P. Neugebauer

Continuous intratympanic infusion of gentamicin via a microcatheter in Menière's disease.

Between 1995 and 1998, 11 patients with disabling Menières disease were treated at our institution with a continuous gentamicin infusion into the middle ear via a microcatheter. The patients had frequent attacks of vertigo and vomiting (functional levels 3-5). Hearing threshold on the affected side was significantly worse than on the healthy side (stage 4+5). Gentamicin was applied by a high-precision insulin pump with a flow rate of 40 mg per day directly in front of the round window. Application was stopped as soon as signs of vestibular affection appeared. A good overall control of vertiginous spells was achieved in 8 patients. Eight patients experienced complete hearing loss on the affected side, 1 experienced a slight worsening, and 1 had no hearing change. There was no correlation between the cumulative gentamicin dosage and the hearing loss. Our findings show that in terms of hearing loss and hospitalization time the continuous gentamicin application is inferior to other applications presented in the literature.

Human keratinocyte culture from the peritonsillar mucosa

Tonsillectomy tissue can be used as a routine source for cultures of oropharyngeal keratinocytes. In so doing, a peritonsillar strip of unaltered mucosa was dissected in the upper submucosa. Subsequent trypsinization yielded 7.0 \+- 3.4 × 106 keratinocytes per bilateral tonsillectomy. Keratinocyte attachment and growth in primary culture were promoted by sublethally irradiated 3T3 murine fibroblasts. Three subcultures could be performed without a feeder layer and were characterized by a population doubling time of 4.5 days during log growth phase. Electrophoretic and immunoblot analysis of the third subculture revealed a strong expression of keratin pairs 5/14 and 6/16 as well as keratins 7 and 19, whereas keratins 8/18 were expressed less intensely. The lowest intensity was found for keratin 13, which is known to be indicative of the differentiated mucosa. The culture technique thus provides an easily available in vitro model for morphological and functional studies on the epithelial compartment of human oropharyngeal mucosa.

Suprabasal overexpression of the hsRPB7 gene in psoriatic epidermis as identified by a reverse transcriptase-polymerase chain reaction differential display model comparing psoriasis plaque tissue with peritonsillar mucosa.

In psoriasis an etiopathogenetic vicious circle is nowadays hypothesized that the disease is triggered by skin-specific autoantigen structures, the expression and accessibility of which are positively correlated with the intensity of the hyperproliferation and inflammation in the epidermopapillary compartment driven by autoreactive T cells. Despite the close microanatomical relation between skin and mucosa, clinicians have always been intrigued by the observation that psoriatic affection of the mucosa, if at all existing, is only seen as very rare events in the lips and tongue sparing buccopharyngeal sites. This prompted us to establish an experimental model system comparing psoriatic-involved skin and peritonsillar mucosa from tonsillectomies by a reverse transcriptase-polymerase chain reaction/differential display strategy. Among more than 60 cDNA species to be displayed in psoriasis, but missing in peritonsillar mucosa, one species was identified as coding for the RNA polymerase IIA seventh subunit (hsRPB7 gene) as a most critical factor for DNA to RNA transcription. Immunohistochemistry showed a hitherto unknown, distinctive pattern of hsRPB7 expression that was 1) tissue type-dependent with a surplus in skin keratinocytes and a near absence in peritonsillar mucosa, 2) tightly regulated by the keratinocyte differentiation process with a sharp suprabasal up-regulation in contrast to a basal down-regulation, and 3) substantially augmented in psoriatic-involved skin as compared to normal and psoriatic uninvolved skin. Keratinocytes of actinic keratoses also showed a strong hsRPB7 expression that however did not strictly spare the basal cell layer presumably reflecting the disturbed intraepidermal stratification because of the premalignant status of these precancerous lesions.

A Rare Differential Diagnosis in Dysphagia: Wound Botulism

The incidence of wound botulism is increasing dramatically among intravenous drug users. Efficient intensive care and early treatment with antitoxin is essential to avoid lethal courses. The clinical picture of botulism is of descending, symmetric, flaccid paralysis. Early symptoms include cranial nerve palsies resulting in blurred vision and diplopia, difficulty in focusing, ptosis, facial weakness, dysphagia, dysphonia, and dysarthria. Because patients presenting with dysarthria and dysphagia will often be seen by an ear, nose and throat specialist initially, this rare but upcoming neurologic disease must be considered in the differential diagnoses.

Diplopia after contusion of the posterior skull. A case for the ENT physician

Ein 8-jähriges Mädchen stürzte beim Inline-Skaten auf den linken Hinterkopf. Eine Bewusstlosigkeit mit Amnesie, Übelkeit oder Erbrechen bestand nicht. Am Folgetag bemerkten die Eltern eine Schielstellung der Augen. Das Kind gab an, doppelt zu sehen. Zwei Tage nach dem Unfall erfolgte die Erstvorstellung zur neuroophthalmologischen Untersuchung, welche die Diagnose einer Abduzensparese links ergab. Ein Schädel-CT wurde von radiologischer Seite als unauffällig befundet. Die von den Augenärzten veranlasste konsiliarische HNO-ärztliche Untersuchung erfolgte mit der dezidierten Frage nach dem Vorliegen einer Felsenbeinfraktur als Ursache einer traumatischen Abduzensparese.

Doppelbilder nach Sturz auf den Hinterkopf

Ein 8-jähriges Mädchen stürzte beim Inline-Skaten auf den linken Hinterkopf. Eine Bewusstlosigkeit mit Amnesie, Übelkeit oder Erbrechen bestand nicht. Am Folgetag bemerkten die Eltern eine Schielstellung der Augen. Das Kind gab an, doppelt zu sehen. Zwei Tage nach dem Unfall erfolgte die Erstvorstellung zur neuroophthalmologischen Untersuchung, welche die Diagnose einer Abduzensparese links ergab. Ein Schädel-CT wurde von radiologischer Seite als unauffällig befundet. Die von den Augenärzten veranlasste konsiliarische HNO-ärztliche Untersuchung erfolgte mit der dezidierten Frage nach dem Vorliegen einer Felsenbeinfraktur als Ursache einer traumatischen Abduzensparese.

Doppelbilder nach Sturz auf den Hinterkopf@@@Diplopia after contusion of the posterior skull: Ein Fall fr den HNO-Arzt?@@@A case for the ENT physician?

Ein 8-jähriges Mädchen stürzte beim Inline-Skaten auf den linken Hinterkopf. Eine Bewusstlosigkeit mit Amnesie, Übelkeit oder Erbrechen bestand nicht. Am Folgetag bemerkten die Eltern eine Schielstellung der Augen. Das Kind gab an, doppelt zu sehen. Zwei Tage nach dem Unfall erfolgte die Erstvorstellung zur neuroophthalmologischen Untersuchung, welche die Diagnose einer Abduzensparese links ergab. Ein Schädel-CT wurde von radiologischer Seite als unauffällig befundet. Die von den Augenärzten veranlasste konsiliarische HNO-ärztliche Untersuchung erfolgte mit der dezidierten Frage nach dem Vorliegen einer Felsenbeinfraktur als Ursache einer traumatischen Abduzensparese.