Laryngo- rhino- otologie
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Using a clinical example we discuss the reasons why some of our colleagues associate unpleasant feelings with the term Evidence-Based Medicine (EBM). We demonstrate what EBM can contribute to solve day-to-day clinical problems and discuss the six formal steps for implementation of EBM into the day-to-day practise. 1. To transform the clinical problem into an answerable 4-part question. 2. ⋯ To critically appraise the found evidence with respect to it's validity, importance and applicability. 5. To integrate the appraised external evidence into your existing internal evidence in order to come to a new decision if the additional new external evidence in convincing. 6. To assess the benefit which was gained for the patient.
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Laryngo- rhino- otologie · Jun 2001
[Tracheostomy valve with integrated cough flap for improving hands-free speech in laryngectomized patients--development and clinical applications].
Following successful voice restoration after laryngectomy either by a voice prosthesis, a surgical shunt or microvascular laryngoplasty, a further goal in rehabilitation is the insertion of a tracheostoma valve, which enables the patient to speak without using his fingers for closure of the tracheostoma. One important disadvantage of the tracheostoma valves, which are available today, is the necessity of removal of the valve in case of coughing, because the valve could be thrown from the stoma by the strong air flow during coughing. As many laryngectomies suffer from chronic bronchitis, this coughing problem is one of the reasons why only few patients could be provided with this useful aid. ⋯ The newly developed tracheostoma valve with integrated coughing lid (Window, ADEVA-medical Company, Lübeck, Germany) provides further improvement in speech rehabilitation of laryngectomies. The low acceptance of tracheostoma valves, which enable the patient to speak without using his fingers for closure of the tracheostoma, possibly may be raised by this new aid.
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Laryngo- rhino- otologie · Mar 2001
Comparative Study[Unilateral opacification of the paranasal sinuses in CT or MRI: an indication of an uncommon histological finding].
Clinical and radiological differentiation between subacute or chronic sinusitis and differential pathologies such as malignoma, inverted papilloma or mycosis can be very difficult. In some cases the CT- or MRI-scan shows a unilateral opacification of the paranasal sinuses. Which histological results can be found in patients with persisting sinusitis related problems and a unilateral opacification of the paranasal sinuses in the CT- or MRI-scan? There are only a few publications on this topic. ⋯ Unilateral opacification of paranasal sinuses in the CT or MRI is--especially at a higher age--an indice for a neoplasm or mycotic sinusitis and therefore an early histological diagnosis or operative treatment is always suggested.
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Laryngo- rhino- otologie · Dec 2000
Review[Medical aspects of diving in otorhinolaryngology. I. Barotrauma and decompression sickness].
Recreational scuba diving has become immensely popular in recent years and is no longer restricted to individualists or adventurers. During a dive, the human body with its gas-filled cavities is exposed to an increased ambient pressure. In the present review article, aspects of diving and hyperbaric medicine related to the otolaryngology field are presented. ⋯ Barotrauma of the outer, middle and inner ear, the paranasal sinuses, face, teeth and larynx are explained and classified in those during the compression and decompression phase. This is followed by a discussion of inner ear decompression sickness. The present article will provide a background and foundation for both, an adequate treatment of these diseases and a critical and responsible health education of the diver.
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Laryngo- rhino- otologie · Dec 2000
[Detection of central auditory compensation in unilateral deafness with functional magnetic resonance tomography].
Functional magnetic resonance imaging (fMRI) is a noninvasive method to detect focal brain activity at high spatial resolution. Acoustic stimulation induces an increase of regional cerebral blood flow in the primary auditory cortex. This entails an increased concentration of diamagnetic oxyhemoglobin in the capillaries and the venous system. The resulting decrease of the local magnetic susceptibility was detected as a signal increase in T2*-weighted images. The central auditory pathways predominantly cross to the contralateral hemisphere in normally hearing subjects. The aim of the present study was to investigate the primary auditory cortex after acoustic stimulation in unilateral deaf patients using fMRI. ⋯ Central-auditory compensation by bilateral cortical activation was demonstrated in unilateral deaf patients. Moreover, a tendency towards a dominance of the left primary auditory cortex was found, although the difference between both hemispheres was not significant. The lateralization ratio in unilateral deaf patients is similar to findings after binaural stimulation in normally hearing subjects.