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Biomedical subjects

T Brusis

Publications and source records attributed to T Brusis.

At least 19 recordsLinked to original sources
PubMed2007

[Compensation for tinnitus in private accident insurance].

According to the provisions of private accident insurance, mental or psychic reactions are excluded from compensation. Until now, tinnitus was taken as fully psychic and therefore excluded. In two recently published judgments of the Federal Supreme Court in Germany the assessment of tinnitus in private accident insurance and particularly the exclusion clause section sign 2 Abs. 4 AUB 88 has been newly defined. According to this actual jurisdiction the compensation of tinnitus could be possible, when as physical underlying reason a proved harm in the inner ear or the auditory pathway (hearing loss), which can be traced back to the accident according to the rules of causality. This leads to the question how Tinnitus could be compensated without modification of the general terms and conditions of the private accident insurance. A compensating table is proposed, which recognizes the somatic (physical) part of tinnitus and is based on medical and scientific findings of the relation between hearing loss and tinnitus.

Disability Evaluation↗
PubMed2007

[Simulation and aggravation in ENT medical examinations. A prospective study].

OBJECTIVE: The occurrence and characteristics of simulation and aggravation in audiology still lack detailed scientific research. A reliable and reasonable classification of simulation and aggravation, which could help assess a patient's cooperative behavior, has not been defined. PATIENTS AND METHODOLOGY: All patients who underwent an audiological medical examination were included in this study prospectively. These patients were examined based on a well structured and predetermined sequence of actions. As a result, they were grouped into one of four categories, from category 0 for no simulation or aggravation to category III for severe simulation and aggravation. For category III, reliable and valid thresholds for pure tone audiometry only can be achieved by using objective audiological measurements such as brainstem electric response audiometry. Measured thresholds were then compared with simulated or aggravated thresholds and finally correlated with socio-economic factors. RESULTS: A total of 61 individuals were included in this study. Only 42% (26/61) showed no simulation or aggravation (category 0). In all 10% were grouped in category III. The remaining 48% fell into categories I and II. Statistical evaluation revealed no significant differences in thresholds between categories I, II and III. The tendency to simulation or aggravation increased with patient' age, level of education and the frequency of medical examinations prior to this investigation. CONCLUSION: Simulation and aggravation is a frequent phenomenon (approximately 58% of all audiological examinations). Additional work on defining a unique schema for the classification of simulation and aggravation is necessary. The use of such a schema is highly recommended.

Artifacts↗
PubMed2004

[Predictors and mechanisms of tinnitus distress - a longitudinal analysis].

BACKGROUND: The available cross-sectional and retrospective evidence does not provide a clear answer to the question whether the multiple psychological problems and disturbances found in patients with chronic decompensated tinnitus are cause or consequence of the tinnitus. The present research took a longitudinal approach to examine this question. METHOD: Psychopathological symptoms, personality, socio-demographical variables and otological features were assessed in 48 patients which had suffered from tinnitus for a period of no longer than 4 weeks. Six months after first assessment 92 % of the original sample (n = 44) were re-examined. 34 of these patients displayed chronic tinnitus. Univariate and multiple regression analyses were conducted in order to identify variables at first assessment which predicted tinnitus distress at second assessment for the 34 patients with chronic tinnitus. RESULTS: Tinnitus attributed sleep disturbance, anxiousness, and life satisfaction, each assessed at first investigation, independently predicted tinnitus distress at second assessment six months later. These three variables together predicted 56 % of the variance of tinnitus distress at second assessment. CONCLUSIONS: Our results support the model that the symptom tinnitus may develop on the basis of an enhanced psychophysiological tension and become a condensational core of preexisting psychological distress as a facilitatory process. Our results suggest that early psychotherapeutic interventions in patients at risk may prevent decompensation.

Adaptation, Psychological↗
PubMed2003

[Laryngeal papillomatosis - first recognition in Germany as an occupational disease in an operating room nurse].

BACKGROUND: The CO (2)-Laser is an established and well-proven tool in the excision and vaporisation of laryngeal papillomatosis. Actually there exists only one report of an iatrogenous infection with the Human Papillomavirs (HPV) in a gynecological laser surgeon. CASE REPORT: A 28-year-old gynecological operating room nurse, who assisted repeatedly in electrosurgical and lasersurgical excisions of anogenital condylomas, developed a recurrent and histologically proven laryngeal papillomatosis. The expert opinion of a virological institute confirmed a high probability of correlation between the occupational exposition and the laryngeal papillomatosis so that it was accepted as occupational disease. INFECTIVITY OF LASER PLUME: HPV-DNA has been repeatedly detected in laser-plume after excision of papillomas and condylomas. As of the present an exact proof that these particles are infectious has not been brought forward. CONCLUSION: When following the recommended protective measures the potential risk of infection is estimated as very low for surgeons and nurses. The risk of exposition seems to be higher in gynecological interventions than in ENT because of the much larger tissue masses and because laser plume escapes easier into the room air when applying an open approach.

Adult↗
PubMed2000

[Studies of the histomorphology and function of the uvula].

BACKGROUND: Alternations in pharyngeal structure and function are considered fundamental in the pathogenesis of snoring or obstructive sleep apnea (OSA). The physiological function of the uvula as a dynamic sealing of the nasopharynx prevents a "craniocaudal aspiration" during deglutition. The oropharyngeal soft tissues and the uvula are known to play an important role in affecting the oropharyngeal airflow resistance but studies about alterations in the histomorphological uvula structure are controversial. METHODS: We studied the histomorphological tissue composition of the uvula (midsagittal and transversal sections) in 142 patients who underwent uvulopalatopharyngoplasty (UPPP) or uvulopalatoplasty (UPP) for snoring and by autopsy in 30 normal subjects not known to have been snoring. Statistical comparisons were controlled for differences caused by age and body mass index. RESULTS: The uvula was found to be significantly longer in patients with snoring than in control subjects. Patients with snoring had a significantly greater percentage of fat content and connective tissue in combination with a muscle atrophy in the uvula than did normal subjects. CONCLUSIONS: The disturbance of the specific muscular composition and formation causes a reduction of muscular tonus and a loss of muscular contraction. The uvula is destabilized on the basis of a missing skeletal and cartilaginous brace. The uvula destabilization causes a narrowing of the pharyngeal airway that could lead to an increased oropharyngeal airflow resistance with an intensified passive uvula movement and vibration during mouth breathing.

Adult↗
PubMed1999

[Acute hearing loss and tinnitus caused by amplified recreational music].

BACKGROUND: Hearing loss resulting from exposure to permanent or repeated amplified music in professional musicians and music consumers is described in literature. The risk of hearing loss does not exist only after prolonged exposure to music. Short-term exposure to very high sound levels, for example in concerts, can also cause hearing loss and tinnitus. PATIENTS: The retrospective study includes 24 patients who required rheologic therapy between 1994 and 1997 due to a music related acoustic trauma. The type, intensity, and length of music exposure as well as the distance and the position to the source of noise were examined. The type of hearing damage and its development during rheological treatment was studied by pure-tone audiometry. RESULTS: In the majority of examined patients (67%) the hearing loss developed on the basis of one-time exposure at a rock concert or pop concert, followed by hearing loss from attending discotheques (17%) or parties (12%), and music exposure from personal cassette players (4%). The majority of patients showed a maximum hearing loss of 40-60 dB (A) in a frequency between 3 kHz and 4 kHz. Pure-tone audiometry in 58% of the patients exhibited a unilateral threshold in a frequency between 3 kHz and 4 kHz combined with ipsilateral tinnitus of the same frequency. Twenty-one percent of the patients showed a symmetric bilateral threshold and tinnitus between 3 kHz and 4 kHz. In 8% there was a unilateral tinnitus, and in 13% a bilateral tinnitus without any hearing loss. All patients improved their hearing loss during rheologic treatment. Improvement in the tinnitus was only achieved in 33% of the examined cases. CONCLUSION: The risk of permanent hearing loss resulting from short-term exposure to amplified music is low compared to the risk of continuous tinnitus. Given the lack of acceptance of personal ear protectors, the risk of acute hearing damage due to amplified music could be reduced by avoiding the immediate proximity to the speakers.

Acute Disease↗
PubMed1998

[Pain therapy after tonsillectomy in adults].

The postoperative pain and stress experienced by tonsillectomy patients are often underestimated. For this reason traditional methods of analgesia are frequently used but with an ineffective result. Our study involved an analysis of pain sensation with regard to postoperative analgesia after adult tonsillectomies. In all, 150 patients following tonsillectomy were treated with different methods of analgesia, which included Diclofenac monotherapy and combined treatment with Tramadol-retard and Naproxen. Postoperative sensations of pain were realized in a visual analogous pain score, with consideration given to individual experiences of subjective pain. In addition, circulatory and hemopoiesis parameters were controlled. Results showed that the postoperative analgesic effect of Diclofenac was significantly less than that of Tramadol-retard and Naproxen. Diclofenac monotherapy after tonsillectomy was only sufficient in cases involving an individual's low pain sensation. In cases with moderate or stronger pain the tonsillectomy patient requires an effective postoperative analgesia, as achieved with combined therapy using Tramadol retard and Naproxen. Aggravating side effects were not found in both schemes of analgesia.

Adult↗
PubMed1998

[Surgical ENT therapy of oropharyngeal amyloidosis].

BACKGROUND: The term "amyloidosis" refers to a disturbance of metabolism with a pathological deposit of extracellular protein. There are two types of amyloidosis, both of which can have oropharyngeal manifestations. The amyloid deposits cause dysfunction of affected tissues and could result in a life-threatening obstruction of neighbouring organs or the upper aerodigestive tract. CASE REPORT: The present paper reports about the symptoms, diagnosis, and surgical treatment of oropharyngeal amyloidosis. The possible life-threatening obstruction of the upper aerodigestive tract by amyloidosis is illustrated in a case report. CONCLUSIONS: Surgical treatment is indicated in cases of amyloid caused obstruction of the upper aerodigestive tract. The transoral approach combined with a laser surgical tissue resection is often not efficient where diffuse amyloid muscular deposits are present in the form of macroglossia with induration of the floor of the mouth. An effective surgical treatment of oropharyngeal amyloidosis consists of suprahyoid pharyngotomy with a partial tongue resection and a supplementary reduction of the induration of the floor of the mouth.

Airway Obstruction↗
PubMed1998

[Ethmoid sinus operation for therapy of recurrence severe epistaxis].

BACKGROUND: Epistaxis is one of the most common otolaryngological emergencies. In cases of bleeding from the anterior or the lower posterior part of the nose, epistaxis could usually be treated with cauterization and anterior or posterior nasal packing. More invasive methods of treatment are the endonasal coagulation of the sphenopalatine artery and the transantral ligation of the maxillary artery. Bleeding from the upper posterior part of the nose usually originates from the anterior and the posterior ethmoidal artery. In most cases a specific styptic treatment in the upper posterior part of the nose is not possible because of a diffuse bleeding from the ethmoidal arteries into the ethmoidal sinus and the lateral wall of the nasal cavity. In this study the endoscopic ethmoidectomy is presented as the therapy of epistaxis from the ethmoidal arteries. PATIENTS AND RESULTS: In the retrospective study the charts of twenty patients with intractable epistaxis from the upper posterior part of the nasal cavity were reviewed. In all cases the bleeding could not be controlled with anterior and posterior nasal packing. In seventeen patients the bleeding could be controlled with a unilateral or bilateral endoscopic ethmoidectomy (average follow-up: 36.5 months). Three patients who complained of a coagulopathy and an arterial hypertonia developed diffuse recurrent bleeding from multiple sources. In one case the recurrent bleeding was controlled by an unilateral transantral ligation of the maxillary artery and a bilateral revision of the ethmoidectomy. In two patients the recurrent bleeding was treated with bilateral posterior nasal packing. CONCLUSION: The endoscopic ethmoidectomy is an efficient therapy of intractable epistaxis from the ethmoidal arteries if systemic coagulopathy and arterial hypertonia are excluded. The ethmoidectomy can be performed by any head and neck surgeon who is familiar with endonasal surgery.

Adult↗
PubMed1997

[Parastomal tumors after laryngectomy: etiology and therapy].

BACKGROUND: Parastomal neoplasm after total laryngectomy for laryngeal carcinoma represents an extremely serious complication and one of the most formidable therapeutic problems encountered by the head and neck surgeon. Studies about the etiology of parastomal neoplasm have been controversial. The factors most strongly implicated in parastomal neoplasm have been recurrence spawned by metastases to deep cervical lymph nodes, undetected neoplasm at the margin of the laryngectomy resection, neoplastic cell implantation by pre-operative tracheotomy, and the development of an additional primary. PATIENTS: To clarify the controversial aspects of parastomal neoplasm etiology, a systematic analysis of parastomal neoplasm after laryngectomy was performed using data from 10 patients who developed parastomal neoplasm. RESULTS: Parastomal neoplasm occurred in 7.9%. The tumor site of the primary laryngeal carcinoma was found in 9/10 cases in the subglottic, supraglottic, or transglottic area. These tumor sites correlate with areas of a lymphatic vessel concentration and an increase of intralaryngeal lymphatic drainage. In average the parastomal neoplasms appear 10.3 months after the laryngectomy. Therapy was unsuccessful in spite of extensive surgical interventions. CONCLUSIONS: If the laryngeal carcinoma was resected with margins of healthy tissue, lymphatic metastasis to the pretracheal and paratracheal cervical lymph nodes is the probable cause of parastomal neoplasm. This could be the consequence of the continuous lymphatic drainage between the supraglottic and subglottic area with a midline crossing and an lymphatic outlet to the pretracheal and paratracheal cervical lymph nodes. The cervical metastasis formation cannot be detected due to the limitations in the assessment of small lymph nodes and the inability to ascertain with confidence the presence or absence of metastasis in any one lymph node in ultrasonography, computed tomography, and magnetic resonance imaging and due to the limitations in the removal of lymph nodes in the pretracheal and paratracheal area by means of a functional or radical neck dissection. The method of treatment should be in cases of a subglottic or a supraglottic laryngeal carcinoma an ipsilateral and contralateral pretracheal and paratracheal lymph node removal in combination with the laryngectomy.

Aged↗
PubMed1996

[Perforation of the ear drum. On the history of paracentesis and grommet insertion].

As early as 1649, Jean Riolan the Younger pierced an ear drum, after which the patient's hearing improved. This occurred as a result of an accidental ear drum injury while cleaning an ear canal with an ear-spoon. In 17th and 18th centuries, several pioneers in medicine (Thomas Willis, Antonio Mario Valsalva, William Cheselden) conducted experiments in an effort to ascertain the function of the ear drum in hearing. At the end of the 18th century, ear drum perforation, like perforation of a cataract, was indiscriminately performed by itinerent quacks and "physicians" in England, France, and Germany. Ear drum perforation was performed in many places even for the healing of deaf and dumb. Astlee Cooper reported about success with ear drum perforation in 1800 and listed strict indications. He recommended the operation only in the presence of obturation of the Eustachian tube. Because of the negative results of indiscriminate ear drum perforation, the operation soon acquired a bad reputation and was not performed for decades. It was only Herrmann Schwartze who reintroduced paracentesis into the daily practice of otorhinolaryngology. He was director of the royal ENT clinic in Halle and published a trailblazing treatise on the indications, value, and success of this operation. Since physicians had soon realized that spontaneous healing tendencies of the ear drum quickly lead to closure of an artificial perforation, many physicians tried different techniques to obtain a permanent opening. Gruber resected half of the ear drum--unsuccessfully. Others put foreign bodies into the ear drum apertures, such as catgut, whalebone rods, and lead wires. In his textbook of 1845, Martell Frank first described a grommet made of gold foil. Politzer experimented with a hard rubber ring but later abandoned his attempts because of lack of success. Voltolini manufactured an open hollow ring of gold foil or aluminium, which had to be fixed at the handle of the malleur. Armstrong described a "new" therapy for chronic secretory otitis media consisting of inserting a vinyl tube into the ear drum. While he was not the inventor of the grommet, he was the first to reintroduce grommets in the middle of the 20th century. Theromoparacentesis was performed as early as 1867 by Voltolini, who performed this operation using a galvanic cautery device. After more than 100 years, the Japanese physician Saito reintroduced thermoparacentesis into the therapy of tube ventilation disorders. Paracentesis, grommet insertion, and thermoparacentesis are among the most successful treatments currently available to the ENT specialist when used properly. They are treatments with a long history.

Europe↗