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C Sittel

Publications and source records attributed to C Sittel.

At least 19 recordsLinked to original sources
PubMed2007

[Subtotal cricoid resection as primary therapy for a highly differentiated chondrosarcoma].

Chondrosarcomas of the larynx are rare malignant tumors usually diagnosed with significant delay due to their nonspecific symptoms. We report a 50-year-old male presenting with progressive dyspnea. Indirect laryngoscopy revealed a subglottic stenosis. The cricoid cartilage was shown on CT to be massively damaged. Histologic differentiation between chondroma and highly differentiated chondrosarcoma was very difficult. Therefore, an organ-preserving treatment concept using partial cricoid resection and staged endoscopic arytenoidectomy was chosen. Total laryngectomy and permanent tracheostomy could be avoided. Due to the risk of recurrence, early follow-up with endoscopy and CT is mandatory.

Chondrosarcoma↗
PubMed2006

[Paediatric laryngotracheal stenosis: pattern of care in Germany].

BACKGROUND: Stenoses of the larynx and upper trachea in the pediatric population require a multidisciplinary approach and center-based treatment. Patterns of care and treatment strategies in Germany were evaluated using a standardized questionnaire. MATERIAL AND METHODS: A questionnaire was transmitted by telefax to 141 departments of Otorhinolaryngology (ORL) and to 214 pediatric (PED) departments. Using primarily multiple-choice questions variables regarding caseload, surgical techniques, cooperating institutions, criteria for surgical indications and subjective assessment of success rates were investigated. RESULTS: The response rate was 55% (ORL) and 46% (PED), respectively, 34% of the replying ORL departments were offering tracheal surgery in children, with most of them using advanced surgical techniques. In 12 ORL departments 1-3 cases per year were operated, in 6 ORL departments more than 6 cases per year and 3 ORL departments were perceived as specialized centers for pediatric airway surgery by their peers. However, 41% of the PED departments were unable to identify a center for pediatric airway surgery. CONCLUSION: In Germany, surgery for pediatric airway stenoses is not primarily focused on treatment centers. There is a significant information gap among German pediatricians regarding success rates of reconstructive airway surgery and available centers offering surgical therapy for this population. Several factors offer potential to be optimized in the care for children with a compromised airway and improving communication between otolaryngologists and pediatricians should be a primary goal in the future.

Adolescent↗
PubMed2006

[Patients with chronic rhinosinusitis: disease-specific and general health-related quality of life].

BACKGROUND: The negative effect of chronic rhinosinusitis on patient quality of life has been generally underappreciated and undervalued. So far, only a few studies have examined health-related quality of life at German language patient collectives with validated measuring instruments. PATIENTS AND METHODS: Preoperatively, 163 patients were included into the study. Three months and 1 year after functional endonasal sinus surgery 123 and 82 patients, respectively, participated in the questioning. To measure health-related quality of life, we used version 20 of the German Adapted Version of the Sinonasal Outcome Test and the Short Form 36 Health Survey (SF-36). The German normative values of the SF-36 were used for analysis. RESULTS: Postoperatively, a significant improvement in health-related quality of life was determined on all scales of both measuring instruments. Comparing our data with the German normative values of the SF-36, we found a lasting approximation of the average assessment levels in seven of eight scales. CONCLUSION: Functional endonasal sinus surgery leads to significant improvements in disease-specific and general quality of life in patients with chronic rhinosinusitis.

Adult↗
PubMed2004

[Diagnostics of diseases and the function of the facial nerve].

The facial nerve has a complicated course from the brainstem to the periphery. It not only contains motor, but also secretory, sensory, and sensitive fibres. Thus, the functional measure of symptoms can be multi-faceted. The nerve is not directly accessible over an extensive distance because of its long course through the temporal bone. Therefore, diagnostics of nerve function and the differential diagnostics of its diseases could be a great challenge for the otolaryngologist. In this review, the most important methods for clinical examination, electrodiagnostics, and modern imaging techniques are critically surveyed. In addition, the significance of facial nerve monitoring for surgery in the cerebello-pontine angle, parotid surgery, and ear surgery is presented.

Diagnosis, Differential↗
PubMed2002

[Telemedicine: interaction between clinic and general practice].

BACKGROUND: The rapid development of information and communication technologies has led to a change of many practical aspects of professional and private life. These technologies also influence interactions between hospitals and outpatient units. METHODS: This paper provides an overview over current telemedical developments with effects on interactions between in- and outpatient units. RESULTS AND CONCLUSIONS: Probably the most important application of telemedicine in Germany is not distant patient care but an improved communication structure between different health care providers. Candidates for first routine applications are electronic medical reports and teleconsultations. The widespread use of telemedicine will be accompanied by an increased standardisation in medicine.

Forecasting↗
PubMed2001

Prognostic value of laryngeal electromyography in vocal fold paralysis.

OBJECTIVE: To analyze the value of electromyography in predicting recovery from acute neurogenic vocal fold paralysis. STUDY DESIGN: Prospective case series. SETTING: University-based hospital of otorhinolaryngology-head and neck surgery. PATIENTS: Ninety-eight patients (56 women, with a mean age of 62.2 years; 42 men, with a mean age of 39.8 years) with 111 paralyzed vocal folds. The causes were varied, with thyroid surgery (53 cases) and idiopathic palsy (18 cases) being the predominant factors. INTERVENTION: Prognostication was based on electromyography performed no earlier than 14 days after onset of palsy. Findings were classified as neurapraxy, axonotmesis, and neurotmesis. Prognosis is inherent in this classification, since neurapraxy is presumed to resolve completely within 8 to 12 weeks, whereas axonotmesis is most likely to be followed by impaired vocal fold mobility. MAIN OUTCOME MEASURES: Vocal fold mobility after 6 months. RESULTS: In 102 vocal folds, some palsy of various degree persisted after 6 months. Free mobility of the paralyzed vocal fold was restored in 9 cases. By means of laryngeal electromyography, defective recovery, defined as absence of completely free vocal fold mobility, was predicted correctly in 94.4% of cases (68/72). For complete recovery, prognosis was accurate in only 12.8% of cases (5/39). CONCLUSIONS: The detection of neural degeneration by laryngeal electromyography allows the prediction of poor functional outcome with sufficient reliability in an early phase of the disease process. Conversely, the absence of signs of degeneration does not imply that complete recovery is to be expected.

Adult↗
PubMed2001

[Bilateral recurrent laryngeal nerve paralysis].

This paper seeks to provide the reader with a state-of-the-art review of the aetiology, diagnosis and clinical management of bilateral recurrent nerve paralysis. The recurrent laryngeal nerves are more frequently involved in bilateral paralysis than any other cranial nerve. Most of the underlying lesions are iatrogenic, with thyroid surgery being the single most important causative factor. However, a variety of different reasons can lead to such a condition. Whenever the aetiology is uncertain, a complete diagnostic work-up is mandatory. Massive stridor on inspiration is the key symptom. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytenoid joint. Moreover, in many cases, laryngeal electromyography yields reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Clinical management is surgical in the vast majority of cases. A variety of endoscopic techniques for widening the glottic airway are available today and are discussed in detail. Compared to permanent tracheostomy, these procedures have much less impact on the patient's quality of life and should be preferred whenever possible. Since such an operation is irreversible, a decision should be made only in the presence of a reliable electrophysiological prognosis and/or after 6-9 months of watchful waiting. Inevitably, voice quality is traded for airway normalisation. However, modern surgical techniques accomplish very tolerable phonatory results. Timing, type and extent of surgery need to be customised for every patient individually.

Humans↗
PubMed2001

[Unilateral and bilateral recurrence of inferior laryngeal nerve paralysis].

Unilateral recurrent nerve paralysis leads to glottic insufficiency, causing a significant lack of vocal ability. In contrast, bilateral palsies present with stridor on inspiration due to glottic stenosis. Most of the underlying lesions are iatrogenic, with thyroid surgery being the single most important causative factor. However, a variety of different reasons can lead to such a condition. Whenever aetiology is uncertain a complete diagnostic work-up is mandatory. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytaenoid joint. Moreover, in many cases laryngeal electromyography provides a reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Speech therapy is the treatment of choice in case of unilateral recurrent nerve palsy. Only if a significant glottal gap persists medialization procedures may become useful for voice improvement. Endoscopic as well as open approaches are available for this purpose. Bilateral recurrent nerve palsies need to be addressed surgically in the vast majority of cases. Today, a variety of endoscopic techniques for widening the glottic airway are available. Compared to permanent tracheostomy these procedures have much less impact on the patient's quality of life and should be preferred whenever possible. Inevitably, voice quality is traded for airway normalisation. However, modern surgical techniques accomplish very tolerable phonatory results.

Functional Laterality↗
PubMed2001

Surgical treatment for hypopharynx carcinoma: feasibility, mortality, and results.

This study seeks to evaluate treatment modalities, mortality after surgery, survival, and local control rates for a consecutive cohort of patients with cancer of the hypopharynx treated according to a prospective protocol that favors surgery as an initial approach to the disease. The charts of 228 consecutive patients with previously untreated hypopharyngeal squamous cell carcinoma were reviewed. Outcome measures (overall survival, disease specific survival, and local control) were calculated using the Kaplan-Meier estimator. Of 228 consecutive patients, 136 (59.6%) were found suitable for initial surgical treatment. Of the remaining 92 patients, 18 (7.9%) had nonresectable lymph node metastases, 16 (7.0%) had unresectable primary tumors, 13 (5.7%) refused surgery, and 13 (5.7%) presented distant metastases during initial diagnostic evaluation. Of those who had surgery, 46 had larynx-sparing procedures, 54 had total laryngectomy, and 36 had total laryngo-pharyngectomy. None of the patients who had surgery died postoperatively. Actuarial 5-year overall survival was 27.2% for all 228 patients, 39.5% for the 136 patients with surgical treatment, and 61.1% for the 46 patients who were treated with larynx-sparing procedures.

Adult↗
PubMed2001

Prognostic value of electromyography in acute peripheral facial nerve palsy.

OBJECTIVE: To analyze the value of electromyography in predicting recovery from acute idiopathic facial nerve paralysis. STUDY DESIGN: Retrospective case-series review. SETTING: University-based hospital department of otorhinolaryngology/head neck surgery. PATIENTS: Three hundred fifty-five patients with sudden facial paralysis of unknown cause (Bell's palsy). INTERVENTION: Treatment consisted uniformly of high-dose prednisolone, dextran, and pentoxifylline. Prognostication was based on electromyography performed not earlier than 10 to 14 days after the onset of palsy. The findings were classified according to Seddon into neurapraxia and axonotmesis/ neurotmesis. There is an inherent statement on prognosis in this classification because neurapraxia is presumed to recover completely within 8 to 12 weeks, whereas axonotmesis is most likely to be followed by sequelae. MAIN OUTCOME MEASURES: Facial nerve function after 6 months. RESULTS: Complete recovery was predicted correctly in 92.4% of cases. For the relatively rare and therefore principally more difficult predictable event defective recovery prognosis was still accurate in 80.8%. CONCLUSION: The detection of spontaneous fibrillation in needle electromyography is a reliable sign predicting unfavorable outcome. An accuracy of 80.8% for predicting unfavorable outcome may be sufficient to advise patients what to expect in the course of their facial nerve disorder. However, it seems dubious to build a decision about surgical intervention on such a test, because in the process, unnecessary surgery would be accepted for as much as one fifth of the patient population.

Acute Disease↗
PubMed2001

Superselective embolization as palliative treatment of recurrent hemorrhage in advanced carcinoma of the head and neck.

We report a case of recurrent major hemorrhage in a patient with advanced head and neck squamous cell carcinoma. Before and between the bleeding episodes, the functional level of the patient was remarkably high. Therefore, an attempt at bleeding control with superselective embolization with Ethibloc was made. Because of its specific characteristics, this substance is almost ideal for the purpose of palliative embolization. The material used and the technique of application are described in detail. After the procedure, no hemorrhage occurred for more than 4 months. We recommend superselective embolization, preferably with Ethibloc, for minimally invasive control of recurrent bleeding as palliative treatment in selected patients with advanced head and neck carcinoma, since significant benefit in terms of the quality of life may result.

Angiography↗
PubMed2001

Treatment of postparotidectomy salivary fistula with botulinum toxin.

We report on the successful treatment with botulinum toxin type A local injections of a salivary fistula that occurred after superficial parotidectomy. In a 58-year-old woman, transcutaneous discharge of saliva in the preauricular region had persisted in spite of 2 surgical revisions. Moreover, facial weakness and synkinesis had developed as a result of an iatrogenic lesion that had occurred at the time of primary surgery and required immediate reanastomosis of the main nerve trunk. Botulinum toxin A was injected into the deep lobe of the remaining parotid gland under ultrasonographic guidance. Additionally, botulinum toxin A was injected into the left orbicularis oculi muscle in order to improve the synkinesis. No adverse effects were observed. The sialorrhea was stopped for 11 months, and the synkinesis of the facial muscles was reduced significantly for 4 months. We conclude that botulinum toxin A injection is a successful alternative for the treatment of chronic salivary fistula.

Adenolymphoma↗
PubMed2001

Atresia of the trachea following repeated percutaneous dilational tracheotomy.

Percutaneous dilational tracheotomy (PDT) and conventional tracheostomy are still competing methods to provide an airway for intensive care patients requiring assisted ventilation. Tracheal stenosis is a late complication for any tracheostomy and long-term intubation. However, late complications in PDT have not been extensively studied. This article is the first to report on total atresia of the subglottic larynx and cervical trachea after PDT. The dimension of the lesion is visualized by three-dimensional reconstructed CT scan. The etiology of this condition is discussed.

Dilatation↗
PubMed2000

Limitations of magnetic resonance imaging in the evaluation of perineural tumor spread causing facial nerve paralysis.

OBJECTIVE: To present and discuss the clinical presentation and treatment in patients with long-duration unilateral facial paralysis and normal magnetic resonance imaging (MRI) findings. DESIGN: Case series. SETTING: Ear, nose, and throat department of the University of Cologne, Cologne, Germany. PATIENTS: A total of 486 patients with unilateral facial paralysis who were treated from 1986 to 1998. Besides the usual diagnostic workup, a complete electrophysiological evaluation, including investigations such as needle electromyography and neuromyography (also known as electroneurography), of the facial nerve was performed at repeated intervals. In 19 patients, a malignant tumor was delineated with ultrasonography or MRI. In 8 of these patients, the initially performed MRI did not detect any parotid gland lesion causing the paralysis, whereas long duration of the paralysis and electroneurography indicated malignancy. RESULTS: Exploration surgery was performed as total parotidectomy in these 8 patients and malignant parotid gland tumors were proved in all 8 patients. CONCLUSIONS: Individuals with facial nerve paralysis without any signs of regeneration 6 months after the onset of paralysis and/or persistent electrophysiological evidence of ongoing neuronal degeneration should undergo surgical exploration of the parotid gland and facial nerve, even if MRI studies show no tumoral lesion.

Adenocarcinoma↗
PubMed2000

Textured polydimethylsiloxane elastomers in the human larynx: safety and efficiency of use.

For the treatment of unilateral laryngeal paralysis with glottic insufficiency injection laryngoplasty is a popular modality of treatment. This procedure augments the volume of the paralyzed vocal fold by endoscopic injection. However, the ideal substance has not yet been found for that purpose. We report for the first time the systematic application and long-term results of vulcanized polydimethylsiloxane (PDMS) particles in the treatment of glottic insufficiency in the human larynx. Of 10 patients treated with PDMS in the early 1990s, 7 patients could be retrieved for reevaluation. Laryngeal function was assessed by videostroboscopy, expert rating, and further characterized by the objective parameters of voice profile and maximum phonation time. In a standardized questionnaire, all patients were asked for their personal impression of the results. Mean follow-up time was 88.4 months (range 69-102 months). Glottic closure was complete in 5 of 7 patients. There were no signs of granuloma formation or other pathologic changes of the injected vocal folds. In 4 cases, voices were rated normal or near-normal; 2 voices were rated as fair; 1 usable. All the patients reported significant and lasting voice improvement. None of the patients reported any problems related to PDMS. PDMS particles provide permanent augmentation of human vocal fold volume without complications. Their use is a valuable and safe alternative when a definitive one-step procedure seems advantageous. However, further studies are needed to assess voice improvement in comparison to other materials.

Aged↗