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Biomedical subjects

S Brosch

Publications and source records attributed to S Brosch.

At least 19 recordsLinked to original sources
PubMed2007

[Chronic polypous rhinosinusitis: Genesis, clinical picture, therapy and relapse rate--a retrospective study].

BACKGROUND: The prevalence of chronic polypous rhinosinusitis is high at 1-2%. In the present study, the predisposing factors for this condition, the clinical symptomatology, results of surgical interventions, significance of computed tomography diagnosis, as well as histology and post-operative therapy with steroids were investigated. METHODS AND RESULTS: A 15% stratified sample, made up of 194 post-paranasal sinus surgery patients of 5 surgical years was investigated. Above all, the eosinophil dominated type led to the formation of polyps. In the diagnosis of chronic polypous rhinosinusitis computed tomography is only sufficiently sensitive for the ethmoid bone. The complication rate was, with 4.6%, in the lower range of comparable pre-examinations. In addition, the 18% relapse rate in the patient population, of whom 49% had already been operated on once or several times, corresponds to a good result when compared at an international level. CONCLUSIONS: These data confirm that surgical experience and a consistent post-surgical treatment can reduce the relapse frequency of chronic polypous rhinosinusitis. This is indicated by the on average late occurrence of a relapse.

Adolescent↗
PubMed2006

[The influence of the Tübingen soft palate plate and early cleft closure on swallowing and Eustachian tube function in children with Pierre Robin sequence].

CURRENT KNOWLEDGE: Children with Pierre Robin sequence (PRS) typically have difficulty with bolus transport and swallowing. Due to velopharyngeal insufficiency caused by the cleft palate, a high percentage of the children affected also have impaired Eustachian tube function. AIMS OF THE STUDY: In the literature, substantial information may be obtained on conductive hearing loss in PRS patients; however, no study has yet been performed to investigate whether wearing a soft palate plate and relatively early surgical cleft palate closure positively influence Eustachian tube function. In the present study this question was investigated. METHODS AND RESULTS: A total of 41 PRS children, 27 girls and 14 boys, were included in the study and were examined for hearing ability prior to and after surgical cleft palate closure. All of the children had been wearing a Tübingen soft palate plate until surgical cleft palate closure, which occurred at an age of 3-13 months (mean age 7.3 months). Based on data obtained prior to surgery by BERA, otoacoustic emissions and tympanometry, a hearing loss of more than 30 dB was diagnosed in 68.4% of the children. After 3-6 months, normal hearing ability was found in 70%. CONCLUSIONS: Wearing the Tübingen soft palate plate, and the improved swallowing function resulting from this, as well as early surgical cleft palate closure had a very positive impact on the hearing ability of the children included in the study.

Auditory Threshold↗
PubMed2005

[Factors influencing rehabilitation of sensorineural hearing loss with hearing aids].

BACKGROUND: A large proportion of older as well as younger patients do not use their hearing aids. Of the younger hearing impaired population, this occurs in the majority of those who do not benefit sufficiently from their hearing aids and, consequently, they face difficulties in their working and social life. SCIENTIFIC QUESTION: Our aim was to evaluate whether a classical hearing aid adjustment is of sufficient predictive value to determine whether adequate rehabilitation in everyday and professional life will occur. METHODS AND RESULTS: A questionnaire was returned by 197 adult hearing impaired patients. Only 108 were using their hearing aids all the time; 57 rarely and 32 never. The main reason for this low rehabilitation rate proved to be inadequate amplification. At the workplace, insufficient speech discrimination came into play. Another important factor was dysacusis induced by specific noise signals. There was an intolerable acoustic feedback in 40% which could not be sufficiently alleviated. Taking these results into account, only about a third of patients were sufficiently rehabilitated. CONCLUSIONS: Proof of effectiveness in a typical audiological testing situation is an important but not a fully reliable predictor for effectiveness in everyday life. Even when hearing aids are shown to be effective with such testing, their application in particular everyday or work situations may be insufficient of even impossible.

Equipment Failure Analysis↗
PubMed2005

[Quality control of audiologic results in a university phoniatric/pediatric institution. An example of expert assessment of occupational noise induced hearing loss].

AIM: An investigation was made to reveal whether suspicion of occupational hearing loss can be satisfactorily determined by an otolaryngologist or workplace audiological measurement. These were compared with a formal audiometrical assessment at a university clinic. METHODS AND RESULTS: A retrospective study was made of 95 cases of noise induced hearing loss. A total of 78 individuals were investigated by an otolaryngologist and 70 by workplace audiometry. Using workplace audiometry, 27% of the tests showed a reduction in working capacity of at least 20%. In only five of these was a specialist opinion sought within a year. In 50%, this took longer than 5 years. A comparison of audiometric data from expert opinion revealed that there was conformity in only 47% with workplace audiometry and 48% with otolaryngologist testing. In some cases (27% workplace and 33% ENT practice), the measured hearing loss and calculation of disability exceeded that determined by the experts. CONCLUSIONS: The results of workplace audiometry demonstrated that hearing loss was frequently reported only after the workers had received a disability of at least 20%. Possible reasons for discrepancies in audiological testing might be the exaggeration of hearing loss by the worker, insufficient recovery time after noise exposure, or inexperienced audiologists. Our data show that audiometric testing in workplace audiometry, as well as in ENT practice, often reveal a higher disability rating compared to formal audiological (university) assessment, even if these discrepancies do not reach statistical significance.

Adult↗
PubMed2005

Complications of ultrasound guided percutaneous ethanol injection therapy of the thyroid and parathyroid glands.

OBJECTIVES: Since 1990 percutaneous ethanol injection therapy (PEIT) has been applied clinically as a treatment strategy for focal and diffuse autonomy of the thyroid, for cystic lesions and for ablation of parathyroid hyperplasia (PEA). There are some additional indications currently under consideration as for example inoperable advanced cancer of the thyroid. Since its inception PEIT and PEA have been regarded as an effective, inexpensive and low risk procedure. MATERIAL AND METHODS: We discuss mild and severe complications of these methods reported in literature and the first case so far of a severe ethyl toxic necrosis of the larynx and adjacent skin in a patient treated with PEIT by a radiologist. RESULTS: To date, no serious side effects have been reported in connection with these therapies. Some authors conclude that the side effects are in no way negligible and caution and routine should be exercised when using PEIT or PEA. Most complications have been transient in nature. The complication of ethyl toxic necrosis of the larynx was serious and the patient was admitted to hospital, treated conservatively and ten month later microsurgically. Voice thus could be restored to almost normal. CONCLUSIONS: PEIT for focal and diffuse autonomy, for cystic lesions of the thyroid, for thyroid hyperplasia and PEA for parathyroid hyperplasia are methods which are inexpensive and can be performed on an ambulatory base. These are the methods of choice if surgical intervention or radioiodine therapies are not practicable out of medical reasons or by refusal of the patient. The patient must be informed about possible severe complications. The examiner should have substantial experience in these methods. If complications an early opinion of a specialist is required.

Adenoma↗
PubMed2005

Valproic acid-associated sialadenosis of the parotid and submandibular glands: diagnostic and therapeutic aspects.

Sialadenosis has been defined as a non-inflammatory, parenchymatous salivary gland disease causing recurrent, bilateral swelling of the salivary glands. As an adverse drug reaction of valproic acid, sialadenosis is very rare. To our knowledge, it has been reported only once in the world literature to date. We present herein the case of a patient with valproic acid-associated sialadenosis of both the parotid and submandibular glands. This appears to be the first published case of a patient who received surgical treatment. On light and electron microscopy of all the affected salivary glands, granular sialadenosis with predominantly moderate electron-dense secretory cytoplasmatic granules was observed. No relevant degenerative alterations were seen. There was no histological evidence of peripheral neuropathy of the nerve supply, leading to disordered activity of acinar cells by loss of neurosecretory granules. Lateral parotidectomy, performed under neuromonitoring control for safety reasons, is the treatment of choice for chronic recurrent parotitis that does not respond to conservative therapy, particularly if the cosmetic deformity is unacceptable to the patient. If the submandibular glands are involved, partial removal is recommended.

Adult↗
PubMed2003

[Hearing loss in a cultural-historical context. Part 1].

BACKGROUND: It is rare to find anything written about hearing loss or its treatment in either representative art or in a medical-historical context in ear, nose and throat journals. METHODS: Examples dating back over the past 4000 years found in medical-historical, philosophical, and literary documents are presented and commented on. RESULTS: The ancient Egyptians and Greeks attempted to explain deafness and sought remedies,making use not only of empiric rational means but also magic and religion. Later, in the Middle Ages, examples from Christian iconography are found demonstrating miracle healing of deafness. Education of the deaf was not considered possible from the time of Aristotle to the sixteenth century, but from then on was organized on a large scale utilizing speech with gestures.

Christianity↗
PubMed2003

[Myoclonus of the middle ear. A rare, differential diagnosis for objective tinnitus].

UNLABELLED: PRESENT STATE OF KNOWLEDGE: Myoclonus of the musculature of the soft palate, as well as middle ear myoclonus resulting from abnormal contraction of the stapedius and/or tensor tympani muscles, are two of the rarer causes in the differential diagnose of objective tinnitus. AIM: Here we describe a childhood case. To our knowledge, no case has previously been described in a child. METHODS AND RESULTS: Our patient isa six year old girl with a bilateral 40 dB sensorineural hearing loss and a high frequency objective tinnitus. The methods of clinical investigation, possible differential diagnoses and therapeutic options are discussed. CONCLUSION: Both intracerebral changes and systemic disorders have been described in some adult patients with palatal myoclonus. Whereas these cases are unlikely to respond to therapy, there is the chance that in some patients with objective tinnitus middle ear myoclonus may be the cause. This should be excluded by appropriate otoneurological investigations.

Acoustic Impedance Tests↗
PubMed2001

Stuttering in history and culture.

The phenomenon of stuttering from Biblical times is covered from a historical and cultural point of view. Theories of its origin and the methods by which it was treated in former times including the surgical procedures of the 18th and 19th century are examined. Since the Renaissance, examples of stutterers in the performing arts have been found.

Attitude to Health↗
PubMed2001

Phenotypic characteristics of human monocytes undergoing transendothelial migration.

In our study we characterised the immunophenotype of monocytes that migrated through an endothelial cell (EC) monolayer in vitro. We found that monocyte migration led to an enhanced expression of CD11a, CD33, CD45RO, CD54 [intercellular cell-adhesion molecule (ICAM)-1] and human leucocyte antigen-DR. The most striking increase was observed for ICAM-1 when ECs were activated with tumour necrosis factor-alpha and interleukin-1alpha. The results of our study indicate the following: (1) there is a characteristic immunophenotype on the surface of monocytes after transendothelial migration; (2) this phenotype seems to be induced by interactions between monocytes and ECs; and (3) this change is enhanced by the pretreatment of ECs with cytokines. Taken together, the results suggest that local cytokine production activating ECs is sufficient to enhance monocyte migration and that this, in turn, can induce changes consistent with an activated phenotype known to be interactive between antigen-presenting cells and T cells. These results have implications for our pathogenetic insights into rheumatoid arthritis.

Cell Movement↗
PubMed2001

[Value of acoustic speech analysis for prognostic assessment of stuttering in children. Partial results of a prospective longitudinal study].

UNLABELLED: PRESENT STATE OF KNOWLEDGE: There are currently no known acoustic parameters by which stuttering children can be appraised which will predict their subsequent speech fluency. AIM: To explain the significance of factors which perpetuate stuttering by using computer-based speech analysis of fluent speech for a 1 1/2 year period and to relate acoustic analysis with clinical measurements of stuttering. Special attention was given to motor-oral and/or linguistic deficits. METHOD AND RESULTS: A prospective study of 58 pre-school children who stutter. Correlations were sought between acoustic variables in the severity and course of the stuttering with the influence of motor-oral and linguistic disturbances. 19 age-matched, normal-speaking children served as controls. A subdivision of the study group into different subgroups with particular motor-oral and/or linguistic problems showed that children whose stuttering coincides with a delayed speech development have a distinctly better prognosis for early remission. In most of these children the stuttering remitted to such a degree as the deficits causing the stuttering could be reappraised, which means simultaneous improvement of the linguistic competence. CONCLUSION: It was apparent that remission rate was much higher in those children who showed linguistic disturbances at the same time with stuttering. Within the stuttering group, subgroups showed a few correlations in several acoustic parameters, but these could not, as yet, be shown to give any prognostic markers in the routine diagnosis of children who stutter. If a child shows any danger-signs of acquiring stuttering on a more permanent basis, a careful diagnosis is necessary in order to find the individually underlying factors before any therapeutical procedure.

Child↗
PubMed2000

Tonsillectomy as a treatment of obstructive sleep apnea in adults with tonsillar hypertrophy.

OBJECTIVES: High surgical success rates for adenotonsillectomy in children with sleep-related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy. STUDY DESIGN: Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep-related breathing disorders were evaluated based on the severity level of their preoperative apnea-hypopnea index (AHI). MATERIAL AND METHODS: Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow-up time was 3 to 6 months. RESULTS: Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI > or = 50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred. CONCLUSIONS: Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.

Adult↗
PubMed2000

Uvulopalatopharyngoplasty changes fundamental frequency of the voice--a prospective study.

The aim of the study was to find whether a muscle-sparing uvulopalatopharyngoplasty (UPPP) and tonsillectomy cause a measurable change in the voice. The fundamental frequency and the first two formants of five sustained vowels were measured before and nine (six to 15) months following operation. The operation consisted of tonsillectomy and UPPP with preservation of the musculature of the soft palate. All patients received a pre- and post-operative 12-canal polysomnography (level-I sleep study). No patient showed signs of any post-operative velopharyngeal insufficiency. Acoustic analysis showed a significant raising of the fundamental frequency of up to 10 Hz. There was also a lowering of the second formant in two of the five vowels. This was correlated with the volume of the excised tissue. The minimal changes will probably have no significance for those who place no special reliance on their voice, but the possible post-operative changes should be made clear to singers and those relying on their voice for professional reasons.

Adult↗
PubMed1999

Stuttering children and the probability of remission--the role of cerebral dominance and speech production.

OBJECTIVE: The identification of critical characteristics which might predict whether childhood stuttering will become chronic. Part of the study investigates the relationship between hearing and central processing of acoustic stimuli, cerebral dominance and the clinical course of the stuttering. METHODS: A prospective study of 79 stuttering children aged 3-9 years. The subjects were examined with regard to their cerebral dominance in various tests of laterality, their peripheral hearing and their ability to discriminate sound using the dichotic discrimination test according to Uttenweiler (V. Uttenweiler, Dichotischer Diskriminationstest für Kinder, Sprache Stimme Gehör 4 (1980) 107-111). Results were correlated with the probability of remission of stuttering. Comparisons were made with a control group of 18 children of kindergarten age with normal speech. The period of investigation was 18 months. RESULTS: Seventy-two children underwent follow-up examinations. Of these, 36 achieved fluency of speech. The results of the dichotic discrimination test showed no relation to the rate of remission. When the relationship between handedness and stuttering was investigated, it was found that left-handed children had a significantly poorer chance of attaining speech fluency. CONCLUSIONS: The Uttenweiler test allowed no prognostic evaluation of the future course of stuttering in the age group studied, though auditory dominance was not completely developed in a majority of the 3-6 year-old children. Handedness, however, appears to be related to the probability that stuttering will become chronic.

Case-Control Studies↗