDHD patients, two with pituitary adenoma (PA) and one with papillary thyroid carcinoma (PTC), and three SDHB patients affected by renal cell carcinomas (RC…

Tree-pollen allergy is efficiently treated by short-term immunotherapy (STI) with seven preseasonal injections of molecular standardized allergens.

The efficacy and tolerance of short-term immunotherapy (STI) by seven preseasonal injections of tree-pollen allergens (ALK7 Fruhbluhermischung) was investigated in a double-blind, placebo-controlled, multicenter study with 111 rhinoconjunctivitis patients. Nasal and bronchial symptoms simultaneously analyzed, and nasal symptoms as a single end point, but not the overall score of nasal, bronchial, and conjunctival symptoms, showed a significantly lower increase with STI during birch-pollen exposure (both P=0.033, n=105, Mann-Whitney U-test). However, a selective analysis with patients from centers with high recruitment figures (n> or =10 patients, n=29 STI, n=32 placebo) showed a significant…

Sonographische Charakteristika laterozervikaler Raumforderungen

UNLABELLED Sonography of the head and neck mainly focuses on tumours of the lateral neck. Even though most of these masses are enlarged lymph nodes, other tumors have to be considered. AIM To determine whether different pathological cervical masses display a characteristic sonographic morphology. METHOD On the basis of 530 sonographical findings in the neck, typical ultrasound characteristics either in B-scan or in colour coded sonography were demonstrated. RESULTS Apart from enlarged lymph nodes, it was possible to differentiate other occurrences such as branchial cysts, abscesses, laryngoceles, lipomas, neurinomas, glomus tumours, paragangliomas and also fibromas by their specific ultraso…

The exposure of healthy volunteers to 200 ppm 1,1,1-trichloroethane increases the concentration of proinflammatory cytokines in nasal secretions

Objectives: Irritating effects of organic solvents have usually been measured by means of questionnaires. The aim of the present study was to evaluate the sensitivity of different methods of detecting subclinical irritating effects. Methods: Twelve healthy, non-smoking students were exposed to 200 ppm and to 20 ppm 1,1,1-trichloroethane in an exposure chamber, using a crossover design. The amounts of interleukins (IL)-1β, IL-6 and IL-8 and prostaglandin E2 (PGE2) in nasal secretions were measured. Mucociliary transport time was determined with the saccharine test. Ciliary beat frequency of nasal epithelial cells was measured with video-interference contrast microscopy. Subjective symptoms w…

Characterization of nitric oxide synthase isoforms expressed in different structures of the guinea pig cochlea.

Nitric oxide synthase (NOS) activity and NADPH diaphorase staining has previously been reported in mammalian cochlea. Here we demonstrate immunoreactivity for neuronal-type NOS I and endothelial-type NOS III in the cochlea of the guinea pig. NOS I immunoreactivity was seen in inner and outer hair cells, and spiral ganglion cells. Staining for NOS I was also shown in basal and intermediate cells of the stria vascularis, spiral ligament cells, and the media of vessels near the modiolus. An antibody to NOS III stained primarily vascular endothelial cells. Some NOS III immunoreactivity was also detected in spiral ganglion cells. An antibody to the inducible-type NOS II did not stain any structu…

Role of fungus in eosinophilic sinusitis.

Chronic rhinosinusitis is characterized by a broad diagnostic and etiologic spectrum. It has been postulated that fungal organisms might represent the immunologic target initiating and maintaining the disease process in patients with chronic rhinosinusitis as a common denominator. This review analyzes the available data to describe the current understanding of the role of fungus in the pathophysiology of chronic rhinosinusitis.Recent findings have demonstrated that using highly sensitive methods, the detection rate of fungi in nasal mucin can be increased to approximately 100% in patients and in healthy controls. If this ubiquitous fungal contamination were to be related to a causative mech…