GMS current topics in otorhinolaryngology, head and neck surgery最新文献

{"title":"Evidence and evidence gaps in the treatment of Eustachian tube dysfunction and otitis media.","authors":"Magnus Teschner","doi":"10.3205/cto000132","DOIUrl":"https://doi.org/10.3205/cto000132","url":null,"abstract":"<p><p>Evidence-based medicine is an approach to medical treatment intended to optimize patient-oriented decision-making on the basis of empirically proven effectiveness. For this purpose, a classification system has been established to categorize studies - and hence therapy options - in respect of associated evidence according to defined criteria. The Eustachian tube connects the nasopharynx with the middle ear cavity. Its key function is to ensure middle ear ventilation. Compromised ventilation results in inflammatory middle ear disorders. Numerous evidence-based therapy options are available for the treatment of impaired middle ear ventilation and otitis media, the main therapeutic approach being antibiotic treatment. More recent procedures such as balloon dilation of the Eustachian tube have also shown initial success but must undergo further evaluation with regard to evidence. There is, as yet, no evidence for some of the other long-established procedures. Owing to the multitude of variables, the classification of evidence levels for various treatment approaches calls for highly diversified assessment. Numerous evidence-based studies are therefore necessary in order to evaluate the evidence pertaining to existing and future therapy solutions for impaired middle ear ventilation and otitis media. If this need is addressed, a wealth of implications can be expected for therapeutic approaches in the years to come.</p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"15 ","pages":"Doc05"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/cto000132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71435032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence and evidence gaps in therapies of nasal obstruction and rhinosinusitis.","authors":"Nicole Rotter","doi":"10.3205/cto000133","DOIUrl":"https://doi.org/10.3205/cto000133","url":null,"abstract":"<p><p>Therapeutic decisions in otorhinolaryngology are based on clinical experience, surgical skills, and scientific evidence. Recently, evidence-based therapies have gained increased attention and importance due to their potential to improve the individual patient's treatment and their potential at the same time to reduce treatment costs. In clinical practice, it is almost impossible to stay ahead of the increasing mass of literature and on the other hand critically assess the presented data. A solid scientific and statistical knowledge as well as a significant amount of spare time are required to detect systematic bias and other errors in study designs, also with respect to assessing whether or not a study should be part of an individual therapeutic decision. Meta-analyses, reviews, and clinical guidelines are, therefore, of increasing importance for evidence-based therapy in clinical practice. This review is an update of the availability of external evidence for the treatment of nasal obstruction and rhinosinusitis. It becomes evident that both groups of diseases differ significantly in the availability of external evidence. Furthermore, it becomes obvious that surgical treatment options are normally based on evidence of significantly lower quality than medical treatment options.</p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"15 ","pages":"Doc06"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5169079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72212236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive surgery of the anterior skull base: transorbital approaches.","authors":"Holger G Gassner,&nbsp;Franziska Schwan,&nbsp;Karl-Michael Schebesch","doi":"10.3205/cto000118","DOIUrl":"https://doi.org/10.3205/cto000118","url":null,"abstract":"<p><p>Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"14 ","pages":"Doc03"},"PeriodicalIF":0.0,"publicationDate":"2016-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34699783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemostatic management of patients undergoing ear-nose-throat surgery.","authors":"Thomas Thiele, Holger Kaftan, Werner Hosemann, Andreas Greinacher","doi":"10.3205/cto000122","DOIUrl":"https://doi.org/10.3205/cto000122","url":null,"abstract":"<p><p>Perioperative hemostatic management is increasingly important in the field of otolaryngology. This review summarizes the key elements of perioperative risk stratification, thromboprophylaxis and therapies for bridging of antithrombotic treatment. It gives practical advice based on the current literature with focus on patients undergoing ENT surgery. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"14 ","pages":"Doc07"},"PeriodicalIF":0.0,"publicationDate":"2015-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72212235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracranial vascular malformations (hemangiomas and vascular malformations) in children and adolescents - diagnosis, clinic, and therapy.","authors":"Behfar Eivazi,&nbsp;Jochen A Werner","doi":"10.3205/cto000105","DOIUrl":"https://doi.org/10.3205/cto000105","url":null,"abstract":"<p><p>The field of extracranial vascular anomalies is considered as special focus of pediatric otolaryngology and it has shown a rapid development during the last years. The reason for this interest is finally also due to the global acceptance of the classification introduced by the ISSVA (International Society for the Study of Vascular Anomalies). Hemangiomas are the most frequently observed vascular tumors. Today the systemic propranolol therapy is mostly used for therapy of hemangiomas requiring treatment. Increasingly, the topical application of beta blocker is discussed while the benefit in the head and neck seems to be limited. Vascular malformations are classified according to the morphology of the affected part of the vascular system in arterial, venous, arterio-venous, lymphatic, capillary, and combined vascular malformations. Conventional surgery, sclerosing therapy, and laser treatment are invasive options for the treatment of lymphatic malformations. The options for the treatment of venous malformations could be significantly improved during the last years. In this context, the use of Nd:YAG laser, the conservative treatment of the localized disseminated intravascular coagulation with low-molecular weight heparin, the re-discovery of bleomycin as effective sclerosing agent, and the improvement of alcohol-based embolization agents must be mentioned. Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy. Arterio-venous malformations as representatives for high-flow lesions are the high-risk lesions. Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course. The combined treatment of embolization and surgical resection and if necessary consecutive defect reconstruction have turned out to be appropriate for arterio-venous malformations. Incurable findings are still a major challenge. Despite the introduction of antiangiogenetic drugs in oncology, the medicamentous therapeutic approach could not be established for arterio-venous malformations up to now. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"13 ","pages":"Doc02"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/cto000105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32973823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia for ORL surgery in children.","authors":"Karin Becke","doi":"10.3205/cto000107","DOIUrl":"https://doi.org/10.3205/cto000107","url":null,"abstract":"<p><p>ORL procedures are the most common operations in children - an optimal anesthetic management provides an uncomplicated, safe perioperative process with as little discomfort for the child as possible. Children at risk must already be identified preoperatively: the combination of ORL surgery, airway susceptibility and age below 3 years can increase the risk of perioperative respiratory adverse events. Postoperatively, it is important to prevent complications such as pain and PONV by dedicated prevention and treatment strategies, as well as to recognize and treat respiratory or circulatory complications competently. Interdisciplinary guidelines and agreements as well as the overall competence of the team have the potential to improve patient safety and outcome in children. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"13 ","pages":"Doc04"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/b5/CTO-13-04.PMC4273165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32973825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical lymph node diseases in children.","authors":"Stephan Lang,&nbsp;Benjamin Kansy","doi":"10.3205/cto000111","DOIUrl":"https://doi.org/10.3205/cto000111","url":null,"abstract":"<p><p>The lymph nodes are an essential part of the body's immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) - a critical aspect especially among children - and can represent an early clinical sign in their exposed position on a child's slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance - from banal infections to malignant diseases - demand a clear and considered approach to the child's individual clinical presentation. Such an approach is described in the following paper. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"13 ","pages":"Doc08"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/cto000111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32974258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diseases of the middle ear in childhood.","authors":"Amir Minovi, Stefan Dazert","doi":"10.3205/cto000114","DOIUrl":"10.3205/cto000114","url":null,"abstract":"<p><p>Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"13 ","pages":"Doc11"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/cto000114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32974262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malformation and plastic surgery in childhood.","authors":"Ralf Siegert, Ralph Magritz","doi":"10.3205/cto000104","DOIUrl":"10.3205/cto000104","url":null,"abstract":"<p><p>Malformations of the head and neck show a huge variety of clinical symptoms with functional and esthetic consequences. Often times its rehabilitation requires multi-staged and multi-disciplinary procedures and concepts. These must consider eating, speech, mimic expression, hearing and \"esthetics\" or at least \"normality\". A survey of the most common head and neck malformations and their treatment options are presented here. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"13 ","pages":"Doc01"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/a0/CTO-13-01.PMC4273162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32973822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric radiology in oto-rhino-laryngology.","authors":"Thekla von Kalle,&nbsp;Assen Koitschev","doi":"10.3205/cto000106","DOIUrl":"https://doi.org/10.3205/cto000106","url":null,"abstract":"<p><p>Head and neck diseases in children and adolescents present special diagnostic and differential diagnostic challenges to ENT surgeons as well as to radiologists. Both disciplines have to adapt the latest radiological and interventional technologies to the needs of the pediatric patient in order to enable a minimally invasive but successful diagnostic procedure. High quality sonography by an experienced examiner is often the only imaging technique that is necessary in children and adolescents. Radiographs are rarely indicated in pediatric head and neck diseases. MRI, compared to computed tomography, has the advantage of absent radiation exposure. Additionally, due to current advances in high resolution techniques to delineate very small details or in visualization of different tissue characteristics, it has become an integral part of pre- and postoperative imaging. However, children should not be denied an adequate diagnostic procedure even if it includes sedation, intervention, or exposure to radiation. The responsible use of the diagnostic options under consideration of the therapeutic consequences is essential. It is most likely to be successful in a close interdisciplinary cooperation of pediatric ENT specialists and radiologists as well as pediatric anesthesiologists in selected cases. Although benign diseases predominate in children and adolescents, the possibility of malignancy has to be considered in cases of atypical clinical and radiological findings. In many of these young patients, the outcome and the probability of survival are directly associated with the initial diagnostic and therapeutic strategies, which should therefore be in accordance with the current guidelines of pediatric oncology therapy studies. Our collection of clinical cases consists of representative examples of useful diagnostic approaches in common and age specific diagnoses as well as in rare diseases and malformations. It shows the significance of a special knowledge in embryology and normal postnatal development for the differentiation of normal variants from pathological findings. Only in considering the results of imaging studies in their clinical context, it is possible to succeed in detecting a syndrome behind a single malformation or adequately caring for patients with a chronic disease such as cystic fibrosis. </p>","PeriodicalId":89377,"journal":{"name":"GMS current topics in otorhinolaryngology, head and neck surgery","volume":"13 ","pages":"Doc03"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/6b/CTO-13-03.PMC4273164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32973824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}