Kurt Tschopp

A randomized, double-blind, placebo-controlled study of dextran/pentoxifylline medication in acute acoustic trauma and sudden hearing loss

The effectiveness of any therapy in acute acoustic trauma or sudden hearing loss of unknown origin has not been demonstrated convincingly. The assessment is difficult because of a relatively high rate of spontaneous recovery. Nevertheless, many different forms of treatment are recommended. We tested one form, treatment with rheoactive substances, in a prospective, randomized, double-blind trial and compared treatment with (a) infusions of dextran-40 with pentoxifylline, (b) saline infusions with pentoxifylline, and (c) saline infusions with placebo medication. Pure-tone hearing thresholds served as control parameters and were taken before treatment and at 1 and 4 weeks after the onset of therapy. Three hundred eighty-two patients were included in the trial, 331 (87%) could be analyzed, 184 patients were treated because of sudden hearing loss, 147 because of acute acoustic trauma. The three treatment groups were comparable in their basic characteristics including the amount of initial hearing loss. In patients with sudden hearing loss, no significant differences of hearing recovery were detected between the three treatment groups. Hearing recovery was also similar in patients with acute acoustic trauma. A power analysis of the study revealed that possible true treatment differences of a hearing recovery of 10 dB would have lead to significance with a probability of over 90%. It is concluded that there were, in fact, no clinically relevant differences in hearing gains of sudden hearing loss or acute acoustic trauma between treatments with saline infusions together with placebo medication and treatment with dextran-40 and/or pentoxifylline.

Local Injection Therapy in 107 Patients with Myofascial Pain Syndrome of the Head and Neck

Myofascial pain syndrome of the head and neck is a frequent cause of facial pain and is characterized by tender trigger points. In a double-blind study of 107 patients, local injection therapy using one of three solutions was applied at the trigger points by intracutaneous injection of 0.3 ml solution followed by deep infiltration of the site. Results using bupivacaine 0.25%, lignocaine 1% and saline 0.9% were compared. There was no significant difference among groups with respect to reduction of pain and overall rating by patients of the therapeutic benefits. Fifty-three patients (49%) were free of symptoms after treatment, 40 patients (38%) reported substantial relief and in 14 patients (13%) symptoms remained unchanged. The findings suggest that relief of pain is mainly due to reflex mechanisms rather than to the pharmacological effects of the injected solutions. Physiological saline solution is recommended for use in local injection therapy.

Acute Acoustic Trauma: A Retrospective Study of Influencing Factors and Different Therapies in 268 Patients

The files of 268 patients with acute acoustic trauma acquired during military service were analysed in a retrospective study. The following factors were examined: age, profession, degree of hearing loss, audiometric contour, and drug treatment. No influence of age or profession on recovery of hearing loss could be detected. The absolute hearing gain, defined as the difference between the hearing loss at onset and, on average, 7 days later, was dependent on the degree of initial hearing loss. The relative hearing gain, defined as absolute hearing gain divided by initial hearing loss, was independent of the degree of initial injury. The audiometric contour after the acoustic trauma had no prognostic relevance. Nine different types of drug treatment were compared in a subgroup of patients (n=199), in all of whom treatment was started within 2 days of the acoustic trauma. There were no significant differences in relative hearing gain between the nine types of treatment. Patients receiving early treatment had significantly better hearing one week after the acoustic trauma, as compared with the group of patients (n=69) not receiving treatment during the first 7 days. However, it was not possible to determine retrospectively whether this difference was due to treatment effects, or whether it was due to the exclusion of spontaneous remissions among those who were neither examined nor treated within the first 7 days.

Therapy of Snoring and Obstructive Sleep Apnea Using the Velumount® Palatal Device

Objectives: The aim of the present study is to investigate the efficacy of the Velumount® device. Methods: In a prospective cohort study 40 patients were examined with and without Velumount. The apnea-hypopnea index and average esophageal pressure were measured using nocturnal manometry of the upper airways, combined with respiratory polygraphy. The snoring index (1–10) and daytime sleepiness using the Epworth Sleepiness Scale were assessed by means of a questionnaire. Results: Using Velumount the snoring index was reduced from on average 8.4 (SD ± 1.3) to 3.7 (SD ± 2.5), the Epworth Sleepiness Scale score from on average 7.9 (SD ± 4.4) to 3.8 (SD ± 3.4) and esophageal pressure from on average 14.8 cm H2O (SD ± 6.7) to 11.2 cm H2O (SD ± 6.4). In patients (n = 25) with obstructive sleep apnea, the average apnea-hypopnea index was 24.3 (SD ± 10.1) without and 13.6 (SD ± 12.2) with Velumount. All changes were highly significant. Conclusions: TheVelumount device is effective for the treatment of snoring and obstructive sleep apnea. The effect is similar to that reported from uvulopalatopharyngoplasty.

Allergic Contact Dermatitis from Tixocortol Pivalate in a Nasal Spray Masquerading as Infectious Complication of Sinusitis

Allergic contact dermatitis to corticosteroids is not uncommon and is increasingly reported. Contact allergy to nasal corticosteroids is rare and may present with atypical symptoms, which may be confused with infectious complications. We report on a patient in whom the misinterpretation of her allergic nasal symptoms to the corticosteroid tixocortol pivalate resulted in hospitalization and considerable medical expenses.

Long-Term Compliance of the Velumount® Palatal Device

Objectives: The aim of this study was to investigate the long-term compliance of the Velumount® palatal device. Methods: This was a cohort study: 46 patients who received a Velumount device three years previously were enrolled. A questionnaire was sent to all patients. The data of 43 patients (93%) could be evaluated. Results: Seventeen (40%) patients used the Velumount device regularly (>5 nights per week). However, 24 (56%) abandoned its use, 1 (2%) used it only occasionally (1-2 nights/week) and 1 (2%) used it only on special occasions. The main reasons for discontinuing Velumount were gag reflex (36%) and foreign body sensation (20%). Conclusions: The long-term compliance of the Velumount is 40%. Those patients who tolerate Velumount well use it regularly at least 5 nights per week. The Velumount palatal device is a valuable treatment option in counseling for patients with primary snoring or mild obstructive sleep apnea.

Contents Vol. 78, 2016

R.L. Alford, Houston, Tex. M. Anniko, Uppsala Y.A. Bayazit, Ankara H.H. Birdsall, Houston, Tex. P.J. Bradley, Nottingham J. Califano, Boston, Mass. P.F. Castellanos, Birmingham, Ala. C. Cernea, São Paulo F.-L. Chi, Shanghai A. Chiu, Tucson, Ariz. N. Cohen, Philadelphia, Pa. M.D. Eisen, Hartford, Conn. L.M. Elden, Philadelphia, Pa. E. Ferekidis, Athens A. Ferlito, Udine R.L. Ferris, Pittsburgh, Pa. L.L. Gleich, Cincinnati, Ohio D.-M. Han, Beijing J.P. Harris, San Diego, Calif. R. Häusler, Bern I. Hochmair, Innsbruck K. Hörmann, Mannheim Journal for Oto-Rhino-Laryngology, Head and Neck Sugery

Resection of Endobronchial Tumors Using a Tracheoscope and Neodymium: YAG Laser

A modified technique for palliative resections of malignant endobronchial tumors with the Nd:YAG laser is described. A special tracheoscope was used in conjunction with the instrument guide of a laser bronchoscope. The main advantage of this technique is easy and simultaneous access to both lungs for ventilation and surgical procedures. The method helps to separate surgical from anesthetic manipulations. The experience of over 70 operations using this technique provides evidence that the use of a tracheoscope is a safe and efficient method of endoscopic resections of larger intrabronchial tumors.