Frank Schmäl

Bacteria and granulation tissue associated with Montgomery T-tubes.

Objectives Although complications (infection, development of granulation tissue) of silicone Montgomery T‐tubes have been reported, the microbiological consequences and the origin of granulation tissue have not yet been evaluated.

Preseptal transconjunctival approach for orbital floor fracture repair: ophthalmologic results in 209 patients

Conclusions. The transconjunctival approach to orbital floor fractures permits excellent exposure of the inferior orbit and provides a good surgical outcome, especially with regard to ocular motility. Objective. Surgical access to orbital floor fractures can be accomplished via the transconjunctival approach. The majority of studies on this subject deal with surgical aspects and complications. The purpose of this study was to report the ophthalmologic outcome after transconjunctival orbital floor fracture repositioning in a significant number of patients. Material and methods. In a retrospective study, the data of 209 patients with orbital floor factures treated via the transconjunctival approach with (n=181) and without (n=28) lateral canthotomy were analyzed. Results. The commonest cause of injury was forms of violence (32%). An isolated fracture of the orbital floor had occurred in 62 cases, while concomitant facial fractures were present in the remaining 147. A total of 24 patients (11%) had an exophthalmos and 13 (9%) an enophthalmos. Most patients (69%) complained of infraorbital dysesthesia. When elevating the eyeball, the majority of patients showed a marked or severe disturbance of ocular motility (53% in abduction; 51% in adduction) and diplopia (37% in abduction; 36% in adduction). Thirteen patients required repeat surgery. After a follow-up period of 2 years, infraorbital dysesthesia was observed in only three patients, one of whom presented with a considerable persistent enophthalmos of 4 mm, and only four patients had persistent reduced motility and diplopia.

Klinische Aspekte der abszedierenden Parotitis

ZusammenfassungFragestellung. Anhand eines größeren Kollektivs soll das diagnostische und therapeutische Vorgehen beim Parotisabszess dargestellt werden. Patienten und Methodik. Retrospektiv wurden die Daten von 36 Patienten (Durchschnittsalter 44 Jahre) mit abszedierender Parotitis analysiert. Ergebnisse. Die Diagnosestellung erfolgte sonographisch. Nach Abszessinzision und -drainage unter elektrophysiologischer Kontrolle des N. facialis kam es in nur 1 Fall zur temporären Funktionsstörung des R. marginalis mandibulae. Im Abszessabstrich fanden sich am häufigsten Staph. aureus, gefolgt von Streptokokken und Peptostreptokokken. Bei 2 Patienten lag eine Tuberkulose, bei 2 Kindern eine atypische Mykobakteriose vor, während bei 1 Patientin die Metastase eines Plattenepithelkarzinoms diagnostiziert wurde. Schlussfolgerungen. Bei jedem Patienten mit akut aufgetretener Schwellung der Regio parotidea, unabhängig von Lebensalter, abszesstypischer Fluktuation oder Leukozytenzahl, ist eine sonographische Untersuchung notwendig. Inzision und Drainage des Parotisabszesses sollten unter Monitoring des N. facialis (Cave: Muskelrelaxation) erfolgen. Darüber hinaus sind eine Probeexzision (Malignome oder atypische Mykobakterien) und ein Abstrich (Erregernachweis) dringend erforderlich. Vor Erhalt des Resistogramms ist die Therapie mit einer Aminopenicillin-Clavulansäure-Kombination oder einem Cephalosporin zu empfehlen.AbstractObjective. The purpose of this paper was to analyse parotideal abscesses on the basis of a larger number of patients. Patients and methods. The data of 36 patients (mean age 44 years) with a parotideal abscess was analysed. Results. Ultrasound scan was always necessary to verify the diagnosis. The surgical drainage was done under myoelectric monitoring of the facial nerve. Only in 1 patient a temporary minor paralysis of the mandibular branch was noticed. The most common bacteria were Staph. aureus, Streptococcus, and Peptostreptococcus. In 2 cases a tuberculosis and in 2 children an atypical mycobacterial infection was discovered. In another patient a metastasis of a squamous cell carcinoma was found. Conclusions. In every patient with an acute swelling of the parotid region without consideration of age, number of leucocytes or a typical fluctuation, an ultrasound scan should be used. The surgical drainage of the abscess should be done under myoelectric monitoring (Cave: muscle relaxant). In every case, a specimen for microbiological analysis (bacterial determination) and a biopsy (to exclude malignoma or atypical mycobacteria) are necessary. A peri- and postoperative therapy with a combination of aminopenicillin and clavulanic acid or with cephalosporine is recommended.

Episodisch auftretendes Schwindelgefühl

ZusammenfassungWährend ein einseitiger Funktionsausfall eines horizontalen Bogengangs oder des gesamten Gleichgewichtsorgans im Rahmen einer Neuropathia vestibularis oder als Folge einer Felsenbeinquerfraktur zu einem länger anhaltenden Schwindel führt, beschäftigt sich dieser Artikel mit dem Phänomen des in Episoden (Dauer: Sekunden bis Stunden) auftretenden Schwindels.Ursächlich können diesem Symptom sowohl peripher-vestibuläre als auch zentrale Störungen zugrunde liegen. Ziel dieses Fortbildungsartikels ist es, HNO-ärztliche und neurologische Erkrankungen darzustellen, die zu episodisch auftretendem Schwindelgefühl führen können.AbstractWhile an acute loss of unilateral vestibular function (for example in case of neuritis vestibularis or temporal bone fracture) leads to long-term vertigo, this paper deals with the phenomenon of episodic vertigo (duration: seconds up to hours).Both peripheral-vestibular and central disturbances can be responsible for this symptom. The aim of this paper is to present otological and neurological diseases which can lead to episodic attacks of vertigo.

Dynamic visual acuity during linear acceleration along the inter-aural axis

Abstract We investigated visual-vestibular interactions during linear acceleration along the inter-aural axis. Eighteen healthy volunteers and two patients with central neurological diseases were subjected to transaural linear acceleration in the direction of gravity force (frequency: 0.5–1.5 Hz; amplitude: 5 cm). During linear acceleration, eye movements were recorded under three test conditions: eyes closed (EC), while staring at an imaginary target (IT) and during the testing of dynamic visual acuity (DVA). As parameters of evaluation we used the amplitude of horizontal eye movements, phase shift and the decrease of DVA threshold (DVAT). Under all test conditions, eye amplitude increased with rising stimulus frequency and exceeded, especially in the higher frequency range, a hypothetically calculated eye amplitude for smooth pursuit. The combination of a visual and vestibular input (DVA and IT) led to a better compensation (lower phase shift) than under vestibular stimulation alone (EC). Eye movements during low-frequency stimulation depended more on the visual system while responses in the higher frequency range were mainly triggered by the otolith organ. At 1.5 Hz the compensatory function of the visual-vestibular system was limited (rising phase shift) and DVAT decreased even in a significant number of healthy subjects. Patients with diseases of the central nervous system showed a higher phase shift and thus a stronger decrease of DVAT (two levels) already at a stimulus frequency of 1.25 Hz.

Effect of ethanol on dynamic visual acuity during vertical body oscillation in healthy volunteers

Abstract Visual orientation is the most important sensory input during locomotion (e.g. walking, driving a car, riding a bicycle). We investigated dynamic visual acuity (DVA) during vertical body-oscillations (amplitude 5 cm; frequency 1.5 Hz) in 12 healthy subjects before and twice after ethanol consumption. During oscillation, vertical eye movements were recorded under two test conditions: with eyes closed (EC) and during DVA testing. A significant increase in vertical eye-amplitude after ethanol ingestion occurred only during EC tests, as a possible sign of vestibular hyperreaction. During vestibular stimulation alone (EC), ethanol did not affect the phase shift between stimulus and eye movements. However, when the subjects were given an additional visual stimulus (DVA), the post-alcohol phase shift rose significantly. Surprisingly, the post-alcohol phase shift values for the two test conditions showed no significant differences. After ethanol ingestion we found no changes in static visual acuity but a significant loss of DVA. Volunteers with a change of DVA threshold (DVAT) showed significantly (P = 0.004) higher post-alcoholic changes in the phase shift. In summary, low doses of ethanol disturbed the visually guided oculomotor response during fixation of an earth-fixed target while the observer was subject to linear vertical acceleration. This effect led to an increasing delay between the beginning of body and eye movements. The consequence was an increasing phase shift and thus a decrease in DVA during whole-body oscillation which was comparable to movements during human locomotion.

The localization of an imaginary target under the influence of caloric vestibular stimulation in healthy adults

Abstract It is well known that fixation of an imaginary target (IT) can influence the vestibulo-ocular reflex, but reports on the effect of peripheral vestibular stimulation on the localization of an IT are still lacking. In a prospective study, errors in pointing towards an IT without and after cold caloric vestibular stimulation (VS) were investigated in 24 right-handed volunteers with the head tilted backwards by 60°. After the stationary target had been extinguished for 120 s each subject had to point towards the target position as remembered in darkness. The vestibular response was recorded by electronystagmography. Without VS 73% of the volunteers showed a systematic horizontal pointing error towards the right side. VS led to an increased horizontal pointing error in the direction of the slow phase of the induced nystagmus and the degree of deviation showed a significant (P = 0.001) positive correlation (r = 0.32) with the amplitude of the calorically induced nystagmus. In summary, an IT is not merely a useful visual stimulus for influencing the vestibulo-ocular reflex during linear and angular acceleration. A peripheral vestibular stimulation is itself able to change the position of an IT significantly and the extent of deviation shows a significant correlation with the amplitude of the evoked nystagmus.

Infektionshäufigkeit und Keimspektrum nach Paukendrainage im Kindesalter

ZusammenfassungHäufigste Komplikation nach Paukenröhrcheneinlage ist die postoperative Otorrhö. Zur Paukendrainage werden in Deutschland vielfach Silikonröhrchen (SR) und Goldröhrchen (GR) benutzt. Interessant sind diesbezüglich In-vitro-Untersuchungen, bei denen eine steigende Silikonkonzentration im Nährmedium das Wachstum von Staphylococcus aureus stimulierte. Wir haben deshalb die Otorrhöhäufigkeit und das Keimspektrum von SR und GR retrospektiv untersucht. Ziel war es zu klären, ob SR mit einem höheren Infektionsrisiko behaftet sind oder ob sie das Wachstum bestimmter Keimarten begünstigen. Innerhalb von 2 Jahren wurden bei 144 Kindern 186 SR und 59 GR implantiert und in folgende 3 Untergruppen eingeteilt: Ersteinlage, Rezidiveinlage und Implantation in ein infiziertes Ohr bei Mastoidektomie. In allen 3 Gruppen fand sich zwar kein Unterschied bezüglich der Otorrhoehäufigkeit; SR waren jedoch signifikant häufiger mit Pseudomonas aeruginosa infiziert als GR (p=0,025). Bei 20% der Ohren mit Mastoiditis ergab der intraoperative Abstrich eine Infektion mit Pseudomonas aeruginosa. All diese infizierten, mastoidektomierten Ohren wurden mit GR versorgt. Keines dieser Ohren zeigte jedoch postoperativ eine Infektion mit Pseudomonas aeruginosa. Im Rahmen einer Mastoidektomie sollten daher unbedingt GR implantiert werden, die einen protektiven Effekt gegenüber Pseudomonas aeruginosa zeigen. Unter dem Aspekt, daß die durch mangelnden Wasserschutz bedingten Paukenröhrcheninfektionen recht häufig sind und Pseudomonas aeruginosa typischerweise im feuchten Milieu vorkommt, ist eine generelle GR-Implantation zur Paukendrainge durchaus zu vertreten.SummaryOtorrhea is the most common complication after tympanostomy tube insertions. In Germany there are currently two commonly used types of tympanostomy tubes: silicon tubes (ST) and gilded silver tubes (GT). Previously published in vitro studies by Tajima uncovered a positive correlation between the silicon concentration in culture fluid and the rate of growth of Staphylococcus aureus. Our study retrospectively evaluates the types of bacteria and rates of otorrhea after ST and GT insertions. The present study was undertaken to determine which of these tubes had a higher incidence of otorrhea and then whether silicon tubes stimulated the growth of certain types of bacteria, such as Staphylococcus aureus. In all, 186 ST and 59 GT were placed in 245 ears of 144 children. Both ST and GT were separated into three groups: first insertion of a tympanostomy tube, second implantation and insertion of a tympanostomy tube in an infected ear in the course of a mastoidectomy. No differences between ST and GT in causing otorrhea were found in the three groups. Nevertheless, ST in comparison to GT was associated with a higher incidence of infections with Pseudomonas aeruginosa. In contrast, a higher incidence of Staphylococcus aureus related to ST could not be proved. Twenty percent of the ears with mastoiditis were found to have Pseudomonas aeruginosa, but none of these ears implanted with a GT developed postoperative otorrhea. Our findings show that GT should be used when a ventilation tube is used during a mastoidectomy. Further, it is tenable to implant only GT because postoperative otorrhea in many cases is caused by insufficient water protection and water isfrequently polluted with Pseudomonas aeruginosa.

The Effect of Optical Devices and Repeated Trials on the Velocity of Saccadic Eye Movements

Objective--The purpose of this prospective study was to analyze the effect of glasses and contact lenses on the latency and velocity of visually evoked saccadic eye movements. Material and Methods--A saccadic test was performed 10 times on 20 emmetropic controls (Group A) and 20 ametropic test subjects with myopia (Group B) who were using glasses (Subgroup Bg) or contact lenses (Subgroup Bc). Results--No training or fatigue effect on either latency or eye velocity was registered. Regardless of visual acuity (Group A or B) or of the optical device used (Subgroup Bg or Bc), no significant intergroup difference in latency could ultimately be established. Subgroup Bc showed a significantly slower eye velocity than Group A. Regardless of the optical device used, subjects with a higher degree of myopia (>6 D) showed a lower eye velocity than the Group A controls. Additionally, saccadic velocity was lower in this subgroup (>6 D) in subjects using contact lenses than in those using glasses. Conclusion--These results demonstrate that optical devices have an influence on the electronystagmographical analyses of the vestibulo-ocular reflex that must be taken into consideration, particularly in scientific investigations.

Clinical and Experimental Investigations of Spontaneous Impedance Changes of the Middle Ear

The major symptoms of glomus tympanicum tumors are pulsatile tinnitus and spontaneous impedance changes (SICs) of the middle ear. On the other hand, SICs often occur even in the absence of pathological findings. The aim of this study was to analyze the occurrence of SICs in patients and healthy volunteers. We retrospectively evaluated 184 patients with SICs and/or complaints of periodic tinnitus. Most of them (n = 134) showed pulse-synchronous SICs. Pathological findings were recorded in only 66 patients. Binaural SICs were registered significantly (p = .03) more frequently in patients with arterial hypertension (63% versus 18%). Because of the positive correlation between arterial hypertension and the occurrence of SICs, the influence of increasing blood pressure (systolic blood pressure > 160 mm Hg after physical activity) on the occurrence of SICs was investigated in a prospective trial in healthy test subjects (n = 42). In 17 of them, pulse-synchronous SICs occurred for the first time or were registered at a lower sensitivity level after an increase in blood pressure. In summary, only half of the patients with pulse-synchronous SICs showed pathological findings. a significant correlation between high blood pressure and binaural pulse-synchronous SICs was demonstrated in patients with arterial hypertension and healthy volunteers after physical activity.