I. Baumann

Open Tübingen titanium prostheses for ossiculoplasty : A prospective clinical trial

Objective The overall purpose of the study was the evaluation of the efficacy of Tübingen titanium prostheses (TTPs) for ossiculoplasty. Study Design A two-part clinical study of 216 patients undergoing ossiculoplasty was performed. The first part was a prospective study using TTPs (n = 114). The second part involved study of historical control patients (n = 102) with gold and ceramic prostheses. Interventions All patients underwent ossiculoplasty. Main Outcome Measures Measures included median air conduction thresholds and air-bone gaps. Results All patients were per-protocol patients. When the air-bone gap “gold standard” (i.e., ≤10 dB) was investigated in the main speech spectrum, partial TTPs reached this level at 2 kHz in 44% (n = 22) and at 3 kHz in 38% (n = 19). Gold and ceramics revealed significantly lower values. Similar results were obtained for total prostheses. Differences for TTPs and ceramics were statistically significant (Mann-Whitney U test, &agr; = 5%). Conclusion The use of TTPs for ossiculoplasty is an efficient treatment method.

Aqueous extracts from peppermint, sage and lemon balm leaves display potent anti-HIV-1 activity by increasing the virion density

BackgroundAqueous extracts from leaves of well known species of the Lamiaceae family were examined for their potency to inhibit infection by human immunodeficiency virus type 1 (HIV-1).ResultsExtracts from lemon balm (Melissa officinalis L.), peppermint (Mentha × piperita L.), and sage (Salvia officinalis L.) exhibited a high and concentration-dependent activity against the infection of HIV-1 in T-cell lines, primary macrophages, and in ex vivo tonsil histocultures with 50% inhibitory concentrations as low as 0.004%. The aqueous Lamiaceae extracts did not or only at very high concentrations interfere with cell viability. Mechanistically, extract exposure of free virions potently and rapidly inhibited infection, while exposure of surface-bound virions or target cells alone had virtually no antiviral effect. In line with this observation, a virion-fusion assay demonstrated that HIV-1 entry was drastically impaired following treatment of particles with Lamiaceae extracts, and the magnitude of this effect at the early stage of infection correlated with the inhibitory potency on HIV-1 replication. Extracts were active against virions carrying diverse envelopes (X4 and R5 HIV-1, vesicular stomatitis virus, ecotropic murine leukemia virus), but not against a non-enveloped adenovirus. Following exposure to Lamiaceae extracts, the stability of virions as well as virion-associated levels of envelope glycoprotein and processed Gag protein were unaffected, while, surprisingly, sucrose-density equilibrium gradient analyses disclosed a marked increase of virion density.ConclusionAqueous extracts from Lamiaceae can drastically and rapidly reduce the infectivity of HIV-1 virions at non-cytotoxic concentrations. An extract-induced enhancement of the virions density prior to its surface engagement appears to be the most likely mode of action. By harbouring also a strong activity against herpes simplex virus type 2, these extracts may provide a basis for the development of novel virucidal topical microbicides.

General and disease-specific quality of life in patients with chronic suppurative otitis media - a prospective study

BackgroundChronic suppurative otitis media (CSOM) is frequently associated with symptoms of inflammation like discharge from the ear or pain. In many cases, patients suffer from hearing loss causing communication problems and social withdrawal. The objective of this work was to collect prospective audiological data and data on general and disease-specific quality of life with validated quality of life measurement instruments to assess the impact of the disease on health-related quality of life (HR-QOL).Methods121 patients were included in the study. Patients were clinically examined in the hospital before and 6 months after surgery including audiological testing. They filled in the quality of life questionnaires SF-36 and Chronic Otitis Media Outcome Test 15 (COMOT-15) pre-operatively and 6 and 12 months post-operatively, respectively.ResultsComplete data records from 90 patients were available for statistical analysis. Disease-specific HR-QOL in patients with CSOM improved after tympanoplasty in all the scales of the COMOT-15. There was no difference in HR-QOL assessment between patients with mesotympanic respectively epitympanic CSOM. However, we did find the outcome to be worse in patients who received revision surgery compared with those receiving primary surgery. Audiometric findings correlated very well with the subscale hearing function from the COMOT-15 questionnaire. General HR-QOL measured with the SF-36 was not significantly changed by tympanoplasty.ConclusionsTympanoplasty did lead to a significant improvement of disease-specific HR-QOL in patients with CSOM while general HR-QOL did not change. Very well correlations were found between the subscale hearing function from the COMOT-15 questionnaire and audiological findings. Revision surgery seems to be a predictor for a worse outcome.

Otorhinolaryngologic disorders and diving accidents: an analysis of 306 divers.

Diving is a very popular leasure activity with an increasing number of participants. As more than 80% of the diving related problems involve the head and neck region, every otorhinolaryngologist should be familiar with diving medical standards. We here present an analysis of more than 300 patients we have treated in the past four years. Between January 2002 and October 2005, 306 patients presented in our department with otorhinological disorders after diving, or after diving accidents. We collected the following data: name, sex, age, date of treatment, date of accident, diagnosis, special aspects of the diagnosis, number of dives, diving certification, whether and which surgery had been performed, history of acute diving accidents or follow up treatment, assessment of fitness to dive and special remarks. The study setting was a retrospective cohort study. The distribution of the disorders was as follows: 24 divers (8%) with external ear disorders, 140 divers (46%) with middle ear disorders, 56 divers (18%) with inner ear disorders, 53 divers (17%) with disorders of the nose and sinuses, 24 divers (8%) with decompression illness (DCI) and 9 divers (3%) who complained of various symptoms. Only 18% of the divers presented with acute disorders. The most common disorder (24%) was Eustachian tube dysfunction. Female divers were significantly more often affected. Chronic sinusitis was found to be associated with a significantly higher number of performed dives. Conservative treatment failed in 30% of the patients but sinus surgery relieved symptoms in all patients of this group. The middle ear is the main problem area for divers. Middle ear ventilation problems due to Eustachian tube dysfunction can be treated conservatively with excellent results whereas pathology of the tympanic membrane and ossicular chain often require surgery. More than four out of five patients visited our department to re-establish their fitness to dive. Although the treatment of acute diving-related disorders is an important field for the treatment of divers, the main need of divers seems to be assessment and recovery of their fitness to dive.

Ossifying fibroma of the ethmoid involving the orbit and the skull base.

c p u w ssifying fibroma is a rare, benign fibroosseus tumor. The average age at diagnosis is 31 years, with a range f 3 to 63 years, and a female-to-male ratio of 1.6:1. It is sually found in the craniofacial bones, with the mandible eing the most common site, accounting for 75% to 89% of ases. Less commonly, the orbit, paranasal sinuses, or axilla have also been involved. Total removal must be erformed to avoid recurrences. We report a case of an ssifying fibroma of the ethmoid with involvement of the rbit, the frontal bone, and the skull base.

Determinants in HIV-1 Nef for enhancement of virus replication and depletion of CD4+ T lymphocytes in human lymphoid tissue ex vivo.

BackgroundHIV-1 Nef critically contributes to AIDS in part by augmenting virus titers in infected individuals. Analyzing which of Nefs activities contribute to HIV pathogenesis has been hampered by the lack of a cell culture model in which Nef exerts pronounced effects on HIV replication. The human lymphoid aggregate culture (HLAC) from tonsil maintains the cell populations and cytokine milieu found in vivo, supports a productive infection without exogenous stimulation, and Nef contributes to efficient HIV-1 replication as well as CD4+ T cell depletion in this experimental ex vivo-model.ResultsTo identify determinants in Nef that mediate these activities, we infected HLAC with a panel of isogenic HIV-1NL4-3 strains that encode for well-characterized mutants of HIV-1SF2 Nef. Determination of HIV-1 replication revealed that enhancement of the virus spread by Nef is governed by a complex set of protein interaction surfaces. In contrast, increased CD4+ T lymphocyte depletion depended on only two protein interaction surfaces in Nef that mediate either downregulation of cell surface CD4 or interaction with the NAKC signalosome. Consistently, in HLAC from 9 out of 14 donors, Nef enhanced CD4+ T cell depletion in the absence of a significant effect on virus replication. Moreover, our results suggest that this Nef-dependent enhancement in depletion occurred predominately in uninfected bystander CD4+ T cells.ConclusionOur findings suggest that Nef facilitates depletion of CD4+ T lymphocytes in HIV-1-infected lymphoid tissue ex vivo by increasing the pool of productively infected cells and by sensitizing bystander cells for killing. This ability might contribute to Nefs pathogenic potential in vivo.

Rationelle CT-diagnostik vor Operationen an den Nasennebenhöhlen

ZusammenfassungDie Darstellung der intraoperativ wichtigen Landmarken kann in der Computertomographie (CT) je nach Bildebene unbefriedigend sein. Die Spiral-CT-Technik verspricht durch die Möglichkeit der Rekonstruktion von sekundären Bildebenen diagnostische Vorteile ohne zusätzliche Strahlenbelastung.Ziel dieser Arbeit war es, HNO-Chirurgen und Radiologen unabhängig voneinander die Abbildungsqualität von primären Aufnahmen und sekundären Rekonstruktionen aus Spiral-CT-Datensätzen der Nasennebenhöhlen vergleichen zu lassen, um die diagnostische Wertigkeit zu bestimmen.Bei insgesamt 80 Patienten wurden je eine koronare und eine axiale Spiral-CT der NNH durchgeführt. Aus den axialen Spiral-CT wurden sekundär koronare Rekonstruktionen und entsprechend aus den koronaren Originalaufnahmen sekundär axiale Rekonstruktionen in 2 mm Abstand berechnet.Im Vergleich zu den primären Aufnahmen wiesen die Sekundärrekonstruktionen zwar Konturstufen und eine reduzierte Ortsauflösung auf, die Erkennbarkeit relevanter Befunde war hierdurch jedoch nicht beeinträchtigt. Als Vorteil der sekundär koronaren Rekonstruktionen erwies sich das Fehlen von Zahnmetallartefakten.AbstractMovement or metal artefacts as well as the relatively high radiation exposure of both the axial and the coronal scan are disadvantages of computed tomography. A single spiral CT scan with a secondary reformation replacing the second CT scan might solve these problems.The goal of this project was to compare the diagnostic value of primary spiral CT scans of paranasal sinuses with secondary reformations. These were evaluated by ENT surgeons as well as radiologists.We performed axial and coronal spiral-CTs of paranasal sinuses in 80 patients. The secondary coronal and axial reformations were calculated with 2 mm image sections.Although a reduced resolution was observed in the secondary reformations, this did not compromise the detection of important anatomical features. Image deterioration due to artifacts was significantly reduced.

Measuring quality of life in patients with head and neck cancer: Update of the EORTC QLQ-H&N Module, Phase III.

The objective of this study was to pilot test an updated version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ‐H&N60).

Quality of life in patients with head and neck cancer receiving targeted or multimodal therapy - Update of the EORTC QLQ-H&N35, Phase i

The objective of this study was to identify relevant quality of life (QOL) issues in patients with head and neck cancer receiving multimodal and/or targeted therapies.

Entwicklung und Validierung des Chronic Otitis Media Outcome Test 15 (COMOT-15)

BACKGROUND Clinical experience has shown that chronic otitis media (COM) affects health-related quality of life (HR-QOL) of the patients. Nevertheless, up to now no validated measurement instrument encompassing all the relevant dimensions of HR-QOL is available. MATERIAL AND METHODS In phase 1 the development of the Chonic Otitis Media Outcome Test (COMOT) was conducted. A group of experts identified 31 HR-QOL concepts as being relative for COM which was reduced to 15 items (COMOT-15) by sequential statistical analysis on the basis of data from 50 consecutive COM patients. In addition to the overall score (GS), three sub-scores (ear symptoms, OS; hearing function, HF; and mental being, PB) were introduced. In phase 2 validation was performed by calculating reliability, validity, and responsiveness with the data of 121 prospectively evaluated patients. RESULTS COMOT-15 showed an excellent reliability with high internal consistency (Cronbachs alpha from 0.89 to 0.91) and high retest reliability coefficients (all r>0.8). Content validity was determined by a study of the literature. COMOT-15 can distinguish COM patients from healthy subjects. Global assessment of impairment of HR-QOL by COM correlated very well with the scores of COMOT-15. However, the responsiveness of the COMOT-15 questionnaire was low. CONCLUSIONS COMOT-15 is a reliable, valid and sensitive instrument for measurement of HR-QOL of COM patients. The results obtained with the questionnaire can be interpreted very well by the investigator. COMOT-15 should be used in otological outcomes research.