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G Rettinger

Publications and source records attributed to G Rettinger.

At least 19 recordsLinked to original sources
PubMed2006

[Long term change in quality of life after adenotonsillectomy for pediatric obstructive sleep disorders].

BACKGROUND: To study short-term and long-term changes in quality of life (QOL) in children before and after adenotonsillectomy (T and A) for obstructive sleep disorders (OSDs). MATERIALS AND METHODS: Prospective study of 20 children underwent T and A for OSDs at the University hospital of Ulm/Germany. Caregivers were asked to complete the Brouillette-Score (BS) and OSA-18 survey, validated instruments for detecting symptoms and QOL change in children with OSDs, at the initial office visit prior to surgery (BS/1 and OSA-18/1) within 7.5 +/- 1.14 weeks after surgery (BS/2 and OSA-18/2), and 14.8 +/- 1.98 months after surgery (BS/3 and OSA-18/3). The BS comprises 3 items including: difficulty breathing during sleep, apnea observed by the caregivers and snoring. The OSA-18 survey comprises 18 items in 5 domains of sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns. Scores from the preoperative and postoperative surveys were compared using the paired T-test and SPEARMAN-RANK test. RESULTS: 13 children were male (65 %). The mean age at the time of inclusion in the study was 6.2 +/- 1.63 years, mean preoperative body mass index (BMI) was 17.4 +/- 1.24 kg/m(2). Brouillette-Score: The mean Brouillette-Score before T and A (2.72) was significantly higher ( P = or < .001) than in the short-term (- 2.19) and in the long-term. (- 3.54). OSA-18 SURVEY: The mean total score for OSA-18/1 (83.4) was significantly higher ( P = or < .001) than the mean total score for OSA-18/2 (29.8) and OSA-18/3 (25.6). The overall correlation between BS and OSA-18 was R = .887 ( P = or < .001). CONCLUSION: Children with suspicious OSDs demonstrate significant short term and long-term improvement in the Brouillette-Score and OSA-18 survey. Caregivers perceive a long-term improvement for a minimum of one year in QOL after T and A for OSDs, although these improvements are not uniform across all domains of the OSA-18 survey. Use of the Brouillette-Score and the OSA-18 survey should decrease the need for polysomnographic monitoring and facilitate selection of children for T and A, whereas the OSA-18 questionnaire permits the more differentiated finding.

Adenoidectomy↗
PubMed2006

[Subcranial resection of malignant tumors infiltrating the anterior skull base].

BACKGROUND: Survival and quality of life after subcranial resection of malignant tumors infiltrating the anterior skull base should be evaluated. METHODS: Data were acquired retrospectively from patient charts and by telephone interview. Quality of life was assessed with the EORTC QLQ30 and H&N35 modules. RESULTS: From 1996 to 2004, 19 patients (mean age 52 years, 4 woman, 15 men) were surgically treated via a subcranial approach. Fifteen patients suffered from advanced carcinoma, 3 from advanced esthesioneuroblastoma, and 1 patient had a fibrosarcoma. Fifteen patients received adjuvant radiotherapy. During the mean follow-up period of 44 months (12-109 months), 6 patients died, 1 unrelated to the tumor. The probability to survive 5 years was 50 %, the mean survival time was 72 months. Anosmia was reported by 18 of 19 patients. A tension pneumocephalus was observed in 2 patients, one with lethal outcome, decreased vision in 1 patient, loss of vision in 1, persisting diplopia in 1, deep wound infections in 2, and CSF leak in 2 patients. Quality of life was assessed on the average 36 months following end of therapy and did not differ substantially from other patients with head-neck malignancies. CONCLUSION: Most, malignant tumors infiltrating the anterior skull base can be treated curatively. The treatment outcome is well comparable to other head and neck tumors of corresponding stage.

Adenocarcinoma↗
PubMed2006

[Examiner variability of clinical findings in patients with sleep related breathing disorders].

BACKGROUND: Clinical findings in sleep related breathing disorders (SRBD) and primary snoring are not only of diagnostic but also of therapeutic relevance because clinical findings may be used for the selection of surgical interventions such as uvulopalatopharyngoplasty (UPPP), maxillofacial surgery or radiofrequency induced surgical alternatives. We developed a standardized protocol for clinical examination of the upper airway using pictograms. MATERIAL AND METHODS: To determine the interinvestigators variability various parameters such as length of the uvula, position of tongue base, Angle-classification, webbing of posterior pillar and tonsil size were assessed by a number of residents and an assistant professor for Otorhinolaryngology and sleep medicine simultaneously. RESULTS: 95 patients (81 male and 14 female) with a mean age of 47.0 +/- 1.21 years, a Body-Mass-Index (BMI) of 27.2 +/- 0.46 kg/m2, and an Apnea-Hypopnea-Index (AHI) of 17.7 +/- 2.4 were examined. The appearance of the uvula has only little variations between different investigators (corr.: 0.943). The interinvestigator variability is also low for position of tongue base (corr.: 0.931) and Angle-classification (corr.: 0.893). The results of tonsil size and webbing assessment seems to have a higher variability (corr.: 0.880 and 0.693). Statistical significance for all parameters was p=<0.0001. CONCLUSION: As to our knowledge, this is the first controlled study to record intraobserver variations of clinical findings of the upper airway. Standardized protocols are mandatory, and the variability of the measurements must be taken into account if results of different investigations must be compared or if changes after therapeutic interventions are to be investigated.

Adult↗
PubMed2005

[Tracheal conditioning in patients with tracheal stoma].

BACKGROUND: The main cause of respiratory problems after permanent tracheostomy is the functional loss of the nose with its cleansing, warming, and humidifying effect on inspiratory air. In this pilot study a device for detection of tracheal heat and moisture in patients with permanent tracheal stoma was tested. METHODS: Patients with permanent tracheal stoma and after laryngectomy were chozen as study participants. Tracheal heat and moisture was measured in the tracheal airway using a miniaturized thermocouple and a humidity sensor which was connected to a suction system. The measurement device was tested after performing different breathing manoeuvres and use of heat and moisture exchangers (HME). RESULTS: Measurement of tracheal temperature and humidity was feasible in all patients with permanent tracheal stoma. The experimental system proved suitable to detect significant changes in tracheal climate after short-time use of a stoma filter for humidity and temperature elevation within the tracheal lumen. CONCLUSIONS: Additional clinical investigations on tracheal conditioning using this detection device will be conducted at this department.

Aged↗
PubMed2004

The use of an ambulatory, automatic sleep recording device (QUISI version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea.

Electroencephalogram (EEG) evaluation with polysomnography (PSG) according to the Rechtschaffen & Kales (R&K) rules is time and cost consumptive, but ambulatory polygraphy systems do not allow EEG recording routinely. As a consequence, the number of sleep disordered events cannot be calculated exactly. QUISI is a one-channel, self-applicable ambulatory EEG recording device. The present study was designed as a prospective, non-randomized clinical trial. This investigation evaluated the results of 40 patients with primary snoring and obstructive sleep apnoea measured with level 1 PSG and QUISI simultaneously. Fifteen patients (37.5%) were primary snorers with normal sleep profiles, whereas 25 patients (62.5%) suffered from obstructive sleep apnoea (OSA) with a Respiratory Disturbance Index (RDI) of 38.6 +/- 23.8. The mean total sleeping time (TST) was underestimated by 4.5%, while Sleep Efficiency Index (SEI) was understimated by 4.6% by the QUISI device compared with PSG. The correlation between the QUISI and the PSG estimates for single sleep stages demonstrated only moderate correlation. The statistical significance for sleep stage 2 was r = 0.42, P = 0.002; for sleep stage 3/4, r = 0.31, P = 0.02; and for WAKE, r = 0.33, P = 0.01. Sleep stage 2 as well as sleep stage 3/4 were underestimated by QUISI substantially (difference: -5.6% and -10.3%), while WAKE was overestimated by QUISI to a larger amount (difference: +10.4%). Sensitivity and specificity of QUISI to recognize pathological sleep profiles compared with PSG/R&K were 0.92 and 0.96 respectively. QUISI is able to evaluate normal versus altered sleep profiles in patients with primary snoring and OSA. Comparing the quartile ranges, we found substantial differences between QUISI and PSG/R&K. QUISI gives an impression of sleep architecture and objective verification of a sleep disturbance in an ambulant setting but cannot replace the sleep laboratory-based PSG.

Adult↗
PubMed2004

Immediate effect of benzalkonium chloride in decongestant nasal spray on the human nasal mucosal temperature.

Benzalkonium chloride is a preservative commonly used in nasal decongestant sprays. It has been suggested that benzalkonium chloride may be harmful to the nasal mucosa. Decongestion with the vasoconstrictor xylometazoline containing benzalkonium chloride has been shown to cause a significant reduction of the nasal mucosal temperature. The purpose of the present study was to determine the short-term influence of xylometazoline nasal spray with and without benzalkonium chloride on the nasal mucosal temperature. Healthy volunteers (30) were included in the study. Fifteen volunteers received xylometazoline nasal spray (1.0 mg/mL) containing benzalkonium chloride (0.1 mg/mL) and 15 age-matched subjects, received xylometazoline nasal spray without benzalkonium chloride. Using a miniaturized thermocouple the septal mucosal temperature was continuously measured at defined intranasal detection sites before and after application of the nasal spray. The mucosal temperature values did not significantly differ between the group receiving xylometazoline containing benzalkonium chloride and the group receiving xylometazoline spray without benzalkonium chloride before and after decongestion (P > 0.05). In both study groups septal mucosal temperatures significantly decreased after decongestion (P < 0.05) because of a reduction of the nasal mucosal blood flow following vasoconstriction. This study indicates that benzalkonium chloride itself does not seem to influence nasal blood flow and nasal mucosal temperature in topical nasal decongestants.

Administration, Inhalation↗
PubMed2004

Numerical simulation of air temperature and airflow patterns in the human nose during expiration.

Recovery of heat and water during expiration is an important but not yet fully understood function of the nose. The presented study investigated cooling of the expiratory air for heat recovery within the human nose applying numerical simulation. A numerical simulation in a bilateral three-dimensional model of the human nose based on computed tomography was employed. Temperature distribution and airflow patterns during expiration were displayed. Cooling of the expiratory air primarily takes place in the areas of inferior and middle turbinate. Areas of the highest decrease in temperature are characterized by turbulent airflow with vortices of low velocity. Numerical results showed good concordance with experimental in vivo temperature measurements. Heating of inspired air not only depends on inspiration but also on expiration. Cooling the warm expiratory air may be regarded as an important factor for heat recovery. Furthermore, the results demonstrate the close relation between heat exchange and airflow patterns.

Exhalation↗
PubMed2003

The impact of expiration on particle deposition within the nasal cavity.

One of the most important functions of the nose is cleansing the inspired air. The aim of this study was to compare the intranasal deposition of particles during inspiration and expiration, applying different breathing manoeuvres. In nine subjects, the non-deposited particles during inhalation of an aerosol of starch particles were laser-optically detected by placing a suction probe transnasally in the anterior nasal segment. The particle deposition was measured during cyclical nose-in/nose-out (nose-only) and nose-in/mouth-out breathing. The deposited fraction was calculated in percentages. Active anterior rhinomanometry and acoustic rhinometry were performed. The mean deposited fraction in the anterior nasal segment was statistically significantly higher (P < 0.02) during nose-only breathing (46.0%) compared with nose-in/mouth-out breathing (33.0%). Our results suggest that intranasal particle deposition takes place during inspiration as well as during expiration. The period of expiration does not only seem to be important for water and heat recovery, but also for cleansing of the respiratory air.

Administration, Inhalation↗
PubMed2003

[Results after erbium:YAG-laser stapedotomy].

BACKGROUND: The analysis of postoperative results after Erbium : YAG-Laser stapedotomy in patients with otosclerosis. METHODS: For all operations the microscope-integrated Erbium : YAG-Laser Twin ER (Zeiss, Oberkochen) was used by different surgeons. Data of 53 patients who were operated on between October 1993 and May 1999 were analysed. The mean follow-up time was 17 months. Postoperative bone-conduction and air-conduction thresholds and the presence of postoperative tinnitus and vertigo were analysed. The data were analysed according to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (1994). RESULTS: In 49 patients unchanged preoperative minus postoperative pure tone bone conduction averages at 1, 2, and 4 kHz were observed. In 4 patients a slight deterioration between 10 and 20 dB was seen. In 2 patients a new postoperative tinnitus was observed. No patient suffered from vertigo at the time of evaluation. In 22 patients the postoperative air-bone gap was between 0 and 10 dB, in 25 patients between 11 and 20 dB, and in 6 patients between 21 and 30 dB. No patient had a postoperative air-bone gap of more than 30 dB. CONCLUSIONS: The Erbium : YAG-Laser stapedotomy is a safe technique. Good postoperative hearing results may be achieved in patients with otosclerosis.

Adolescent↗
PubMed2003

[Critical analysis of complications and disorders in wound healing after tracheostomy in children].

BACKGROUND: The analysis of early and late postoperative results after tracheostomy in children. METHODS: A 6 year, prospective, observational cohort study was undertaken in 14 children of mean age 4 years 7 months (range 0.03 month-15 years) at the Department of Otorhinolaryngology, University of Ulm. Children were included if they had at least two follow-up examinations postoperatively because of local disorders in wound healing of the tracheostoma. Etiologic factors, the type of tracheotomy, the size and type of the tracheostomy tube, primary and secondary local disorders in wound healing of the tracheostoma, and the clinical follow-up were analyzed. RESULTS: Formation of granulation tissue and tracheal stenosis were the most observed local disorders. In five patients, the tracheal stenosis was located below the stoma, in one patient also above the stoma. A stenosis of the stoma was found in two patients. One patient died because of a tracheoinnominate artery fistula. In 10 patients problems in swallowing and recurrent aspiration of saliva was observed early postoperatively. CONCLUSIONS: The tracheotomy in childhood is often related with late wound healing disorders. An association of wound healing disorders with a feasible lethal outcome is rarely found. Local formation of granulation tissue renders decannulation more difficult. The choice of a correctly fitting tracheostomy tube and special care of the tracheostoma in long-term cannulated children has to be emphasized.

Adolescent↗
PubMed2003

The relationship between water vapour saturation of inhaled air and nasal patency.

The nasal cavity volume and the temperature of the nasal mucosa are considered to be the most important predictors of nasal conditioning. The aim of this study was to assess the relationship between the intranasal degree of water vapour saturation of inhaled air and nasal patency. Intranasal humidity values at different locations within the nasal cavity of 15 healthy subjects were compared to nasal airway resistance detected by active anterior rhinomanometry (AAR). Repeated measurements were carried out during one day to obtain varying nasal cavity volumes due to the nasal cycle. The end-inspiratory humidity data were obtained with a miniaturised capacitive humidity sensor at defined detection sites within the anterior nasal segment without interruption of nasal breathing. Measurements were carried out at four different times during one day. The degree of water vapour saturation did not correlate with the values of the AAR at any intranasal detection site and time of detection during one day. The study supports the view that there is no correlation between the degree of water vapour saturation within the anterior nasal segment and the nasal resistance during the nasal cycle over the day. Although nasal patency varies because of the nasal cycle, the changes of nasal cavity volume due to the nasal cycle do not seem to influence the degree of water vapour saturation of the inspiratory air.

Adult↗
PubMed2002

Nasal mucosal temperature during respiration.

One of the most important functions of the nose is heating the inspiratory air. The aim of the present study was to measure nasal mucosal temperature at defined intranasal sites during respiration, without interruption of nasal breathing. A total of 15 healthy volunteers was included in the study. A miniaturized thermocouple was used for continuous detection of the septal mucosal temperature in the nasal vestibule, the nasal valve area, the anterior turbinate area and the nasopharynx during respiration. The highest temperature values were measured at the end of expiration, the lowest values at the end of inspiration with a statistically significant difference (P < 0.005). Mean mucosal temperature ranged from 30.2 +/- 1.7 degrees C to 34.4 +/- 1.1 degrees C. Statistically there were significant differences between the detection sites during inspiration and expiration (P < 0.05). In our study, the temperature values of the nasal mucosa depend on the intranasal detection site and the respiratory cycle. We therefore conclude that whenever data of nasal mucosal temperature are published, it is absolutely essential to describe the precise site of detection and to give information about the time of detection in the respiratory cycle.

Adult↗
PubMed2002

Safety of the erbium:yttrium-aluminum-garnet laser in stapes surgery in otosclerosis.

OBJECTIVE: The purpose of this study was to present early and late bone-conduction hearing thresholds and data about cochlear and vestibular disturbances in patients after erbium:yttrium-aluminum-garnet (Er:YAG) laser stapedotomy in otosclerosis. STUDY DESIGN: The study design was a retrospective study. SETTING: The study was conducted at an academic tertiary referral center. PATIENTS: In this study, audiologic data of 117 patients undergoing Er:YAG laser-assisted stapedotomy for otosclerosis between 1993 and 1999 were included. MAIN OUTCOME MEASURES: The preoperative minus 2 postoperative (early, 1-3 days; late, at least 6 weeks) average pure-tone bone-conduction thresholds at 1, 2, and 4 kHz and 0.5, 1, 2, and 3 kHz were calculated. The postoperative appearance of nystagmus, vertigo, and tinnitus was analyzed. RESULTS: A total of 91 of 117 patients showed unchanged preoperative minus postoperative pure-tone bone-conduction averages at 1, 2, and 4 kHz in the late postoperative measurement. A slight deterioration was observed in 8 of 117 patients. Regarding the frequencies 0.5, 1, 2, and 3 kHz, 97 of 117 patients showed unchanged preoperative minus postoperative pure-tone bone-conduction averages. A new transient tinnitus appeared in 37 of 117 patients, and a new persistent tinnitus was found in 3 of 117 patients. Most of the patients had no postoperative dizziness (63/117 patients) and no postoperative nystagmus (109/117 patients). CONCLUSION: The study did not show significant sensorineural hearing loss at or below 3 kHz. Vestibular and cochlear function has no clinically relevant suppression after Er:YAG laser stapedotomy.

Adolescent↗
PubMed2001

[Warming inhaled air in the nose].

BACKGROUND AND OBJECTIVE: The purpose of this study was to determine whether the temperature at the end of inspiration is the same as the temperature a few seconds after breathing stops at the end of inspiration to study if the nasal mucosa are capable of providing heat during a cessation of breathing. PATIENTS/METHODS: Fifteen healthy volunteers were included in the study. The temperature at the end of inspiration was compared to the temperature obtained 5 s after cessation of breathing at the end of inspiration and at the end of expiration. Intranasal temperature measurements were taken at three locations in the nose with a miniaturized thermocouple. RESULTS: The temperature increased during cessation of breathing at all locations. The highest temperature differences between the end of inspiration and 5 s later (breathing at rest) could be observed at the nasal valve area. The lowest temperature difference was found in the nasopharynx. At the end of expiration,the temperature decreased only slightly from the nasopharynx to the nasal valve area. CONCLUSIONS: The anterior part of the nose in particular is capable of heating the inspired air. This is also important for humidification. Heating of inspired air requires special anatomical conditions of the anterior nasal segment.

Adult↗
PubMed2001

[Endonasal temperature and humidity profile after exposure to various climate-controlled inspiratory air].

BACKGROUND AND OBJECTIVE: The nose as the first segment of the upper respiratory tract is exposed to different climatic conditions of the ambient air. The purpose of this study was to determine whether nasal air conditioning of ambient air is influenced by a short-term exposure to air of different climatic conditions. PATIENTS AND METHODS: Fifteen healthy volunteers were enclosed into the study. A miniaturised humidity sensor and thermocouple was used for detection of humidity and airway temperature at three detection sites within the anterior nasal cavity. Both parameters were measured at the end of inspiration during breathing of ambient air after exposure to cold dry air, "normal" ambient air, and warm humid air for 10 minutes. RESULTS: The end-inspiratory intranasal humidity during breathing of ambient air increased at all locations within the nose when the temperature and humidity of the exposure condition increased. At the most anterior detection site, the effect of increase in humidity after exposure to the different climatic conditions was the most pronounced. The increase in intranasal temperature had no relation to the different climatic conditions during the short-term exposure. CONCLUSIONS: The results suggest that nasal humidification in ambient air can be influenced by short-term exposure to air of extreme temperature and humidity prior to breathing of ambient air.

Adult↗