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H J Schultz-Coulon

Publications and source records attributed to H J Schultz-Coulon.

At least 19 recordsLinked to original sources
PubMed2002

[Morphological and functional results of Palisade Cartilage Tympanoplasty].

BACKGROUND AND OBJECTIVE: The application of cartilage in tympanoplasty has been generally accepted, because cartilage as a bradytrophic tissue allows stable and functionally reliable reconstruction of the eardrum even in difficult pathological conditions (such as subtotal defects, tympanosclerosis etc.). A special surgical technique using small cartilaginous chips for the reconstruction of the eardrum has been developed by J. Heermann, who introduced it as Palisade Cartilage Tympanoplasty (PCT). Although being increasingly applied in otosurgery, this technique has to date neither been evaluated regarding morphological and hearing results nor regarding its combination with titanium ossicular reconstruction prostheses. PATIENTS AND METHODS: Therefore we reviewed 84 of 94 ears (92 patients, 58 female, 34 male) 12 to 36 months after PCT. RESULTS: A recurrent defect was seen in 2 ears (1 adhesive otitis, 1 subtotal defect). There were no extrusions of prostheses. Preoperatively an ear-bone-gap of 0-10 dB was seen in 2 ears, 11-30 dB in 48 and 31-59 dB in 34 ears. Postoperatively the corresponding numbers were 25, 50 and 9 ears. CONCLUSIONS: The low rate of recurrent tympanic membrane defects (2.4%) shows that palisade cartilage tympanoplasty is particularly appropriate for the management of difficult indications in middle ear surgery. Further, it could be demonstrated that the PCT can be combined safely with titanium ossicular reconstruction prostheses. Regarding postoperative hearing results the negative preselection of pathological conditions has to be considered.

Adolescent↗
PubMed2002

[Clinical manifestations of diffuse idiopathic skeletal hyperostosis (DISH)].

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH, Forestier disease) is in most cases a harmless, asymptomatic disease characterized by a massive, noninflammatory ossification with intensive formation of osteophytes affecting ligaments, tendons, and fasciae, especially of the spinal column. If the disease becomes symptomatic at all, the leading complaints will usually be dysphagia in the sense of a lump in the throat and difficulty in swallowing. However, in rare cases the osteophytes may influence the laryngeal function ranging from hoarseness and immobility of the vocal cord to life-threatening inspiratory stridor. Such laryngeal manifestations are almost unknown. PATIENTS AND METHOD: We report on three patients, two female and one male, suffering not only from chronic dysphagia but also from increasing inspiratory stridor and difficult breathing. RESULTS: Especially one case illustrates how difficult it can be to establish the etiological relationship between a cancer-like ulcer in the postcricoid region and a bilateral inactivity of the vocal cord on the one hand and DISH on the other hand. Only the resistance of the ulceration to any therapy as well as rare case reports in the literature confirmed our suspicion that the ulcer and disturbance of laryngeal function were caused by chronic pressure exerted by the huge vertebral osteophytes. In all three patients surgical resection of the osteophytes resulted in complete relief of complaints. CONCLUSION: Uni- or bilateral immobility of the arytenoids, possibly associated with chronic inflammatory hyperplasia of the tissue of the arytenoids and the postcricoid region, may be a symptom of an unusual manifestation of DISH.

Aged↗
PubMed2001

[Use of the Appropriateness Evaluation Protocol in inpatient ENT practice].

BACKGROUND AND OBJECTIVE: Determination of inappropriate hospital use is of increasing importance due to limited resources in health care. The Appropriateness Evaluation Protocol (AEP) serves as an instrument to identify this inappropriate hospital use. It was designed in the USA in 1981 for use in Internal Medicine and General Surgery and consists of criteria items to assess the appropriateness of hospital admissions and days of care. PATIENTS/METHODS: The present study aims to examine the practicability of the AEP in Otorhinolaryngology. The charts of all patients hospitalized in the ENT Department at that particular day were surveyed on 4 consecutive Wednesdays. Three reviewers each reviewed 196 charts. RESULTS: The overall level of inappropriate use was 41.5%. Presuming that the day preoperative to elective surgery was appropriate, the level was 23.1%. CONCLUSIONS: The critical comparison between this result and the actual reasons for hospital admissions and days of care showed, that the present German version of the AEP is less suitable for use in Otorhinolaryngology. Based on the experiences with the AEP an AEP adjusted to Otorhinolaryngology (AEP-ENT) is proposed.

Germany↗
PubMed2001

[Clinical aspects of tracheopathia osteoplastica].

Tracheopathia osteoplastica is a rare condition of the tracheobronchial tree characterized by the formation of multiple osseous or cartilaginous submucosal nodules which protrude into the lumen. Clinical features, pathological-anatomical, and radiological findings are described and discussed on the basis of three recent cases and a literature review.Two female patients (age 56 and 62 years) and one male (age 44 years) presented with recurrent tracheobronchitis, a "difficult intubation" at the time of an emergency situation requiring tracheostomy. The diagnosis was confirmed by tracheoscopy. CT scans showed radiodense nodular thickening of the tracheal wall compromising the lumen in all patients, whereas plain chest radiography revealed scalloped linear calcification in only one case. Histologically the nodules consisted of lamellar-type bone covered by normal mucosa. None of the patients needed therapeutic measures as there was no impairment of ventilatory function. The long-term observations (>15 years) of a few authors suggest that the disease is of benign course and does not deteriorate.

Adult↗
PubMed2001

[Ocular myositis. A rare differential diagnosis of sinus-induced orbital complications].

Orbital myositis is an uncommon subgroup of the nonspecific orbital inflammatory syndromes (previously termed orbital pseudotumor) and presents with eyelid swelling and redness, conjunctival chemosis, pain, proptosis, and diplopia. The disease is to date of unknown origin; autoimmune processes are suspected for the etiology. In the case of an otherwise healthy young male patient (age 28 years), the coexistence of chronic sinusitis primarily led to the diagnosis of sinugen orbital cellulitis. Despite antibiotic drug administration and surgical drainage of the paranasal sinuses the symptoms persisted. A second computed tomography revealed fusiform, inflammatory enlargement of the m. rectus lateralis. This muscle showed a restrictive paresis so that initially the m. rectus medialis was suspected to be paretic. The patient responded dramatically to administration of prednisolone within 2 days. The differential diagnosis between a sinugen orbital complication and orbital myositis is significant because corticosteroids are contraindicated for orbital cellulitis whereas they remain the therapy of choice for orbital myositis.

Adult↗
PubMed2001

[Early surgical pharyngostoma in therapy of postoperative pharyngeal fistulas].

BACKGROUND: Postoperative salivary fistulas after laryngectomy occur in 2-65% of cases according to the literature. They are not only inconvenient but also dangerous, as the permanent leakage of saliva prevents wound healing and may cause a life threatening arrosion hemorrhage from the jugular vein or carotid artery. Spontaneous closure of such fistulas is unlikely unless the leakage of saliva can be reduced sufficiently by suction and wound compression. However, about 50% of these patients develop a mucocutaneous pharyngostome after several weeks or even months, then requiring extensive flap reconstruction. In order to shorten this long rehabilitation process and to protect the patient from the danger of hemorrhage the commonly recommended therapeutic concept was modified in that the saliva was completely drained from the wound by creation of a submental epithelialized pharyngostome. In this paper our 10 year experience with this concept is reported. PATIENTS AND METHOD: During the period from 1991 to 1999 postoperative salivary fistulas were seen in 9 of 94 consecutive patients after total laryngectomy. Right after diagnosis a meticulous surgical wound debridement was performed and a submental pharyngostome was created in each case. After healing of the mucocutaneous lining the pharyngostome itself was closed with regional skin flaps. RESULTS: In 7 of the 9 patients a quick and permanent closure of the fistula was achieved by the treatment described. The sooner after diagnosis of the fistula the pharyngostome was created, the earlier the closure of the fistula was obtained. In 1 patient the pharyngeal reconstruction was complicated by nosocomial infections, 1 patient died in the course of treatment due to non fistula related concomitant disease. CONCLUSIONS: In case of postoperative salivary fistulas following laryngectomy the immediate creation of a mucocutaneous pharyngostome can reduce the duration of treatment and at the same time protect the patient from the danger of vascular arrosion.

Adult↗
PubMed2001

[Posterior crus stapedectomy: an obsolete method in otosclerosis surgery?].

BACKGROUND: Stapedectomy and stapedotomy with interposition of prostheses are the methods of choice for surgical treatment of otosclerosis. For the present study we resumed and reevaluated the posterior crus stapedectomy, a method based on the principal of renouncing a prosthesis by cutting the posterior crus of the stapes close to the footplate and the anterior crus close to the stapes head. METHODS: The posterior crus is temporarily transposed with the incudostapedial joint remaining intact. After performance of platinectomy and sealing of the oval window with fascia it is repositioned onto the center of the window. RESULTS: 19 of 20 ears operated on applying this technique showed good results (closure of air bone gap) after a mean follow up of 24.6 months. One patient showed persistence of air bone gap of 32.5 dB. Revision surgery revealed that the posterior crus had migrated to the posterior rim of the oval window. No inner ear affection, perilymph fistula or sensorineural hearing loss were observed. CONCLUSIONS: The major advantage of this technique is the avoidance of incus necrosis and foreign body reactions related to the material of the prosthesis. Disadvantages are technical plus the longer duration of the procedure.

Adult↗
PubMed2000

[Management of complications after prosthetic voice rehabilitation].

The growing popularity of prosthetic voice restoration after total laryngectomy confronts ENT specialists with an increasing number of prosthesis-related complications. The ENT specialist should be familiar with the management of these complications in order to maintain the patients speech and social rehabilitation. In a retrospective study on 108 consecutive patients, complications were encountered in 30%. The incidence was not related to the factors age or primary vs. secondary insertion of the prosthesis. Complications consisted of formation of granulation tissue (15.7%), shunt dilatation (5.5%), loss of prosthesis (3.7%), local cellulitis (2.8%), extrusion (1.9%), ingrowth of prosthesis (1.9%) and formation of excessive scar tissue with dislocation of prosthesis (0.9%). Permanent removal of the prosthesis due to complications was necessary in 3 cases (2.8%). Therapeutic measures for the management of complications are described and evaluated. The treatment of complications was well tolerated by all patients and led to satisfying results in most cases. Our observations show that prosthetic voice rehabilitation is associated with various difficulties and complications, but that these can be handled quite easily and successfully in the majority of cases.

Adult↗
PubMed1997

[Prognostic criteria in sudden deafness].

The present study was devised to determine whether the pattern of hearing loss has any meaning for prognosis in patients with sudden hearing loss. The audiograms and clinical records of 145 patients with sudden deafness between 1991 and 1993 were reviewed. Forty-eight of the patients were females and 97 were males. All patients had been hospitalized and treated with intravenous infusions of naftidrofuryl. The best recovery rate was seen in patients with low-tone hearing losses (68.8% complete and 25% partial recoveries), whereas in patients with high-tone and flat losses the recovery rates were 41.9% and 45.5% respectively for complete recovery and 52.4% and 36.3% for incomplete recovery. The entire group showed an overall recovery rate of 52.4% for complete recovery and 30.3% for incomplete recovery. Immediate treatment resulted in a positive effect on prognosis. Patients under 30 years of age had a somewhat better recovery rate than did older patients. Pre-existing risk factors (diabetes, hypertension, etc.) or accompanying symptoms of vestibular disturbances did not influence prognosis, whereas patients with pre-existing inner ear deafness or with a recurrence of sudden deafness showed relatively lower recovery rates. The possible reasons responsible for exceptionally good prognosis of low-tone hearing losses are discussed.

Adult↗
PubMed1997

[Nasal septum repair-plasty with pedicled flap technique in 126 patients--an analysis].

BACKGROUND: The surgical closure of a nasal septal perforation is considered to be one of the most difficult procedures in nasal surgery with a relatively poor success rate. After a new surgical concept ("bipedicled-flap technique") was developed, a follow-up study was done in order to find out whether surgical results can be improved by means of this new method. PATIENTS AND METHOD: From 1988-1995 the bipedicled-flap technique was applied in 126 patients with nasal septal perforations (82 males, 44 females). In all patients the closure of the septal perforation was performed with an endonasal bilateral bipedicled-flap plasty and reconstruction of the cartilaginous defect with an autogenous cartilage graft from either the rib, the auricle, or from remnants of the septal cartilage. Postoperative results were evaluated in all patients. The follow-up period varied from a minimum of six months to a maximum of over seven years. RESULTS: The age peak was found in the third decade of life (females) and fifth decade (males), respectively. Most frequent preoperative symptoms were difficult nasal breathing, crusting and recurrent epistaxis. 65.8% of septal perforations were of iatrogenic origin. In 32 patients, the aetlology remained unknown. Six patients used silicone obturators preoperatively without getting any relief from complaints. In nine patients, surgical repair of the septal perforation had been attempted previously at another hospital. With the bipedicled-flap technique, primary closure was achieved in 118 patients (= 93.6%); revision surgery (same technique) was successfully performed in 2 patients, increasing the final success rate to 95.2%. Complications were rare and could always be managed easily. CONCLUSIONS: At present, the bipedicled-flap technique appears to be the most successful method for surgical repair of nasal septal perforations. The underlying principles responsible for the good success rate are: (1) the bilateral closure of the mucosal defects; and (2) the additional reconstruction of the cartilaginous septal defect with an autogenous cartilage graft only.

Adult↗
PubMed1996

[Arthrogenic ear canal tumor].

We report our findings in two female patients (aged 56 and 64 years) who complained about slight hearing loss that varied during jaw movements. In both cases a polypoid tumor of the external auditory meatus was found that almost completely disappeared with mouth opening. CT showed a bony defect of the anterior wall of the external auditory canal in both patients. Biopsies from the tumor-like lesions were done, revealing a chronic inflammatory hyperplasia of the connective tissue in one case and a rheumatic granuloma in the other. Review of medical histories showed that the first patient suffered from a recurrent neurodermatitis and the second had experienced a chronic polyarthritis for many years. From these findings and on the basis of a literature review, we conclude that these pseudotumors represent a chronic inflammatory hyperplasia of the periarticular tissue which herniated through a persistent "foramen of Huschke." This foramen is formed during embryological development of the two tympanic tubercles, but normally closes before the age of 5 years. However, in a few rare cases is may persist to allow herniation of synovial tissue.

Arthritis, Rheumatoid↗
PubMed1996

[Endonasal microsurgical paranasal sinus revision].

In order to compare long-term-results of revision sinus surgery with the results of primary sinus surgery, the charts of 226 patients were reviewed 17-72 months (mean 42.3 months) after endonasal microsurgical ethmoidectomy or sphenoethmoidectomy, respectively (primary operation, n = 135; revision operation, n = 91). Additionally, 203 of the patients were asked to subjectively evaluate the success of the sinus surgery by means of a questionnaire. Responses were received from 67.5% of the patients (primary operation, n = 82; revision operation, n = 55). Eighty-three percent of the primary group and 82% of the revision patients felt that their operations had been successful, whereas the remaining patients thought it to have been a failure. The most frequent complications were temporary post-operative edema or hematoma of the lower eyelid, the complication rate being 8.8% in both groups. No serious complications were observed. Additionally, it was found that the results of endonasal sinus surgery did not depend on the medical history of the patient, preoperative CT findings, or the surgical techniques employed. These findings suggest, that despite all diagnostic and therapeutic tools being available at present we still cannot prohibit, that after sinus surgery 15%-20% of patients will develop recurrent sinus polyposis, and are unable to predict, in which patient and at what time the disease will recur. From this point of view the availability of an almost atraumatic sinus surgery by means of an endonasal (microscopic or endoscopic) approach is definitely a great advantage for patients with chronic sinus disease.

Adolescent↗