William W. Steiner

Lupenendoskopische Elektromyographie des Musculus crico-arytaenoideus dorsalis (Posticus) am wachen Patienten

SummaryThe EMG enables diagnosis, follow-up and prognosis of vocal cord palsy as well as an indication for surgery. Using the zoom-endoscope by v. Stuckrad the EMG can be performed in local anesthesia. With a specially designed instrument the needle electrode can be transorally applied exactly in the posterior cricoarytenoid muscle as well as in other muscles of the larynx. As the patient can follow instructions both voluntary and spontaneous activity can be recorded under visual and acoustic control during inspiration, phonation and exspiration on a tape. Thus replay, control examination and electronic summation is possible.

Laserendoskopie in Pharynx, Larynx und Trachea

SummaryOn the basis of our experience with a CO2 laser, gained at the ENT Department of the Erlangen University Hospital, an attempt is made to represent the advantages and disadvantages of laser treatment as compared with conventional methods, and to list the indications for its use. Over a period of one year, the CO2 laser was employed through the endoscope in the pharynx, larynx and trachea in a total of 108 patients.The advantages described in the literature, for example accurate cutting, minimal traumatisation, the absence of postoperative edema and freedom from pain, are also found with conventional microsurgery — in fact cutting with the scalpel is certainly more accurate — while a certain thermal damage to the surrounding tissue is unavoidable with the laser. Temporary neuralgia has been observed following resection with the laser in the supraglottis, oropharynx and hypopharynx. Healing of the surgical wound, epithelialization and the formation of scar tissue, and the postoperative function are dependent upon the site, size and depth of the wound and not on the “cutting technique”. In the case of large wounds, healing is even delayed as a result of the sloughing of coagulation necrosis.The real advantages are of a different nature: bloodless, contact-free and accurate surgery also in the cavities that are difficult of manual access, such as the nasopharynx — these are the essential features of laser surgery. When healing is complete, the organic and functional results are impressive.On the basis of a thoroughgoing photographic documentation of the findings and the course of healing in selected cases subjected to surgery of the pharynx, larynx and trachea, the most important indications are discussed. These include choanal atresia and peritubal adenoids.Among the benign lesions, using the laser makes sense in particular in the treatment of haemangioma and papilloma, and of cicatricial stenoses. In the case of lesions of unclear dignitiy, the smaller they are, the less the laser is indicated — in conformity with the oncological requirement for an accurate histological diagnosis and resection, based on histological criteria, with wide margins in the healthy tissue.

Endoskopische Therapie von Krebsfrühstadien im Larynx — vorläufige Ergebnisse

SummaryDuring the last 8 years 118 patients of the ENT Department of the University Erlangen, presenting with leukoplakia, hyperplastic, papillomatous or ulcerative processes of the larynx, were treated by endolaryngeal microsurgery — some with the CO2 laser — under intubation anaesthesia. Histologically, these lesions were classified as carcinoma in situ or invasive squamous cell carcinoma (T1, T2 with no loss of vocal cord mobility).In addition to this local treatment also a systematic antiinflammatory treatment up of the upper airways aimed at the elimination of chronic mucosal irritation. Additionally the patient was always urged to strictly avoid contact with exogenous noxae and inhalative carcinogens, in particular cigarette smoking.With this etiology-oriented regimen, compromising endoscopic microsurgery and supporting measures, recurrences occurred in only 11 patients out of 118. In every case, the recurrent lesion was successfully treated by function-preserving endoscopic (9) or extralaryngeal (2) partial resections. To date, no patient has had to be subjected to aggressive cancer therapy (radiation, laryngectomy or neck dissection). Four patients died from causes other than the primary tumour, all others are still alive.

Rhino-laryngologische und arbeitsmedizinische Untersuchungen zur Berufsgefahrdung von Schornsteinfegern

SummaryThe chimney sweep is professionally exposed to air pollution and carcinogenetic substances more than others.Within the scope of an occupational-medicine study begun in 1974, 121 chimney sweeps were examined with regard to history, physical status, pulmonary function including X-rays. The concentrations of different noxious substances at the place of work were measured.At the same time they underwent an ENT-medical examination including X-ray studies of the paranasal sinuses. In 1976 the follow-up examination was performed. The larynx and pharynx of all subjects were endoscopically inspected. More than 60% showed an inflammation or irritation of the pharyngeal and laryngeal mucosa. In24 of the pathological X-ray findings in the paranasal sinuses mostly cysts, solitary or multiple, were found by endoscopic inspection.This follow-up examination contributes to the evaluation of the etiological role of chronic inflammatory diseases of the upper respiratory mucosa in chronic bronchitis.

Simultanes Wachstum von Carcinom und Präcancerose im Kehlkopf — eine stratigraphische histomorphologische Analyse

SummaryChronic and diffuse contact between inhalation noxae and the mucosa plays an important role in the pathogenesis of cancer of the larynx and lead us to expect a multilocular development of carcinoma and precancerous changes. This supposition was examined in some 100 larynx resection preparations.After standardized stratigraphic sub-divisioning of the larynx, it was lamellated and the individual zones studied histologically for epithelial dysplasias, varying degrees of differentation up to an including carcinoma, and for inflammatory changes.Certain relationships were found to exist between certain characteristics of growth of the carcinoma and the site, extent and histological classification of the tumour. The fact that, frequently, a macroscopically non-verifiable coexistance of precancer and carcinoma can be found, is taken account of in the modified conception for the taking of biopsies.

Krebsfrüherkennung in Mund-, Rachen- und Kehlkopfbereich

SummaryDuring a six months lasting screening project 6866 persons complaining of hoarseness or other related symptoms of the head and neck were examined free of cost.Inspection of the mouth, endoscopy of the naso-hypopharynx and larynx with the Wolf-endoscope after v. Stuckrad, and palpation of the neck were included. The data from both the questionaires and the examination were evaluated by computer. Every sixth person required further diagnosis or treatment. Precanceroses were found in almost 3%, and up to now malignomas were found in 0.3% of the screened persons. Among theses 14 cases of cancer were 9 carcinomas of the larynx. This comperatively high percentage of precanceroses and cancer favors the establishment of pharyngo-laryngeal endoscopy in cancer prevention projects. In particular the endoscopic screening of patients with organ-related symptoms and of high risk groups is recommended.

Endoskopische Krebsnachsorge im oberen Aero-Digestiv-Trakt

SummaryBetween 1975 and 1980, at the ENT Department of the University Hospital of Erlangen, more than 900 patients were treated for malignant lesions in mouth, pharynx and larnyx. About 40% of these lesions were laryngeal carcinomas.Long range after-care serves to ensure early recognition of residual, recurrent or second carcinomas. It rises particular demands with respect to organization and methods. Prerequisite is a good cooperation between patient and doctor. A tumour register in connection with a precise patient-summoning system, permits expedient patient follow-up at regular intervals.The ENT examination always includes endoscopy of the nose, pharynx and larynx in the awake patient. In addition to the routine photographic (and video-) documentation, a cytological swab is always obtained from the area of primary tumour manifestation. All visible proliferations are subject to a thorough cytological and histological (biopsy) investigation, irrespective of size or clinical significance. In the case of changes produced by irradiation or surgery, which can be difficult to evaluate, a different methodical approach may sometimes be required.Provided that the patient is properly instructed and is willing to cooperate, this standardized concept enables the detection of recurrences at an early stage — in particular in the larynx — and to ensure improved treatment with respect both to the functional result and the subsequent prognosis.

Simultanes Vorkommen von Präkanzerosen und Karzinomen in Mund, Rachen und Kehlkopf. Vorläufige Ergebnisse einer interdisziplinären Studie

SummaryThe incidence of two simultaneous carcinomas within the organism is 5%, in the region of the upper airways and alimentary tract, less than 1%. With the aid of systematized clinical endoscopic and cyto-histomorphological screening procedures for carcinomas along the “smokers pathway“, concomitant carcinomas and pre-cancerous states are being detected more and more frequently and at an earlier stage.Between 1976 and 1978, 210 patients presenting with oral leukoplakia of varying genesis and localization, and both benign and malignant, were subjected to systematic dermatological, dental and ENT examinations. A therapy-relevant finding in the ENT region was found in every third patient. In 41 patients with oral pre-cancerous conditions and carcinomas, similar concomitant findings were seen in the larynx in 15%, localized in the glottis in 90% of the cases. — Etiologically particularly high-risk patients proved to be men over 30, with oral leukoplakia and poor oral hygiene and a history of regular smoking and consumption of considerable quantities of alcohol.The basis for the detection of concomitent or consecutive pre-cancerous conditions and early cancers in the region of the upper airways and alimentary tract is the interdisciplinary cooperation covering the inspection of the oral cavityand pharynx and larynx.

Endoskopische und zyto-histomorphologische Möglichkeiten der Krebsfrüherkennung im Hypopharynx

SummaryHypopharyngeal carcinomas are usually diagnosed in stage 3 and 4 and, even when subjected to combined radiological and surgical therapy, have a very poor prognosis. An improvement in this lamentable therapeutic and diagnostic situation can be expected only from early detection. Therefore, for the detection of precancerous and early stages of hypopharyngeal carcinoma, the proven techniques employed for early detection and grading of precancers and early carcinomas in the larynx were employed.Within the framework of this prospective study, a total of 328 patients have been examined since the beginning of 1978. Following the completion of a computer-compatible questionnaire covering pre-history, symptoms and smoking and drinking habits, a complete endoscopic investigation of the head and neck regions was carried out. For the examination of the pharynx and larynx, the v. Stuckrad zoom endoscope has proved its value, since, with it, even concealed regions of mucosa, as in the hypopharynx, can be reliably inspected. Thus, the visual early detection of very minute and early changes of the mucosa is also possible in this area. Cytological material is obtained from the various topographical regions, stained in accordance with Papanicolaou and evaluated. In the case of suspicious findings (Pap. III) an endoscopic-cytological check is carried out, or tissue biopsy taken for histomorphological work-up.The analysis of the cytological findings showed that, in particular, six cases with Pap. III, manifesting no visible changes in the mucosa of the hypopharynx, were of interest. Since multiple check cytological examinations indicated the moderate dysplasia, these patients were classed as being at particular risk and are now being monitored endoscopically and cytologically, every 3 months.In the examination of etiologically high-risk groups and patients with precancerous conditions of the upper airways and alimentary tract, cytologically suspicious cases indicating dysplasia or early tissue changes in the mucosa, may be more frequently expected in the hypopharynx, too. Only long-term observation will reveal how a cytological finding with dyscaryosis (Pap. III), in the presence of a clinically and endoscopically normal mucosa is to be classified.

Endoskopische Grobnadelbiopsie in Rachen und Kehlkopf

SummaryThe needle-biopsy taken in the pharynx and larynx is a simple and reliable procedure for the histological diagnosis of submucosal tumours. It can be performed either in local anaesthesia using the zoom-endoscope by v. Stuckrad or during microlaryngoscopy under general anaesthesie. This method however does neither replace the single biopsy of exophtic tumours nor the microlaryngoscopic excision of suspicious, precancerous lesions.The needle-biopsy taken in the pharynx and larynx is a simple and reliable procedure for the histological diagnosis of submucosal tumours. It can be performed either in local anaesthesia using the zoom-endoscope by v. Stuckrad or during microlaryngoscopy under general anaesthesie. This method however does neither replace the single biopsy of exophtic tumours nor the microlaryngoscopic excision of suspicious, precancerous lesions.