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Biomedical subjects

J Heermann

Publications and source records attributed to J Heermann.

At least 19 recordsLinked to original sources
PubMed1992

Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction.

Since Utech's introduction of cartilage as a columella in ear surgery in 1969, we have used tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall in 13,000 cases. As large pieces of cartilage can twist in later years, we place palisaded cartilage fragments with perichondrium parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus (and malleus), crossing the promontory and reducing adhesions. A "tunnelplasty" keeps the eustachian tube entrance open with the semiring of cartilage ("simmering") apposed to the inside of the annulus, reconstructing the tympanomeatal niche. The "architrave" created rests on the tensor tympani while the palisaded epitympanum and antrum plasty allows ventilation of the antrum. Mastoid obliteration is performed with an autogenous perichondrial transplant to which the palisaded incised cartilage portions adhere, adapting to the underlying structure.

Cholesteatoma↗
PubMed1988

[Unilateral patulous eustachian tube with tinnitus, inner ear damage, vertigo and sudden deafness--collagen injection].

In elderly patients an unilateral sensorineural hearing loss is frequently associated with a relatively more patent eustachian tube on the involved side. A simple method of investigation is observation under the operating microscope during tubal inflation by the patient. In right-handed patients the abnormally patent tube most often lay on the left side. Powerful self inflation in these patients induces acute hearing loss and vertigo. Acute hearing loss is commoner on the left side. The air bone gap is greater at higher frequencies due to mobility of the stapes, loosening of the incudal joints and the tympanic membrane. In contrast the air bone gap is greater at lower frequencies in otosclerosis or malleus head ankylosis. Minor degrees improve after self inflation is prohibited. In most patients with abnormally patent eustachian tubes further therapy is not necessary after the patient has received precise advice. In only about 20% of the cases is the patient disturbed by a feeling of fullness in the ear, autophony and tinnitus. After stabilisation of weight and blood pressure, a septoplasty with correction of the posterior turbinates may reduce the exspiratory resistance. The most drastic treatment is a collagen injection around the tube. Patients with depression should be treated appropriately.

Aged↗
PubMed1986

[Intranasal microsurgical procedure in epistaxis of the cribriform plate and further interventions using hypotension].

For the past 25 years we have been able to control severe epistaxis in all patients by an intranasal procedure. If the source of bleeding in patients with epistaxis from the upper part of the nose cannot be seen during the acute phase, a combined anterior-posterior nasal pack is inserted and left in place for three days. Should bleeding persist or recur after removal of the packing we resect the superior nasal septum to expose the bleeding point in the anterior area of the cribriform plate. Cauterization at this site is not safe because of the risk of CSF rhinorrhea, and it is not always successful, as the main blood supply to the ethmoidal arteries stems from the internal carotid artery. Cauterization of the anterior or posterior ethmoidal arteries within the bony canal of the ethmoidal sinus (after partial ethmoidectomy) is always successful. Ligation or embolization of the carotid arteries is indicated only for tumour patients. Intranasal ethmoidal microsurgery requires much practice and preliminary experience on at least 50 cadavers. In 25 years with an annual load of about 180 ethmoidal sinus surgery cases we have never had serious complications such as cerebrospinal fluid rhinorrhea or persisting optical disturbances in more than 4,000 operations. During 1984 at the Krupp Hospital we used the intranasal microsurgical approach for all patients with septal, ethmoidal sinus and lacrimal duct pathology, for 98% of cases requiring maxillary sinus procedures and for 82% of patients with frontal sinus problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1979

[Flunitrazepam with anterograde amnesia and reduction of blood pressure before local anaesthesia without intubation in 3000 ENT operations (author's transl)].

After premedication with flunitrazepam=Rohypnol 2 mg orally (2--3 hours preop.) and morphine-atropine (30 min preop.) the patient receives slowly "Ro" i.v. until the phenomenon of volume reduction when speaking is observed. This allows for the smallest possible dosis to achieve sufficient amnesia. After about 20 min the patient becomes responsive again, while his amnesia lasts for about 3 hours more. The cardiovascular functions remain stable with a 25% decrease of systolic blood pressure. Vomiting is reduced. The dry operative field makes microsurgery much easier and improves the final result of the operation. After gaining sufficient experience of the staff, 100% amnesia was achieved in all operations during the last 3 months.

Administration, Oral↗
PubMed1978

[Valve-neoglottis after laryngectomy by cartilage implantation into the trachea (author's transl)].

After laryngectomy the opening of the upper trachea is closed up to 3/4--4/5 by implantation of a cartilage plate (if possible from the epiglottis). The anterior part is left open. During exspiration the oesophago-pharyngeal flap is pressed upwards, whereas the position of the cartilage plate does not change much. The air can be expired by a 90 degrees turned 6--8 mm fistula (Staffieri) in the flap opposite of the cartilage plate (valve opened). As well as by its own weight as by flow of saliva, eating, drinking and vomiting the fistula is pressed on the cartilage plate (valve closed). By aid of this valve mechanism the patient can drink 1 week postoperatively without suffering from flow of saliva into the trachea. The patient's ability to speak developes well 10--14 days postoperatively.

Glottis↗
PubMed1978

[Valve-neoglottis by placing ear cartilage and mucosa on inverted lateral tracheal wall after liquid insufficiency of a Staffieri fistula (author's transl)].

Six month after laryngectomy with a neoglottis phonatoria (Staffieri) one patient developed increasing trouble when swallowing liquids. When the patient was operated on again, the upper end of the trachea was closed up to a small anterior opening, by turning the lateral parts of the trachea into the lumen with dexon sutures. On this material cartilage from the ear was transplanted (because of the missing epiglottis) and covered with a free transplant of mucosa from the pharynx underneath the Staffieri fistula. After this second stage operation the patient had no more trouble when swallowing liquids and he developed again a good voice.

Cartilage↗
PubMed1977

[Development from skin- to fascia- and to cartilage tympanoplasty (epitympanon-antrum-mastoidplasty) (author's transl)].

Experiences with 8029 endaural tympanoplastes show interruption of the self-cleaning process of the endaural epithelium after 366 tympanoplasties with skin grafts. The self-cleaning process may be preserved after fascia temporalis (2325) and cartilage (5338) plasties, because of overgrowth with local epithelium. 16 years after combined fascia temporalis and cartilage tympanoplasty the pieces of cartilage are almost unchanged but the fascia temporalis is more or less thinned to atrophic scars and according to tubal function it shows adhesive retraction pockets or bulging. For 7 years we have not been using fascia any more, but ear cartilage for the tympano-epitympano-antrum-mastoidplasty. Cartilage material not used is kept in a cartilage bank. Recurrence of cholesteatoma will press the cartilage plasty into the external auditory canal, whereas after osteoplasty of the endaural canal wall the patient runs to an uncertain percentage the same risk as before the operation.

Cartilage↗
PubMed1977

[Prolongated amnesia after "rohypnol" i.v. before local anesthesia and responsiveness during operation (author's transl)].

An up-to-eight-hour lasting anterograde amnesia is achieved by "Rohypnol" i.v. causing no excitation before local anesthesia is given (prolongation by analgetics, anesthetics, neuroleptics). The cardiovascular functions remain stable with spontaneous breathing and preservation of the swallow and coughing reflexes. During the operation the patient is responsive and cooperative. The patient answers all questions, moves his body into any wanted position and when ordered he performs Valsalva's manoeuver without any remembrane. If not spoken to and having no pain he falls asleep right away. Postoperative vomiting is reduced. The patient feels relaxed after waking up. No complications have been noticed during more than 500 operations. The later questioning of all patients showed only 4 patients (with unsufficient preoperative sedation) who could remember part of the terminal phase of the operation.

Amnesia↗
PubMed1976

[Rupture of the round window membrane after slight head injury with flush of perilymph probably caused by large opening of aquaeductus cochleae (author's transl)].

A ringing deaf ear was noticed after slight head injury without loss of consciousness nor fracture of the skull. After performig tympanotomy a ruptured round window membrane with excessive flush of perilymph was found. We might rightly assume that this was induced by a large opening of aquaeductus cochleae combined with the force of inertia of the cerebral liquor and the direction of the push to the round window (blow behind the left ear).

Accidents, Home↗
PubMed1975

[Facial neuroma without facial paresis (author's transl)].

Over a 15 year period during which 12156 operations were performed for improvement in hearing 2 facial neuromas were diagnosed. In both patients aged 55 and 61 years no treatment was considered indicated. One case which had a conductive deafness for 5 years, had a diagnostic tympanotomy and biopsy in 1961 and during the subsequent 10 years no paresis developed.

Bone Conduction↗
PubMed1975

[Excision in the epipharynx anterior or posterior to the ostium tubae with stenosis of the cartilaginous eustachian tube (author's transl)].

A large excision anterior to the ostium tubae in the epipharynx is advised in cases with stenosis of the cartilagenes eustachian tube. The operations performed by transpalatimal approach under general anesthesia were in 11 cases without complications so far. Excision and scar retraction yielded good functioning results over the longest observation period of 18 month. -A resection of the tensor tympani muscle out of its bony canal is advised in bony tubal obstruction. Ventilation may be improved by use of our conic and oval shaped steel probe which helps to combine the bony tensor typani canal with the eustachian tube.

Constriction, Pathologic↗