HNO
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Special problems are described concerning expert opinions on hearing disability and hearing loss with regard to the German Social Rights for Compensation and the laws for handicapped persons. In some aspects there are similarities to the rights of accident insurance, but disability programs question only the degree of handicap present and not the source of the hearing loss. The expert opinion on the subject's ability to work in his or any other profession must only determine the patient's ability to hear and the tasks needed to fulfill the profession. Special attention is given to the problems arising from tinnitus.
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The Rosai-Dorfman syndrome is a benign disease, one of its commonest affected sites being the cervical lymph nodes. This disease should be considered in the differential diagnosis of a cervical lymphadenopathy. The syndrome often begins with a chronic rhinitis, and is accompanied by sinusitis, tonsillitis or pharyngitis; blood tests indicate chronic infection. ⋯ The diagnosis is established by the findings of characteristic histiocytes with haemophagocytosis. We report a female patient with persistent cervical lymph node swelling resistant to treatment. The cause was proved by histology to be a Rosai-Dorfman syndrome.
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Laser surgery can be performed using either endotracheal intubation, apnoea or jet ventilation. For operations performed under endotracheal intubation the same technical rules apply as for any other type of anaesthesia. To facilitate intubation a special laser tube is required. ⋯ For monitoring purposes during jet ventilation or procedures under apnoea, transcutaneous oximetry, ECG recording as well as non-invasive blood pressure measurements at short intervals is mandatory. In addition video monitoring is desirable to allow visual anaesthesiological surveillance of the larynx. The jet ventilator must meet established standards; the option must be available to survey inspiratory peak pressure and end-exspiratory pressure as well as the setting of appropriate alarm limits.
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In 1988 we described a method of diagnosis of the larynx using ultrasound, and called it echolaryngography. Now we discuss the ultrasound diagnosis of the normal epiglottis function and lesions of the epiglottis. In principle, three methods of examination are possible with simultaneous B- and M-mode display: transverse function test, sagittal function test and diagonal function test of the epiglottis. ⋯ The description of the clinical results is confined to carcinoma of the epiglottis. Ultrasound diagnosis before and after laser surgery for a lesion on the free edge of the epiglottis is described. In the second example the results of CT scans and ultrasound in a case of T4 supraglottic cancer of the larynx with invasion of the pre-epiglottic space are compared.
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Randomized Controlled Trial Clinical Trial
[Perioperative preventive use of antibiotics in head and neck surgery].
The results of five consecutive prospective trials define the role of perioperative antibiotic prophylaxis in head and neck surgery. For contaminated head and neck cases and for endonasal sinus surgery, a single-dose prophylaxis seems to be sufficient. ⋯ Risk factors for wound infection include nicotine or alcohol abuse, poor oral hygiene and increasing age. Previous radiotherapy seems to be of minor importance.