[Potential effect of the stimulus threshold level of the nociceptive flexion reflex (NFRT) on mortality and delirium incidence in the critically ill patient: a retrospective cohort analysis]

BACKGROUND

Mortality and delirium in critically ill patients are affected by the provided analgesics and sedatives. The deeper the sedation and the higher the dose of analgesics applied, the more difficult it is to assess pain and the depth of sedation. Therefore, instrumental measurement methods, such as the measurement of the stimulus threshold of the nociceptive flexion reflex (NFRT), are becoming increasingly more important.

OBJECTIVE

The aim of the present study is to investigate a potential association between the level of the nociceptive flexion reflex, mortality, and the occurrence of delirium.

MATERIAL AND METHODS

By retrospectively analyzing a pilot data set of 57 ICU patients from the interdisciplinary surgical ICU of Ulm University Hospital surveyed between 11/2018 and 03/2020, a possible association between the NFRT, mortality, and the occurrence of delirium was calculated in an adjusted logistic regression model. Depending on the cut-off value, the stimulus threshold corridors result in the following comparison pairs: < 20 mA vs. 20-40 mA/20-50 mA/20-60 mA, > 40 mA vs. 20-40 mA, > 50 mA vs. 20-50 mA and > 60 mA vs. 20-60 mA. Results are presented as odds ratios (OR) adjusted for age, sex, height, TISS-28, SAPS II, RASS, BPS, and applied analgesics. Pain assessment was performed, in addition to the Behavioral Pain scale, ≥ 3 times daily by measuring NFRT.

RESULTS

A statistically nonsignificant tendency for an increase in mortality incidence occurred with an NFRT > 50 mA, versus a stimulus threshold corridor of 20-50 mA (OR 3.3, CI: 0.89-12.43, p = 0.07). A trend toward a reduction in delirium incidence occurred at an NFRT < 20 mA, versus a stimulus threshold corridor of 20-40 mA (OR 0.40, CI: 0.18-0.92, p = 0.03).

CONCLUSION

Based on the level of the NFRT, no recommendation can be made at this point to adjust the analgesic regimen of critically ill patients, who are unable to communicate. The observation of a tendency towards an increase in mortality at high stimulus thresholds or a reduction in the occurrence of delirium at low stimulus thresholds of the NFRT must be verified in standardized studies.

Online monitoring of gas transfer rates during CO and CO/H2 gas fermentation in quasi-continuously ventilated shake flasks

Syngas fermentation is a potential player for future emission reduction. The first demonstration and commercial plants have been successfully established. However, due to its novelty, development of syngas fermentation processes is still in its infancy, and the need to systematically unravel and understand further phenomena, such as substrate toxicity as well as gas transfer and uptake rates, still persists. This study describes a new online monitoring device based on the respiration activity monitoring system for cultivation of syngas fermenting microorganisms with gaseous substrates. The new device is designed to online monitor the carbon dioxide transfer rate (CO₂ TR) and the gross gas transfer rate during cultivation. Online measured data are used for the calculation of the carbon monoxide transfer rate (COTR) and hydrogen transfer rate (H₂ TR). In cultivation on pure CO and CO + H₂ , CO was continuously limiting, whereas hydrogen, when present, was sufficiently available. The maximum COTR measured was approximately 5 mmol/L/h for pure CO cultivation, and approximately 6 mmol/L/h for cultivation with additional H₂ in the gas supply. Additionally, calculation of the ratio of evolved carbon dioxide to consumed monoxide, similar to the respiratory quotient for aerobic fermentation, allows the prediction of whether acetate or ethanol is predominantly produced. Clostridium ljungdahlii, a model acetogen for syngas fermentation, was cultivated using only CO, and CO in combination with H₂ . Online monitoring of the mentioned parameters revealed a metabolic shift in fermentation with sole CO, depending on COTR. The device presented herein allows fast process development, because crucial parameters for scale-up can be measured online in small-scale gas fermentation.

[Current diagnostic imaging and treatment planning for laryngeal cancer]

CLINICAL/METHODICAL ISSUE

Laryngeal cancer is the third most common malignancy in the head and neck region. Endoscopic laryngoscopy with assessment of vocal fold function, microlaryngoscopy with biopsy and computed tomography (CT)/magnetic resonance imaging (MRI) remain the cornerstones of diagnostic workup. Thus, in the context of therapy planning, consideration of individual functional and socioeconomic aspects is of major importance.

STANDARD RADIOLOGICAL METHODS

Due to the short acquisition time and the possibility to perform functional maneuvers, CT is the tool of choice. MRI allows better soft tissue differentiation, but is more susceptible to movement artifacts and is complicated by disease-specific symptoms. The choice of examination method therefore depends on the patient's physical resilience.

PERFORMANCE

Depending on the study, the information on the sensitivity of CT with regard to the question of cartilage infiltration varies between 62 and 87% with a specificity between 75 and 98%. For MRI, sensitivity between 64 and 95% and specificity between 56 and 88% are stated.

ACHIEVEMENTS

The synthesis of the findings from endoscopy, biopsy and imaging is prerequisite for initiation of stage-appropriate treatment. For image interpretation, knowledge of the anatomical landmarks is essential. However, the assessment of posttherapeutic changes also poses a challenge for the radiologist.

PRACTICAL RECOMMENDATIONS

Regular interdisciplinary dialogue between radiologists, otorhinolaryngologists and radiotherapists in the context of primary diagnostics, therapy planning and aftercare is essential.

[Infantile hemangiopericytoma of the nasal cavity]

An infantile sinunasal hemangiopericytoma as a variant of infantile myofibroma is a rare finding. The observation of a sinunasal, infantile hemangiopericytoma affecting the anterior skull base and ethmoid bone in a female infant is presented. Chromosomal gains (6q14q16.2 und 18q22qter) as well as chromosomal losses (5q33.3q35.2, 10p11.2p12.2, 10q24.3q26.1, 15q23q25, 17p12pter and 22q11.2q13.2) were present. Endonasal tumor resection was achieved.

[Sonographic analysis of swallowing in the cervical section of the esophagus]

BACKGROUND

Dysphagia is a common symptom reported by patients in various medical fields, raising the question of diagnosis. In addition to otorhinolaryngologic examination with a mirror, the current gold standards videofluoroscopy and fiber optic endoscopic evaluation of swallowing (FEES) are available. Ultrasound is frequently used in everyday clinical practice, although its application for swallowing diagnostics needs addressing.

MATERIALS AND METHODS

Between April 2012 and February 2014, 81 subjects (age 19-66 years) with no indication of a swallowing disorder were sonographically examined. The anatomic representation of swallowing structures was evaluated and videos of the cervical part of the esophagus during swallowing of different consistencies (saliva, water, jelly) were recorded and analyzed. In a pilot study, the examination was tested on 3 dysphagia patients.

RESULTS

The base of the tongue, the intralaryngeal structures, the cervical spine, and the thyroid glands were well visualized. Sonographic representation of the cervical esophagus section was particularly successful. Its length could be detected at 5.78 ± 1.66 cm, the diameter measured at 0.88 ± 0.10 cm. Sonographic inspection of the sinus piriformis was most difficult; it could not be seen in 39.5% of cases. Visualization of the sinus piriformis was better in cases of normal weight and age <25 years (odds ratios 5.6 and 11.3, respectively). In the examination of patients with a swallowing disorder, three different pathologies (Forestier's disease, esophageal stenosis, and motor neuron disease) were identified as the cause of complaints.

CONCLUSION

Sonography enables very good visualization of swallowing and evaluation of the cervical esophagus. Where available, the otorhinolaryngologist should consider ultrasound as a diagnostic option, as it enables repeated evaluation of swallowing and can complement previously available diagnostic tools.

Flea market finds and global exports: Four multistate outbreaks of human Salmonella infections linked to small turtles, United States-2015

Zoonotic transmission of Salmonella infections causes an estimated 11% of salmonellosis annually in the United States. This report describes the epidemiologic, traceback and laboratory investigations conducted in the United States as part of four multistate outbreaks of Salmonella infections linked to small turtles. Salmonella isolates indistinguishable from the outbreak strains were isolated from a total of 143 ill people in the United States, pet turtles, and pond water samples collected from turtle farm A, as well as ill people from Chile and Luxembourg. Almost half (45%) of infections occurred in children aged <5 years, underscoring the importance of the Centers for Disease Control and Prevention recommendation to keep pet turtles and other reptiles out of homes and childcare settings with young children. Although only 43% of the ill people who reported turtle exposure provided purchase information, most small turtles were purchased from flea markets or street vendors, which made it difficult to locate the vendor, trace the turtles to a farm of origin, provide education and enforce the United States federal ban on the sale and distribution of small turtles. These outbreaks highlight the importance of improving public awareness and education about the risk of Salmonella from small turtles not only in the United States but also worldwide.

[Influence of external and endogenous factors on cervical lymph nodes : Sonographic study of size and morphology]

BACKGROUND

Sonographic evaluation of the dignity of cervical lymph nodes is essential for further diagnostics and treatment concepts in various diseases. The aim of this prospective monocenter study was to determine the sonomorphology and size of benign changes of lymph nodes in healthy subjects and patients who had undergone surgery, in order to examine the influence of various factors.

MATERIALS AND METHODS

Data from 205 healthy subjects and 15 patients before and after surgery were analyzed. Sonographically representative lymph nodes were measured in diameter and volumes were calculated; margins, the recognizability of a hilus, and vascularization were documented. A detailed medical history was taken using a standardized questionnaire.

RESULTS

In 20-39-year-olds, lymph node diameters were larger than in 40-59- and over 60-year-olds, and in 40-59-year-olds, the lymph nodes were larger than over 60-year-old subjects. Individuals with consumption of less than 10 and 10-20 cigarettes per day showed larger cervical lymph nodes compared to subjects with a consumption of more than 20 cigarettes per day. Smokers who additionally exercised routinely showed larger lymph nodes than those who never smoked or exercised. In addition, we observed that both the size and the number of cervical lymph nodes increased postoperatively compared to preoperative.

CONCLUSION

The recorded lymph nodes corresponded to the established sonographic criteria of benign lymph nodes. Our results show that age, smoking intensity, combination of smoking with sporting activity, and surgery influence the size of sonographically measured cervical lymph nodes.

[Satisfaction of patients with tracheostomal epithesis]

BACKGROUND

The utilization of craniofacial prosthesis has proven to be very successful for craniofacial defects. However, there is a lack of knowledge about the value of an epithesis for voice rehabilitation in patients with tracheostomy. The aim of this study was to describe application of the tracheostomy epithesis and to present a systematic analysis of the functional results of this prosthetic technique.

MATERIALS AND METHODS

This retrospective analysis included 48 patients on follow-up being treated in three different centers after laryngectomy and/or tracheostomy between 2008 and 2014. Subjects were given a questionnaire with items such as speech quality, quality of life, free hand speech ability, respiratory quality and sufficient tracheostomal sealing comparing values before and after application of an individually custom-made tracheostomy epithesis. Twenty-eight answered the questionnaire and could be reported.

RESULTS

Twenty-eight of 48 patients were consistently being included in follow-up. The statistical analysis revealed a significant improvement of tracheostoma occlusion (p < 0.05) and improvement in free hand speech ability (p < 0.05). A leakage of air during voice production could be prevented in 59.3% after application of an epithesis. Quality of life correlated directly with successful utilization of an epithesis.

CONCLUSION

In the literature, different industrialized products are described to realize occlusion of the tracheostoma for sufficient speech production without using the hands. In numerous cases commercial solutions fail and the patients need individual modifications. Our study first describes the evaluation of custom-made tracheostomal epithesis. From our observed results we advocate the individual tracheostomal epithesis as a durable solution for voice rehabilitation.

[Today's importance of ultrasound in ENT]

Since ultrasound has been established for diagnosis in ENT several new techniques have been introduced. But also ultrasonography has technically developed and thus has earned even more importance and indications. This was to be shown by this paper as well as the advantages and pitfalls. Ultrasound is quite useful in inflammatory, infectious and tumor pathology in order to make a better diagnosis or staging and to help the surgeon for punture or incision of a pathologic lesion (cytology, bacteriology, drainage). Especially in ENT oncology and post-treatment follow up ultrasound is a very precious technique. Ultrasound can be realized by the ENT specialist himself anywhere and at any time. It is a non aggressive, non invasive technique and its cost is relatively low. Unfortunately by itself it is not very performant to distinguish benign and malignant lesions. But its specificity can be considerably enhanced by combinating it with cytology (UGFNAB, ultrasound guided fine needle aspiration biopsy). Another important field of ultrasound is the examination of salivary glands.

Endonasal modification of the frontal sinus drainage type IIb according to Draf

The description of different endonasal drainage options (type I, II and III according to Draf) and their successful use in numerous patients has reached a milestone in frontal sinus surgery. We herein describe a modification of an endonasal frontal sinus drainage type IIb with the additional removal of the lower part of the frontal sinus septum without opening the frontal recess of the other side and without resection of the nasal septum. The modified endonasal endoscopic frontal sinus drainage type IIb was performed on 9 patients at the Department of Otorhinolaryngology, University Medical Center, Homburg/Saar between 02/2011 and 6/2013 after having gained patients' consent. Follow-ups with endoscopic examination were performed after 6, 12 and 24 months (median follow-up: 14 months). Endonasal endoscopic opening of the frontal sinus was achieved in all patients. Endoscopic examination 6, 12 and 24 months after surgery revealed patent frontal sinus drainage in 8 patients. The frontal sinus drainage could not be visualized endoscopically in one patient who was free of symptoms for 24 months and where a ventilated frontal sinus was proven radiologically by computed tomography. The study demonstrates the option to additionally remove the lower part of the inter-frontal septum with a frontal sinus drainage type IIb. As the number of patients treated by this modified frontal sinus type IIb drainage is limited, further investigations are needed to define the value of a modified frontal sinus drainage type IIb.

[A new implant system for orbital prosthetic rehabilitation: "epiplating mono"]

A New Implant System for Orbital Prosthetic Rehabilitation: "Epiplating Mono" Prosthetic or episthetic rehabilitation of ear, eye and nose are currently most common performed using magnetic fixation. While at the beginning single implants have been used, now-a-days a more extended approach with plate fixation are recommended to enhance the stability of the anchored magnets. A newly designed implant system epiplating mono is presented that combines the structure of a single implant with additional fixation elements. In a pilot study this new implant system was used in 4 patients for prosthetic orbital rehabilitation. Further experiences with this new implant system are required necessitating long-term experiences of implant stability to define the value of the presented epiplating mono system for prosthetic rehabilitation.

[First experience in the thyroid and parathyroid surgery using the da Vinci® system]

BACKGROUND

Endoscopic surgery for the treatment of thyroid and parathyroid pathologies is gaining increasing attention. The da Vinci® system has been already widely used in different fields of medicine including recently thyroid and parathyroid surgery. Herein we report our first experiences in endoscopic surgery of thyroid and parathyroid pathologies using the da Vinci® system.

MATERIAL AND METHODS

8 patients presenting with struma nodosa in 6 cases and parathyroid adenomas in 2 cases have been treated using the da Vinci® system at the ENT department of Homburg/Saar University.

RESULTS

The skin incision to introduce the instruments with the da Vinci® system were axilar or at the lateral segment of the clavicle. The neurovascular structures like inferior laryngeal nerve as well as the pathologies were clearly 3-dimensional visualized in all 8 cases. No paralysis of the vocal cord was observed. All patients had in histological examination a benign pathology.

CONCLUSIONS

The endoscopic surgery of the thyroid and parathyroid gland can be performed using the da Vinci® system and offers an excellent, intraoperative, 3-dimensional visualization of the neurovascular structures. Additionally the da Vinci® system enables skin incisions within considerable distance from the thyroid and parathyroid gland.

[Complications and pitfalls in surgery of the ear/lateral skull base]

Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills.Following a summary about general aspects in pre-, intra- and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation, surgery of vestibular schwannomas, and jugulotympanal paragangliomas. Based on these exemplary procedures, basic "do's and don'ts" of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed.An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process.

[Experience with individual obturators to treat nasal septum perforation]

BACKGROUND

Individual septal buttons have gained more attention during the last years. However, experiences in patients being treated by an individual septal button are limited. Therefore, further evaluation of this treatment option is needed.

MATERIAL AND METHODS

Records of 64 patients being treated by an individual septal button were evaluated retrospectively. As the silicon prints of the septum perforation were available size of the septal perforation were measured. Telephone interview were used to ask the patients about their general judgement and eff ect of the septal button on their different complaints.

RESULTS

Septumplasty in 42 patients and a trauma in 10 patients had been documented prior to treatment. In 7 patients Wegner's granulomatosis had been proven by serological and histopathological analysis. Digital manipulation and nasal drop abuses were judged to be the reason of the septal perforation in 2 patients each. In one patient the etiology remained unknown. Size of the septal perforation ranged from 7.4 to 807 mm(2). Using visual analog scale 42 patients reported to be highly satisfied. A statistically significant improvement was reported for all symptoms. Respiratory noise and nasal obstruction were improved best followed by nasal bleeding, pain and crust formation.

CONCLUSION

Treatment of septal perforations with individual septal buttons should be considered in treating septal perforations. Nasal obstruction and nasal bleeding were found to be improved best by this treatment option.

[Diagnosis and treatment of frontobasal cerebrospinal fluid fistulas]

Independent of its origin a frontobasal cerebrospinal fluid (CSF) fistula is characterized by an open connection between the intracranial space with the outside world (usually the nose and paranasal sinuses). It leads to loss of CSF and is associated with a significant risk of developing meningitis for the patient during further life. Precise knowledge of possible aetiologies, clinical symptoms, current diagnostic options and surgical strategies are essential for the detection and successful management of frontobasal CSF fi fistulas. This article summarizes aetiology and clinical signs of frontobasal CSF fistulas. Further, laboratory tests to analyse fluid samples for cerebrospinal fluid as well as radiological and endoscopic investigation methods aiming to localize a CSF-fistula are presented. Finally, surgical techniques to close a frontobasal CSF fistula are explained.

[First experience in endonasal surgery using a new 3D-Chipendoscope]

BACKGROUND

Endoscopic surgery for treatment of nasal, paranasal and anterior skull base pathologies is an established treatment modality. Available rigid endoscopes with angled views provide a 2-dimensional view with restriction of depth perception. In this study we report about our first experience with a new 3D-Chipendoscope in surgery at the nose, paranasal sinuses und anterior skull base.

MATERIAL AND METHODS

30 patients were enrolled in this study with chronic rhinosinusitis, inverted papilloma, frontal sinus mucocele, frontal sinus osteoma, chronic dacryocystitis and pituitary adenoma. All patients were subjected to standard endonasal endoscopic surgery using 3D-endoscopes.

RESULTS

Surgery was performed by the use of the 3D-endoscope in all patients. The operative handling of the 3D-endoscopes was user friendly in regard to design and weight of the endoscopes. The problem of fogging during endoscopic surgery diminishing the quality of view was not observed. Blood crusts on the endoscope tip however was able to changed the 3D-view to a 2D-view. To close positioning of the 3D-endoscopes to the surgical field reduced image quality. The visualisation of the frontal sinus was limited.

CONCLUSION

3D-endoscopic surgery is an interesting development in endonasal surgery of pathologies at the nose, paranasal sinuses and anterior skull base.

[Endoscopic frontal sinus revision following transcutaneous endoscopic puncture and diaphanoscopy]

BACKGROUND

Endoscopic revision sinus surgery in case of frontal sinus pyocele may poses a great surgical challenge for various reasons. Due to the often troublesome anatomical changes caused by prior resection and findings of scaring with new bone formation, the identification of the frontal sinus in revision surgery is frequently a challenge for the surgeon. An easy endoscopic technique for a safe endonasal identification of the frontal sinus in revision surgery is therefore of major importance.

MATERIAL AND METHODS

4 patients (3 men, 1 female) were enrolled with an acute frontal pyocele following prior open frontal sinus surgery over an external access. All patients were subjected to standard endonasal endoscopic frontal sinus surgery. The frontal sinus was endonasally approached after endoscopic transcutaneous frontal sinus puncture through the pre-existing bone defect achieving a diaphanoscopy with endonasal identification of the frontal sinus floor.

RESULTS

The external endoscopic puncture and illumination of the frontal sinus was performed in all 4 patients with a modular endoscopic system (Sinus View). A visual exploration of the frontal sinus was easily carried out after irrigation. A clear endonasal identification of the frontal sinus floor by diaphanoscopy was achieved in all patients and guided a direct opening of the frontal sinus. A stable frontal sinus drainage type IIb according to Draf was reached in all cases.

CONCLUSION

Transcutaneous frontal sinus puncture with an modular endoscope allows not only to verify frontal sinus pyocele diagnosis, but also provides the option to open the frontal sinus directly guided by the diaphanoscopy at the frontal sinus floor even in situations of complex anatomy.

Papillary tumor of the temporal bone

Papillary tumors of the middle and inner ear have been interpreted histogenetically in many ways. In 1989 Heffner proposed the endolymphatic sac epithelium as a possible origin. These rare tumors are clinically aggressive and can cause extensive temporal bone destruction. Because of this behavior, endolymphatic sac tumors (ELST) were classified as low-grade adenocarcinomas, although metastasis has not yet been documented. Two papillary neoplasms of the temporal bone are presented, which we believe are examples of adenomatous tumors arising from the epithelium of the endolymphatic sac. One was associated with a pituitary adenoma. A third case of a papillary middle ear neoplasm is described that shows histologic features similar to the other two, but it was located in the tympanum and had no connection to the endolymphatic sac. This report focuses on clinical, radiologic, and histologic findings of papillary tumors of the temporal bone with additional emphasis on modern concepts of histogenesis and aspects of differential diagnosis.

Late manifestations of traumatic lesions of the anterior skull base

The authors review their experience in detecting occult traumatic dural lesions. In a retrospective study covering the period from January 1, 1984 to December 31, 1996, 23 patients were evaluated for occult traumatic dural lesions. Clinical presentation, diagnostic work-up, and management of the dural lesions were analyzed.The clinical presentations of the previously undetected dural lesions of the anterior skull base were meningitis in eight cases, cerebrospinal fluid (CSF) rhinorrhea in eight cases, both meningitis and CSF rhinorrhea in five cases, and a pulsating swelling in the region of the right upper eyelid in one case. In another case a fracture of the posterior frontal wall was detected incidentally on the preoperative CT scan performed prior to surgery for chronic sinusitis. One patient had a CSF fistula of the lateral skull base in addition to the frontobasal fistula. The interval between trauma and diagnosis varied from 1 to 48 years. Dural lesions were localized by high-resolution CT, fluorescein nasal endoscopy, CT cisternography, and MRI. Intraoperative exposure of the dural lesions and duraplasty were possible in all cases. During the first attempt successful repair of the dural lesions was accomplished in 22 (95.7%) of the 23 patiants. Two interventions were necessary to close a CSF leak of the cribriform plate.Modern clinical and radiologic diagnostic methods should be employed to search for an occult dural lesion in patients with recurrent meningitis, meningitis caused by upper airway pathogens, or CSF rhinorrhea. The patient will remain at risk of potentially fatal meningitis until the lesion is appropriately repaired by duraplasty.

How I do it: endoscopic-microscopic anterior skull base reconstruction

Reconstruction of the anterior skull base must be secure and watertight. Failure to achieve this places the patient at risk of the development of cerebral sepsis. We have developed the technique of endonasal duraplasty and have achieved a 90% long-term success rate. In this article we described the key elements of our technique starting with radiographic and fluorescein localization of a skull base defect. The main steps in reconstruction and materials used are detailed, together with modifications of our technique for certain difficult situations and tips for success. Attention is drawn to potential pitfalls that have been identified over 25 years of clinical practice.

Mode of communication, perceived level of understanding, and perceived quality of life in youth who are deaf or hard of hearing

Given the important role of parent-youth communication in adolescent well-being and quality of life, we sought to examine the relationship between specific communication variables and youth perceived quality of life in general and as a deaf or hard-of-hearing (DHH) individual. A convenience sample of 230 youth (mean age = 14.1, standard deviation = 2.2; 24% used sign only, 40% speech only, and 36% sign + speech) was surveyed on communication-related issues, generic and DHH-specific quality of life, and depression symptoms. Higher youth perception of their ability to understand parents' communication was significantly correlated with perceived quality of life as well as lower reported depressive symptoms and lower perceived stigma. Youth who use speech as their single mode of communication were more likely to report greater stigma associated with being DHH than youth who used both speech and sign. These findings demonstrate the importance of youths' perceptions of communication with their parents on generic and DHH-specific youth quality of life.

[Lacrimal systems endoscopy with a new endoscope system]

BACKGROUND

Successful therapy of postsaccal stenosis in the lacrimal system can be done by an ENT Surgeon by endonasal dacryocystorhinostomy. It is desirable to have a good diagnostic method of the lacrimal system before undertaking surgery. This study describes the first experiences of endoscopic diagnostics of the lacrimal system with a new endoscope.

MATERIAL AND METHODS

24 patients (10 male and 14 female, between 3 and 65 years old) with epiphora and chronic lacrimal system infections were examined in the ENT Department Homburg/Saar with a 0.53 mm modular endoscope, between 11/2008 and 12/2009. The result were evaluated and analysed.

RESULTS

The endoscopic lacrimal system examination was done in all 24 patients. 8 patients with high stenosis postsaccal and purulent epiphora had an endonasal dacryocystorhinostomie. 13 patients with prasaccal stenosis or stenosis in the ductus nasolacrimalis with clear epiphora were treated with irrigation, dilatation and U-intubation. The removal of the Endoscopic dilatation was undertaken in 3 children without using bicanicular intubation.

CONCLUSION

Lacrimal system endoscopy with a modular endoscope with the possibility of interventional procedures is an efficient option in the widening diagnosis and therapy of the lacrimalm system disease. With this technique is it possible with selected patients to do interventional therapy. On the basis of the endoscopic findings an interventional therapy or an endonasal dacryocystorhinostomie can be done.

[Malignant melanoma of the lacrimal sac]

A 68-year-old woman presented with a 10-month history of right-sided epiphora, bloody tears, and medial canthal mass. Computed tomography revealed a soft tissue mass of the right lacrimal sac with widening of the bony nasolacrimal canal. External dacryocystorhinostomy with incisional biopsy confirmed the diagnosis of malignant melanoma. After staging, further therapy included orbital exenteration, lateral rhinotomy with en bloc resection of the lacrimal drainage apparatus, and adjuvant radioimmunotherapy. One year after surgery, no evidence of local recurrence or metastatic disease could be detected.

In vitro adhesion measurements between skin and micropatterned poly(dimethylsiloxane) surfaces

Micropatterned adhesive surfaces may have potential in reconstructive surgery. The adhesion performance of mice ear skin to micropatterned poly(dimethylsiloxane) (PDMS) was investigated, under in vitro conditions, and compared to flat substrates. No significant difference in separation force F was observed between flat substrates and micropatterned surfaces with pillar arrays. However, the energy necessary for separation of the substrate from the skin was sensitive to the topography. Furthermore, our results show that the force-displacement curves depended on the wetness of the skin: Highest force values were obtained for fresh skin while the forces decreased as the skin dried out. The results are encouraging for further studies on the potential of patterned PDMS in biomedical applications.

Liposarkom

With less than 100 cases described in the literature, the incidence of liposarcoma in the head and neck is very low. We report on a 54-year-old patient with a liposarcoma of the right cervical soft tissue. After complete tumor extirpation the patient underwent radiotherapy. Diagnostics, histopathological classification, therapy and prognosis of liposarcoma are discussed in this case report and review of the literature.

[Salivary gland tumor of the hard palate]

BACKGROUND

Pleomorphic adenomas of the small salivary glands are very rare and usually arise from the hard palate.

CASE REPORT

We present a female patient who was referred to our Department because of a bleeding enoral tumor, which persisted for 35 years. Histopathological examination after complete tumor excision showed a pleomorphic adenoma.

CONCLUSION

Pleomorphic adenomas are an important differential diagnosis for tumors of the hard palatine. The therapy of choice is surgical excision.

[First experiences with a new nickel-titanium piston with a shape memory feature]

BACKGROUND

The aim of this study was to describe a new stapes prosthesis with memory characteristics for wire crimping (SMart-Piston).

PATIENTS AND METHODS

This technique was used in 15 patients (mean age 43.4 years; range 28-71) undergoing routine stapes surgery. SMart-Piston prostheses with a shaft diameter of 0.5 mm and length ranging from 4.25-4.5 mm were used. Heat induced wire crimping was performed by CO2 laser in five patients, and by bipolar diathermy forceps in ten patients. In 15 patients, postoperative audiological testing was performed at an average 21.9 days and in another 10 again after 435 days following surgery.

RESULTS

The median observed air-bone-gap (ABG) postoperatively was 8.7 dB+/-7.7 dB. A total of 73% of all patients had an ABG of 10 dB or less, and all patients had less than 20 dB. In the ten patients controlled after 435 days, the ABG was 4.4 dB+/-2.4 dB. It was lower than 10 dB in all individuals.

DISCUSSION

A critical point in every stapes surgery, the prosthesis fixation to the incus, is greatly facilitated by this novel technique. Long-term results in a larger group of patients are pending.