Biomedical subjects
B Kellerhals
Publications and source records attributed to B Kellerhals.
[Treatment of tinnitus with lidocaine?].
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Medico-Legal Aspects of Tinnitus in Switzerland and the Federal Republic of Germany.
Issues of impairment, hand and eye disabilities have worldwide significance. This paper presents the issues from a medical-legal perspective in Switzerland and the Federal Republic of Germany.
[Tinnitus].
Tinnitus rarely can be cured. The patient, however, needs help in order to avoid countless ineffective treatments and considerable costs. The paper deals with the management of decompensated tinnitus. It outlines the problems and possible means for guidance of the patient toward acceptance of the handicap.
[Neck cysts].
Cystic neck alterations are discussed. Practically important guidelines and possible pitfalls are outlined. The importance of a thorough preoperative evaluation is stressed, in order to obtain optimal surgical results.
A randomized, double-blind, placebo-controlled study of dextran/pentoxifylline medication in acute acoustic trauma and sudden hearing loss.
The effectiveness of any therapy in acute acoustic trauma or sudden hearing loss of unknown origin has not been demonstrated convincingly. The assessment is difficult because of a relatively high rate of spontaneous recovery. Nevertheless, many different forms of treatment are recommended. We tested one form, treatment with rheoactive substances, in a prospective, randomized, double-blind trial and compared treatment with (a) infusions of dextran-40 with pentoxifylline, (b) saline infusions with pentoxifylline, and (c) saline infusions with placebo medication. Pure-tone hearing thresholds served as control parameters and were taken before treatment and at 1 and 4 weeks after the onset of therapy. Three hundred eighty-two patients were included in the trial, 331 (87%) could be analyzed, 184 patients were treated because of sudden hearing loss, 147 because of acute acoustic trauma. The three treatment groups were comparable in their basic characteristics including the amount of initial hearing loss. In patients with sudden hearing loss, no significant differences of hearing recovery were detected between the three treatment groups. Hearing recovery was also similar in patients with acute acoustic trauma. A power analysis of the study revealed that possible true treatment differences of a hearing recovery of 10 dB would have lead to significance with a probability of over 90%. It is concluded that there were, in fact, no clinically relevant differences in hearing gains of sudden hearing loss or acute acoustic trauma between treatments with saline infusions together with placebo medication and treatment with dextran-40 and/or pentoxifylline.
Progressive hearing loss after single exposure to acute acoustic trauma.
Progressive hearing loss after single episodes of acute acoustic trauma (Knalltrauma) has been reported in only a few cases. Many authors dispute such a progressive evolution. Since this question is of obvious importance in cases evolving into lawsuits, its occurrence also arouses scientific interest. The present study reports 58 bilateral and 17 unilateral cases of acute acoustic trauma showing progression of more than 20 dB at least at one frequency. The mean follow-up time was more than 20 years. The incidence was estimated as less than 1% of cases involving acute acoustic trauma. The evolution of the progressive hearing loss did not show a specific pattern; in the unilateral group, there were no statistically significant differences between the progression in both ears. The findings clearly indicate that late progression of hearing loss due to single episodes of acute acoustic trauma does not exist unless the affected ear is exposed to additional damage not related to the initial trauma.
Tinnitus-induced weight loss in rats. An animal model for tinnitus research.
Growing rats were exposed to noise and/or tinnitus-producing drugs (sodium salicylate, quinine, gentamycin). Growth inhibition or weight loss was absent or significantly lower in the noise-only and salicylate-only/quinine-only groups than in the groups exposed to both noise and drugs. In the gentamycin groups, initially the same trend was found, but general toxicity soon prevailed, leading to heavy weight losses in both groups. The findings clearly favor the hypothesis that tinnitus-induced stress may be the cause for this effect. The experimental set-up thus could serve as an animal model for tinnitus research. In humans, high doses of salicylate or quinine should be avoided in persons exposed to elevated noise levels.
[Globus of the pharynx? Differential diagnosis].
Globus sensation is felt medially deep in the throat during empty swallowing, never while drinking or eating. It is not painful, and there is no hindrance for the passage of food. It is caused mainly by cervical disturbances (tendinopathy of the hyoid bone) or by reflux. Similar complaints, however, can be due to various other pathologies, e.g. early hypopharyngeal cancer. Possible pitfalls abound. The management of such cases is dealt with in detail.
[Pain syndromes of the head, neck and locomotor system--determining current status].
A small series of pain syndrome patients shows that disturbances of the head and neck motor system can lead to various pain syndromes as the vicious circle between pain and muscle tension is initiated by a triggering factor. These pain syndromes include varying combinations of the following symptoms: headache, referred otalgia, arthralgia of the temporomandibular joint, styloid syndrome, tendopathia of the hyoid bone, carotidynia, cervical dysphagia and probably most patients with superior laryngeal nerve neuralgia or glossopharyngeal neuralgia. A detailed differentiation of those syndromes is of little value for diagnostic and therapeutical purposes, because the mixed distribution of the pain irradiation does not indicate the localisation of the primary pathology. The pain syndromes of the head and neck motor system can be caused by temporomandibular joint pathology as well as by anatomical or functional alterations of the cervical spine. Acute exacerbations are triggered off by various influences such as inflammation, trauma, scarring after surgery or radiotherapy. Thus diagnostic and therapeutic measures must take into consideration both the motor system itself and any possible triggering factors. The problem frequently needs interdisciplinary co-operation. An attempt to handle the problem within the boundaries of a single discipline such as ENT, may lead to unnecessary and misleading steps. Guidelines for the management of such pain syndromes are outlined.
[Microcirculation of the internal ear].
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[Drug therapy of hearing disorders].
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Woakes' syndrome: the problems of infantile nasal polyps.
Usually, nasal polyposis in early childhood (children aged less than 5 years) is caused by cystic fibrosis of Kartagener's syndrome. In later age groups, recurrent sinus infections, allergy and ASA disease (asthma, aspirin intolerance and nasal polyps) have to be taken into consideration. Four cases of early childhood polyposis are reported which fit into none of these etiological groups. This newly defined Woakes' syndrome comprises recurrent nasal polyposis with broadening of the nose, frontal sinus aplasia, bronchiectasis, and dyscrinia (production of highly viscous mucus). The disease seems to be hereditary. The possible origins of the disease are discussed.
[Perennial rhinitis due to bacterial allergy (author's transl)].
Bacterial allergy causing perennial rhinitis remains a controversial nosological entity. Clinically, however, many cases of perennial rhinopathy do fit into the definition of this disease, and may represent a late stage of earlier inhalant allergy. It is characterized by positive delayed (type IV) skin tests with bacterial extracts as well as by a pronounced tendency to oedema and polyp formation. Topically applied steroids seem to provide sufficient prophylactic protection. Acute bacterial infections or any nasal surgery, however, require antibiotic treatment.
[Risk of inner ear damage from ototoxic eardrops (author's transl)].
Antibiotic eardrops with ototoxic properties are widely used in the treatment of discharging ears and have also been used in cases with perforated tympanic membranes. There has thus far been no information available on the incidence of ototoxic inner ear damage caused by such treatments. An inquiry among the members of the Swiss Otolaryngological Society uncovered 15 such cases with inner ear damages: 8 patients with total loss of hearing and 7 patients with profound deafness. The risk of such ototoxic injury is approximately 1 case in 1--3000 treatments. The present study indicates that topical treatment in cases with perforated tympanic membranes should not be given longer than 10 days, or it should be interrupted as soon as mucosal swelling subsides.
[Drug treatment of hearing losses (author's transl)].
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[Treatment of acute inner ear deafness (sudden deafness and acoustic trauma) (author's transl)].
The principal facts concerning therapeutic measures in cases of sudden deafness and acoustic trauma are outlined. Experiment data concerning the pharmacology of inner ear circulation are presented. There is sufficient evidence for a critical evaluation of a few treatments whose effect seems to be proven (experimental increase of inner ear circulation in normal animals) or at least possible (in normal animals no or dubious increase; effective under pathological conditions only?). Experimental and clinical experiences concerning the dextran treatment of sudden deafness and acoustic trauma are reported.