[Fever, bilateral conjunctivitis, cervical lymphadenopathy, lacquered lips and rash].
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Child, Preschool↗
Biomedical subjects
A Laubert
Publications and source records attributed to A Laubert.
[Zenker's diverticulum. The endoscopic-microscopic, staple-assisted esophagodiverticulostomy].
BACKGROUND: The endoscopic-microscopic staple-assisted esophagodivertikulostomy of Zenker's diverticulum is a new modification of endoscopic operation techniques which minimizes complications and is able to speed up the patient's convalescence. PATIENTS AND METHODS: A total of 22 out of 32 patients with Zenker's diverticulum underwent surgery. The operation involves cutting the wall between the diverticular sac and the oesophagus and, at the same time, closing the mucosal wound edges using the "closed" surgery method. RESULTS: All operations were effective and uncomplicated. A total of 28 operations were performed on 22 patients. The operations due to relapse were predominantly necessary among younger patients, of whom three were operated endoscopically and three through the cricopharyngeal myotomy. CONCLUSIONS: The "closed" endoscopic-microscopic staple-assisted esophagodivertikulostomy of Zenker's diverticulum avoids opening the retropharyngeal and retrooesophageal areas and allows a quick convalescence in the mostly elderly patients. This technique is effective, safe and has no major complications.
Adult↗
[Reversible hearing loss in acute salicylate intoxication].
Acetylic acid, such as aspirin, is one of the most commonly used medication in Western societies. Aspirin overdosage causes ototoxic side effects in some patients, such as bilateral mild to moderate sensorineural hearing loss and tinnitus. Recent literature describes, that salicylates act as competitive inhibitors of Cl- anions at the anion-binding site of prestin, the motor protein of the outer hair cell. This molecular mechanism correlates well with the clinical audiological mainstays of aspirin-induced hearing loss, dose dependency, cochlear site of hearing loss and reversibility. We report about a young man with an acute moderate aspirin intoxication resulting in asymmetric hearing loss of 50 dB HL and tinnitus for five days. Otoacoustic emissions were absent on the first day of intoxication but could be measured again on the fifth day after the intoxication. As the ototoxic side effects resolve with in two or three days, no specific treatment is necessary for ototoxicity. Medical treatment of acute or chronic aspirin intoxications aims to decrease further drug absorption by gastrointestinal decontamination and to accelerate elimination by alkaline diuresis. Only in severe intoxications hemodialysis may be considered to treat neurologic, pulmonal, renal or cardial complications.
Adaptation, Physiological↗
[Oncocytic adenocarcinoma of the submandibular gland].
BACKGROUND: Malignant oncocytic tumors rarely occur in major salivary glands and generally account for < 1% of all salivary tumors. There is no difference of both sexes and appearing mainly between 50 and 60 years of age. They comprise oncocytes, which are epithelial cells with abnormally formed cytoplasm and acidophilic granular cytoplasma. In the process of the malignant transformation the coexistence from oncocytic rests and untypical oncocytic carcinoma portions can be seen. The tumors show no capsule and an infiltrative local growth with perineural and vascular expansions. PATIENT AND METHOD: A rare case of a 59-year-old man with malignant oncocytoma is presented. The tumor was found in the left submandibular gland with one enlarged lymph node near by. RESULT AND CONCLUSIONS: A general overview of the available literature and the histological classification of oncocytomas is given. Therapy consists of surgical resection and radiotherapy. Close clinical controls are necessary.
Adenocarcinoma↗
[Myositis proliferans. Differential cervical space-occupying lesion diagnosis].
Myositis proliferans is a rare and benign pseudosarcomatous tumour of soft tissue. In most cases it is found in the region of the shoulder and arm and its occurrence in the region of the neck is described in literature in 16 cases in all. For the ear, nose and throat specialist it is an important differential diagnosis in contrast to malignant tumours. In this report we present the cases of two patients, who were suffering from painful cervical swelling that had been increasing for some days. The problems inherent in the diagnosis of this illness are discussed. Due to its rapid growth the tumour is generally falsely diagnosed and radically removed. Therefore, in appropriate case history, this possibility should be considered and excluded in order to prevent the patient from unnecessary radical operation. In addition to clinical symptoms, imaging and trial excision are suitable.
Diagnosis, Differential↗
[Acoustic neurinoma with preserved inner ear function. Interesting audiologic constellation of findings].
Neurofibromatosis (NF) is a syndrome with multiple neuromas. With the central form or NF2 very often bilateral acoustic neuromas are found. Tumours derive from Schwann cells of the eighth cranial nerve; symptoms are tinnitus, hearing loss and vertigo. Therapy is surgical, if possible with the protection of remaining hearing function. We report the case of a 28 year old female patient with neurofibromatosis type 2. After complete resection of the left AN and partial resection of the right AN the patient suffered from bilateral complete deafness, although almost normal DPOAE can be recorded on one side. Therefore we find the classical neural deafness with intact function of outer haircells (OHC).
Adult↗
[Tinnitus retraining therapy. Indications and treatment goals].
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Acoustic Stimulation↗
[Intensive inpatient therapy of auditory processing and perceptual disorders in childhood].
UNLABELLED: PRELIMINARY REMARKS: The prevalence of central auditory processing disorders (CAPD) is supposed to be 2-3% of all children. Given the number of affected children and restricted resources in the public health there is a need for an effective and evaluated therapeutic approaches. On the other hand the number of outcome studies is remarkably small. PATIENTS AND METHODS: The presented study reports strategies and pitfalls in outcome measurements of 34 children with CAPD, based upon a 3-weeks indoor therapeutic intervention. Diagnostic criteria of auditory processing and perception were recorded before and after therapy. RESULTS: The data shows a highly significant improvement of certain perceptive abilities, including audiological parameters (dichotic testing, discrimination, loudness scaling) and awareness, psycholinguistic development and orthographic tests. CONCLUSION: The study demonstrates that an effective therapy of CAPD in children is possible and scientifically proven. Long term surveillance however seems to be necessary. It also has to be studied whether intensive indoor treatment is superior or equal to out clinic therapy.
Auditory Perceptual Disorders↗
[Is recurrent loss of low frequency tone perception--without vertigo--a precursor of Meniere disease?].
PURPOSE: Recurrent low-frequency sensory hearing loss is one characteristic sign of Meniere's disease. It is therefore often assumed to be a prodromal sign of Meniere's disease. METHODS: We report on 81 patients with recurrent low-frequency sensory hearing loss who did not previously suffer from vertigo. All patients underwent a follow-up examination after at least 1 year up to more than 10 years after the onset of the disease [average: 64.65 months (SD 56.33)]. CONCLUSIONS: Only 3.7% of these patients developed the typical signs of Meniere's disease with labyrinthine vertigo, whereas 25.9% suffered from recurrent hearing loss and an unspecific vertigo, which could be diagnosed and treated as psychogenic vertigo; 3.7% showed a typical benign positional vertigo. We can thus conclude that although almost every patient with Meniere's disease suffers from recurrent hearing loss, only a few patients with recurrent hearing loss will develop Meniere's disease. However, many patients with low-frequency sensory hearing loss develop anxiety and psychogenic dizziness in expectation of "imminent" Meniere's disease. Therefore, it is important to counsel the patients carefully that the probability of this occurring is not very high.
Adult↗
[Schwannoma of the tongue].
BACKGROUND: Schwannoma, in the English literature mostly called neurilemmoma, are well known in the ear-nose-and-throat-medicine as benign tumors of the nerve-sheath, for example as neuroma of the acoustic nerve. They are seldom found at other peripheral nerves of the head. The localisation in the tongue has so far only been described in some individual cases. CASE REPORT: We present a case of a 28-year-old woman with a schwannoma of the tongue, measuring 4.0 x 2.2 x 3.2 cm. The case history and the radiological investigations suggested a malignant tumor. During the operation the lump revealed itself as being encapsulated. Under the histological examination it was discovered to be a Schwannoma. CONCLUSIONS: We would like to add a further case of a schwannoma of the tongue to the so far published cases, thus allowing this possibility to be considered in general diagnosis.
Adult↗
[Chronic complex tinnitus: therapeutic results of inpatient treatment in a tinnitus clinic].
BACKGROUND: In-patient treatment of patients with chronic tinnitus is necessary only when these patients have a severe psychosomatic co-morbidity and suffer severely. However this therapeutic approach has to be supervised and evaluated properly. METHODS: We present data and results of 1841 patients suffering from chronic tinnitus. Due to the severity of the symptom and psycho-neurotic side effects in-patient treatment was necessary. Therapy lasted 5 - 6 weeks, the main aspect was an intensive psychotherapeutic evaluation and stabilisation next to retraining and habituation programmes. Relaxation techniques were taught. Patients suffered from their tinnitus more than six month; 95 % further suffered from hearing-loss, mainly in high frequencies. The study evaluates results of patients from October 1994 until June 2000. Basis of the study was the evaluation of a specific tinnitus-questionnaire (TQ), published by Hallam in the UK and translated by Goebel and Hiller in Germany. Data was recorded at registration in our clinic, 4 - 6 months later during admission and at the end of the therapy. Final data was gained during a special meeting or questioning 6 months after dismissal from the clinic. RESULTS: Patients that suffered most showed the greatest improvement; directly after therapy there was a highly significant improvement in the TQ for an average of 13.01 points. Highly significant improvements were found in all the TQ-subscales respectively. Only 10 % of the patients did not show any improvement at all. CONCLUSION: Therapy of most severe cases of chronic tinnitus is possible, using an integrated concept of otologic and psychosomatic treatments. With large numbers of patients and sufficient data a thorough and necessary evaluation of this therapy can be achieved.
Adolescent↗
[Ear dysfunction due to air bag detonation?].
Air bags are among the latest developments in extensive automobile safety systems. They successfully have saved the lives of car occupants in road accidents. Many additional injuries caused by air bags from minor to severe have been reported. With the help of two acceleration sensors, the electronic tuner amplifier records the vehicle's deceleration. This is the adequate trigger for air bag deployment, which creates an intense noise of up to 170 dB sound pressure level. This noise level can cause cochlear damage. We present two patients with otologic symptoms after spontaneous air bag deployment.
Adult↗
[Diagnosis of postoperative dysphagia and aspiration. Fiberoptic-endoscopic controlled methylene blue drinking].
Postoperative swallowing disorders are common after such function-preserving surgery as conventional resections or endoscopic laser procedures for carcinomas of the larynx and hypopharynx. In most cases a reduction in motility of the pharyngeal muscles and sensory impairment of the pharyngeal and laryngeal regions can occur because of postoperative tissue abnormalities, including scarring due to the healing process. We have used fiberoptic endoscopic examinations with methylene blue to analyze postoperative swallowing and observe whether staining or aspiration occurs. By so doing, we have improved postoperative swallowing in 25 patients after extended surgery for cancer and were able to detect or exclude aspiration. The advantages of this minimally invasive, non-stressful diagnostic procedure are discussed and can be important for further successful care after surgery.
Administration, Oral↗
[Intraductal papilloma of the parotid gland].
BACKGROUND: This rare intraductal papilloma of the salivary glands is classified as an adenoma of the subgroup ductal papillomas. The nature of intraductal papillomas has not been fully researched. It is assumed that the intraductal papilloma arises from the excretory duct reserve cell population. Since the lesion was first described, 9 cases have been reported. CASE REPORT: An additional case of intraductal papillomas of the parotid gland is presented: a 62-year-old woman with a solid and well displaceable tumor of the left preauricular region. After a standard superficial parotidectomy was performed the histological examination revealed an intraductal papilloma. RESULT AND CONCLUSION: The case represents the first published case in German literature. This study presents a review of the literature and a discussion of the histopathologic characteristics and possible histogenesis of the intraductal papilloma. Regular follow-up has not revealed any recurrence of the disease 15 months after resection. The treatment of choice is local excision or removal.
Female↗
[Malignant head-neck tumors in childhood--an interdisciplinary challenge from the viewpoint of the ENT physician].
BACKGROUND: Malignant tumors of the head and neck are very rare in children, and their symptoms are usually uncharacteristic. In most cases these tumors are of mesenchymal origin: sarcoma or lymphoma. As their growth is quick and destructive, irreversible damage of adjacent structures or even infiltration of the endocranium occurs early and rapidly, resulting in a dramatic deterioration of survival rate and life quality in advanced stages. PATIENTS: Three cases of a malignant head-and-neck tumor in children are described, stressing typical key symptoms which might often be neglected or misinterpreted as aggravation or psychogenic if the physician is not aware of the possibility of a malignant tumor. The diagnostic and therapeutic approach is illustrated according to the tentative diagnosis and the underlying histologic results. RESULTS: In any suspicious case, diagnostics must start immediately and often under emergency conditions. Interdisciplinary communication is mandatory from the beginning and should be directed by oncopediatricians. Since there are often fundamental differences in diagnostic procedures and therapeutic regimen compared with malignant tumors in adults, unnecessary repetitive examinations and consecutive delay in the onset of therapy can be avoided by early planning of a diagnostic strategy. Therapeutic principles differ widely from those in malignancies of adults. Following biopsy, histological examination, and staging, cytostatic chemotherapy and/or radiation is usually performed, but surgical procedures are indicated only in rare cases in the presence of a very small tumor. Mutilating surgery is always contraindicated in children. Restaging should follow conservative therapy, after which surgical removal of necrotic masses or residual tumor may be indicated. CONCLUSIONS: An immediate onset of diagnostics and therapy is crucial for children's prognosis concerning survival and function of affected organs. An interdisciplinary approach is mandatory from the beginning. In early cases, this strategy gives a chance to restore organ function and life quality. In advanced cases, life and a residual organ function may be preserved but complete restoration is rare, especially if a rhabdomyosarcoma is the underlying histologic diagnosis.
Adult↗
[Resorbable intracutaneous suture as wound closure in cochlear implant].
The extended incision in cochlear implantation has to be performed for several reasons; therefore the wound closure needs single or continuous suture for the skin. The suture removal seems to be traumatic for children. That is why we have using an intracutaneous absorbable suture to avoid material removal for more than 6 months now without any complications in the 35 patients in question.
Child↗
Some Remarks on the Classification of Subjective Idiopathic Tinnitus (SIT) - An Essay toward Establishing a Cross-matched Grading System.
To better quantify levels of individual impairment caused by SIT, two different sets of classification were cross matched. This combination factored in the inaccuracy caused by terminologic inexactitude. Although the system which developed historically had a subjective bias, the newer tests created to analyze tinnitus specifically were far more objective. By combining the findings of both tests using a numeric score, rating tinnitus should become more exact. Classification of tinnitus began long ago in ancient Babylon. In the library of the court of King Assurbanipal (668 to 626 B.C.), clay slates were found which gave the first written classification of tinnitus. Later Pliny, Paracelsus, Itard, and Politzer developed separate systems of tinnitus classification.(2) All these systems can be broken down into the branches of epidemiology, etiology, and legal requirements. Epidemiology gives information on tinnitus in "terms of time, place, and persons." Etiology provides a means to summarize the relationships between the subjective findings of tinnitus and relationships in terms of pathoetiology. It is the large numbers of single complaints about tinnitus and possible associated relationships of pathologic relationships that cause the different clinical classification of tinnitus. In terms of legal disability, a more accurate classification will permit graduated comprehensions of the irritation experienced by the patient and related personal, social and occupational interferences. Measuring these grades of impairment will allow comparison of different types of tinnitus. Unlike other audiologic failures such as generalized hearing loss and disturbances of equilibrium resulting from vestibular affections, assessment of the intensity of tinnitus and its involvement in personal life is restricted by limitations, because each classification system contains inaccuracies per se.
Journal Article↗
[Rare tumor of the nose and paranasal sinuses. Leiomyosarcoma].
Leiomyosarcoma is a rare malignant tumor of the nose and paranasal sinuses. Including our patient, 32 cases have been reported in the literature. Radical surgery is currently the best therapy. In comparison with results of conventional irradiation, postoperative neutron treatment appears to be more effective.
Adult↗