M. Lehmann

Chronisch obstruktive Tubenfunktionsstörung des Erwachsenen

BACKGROUND Sufficient diagnostic tools and effective therapies for chronic obstructive eustachian tube dysfunction are lacking. PATIENTS AND METHODS A total of 120 patients (209 ears) with chronic obstructive eustachian tube dysfunction were treated over a 2-year period using transnasal endoscopic balloon dilatation of the cartilaginous part of the eustachian tube (balloon eustachian tuboplasty, BET). A balloon catheter is inserted into the eustachian tube via the pharyngeal opening and dilated with a pressure of 10 bar for 2 min. RESULTS The first 12 patients (20 dilatations) had a pretreatment average tube score of 1.25 (± 1.83 SD), and 1 year after treatment, the score improved to 6.2 (± 2.61 SD). Furthermore, the pretreatment and 2-month posttreatment data of 66 additional patients (115 dilatations) were analyzed. In these patients, the tube score improved significantly from 2.21 (± 2.02 SD) to 5.4 (± 2.53 SD). CONCLUSION The initial long-term results suggest that BET is feasible and safe for the treatment of chronic obstructive eustachian tube dysfunction.

Therapie chronisch obstruktiver Funktionsstörungen der Tuba Eustachii

This paper reviews the past and present developments in the treatment of chronic obstructive eustachian tube dysfunction. Alongside tube catheterization and bougie insertion, modern approaches such as laser eustachian tuboplasty and balloon eustachian tuboplasty (BET) are described. In BET, transnasal endoscopic insertion via the pharyngeal ostium places a balloon catheter in the cartilaginous portion of the eustachian tube. This is then dilated to a pressure of 10 bar for 2 min. Up until January 2013, 351 chronic obstructive eustachian tube dysfunction patients had been treated in our department using BET. The average preoperative eustachian tube score was 2.1 (± 1.8 standard deviation, SD); 12 months postoperatively it was 6.1 (± 2.6 SD). Of these patients, 87% expressed satisfaction with the improvement in chronic obstructive dysfunction. These results demonstrate that BET is a safe and effective treatment for improving eustachian tube function and ear ventilation.

[Chronic obstructive eustachian tube dysfunction in adults: long-term results of balloon eustachian tuboplasty].

BACKGROUND Sufficient diagnostic tools and effective therapies for chronic obstructive eustachian tube dysfunction are lacking. PATIENTS AND METHODS A total of 120 patients (209 ears) with chronic obstructive eustachian tube dysfunction were treated over a 2-year period using transnasal endoscopic balloon dilatation of the cartilaginous part of the eustachian tube (balloon eustachian tuboplasty, BET). A balloon catheter is inserted into the eustachian tube via the pharyngeal opening and dilated with a pressure of 10 bar for 2 min. RESULTS The first 12 patients (20 dilatations) had a pretreatment average tube score of 1.25 (± 1.83 SD), and 1 year after treatment, the score improved to 6.2 (± 2.61 SD). Furthermore, the pretreatment and 2-month posttreatment data of 66 additional patients (115 dilatations) were analyzed. In these patients, the tube score improved significantly from 2.21 (± 2.02 SD) to 5.4 (± 2.53 SD). CONCLUSION The initial long-term results suggest that BET is feasible and safe for the treatment of chronic obstructive eustachian tube dysfunction.

[Assessment of chronic obstructive eustachian tube dysfunction : Evaluation of the German version of the Eustachian Tube Dysfunction Questionnaire].

BACKGROUND Eustachian tube dysfunction can cause middle ear diseases and impair quality of life. Sufficient diagnostic tools for chronic obstructive eustachian tube dysfunction are lacking and not reliable enough. PATIENTS AND METHODS The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was published by McCoul et al. in 2012 as an instrument to evaluate eustachian tube function. They demonstrated the reliability und validity of their questionnaire. The cut-off point for the diagnosis of eustachian tube dysfunction is ≥ 14.5 at 100 % sensitivity and 100 % specificity. We translated the ETDQ-7 into German and used it on 100 healthy subjects and 43 patients with chronic obstructive eustachian tube dysfunction. RESULTS The results in the English questionnaire were confirmed by our examinations with the German version of the questionnaire. The mean ETDQ-7 score was 8.67 in the healthy subjects and 24.7 in the patients with chronic obstructive eustachian tube dysfunction. The area under the curve in ROC analysis was 98.8 % (p < 0.0001). CONCLUSION We recommend the ETDQ-7 as an addition to patient history in the examination of eustachian tube dysfunction. It may as well be valuable in follow-up examinations to monitor treatment success.

Beurteilung der chronisch-obstruktiven Tubenfunktionsstörung

BACKGROUND Eustachian tube dysfunction can cause middle ear diseases and impair quality of life. Sufficient diagnostic tools for chronic obstructive eustachian tube dysfunction are lacking and not reliable enough. PATIENTS AND METHODS The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was published by McCoul et al. in 2012 as an instrument to evaluate eustachian tube function. They demonstrated the reliability und validity of their questionnaire. The cut-off point for the diagnosis of eustachian tube dysfunction is ≥ 14.5 at 100 % sensitivity and 100 % specificity. We translated the ETDQ-7 into German and used it on 100 healthy subjects and 43 patients with chronic obstructive eustachian tube dysfunction. RESULTS The results in the English questionnaire were confirmed by our examinations with the German version of the questionnaire. The mean ETDQ-7 score was 8.67 in the healthy subjects and 24.7 in the patients with chronic obstructive eustachian tube dysfunction. The area under the curve in ROC analysis was 98.8 % (p < 0.0001). CONCLUSION We recommend the ETDQ-7 as an addition to patient history in the examination of eustachian tube dysfunction. It may as well be valuable in follow-up examinations to monitor treatment success.

[Therapy of chronic obstructive eustachian tube dysfunction: evolution of applied therapies].

This paper reviews the past and present developments in the treatment of chronic obstructive eustachian tube dysfunction. Alongside tube catheterization and bougie insertion, modern approaches such as laser eustachian tuboplasty and balloon eustachian tuboplasty (BET) are described. In BET, transnasal endoscopic insertion via the pharyngeal ostium places a balloon catheter in the cartilaginous portion of the eustachian tube. This is then dilated to a pressure of 10 bar for 2 min. Up until January 2013, 351 chronic obstructive eustachian tube dysfunction patients had been treated in our department using BET. The average preoperative eustachian tube score was 2.1 (± 1.8 standard deviation, SD); 12 months postoperatively it was 6.1 (± 2.6 SD). Of these patients, 87% expressed satisfaction with the improvement in chronic obstructive dysfunction. These results demonstrate that BET is a safe and effective treatment for improving eustachian tube function and ear ventilation.

Intratumoral Onyx embolisation in the management of juvenile nasopharyngeal angiofibroma

Preoperative embolization for the treatment of juvenile nasopharyngeal angiofibroma was successfully accomplished with Onyx by intratumoral puncture for the first time. Extratumoral migration of Onyx particles was not observed, precluding the necessity to inflate the shield balloon. Postinterventional angiography showed complete occlusion of all supporting blood vessels. Transnasal surgery on the following day achieved complete resection of the angiofibroma without complications. Direct intratumoral embolization of juvenile nasopharyngeal angiofibromas appears to be a safe and effective preoperative method without complications. It could represent a new strategy for the treatment of JNA, as is already the case with other highly vascularized head and neck tumors. Moreover, it increases the likelihood of achieving complete resection.ZusammenfassungDie präoperative Embolisation zur Behandlung von juvenilen Nasenrachenangiofibromen wurde erstmalig mit Onyx® intratumoral durchgeführt. Eine extratumorale Abwanderung von Onyx®-Partikeln entlang der zuführenden Arterien in die Hauptarterie wurde nicht beobachtet, sodass die Inflation des Abschirmballons nicht notwendig war. Die postinterventionelle Angiographie zeigte eine vollständige Okklusion aller versorgenden Gefäße. Der chirurgisch transnasale Eingriff am Folgetag führte zu einer kompletten Resektion des Angiofibroms ohne Komplikationen. Die direkte intratumorale Embolisation von juvenilen Nasenrachenangiofibromen erwies sich als eine sichere und effektive präoperative Behandlungsmaßnahme ohne Komplikationen. Sie könnte eine neue Säule in der Behandlungsstrategie von juvenilen Nasenrachenangiofibromen, wie schon bei anderen gefäßreichen Tumoren des Kopf- und Halsbereiches beobachtet, darstellen. Außerdem wird die Wahrscheinlichkeit einer vollständigen Resektion deutlich erhöht.AbstractPreoperative embolization for the treatment of juvenile nasopharyngeal angiofibroma was successfully accomplished with Onyx® by intratumoral puncture for the first time. Extratumoral migration of Onyx® particles was not observed, precluding the necessity to inflate the shield balloon. Postinterventional angiography showed complete occlusion of all supporting blood vessels. Transnasal surgery on the following day achieved complete resection of the angiofibroma without complications. Direct intratumoral embolization of juvenile nasopharyngeal angiofibromas appears to be a safe and effective preoperative method without complications. It could represent a new strategy for the treatment of JNA, as is already the case with other highly vascularized head and neck tumors. Moreover, it increases the likelihood of achieving complete resection.

Intratumorale Onyx®-Embolisation in der Therapie von juvenilen Nasenrachenangiofibromen

Preoperative embolization for the treatment of juvenile nasopharyngeal angiofibroma was successfully accomplished with Onyx by intratumoral puncture for the first time. Extratumoral migration of Onyx particles was not observed, precluding the necessity to inflate the shield balloon. Postinterventional angiography showed complete occlusion of all supporting blood vessels. Transnasal surgery on the following day achieved complete resection of the angiofibroma without complications. Direct intratumoral embolization of juvenile nasopharyngeal angiofibromas appears to be a safe and effective preoperative method without complications. It could represent a new strategy for the treatment of JNA, as is already the case with other highly vascularized head and neck tumors. Moreover, it increases the likelihood of achieving complete resection.ZusammenfassungDie präoperative Embolisation zur Behandlung von juvenilen Nasenrachenangiofibromen wurde erstmalig mit Onyx® intratumoral durchgeführt. Eine extratumorale Abwanderung von Onyx®-Partikeln entlang der zuführenden Arterien in die Hauptarterie wurde nicht beobachtet, sodass die Inflation des Abschirmballons nicht notwendig war. Die postinterventionelle Angiographie zeigte eine vollständige Okklusion aller versorgenden Gefäße. Der chirurgisch transnasale Eingriff am Folgetag führte zu einer kompletten Resektion des Angiofibroms ohne Komplikationen. Die direkte intratumorale Embolisation von juvenilen Nasenrachenangiofibromen erwies sich als eine sichere und effektive präoperative Behandlungsmaßnahme ohne Komplikationen. Sie könnte eine neue Säule in der Behandlungsstrategie von juvenilen Nasenrachenangiofibromen, wie schon bei anderen gefäßreichen Tumoren des Kopf- und Halsbereiches beobachtet, darstellen. Außerdem wird die Wahrscheinlichkeit einer vollständigen Resektion deutlich erhöht.AbstractPreoperative embolization for the treatment of juvenile nasopharyngeal angiofibroma was successfully accomplished with Onyx® by intratumoral puncture for the first time. Extratumoral migration of Onyx® particles was not observed, precluding the necessity to inflate the shield balloon. Postinterventional angiography showed complete occlusion of all supporting blood vessels. Transnasal surgery on the following day achieved complete resection of the angiofibroma without complications. Direct intratumoral embolization of juvenile nasopharyngeal angiofibromas appears to be a safe and effective preoperative method without complications. It could represent a new strategy for the treatment of JNA, as is already the case with other highly vascularized head and neck tumors. Moreover, it increases the likelihood of achieving complete resection.

Direct percutaneous embolization of a carotid body tumor with Onyx

ZusammenfassungDie perkutane präoperative Embolisation zur Behandlung von Tumoren des Glomus caroticum mit Ethylen-Vinylalkohol-Kopolymer (Onyx®) wurde erst vor kurzer Zeit im deutschsprachigen Raum eingeführt. Nach Direktpunktion des Tumors wurde Onyx® unter Angiographiekontrolle perkutan injiziert. Die postinterventionelle Angiographie zeigte eine vollständige Okklusion aller tumorversorgenden Gefäße. Im anschließenden chirurgischen Eingriff konnte der Tumor komplett komplikationslos entfernt werden. Die direkte perkutane Embolisation von Glomus-caroticum-Tumoren der Kopf-Hals-Region ist eine sichere und effektive präoperative Behandlungsmaßnahme mit geringer Komplikationsrate. Sie stellt eine neue Säule in der Behandlungsstrategie von Glomus-caroticum-Tumoren dar. Mit dieser Methode wird die Möglichkeit einer vollständigen Tumorresektion deutlich erhöht.AbstractCarotid body tumors are highly vascularized lesions that require successful preoperative embolization to achieve favorable clinical results in terms of morbidity and complete tumor resection. The procedure of percutaneous embolization was performed using ethylene-vinyl alcohol copolymer (Onyx) in addition to balloon-catheter protection to prevent particle displacement into the internal carotid artery. The procedure resulted in nearly complete tumor embolization and facilitated the uneventful complete surgical resection. Percutaneous angiographic embolization of carotid body tumors in the head and neck was found to be safe and effective. This technique is likely to result in improved surgical outcomes and tumor resectability.Carotid body tumors are highly vascularized lesions that require successful preoperative embolization to achieve favorable clinical results in terms of morbidity and complete tumor resection. The procedure of percutaneous embolization was performed using ethylene-vinyl alcohol copolymer (Onyx) in addition to balloon-catheter protection to prevent particle displacement into the internal carotid artery. The procedure resulted in nearly complete tumor embolization and facilitated the uneventful complete surgical resection. Percutaneous angiographic embolization of carotid body tumors in the head and neck was found to be safe and effective. This technique is likely to result in improved surgical outcomes and tumor resectability.

Perkutane Onyx®-Embolisation zur Therapie von Glomus-caroticum-Tumoren

ZusammenfassungDie perkutane präoperative Embolisation zur Behandlung von Tumoren des Glomus caroticum mit Ethylen-Vinylalkohol-Kopolymer (Onyx®) wurde erst vor kurzer Zeit im deutschsprachigen Raum eingeführt. Nach Direktpunktion des Tumors wurde Onyx® unter Angiographiekontrolle perkutan injiziert. Die postinterventionelle Angiographie zeigte eine vollständige Okklusion aller tumorversorgenden Gefäße. Im anschließenden chirurgischen Eingriff konnte der Tumor komplett komplikationslos entfernt werden. Die direkte perkutane Embolisation von Glomus-caroticum-Tumoren der Kopf-Hals-Region ist eine sichere und effektive präoperative Behandlungsmaßnahme mit geringer Komplikationsrate. Sie stellt eine neue Säule in der Behandlungsstrategie von Glomus-caroticum-Tumoren dar. Mit dieser Methode wird die Möglichkeit einer vollständigen Tumorresektion deutlich erhöht.AbstractCarotid body tumors are highly vascularized lesions that require successful preoperative embolization to achieve favorable clinical results in terms of morbidity and complete tumor resection. The procedure of percutaneous embolization was performed using ethylene-vinyl alcohol copolymer (Onyx) in addition to balloon-catheter protection to prevent particle displacement into the internal carotid artery. The procedure resulted in nearly complete tumor embolization and facilitated the uneventful complete surgical resection. Percutaneous angiographic embolization of carotid body tumors in the head and neck was found to be safe and effective. This technique is likely to result in improved surgical outcomes and tumor resectability.Carotid body tumors are highly vascularized lesions that require successful preoperative embolization to achieve favorable clinical results in terms of morbidity and complete tumor resection. The procedure of percutaneous embolization was performed using ethylene-vinyl alcohol copolymer (Onyx) in addition to balloon-catheter protection to prevent particle displacement into the internal carotid artery. The procedure resulted in nearly complete tumor embolization and facilitated the uneventful complete surgical resection. Percutaneous angiographic embolization of carotid body tumors in the head and neck was found to be safe and effective. This technique is likely to result in improved surgical outcomes and tumor resectability.