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Biomedical subjects

G Oberascher

Publications and source records attributed to G Oberascher.

At least 19 recordsLinked to original sources
PubMed1992

[Itching following therapy with hydroxyethyl starch (HES) in otoneurological diseases].

It is generally assumed, that a disturbance of microcirculation is the common pathogenetic end factor in various cochleovestibular disorders of different etiology. Therefore improvement of microcirculation is an important therapeutic goal. Several studies demonstrated, that hydroxyethylstarch (HES) has better haemorheological effects than Dextran and less side effects. For this reason we have changed the therapy with Dextran since 1987 to hydroxyethylstarch in several oto-neurological disorders (as sudden hearing loss, neuronopathia vestibularis, idiopathic facial palsy). As after the therapy with HES--generally after dismissal from the ENT-department--some patients complained of general pruritus, so we performed a retrospective study with a standardized interview-protocol. Of 481 treated patients we investigated 237 (49%): of 149 patients treated with HES 200/0.5, 43 patients (28.8%) complained of pruritus; from 88 patients treated with Dextran 40, only 5 patients (5.7%) reported pruritus. The difference is significant (p less than 0.0001). In nearly half of the patients (more than 40%) the pruritus started in normal skin 1 to 3 weeks after the HES-therapy and lasted for 6 weeks to 6 months; the itching was very resistant to therapy (f.e. with antihistaminics). We want to draw the attention to this possible, in the literature until now quite neglected, for some patients extremely uncomfortable and socially embarrassing side effects after HES-therapy when given in relatively high doses. It is therefore suggested therapeutic recommendations should be developed to prevent this undesired side effect.

Cochlear Diseases↗
PubMed1992

[Otosclerosis--diagnosis and therapy].

Otosclerosis (synonym: otospongiosis) is a focal or diffuse spongifying disease of the bony labyrinth. So far pathogenesis is unknown, some recent investigations assume a paramyxovirus infection. But there are no doubts about hereditary and genetic factors, females are twice often affected as males with a maximum incidence between 20 and 40 years. If the disease invades the oval window niche it causes fixation of the stapes with conducting hearing loss. In some cases otospongiosis is associated with and presumably causes cochlear degeneration alone with sensoneurale hearing impairment of varying degree. The surgical technique is now well developed and the operative treatment enables in over 90% a closure of the air-bone gap by using stapes pistons. The medical therapy in cases of sensoneural hearing loss with sodium fluoride is still controversially discussed.

Adult↗
PubMed1992

[Acute otitis media. Current therapeutic and clinical aspects].

Otitis media acuta is defined as an acute inflammation of the pneumatic spaces of the temporal bone, that means the middle ear including the mucous membranes of the mastoid cells and of the Eustachian tube; it is caused mainly by bacteria, rarely by viruses. When treated properly by antibiotics, otitis media acuta heals in the rule within two to three weeks completely. If more than three episodes of otitis media occur within one year, the disease is called recurrent otitis media. Secretory otitis media (mucoserotympanon) may be proceeded by an otitis media acuta, but it can also develop without any fore-going disease. If the inflammation of the middle ear is quite symptomless, it is called an occult otitis media or an occult mastoiditis; the causes are often insufficient antibiotic therapies. In these cases an operative treatment (paracentesis, mastoidectomy, antrotomy, adenoidectomy, ventilating tubes) may be necessary. If the defense of the mucous membranes respectively of the whole body is weak or the antibiotic treatment insufficient, there may develop some other sequelae like chronic otitis media, atelectasis, otitis media chronica adhesive, tympanosclerosis, with or without development of cholesteatoma. The typical clinical symptoms, possible complications and the recommended antibiotic and physical treatment are referred.

Acute Disease↗
PubMed1992

[Muco-serous otitis media].

Typical symptoms of the otitis media with effusion (OME)--synonym (secretory otitis media--SOM)--are fluid (serous/mucoid) in the middle ear space and a conductive hearing loss. Its most incidence can be found in infants and kids, during this period often bilaterally, but also in adolescents and adults. Etiopathological factors are infections of the upper respiratory tract, obstructing adenoids, tumors of the nasopharynx, cleft palate patients, allergological and immunological influences. As most important anatomical factor ventilation problems, respectively insufficiency of drainage of the eustachian tube is considered. Especially in childhood, OME reveals high spontaneous remission. Thus in many cases is no need for treatment. Persists OME over a longer period (some months) or in patients with recurrent disease, therapy is necessary: decongestant nasal drops, local heat during concomitant upper air way infections, long term application of low dose antibiotics, adenoidectomy with myringotomy, or insertion of ventilating tubes.

Audiometry, Pure-Tone↗
PubMed1992

[Sudden deafness--diagnosis and therapy].

Sudden deafness is defined as acute inner ear hearing loss, in the rule one-sided, of unknown etiology. The tentative diagnosis can be made easily by otoscopy and simple audiological forke tests. To exclude symptomatic acute hearing losses during the first treatment period, f.e. acoustic neurinoma, rupture of the round window membrane, multiple sclerosis, infectious diseases like Borreliosis or Lues, but also psychogenic hearing disorders we recommend an immediate hospitalization. Neurological and internal check up should look for inflammatory or degenerative diseases of the vascular or nervous system and also for metabolic risk factors like diabetes mellitus, hyperlipidemia, gout or blood hyperviscosity. Today there are some reasons to assume, that disturbances of the microcirculation of the cochlea end vessels may a possible prominent etiological factor in sudden deafness. Therefore the aim of therapy today is to improve the microcirculation and the oxygenation of the sensory cells of the inner ear.

Cochlea↗
PubMed1990

A map of cochlear perilymph protein based on high-resolution two-dimensional electrophoresis.

For systematic characterization of cochlear perilymphatic (PL) fluid proteins and to compare the complex protein mixtures of PL fluid, cerebrospinal fluid (CSF) and blood plasma, we subjected eight postmortem PL fluid samples to two-dimensional (2D) electrophoresis. To avoid contamination of perilymph by blood and blood plasma, the samples were taken immediately after death and analyzed by keeping to certain selection criteria. When compared with CSF, PL fluid in the scala vestibule was found to have an albumin content of approximately 1-2g/l, or 10 times the level of CSF albumin. Due to the small volume of the sample obtained, it was not possible to concentrate the PL fluid. As a result, protein spots in the 2D-gel could only be detected with a highly sensitive silver stain. Visual inspection of the resulting 2D-electrophoretograms showed that most of the "CSF-specific" protein clusters were present in the PL fluid pattern.

Blood Proteins↗
PubMed1990

[Pruritus--a side effect of hydroxyethyl starch? First report].

It is generally assumed that a disturbance of microcirculation is the common pathogenic pathway of various cochleovestibular disorders. Several studies have demonstrated that hydroxyethyl starch (HES) has better rheological effects than dextran 40, and fewer side-effects. Therefore, we changed from dextran 40 to hydroxyethyl starch in 1987 for the treatment of several otoneurological disorders. However, some patients complained of general pruritus after 1 or 2 weeks of therapy with HES. Therefore, a retrospective study was performed using a questionnaire of 491 patients treated for various cochleovestibular disorders. We received answers from 94 (20%): 25 of 59 (42.4%) patients treated with HES complained of pruritus compared with only 4 of 35 (11.4%) patients treated with dextran 40. The difference was significant (P less than 0.01). Critical points are the retrospective study design and the small number of patients, so that no conclusions can be drawn about the incidence of pruritus after therapy with HES. However, we would like to focus attention on this side-effect, which has been neglected in the literature but is extremely uncomfortable and socially embarrassing for some patients.

Dextrans↗
PubMed1989

[Radiation dosage and clinical value of conventional tomography and high resolution computerized tomography of the nose and ear].

Hypocycloidal (frontal and temporal) tomography of the base of the skull is compared with high resolution computed tomography (HR-CT) with respect to dose and clinical usefulness. In most cases HR-CT is indicated because of its better density resolution in comparison with conventional hypocycloidal tomography. As the X-ray beam is directed at the slice plane the dosage is noticeably less than when using conventional tomography. Slice thickness depends on the required geometric resolution. This is an additional factor in radiation protection.

Ear↗
PubMed1988

Cerebrospinal fluid otorrhea--new trends in diagnosis.

In this paper we describe the different causes of cerebrospinal fluid (CSF) otorrhea and their pathomechanisms, followed by a short description and illustration of the most common methods used until now for identifying CSF. We then present a new and modern method, immunologic identification of CSF using beta 2-transferrin (tau band). This protein variant is found only in CSF, not in any other body fluids, such as tears, nasal secretions, saliva, or blood serum. Analysis of CSF using this method always indicates two bands, the beta 1-transferrin and the beta 2-transferrin band. The latter is typical for CSF. The analysis of all other body fluids shows just one band, the beta 1-transferrin band. It is therefore possible to identify CSF accurately. The required reagents and equipment are listed and methods of taking samples are explained, followed by a detailed description of sample preparation, electrophoresis, immunofixation, and silver staining. Staining with alkaline silver nitrate has a 40-fold higher sensitivity than staining with the commonly used coomassie brilliant blue. With this method, 1 microliter pure CSF (corresponding to approximately 1/50 of a drop) and 100 microliter CSF (two drops) per 1 ml wound secretion can be identified.

Cerebrospinal Fluid Otorrhea↗
PubMed1988

A modern concept of cerebrospinal fluid diagnosis in oto- and rhinorrhea.

Three successive CSF investigations make it possible to identify even the smallest amount of cerebrospinal fluid (CSF) in cases of otorrhea and rhinorrhea: 1. Immunological identification of beta 2-transferrin. 2. Laboratory fluorescein identification. 3. Endoscopic fluorescein detection. As a screening procedure the beta 2-transferrin identification method is always used as the first step towards clarifying a suspect liquorrhea. In addition both fluorescein tests are used for the diagnosis depending on the result of the beta 2-transferrin identification and further measures. As a result of recent practical experience special attention is paid to the test analyses; the various possibilities of taking samples as well as mailing them. A newly developed diagnostic plan of procedure should (by using practical examples) underline the clinical significance. This study describes the most up-to-date level in CSF diagnosis and demonstrates that, when combined with a corresponding X-ray investigation, a much more exact range of indication for the surgical treatment of fractures of the base of the skull and CSF leaks is possible.

Cerebrospinal Fluid Otorrhea↗
PubMed1988

[Endoscopic concept and fiberoptic technic in monitoring long-term intubation].

An endoscopic procedure has been developed to enable constant monitoring of the mucous membrane of the larynx and trachea. The examination can be divided into four stages. 1. Transnasal inspection. 2. Transtubal inspection. 3. Partial, endoscopically controlled extubation. 4. Endoscopically controlled re-intubation. The advantage of this newly developed technique using a flexible fiberoptic endoscope is that complete extubation is not necessary in patients who are under artificial respiration and subject to long-term intubation. In long-term intubation without artificial respiration care must be taken to provide the best possible means of sedation. Endoscopic monitoring of this kind guarantees the following: 1. Early determination of intubation damage to larynx and trachea. 2. Exact control of the position of the tube, rendering X-ray identification unnecessary. 3. Examination of the bronchial system. 4. A final check on the above-mentioned critical points during complete extubation after long-term intubation. Regular examination by this atraumatic method provides an early diagnosis of any mucosal damage caused by tubes. The recommendation that a secondary tracheotomy should be carried out after 48 h, and at the latest after a week, can no longer be supported, provided the necessary modern anaesthetic equipment and management is available.

Bronchi↗
PubMed1988

[Ofloxacin in the treatment of Pseudomonas aeruginosa infections of the ear].

Twenty-three patients suffering from a Pseudomonas infection of the ear were treated with ofloxacin in a prospective study. The type of infection was as follows: external otitis 4, external otitis with furuncle 3, external otitis and otitis media 5, acute exacerbation of chronic otitis media 7, infection of radical mastoidectomy 3, malignant external otitis 1. All patients had previously been unsuccessfully treated elsewhere. The average period of infection was 13.7 days. The patients received 200 mg of ofloxacin (Tarivid) twice daily for 3 weeks. At the same time the ear was cleaned by suction at 2-4 day intervals and a Normison ear strip applied. Twenty patients were completely cured, 2 patients stopped taking ofloxacin early as a result of improved symptoms but their condition subsequently deteriorated. After a further 3 weeks of consistent treatment both of the cases were also cured. Hence only one patient did not respond to our therapy; that is a success rate of 95%. These results are compared with those of our former therapeutic plan in which all patients with resistant Pseudomonas ear infections were treated as in-patients with selected intravenous antibiotics.

Adult↗
PubMed1988

[Excluding a recurrence of cholesteatoma using high resolution computerized tomography. Can one dispense with the second-look operation?].

In a prospective study 20 patients were examined by high-resolution computed tomography of the temporal bone (HR-CT) before an early or late second-look operation. One year earlier 8 of the patients had undergone a posterior tympanotomy ("intact canal wall" technique) for a cholesteatoma and if necessary a one-stage ossicular reconstruction. In 4 other patients a two-stage ossicular reconstruction was carried out. In the remaining 8 patients a one stage operation had been carried out several years before. After a cholesteatoma operation three typical X-ray findings can be observed in HR-CT: 1. Normal findings (no granulation tissue in the middle ear space, antrum or mastoid) 2. Granulation tissue without destruction 3. Cholesteatoma recurrence (homogeneous soft tissue mass with bony destruction) Based on previous experience we forego an early second-look 1 year later and suggest the following plan: 1. Providing the post-operative follow up proves normal, a HR-CT examination is carried out 2 years, after a cholesteatoma operation. 1.1 If the HR-CT, the clinical and audiological examinations are normal a HR-CT investigation is necessary a further 2 years later. 1.2 In the case of granulation tissue a further HR-CT must be carried out 1 year later. Should the granulations become progressively worse a second-look is mandatory. 1.3 Homogeneous soft tissue mass and destruction are signs of cholesteatoma recurrence. Immediate operation is necessary. 2. If audiological or clinical findings suggest a recurrent cholesteatoma within the first 2 years after the operation, HR-CT should be carried out at once.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Cerebrospinal otorrhea--cerebrospinal rhinorrhea. The Salzburg concept of cerebrospinal fluid diagnosis].

The three following cerebrospinal fluid (CSF) examinations make it possible to identify even the smallest amounts of CSF in case of CSF otorrhoea and rhinorrhoea. 1. Immunological identification of beta 2-transferrin (Oberascher/Arrer) 2. Laboratory fluorescein identification (Oberascher/Arrer) 3. Endoscopic fluorescein detection according to Messerklinger. For screening, and as the method of choice, beta 2-transferrin identification is always used as a first step if there is a suspicion of liquorrhoea. Depending on the result and on further measures, both fluorescein tests are used additionally in diagnosis. Basing on practical experience gained recently, special attention is given to test analysis, the various possibilities of taking samples, and their means of transport or mailing. A newly developed diagnostic step-by-step plan is intended to emphasise the clinical significance by means of practical examples. This concept represents the present state of the art in CSF diagnosis and demonstrates that a much mor precise range of indication is possible in surgery of fractures of the base of the skull and CSF leaks if it is combined with an appropriate x-ray examination.

Brain Concussion↗
PubMed1988

[Identification of middle ear implants in high-resolution computerized tomography].

As a result of the increase in the use of computed tomography and the possibility of demonstrating very small structures, x-ray diagnosis is becoming more and more important in investigating complications after examined in patients as well as cadaver temporal bones by using high resolution middle ear computed tomography: 1. autologous/allogenic ossicular implants, 2. alloplastic implants made of ceramic, plastic or metal. As can be seen from our investigations the homografts and some of the implants are easily identifiable (autologous/allogenic ossicular implants, Ceravital and Frialit PORP/TORP and metal devices), are only partly identifiable (Fisch-Tef Platinum and Stainless Steel as well as Titan stapes pistons), hardly or not at all identifiable (PORP/TORP and stapes pistons made of plastic, e.g. teflon, silicone, plasti-pore). The same applies to ventilating tubes. Thus the position in the middle ear of metal tubes which have slipped can be seen clearly, whereas plastic tubes cannot be seen so well. It is of clinical importance that prosthesis dislocation is visible in CT so that should complications occur it is better possible to determine whether revision surgery is necessary. As, however, identification of various devices in CT is still not satisfactory, the manufactures must soon fulfil our demands for a contrast agent to be added to prosthesis.

Bioprosthesis↗
PubMed1988

[Dislocations and fractures of the ossicles--high resolution computerized tomography of the petrous bone].

As in traumatology of the head the HR-CT of the injured petrous bone is now the imaging method of choice. With axial and coronary slices one can show not only the different parts of the ear but also the course of the facial nerve and particularly the ossicles in the tympanon. The fractures are nice to show, also the soft tissue lesions like brainprolaps in the tympanon or hematotympanon because of the better density resolution in comparison to the conventional tomography with rather higher radiation dose especially for the eye lenses. Important are the slice thickness of 1.5 mm with special examination technique, that also small fractures of the pyramid particularly the labyrinthous organ and of the ossicles mostly associated with dislocations are detectable. Regarding that with the clinical possibilities there are particular consequences for the otosurgeon. The ossicular dislocations of other than traumatic cause are rare.

Adolescent↗
PubMed1987

[Preformed, autologous rib cartilage in the reconstruction of defects of the frontal bone].

The production of exactly fitting, preformed cartilage implants is described. These implants consist of rib cartilage chips that develop after 6 to 9 months' implantation under the thoracic and abdominal skin to a homogeneous and compact cartilage-connective tissue mass. The autologous implants are formed by using plastic shells that are perforated. This technique enables us to repair bone defects of the frontal and skull base region. As well as explaining the surgical procedure the advantages, disadvantages and indications are stressed.

Aged↗