B. Sedlmaier

Tacrolimus: A new option in therapy-resistant chronic external otitis

Objective: To evaluate the efficacy of the novel topical immune modulator tacrolimus in chronic uninfectious otherwise therapy‐resistant external otitis (EO).

Rhinitis medicamentosa: therapeutic effect of diode laser inferior turbinate reduction on nasal obstruction and decongestant abuse.

Background The purpose of this study was to evaluate long-term outcomes of an outpatient-based diode laser inferior turbinate reduction (ITR) in therapy-refractory rhinitis medicamentosa (RM). Methods In a prospective clinical investigation, 42 consecutive RM patients underwent videoendoscopic ITR with a diode laser after topical anesthetic preparation. Intra- and perioperative details were recorded including the occurrence of bleeding, crusting, pain, or discomfort. Treatment efficiency was assessed by follow-ups 1 and 6 weeks as well as 6 and 12 months after surgery. Subjective pre- and posttherapeutic nasal airflow (NA) and patient satisfaction were rated on visual analog scales (VASs). Assessment of the long-term objective clinical effectiveness was based on rhinomanometry, IT photodocumentation, and the recurrent need for decongestants. Results Preoperative addiction to decongestants lasted 5 ± 2 years (mean ± SD). There was no major bleeding requiring nasal packing, and there were no other perioperative complications. Postoperative edema disappeared within the 1st week and crusting within 6 weeks after surgery. VAS was characterized by very low values for intraoperative pain and discomfort and high postoperative patient satisfaction. After 6 months, NA data revealed a significant improvement of subjective VAS and objective rhinomanometry (250.4–413.9 cm3/s inspiration at 150 Pa). A total of 88% of patients managed to successfully stop decongestant abuse after 6 months (74% after 1 year). Conclusion In therapy-refractory RM, outpatient diode laser ITR of hyperplastic IT represents a highly effective, safe, and well-tolerated treatment option that provides long-lasting recovery by markedly improving NA and stopping addiction to nasal decongestants.

A comparison of white light laryngostroboscopy versus autofluorescence endoscopy in the evaluation of vocal fold pathology

To prove the diagnostic value of autofluorescence endoscopy (AFE) and white light laryngostroboscopy (WLS) versus the gold standard microlaryngoscopy with histopathological examination in differential diagnostics of laryngeal lesions for experienced phoniatricians and laryngologists, using the PENTAX SAFE‐3000 system.

Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia. Clinical results

INTRODUCTION The aim of this retrospective study was to present the postoperative development, therapy effectiveness, and parental satisfaction after an outpatient diode laser tonsillotomy in children with noninflammatory tonsillar hyperplasia. METHOD The study included 183 children with noninflammatory tonsillar hyperplasia who were operated on between October 2004 and October 2006 (average age: 4 years and 7 months). All children underwent diode laser tonsillotomy in contact mode (812 nm, continuous wave, 13 W) with or without additional procedures (adenotomy, paracentesis, tympanic drainage). All surgeries were carried out under endotracheal anesthesia by two ENT physicians in private practice in an outpatient surgery center. The patients (n=82) of one of the physicians were given an oral antibiotic for the 7 days following the surgery (cefuroxime syrup), and all children were given standard pain medication after the surgery (ibuprofen syrup). The postoperative development, complications, or late complications, the recurrence frequency, the effectiveness of the treatment, and the parental satisfaction were assessed using the respective results of the follow-up exams (average follow-up period: 1 year) and a standardized parent questionnaire, completed on average 1 year and 8 months after the surgery. For data digitalizing and statistical analysis with SPSS the chi(2) test and the Wilcoxon test were used (p<0.05). RESULTS Generally, patients experienced no or only very little pain, and there was no secondary bleeding after tonsillotomy. Occasionally, a conspicuous wound surface (2.9%), fever (2.3%), or reddened palatal arch (1.2%) were noted. There were no late complications such as scar tissue distortions on the soft palate or peritonsillar abscesses. The procedures effectiveness with regard to snoring, obstructed respiration, apnea, lack of appetite, and susceptibility to infection was very good and the level of parental satisfaction very high. The postoperative development showed significant differences between the two groups (with and without oral antibiotic) concerning postoperative pain (point score: 0-3): in the antibiotics group there was no postsurgical pain (average point score: 0.1), and in the group without antibiotics there was slight postsurgical pain (point score: 0.5). CONCLUSION Outpatient diode laser tonsillotomy for children with symptomatic tonsillar hyperplasia is a rather painless surgery method with a low perioperative risk, very high treatment effectiveness, and parental satisfaction. For this indication tonsillotomy is the therapy of choice. There were no differences in terms of postoperative development between the diode laser tonsillotomy compared to the literature of the more common CO(2) laser tonsillotomy.

Ambulant durchgeführte Diodenlasertonsillotomie bei symptomatischer Tonsillenhyperplasie des Kindes

INTRODUCTION The aim of this retrospective study was to present the postoperative development, therapy effectiveness, and parental satisfaction after an outpatient diode laser tonsillotomy in children with noninflammatory tonsillar hyperplasia. METHOD The study included 183 children with noninflammatory tonsillar hyperplasia who were operated on between October 2004 and October 2006 (average age: 4 years and 7 months). All children underwent diode laser tonsillotomy in contact mode (812 nm, continuous wave, 13 W) with or without additional procedures (adenotomy, paracentesis, tympanic drainage). All surgeries were carried out under endotracheal anesthesia by two ENT physicians in private practice in an outpatient surgery center. The patients (n=82) of one of the physicians were given an oral antibiotic for the 7 days following the surgery (cefuroxime syrup), and all children were given standard pain medication after the surgery (ibuprofen syrup). The postoperative development, complications, or late complications, the recurrence frequency, the effectiveness of the treatment, and the parental satisfaction were assessed using the respective results of the follow-up exams (average follow-up period: 1 year) and a standardized parent questionnaire, completed on average 1 year and 8 months after the surgery. For data digitalizing and statistical analysis with SPSS the chi(2) test and the Wilcoxon test were used (p<0.05). RESULTS Generally, patients experienced no or only very little pain, and there was no secondary bleeding after tonsillotomy. Occasionally, a conspicuous wound surface (2.9%), fever (2.3%), or reddened palatal arch (1.2%) were noted. There were no late complications such as scar tissue distortions on the soft palate or peritonsillar abscesses. The procedures effectiveness with regard to snoring, obstructed respiration, apnea, lack of appetite, and susceptibility to infection was very good and the level of parental satisfaction very high. The postoperative development showed significant differences between the two groups (with and without oral antibiotic) concerning postoperative pain (point score: 0-3): in the antibiotics group there was no postsurgical pain (average point score: 0.1), and in the group without antibiotics there was slight postsurgical pain (point score: 0.5). CONCLUSION Outpatient diode laser tonsillotomy for children with symptomatic tonsillar hyperplasia is a rather painless surgery method with a low perioperative risk, very high treatment effectiveness, and parental satisfaction. For this indication tonsillotomy is the therapy of choice. There were no differences in terms of postoperative development between the diode laser tonsillotomy compared to the literature of the more common CO(2) laser tonsillotomy.

Laser-assisted cholesteatoma surgery: technical aspects, in vitro implementation and challenge of selective cell destruction.

Cholesteatoma is a destructive ear condition requiring complete surgical removal. One major problem lies in the frequent occurrence of residual cholesteatoma caused by squamous epithelium remaining in the middle ear. Our aim is to develop a laser treatment that is selectively directed against residual cholesteatoma cells and can be performed after cholesteatoma surgery in the same session. In a first trial, we studied the photodynamic effect of argon (AL) and diode lasers (DL) on cholesteatoma tissue. Intraoperatively harvested monolayer-cultured cholesteatoma cells were stained in vivo with different absorption enhancers: neutral red (NR), fluorescein diacetate (FDA), and indocyanine green (ICG). In vitro, staining tests on enhanced cellular dye absorption and laser tests were followed by cytotoxicity measurements to determine the respective amount of damage. To achieve selective cell destruction, antibody-mediated staining of cholesteatoma and middle ear mucosa cells was examined in a second trial. Cell cultures (cytospin and coverglass growing) and paraffin-embedded cholesteatoma tissue sections were studied immunohistochemically to determine the binding of monoclonal mouse antibodies against human cytokeratins CK5, CK10, CK14 and the epidermal growth factor receptor EGFR. Intracellular staining with absorption enhancers increased the optical density at the wavelength corresponding to the dye. Staining and subsequent laser irradiation destroyed up to 92% of cultured cholesteatoma cells. Unstained irradiated tissue was not affected. In cytospins, the antibody against CK5/6 showed strong staining of cholesteatoma and weak staining of mucosa cells. Reactivity for CK14 and EGFR was positive in both tissues. In coverglass cultures, staining of cholesteatoma cells was positive for CK5/6, CK14 and EGFR. Mucosa cells were positive for EGFR but negative for cytokeratins. Both cell types were negative for CK10. In embedded cholesteatoma tissue, CK5/6 and CK14 were localized in the basal layers of the matrix, while CK10 was situated in the suprabasal layers, and EGFR was present in all layers of the matrix and perimatrix. As for the technical aspects of laser-assisted cholesteatoma surgery, AL and DL have proved to be suitable devices; ICG and FDA are effective nontoxic absorption enhancers. The investigated antibodies against cytokeratins and EGFR show nonselective staining and thus appear to be inappropriate for avoiding unwanted cell damage. For safe and specific intraoperative application to intact tissue, the chromophore should be coupled to a particular antibody that binds solely to an easily accessible specific antigen at the surface of cholesteatoma cells.

[Topical immunomodulation. A milestone for the treatment of therapy-resistant noninfectious chronic external otitis?].

ZusammenfassungHintergrundRezidivierende Exazerbationen bei chronischer Otitis externa stellen für den Behandler eine besondere Herausforderung dar. Untersucht werden sollte die therapeutische Wirksamkeit einer neuen Klasse von lokal applizierbaren Immunmodulatoren mit antiinflammatorischem, nichtsteroidalem Wirkmechanismus.Patienten und MethodenIn einer prospektiven Studie an 33 Patienten erfolgte alle 2 (–3) Tage eine Streifeneinlage mit Tacrolimus-Salbe (Protopic® 0,1%), insgesamt 3-mal ein Streifenwechsel. Der Behandlungserfolg wurde durch Nachuntersuchungen, anhand einer Videodokumentation und eines standardisierten Befundbogens beurteilt.Ergebnisse28 Patienten zeigten eine signifikante Verbesserung der klinischen Symptomatik, 13 von ihnen eine komplette Heilung (Follow-up: 10–22 Monate). Bei Rezidiven (15 Fälle) waren die symptomfreien Intervalle signifikant verlängert und die Anzahl weiterer Episoden verringert.SchlussfolgerungDank ihrer sicheren und erfolgreichen antientzündlichen Wirkung stellen topische Immunmodulatoren eine neue Alternative bei chronisch therapieresistenter Otitis externa dar.AbstractBackgroundRecurrent exacerbation of chronic external otitis represents a special challenge for the attending physician. The goal of our study was to evaluate the effectiveness of novel topical immunomodulators acting through an anti-inflammatory, nonsteroidal mechanism.Patients and MethodsIn a prospective study, in 33 patients an ear wick containing tacrolimus ointment (Protopic 0.1%) was inserted every 2–3 days. Altogether, the wick was changed three times. Therapeutic outcomes were assessed by reexaminations, video-otoscopy, and a standardized findings sheet.ResultsTwenty-eight patients showed significant improvement of clinical symptoms, with 13 of them showing complete healing (follow-up 10–22 months). Relapses (15 cases) were associated with significantly extended symptom-free intervals and reduced numbers of further recurrent episodes.ConclusionsBecause of the safe and successful anti-inflammatory effects, topical immunomodulators represent a new alternative in chronic inflammatory stages of otherwise therapy-resistant external otitis.

Ambulant durchgeführte Diodenlasertonsillotomie bei symptomatischer Tonsillenhyperplasie des Kindes@@@Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia: Klinische Ergebnisse@@@Clinical Results

INTRODUCTION The aim of this retrospective study was to present the postoperative development, therapy effectiveness, and parental satisfaction after an outpatient diode laser tonsillotomy in children with noninflammatory tonsillar hyperplasia. METHOD The study included 183 children with noninflammatory tonsillar hyperplasia who were operated on between October 2004 and October 2006 (average age: 4 years and 7 months). All children underwent diode laser tonsillotomy in contact mode (812 nm, continuous wave, 13 W) with or without additional procedures (adenotomy, paracentesis, tympanic drainage). All surgeries were carried out under endotracheal anesthesia by two ENT physicians in private practice in an outpatient surgery center. The patients (n=82) of one of the physicians were given an oral antibiotic for the 7 days following the surgery (cefuroxime syrup), and all children were given standard pain medication after the surgery (ibuprofen syrup). The postoperative development, complications, or late complications, the recurrence frequency, the effectiveness of the treatment, and the parental satisfaction were assessed using the respective results of the follow-up exams (average follow-up period: 1 year) and a standardized parent questionnaire, completed on average 1 year and 8 months after the surgery. For data digitalizing and statistical analysis with SPSS the chi(2) test and the Wilcoxon test were used (p<0.05). RESULTS Generally, patients experienced no or only very little pain, and there was no secondary bleeding after tonsillotomy. Occasionally, a conspicuous wound surface (2.9%), fever (2.3%), or reddened palatal arch (1.2%) were noted. There were no late complications such as scar tissue distortions on the soft palate or peritonsillar abscesses. The procedures effectiveness with regard to snoring, obstructed respiration, apnea, lack of appetite, and susceptibility to infection was very good and the level of parental satisfaction very high. The postoperative development showed significant differences between the two groups (with and without oral antibiotic) concerning postoperative pain (point score: 0-3): in the antibiotics group there was no postsurgical pain (average point score: 0.1), and in the group without antibiotics there was slight postsurgical pain (point score: 0.5). CONCLUSION Outpatient diode laser tonsillotomy for children with symptomatic tonsillar hyperplasia is a rather painless surgery method with a low perioperative risk, very high treatment effectiveness, and parental satisfaction. For this indication tonsillotomy is the therapy of choice. There were no differences in terms of postoperative development between the diode laser tonsillotomy compared to the literature of the more common CO(2) laser tonsillotomy.

Die CO2-Laser-assistierte Perforationsanfrischung bei persistierender Trommelfellperforation

INTRODUCTION The standard treatment of persistent eardrum perforation is conventional surgical closure using myringoplasty or a tympanoplasty type I. In this study the valence of a modified, CO(2)-laser-assisted de-epithelialization of perforation margins was investigated. MATERIAL AND METHODS A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested. RESULTS Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment. CONCLUSION A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.

[CO2-laser-assisted de-epithelialization of perforation margins of persistent tympanic membrane perforations. An alternative to conventional surgical procedures].

INTRODUCTION The standard treatment of persistent eardrum perforation is conventional surgical closure using myringoplasty or a tympanoplasty type I. In this study the valence of a modified, CO(2)-laser-assisted de-epithelialization of perforation margins was investigated. MATERIAL AND METHODS A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested. RESULTS Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment. CONCLUSION A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.