W. Mann

Liability of ultrasound in maxillary sinus disease

SummaryFor the first time liability of ultrasonography in diagnosing paranasal sinus disease was controlled in 256 patients with acute maxillary sinusitis as compared to irrigation findings and in 150 patients with persistent maxillary sinus disease using x-rays, sinoscopy and sinumanometry as controls.Confidence in diagnosing the presence of discharge ranges up to 90%. In cases of total opacity of the sinus, ultrasonography helps differentiating mucosal swelling, tumor and discharge.

Growth influence on tubal function.

The influence of growth on tubal function was studied in 26 children by means of tubal function tests in a pressure chamber and by geometric analysis of lateral cephalograms. Good tubal function coincided with mesoor brachycephalic skeletons, poor tubal function with dolichocephalic morphologic patterns. According to our results, tubal function seems to be strongly influenced by the growth processes of the skull.

The Role of Matrix Vesicles in the Pathogenesis of Tympanosclerosis

In a histological and electron microscopical study the authors investigated the pathogenesis of tympanosclerosis. Emphasis was placed on the role of extracellular lysosomes (= matrix lysosomes). The function of such matrix lysosomes is connected with the two-stage degradation of the connective tissue. This system gets out of control in tympanosclerosis. Inflammatory and immunological processes are suggested to be superimposed on this lysosomal action.

Cation distribution in the organ of Corti of the guinea pig

SummaryCations were precipitated with potassium antimonate in the cochlea of the guinea pig and the distribution of the formed precipitates was studied by electron microscopy. The precipitate density in different cells of the organ of Corti was determined on electron micrographs by counting numbers of precipitates per unit area. The spatial distribution of the precipitates was also determined by electron spectroscopic imaging (ESI). Significant differences were found among the cells of the same tissue being analyzed. These precipitate-rich cells may play a role in a postulated current flow in the organ of Corti.

Tracheomalacia repair using ceramic rings

Tracheomalacia resulting from tracheostomy or compressive thyroid disease often represents a difficult problem in airway management. In an attempt to improve this condition, biocompatible ceramic rings were surgically implanted in 16 patients to restore normal patency of the airway by first expanding the tracheal lumen lateral, and then in an anterior dimension. Preoperatively, patients displayed moderate to severe obstruction with marked restrictions in lifestyle, as confirmed by history, physical examination, and airway resistance studies. Additionally, three of these patients were trach-dependent at the time of implantation. Postoperatively all 16 patients have normal airway resistance parameters with a dramatic improvement in lifestyle, whereas the three with tracheostomy were successfully decannulated. The routine use of these rings has alleviated the need for rib/cartilage grafts, primary resections with anastomosis, prolonged periods of cannulation, and multiple surgeries. Our experience in the use of ceramic rings for tracheomalacia repair will be presented, highlighting selection criteria for their use, intraoperative placement, perioperative complications, and postoperative followup for a minimum of 6 months.

Calcium antagonists in the treatment of sudden deafness

SummaryIn the treatment of patients with sudden deafness, we found no significant difference between an oral calcium antagonist (nifedipine) and intravenous naftidrofuryl given concomitantly with vitamin A, vitamin E, and zinc. This prospective randomized study in 50 patients again shows that recovery to useful hearing levels tends to be spontaneous and independent of the type of medical treatment given. Irrespective of their capability to prevent contractions of cerebral vascular smooth muscle induced by neurotransmitter and vasoconstrictor substances and of their rheological properties, currently available calcium antagonists of the nifedipine type are unable to enhance hearing recovery at the present time.

The significance of calcium antagonists in rat experimental tympanosclerosis

SummaryThe effect of calcium antagonists in experimental tympanosclerosis following infection with Streptococcus pyogenes and vitamin D3 intoxication has been analyzed in a rat animal model. Compared with untreated animals, calcium antagonists exert a positive effect on the degenerative process and on secondary calcification in the subepithelial layer. This effect could be substantiated planimetrically.

A Contribution to the pathogenesis of otosclerosis

ZusammenfassungIn einer histochemischen und ultrastrukturellen Untersuchung werden die pathologischen Bindegewebsveränderungen bei der Otosklerose analysiert. Die Erkrankung führt zu einer komplexen Schädigung aller Bindegewebskomponenten. Es finden sich morphologische Anhalte für einen Enzymdefekt, der dem initialen pathologischen Reiz aufgelagert sein kann. Die beobachtete chondrozytäre Chondrolyse unterstreicht die Bedeutung der Knorpelreste in der otischen Kapsel als pathogenetischen Faktor der Otosklerose.SummaryIn a histochemical and electron microscopical study the pathogenesis of Otosclerosis was investigated. The morphological changes in the extra- and intracellular space indicated a complex metabolic disturbance of all tissue components. The observed chondrocytic chondrolysis stressed the role of the cartilage remnants in the otic capsule as an etiological factor. There was morphological evidence of a superimposed enzymatic defect.

Relationship between tubal function, craniofacial morphology and disorder of deglutition

Summary26 children without hearing impairment have been examined by otolaryngologists and orthodontists. According to the tubal function test in a pressure chamber they were classified into a group with good and poor tubal function. The E.N.T. examination was unconclusive for a possible relationship between rhinological findings, mode of breathing, sinusitis, size of tonsils, nasal airway resistance and tubal function. Adenoids proved to be a mechanical impairment for active tubal function as stated by many authors.The cephalometric analysis of lateral head films combined with a static and dynamic-functional evaluation of tongue posture revealed significant differences between children with good and poor tubal function.Subjects with a vertical craniofacial growth pattern seem to be predisposed for poor tubal function.Analysing static tongue posture in children with poor tubal function the tongue lies more retracted in a backward position. The back of the tongue is flattened in relation to the palatal arch. In children with good tubal function there is a much closer contact between the back of tongue and the hard palate.Subjects with poor tubal function have an increased incidence of abnormal deglutition combined with tongue-thrust, teeth-apart swallowing, lack of sealing off the anterior oral cavity and contraction of the circumoral musculature. In children with good tubal function one can find the somatic type of swallowing that means no contractions of the circumoral muscles, no tongue-thrust during deglutition but contact of the molars and contraction of the masseter muscle.

Orbital Decompression for Endocrine Ophthalmopathy: The Endonasal Approach

A surgical endonasal procedure is described to perform orbital decompression in patients suffering from ophthalmopathy in Graves disease. The decompression technique employs removal of the lamina papyracea as an exclusive modality or in conjunction with a transmaxillary or lateral decompression approach. This present series contain 23 patients who underwent decompression over a 3-year period and were followed for at least 6 months postoperative. The results of decompression were assessed by measuring reduction in proptosis and visual acuity. All patients demonstrated improved visual acuity. Measuring retroplacement of the globe, the endonasal approach proved to equal the results obtained after a combined transantral-endonasal approach. Orbital fat was removed depending on the degree of proptosis. The complication rate was low, and establishment of an ocular muscle training program proved helpful.