[Is surgery necessary in every case of cholesteatoma?].
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Anti-Bacterial Agents↗
Biomedical subjects
H W Pau
Publications and source records attributed to H W Pau.
[Lightening-induced injury of the air. Lightening-induced tympanic membrane perforation left with subsequent temporary pancochlear inner ear hearing loss as well as left-sided tinnitus].
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Adult↗
[Vertigo in suction of open mastoid cavities ("radical surgery cavities")].
BACKGROUND: Vertigo during suction-cleaning of open mastoid cavities is caused by cold stimulation of the vestibular organ. In clinical and model-experimental measurements we tried to estimate the physical background and the dimension of this temperature drop. METHODS: Using different techniques like thermo-probes, thermovision, or additional model experiments temperature changes during suction were measured in 5 volunteers with open mastoid cavities. These registrations were carried out with special regard to the moisture of the cavity-walls. RESULTS: Distinct temperature changes during suction were observed. In moist cavities superficial temperature decrease was much higher than in dry ones. Using additional model experiments, temperature conduction towards e.g. the horizontal semicircular canal could be simulated. DISCUSSION AND CONCLUSIONS: Among other mechanisms like replacement of sucked-off air by colder air, or taking away warm air close to the cavity walls, effects of evaporative cold seem to be very significant. This could be demonstrated by moistening cavity walls in patients as well as in model experiments. The conclusion to keep the cavity walls as dry as possible is already a clinical demand. In this paper, the physical background and the dimensions of thermal effects during suction-cleaning could be elucidated.
Body Temperature Regulation↗
[Cholesteatoma recurrences caused by intraoperative cell seeding? Contact endoscopic and cytologic studies].
BACKGROUND: The high rate of recurrences of cholesteatomas after surgery is mostly caused by insufficient removal of matrix. Another factor may be intraoperative scattering of matrix cells e. g. with the running burr, which later may become the origin of new cholesteatoma growth. In this paper we tried to visualize these cells for gaining further informations. PATIENTS AND METHODS: In 10 patients intraoperative contact endoscopy of the cholesteatoma was carried out during mastoidectomy. After intravital staining with methylene blue the very superficial tissue layers can directly be considered via a contacting endoscope. In addition, sucked-off rinsing fluid was cytologically examined for epithelial cells. RESULTS: Both investigations show only very rare vital squamous cells - besides other cells like or ciliated cells and foreign body giant cells. DISCUSSION AND CONCLUSIONS: Inspite of their small number, these squamous cells in principle could cause dispersed growth of cholesteatoma. However, this seems to be much less significant than the assumption of matrix left behind intraoperatively. The danger of dispersed cell growth can further be diminished by adequate operating techniques with sufficient rinsing, smoothing the bony cavity walls and avoiding blind corners.
Cholesteatoma, Middle Ear↗
Heat radiation during caloric vestibular test: thermographic demonstration in temporal bone experiments.
Since Barany's descriptions in 1906, cold and warm irrigations of the external ear canal have been used for unilaterally testing vestibular excitability. The fluid kinetics within the endolymph have been studied thoroughly, whereas relatively few published articles deal with the mechanisms of heat transfer from the external to the internal ear. Even though heat conduction via the bone seemed to be well established in the textbooks, Feldmann and co-workers found heat radiation to be a very important factor. Using a rather uncommon method, we tried to make this heat radiation more apparent: in temporal bone experiments, temperature distribution was followed by thermography. Temporal bone specimens were prepared in such a way that heat distributions became visible after experimental caloric irrigations of the external ear canal. Temperature changes could well be verified by changes in coloration of the 2-dimensional thermograms. Conclusions were drawn from registrations performed in 2 projections, 90 degrees to each other, allowing cautious statements about 3-dimensional distribution. The velocity of heat transfer at the very onset of the reaction can only be explained by radiation, whereas later, other mechanisms, such as conduction via the bone or convection via the middle ear gas, may have some influence. Our results support Feldmann's findings and underline the significance of radiation in the heat transfer mechanism.
Body Temperature↗
[Danger from exploding fireworks and blank firearms].
Explosive amusement and deterrent articles such as New Year's Eve cannons and rockets, toy pistols, and blank guns are not at all harmless items. Their potential dangerousness is often extremely underestimated. Two damaging mechanisms are important: during explosions, high pressures and temperatures develop and a considerable sound pressure level can be measured. If the explosion happens near the human body (intentionally or inadvertently), not only superficial lesions can occur, but also (mainly due to contact shots) serious, deep-seated tissue damage, especially in the head and neck region with its endangered sense organs such as eye and ear, the vessels and nerves supplying the brain, the speech- and voice-forming apparatus, and in particular the face, can be the consequence. Their mutilation can lead to serious and extensive interpersonalchanges. Accidents are published in the relevant otological and forensic medical papers, but nevertheless it seems important to us to point out the dangerousness of these readily available items.
Adolescent↗
[100 years of the Otto Körner ENT Clinic, Rostock. The merits of Christian Lemcke and Otto Körner in the development of ENT specialty].
BACKGROUND: The first special ENT hospital in Germany and northern Europe, the Department of Otorhinolaryngology, Head- and Neck-Surgery "Otto Körner" in Rostock is celebrating its 100th anniversary on October 25, 1999. METHODS: There is a presentation on the efforts in the ENT-specialty from the beginning considering the special situation at the university of Rostock. RESULTS: The efforts of Christian Lemcke (1850-1894), who associated the three sections Otology, Laryngology and Rhinology are appreciated, Otto Körner (1859-1935) continued this development. He achieved the building of a special ENT-hospital by his excellent knowledge and surgical skills. The opening date was October 25, 1899, Körner became the first full professor in Otology and Laryngology in Germany in 1901. His "Textbook Of Otology And It's Bordering Specialties" was published in 1906. As one of the first, he supported the independence of ENT-medicine as a separate field in the course of medicine. CONCLUSION: Today, Otto Körner's claims are more relevant than ever before, because the today's students in their practical course of medicine and even young doctors at the hospitals obviously show a lack of knowledge in the ENT-field. The current "multiple choice" type of examinations could be one of the main reasons.
Germany↗
[Thermographic detection of heat radiation in caloric vestibular function tests].
BACKGROUND: Since Bárány; caloric irrigations in the external ear canal have been used for unilateral stimulation of the peripheral vestibular system. However, the mechanism of heat transfer from the auditory canal to the vestibular organ is not completely known. From the physical point of view, three mechanisms may be discussed: heat conduction via the bone, convection via the middle ear gas, or radiation. Feldmann et al. (1991) singled out radiation as a very important factor in this regard. Using high-resolution thermography, we were able to "see" radiation almost directly in temporal bone experiments. METHODS: Using the system of infrared thermovision specially adapted for close-up studies, the effect of calorization can be observed and documented in colored planar thermograms. Fresh temporal bone specimens had to be prepared so as to permit simultaneous observation of the tympanic membrane and the medial tympanic wall. RESULTS: Changes in temperature were readily visible during experimental caloric tests: turning blue indicated cooling and red indicated warming. In the caloric test with 44 degrees C or 30 degrees C water, changes in color of the eardrum appeared immediately. At the very same time, however, an area of the medial tympanic wall also changed color. This velocity of transfer cannot be attained by conduction or convection: heat radiation is the only possible explanation. This could only be demonstrated at the very onset of the reaction; subsequent thermograms became more and more diffuse. In this stage the heat transfer may also be effected by conduction and/or convection. CONCLUSIONS: Thermography demonstrates that radiation is a very important factor in heat transfer; at least in the initial phase of calorization.
Body Temperature↗
[The "ear fever thermometer"--studies of ear thermography].
BACKGROUND: Though rarely mentioned in the ENT literature, the "ear thermometer" has become more and more popular in recent years, not only in hospitals but also in households. These instruments are easy to use, and their infrared technology is said to provide precise measurements. The purpose of this study was to verify these claims. PATIENTS AND METHODS: Infrared thermometers were tested in various conditions, and the results were compared. We assessed the effects of "distending" the outer ear canal, different body positions, and irritation of the ear (slight external otitis, hearing aids, otitis media, etc.). We did not specifically test effects of ear wax, as it had sufficiently been studied in pediatric or anesthesiological papers before (almost no effect, except in cases of occlusion of the auditory canal). RESULTS: Using the ear thermometer we found small but statistically significant differences in febrile patients in different body positions. Irritated ears always showed higher temperatures than the normal contralateral ears. The most significant differences were found in persons lying on one side. The "pillow ear" was found 0.7 degree C (average) warmer than the contralateral ear. CONCLUSIONS: Ear thermometers for estimating the body temperature permit easy and fast measurements. However, they include possible sources of measurement error. This study describes possible errors that the therapists should be aware of to avoid misinterpreting the course of a disease.
Adult↗
Inner ear damage in TORP-operated ears: experimental study on danger from environmental air pressure changes.
In some cases of sudden inner ear hearing loss in ears with a total ossicular replacement prosthesis, the prosthesis has been found to be penetrating the footplate. Some authors have assumed an external pressure increase for this event. In this study I tried to estimate experimentally the pressure needed for perforating a normal footplate in a temporal bone model. From the data I concluded that "cracking" the footplate can hardly be due to 1 major event of increased pressure. On the other hand, different mechanisms making the footplate a "weak spot" must be discussed and further investigated. In those cases, secondary to thinned or even perforated footplates, environmental pressure changes may be dangerous.
Air Pressure↗
[Variations in the course of the internal carotid artery: possible risks in so-called standard operations in the area of the pharynx].
BACKGROUND: Many abnormalities in the course of the major vessels of the head and neck have been described. Special care must be taken in case of deviation of the internal carotid artery bulging the pharyngeal wall. PATIENTS: In two cases we demonstrate internal carotid arteries partially running underneath the posterior pharyngeal wall. RESULTS: Those variations are often asymptomatic, only requiring surgical treatment when causing neurologic complaints. On the other hand, they may be very dangerous, if operations in the upper pharynx are carried out. CONCLUSIONS: The surgeon (in special the younger surgeon) must be well-informed about potential vascular abnormalities, before performing "routine-operations" (tonsillectomies, adenotomies) in the upper pharynx.
Adenoidectomy↗
[Thermographic study of temperature gradient during ear surgery intervention].
BACKGROUND: During middle ear surgery manipulations like burring, cooling with water, suction or even screwing cause changes of temperature which should be known to the surgeon. METHOD: An infrared thermovision device was introduced for registration. RESULTS: Thermography is an easy way for continuously recording thermic effects during surgery. If sufficient cooling is guaranteed, no temperatures high enough to cause tissue damage or functional defects could be observed. CONCLUSIONS: Adequate cooling provided, thermal injuries during ear surgery can be neglected. Thermography is an easy method for answering such questions, not only in ear surgery but also in other medical fields.
Ear, Middle↗
An adjuvant afterloading brachytherapy device for use after orbital exenteration in patients with orbital malignancies.
In cases of malignant diseases situated within the orbit and threaten to extend beyond it, removal of the orbit and periorbital contents may be indicated, followed by adjuvant chemotherapy or irradiation. An effective radiotherapy device for treatment of residual or suspicious cancer in the enucleated orbit consists of an external-beam radiation source (60Co) and an intraoperatively fitted mould as a guide for the flexible afterloading tubes using a 192Ir source. Considering the physical dose distribution and the local situation, this therapy permits a high dose with homogeneous dose distribution to the target area of the orbit but also allows significant dose reduction to adjunctive critical structures. Four patients with different orbital malignancies were treated by means of a combination of percutaneous radiotherapy with afterloading brachytherapy following orbital exenteration. The individual mould of the orbital cavity is modeled at the end of the operation. The technique of radiotherapy, dose distribution, and follow-up of the disease are demonstrated. Orbital malignancies with an extremely poor prognosis may profit from the application of this combined radiotherapy to avoid supraradical surgical intervention.
Adenocarcinoma↗
Middle ear retractions--the role of predamaged tympanic membranes.
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Child↗
[Status of interventional angiography procedures in refractory epistaxis].
In cases of severe bleeding of the nose, besides sufficient packings further steps like surgical exploration and closure of vessels like maxillary or ethmoidal arteries or even the external carotid artery are described in most textbooks. Superselective angiographical embolisation is also mentioned, mostly as an alternative method, while often pointing out the danger of severe thromboembolic complications. In the last two years, we had excellent experiences with this method in 15 cases, without any of the complications mentioned above. We do feel that attempts at superselective angiological embolisation should be made prior to surgical intervention. Of course, technical and personal prerequisites must be adequately met besides excellent individual experience in interventional angiography.
Adult↗
[Differential diagnosis of bluish red tumors of the posterior intact tympanic membrane].
Middle ear tumours may be seen frequently as bluish-red masses behind an intact tympanic membrane. In these cases all modern methods of visualisation such as CT or NMR are required for correct diagnosis and for planing adequate treatment. Most frequent are glomus tumours, either of the glomus tympanicum or the glomus jugulare. However, differential diagnosis must be considered, e.g. a tumour in the lower parts of the tympanon. In very rare cases the internal carotid artery takes an abnormal course, running free through the middle ear and touching the tympanic membrane. More often, granulomas or other inflammatory processes may be seen through a transparent ear drum. Haemangiomas or--of course--malignant tumours must be kept in mind. The role of modern radiographic methods is described in this paper, including some of the differential diagnoses mentioned above, with special reference to a case of carotid artery anomaly.
Adult↗
[The Wittmaack temporal bone collection and possibilities for cataloguing with electronic data processing].
Karl Wittmaack, head of the otology department at Greifswald (1904-1908) and professor of otorhinolaryngology at the universities of Jena (1908-1925) und Hamburg (1926-1946) created a unique histological collection of human and animal temporal bones that is thought to be the largest of its kind in the world. The serial sections of more than 1700 human temporal bones still represent current otological problems--many of which are now rare but are still encountered--such as tuberculosis, lues or diphtheria of the ear. Complications following acute otitis--which were much more frequent and dangerous in the pre-antibiotic era--can be studied in detail. There are numerous cases of labyrinthitis, meningitis, sinus thrombosis, brain abscess etc.--complications which must always be borne in mind to this day. The same is true for tumors like acoustic neurinomas or even malignant tumors, metastases, or manifestations of leukemia. Differences in pneumatization or changes of the bone structure as in otosclerosis have been the subjects of studies dating from Wittmaack's time until very recently. In spite of its topicality, the true value of the collection has only be appreciated by a limited group of persons, which may be due in part to difficulties in orientation within this vast amount of material. Although there are catalogues, it may be difficult to find the appropriate preparations for particular questions. Searching for such specimens often requires rummaging through the whole collection, sometimes resulting in damage or loss of slides or handwritten notes.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Tensile strength of the stapes footplate. Pressure-induced inner ear damage in operated ears caused by TORP prostheses?].
In a recent textbook concerning ear surgery, it is recommended to put some connective tissue on the stapes footplate before introducing a TORP. This should avoid penetration of the shaft of the TORP into the inner ear. Experimental studies were performed to estimate the pressure needed for pushing a TORP through the footplate. We found those pressures to be much higher than those which might occur by increasing pressure in the external ear canal or decreasing pressure in the middle ear. This means that perforations of the footplate are not due to one big event of changing pressure, but rather by chronic irritations or foreign body reactions. Anyhow, we consider the protection of the footplate by a layer of connective tissue to be very useful.
Ear, Middle↗