[Swelling in the scar area after orbital margin injury].
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Child↗
Biomedical subjects
W Stoll
Publications and source records attributed to W Stoll.
[Direct loudness scaling in diagnosis of tinnitus. A contribution to loudness perception in tinnitus].
We used free-field audiometry to investigate the loudness perception of unilateral high-frequency tinnitus in 16 "normal-hearing" ears by comparing the results with loudness scaling in 20 normally hearing ears without any tinnitus. Narrow-band noise signals at four different frequencies from 500 to 4000 Hz were employed. The parameters used included the slope m of the loudness function and the level Lm (corresponding to the loudness perception of "medium loud") as well as the suitability of fit (delta FIT). The results showed that in subjects with tinnitus the slope of the mean loudness level tended to decrease at 4000 Hz. The dynamic range of ears affected by tinnitus was restricted for stimulation with noise signals at 1000, 2000 and 4000 Hz. The parameters of delta FIT fitted to the loudness functions were increased in the whole frequency range of 500-4000 Hz, indicating that loudness scaling was not as reliable for normal hearing ears when influenced by tinnitus. Tinnitus masking was based on the finding that external sound could change tinnitus loudness. Our results showed that the loudness perception of external sound was influenced by tinnitus. This change in loudness perception seemed to be not restricted to the frequency range of the tinnitus.
Adult↗
[Reaction times at auditory threshold: a comparison of normal hearing probands and patients with hearing damage].
BACKGROUND: The purpose of the study was to examine the latencies between tonal stimuli and response of normal ears at the threshold compared with ears with a frequency-specific threshold above 70 dB. PATIENTS AND METHODS: Reaction times to tonal stimuli of 122 adults with normal hearing and adults with hearing loss were compared at the threshold of hearing to reaction times beyond the threshold. The study group of tested patients was divided into four groups corresponding to the frequency-specific hearing loss on the basis of previous audiometric investigations. RESULTS: The results reveal that response latencies in ears with normal hearing asymptomatically approach the auditory threshold. In contrast, we failed to measure a significant prolongation of reaction times in presence of extensive hearing loss (above 70 dB) even at the minimum level of auditory perception. In the presence of extensive hearing loss (above 70 dB), we detected a significantly lower rise of threshold response latencies at normal audiometric frequencies than in normal ears. CONCLUSION: The reaction time results are evaluated, and the possible role of the outer hair cells are discussed.
Adult↗
[Effect of various electrode configurations and voluntary, reproducible artifacts in computer-assisted analysis of nystagmus].
BACKGROUND: There is no detailed information in the current literature about the best position for the electrodes with regard to electronystagmography. The computer nystagmograph registers potential changes resulting from electrodes on the forearm as nystagmus (pseudonystagmus). This phenomenon led us to investigate more closely the effect of various electrode arrangements and artifacts on the result of computer nystagmography. METHODS: The following four electrode arrangements were investigated on 20 human subjects: distance between the horizontal electrode and the lateral canthus (1 cm versus 2 cm), diagonal arrangement of the lateral electrodes, and changes to the lower vertical electrode. Recorded parameters included calibration potential, rotary nystagmus, post-rotary nystagmus, and optokinetic nystagmus. After determining the basic activity with closed eyes, the influence of five human artifacts on the computer nystagmography was investigated, namely blinking, contractions of the masticatory muscles, swallowing, facial expression, and squinting. RESULTS: The arrangement in which the horizontal electrodes were placed 1 cm away from the lateral canthus showed the greatest calibration potential and the smallest degree of human influence with regard to frequency and amplitude of the pseudonystagmus since a larger potential does not have to be amplified as much as a smaller one to achieve the same needle deflection. For this reason, the artifacts experience a smaller degree of amplification. CONCLUSIONS: We think the following arrangement of the electrodes guarantees the best signal reproduction: a distance between horizontal electrodes and the lateral canthus of 1 cm. The medial electrode is centered between the eyes on the bridge of the nose. The upper vertical electrode is placed above the left eyebrow in the line with the middle of the pupil. The lower vertical electrode is also in line with the middle of the pupil, 1 cm below the lower eyelid. The result is a clear recording of a physiological nystagmus, e.g. on rotation. In the absence of nystagmus, the analysis program is too unreliable and produces a multiplicity of pseudonystagmi. To avoid this we have to improve the recognition of nystagmus in the analysis program.
Adult↗
[Experiences with transverse resections and vertical incisions in treatment of tracheal stenoses and tracheal injuries].
BACKGROUND: The treatment of stenoses and traumatic lesions in subglottic and tracheal areas often requires long term follow-up. This study was undertaken to evaluate the efficiency of tracheal resections and vertical dissections with respect to the length and the quality of the treatment. PATIENTS: Thirty-one adult patients underwent tracheal resections. This group includes one patient with an esophagotracheal fistula which was closed after segmental resection. Two cases of traumatic tracheal lesions in the lower third of the trachea in children are also presented. RESULTS: Long-term intubation was the reason of stenosis in 93.5% of the patients. The tracheal stenosis was successfully resected in 87% of the patients without any complications. The healing process was not related to age and sex. The prognosis was influenced negatively by the type and frequency of previous treatments. We detected paresis of the recurrent nerve postoperatively in two patients. CONCLUSIONS: 1. Our experience has shown that tracheal resection is the optimal treatment of stenosis. 2. The transtracheal access in childhood is very suitable for the closure of tracheal lesions located in the lower third of the trachea.
Adolescent↗
[Congenital abnormalities of the prenasal space: glioma, fistulas and epidermoid cysts].
BACKGROUND: Nasal gliomas are uncommon neurogenic malformations, which derive from the prenasal space. They may appear as intranasal masses, frontonasal masses, or deformities of the nose, brow, or lower central forehead. Almost all of these tumors were diagnosed shortly after birth. The clinical findings of meningoencephaloceles, nasal fistulas, dermoides and epidermoid cysts are presented additionally for differential diagnosis. PATIENTS: Following some interesting case reports, the management of these types of benign tumors is discussed. RESULTS: Complete radiologic evaluation with computed tomography and magnetic resonance imaging should be performed, because a possible intracranial connection must be considered. The preferred surgical treatment of glioma is an endoscopically controlled procedure. In most cases craniotomy is not required. Open rhinoplasty can be helpful for removal of ectodermic malformations. CONCLUSIONS: The surgeon should be familiar with the diagnosis and management of the rare congenital tumors of the nose to ensure proper therapy and to provide the requisite information for patients, parents, and colleagues.
Airway Obstruction↗
[Spontaneous delivery from breech presentation. Plea for natural delivery].
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Anesthesia, Obstetrical↗
[Traumatology of the facial skull in bicycle accidents].
About 15% of all traffic-related personal injuries involve bicycles. In 1989, 67,085 injuries involving bicyclists were registered in West Germany. The city of Münster is a particularly suitable site for studies of bicycle-related injuries because a high percentage of employees and students ride bicycles to work. The severity of bicycle injuries depends on the degree to which the head is traumatized. However, studies concerning trauma to the head in bicycle-related injuries are rare. The risk and the distribution of facial injuries in bicyclists is analyzed within the present study, which covers 78 patients with a total of 88 cranial fractures. The zygomatic and alveolar and orbital regions were most frequently fractured (35%), including 7% blow-out fractures. Thirty-three percent were fractures of the mandibular region, 12% of the bony nose. The soft tissue of the face was injured in 72% of all patients. Middle-aged male patients are more likely to suffer severe bicycle-related injuries. Bicyclists with a significant blood alcohol concentration are more likely to be involved in accidents that are their own fault. The results show that the helmets generally worn are not sufficient to prevent most facial injuries.
Accidents, Traffic↗
[Quantitative evaluation of the Romberg test].
Simple and economical measuring platforms are available to aid the ENT clinician in examining vestibulospinal disorders. The aim of our study was to quantitatively interpret Romberg test measurements. Calculating the area between the zero line and the curves in sagittal and lateral direction--for the Romberg test with closed and open eyes--enables a quantification of body sway. For the evaluation of data, we developed a triangular diagram which allows a graphic representation and quantifies vestibulospinal reaction at a glance. We assessed a group of 80 persons without any symptoms of peripheral or central vestibular system disturbance. Selected patients complaining of vestibular disorders are helpful in demonstrating the objective and quantitative interpretation of the Romberg test, which is often analysed in a more subjective way.
Adult↗
[Clinical aspects of coping with tinnitus].
Forty-two patients suffering form chronic tinnitus participated in our psychologically oriented treatment last year. The following study presents the results of the psychological management of chronic tinnitus combining counselling with relaxation training. Furthermore individual therapy is compared with group therapy. The therapeutical efficiency can be tested using visual analog scales. The individual estimated loudness and annoyance of tinnitus are registered. A quantitative assessment of complaints is made via questionnaires (adapted to Back Depression Inventory). In most cases a reduction of tinnitus loudness and annoyance after individual and group therapy is seen directly. But a constant therapeutical effect is only found is individual therapy. In group therapy, many of our patients reported an increase in the pretherapeutical estimation of tinnitus loudness and annoyance. We believe that permanent confrontation with the tinnitus problem may advance the psychological conflict in many cases. Therefore, psychological management of tinnitus should be concentrated on temporary limited support aimed at overcoming tinnitus sensation.
Adaptation, Psychological↗
[Posturographic registration of body sway after odor stimulation].
The methods of "reflex olfactometry" are rarely able to detect simulated anosmia because of the lack of reproducible correlations between stimulus and intensity of reaction. Interactions between the olfactory and vestibulospinal systems have not yet been investigated. Thirty persons with normosmia and 21 patients with anosmia were studied using a posturographic platform. Only in subjects with normosmia were body sway increases statistically significant in an anterior-posterior direction after the application of an olfactory nerve stimulant. Stimulations of the trigeminal nerve cause both in subjects with normosmia, and anosmia an increase in body sway occurred in a sagittal and lateral direction. The recording of vestibulospinal reactions during platform posturography after application of an olfactory stimulations enables quantification of body sway. These responses can also be useful in differentiating real from stimulated anosmia.
Acetates↗
[Long-term results of lateral rhinotomy with medial maxillo-ethmoidectomy].
Functional and cosmetic results in 93 patients were analysed on average at 42 months after lateral rhinotomy and medial maxilloethmoidectomy. The rate of postoperative complications was 11.8%. The final cosmetic result was more than 1 year postoperatively satisfactory or better in 93.1% after osteoclastic and in 97.8% after osteoplastic lateral rhinotomy. 38.7% of the patients suffered from different postoperative complaints. The main problems were endonasal crusting, hypaesthesia in the V2 region, olfactory dysfunction and epiphora. Considering the results neither the rate of complications nor the cosmetic outcome are critical as usually mentioned in the literature. However, the rate of other different problems complained by the patients postoperatively give reason to add alternative oncosurgical procedures like midfacial degloving and endoscopic techniques, to the general operative repertoire of a hospital.
Adolescent↗
[Fitness for flying despite laryngectomy].
Fitness for flying following laryngectomy is an outstanding result of reintegration. Similar cases are not described in the literature. The pilot had to pass a lot of tests before he was allowed return to his place in the cockpit.
Adult↗
[Detailed results of orbital and optic nerve decompression].
Orbital complications of various pathogenesis include impairment or loss of vision inhibition of globe motility and exophthalmos, and are treated best by an interdisciplinary team. Preoperative strategy should include information about underlying diseases, since success of treatment is related to diagnosis. To analyse our postoperative results we examined four groups of cases: injuries, tumors, infections and mucoceles. Diseases were located in the orbit or paranasal sinuses and produced similar symptoms. But prognosis and results of surgical treatment produced significant differences. The best improvement in vision was seen after treatment of inflammatory processes or after post-traumatic optic nerve decompression. An 88% improvement in globe motility and diplopia was seen in patients undergoing treatment for mucoceles, while a 95% improvement was found following transethmoidal surgery for inflammations of the paranasal sinuses. Overall results represent current trends for indications for surgical techniques employed to treat orbital and paranasal sinus disease.
Exophthalmos↗
[Sense of smell before and after endonasal surgery in chronic sinusitis with polyps].
Although olfactory dysfunction is a common clinical symptom in patients with chronic sinusitis, there are few written reports about the nature, frequency and therapeutic accessibility of the various dysosmias. We analysed pre- and postoperative olfactory function in 78 patients suffering from chronic sinusitis with nasal polyposis. Using a squeeze bottle technique we were able to detect preoperative hyposmia and/or dysfunction of olfactory discrimination in 40% and anosmia in 36%. Only 22% of these patients complained spontaneously of disabilities in smell. Endoscopic surgery improved hyposmias and anosmias in 71% and preoperative dysfunctions of olfactory discrimination in 61%. Postoperative thresholds for 2-phenylethanol and dimethyldisulfide worsened in 9% of all patients. Postoperative olfactory discrimination deteriorated in 11%. Preoperative and postoperative olfactory functions were not predictable in individual cases when nasal polyposis was limited. However, mechanical blockage of the nasal airway was just one of many other pathophysiological factors causing olfactory loss in patients with chronic sinusitis.
Adolescent↗
[The elderly in street traffic from the viewpoint of the ENT specialist].
PROBLEM: A person's orientation in space-also of importance in road traffic-is largely dependent on hearing and sense of balance. These functions are subject to a physiological ageing process that needs to be taken into account. Major points: The effect of age and illness-related problems on a person's ability to cope with road traffic is discussed on the basis of a study of the literature. A detailed discussion of the effects of vestibular disorders on driving ability and the ability to cope with road traffic is discussed. CONSEQUENCES: There is no such thing as an age-related general unfitness to cope with road traffic, merely an individual impairment. Nevertheless, it is our view that the recommendation that hearing and the sense of balance should be regularly checked in the elderly is not taken seriously enough. For it is only in this way that self-monitoring can be improved and the demands posed by modern traffic met.
Accidents, Traffic↗
[Morphology and rhinologic importance of intumescentia septi nasi anterior].
The intumescentia septi nasi anterior is a protuberance on each side of the anterior part of the nasal septum containing "cavernous" tissue. None of the previous studies devoted to the general aspects of endonasal "cavernous" tissue refer to the incidence and rhinological function of the intumescentia. This investigation revealed an incidence of more than 80% in 170 individuals without any rhinological symptoms. The external morphology observed in 7 cadavers indicated a close topographical correlation of the position of the middle turbinate, the depth of the lateral nasal wall and the extension of the intumescentia. Histological examination showed a glandular mass interspersed with a dense vascular network similar to the "cavernous" tissue found within the lateral turbinates. Various filling conditions of the intumescentia have no significant influence on rhinomanometrical parameters and the quantity of nasal airflow. However, visualization of the endonasal flow within a nasal model containing the septal protuberance indicated that the intumescentia considerably alters the quality and local velocities of the endonasal airstream. Considering the results of the study, the intumescentia must be regarded as a completely normal formation of particular rhinophysiological importance, which, up until now, has not been mentioned in rhinosurgery.
Adolescent↗
[Otogenic vertigo. Differentiation and therapy].
Disturbance of equilibrium is perceived subjectively as vertigo. The origin of this unspecified symptom can be varied and must be differentiated for causal therapy. Sudden vestibular disorders were treated symptomatically using drugs that suppress different input activities. For long-term therapy other antivertigo drugs like Betahistin are appropriate. This medication produces positive vasoactive effects and inhibits central vestibular structures. Clinicians are now challenged to design the best possible treatment and exercise regimes, including medication, for patients suffering from vestibular disturbances.
Diagnosis, Differential↗