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Biomedical subjects

F Schmäl

Publications and source records attributed to F Schmäl.

At least 19 recordsLinked to original sources
PubMed2003

[Prognostic factors in hearing recovery following sudden unilateral deafness].

A perilymph fistula is a possible cause for sudden unilateral sensory deafness. In this retrospective study the data of 73 patients with unilateral sudden deafness were analyzed. All of them underwent an exploratory tympanotomy during which both windows were packed with soft tissue. Postoperatively all patients received rheological therapy with pentoxifyllin and steroids. The following possible prognostic indicators were analyzed: age, sex, tinnitus, vertigo, vomiting, spontaneous nystagmus, positive fistula test, time between onset of symptoms and therapy, intraoperative proof of a perilymph fistula, and signs of barotrauma in the patient's history. A significant postoperative recovery of the hearing loss (>20%) was found in 29 patients (39.7%) (group 1), and 44 patients (60.3%) showed only an increase of <20% (group 2). The statistical analyses showed the following significant difference: The symptoms vertigo (p=0.002) and spontaneous nystagmus (p=0.014) occurred more frequently in group 2 (patients with a poor hearing recovery) than in group 1. Patients with a barotrauma,however, had an overproportionally good outcome (50-100% hearing recovery). A perilymph fistula was seen intraoperatively equally often in both groups. In summary, the symptoms vertigo and spontaneous nystagmus are indicators of complex damage in cases of sudden deafness and are associated with a worse prognosis concerning hearing recovery. Exploratory tympanotomy in combination with drug treatment is a reasonable therapy as an ultima ratio in every case of unilateral sudden deafness.

Adolescent↗
PubMed2003

[Drug treatment for vertigo].

The approach to drug treatment of vertigo is almost exclusively symptomatic. There are 3 major goals for drug treatment of vertigo: to eliminate the hallucination of motion, to reduce the accompanying neurovegetative and psychoaffective signs (nausea, vomiting, anxiety), and to enhance the process of "vestibular compensation" to allow the brain to find a new sensory equilibrium in spite of the vestibular lesion. Three different types of vertigo drug treatment must be distinguished: the treatment of acute vertigo attacks, the treatment of chronic vertigo, and the treatment of patients with Menière's disease to avoid vertigo attacks. Furthermore, this paper deals with the treatment of motion sickness and of the postoperative nausea and vomiting.

Antiemetics↗
PubMed2002

[Thiel method fixed cadaver ears. A new procedure for graduate and continuing education in middle ear surgery].

BACKGROUND AND OBJECTIVE: An efficient training program in ear surgery needs suitable models to learn the specific preparation techniques. However, conventionally fixed or fresh frozen ears of human corpses do not meet all demands. Therefore we investigated the feasibility of ears fixed according to Thiel for surgical training in the temporal bone lab. METHODS: Various surgical techniques on external and middle ears were evaluated on ears from cadavers fixed according to Thiel. Structure and consistency of the tissues were compared to vital conditions by means of a standardized questionnaire. RESULTS: Structure and consistency of the tissues of the auditory canal, the tympanic cavity and the mastoid were comparable to vital conditions. Merely the cartilage of the auricle was considerable softened. This enabled a surgical preparation under conditions close to the intravital situation. CONCLUSIONS: Under the aspects of quality assurance and efficiency of continuous medical education in middle ear surgery, the Thiel fixation technique provides an excellent prerequisite.

Cadaver↗
PubMed2002

[Differential diagnosis and management of retropharyngeal space-occupying lesions].

BACKGROUND: Diseases of the retropharyngeal space place high request on the diagnostic and therapeutic knowledge of the otorhinolaryngologist. METHODS: Under consideration of six own cases and of all other published case reports, this inhomogeneous symptom is analysed systematically. RESULTS: Commonly, these alterations of the retropharyngeal space are observed incidentally during routine throat examination or in patients suffering from dyspnoea, dysphagia, dysphonia, sleep apnoea syndrome or neck pain. Six own cases show the very inhomogeneous aetiology (retropharyngeal abscess, lipoma, malignant schwannoma, sarcoidosis, aberrant internal carotid artery, Forestier disease). Therefore, before surgery, a sufficient radiologic diagnosis (lateral neck radiography and CT or MRI respectively) is necessary to avoid grave complications (injury to the cervical spine, the brain, the spinal cord or the internal carotid artery). A tissue sample can be obtained by the transoral approach while the lateral cervical approach seems to be the better way to treat a retropharyngeal abscess. CONCLUSION: Because of the very different aetiology of retropharyngeal space diseases the therapy finally depends on the definite diagnosis.

Adult↗
PubMed2002

[Clinical aspects of abscess development in parotitis].

OBJECTIVE: The purpose of this paper was to analyse parotideal abscesses on the basis of a larger number of patients. PATIENTS AND METHODS: The data of 36 patients (mean age 44 years) with a parotideal abscess was analysed. RESULTS: Ultrasound scan was always necessary to verify the diagnosis. The surgical drainage was done under myoelectric monitoring of the facial nerve. Only in 1 patient a temporary minor paralysis of the mandibular branch was noticed. The most common bacteria were Staph. aureus, Streptococcus, and Peptostreptococcus. In 2 cases a tuberculosis and in 2 children an atypical mycobacterial infection was discovered. In another patient a metastasis of a squamous cell carcinoma was found. CONCLUSIONS: In every patient with an acute swelling of the parotid region without consideration of age, number of leucocytes or a typical fluctuation, an ultrasound scan should be used. The surgical drainage of the abscess should be done under myoelectric monitoring (Cave: muscle relaxant). In every case, a specimen for microbiological analysis (bacterial determination) and a biopsy (to exclude malignoma or atypical mycobacteria) are necessary. A peri- and post-operative therapy with a combination of aminopenicillin and clavulanic acid or with cephalosporine is recommended.

Abscess↗
PubMed2002

[Trauma of the Membranous Trachea Managed by the ENT-Surgeon].

BACKGROUND: Isolated perforations of the membranous trachea are extremely rare but potentially life-threatening complications of endotracheal intubations and minimally invasive tracheostomy techniques. Most of the case-reports have been written by thoracic surgeons or anesthesiologists but both the diagnostic procedures and the therapy are not standardized. The aim of this study was to evaluate the position of the ENT-surgery in the management of these lesions. PATIENTS AND METHODS: Over a period of 6 years we treated 5 females, 3 males and 3 children with iatrogenic lacerations of the posterior tracheal wall. The lesions were complications of percutaneous tracheostomies or emergent intubations. The charts and videoprints of each patient were reviewed. RESULTS: Clinical presentation was marked in all patients by the characteristical symptoms of paratracheal air leakage, i.e. pneumothorax, emphysema or airway obstruction. In 6 patients the onset of the symptoms occurred with a significant delay until to 2 days after the lesion was originated. Perforations were located at the distal third (8) and at the medial third (2) of the trachea or the subglottic area (1) and had a vertical shape with a length of 0.3-5.5 cm. Surgical repair using a transtracheal cervical approach or an endoscopical procedure was performed in 8 cases. 3 lesions having a length below 2 cm were treated nonoperatively. Outcome was excellent in all patients but a certain percentage of them claimed cough and dysphonia one or more years after the acute phase. CONCLUSIONS: Because of their life-threatening character perforations of the membranous trachea must be diagnosed as soon as possible. However, the clinical presentation is not obvious in many cases. For the exact detection of the perforations rigid endoscopy is superior to flexible technique. The early surgical repair is recommended for the majority of the cases. Therefore, the transtracheal approach and endoscopical procedures are favorized. Moreover, these methods used routinely in ENT-surgery are also appropriate for lesions of the distal part of the membranous trachea and can be an alternative to the more invasive thoracotomy. Conservative treatment strategies should be limited to selected patients with small lacerations.

Adolescent↗
PubMed2001

[Differential perilymph fistula diagnosis].

If sudden unilateral deafness accompanied by vertigo and spontaneous nystagmus on the afflicted side occurs during birth, a perilymph fistula with rupture of the round window membrane caused by pressure has to be considered. A 35-year-old pregnant patient was presented with the aforementioned symptoms on the day she gave birth to triplets. During examination, surditas and a paranasal hyposensitivity were found on the right side. Furthermore, a spontaneous nystagmus on the affected side occurred which was not suppressed by fixation. The nystagmus was apparent as a direction-fixed gaze nystagmus. Saccades during smooth pursuit testing as well as a lack of the auriculofacial reflex during contralateral stimulation of the deaf ear could be observed. Magnetic resonance imaging (MRI) of the skull revealed a fresh hemorrhagic cavernoma of the cerebellar pedunculi. This rare lesion caused a nerve compression of the fifth and eighth cranial nerve due to perifocal edema. Neurosurgical intervention was not necessary because of subsequent spontaneous resorption of the lesions and abatement of the deafness within a few days.

Adult↗
PubMed2000

[Kinetoses].

Motion sickness is a well known nausea and vomiting syndrome whose physical signs occur during travel by sea, automobile, airplane, and space. This review describes current concepts concerning the aetiology, nature and therapy of this common phenomenon. Motion sickness involve a neural mismatch or confusion between the vestibular, visual, and proprioceptive systems. Therapy is directed towards decreasing conflicting sensory input, controlling nausea, and speeding the process of adaptation.

Humans↗
PubMed2000

[Significance of the SISI test within the scope of expert assessment of noise-induced hearing loss].

BACKGROUND AND OBJECTIVE: Proof of cochlear hearing loss is an essential prerequisite for the diagnosis of noise deafness. For this purpose, the Königsteiner instruction leaflet (Königsteiner Merkblatt) recommends among other items the SISI test. PATIENTS/METHODS: The results of the SISI test at 1 and 4 kHz were analysed for 100 expert opinions of noise (200 ears). RESULTS: 10% of the subjects showed at 1 and 4 kHz a positive and 44% a negative result. At 1 kHz, 46% indicated a negative result and at 4 kHz a positive result. In the group with a negative SISI test at both frequencies, 74% demonstrated characteristics of pseudohypacusis. There was no correlation between a retrocochlear hearing disorder and a negative SISI test. CONCLUSIONS: Our analysis demonstrated that the negative SISI test is more often evidence of pseudohypacusis rather than a retrocochlear disorder. Consequently, the validity of a negative SISI test is limited.

Adult↗
PubMed2000

Effect of ethanol on dynamic visual acuity during vertical body oscillation in healthy volunteers.

Visual orientation is the most important sensory input during locomotion (e.g. walking, driving a car, riding a bicycle). We investigated dynamic visual acuity (DVA) during vertical body-oscillations (amplitude 5 cm; frequency 1.5 Hz) in 12 healthy subjects before and twice after ethanol consumption. During oscillation, vertical eye movements were recorded under two test conditions: with eyes closed (EC) and during DVA testing. A significant increase in vertical eye-amplitude after ethanol ingestion occurred only during EC tests, as a possible sign of vestibular hyperreaction. During vestibular stimulation alone (EC), ethanol did not affect the phase shift between stimulus and eye movements. However, when the subjects were given an additional visual stimulus (DVA), the post-alcohol phase shift rose significantly. Surprisingly, the post-alcohol phase shift values for the two test conditions showed no significant differences. After ethanol ingestion we found no changes in static visual acuity but a significant loss of DVA. Volunteers with a change of DVA threshold (DVAT) showed significantly (P = 0.004) higher post-alcoholic changes in the phase shift. In summary, low doses of ethanol disturbed the visually guided oculomotor response during fixation of an earth-fixed target while the observer was subject to linear vertical acceleration. This effect led to an increasing delay between the beginning of body and eye movements. The consequence was an increasing phase shift and thus a decrease in DVA during whole-body oscillation which was comparable to movements during human locomotion.

Acceleration↗
PubMed2000

The localization of an imaginary target under the influence of caloric vestibular stimulation in healthy adults.

It is well known that fixation of an imaginary target (IT) can influence the vestibulo-ocular reflex, but reports on the effect of peripheral vestibular stimulation on the localization of an IT are still lacking. In a prospective study, errors in pointing towards an IT without and after cold caloric vestibular stimulation (VS) were investigated in 24 right-handed volunteers with the head tilted backwards by 60 degrees. After the stationary target had been extinguished for 120 s each subject had to point towards the target position as remembered in darkness. The vestibular response was recorded by electronystagmography. Without VS 73% of the volunteers showed a systematic horizontal pointing error towards the right side. VS led to an increased horizontal pointing error in the direction of the slow phase of the induced nystagmus and the degree of deviation showed a significant (P = 0.001) positive correlation (r = 0.32) with the amplitude of the calorically induced nystagmus. In summary, an IT is not merely a useful visual stimulus for influencing the vestibulo-ocular reflex during linear and angular acceleration. A peripheral vestibular stimulation is itself able to change the position of an IT significantly and the extent of deviation shows a significant correlation with the amplitude of the evoked nystagmus.

Adult↗
PubMed2000

Dynamic visual acuity during linear acceleration along the inter-aural axis.

We investigated visual-vestibular interactions during linear acceleration along the inter-aural axis. Eighteen healthy volunteers and two patients with central neurological diseases were subjected to transaural linear acceleration in the direction of gravity force (frequency: 0.5-1.5 Hz; amplitude: 5 cm). During linear acceleration, eye movements were recorded under three test conditions: eyes closed (EC), while staring at an imaginary target (IT) and during the testing of dynamic visual acuity (DVA). As parameters of evaluation we used the amplitude of horizontal eye movements, phase shift and the decrease of DVA threshold (DVAT). Under all test conditions, eye amplitude increased with rising stimulus frequency and exceeded, especially in the higher frequency range, a hypothetically calculated eye amplitude for smooth pursuit. The combination of a visual and vestibular input (DVA and IT) led to a better compensation (lower phase shift) than under vestibular stimulation alone (EC). Eye movements during low-frequency stimulation depended more on the visual system while responses in the higher frequency range were mainly triggered by the otolith organ. At 1.5 Hz the compensatory function of the visual-vestibular system was limited (rising phase shift) and DVAT decreased even in a significant number of healthy subjects. Patients with diseases of the central nervous system showed a higher phase shift and thus a stronger decrease of DVAT (two levels) already at a stimulus frequency of 1.25 Hz.

Acceleration↗
PubMed1999

[Infection frequency and type of bacteria after tympanostomy tube drainage in childhood: gilded-silver tubes versus silicone tubes].

Otorrhea is the most common complication after tympanostomy tube insertions. In Germany there are currently two commonly used types of tympanostomy tubes: silicon tubes (ST) and gilded silver tubes (GT). Previously published in vitro studies by Tajima uncovered a positive correlation between the silicon concentration in culture fluid and the rate of growth of Staphylococcus aureus. Our study retrospectively evaluates the types of bacteria and rates of otorrhea after ST and GT insertions. The present study was undertaken to determine which of these tubes had a higher incidence of otorrhea and then whether silicon tubes stimulated the growth of certain types of bacteria, such as Staphylococcus aureus. In all, 186 ST and 59 GT were placed in 245 ears of 144 children. Both ST and GT were separated into three groups: first insertion of a tympanostomy tube, second implantation and insertion of a tympanostomy tube in an infected ear in the course of a mastoidectomy. No differences between ST and GT in causing otorrhea were found in the three groups. Nevertheless, ST in comparison to GT was associated with a higher incidence of infections with Pseudomonas aeruginosa. In contrast, a higher incidence of Staphylococcus aureus related to ST could not be proved. Twenty percent of the ears with mastoiditis were found to have Pseudomonas aeruginosa, but none of these ears implanted with a GT developed postoperative otorrhea. Our findings show that GT should be used when a ventilation tube is used during a mastoidectomy. Further, it is tenable to implant only GT because postoperative otorrhea in many cases is caused by insufficient water protection and water is frequently polluted with Pseudomonas aeruginosa.

Bacteria↗
PubMed1999

[Category loudness scaling to evaluate sound perception in cochlear and retro-cochlear lesions].

Category loudness scaling was used to investigate the loudness perception of 31 patients with a cochlear hearing loss (Group 1) by comparing the results with those found in 15 patients with retro-cochlear hearing loss caused by an acoustic neuroma (Group 2). Narrow-band noise signals at four different frequencies (0.5 to 4.0 kHz) were used. In the cochlear hearing-impaired subjects the slopes of the level-loudness functions tended to increase with increasing hearing loss, indicating positive recruitment, whereas the much shallower slopes associated with retro-cochlear lesions were presumed to reflect negative recruitment. The graphic representation of the iso-loudness functions revealed a different dynamic range between Group 1 and 2 with the ability to discriminate small differences of stimulus levels reduced in the presence of an acoustic neuroma. Category loudness scaling has been shown to be a valuable tool describing the individual perception of sound in a qualitative and quantitative manner. Furthermore, the method can be employed as an indicator of recruitment without any restrictive preconditions. For this reason the categorical loudness scaling can be a desirable method for supplementing the audiological diagnosis of a retro-cochlear hearing impairment through the frequency-specific description of a usable hearing-field and its dynamic range.

Adult↗
PubMed1999

Effects of alcohol on body-sway patterns in human subjects.

The vestibulospinal aspects of vestibular function are commonly neglected in the evaluation of alcohol-induced intoxication. Thus, in the present study the effect of an acute intoxication with a low or moderate quantity of alcohol was examined with respect to the equilibrium in 30 healthy subjects. The blood alcohol concentration (BAC) was measured 30 min after the ingestion of the last alcohol, ranging between 0.22 and 1.59 per thousand. Stability of stance was quantified by static platform posturography in Romberg-test conditions with eyes open and eyes closed. Among other parameters, the average body sway path (SP) and area of body sway (SA) were assessed. Posturography revealed a significant increase in body sway. There was a positive correlation between SA (or SP) and BAC both with eyes open and eyes closed. Multiple group comparisons revealed that the large-alcohol-dose group (BAC > or = 1.0 per thousand) could be clearly differentiated from test cases with BAC lower than 0.8 per thousand. Sway area was the most sensitive parameter for detecting increased body sway after alcohol ingestion. The area increase, present not only with eyes closed but with eyes open, revealed an inadequate compensation of the ethanol-induced ataxia by visual stabilization. The Romberg's quotient, which denotes eyes closed relative to eyes open, remained constant. The increase in sway path with eyes closed showed an omnidirectional sway. A comparison of the sway pattern of subjects after acute ethanol ingestion with the data of patients with permanent cerebellar lesions suggested that the acute effect of alcohol resembles that of a lesion of the spinocerebellum. This finding contrasts with earlier studies, which postulated an acute effect of ethanol resembling that in patients with an atrophy of the anterior lobe of the cerebellum due to chronic alcohol abuse. In seven cases of the lower dose group (BAC < or = 0.8 per thousand), a reduction in body sway after alcohol ingestion was observed. This finding may be consistent with a dose-related biphasic action of alcohol, which - besides its well-known depressant effects with high doses - also shows stimulatory action with small doses.

Adult↗