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Hellings PW, Fokkens WJ, Orlandi R, Adriaensen GF, Alobid I, Baroody FM, Bjermer L, Senior BA, Cervin A, Cohen NA, Constantinidis J, De Corso E, Desrosiers M, Diamant Z, Douglas RG, Gane S, Gevaert P, Han JK, Harvey RJ, Hopkins C, Kern RC, Landis BN, Lee JT, Lee SE, Leunig A, Lund VJ, Bernal-Sprekelsen M, Mullol J, Philpott C, Prokopakis E, Reitsma S, Ryan D, Salmi S, Scadding G, Schlosser RJ, Steinsvik A, Tomazic PV, Van Staeyen E, Van Zele T, Vanderveken O, Viskens AS, Conti D, Wagenmann M. The EUFOREA pocket guide for chronic rhinosinusitis. Rhinology 2023; 61:85-89. [PMID: 36507741 DOI: 10.4193/rhin22.344] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic rhinosinusitis (CRS) is known to affect around 5 % of the total population, with major impact on the quality of life of those severely affected (1). Despite a substantial burden on individuals, society and health economies, CRS often remains underdiagnosed, under-estimated and under-treated (2). International guidelines like the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) (3) and the International Consensus statement on Allergy and Rhinology: Rhinosinusitis 2021 (ICAR) (4) offer physicians insight into the recommended treatment options for CRS, with an overview of effective strategies and guidance of diagnosis and care throughout the disease journey of CRS.
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Affiliation(s)
- P W Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Nethe
| | - W J Fokkens
- Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland
| | - R Orlandi
- Rhinology and Skull Base, Department of Otorhinolaryngology, Hospital Clinic, Universidad de Barcelona, Centro Medico Teknon, Barcelona, Spain
| | - G F Adriaensen
- Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland
| | - I Alobid
- Rhinology and Skull Base, Department of Otorhinolaryngology, Hospital Clinic, Universidad de Barcelona, Centro Medico Teknon, Barcelona, Spain
| | - F M Baroody
- The University of Chicago Medicine, Chicago, IL, United States
| | - L Bjermer
- Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden
| | - B A Senior
- Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Cervin
- The university of Queensland Centra for Clinical Research, Herston, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - N A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - E De Corso
- Department of Otolaryngology Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Universita; Cattolica Sacro Cuore, Rome, Italy
| | - M Desrosiers
- Department of Otolaryngology-Head and Neck Surgery, Universita de Montreal, Montreal, Canada
| | - Z Diamant
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden; Department Clinical Pharmacy and Pharmacology, University Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R G Douglas
- Department of Surgery, The University of Auckland, New Zealand
| | - S Gane
- Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom
| | - P Gevaert
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
| | - J K Han
- Department of Otolaryngology and Head and Neck Surgery at Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - R J Harvey
- Rhinology and Skull Base, Applied Medical Research Center, Department of Otolaryngology and Head and Neck Surgery at Eastern Virginia Medical School, Norfolk, Virginia, USA; Faculty of medicine and heath sciences, Macquarie University, Sydney, Australia
| | - C Hopkins
- Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom
| | - R C Kern
- Department of Otolaryngology, Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - B N Landis
- Hopitaux Universitaires de Geneve, Geneve, Geneve, Switzerland
| | - J T Lee
- Brigham and Women's Hospital, Harvard Medical School, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Section of Rhinology and Skull Base Surgery, Massachusetts, USA
| | - S E Lee
- Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - A Leunig
- Rhinology Center, Munich and ENT-Clinic, Munich, Germany
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
| | | | - J Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain
| | - C Philpott
- NIHR UCLH Biomedical research Centre, London, UK; Ear Institute, University College London, London, UK
| | - E Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece
| | - S Reitsma
- Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland
| | - D Ryan
- Usher institute, University of Edinburgh, Edinburgh, UK
| | - S Salmi
- Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland; Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - G Scadding
- Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom
| | - R J Schlosser
- Department of Otolaryngology Head and Neck surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - P V Tomazic
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - E Van Staeyen
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
| | - T Van Zele
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
| | - O Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium; Multidisciplinary Sleep Disorder Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - A-S Viskens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | | | - M Wagenmann
- Department of Otorhinolaryngology, Universitatsklinikum Disseldorf, Dusseldorf, Germany
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2
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Prokopakis E, Vardouniotis A, Bachert C, Bousquet J, Carrie S, Castelnuevo P, Constantinidis J, Fokkens W, Hopkins C, Leunig A, Molteni G, Mullol J, Scadding G, Marien G, Doulaptsi M, Hellings P. Rhinology Future Debates 2018, a EUFOREA Report. Rhinology 2020; 58:384-393. [PMID: 32333751 DOI: 10.4193/rhin19.455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The third Rhinology Future Debates was organized by the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) in 2018 in Brussels. Experts from different specialties and countries, alongside patients, health policy makers and industry representatives discussed relevant topics in Rhinology, in an attempt to improve current clinical practices, through implementation of precision medicine, by empowering patients' participation and the use of eHealth tools. The debates which are available on-line (www.rhinology-future.com) dealt with 5 topics in Rhinology: the adoption of allergen-specific immunotherapy (AIT) by implementing change management strategies, the needs and obstacles in care delivery in respiratory diseases, 3D technology in nose and sinus surgery, ambulatory nasal surgery, and clinical evidence for efficacy of biologicals in CRSwNP and asthma. This report summarizes the outcomes of the brainstorming sessions highlighting novel approaches and unmet needs in the field of respiratory diseases by focusing on integrated care pathways.
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Affiliation(s)
- E Prokopakis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - A Vardouniotis
- ENT Department, St Mary's Treatment Centre, Portsmouth, UK
| | - C Bachert
- Ghent University Hospital, Ghent, Belgium
| | - J Bousquet
- University Hospital, Montpellier, MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - S Carrie
- ENT Department, Newcastle upon Tyne NHS Hospitals FT, Newcastle upon Tyne, UK
| | - P Castelnuevo
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - J Constantinidis
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - W Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Hopkins
- ENT Department, Guy's and St Thomas' Hospital, London, UK
| | - A Leunig
- Rhinology Center, ENT-Clinic Bogenhausen, Dr. Gaertner GmbH, Munich, Germany
| | - G Molteni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - J Mullol
- Clinical and Experimental Respiratory Immunoallergy, Hospital ClÃ-nic, IDIBAPS, Barcelona, Spain
| | - G Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - G Marien
- European Forum for Research and Education in allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - M Doulaptsi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - P Hellings
- Ghent University Hospital, Ghent, Belgium; 1st Department of Otorhinolaryngology, Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece; Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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3
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Seys SF, Bousquet J, Bachert C, Fokkens WJ, Agache I, Bernal-Sprekelsen M, Callebaut I, Cardel LO, Carrie S, Castelnuovo P, Cathcart R, Constantinidis J, Cools L, Cornet M, Clement G, de Sousa JC, Cox T, Doulaptsi M, Gevaert P, Hopkins C, Hox V, Hummel T, Hosemann W, Jacobs R, Jorissen M, Landis BN, Leunig A, Lund VJ, Mullol J, Onerci M, Palkonen S, Proano I, Prokopakis E, Ryan D, Riechelmann H, Saevels J, Segboer C, Speleman K, Steinsvik EA, Surda P, Tomazic PV, Vanderveken O, Van Gerven L, Van Zele T, Verhaeghe B, Vierstraete K, Vlaminck S, Wilkinson J, Williams S, Pugin B, Hellings PW. mySinusitisCoach: patient empowerment in chronic rhinosinusitis using mobile technology. Rhinology 2018; 56:209-215. [PMID: 29466477 DOI: 10.4193/rhin17.253] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mobile health technology is emerging to take a prominent position in the management of chronic diseases. These technologies aim at enhancing patient empowerment via education and self-management. To date, of all the different apps available for patients with sinus disease, none were developed by medical experts dealing with chronic rhinosinusitis (CRS). The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) has undertaken a multi-stakeholder approach for designing, developing and implementing a tool to support CRS patients in monitoring their symptoms and to provide patients with a digital support platform containing reliable medical information about their disease and treatment options. mySinusitisCoach has been developed by medical experts dealing with CRS in close collaboration with patients, primary care physicians and community pharmacists, meeting the needs of both patients and health care providers. From a research perspective, the generation of real life data will help to validate clinical studies, patient stratification and improve understanding of the socio-economic impact of CRS, thereby paving the way for better treatment strategies.
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Affiliation(s)
- S F Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - J Bousquet
- Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France
| | - C Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clinic Universitari, Barcelona, Spain
| | - I Callebaut
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - L O Cardel
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - S Carrie
- ENT Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - P Castelnuovo
- ENT Department, Ospedale Di Circolo E Fondazione Macchi, Varese, Italy
| | - R Cathcart
- ENT Department, Cumberland Infirmary, Carlisle, Cumbria, UK
| | - J Constantinidis
- 2nd Academic ENT department, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - L Cools
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - M Cornet
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - G Clement
- ENT Department, AZ Damiaan, Oostende, Belgium
| | - J C de Sousa
- Community Health, Life and Health Sciences Research Institute, School of Health Sciences, Univerity of Minho, Portugal
| | - T Cox
- ENT Department, Jessa hospital, Hasselt, Belgium
| | - M Doulaptsi
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - P Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - C Hopkins
- ENT Department, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - V Hox
- Departement dOtorhinolaryngologie, Cliniques Universitaires Saint-Luc, Belgium
| | - T Hummel
- Smell and Taste Clinic, ENT Department, Technische Universitat Dresden, Dresden, Germany
| | - W Hosemann
- ENT Department, University of Greifswald, Germany
| | - R Jacobs
- Department of Otorhinolaryngology, Head and Neck Surgery, General Hospital Sint-Blasius, Dendermonde, Belgium
| | - M Jorissen
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - B N Landis
- Unite de Rhinologie-Olfactologie, Service dOto-Rhino-Laryngologie et de Chirurgie cervico-faciale, Hopitaux Universitaires de Geneve, Geneve, Suisse
| | - A Leunig
- ENT Department, Ludwig Maximilians University Munich, Germany
| | - V J Lund
- UCL and Honorary Consultant ENT Surgeon, UCLH, UK
| | - J Mullol
- IDIBAPS, Hospital Clinic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - M Onerci
- ENT Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - S Palkonen
- European Federation of Allergy and Airways Diseases Patients Associations (EFA), Brussels, Belgium
| | - I Proano
- European Federation of Allergy and Airways Diseases Patients Associations (EFA), Brussels, Belgium
| | - E Prokopakis
- ENT Department, Jessa hospital, Hasselt, Belgium
| | - D Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - H Riechelmann
- Universitatsklinik fur Hals- Nasen- Ohrenheilkunde Innsbruck, Austria
| | - J Saevels
- Association of Pharmacists in Belgium, Brussels, Belgium
| | - C Segboer
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Speleman
- ENT Department, AZ Sint-Jan, Bruges, Belgium
| | - E A Steinsvik
- Department of Otorhinolaryngology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - P Surda
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - P V Tomazic
- Department of General ORL, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - O Vanderveken
- ENT Department, University Hospital of Antwerp, Wilrijk, Belgium
| | - L Van Gerven
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - T Van Zele
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - B Verhaeghe
- ENT Department, Sint-Jozefskliniek, Izegem, Belgium
| | | | - S Vlaminck
- ENT Department, AZ Sint-Jan, Bruges, Belgium
| | - J Wilkinson
- Pharmaceutical Group of the European Union, Brussels, Belgium
| | - S Williams
- International Primary Care Respiratory Group, Aberdeen, UK
| | - B Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - P W Hellings
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
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Fokkens WJ, Bachert C, Bernal-Sprekelsen M, Bousquet J, Djandji M, Dorenbaum A, Hakimi-Mehr D, Hendry S, Hopkins C, Leunig A, Mannent L, Mucha D, Onerci M, Pugin B, Toppila-Salmi S, Rowe P, Seys SF, Stimson S, Strzembosz A, Hellings PW. Rhinology Future Debates, an EUFOREA Report. Rhinology 2018; 55:298-304. [PMID: 29166426 DOI: 10.4193/rhin17.221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The first Rhinology Future Debates was held in Brussels in December 2016, organized by EUFOREA (European Forum for Research and Education in Allergy and Airways diseases). The purpose of these debates is to bring novel developments in the field of Rhinology to the attention of the medical, paramedical and patient community, in a highly credible and balanced context. For the first time in Rhinology, a peer to peer scientific exchange with key experts in the field of rhinology and key medical colleagues from leading industries let to a brainstorming and discussion event on a number of hot issues in Rhinology. Novel developments are presented by key experts from industry and/or key thought leaders in Rhinology, and then followed by a lively debate on the potential positioning of new developments in care pathways, the strengths and weaknesses of the novel development(s), and comparisons with existing and/or competing products, devices, and/or molecules. As all debates are recorded and distributed on-line with limited editing (www.rhinology-future.com), EUFOREA aims at maximizing the education of the target groups on novel developments, allowing a critical appraisal of the future and a more rapid implementation of promising novel tools, techniques and/or molecules in clinical practise in Europe. The next Rhinology Future debate will be held in Brussels in December 2017.
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Affiliation(s)
- W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University, Belgium
| | - M Bernal-Sprekelsen
- Hospital Clinic, ENT-Department, Universidad de Barcelona Medical School, Spain
| | - J Bousquet
- University Hospital of Montpellier, Montpellier, France
| | - M Djandji
- Medical Affairs, Sanofi Genzyme, Cambridge, MA, USA
| | | | | | - S Hendry
- RVP and GM Europe, Entellus Medical Inc, Minneapolis, MN, USA
| | - C Hopkins
- Guys and St Thomas Hospital, and Kings College, London, UK
| | - A Leunig
- Rhinology Center Munich, Germany
| | - L Mannent
- Research and Development, Sanofi, Chilly Mazarin, France
| | - D Mucha
- Fiagon Ag Medical Technologie, Hennigsdorf, Germany
| | - M Onerci
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
| | - B Pugin
- EUFOREA- European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | - S Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - P Rowe
- Global Medical Affairs, Immunology and Inflammation, Sanofi Genzyme, Bridgewater, NJ, USA
| | - S F Seys
- EUFOREA- European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | | | - A Strzembosz
- International Medical Affairs, Medtronic ENT, Tolochenaz, Switzerland
| | - P W Hellings
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands and Department of Otorhinolaryngology, University Hospitals Leuven, Belgium
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Hopkins C, Hettige R, Soni-Jaiswal A, Lakhani R, Carrie S, Cervin A, Douglas R, Fokkens W, Harvey R, Hellings P, Leunig A, Lund V, Philpott C, Smith T, Wang D, Rudmik L. CHronic Rhinosinusitis Outcome MEasures (CHROME), developing a core outcome set for trials of interventions in chronic rhinosinusitis. Rhinology 2018; 56:22-32. [DOI: 10.4193/rhin17.247] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ledderose GJ, Stelter K, Betz CS, Englhard AS, Ledderose C, Leunig A. Cerebrospinal fluid leaks during endoscopic sinus surgery in thirty-two patients. Clin Otolaryngol 2017; 42:1105-1108. [PMID: 28317322 DOI: 10.1111/coa.12870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- G J Ledderose
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany
| | - K Stelter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany.,ENT-Center Mangfall-Inn, Rosenheim, Germany
| | - C S Betz
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany
| | - A S Englhard
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany
| | - C Ledderose
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A Leunig
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany.,Rhinology Center, ENT-Clinic Munich Bogenhausen, Dr. Gaertner GmbH, Munich, Germany
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7
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Theodoraki MN, Ledderose GJ, Becker S, Leunig A, Arpe S, Luz M, Stelter K. Mental distress and effort to engage an image-guided navigation system in the surgical training of endoscopic sinus surgery: a prospective, randomised clinical trial. Eur Arch Otorhinolaryngol 2014; 272:905-913. [PMID: 25007736 DOI: 10.1007/s00405-014-3194-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022]
Abstract
The use of image-guided navigation systems in the training of FESS is discussed controversy. Many experienced sinus surgeons report a better spatial orientation and an improved situational awareness intraoperatively. But many fear that the navigation system could be a disadvantage in the surgical training because of a higher mental demand and a possible loss of surgical skills. This clinical field study investigates mental and physical demands during transnasal surgery with and without the aid of a navigation system at an early stage in FESS training. Thirty-two endonasal sinus surgeries done by eight different trainee surgeons were included. After randomization, one side of each patient was operated by use of a navigation system, the other side without. During the whole surgery, the surgeons were connected to a biofeedback device measuring the heart rate, the heart rate variability, the respiratory frequency and the masticator EMG. Stress situations could be identified by an increase of the heart rate frequency and a decrease of the heart rate variability. The mental workload during a FESS procedure is high compared to the baseline before and after surgery. The mental workload level when using the navigation did not significantly differ from the side without using the navigation. Residents with more than 30 FESS procedures already done, showed a slightly decreased mental workload when using the navigation. An additional workload shift toward the navigation system could not be observed in any surgeon. Remarkable other stressors could be identified during this study: the behavior of the supervisor or the use of the 45° endoscope, other colleagues or students entering the theatre, poor vision due to bleeding and the preoperative waiting when measuring the baseline. The mental load of young surgeons in FESS surgery is tremendous. The application of a navigation system did not cause a higher mental workload or distress. The device showed a positive effort to engage for the trainees with more than 30 FESS procedures done. In this subgroup it even leads to decreased mental workload.
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Affiliation(s)
- M N Theodoraki
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulm, University Clinic of Ulm, Ulm, Germany.
| | - G J Ledderose
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
| | - S Becker
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
| | - A Leunig
- Clinics and Private Practice Dr. Gärtner, Munich, Germany
| | - S Arpe
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
| | - M Luz
- Industrial, Engineering and Organisational Psychology of the Technical University, Berlin, Germany
| | - K Stelter
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
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Ledderose GJ, Leunig A. Surgical management of recurrent sinonasal mucosal melanoma: endoscopic or transfacial resection. Eur Arch Otorhinolaryngol 2014; 272:351-6. [PMID: 24880472 DOI: 10.1007/s00405-014-3119-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/22/2014] [Indexed: 02/03/2023]
Abstract
Sinonasal mucosal melanoma (SNMM) is associated with poor prognosis. Local recurrence is common and represents a major problem in the therapy. Wide resection surgery is usually applied. However, given the almost futile prognosis, optimal symptom control may be preferable to wide resection at all costs. The aim of our study was to analyze the outcome in patients with recurrent SNMM treated by transfacial radical surgery or by a less invasive endoscopically controlled approach. Patients with recurrent grade III or IV staged SNMM who presented to our ENT department between 2000 and 2010 were either treated by transfacial (n = 10) or endoscopically controlled surgery (n = 12). The patients' charts were reviewed for clinical symptoms, relapse-free time and survival time. Clinical symptoms improved after surgery. The morbidity after endoscopic surgery was significantly lower than after transfacial surgery. The chosen surgical technique did neither affect relapse-free nor survival time. When treating recurrent SNMM, the comparatively gentle and less mutilating endoscopic approach proved to be a sufficient surgical procedure, being not inferior to aggressive surgery with respect to recurrence and survival rate.
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Affiliation(s)
- G J Ledderose
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany,
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9
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Kastl K, Reichert M, Scheithauer M, Sommer F, Kisser U, Braun T, Havel M, Leunig A. Patient comfort following FESS and Nasopore® packing, a double blind, prospective, randomized trial. Rhinology 2014. [DOI: 10.4193/rhin13.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Kastl K, Reichert M, Scheithauer M, Sommer F, Kisser U, Braun T, Havel M, Leunig A. Patient comfort following FESS and Nasopore® packing, a double blind, prospective, randomized trial. Rhinology 2014; 52:60-5. [DOI: 10.4193/rhino13.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: The use of nasal packing after functional endoscopic sinus surgery (FESS) is often associated with pain and a feeling of pressure for patients. The aim of the present work was to investigate a modern wound dressing made of polyurethane (Nasopore®) that makes removal of the nasal packing unnecessary and is focussed on patient comfort. Methodology: Following bilateral FESS, after randomisation, one side was packed with Nasopore® while the other side was without packing as a control. The following parameters from 47 patients were determined daily in two centres from post-operative day 1 for the duration of the inpatient stay in a double-blinded setting: side-specific post-operative bleeding, nasal breathing and feeling of pressure as well as the general parameters sleep disturbance, headaches and general well-being. Which side patients considered subjectively the better was also recorded. Results: No significant differences were determined between the two sides in terms of the rates of post-operative bleeding and nasal breathing. The feeling of pressure was slightly less on the side packed with Nasopore® on post-operative days 2 and 3. No trend could be observed regarding which side patients described as being subjectively better. Conclusion: There were only slight differences in patient comfort between the Nasopore® side and the control. Because the feeling of pressure in the midface was significantly less and there were no complications, this suggests there is greater patient comfort when using Nasopore® compared to using no nasal packing.
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11
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Braun T, Betz CS, Ledderose GJ, Havel M, Stelter K, Kuhnel T, Strauss G, Waschke J, Kirchner T, Briner HR, Simmen D, Caversaccio M, Wormald PJ, Jones N, Leunig A. Endoscopic sinus surgery training courses: benefit and problems - a multicentre evaluation to systematically improve surgical training. Rhinology 2013; 50:246-54. [PMID: 22888480 DOI: 10.4193/rhino11.266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this multicentre study was to systematically analyse the strengths and weaknesses in the surgical training for endoscopic sinus surgery (ESS) and identify measures that may improve training. METHODOLOGY Using a structured questionnaire, 133 participants of ESS courses in seven centres in Germany, Switzerland and Australia were asked about their experiences during their dissection courses and how they perceived their course could be improved. RESULTS Gaining confidence in handling of instruments and endoscopes was only a problem for participants with little experience in ESS. The majority of the participants, independent from their level of training, considered infundibulotomy and anterior ethmoidectomy as the easiest dissection steps, whilst surgery of the frontal sinus posed a considerable challenge for many surgeons even those with a higher level of training. Participants with and without ESS experience thought that emphasis on anatomy was the most important improvement that could be made during their surgical training. Virtually all participants stated that the course improved their anatomical knowledge, their surgical skills and their confidence when performing ESS. CONCLUSIONS ESS dissection courses are considered beneficial by surgical trainees. Participants felt that more emphasis on sinus anatomy in conjunction with private study is essential to maximize their skills in surgical dissection. For beginners with ESS, an infundibulotomy and anterior ethmoidectomy were thought to be the best initial procedures to help develop endoscopic surgical skills.
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Affiliation(s)
- T Braun
- Department of Otorhinolaryngology, Ludwig Maximilian University, Munich, Germany.
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Stelter K, Ertl-Wagner B, Luz M, Muller S, Ledderose G, Siedek V, Berghaus A, Arpe S, Leunig A. Evaluation of an image-guided navigation system in the training of functional endoscopic sinus surgeons. A prospective, randomised clinical study. Rhinology 2012; 49:429-37. [PMID: 21991568 DOI: 10.4193/rhino11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Many sinus surgeons report improved spatial orientation after using a navigation system. This study investigates the surgical, ergonomic and economic aspects of using a navigation system in training and teaching. MATERIALS AND METHODS Eight rhino-surgeons in training and 32 patients with bilateral diseases of the paranasal sinus system were included. After randomisation, one patient`s side was operated on with a navigation system while the other side was operated on without navigation. It was monitored how often the surgeon used the navigation pointer and then changed the procedures. A standardised and validated interview recorded the cognitive load when using the navigation system and the application efficiency. RESULTS The operations lasted on average 16 minutes longer with the navigation. Five paranasal sinuses could not be found in the control group without navigation. In only 10-13% of cases did the surgical procedure change after the use of the pointer. Most of the surgeons admitted that particular steps of the operation were more reliable and safer to carry out with the navigation system. The general trust in the system rose in proportion to intraoperative accuracy and repeated use. CONCLUSION Overall, there was an overwhelming level of trust in the navigation system. Trainee sinus surgeons seeing their more experienced colleagues using a navigation device tend to overestimate the possibilities of the system and to underestimate the risks. The assistance system was used particularly effectively in the group of slightly more experienced surgeons. In this group, the additional expenditure of time was less and the navigation substantially contributed to reinforcing the anatomical sense of direction.
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Affiliation(s)
- K Stelter
- Department of Otorhinolaryngology, Ludwig Maximilian University, Munich, Germany.
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Braun T, Betz C, Ledderose G, Havel M, Stelter K, Kohnel T, Straus G, Waschke J, Kirchner T, Briner H, Simmen D, Caversaccio M, Wormald P, Jones N, Leunig A. Endoscopic sinus surgery training courses: benefit and problems - a multicentre evaluation to systematically improve surgical training. Rhinology 2012. [DOI: 10.4193/rhin11.266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Stelter K, Ertl-Wagner B, Luz M, Muller S, Ledderose G, Siedek V, Berghaus A, Arpe S, Leunig A. Evaluation of an image-guided navigation system in the training of functional endoscopic sinus surgeons. A prospective, randomised clinical study. Rhinology 2011. [DOI: 10.4193/rhin11.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Braun T, Ihrler S, Kisser U, Leunig A. [Cystic lesion with a displaced tooth in the maxillary sinus]. HNO 2011; 59:700-4. [PMID: 21607801 DOI: 10.1007/s00106-010-2204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ameloblastomas are epithelial odontogenic tumors in the mandibula or maxilla with potential local infiltrating growth; therefore, relapses can occur after incomplete resection. Among the different histological subtypes, the following are of clinical importance: The so-called unicystic ameloblastoma, radiologically presenting as a common dentigerous cyst, and the so-called extraosseous ameloblastoma. This case report describes the rare combination of a unicystic ameloblastoma with extraosseous localization in the maxillary sinus and association with a displaced tooth. This unusual constellation can cause major diagnostic problems.
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Affiliation(s)
- T Braun
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Ludwig-Maximilians-Universität, München, Deutschland.
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Heimgartner S, Eckardt J, Simmen D, Briner HR, Leunig A, Caversaccio MD. Limitations of balloon sinuplasty in frontal sinus surgery. Eur Arch Otorhinolaryngol 2011; 268:1463-7. [PMID: 21559809 DOI: 10.1007/s00405-011-1626-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/29/2011] [Indexed: 11/28/2022]
Abstract
Balloon sinuplasty is a tool that is used to treat selected patients with paranasal sinus pathologies. No studies have investigated the aetiology of failed access to the frontal sinus. The aim of our study was to specify the intraoperative technical failure rate and to analyse the aetiology of the failed access to predict potential technical difficulties before surgery. We retrospectively analysed the charts of patients who underwent balloon sinuplasty from November 2007 to July 2010 at three different ENT-Centres. CT-analysis of the patients with failed access was performed. Of the 104 frontal sinuses, dilation of 12 (12%) sinuses failed. The anatomy of all failed cases revealed variations in the frontal recess (frontoethmoidal-cell, frontal-bulla-cell or agger-nasi-cell) or osteoneogenesis. In one patient, a lymphoma was overlooked during a balloon only procedure. The lymphoma was diagnosed 6 months later with a biopsy during functional endoscopic sinus surgery. In complex anatomical situations of the frontal recess, balloon sinuplasty may be challenging or impossible. In these situations, it is essential to have knowledge of classical functional endoscopic sinus surgery of the frontal recess area. The drawbacks of not including a histopathologic exam should be considered in balloon only procedures.
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Affiliation(s)
- S Heimgartner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bern, Switzerland, Freiburgstrasse, 3010 Bern, Switzerland
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Abstract
BACKGROUND The literature lacks studies analyzing the specific problems of colleagues in the surgical training for FESS. The presented date can help to systematically improve the training. METHODS The participants of the 11 (th) Munich FESS Course were asked about problems occurring during dissection and about their opinion how the training could be improved. RESULTS Handling of instruments and endocopes was only a problem for participants without any experience in FESS. The majority of the participants, independently from their training level, considered infundibulotomy and anterior ethmoidectomy the easiest dissection steps. Participants with and without FESS experience regarded a more extensive study of anatomy in the forefront as the most important toehold in the improvement of the surgical training. Virtually all participants stated that the course improved their anatomical knowledge, their confidence on the patient, and their surgical skills. CONCLUSIONS FESS dissection courses are well accepted and considered as beneficial by surgical trainees. An exhaustive private study of anatomy is essential. For beginners with FESS, infundibulotomies and anterior ethmoidectomies should preferentially be chosen.
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Affiliation(s)
- T Braun
- Klinikum der Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, München.
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Havel M, Nicolai T, Betz CS, Berghaus A, Leunig A. Symptome und Therapie der Choanalatresie - Stents weiterhin umstritten. Klin Padiatr 2010; 222:430-6. [DOI: 10.1055/s-0030-1262781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Siedek V, Kremer A, Betz CS, Tschiesner U, Berghaus A, Leunig A. Management of orbital complications due to rhinosinusitis. Eur Arch Otorhinolaryngol 2010; 267:1881-6. [DOI: 10.1007/s00405-010-1266-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 04/22/2010] [Indexed: 11/30/2022]
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20
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Leunig A, Sommer F, Betz C, Sommer B. Anatomic Variations of the Sinuses: Multiplanar Computed Tomography Analysis in 641 Patients. Skull Base 2009. [DOI: 10.1055/s-2009-1224444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Leunig A, Flohrschütz C, Betz C. Mucoceles of the Frontal Sinus: Munich Experience with Drill-Out Procedures. Skull Base 2009. [DOI: 10.1055/s-2009-1224443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Leunig A, Braunschweig F, Havel M, Markmann S, Kramer M, Menz G. [Chronic rhinosinusitis and aspirin intolerance]. MMW Fortschr Med 2009; 151:44-45. [PMID: 19391414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
MESH Headings
- Adult
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Aspirin/administration & dosage
- Aspirin/adverse effects
- Asthma/chemically induced
- Asthma/diagnosis
- Bronchial Spasm/chemically induced
- Bronchial Spasm/diagnosis
- Desensitization, Immunologic
- Diagnosis, Differential
- Drug Hypersensitivity/diagnosis
- Female
- Humans
- Male
- Middle Aged
- Nasal Polyps/chemically induced
- Nasal Polyps/diagnostic imaging
- Radiography
- Rhinitis, Allergic, Perennial/chemically induced
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/therapy
- Sinusitis/chemically induced
- Sinusitis/diagnosis
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Affiliation(s)
- A Leunig
- HNO-Klinik, Klinikum Grosshadern der LMU München, München.
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23
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Betz CS, Zhorzel S, Schachenmayr H, Stepp H, Havel M, Siedek V, Leunig A, Matthias C, Hopper C, Harreus U. Endoscopic measurements of free-flap perfusion in the head and neck region using red-excited Indocyanine Green: preliminary results. J Plast Reconstr Aesthet Surg 2008; 62:1602-8. [PMID: 19036663 DOI: 10.1016/j.bjps.2008.07.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/28/2008] [Accepted: 07/24/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Free-tissue transfer has become a standard procedure for reconstructive surgery in the head and neck area. Flap failures are relatively rare (<or=5%), and a high percentage can be salvaged if detected early. Indocyanine Green (ICG) angiography might be able to improve the detection of flap malperfusion at an early stage. METHODS So far, 11 patients with free-flap reconstructions of the upper aerodigestive tract (UADT) have participated in this study. Each participant underwent three endoscopic ICG angiographies (24h intra-operatively and 72h postoperatively). The data obtained were evaluated online as well as offline on a personal computer (PC), and the results compared to the clinical outcome. RESULTS There were no partial or complete flap losses. One flap was successfully salvaged following initial arterial kinking with impeded perfusion. The ICG fluorescence angiography was tolerated well in all patients. The free flaps showed a delayed yet equal ICG fluorescence as compared to the surrounding tissue. The timing and slope of fluorescence build-up were dependent on circulatory factors. The relative fluorescence maxima of flap versus surrounding were 33% in the initially failing flap and >or=64% for all other examinations. CONCLUSIONS It was possible to prove the feasibility of endoscopic ICG fluorescence angiography in patients undergoing free-flap transfer to the UADT. The method provides instant information about the perfusion state of the tissue and is easily performed without greater patient discomfort or risk of side effects. Due to the endoscopic approach, the method seems highly promising for this indication and merits further evaluation.
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Affiliation(s)
- C S Betz
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Grosshadern Medical Campus, Marchioninistr 15, D-81377 Munich, Germany.
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Abstract
INTRODUCTION The diagnostic workup proceeding paranasal sinus surgery routinely includes coronal CT views to get an exact representation of the microanatomy in the region of the lateral nasal wall and the anterior skull base. Axial and sagittal views are often not available, yet they can provide important additional information. STUDY DESIGN AND METHODS It was the aim of the current study to analyse multislice CT data sets in order to determine the incidence of anatomical variants. The investigation was performed as a retrospective, monocentrical study on n = 641 patients. Prior paranasal sinus surgery was defined as the sole exclusion criterion. RESULTS The analysis of the data showed the following anatomical variants of frontoethmoidal cells: Kuhn Typ I: 17.0 %, Typ II6.8 %, Typ III: 12.5 %, Typ IV: 0.1%. The prevalence for Agger nasicells was 80.0 %, that for supraorbital cells was 10.2 %, that for suprabullar cells was 28.2%, that for frontal bullae was 16.0% and the one for cells of the interfrontal septum was 11.9 %. The incidence of other anatomical variants was as follows: Concha Bullosain 22.2 %, Haller cells in 16.0 %, pneumatised Uncinate Process in 8.8% and Onodi Cells in 8.4 %. CONCLUSIONS A multiplanar reconstruction of the frontoethmoidal complex with its numerous variants is essential in the preoperative workup of patients with conditions of the frontal sinus. This advantage can even be enhanced by using navigation systems, even though they are not available for every rhinosurgeon yet. However, navigation systems should not be considered as a surrogate for lacking anatomical knowledge.
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Affiliation(s)
- A Leunig
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde.
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25
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Leunig A, Sommer B, Betz CS, Sommer F. Surgical anatomy of the frontal recess--is there a benefit in multiplanar CT-reconstruction? Rhinology 2008; 46:188-194. [PMID: 18853869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Anatomical variations in the sinus region are not necessarily pathological, but they may complicate the anatomy of the lateral nasal wall and contribute to the occurrence or persistence of chronic inflammatory diseases. In this study the interpretations of initial coronal CT scans were significantly altered following multiplanar CT-reconstruction. Assuming that a multiplanar analysis includes coronal views, we may conclude that imaging in three planes yields more information and provides a substantial benefit in the planning and performance of a surgical procedure on the paranasal sinuses.
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Affiliation(s)
- A Leunig
- Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany.
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Abstract
Schwannomas of the nasal cavity and paranasal sinuses are quite rare, with 4% occurring in this location. Most of them are benign and do not recur when totally removed by surgery. It is very important to distinguish between schwannoma and primary benign neurofibroma. Neurofibromas are lesions having the possibility for malignant transformation and recurrence. A case of schwannoma in the nasal cavity is reported, and the diagnostic and therapeutic procedures, as well as recommendations from the literature, are described. The histological and immunohistochemical features are discussed in detail to draw a distinction between schwannoma and neurofibroma. In cases of intranasal and paranasal lesions, the existence of a schwannoma must be considered. Differentiating between schwannoma and neurofibroma is important for estimating the risk of malignant transformation and recurrence.
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Affiliation(s)
- F Braunschweig
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Ludwig-Maximilians-Universität, München.
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Willer G, Braunschweig F, Leunig A, Menz G. Stellenwert der adaptiven Desaktivierung mit Aspirin bei Rezidivpolyposis nasi et sinuum. Pneumologie 2008. [DOI: 10.1055/s-2008-1074117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Ernst E, Füßl HS, Leunig A, Stiefelhagen P, Malberg K. [Not Available]. MMW Fortschr Med 2008; 150:18-23. [PMID: 27370889 DOI: 10.1007/bf03365417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- E Ernst
- Peninsular Medical School, University of Exeter/UK, UK
| | - H S Füßl
- Isar-Amper-Klinikum Klinikum München-, Ost, Haar, Deutschland
| | - A Leunig
- HNO-Klinik, Klinikum Großhadern, München, Deutschland
| | | | - K Malberg
- Immunologie, Dresden-Loschwitz, Deutschland
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Kristin J, Betz CS, Stelter K, Berghaus A, Leunig A. Frontal sinus obliteration--a successful treatment option in patients with endoscopically inaccessible frontal mucoceles. Rhinology 2008; 46:70-74. [PMID: 18444497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study evaluates non-standardized subjective patient satisfaction- and clinical outcome variables following frontal sinus obliteration with abdominal fat in endoscopically inaccessible mucoceles. METHODS In a retrospective chart review, all patients who underwent frontal sinus obliteration for endoscopically inaccessible mucoceles at the Ludwig Maximilian University in Munich between 1996 and 2006 were identified and the postoperative outcomes were evaluated by a non-standardized patient questionnaire rating the degree of symptoms before and after surgery. Additionally, the postoperative clinical status and MRI-scans were analysed in a subgroup of patients. RESULTS Nine out of 10 patients were generally satisfied with the obliteration. Most had a significant improvement in their main symptoms and reported a decrease in annual days of missed work and a reduced use of disease-specific drugs. The sense of smell and the intensity of postnasal dripping remained subjectively unchanged. Seventy percent of patients complained about temporary pain at the abdominal donor side. CONCLUSIONS Based on these results, osteoplastic frontal sinus obliteration using abdominal fat seems to be a successful treatment option in patients in whom mucoceles of the frontal sinus are not endoscopically accessible.
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Affiliation(s)
- J Kristin
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Klinikum Grosshadern, Munich, Germany
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30
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Abstract
Myxoid neoplasms are histopathologically divided into true myxomas and other tumors of myxomatous character. In the region of the nasal septum, this tumor entity is extremely rare. In the following two case reports, the unusual findings of a myxoma and a myxoid chondrosarcoma of the nasal septum are presented and discussed. At first visit, both patients reported a slowly progressing, bilateral nasal obstruction. In nasal endoscopy, both showed a smoothly surfaced, spheroid, soft tissue mass in the dorsal nasal septum. On CT-scans, a displacing growth was described for the first patient; in the second patient, a bony arrosion of the floor of the sphenoid sinus was suspected. Both lesions were surgically completely removed. The histopathological diagnosis was myxoma in the first and myxoid chondrosarcoma in the second patient. An early, locally recurrent tumor in the second patient could also be surgically removed. Both patients have been in full remission for more than a year. In spite of the similar symptoms and clinical findings, histopathologically different myxoid neoplasms of the nasal septum show marked variations in growth and recurrence.
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Affiliation(s)
- C S Betz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Ludwig-Maximilians-Universität München-Klinikum Grosshadern, 81377, München.
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31
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Abstract
BACKGROUND Hereditary angioedema (HAE) is extremely rare and clinically characterized by recurrent and self-limiting skin, intestinal and life threatening laryngeal edema. Because of the danger of asphyxiation, it is vital that acute attacks of laryngeal edema be interrupted immediately. The aim of this study is to provide information on the incidence, diagnosis and treatment of laryngeal edema with upper airway obstruction in general and due to HAE. METHODS 102 patients with swelling of the larynx and difficulty in breathing (stridor) and 21 patients with a manifest HAE were surveyed at the Department of Otorhinolaryngology, Head and Neck Surgery of the Ludwig-Maximilians-University of Munich from 2001 to 2004. RESULTS 63% of the laryngeal swellings with airway obstruction were due to radiotherapy in cancer and the intake of ACE-Inhibitors. Just 22% were due to allergic reactions. Only one patient (< 1%) suffered from HAE. All patients were treated with intravenous steroids and anti-histamines successfully, except the HAE patient. After emergency coniotomy the patient was treated with purified C1 inhibitor concentrate (C1-INH). CONCLUSIONS According to our experience almost all patients with laryngeal swelling and upper airway obstruction react well to the standard therapy with steroids and anti-histamines. In contrast these drugs have no effect on HAE. Replacement therapy with C1-INH has proved to be effective. The challenge is to realize whether an airway obstruction is due to HAE or not. In this case, careful observation, the right medication and an appropriate airway management are lifesaving. The possibility of sudden airway obstruction and asphyxiation must be discussed with these patients and their relatives.
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Affiliation(s)
- K Stelter
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde der Ludwig-Maximilians-Universität München.
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Abstract
Tonsillectomy is one of the most commonly performed surgical procedures in the field of otorhinolaryngology. The first tonsillectomy was done about 600 B.C. [3]. This operation is indicated for patients with recurrent tonsillitis, peritonsillar abscess, hypertrophy or asymmetry of the tonsils. Even though a routine procedure, it has a relatively high risk of complications such as post operative hemorrhage, infection or impaired wound healing. The reported case involves a 20 year old female patient who developed velopharyngeal insufficiency as a result of impaired wound healing after tonsillectomy. The patient was treated conservatively and is free of discomfort after 2 months.
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Affiliation(s)
- P Zengel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München.
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Arens C, Reussner D, Woenkhaus J, Leunig A, Betz CS, Glanz H. Indirect fluorescence laryngoscopy in the diagnosis of precancerous and cancerous laryngeal lesions. Eur Arch Otorhinolaryngol 2007; 264:621-6. [PMID: 17294205 DOI: 10.1007/s00405-007-0251-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 01/17/2007] [Indexed: 10/23/2022]
Abstract
Indirect fluorescence endoscopy of the larynx has proven to facilitate the detection and delineation of precancerous and cancerous lesion. The different methods are easy to handle and can be performed on an outpatient basis. Early diagnosis of laryngeal cancer and its precursor lesions is simplified. The aim of the present study is to compare indirect autofluorescence laryngoscopy to 5-ALA-induced PPIX fluorescence laryngoscopy. In a prospective study, 56 patients with suspected precancerous or cancerous lesions were primarily investigated by indirect autofluorescence laryngoscopy. In a second step 5-ALA-NaCl (0.6%) was topically applied to the larynx by inhalation, and indirect fluorescence laryngoscopy repeated 2 h after application. Autofluorescence as well as 5-ALA-induced fluorescence was induced by filtered light (375-440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF System, Storz, Tuttlingen, Germany). White-light and fluorescence images were digitally recorded, immediately assessed for diagnosis and finally compared to pathohistological findings. Inconspicuous laryngeal mucosa presented a typical green fluorescence signal in autofluorescence endoscopy, which turned blue during 5-ALA-laryngoscopy. Precancerous and cancerous lesions displayed a loss of autofluorescence in autofluorescence endoscopy whereas increased protoporphyrin IX fluorescence could be observed in 5-ALA laryngoscopy. Both imaging techniques were suitable to distinguish benign from precancerous or cancerous lesions. In contrast PPIX fluorescence was easily recognized in scarred vocal folds. According to our results, both non-invasive fluorescence imaging techniques are useful in the early diagnosis of laryngeal cancer. Moreover autofluorescence can be used immediately without drug application and possible side effects. 5-ALA-induced fluorescence seems to be more suited for diagnostic examination of mucosal lesions in recurrent precancerous and cancerous lesions after surgery.
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Affiliation(s)
- C Arens
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospitals Giessen and Marburg, Feulgenstrasse 10, 35385, Giessen, Germany.
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Stelter K, Andratschke M, Leunig A, Hagedorn H. Computer-assisted surgery of the paranasal sinuses: technical and clinical experience with 368 patients, using the Vector Vision Compact system. J Laryngol Otol 2006; 120:1026-32. [PMID: 16995972 DOI: 10.1017/s0022215106003197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2006] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This paper presents our experience with a navigation system for functional endoscopic sinus surgery. In this study, we took particular note of the surgical indications and risks and the measurement precision and preparation time required, and we present one brief case report as an example. MATERIALS AND METHODS Between 2000 and 2004, we performed functional endoscopic sinus surgery on 368 patients at the Ludwig Maximilians University, Munich, Germany. We used the Vector Vision Compact system (BrainLAB) with laser registration. The indications for surgery ranged from severe nasal polyps and chronic sinusitis to malignant tumours of the paranasal sinuses and skull base. RESULTS The time needed for data preparation was less than five minutes. The time required for preparation and patient registration depended on the method used and the experience of the user. In the later cases, it took 11 minutes on average, using Z-Touch registration. The clinical plausibility test produced an average deviation of 1.3 mm. The complications of system use comprised one intra-operative re-registration (18 per cent) and one complete failure (5 per cent). Despite the assistance of an accurate working computer, the anterior ethmoidal artery was incised in one case. However, in all 368 cases, we experienced no cerebrospinal fluid leaks, optic nerve lesions, retrobulbar haematomas or intracerebral bleeding. There were no deaths. DISCUSSION From our experience with computer-guided surgical procedures, we conclude that computer-guided navigational systems are so accurate that the risk of misleading the surgeon is minimal. In the future, their use in certain specialized procedures will be not only sensible but mandatory. We recommend their use not only in difficult surgical situations but also in routine procedures and for surgical training.
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Affiliation(s)
- K Stelter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany.
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Abstract
Endoscopic sinus surgery is one of the most frequent surgical ENT-procedures. Bleeding during surgery may increase complications and may have negative effects on surgery and outcome. The present paper describes strategies to prevent and deal with bleeding during sinus surgery. Preoperative conservative treatment of mucosal inflammation as well the use of adrenalin for decongestion may reduce intraoperative bleeding and hence complications.
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Siedek V, Betz CS, Leunig A. [Cervical skin emphysema: a rare complication following tonsillectomy]. HNO 2006; 55:121-4. [PMID: 16528501 DOI: 10.1007/s00106-006-1389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emphysema of the subcutis or interstitial compartments of the neck or around the naso- oro- or hypopharynx is caused by a perforation. In most cases, it occurs after surgery in this area; spontaneous emphysema is very rare. The characteristic symptom is crepitation; the extension is best seen on a CT scan. Endoscopic control of the surgical area for other lesions is necessary. An anaerobic, gas producing infection must be ruled out. Antibiotics should be given prophylactically.
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Affiliation(s)
- V Siedek
- Klinik und Poliklinik für Hals-Nasen- Ohren-Heilkunde der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, 81366, München.
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Leunig A, Berghaus A. [New information on chronic rhinosinusitis and polyposis nasi]. MMW Fortschr Med 2005; 147:28-32. [PMID: 16245778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
New Information on Chronic Rhinosinusitis and Polyposis Nasi Chronic inflammation of the paranasal sinuses is more common than inflammatory or degenerative diseases of the joints or arterial hypertension. The pathogenesis of chronic rhinosinusitis has still not been completely worked out. It is known that in particular the administration of antibiotics is incapable of healing the condition. Once the diagnosis has been established by an ENT specialist, topical or systemic steroids may be helpful. In most cases, however, it is necessary to combine these substances with surgical treatment. For this purpose, endoscopic sinus surgery is an approach that is capable of providing good long-term results.
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Affiliation(s)
- A Leunig
- HNO-Klinik Klinikum Grosshadern LMU München.
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Rasp G, Leunig A, Matthias C, Hagedorn H. Computer-Aided Minimal Invasive Approach in Nasal Polyp Surgery. Skull Base 2005. [DOI: 10.1055/s-2005-917658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Leunig A. [Look diagnosis. Grown over the years. Unilateral hamster cheek]. MMW Fortschr Med 2005; 147:57. [PMID: 15832765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- A Leunig
- Oberarzt der Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU München
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Abstract
Primary adenocarcinoma of the nasolacrimal drainage system is a highly uncommon diagnosis, which is presumably derived from malignantly transformed glandular cells that are interspersed amongst the epithelium of the nasolacrimal duct. The patients usually present with unspecific orbital or sinus-nasal symptoms. An appropriate therapeutic regime consists of a preferably early, radical resection and local postoperative radiation therapy. This brief contribution deals with an especially uncommon case of a carcinoma of the nasolacrimal drainage system. On his first presentation, the 62-year old patient complained about right sided epiphora which had been present over the last few weeks. Eight years prior to presentation, he had been treated for a nasolacrimal duct stenosis by endoscopic dacryocystorhinostomy on this side. Diagnostic imaging revealed a soft tissue mass in the right nasolacrimal duct which was removed by a combined extra-endonasal approach. The final histopathological evaluation was adenocarcinoma. Following postoperative radiotherapy, the patient has been free of disease for 42 months. The occurrence of adenocarcinoma of the nasolacrimal drainage system in the setting of previous surgery may provide a new insight into the clinical spectrum of the natural history of this disease.
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Affiliation(s)
- C S Betz
- Klinik für Hals-, Nasen- und Ohrenheilkunde der LMU München.
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Leunig A, Rasp G. [Nosebleed to be diagnosed specifically. Not always a "nose picking accident"]. MMW Fortschr Med 2005; 147:67-68. [PMID: 18437877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- A Leunig
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde der Ludwig-Maximilians-Universität München, München
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Leunig A. [Look diagnosis? Here something showed on the ear]. MMW Fortschr Med 2005; 147:61. [PMID: 15704578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- A Leunig
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde der LMU München
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de la Chaux R, Dreher A, Klemens C, Rasp G, Leunig A. [Respiratory sleep disorders: benefit from laser-surgery]. MMW Fortschr Med 2004; 146:49-50, 52. [PMID: 15624659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Laser-assisted surgery is a valid option for the treatment of respiratory sleep disorders and complements established therapies. Laser-surgery of the inferior turbinates can improve nasal obstruction and amend or eliminate primary snoring. LAUP is as well an ambulant therapeutic method for snoring, but it is leading to strong post-operative pain and should exclusively be applied to patients with small tonsils or who already underwent tonsillectomy. OSAS can be worsened by LAUP and should therefore be excluded before the operation. In childhood OSAS laser tonsillotomy leads to a distinct improvement of sleep-disordered breathing with normalisation of the sleeping profile; it is less painful than tonsillectomy and a part of the tonsil is left to continue to exercise its function in the immune system.
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Affiliation(s)
- R de la Chaux
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Interdisziplinäres Schlaflabor am Klinikum Grosshadern, München.
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Leunig A. [Look diagnosis. Until the collar burst... ]. MMW Fortschr Med 2004; 146:69. [PMID: 15581114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- A Leunig
- Klinik und Poliklinik für Hals-, Nasen- Ohrenkranke der LMU München
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Pauli C, Leunig A. [Acute otitis media in childhood]. MMW Fortschr Med 2004; 146:32-5. [PMID: 15366465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Because of its distinct anatomy, pathogens can quickly reach the middle ear of a child and cause acute otitis media. Depending on the age of the child, the clinical symptoms can vary from intense earaches, fever, pressure sensation and hearing loss to vomiting, diarrhea and refusal of food by infants. The progression of otitis media through four phases can be observed in an otoscopic examination. To improve Eustachian tube ventilation in uncomplicated cases, nose drops to reduce swelling along with pain therapy are employed first. Antibiotics can be administered to reduce the rate of complications from, for example, mastoiditis, paresis of the facial nerve, and labyrinthitis. In recurrent middle ear infections, an operative therapy should also be considered.
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Affiliation(s)
- C Pauli
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Grosshadern der LMU München.
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Abstract
BACKGROUND Synovial sarcoma is a rare soft tissue malignancy that most often occurs in the extremities of young adults. Approximately 3 % of these mesenchymal malignant tumors occur in the head and neck region. Up to now about 100 cases have been published. PATIENTS We report on two cases of a synovial sarcoma of the hypopharynx. In the first case the patient died 3.5 years after beginning of therapy including all therapeutical efforts (surgery, chemotherapy, radiotherapy). The second patient with a synovial sarcoma of his left hypopharynx and a distant metastasis in his 8th thoracic vertebral body is actually treated by neoadjuvant chemotherapy and included into a clinical study to optimize therapy of advanced soft tissue sarcomas. Further surgical treatment depends on the success of this therapeutic approach. CONCLUSION Despite multitherapeutic approaches over all 5-year survival rates for advanced synovial sarcomas of the head and neck have moderately improved in the recent decades and an ideal treatment has not yet surfaced. Modification of accepted treatment modalities is discussed and therapy options in controlled clinical studies are described.
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Affiliation(s)
- O Reichel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde der Ludwig-Maximilians-Universität München.
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Leunig A, Kremer A, Betz C, Janda P. Langzeitergebnisse nach Komplikationen entzündlicher Nasennebenhöhlen-Erkrankungen: Eine retrospektive Analyse von 138 Patienten. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hagedorn HG, Tanner P, Leunig A, Berghaus A, Rasp G. CAS als diagnostisches Instrument bei Tumoren der Schädelbasis. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Janda P, Killian T, Sroka R, Betz CS, Leunig A. Langzeitergebnisse der Ho: YAG- und Dioden-Laserbehandlung von hyperplastischen Nasenmuscheln. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zwickl A, Leunig A, Rasp G, Hagedorn H. Erste Erfahrungen mit dem neuen Kolibri Navigationssystem von Brain LAB. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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