Laryngo- rhino- otologie
-
Evidence-based medicine (EBM) is a strategy for the standardization of medical decision-making. The purpose of this review was to demonstrate the most important tools of EBM and to critically appraise them. ⋯ The critical use of the systematic tools of EBM for clinical decision-making is recommended.
-
Laryngo- rhino- otologie · May 1999
Historical Article[The nasopharynx and pharyngeal tonsil in the history of otology and rhinology. Pictures from the history of otorhinolaryngology, presented by instruments from the collection of the Ingolstadt Medical History Museum].
Anatomy, nomenclature, first clinical observations: In ancient Greece and Rome and in the Middle Ages the posterior opening of the nasal passage was known (Greek "choane" = funnel) as an atomical structure, and it was also known that chronic nasal catarrh is common in children, but it was not realized that this was associated with special pathological alterations. The anatomist H. von Luschka in Tübingen, Germany, was the first to describe the nasopharynx in detail, and he coined the term "pharyngeal tonsil." The otologists of the 19th century like Kramer and Toynbee had placed the Eustachian tube in the center of their investigations and carried out numerous dissections with demonstration of the tubal orifice. They also knew that middle ear infections usually originated in the nasopharynx, but they did not realize that the hypertrophic pharyngeal tonsil was the cause. ⋯ Rudloff in Wiesbaden, Germany, in 1900 adopted this position for adenoidectomy, but this was generally accepted only after the mouth gags developed by Davis-Boyle and Negus had been introduced. The diagnostic and surgical interventions in the nasopharynx were a powerful link in the process of fusion between otology and rhinolaryngology around the turn of the century. This historical development is described in great detail with many figures and quotations from the literature.
-
Laryngo- rhino- otologie · Feb 1999
Comparative Study Clinical Trial[Tracheotomy: discussion of various surgical procedures using argon plasma coagulation].
At present there is a discernible lack of consensus among different medical specialties regarding methods of tracheotomy in an intensive care setting. There is an obvious preference for percutaneous dilatational tracheotomy methods. Comparison of different methods are necessary to determine whether this trend is justified. ⋯ On the basis of our experience with 270 tracheotomies we have found there are clear indications for the various methods of tracheotomy. They depend on both the history of the disorder and its course and on the known contraindications to percutaneous tracheotomy methods. For safety reasons, we do not perform percutaneous tracheotomies on patients with severe brain damage who tend to aspirate and require prolonged neurological rehabilitation. Preoperative bleeding in percutaneous tracheostomies is the most important complication. It led to a life-threatening situation in 2.4% of our cases. Preoperative neck ultrasound may decrease the risks due to unusual anatomical conditions. Comparison of significant perioperative complications does not appear to favor any one method at present. In light of our effective cooperation with other specialties in planning and performing tracheotomies we do not feel that the current general preference for percutaneous methods in intensive care medicine is justified. Initial experience with APC shows promising results concerning its use in conventional tracheotomies. However, we noticed a shorter operation time, reduction of bleeding complications, and use of less suture material. The effectiveness of surgical intervention is improved by a number of factors.
-
Laryngo- rhino- otologie · Jul 1998
[Dislocation of the cricoarytenoid joint: diagnosis and therapy].
Laryngeal joint injury or cricoarytenoid dislocation is a relatively rare laryngologic finding, according to the international medical literature. It may occur as a result of external neck trauma or more frequently as a result of intubation. Chief symptoms are hoarseness, vocal fatigue, and loss of voice control. ⋯ Our results suggest that a closed reduction of the arytenoid luxation can be successful even several weeks after the injury.