Discomforts after endoscopy of the maxillary sinus via canine fossa

A retrospective study on a series of 99 antroscopies of the maxillary sinus via canine fossa showed that this routine procedure may cause longer standing discomforts to the patients. Indications for this procedure should therefore be more severe.

[Follow-up studies and prognostic references for pre- and post-therapy pure tone audiometry and acoustically evoked potentials in sudden deafness]

In 95 patients with unilateral sudden deafness, pure-tone and speech audiometry was performed before, during and after drug therapy. Auditory brain-stem evoked responses (ABR) were recorded in all cases. Stapedial reflex audiometry and SiSi tests were also performed. The tone-audiometry thresholds for the frequencies 250, 500, 1000, 2000, 4000 and 6000 Hz were analysed, and likewise the ABR latencies for waves I to V and the I-III, III-V and I-V interpeak latencies. 57 patients showed a flat hearing loss before therapy, 31 patients a high tone loss and 7 patients a hearing loss for low frequencies. Recruitment was positive in 77%. After therapy 81% of the patients showed increased pure-tone thresholds of more than 20 dB. In 11 patients ABR showed signs for retrocochlear hearing loss; in 6 patients initially no waves could be reproduced. The tendency for remission was best in patients with flat hearing loss of less than 40 dB and normal or only moderate alterations of the ABR. In patients with severe hearing loss of greater than 40 dB and signs for retrocochlear lesions in ABR, the tendency of remission was worse. In these cases recruitment was mainly negative.

[Fractures of the orbital floor. Review of 346 cases]

From 1976 to 1988 346 fractures of the orbital floor were repositioned in the ENT-Department of the University of Mainz. 145 (41.9%) cases were pure orbital fractures, in 201 (58.1%) cases the fractures were extended. Assaults followed by accidents were the most frequent causes of injury. Preoperatively, diplopia and enophtalmus were among the most frequent symptoms, followed by fracture of the orbital rim, parestesias or anestesias of the infraorbital nerve and limitation of ocular motility. A support of the orbital floor was necessary in 122 (32.7%) of the cases, which was achieved by a modified vesical Foley catheter. In 194 (56.1%) patients lyofilized dura was used to cover the repositioned bone fragments. The orbital floor had to be reconstructed in 37 cases (10.7%) with autologue cartilage or bone. Supplementary wiring was necessary in 95 (27.5%) cases. In the follow up, diplopia and alterations of the infraorbital nerve were studied. 176 (50.8%) of the patients had diplopia with or without alterations of ocular motility, which was confirmed by routinely performed explorations in the Department of Ophthalmology. In 24 (6.9%) cases light alterations of ocular motility persisted six months postoperatively. 113 (32.7%) patients referred parestesias of the infraorbital region, persisting in 40 (11.6%) patients for at least six months.

[Therapy of ear hematoma and ear seroma]

Conservative techniques for the treatment of auricular haematomas are unsuccessful. We discuss different operative methods and compare our results with these techniques. In our opinion the method described by Kelleher is a simple and reliable method for the treatment of auricular haematoma and seroma. After incision and evacuation of the fluid, tie-over sutures over wet sponges achieve efficient obliteration of the subperichondrial space. The most important advantages of the technique are that no resection of cartilage is necessary, the obliteration of the subperichondral space is stable, the cosmetic results are good, and the complication rate is low.

[Value and status of neurologic, serologic, internal medicine and orthopedic studies in routine diagnosis of sudden deafness]

One hundred and eighteen patients with acute unilateral sensorineural hearing loss were examined. Diagnosis included a neurological, orthopedic, and internal medical examination. Serological tests were performed including influenza-, parainfluenza-, adenovirus-, RS-virus, enterovirus-, morbilli-, varicella- and cytomegalie-virus-KBR, also the serological tests for toxoplasmosis, rheuma, lues, mycosis, and Borrelia. The examinations allowed conclusions to be drawn about a possible etiology in five of the patients only: in one patient it was possible to detect an acute infection with morbilli virus; in two other patients, an acute lues infection was detected. In two other patients, neurological examinations showed symptoms of a brainstem disease. The authors' experience shows that the following examinations are useful in the diagnosis of acute unilateral sensorineural hearing loss: the recording of acoustically evoked brainstem potentials, an otoneurological examination, a neurological examination to detect a possible centrally located reason for the hearing loss, serological examinations for lues, toxoplasmosis, Borrelia, and the virus KBR if there is any suspicion of a previous virus infection. An orthopedic examination should be performed, if functional aspects, especially of the craniocervical segment are under consideration.

[Keratocysts of the maxilla and zygoma. Case report and review of the literature]

Keratocysts are a special entity of jaw cysts. The horizontal and distal regions of the mandible and the ascending ramus of the mandible are the most common locations of these cysts. Keratocysts of the os zygomaticum and orbital floor are extremely rare. In case of infection radiologic and histologic diagnosis are difficult and these cysts are often misdiagnosed as radicular and follicular cysts. The case of a 49-year old man is reported, who was admitted to hospital suffering from recurrent episodes of maxillary sinusitis with orbital involvement. He had previous sinus surgery six times. The clinical, histologic and radiologic characteristics are reported. In a literature review the present case is discussed. Because the recurrent-rate of keratocysts is rather high, complete removal and careful post-operative follow-up are mandatory.

[The dependence of phase inversion of the visual evoked potential during half-field stimulation on the stimulation target and the pattern size]

In 10 young and healthy subjects visual evoked potentials were recorded to monocular whole-field and half-field (12 degrees radius) stimulation, with and without central (3 degrees radius) and peripheral occlusion of the target. The records were made from a horizontal array of 3 occipital electrodes, one placed in the midline 5 cm above the inion and the others 8 cm each lateral of the inion. The early and main components of the VEPs were analyzed and compared. We found that the N2-Peak has its origin in the macular parts of the retina and the P2-peak in the central and peripheral parts of the visual field. Inverted polarity of the P2-peaks contralateral to the stimulated half-field could be observed only when the VEP was recorded with small checks. When using large checks, only the early components inverted. The probable origin of the inverted main components is discussed, being either a simple inverted P2-peak because of the direction of the cortical dipoles, or a new, paramacular N105-peak.

[Results of tinnitus therapy using lidocaine iontophoresis]

54 patients with severe tinnitus were treated by lidocaine iontophoresis. 25 patients suffered from a bilateral tinnitus. A total of 75 ears were treated. The ratio of male to female patients was 3:1. The average age was 45 years. All patients had got over at least one ineffective treatment. Prior to iontophoresis a complete audiologic, neuro-otologic and x-ray examination of the temporal bones was performed. In all patients the frequency and intensity of tinnitus were determined before and immediately after a treatment. In 44 patients there was no difference in their tinnitus after the treatment. In one patient the tinnitus has become lower by the iontophoresis. The value of this method in tinnitus therapy is discussed.

[Pattern reversal VEP and computer perimetry of the partner eye in optic neuritis]

The pattern-reversal VEP with different check size and the computerized perimetry in the 10 degrees and 30 degrees radius field were recorded in 22 patients suffering from unilateral optic neuritis diagnosed by historical as well as by clinical findings. During the acute attack 12/22 optic neuritis eyes and 3/22 partner eyes had a diminished visual acuity below 0.7. After the attack the visual acuity remained reduced in 9/22 of the affected and 2/22 of the nonaffected partner eyes. The VEP was prolonged in 19/22 optic neuritis eyes and in 12/22 partner eyes applying 50' checks and in 15/22 resp. applying 15' checks. The computed visual fields showed depressions in 21/22 optic neuritis-eyes and in 15/22 partner eyes within in the 30 degrees radius field. VEP and computerized perimetry, there for, can detect subclinical affections of partner eyes in unilateral optic neuritis in a very high percentage.