The hyoid suspension.
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Anesthesia, Local↗
Biomedical subjects
K Hörmann
Publications and source records attributed to K Hörmann.
Delayed genomic and acute nongenomic action of glucocorticosteroids in seasonal allergic rhinitis.
BACKGROUND: Glucocorticosteroids are effective in the treatment of allergic rhinitis, a disease characterized by a variety of symptoms, e.g. rhinorrhea and itching. The time course of symptomatic relief for allergic rhinitis by steroids has not been examined in detail to date, although the onset of steroid action is one of the main discriminations between genomic and nongenomic actions of steroids. We therefore investigated the time course of subjective and objective measures of nasal affection after steroid administration in patients with allergic rhinitis following specific allergen challenge. METHODS: Six female and 18 male volunteers (median age 26 years) with a history of allergic rhinitis but currently free of symptoms were included in this randomized, placebo-controlled, double-blind, three-period crossover study. A single dose of either betamethasone (60 mg), methylprednisolone (400 mg) or placebo was given intravenously, 5 min after intranasal allergen provocation. After 10, 20, 60, 150 and 240 min, nasal itching and nasal obstruction were assessed using a standardized visual analogue scale. In addition, nasal airflow was measured by anterior rhinomanometry. RESULTS: Nasal itching was markedly reduced following either of the two steroids within 10 min after administration of study drug. Itching was depressed by 38% following betamethasone (P<0.05) and by 18% following methylprednisolone (P=0.07) compared with placebo. Nasal airflow and nasal obstruction were not significantly altered by steroids during the first 2 h of the study. However, after 150 min, nasal airflow was 21% rsp. 19% higher after methylprednisolone and betamethasone (P<0.05) compared with placebo. After 240 min, nasal airflow was increased by 20% following betamethasone (P<0.05) and by 19% following methylprednisolone. Nasal obstruction was also beneficially affected by both steroids 150 and 240 min after administration compared with placebo (P<0.05 for both time points following betamethasone). CONCLUSION: This study for the first time shows rapid in vivo effects of external glucocorticosteroids in humans. Itching, a pathophysiologically complex sensation, is favourably influenced by steroids within 10 min, therefore presumably via nongenomic mechanisms. Though no detailed mechanisms can be derived from this study, steroid interaction with receptors in the central nervous system may play an important role in mediating this effect.
Allergens↗
[Submental transcutaneous electrical stimulation for obstructive sleep apnea].
BACKGROUND: Transcutaneous electrical stimulation while asleep has been used to treat obstructive sleep apnea (OSA), although without convincing results. Modern strategies consist of electrical muscle training for a number of weeks during wakefulness rather than stimulation during sleep. OBJECTIVE: The purpose of this study was to assess the practicability, safety, and efficacy of a new device, SilentOne (Imperpuls, Chemnitz, Germany). PATIENTS AND METHODS: Fifteen patients with various degrees of OSA used transcutaneous submental electrical stimulation therapy for 4-5 weeks every day, day and night. A patient's diary recorded practicability and potential adverse events. Respiratory parameters were recorded by fully attended polysomnography in the sleep lab. Daytime sleepiness and snoring were assessed by questionnaires. RESULTS: The apnea-hypopnea-index decreased from 29.2 before to 21.2 after therapy (P<0.05). Daytime sleepiness improved significantly (P<0.01) as did snoring (P<0.005). CONCLUSIONS. Transcutaneous electrical stimulation therapy using SilentOne proved to be safe, easy to use, and potent. However, therapy showed a limited cure rate.
Adult↗
[Magnetic resonance imaging in the evaluation of temperature-controlled radiofrequency volumetric tissue reduction].
BACKGROUND: Due to its minimally invasive character, radiofrequency surgery has become a topic of increasing attention, especially with respect to the surgical treatment of sleep-related breathing disorders. Temperature-controlled radiofrequency volumetric tissue reduction is the most common technique employed in these cases. However, despite the increasingly widespread use of this technique, there is little data available on the induced effects in vivo. The aim of the present study was to investigate whether magnetic resonance imaging could be used in the evaluation of the in vivo effects of radiofrequency surgery at the base of the tongue. PATIENTS AND METHODS: Six patients were treated at the base of tongue with radiofrequency surgery. At 4-6, 8-10 and 24 h after surgery, magnetic resonance imaging was performed using an inversion recovery technique (TIRM) and the lesions created were evaluated. RESULTS: The lesions could be visualised at all postoperative measurement times. They appeared as oval hypointense structures encircled by a hyperintense area. Lesion size diminished slightly over time. DISCUSSION: Lesions induced by radiofrequency surgery can be clearly visualised with magnetic resonance imaging. Lesion size may be assessed in relation to energy application. In the future, the treatment of sleep-related breathing disorders may be further optimised with the help of this technique.
Adult↗
[The new G-DRG case reimbursement system. First adjustment of ENT case groups to the German cost structure].
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Cost-Benefit Analysis↗
[Treatment of obstructive sleep apnea with a new vest preventing the supine position].
BACKGROUND AND OBJECTIVE: Prevention of the supine position has for decades been a well known treatment option in positional obstructive sleep apnea. It was the aim of this study to test the efficacy of a recently patented commercially available supine position preventing vest. PATIENTS AND METHODS: The vest is made of linen tissue with a half cylindrical piece of hard foam in its dorsal part. 12 male patients slightly overweight (body mass index 26.5 +/- 2.6 kg/m(2)) and 55.8 +/- 11.6 years old were investigated polysomnographically prospectively. RESULTS: The pretherapeutical respiratory-disturbance index (RDI) was 26.7+/-11.9/h increasing to 39.3+/-16.1/h in the supine position. When using the vest, patients no longer slept on their back and the RDI dropped to 7.6 +/- 5.1/h (p < 0.005). Total sleep time at an oxygen saturation below 90 % was reduced from 11.7 +/- 11.3 % to 1.5 +/- 2.1 %. 9 patients (75 %) were cured (RDI < 10/h and RDI reduction > 50 %), 2 patients (17 %) improved (RDI reduction > 50 %) and only the oldest patient (76 years old) remained unchanged. Even though snoring decreased from 180 +/- 125 minutes to 110 +/- 52 minutes, an increase was observed in 30 % of the patients. Sleep quality and structure did not change considerably. CONCLUSION: The supine position prevention vest is a safe and simple treatment alternative of high efficacy in positional sleep apnea. As a complete remission cannot be predicted, polygraphic or polysomnographic controls are necessary.
Adult↗
[Argon plasma coagulation and topically applied estriol. Long-term results in the treatment of hereditary hemorrhagic telangiectasia of the nasal mucosa].
BACKGROUND AND OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant fibrovascular dysplasia with the main symptom of recurrent epistaxis. At present, only limited data are available on long-term results in the treatment of epistaxis. A part from the surgical treatment of the bleeding telangiectasia with argon plasma, an additional postoperative long-term treatment with estriol nose-ointment was performed and the results were analysed. PATIENTS AND METHODS: 69 patients with HHT were treated with APC and estriol nose ointment. 43 patients could be examined over a follow-up period of more than 20 months. The bleeding frequency and intensity as well as the patient's satisfaction with the treatment result were evaluated and the serum estriol level determined. RESULTS: After more than 20 months, the bleeding frequency and intensity were reduced in 95% of the patients compared to their preoperative findings. Under the influence of estriol, former berry-like telangiectasias became flatter and more even. Neither systemic side effects under topically applied estriol nor a relevant increase of serum estriol levels were observed. CONCLUSION: The combined treatment regimen with APC and topically applied estriol provides a new treatment concept of epistaxis in HHT.
Administration, Topical↗
Mometasone furoate nasal spray improves olfactory performance in seasonal allergic rhinitis.
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Adult↗
An update on the diagnosis and treatment of sinusitis and nasal polyposis.
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Humans↗
[Cluster-immunotherapy in seasonal allergic rhinitis: safety aspects of induction therapy with depot allergoids (Purethal)].
BACKGROUND: Specific immunotherapy (SIT) represents the only specific treatment that can be offered to allergic patients apart from allergen avoidance. SIT has been widely used in pollen allergic rhinitis. Clinical efficacy has been demonstrated in several controlled clinical trials and depends on the specific allergen the individual patient is sensitive to, the quality and total amount of allergen applied, and the SIT schedule. In classic SIT, gradually increasing dosages of the allergen extract are injected subcutaneously. Several dosage schedules for subcutaneous SIT can be applied. In Cluster-SIT, 2 - 3 injections per day of treatment are given once a week during induction treatment. PATIENTS: In this study, we investigated 64 patients (33 female, 31 male) from 18 to 54 years (26.9 +/- 5.1 years) in terms of side-effects of Cluster-SIT during induction treatment. RESULTS: The total amount of enlarged local reactions (> grade 1) was n = 77 or 15.2 % of all injections. Of these, 68 (88 %) were classified as immediate reactions, 8 (11 %) were late phase reactions and 1 (1 %) was immediate as well as late phase reaction. Of all enlarged local reactions, 48 (62 %) were grade 1 reactions, 13 (17 %) were grade 2 reactions, 13 (17 %) were grade 3 reactions and 1 (1 %) was a grade 4 reaction. The total amount of systemic reactions was n = 22 or 4.3 % of all injections. Of these, 19 (86 %) were classified as immediate reactions, 3 (14 %) were delayed reactions. Of all systemic reactions, 18 (82 %) were grade 1 reactions and 4 (18 %) grade 2 reactions. Grade 3 or grade 4 reactions did not occur. There were no differences in gender or age regarding the occurrence of side effects (all p > 0.05). CONCLUSIONS: Frequency and severity of adverse side effects in Cluster-SIT correspond to those in other dosage schedules. On behalf of security aspects, Cluster-SIT could become an interesting alternative dosage schedule for dose increase during SIT. Furthermore, in Cluster-SIT with allergoids, induction treatment can be carried out in two treatment days of approximately 2.5 hours each.
Adolescent↗
Assessment of rhinological parameters for evaluating the effects of airborne irritants to the nasal epithelium.
OBJECTIVES: The initial contact area of inhaled toxins with the human body is the nasal mucosa. Upon irritation, nasal symptoms may occur that are well known as common viral infections of the airway and thus neglected by patients and physicians. Therefore, objective methods should be used to determine even minor irritative or inflammatory changes. METHODS: Objective methods to assess changes in the nasal epithelium include endoscopy, rhinomanometry, acoustic rhinometry, anemometry, thermometry, laser Doppler flowmetry, measurements of mucociliary transport time and ciliary beat frequency, analysis of nasal secretions, nasal cytology, and subjective (UPSIT, CCCRC, Sniffin Sticks) and objective (electro-olfactogram, olfactory event related potentials) and olfaction tests. RESULTS: Several different inhaled irritative and toxic substances, including metal dusts and steam, volatile organic substances, and inorganic gases, may harm the nasal epithelium. CONCLUSIONS: The objective evaluation of nasal functions should be used to assess effects of airborne irritants. For patients complaining of toxic effects, early diagnosis is important in the prevention of severe damage to the upper and lower airways.
Air Pollutants, Occupational↗
[Steroid sprays in non-infectious rhinitis and sinusitis. Proper and regular spraying does not damage the nasal mucosa].
Glucocorticoids are an effective therapeutic option for most forms of non-infectious rhinitis and sinusitis. In Germany, dexamethasone, beclomethasone diproprionate, flunisolide, fluocortin butyl ester, budesonide, fluticasone proprionate, triamcinolone acetonide and mometasone furoate are available for nasal application. The action of these drugs is mediated by cytoplasmic receptors (glucocorticoid receptors). In addition, receptor-independent immediate effects are also known. To ensure optimal efficacy of corticoid sprays, detailed patient instruction is of importance, with particular emphasis being placed on the correct spraying technique and regular application. Modern preparations are associated with very few side effects. There is no evidence that mucosal atrophy occurs.
Administration, Intranasal↗
Expression of cell cycle proteins in head and neck cancer correlates with tumor site rather than tobacco use.
Head and neck squamous cell carcinomas of non-smoking patients may result from specific defects in cell cycle control. Expression of p53, pRb, p16(INK4a) and Cyclin D1 was examined by immunohistochemistry of biopsies obtained from 24 non-smoking and 25 smoking patients, both groups representing similar clinical features (tumor site, stage of disease, gender). Expression of p16(INK4a) was restricted to carcinomas of the tonsils (8/24), P=0.0069. In 6/8 p16(INK4a)-positive cases, expression of pRb was absent or reduced. p16 was the only marker showing a significant correlation with a negative smoking history (P=0.0208). Overexpression of Cyclin D1 was frequent in carcinomas of the tongue (6/14) but rare in tonsillar carcinomas (2/24), P=0.0303. Expression of p53 was independent of the smoking history and the tumor site. Our results implicate that there are factors other than tobacco consumption which may influence the development of head and neck cancers at distinct tumor sites.
Adult↗
[Treatment of therapy refractory chronic otitis externa by local injection of triamcinolone acetate crystalline suspension. Initial experiences].
BACKGROUND AND OBJECTIVE: External otitis is characterized by otalgia, otorrhea, itching, and hearing loss. Treatment usually consists of local application of corticosteroids and antibiotics. Chronic external otitis is accompanied by thickening of the skin in the external auditory channel. This reduces the effect of the applied substances. Local injection of suitable drugs may support the conservative treatment. The aim of the study was to evaluate the efficacy of local injection of triamcinolone acetonide in the external auditory channel. PATIENTS/METHODS: Thirteen patients with external otitis resistant to conservative treatment received an injection of triamcinolone acetonide in the external auditory channel. The improvement achieved was assessed by clinical examination and questionnaires. RESULTS: The symptoms improved substantially in all patients; most of the patients were cured completely. CONCLUSIONS: Our results demonstrate that local injection of triamcinolone acetonide is effective in the management of chronic external otitis.
Adult↗
[Dyspnea caused by spontaneous hematoma of the oropharynx and larynx during marcumar therapy].
A patient with a history of tachycardiac atrial fibrillation and pulmonary embolism was admitted to the emergency unit with acute shortness of breath. The patient was on coumarin medication. Pulmonary embolism, heart failure, or pulmonary edema could be ruled out. Laryngoscopy revealed a huge hematoma of both valleculae extending to the lateral pharyngeal wall and the epiglottis. The epiglottic cartilage was displaced to the posterior pharyngeal wall. The INR was > 6. Prothrombin complex, vitamin K1, corticoids, and fresh frozen plasma were administered immediately. The patient was monitored--without tracheotomy--in the intensive care unit and received oxygen. In a patient with dyspnea, impaired ventilation has to be considered besides impaired perfusion or diffusion.
Aged↗
[Sleep-associated respiratory disorders in childhood].
Sleep-related breathing disorders in children are common. Nearly 10% of preschool-aged children snore, and 1% of 4- to 5-year-old children present with an obstructive sleep apnea syndrome (OSAS), mostly due to an adenotonsillar hyperplasia. OSAS in children differs markedly from adults concerning etiology, clinical symptoms, polysomnographic findings, and course of the disease. Therefore, results of adult sleep medicine cannot easily be applied to children. The disease may result in pulmonary or systemic hypertension, failure to thrive, and neurocognitive misbehavior. Up to now, there is no consensus concerning diagnosis and therapy. In this article, we summarize and discuss what is known so far about sleep-related breathing disorders in children, focussing on the OSAS as the most important diagnosis for the ENT specialist.
Adenoids↗
[Modified uvula flap in therapy of sleep-related breathing disorders].
BACKGROUND/OBJECTIVE: Velopharyngeal incompetence is a well described complication of uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea. A new uvulopalatal flap technique (UPF), first presented by Powell in 1996 was now modified by our team. The new technique intends to lateralize the posterior faucial pillars as the UPPP, entirely sparing uvulopalatal muscles. RESULTS: No statistical difference existed in change of AHI before and after surgery in all patients even though 14 patients had a statistically significant decrease in AHI (pre 19.2 +/- 19.6; after 8.2 +/- 9.8; p < 0.05). Snoring decreased clearly (p < 0.05) from 49.4% to 25.9%.
Adult↗