Publications by authors named "Andreas M Sesterhenn"

46 Publications

[Impact of the COVID-19 pandemic on consultations and diagnosis in ENT practices in Germany].

Laryngorhinootologie 2021 Jun 15. Epub 2021 Jun 15.

Klinik für Hals-Nasen-Ohrenheilkunde, Städtisches Klinikum Solingen, Solingen, Germany.

Objective: During the first months of the COVID-19 pandemic, there was a significant reduction in the frequency of visits to healthcare institutions. This circumstance influenced the timely diagnosis and subsequential initiation of therapy in almost all specialties. The aim of the present study is to evaluate a hypothetical change in health awareness with regard to outpatient consultations of ENT physicians in Germany.

Material And Methods: This study used anonymized data from 146 ENT practices in Germany and included 162,724 patients in Q2 2019, 158,077 in Q3 2019, 128,342 in Q2 2020, and 149,153 in Q3 2020. The first outcome was the difference in the number of patients with at least one visit to these practices between the second and third quarters of 2019 and the second and third quarters of 2020. The second outcome was the number of patients with new diagnoses per practice, defined as diagnoses not previously documented in the database for a given patient.

Results: The number of patients per practice was significantly lower in Q2 2020 compared to Q2 2019 (879 versus 1108, p<0.001). There were no significant differences when comparing Q3 2020 to Q3 2019 (1022 versus 1083, p=0.261). Diagnoses of otitis media (-43%), acute upper respiratory tract infections (-42%), chronic upper respiratory tract diseases: (-21%), hearing loss (-20%) decreased significantly in Q2 2020 compared to Q2 2019. There was still a significant decrease in patient numbers for acute upper respiratory tract infections (-26%) and otitis media (-25%) in Q3 2020 compared to Q3 2019.

Conclusions: The presented results are attributable to several facts. Avoidance of doctor´s visits by the patients, reduction of allocation of appointments by practices and consistent obeying of distance and hygiene measures in terms of wearing filtering face masks (e.g. FFP2/KN95).
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http://dx.doi.org/10.1055/a-1510-9686DOI Listing
June 2021

[Oncology Services for Patients with Head Neck Cancer during Corona-Times - Patients' Perspective].

Laryngorhinootologie 2021 02 14;100(2):104-110. Epub 2020 Dec 14.

Professur für Lebensqualität, Spiritualität und Coping, Universität Witten-Herdecke, Witten, Germany.

Objective: COVID-19 pandemic has impact on the oncology service system for tumor patients. What is the view of head and neck cancer patients (HNC) on this situation and which coping strategies were developed?

Material & Methods: In study 1 PRIO asked 433 tumor patients regarding their impressions/fears during the lockdown between April 15 and May 15, 2020 (online, standardized questionnaire). In 2 study 292 tumor patients reported their pandemic-induced perceived changes and coping strategies by established questionnaires (WHO-5, MLQ, GrAw-7). An analysis of the HNC-data obtained by standardized questionnaires was performed.

Results: Study 1 had 91 HNC, study 2-84 HNC. Study 1 shows high stress levels for the majority of HNC (53,8 %). Personal fears regarding the own disease and therapies (39.6 %) are a central problem. The participants await physical (24.7 %) as well as psychological (21.3 %) consequences due to the pandemic and its current management. During the lockdown the isolation (banned visitors at any hospital) was discussed as critical main point by 58.5 % of HNC patients. Study 2 (after lockdown) underlined the mental stress caused by pandemic. Intensified relations within the families (58/100 points) as well as more intensive experience of nature and silence (58/60 points) are the most perceived changes in corona-times. HNC showed increased own inactivity (MLQ) and depressed well-being (WHO-5) and attention to the moment (GrAw-7).

Conclusions: HNC patients have had high burden and fears due to the COVID-19 pandemic in spring 2020. Their views are important for further strategies to organize and stabilize the oncology service system during further pandemic periods.
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http://dx.doi.org/10.1055/a-1327-4234DOI Listing
February 2021

Incidence and Risk of Various Disorders of the External Ear in Patients With Hearing Aids Treated in ENT Practices in Germany.

Otol Neurotol 2019 09;40(8):1076-1081

Epidemiology, IQVIA, Frankfurt, Germany.

Objective: The aim of the study was to investigate the relationship between the presence of a hearing aid (HA) and the occurrence of various disorders of the external ear, using data from ear, nose, and throat (ENT) practices in Germany from a nationwide, representative practice database.

Methods: In the period between 2012 and 2016, the incidences of disorders of the external ear (ICD-10 groups H60 and H61) in patients with HA prescriptions were compared retrospectively with a control group without HA prescriptions (1:1 matching).

Results: A total of 20,127 patients with HA prescriptions were compared with 20,127 controls. The highest 12-month incidences (HA vs. controls) were determined for "Impacted cerumen" (H61.2) (16.5% vs. 4.2%), "Unspecified otitis externa" (H60.9) (2.6% vs. 1.2%) and 'Acute noninfective otitis externa' (H60.5) (2.3% vs. 0.7%). The most significant risk increases for HA wearers were found for "Abscess of external ear' (H60.0, OR 10.03), "Other otitis externa' (H60.8, OR 6.00), and "Impacted cerumen' (H61.2, OR 4.55). A smaller risk increase was found for "Cholesteatoma of external ear' (H60.4, OR 2.26), among others.

Conclusion: In HA wearers, the risk of developing almost all of the diagnoses reviewed is significantly increased, especially for external auditory canal (EAC) furuncle, chronic otitis externa, and impacted cerumen. This study provides the first epidemiological evidence for HA as a risk factor for the rare EAC cholesteatoma.
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http://dx.doi.org/10.1097/MAO.0000000000002309DOI Listing
September 2019

Demographic data and seasonal variation in peripheral vestibular disorders in ENT practices in Germany.

J Vestib Res 2019;29(4):181-190

Epidemiology, IQVIA, Frankfurt, Germany.

Aim: The aim of this study was to analyze the demographic data pertaining to and seasonal variation in specific vestibular disorders in ear, nose, and throat (ENT) practices in Germany based on data from a representative nationwide practice database.

Method: The study sample included patients from 116 ENT practices in Germany who received an initial diagnosis (ICD-10 code) of Meniere's disease (MD, H81.0), benign paroxysmal positioning vertigo (BPPV, H81.1), or vestibular neuronitis (VN, H81.2) between January 2014 and December 2016. Collected parameters included age, sex, and month of diagnosis. Seasonal variation was analyzed for younger vs. older patients (≤50 vs. >50 years of age). Two univariate Poisson regression models were fitted to estimate the association between the month of diagnosis and the number of diagnosed patients per practice.

Results: A total of 20,720 patients were available for analysis. The average case numbers for MD, BPPV, and VN were 0.8 patients, 2.7 patients, and 1.5 patients per practice per month, respectively. The mean ages of female vs. male patients were 55 and 56 years (MD), 59 and 60 years (BPPV), and 58 and 57 years (VN), respectively. The proportions of female patients with these diagnoses were 62%, 70%, and 61%, respectively. All diagnoses were evenly distributed throughout the years in all age groups. No seasonal variation was observed.

Conclusions: The demographic data of MD and BPPV patients are comparable to those found by previous large-scale epidemiologic studies. However, no seasonal variation was demonstrated for any vestibular disorder in this large sample.
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http://dx.doi.org/10.3233/VES-190668DOI Listing
June 2020

Association of laryngeal cancer with vocal cord leukoplakia and associated risk factors in 1,184 patients diagnosed in otorhinolaryngology practices in Germany.

Mol Clin Oncol 2018 May 21;8(5):689-693. Epub 2018 Mar 21.

Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, D-42653 Solingen, Germany.

The aim of the present study was to analyze the association between laryngeal cancer and vocal cord leukoplakia in a large nationwide practice database. The study sample included 1,184 patients aged 18-90 years from 113 otorhinolaryngology practices in Germany who were diagnosed with vocal cord leukoplakia between 2007 and 2014. The rates of laryngeal cancer diagnosis within 5 years and the associated risk factors were analyzed. Within 6 months of initial diagnosis of vocal cord leukoplakia, 11% of the patients were diagnosed with laryngeal cancer. Between 7 months and 5 years after the diagnosis of leukoplakia, laryngeal cancer was diagnosed in 7.6% of the patients. Overall, within 5 years of leukoplakia diagnosis, 18.6% of the patients were diagnosed with laryngeal cancer (26.1% of men and 6.3% of women; P<0.001). Moreover, 31.3% of patients aged >65 years, 16.1% of patients aged 50-65 years and 7.6% of patients aged <50 years were diagnosed with laryngeal cancer (P<0.001). Patients aged >65 and those aged 50-65 years had a higher risk of being diagnosed with laryngeal cancer [odds ratio (OR)=4.90 and 2.55, respectively]. Furthermore, the risk of being diagnosed with laryngeal cancer was higher in men compared with that in women (OR=4.09). In the present real-world analysis, the rate of laryngeal cancer underlying vocal cord leukoplakia at first diagnosis appeared to be higher compared with the secondary malignant transformation rate occurring later during the course of the disease. Risk factors for laryngeal cancer included advanced age and male sex.
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http://dx.doi.org/10.3892/mco.2018.1592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920511PMC
May 2018

Diagnoses of Dizziness- and Vertigo-related Disorders in ENT Practices in Germany.

Otol Neurotol 2018 04;39(4):474-480

Epidemiology, QuintilesIMS, Frankfurt, Germany.

Aim: The aim of this study was to analyze the prevalence of dizziness- and vertigo-related diagnoses in ear, nose, and throat (ENT) practices in Germany and the associated demographic characteristics based on data from a representative nationwide practice database.

Method: The study sample included patients from 138 ENT practices in Germany who received dizziness- and vertigorelated diagnoses (ICD-10 code) between January 2012 and December 2015. Collected parameters included age, sex, insurance status, prescribed medication (anatomical therapeutic chemical [ATC] class), and referrals to other specialists and hospitals.

Results: A total of 107,458 patients were available for analysis. Most common diagnoses were "dizziness and giddiness" (67.7%), "benign paroxysmal vertigo" (10.2%) and "disorder of vestibular function, unspecified" (7.2%). Referrals and admissions were made in 12.8%, mostly to radiologists (7.7%), followed by neurologists (3.7%), and hospitals (1.4%). Most referrals were made for unspecific diagnoses and for "vestibular neuronitis." The rate of medical prescriptions was 37.3%, with the most common prescription being for antivertigo preparations.

Conclusions: Dizziness- and vertigo-related disorders are frequently diagnosed in ENT practices in Germany. The majority of these diagnoses are unspecific and lead to an increased rate of referrals and hospital admissions. The medical prescription rate, especially of antivertigo preparations, was high, even among patients with benign paroxysmal positioning vertigo. This study reflects a mostly pragmatic approach to a complex diagnostic and therapeutic challenge in daily ENT practice as well as the limited ability of the ICD-10 system to classify the underlying etiology.
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http://dx.doi.org/10.1097/MAO.0000000000001755DOI Listing
April 2018

Seasonal Variation of Epistaxis in Germany.

J Craniofac Surg 2018 Jun;29(4):e365-e367

Department of Epidemiology, QuintilesIMS, Frankfurt, Germany.

Aim: The goal of the present study was to analyze the seasonal variation of epistaxis in ear, nose, and throat (ENT) practices in Germany in 2016.

Methods: The present study sample included patients who received a first epistaxis diagnosis from physicians in 114 ENT practices in Germany between January 2016 and December 2016. The number of epistaxis patients per practice was calculated for each month. A logistic regression model, adjusted for age and sex, was used to calculate the association between epistaxis diagnosis and the month.

Results: The authors found a total of 15,523 patients with epistaxis in 114 ENT practices. Of these patients, 55.9% were men and the mean age was 47.8 ± 27.6 years. The highest number of epistaxis patients was found in February (14.89 patients per practice) and the lowest in August (7.22 patients per practice). The age- and sex-adjusted risk of epistaxis was significantly higher in the months of February (OR = 1.32), March (OR = 1.37), April (OR = 1.34), May (OR = 1.35), and December (OR = 1.33) compared with August.

Conclusions: The presentation of patients with epistaxis at German ENT practices shows a marked seasonal variation with a low in the summer, an increase in fall and winter, and a peak in February, March, and April.
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http://dx.doi.org/10.1097/SCS.0000000000004351DOI Listing
June 2018

Frequency of Thyroid-Stimulating Hormone Monitoring in Patients After Thyroidectomy: A Retrospective Study in Primary Care Practices in Germany.

Exp Clin Endocrinol Diabetes 2018 Nov 2;126(10):640-644. Epub 2018 Feb 2.

Faculty of Medicine, University of Paris 5, Paris, France.

Aim: The goal of this study was to analyze the frequency of thyroid-stimulating hormone (TSH) monitoring in thyroidectomy patients followed by general practitioners in Germany.

Methods: This study included all individuals ≥18 years who had undergone a thyroidectomy between 2000 and 2015 in 258 general practices in Germany. Another inclusion criterion was a minimum of three medical visits between 2015 and 2016, following thyroidectomy. The primary outcome was the annual frequency of TSH monitoring in thyroidectomy patients in 2015. Demographic data included age, sex, and type of health insurance coverage (private versus statutory). Clinical and therapeutic data included the amount of time since the first thyroidectomy, thyroidectomy-associated diagnosis (thyroid cancer, noncancerous enlargement of the thyroid (goiter), or hyperthyroidism), type of thyroidectomy (total or hemithyroidectomy), the Charlson Comorbidity Index score, and the prescription of levothyroxine therapy in 2015. A multivariable logistic regression model was performed to identify variables potentially associated with the likelihood of having been tested at least once for TSH in the year 2015.

Results: The present study included 1,135 thyroidectomy patients. The mean age was 60.1 years (SD=14.3 years), and 75.8% of the patients were women. TSH was measured at least once in 42.3% of patients. In addition, 31.5% of individuals after thyroidectomy had mean TSH values between 0.25 and 1 mIU/L in 2015. No variable was significantly associated with the frequency of TSH monitoring. However, there was a tendency toward a lower TSH monitoring frequency in the groups which had undergone thyroidectomy years ago (OR=0.77 (95% CI: 0.53-1.11) for 1-5 years and OR=0.67 (95% CI: 0.45-0.99) for>5 years compared to<=1 year).

Conclusions: Only 40% of thyroidectomy patients followed by general practitioners in Germany were monitored at least once for TSH in 2015.
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http://dx.doi.org/10.1055/s-0044-100038DOI Listing
November 2018

Actin isoform expression patterns in adult extracardiac and cardiac rhabdomyomas indicate a different cell of origin.

Virchows Arch 2017 Mar 14;470(3):285-290. Epub 2017 Jan 14.

Institute of Pathology, Philipps University and University Hospital Giessen and Marburg, Baldingerstrasse, D-35043, Marburg, Germany.

Rhabdomyomas are rare striated muscle-type tumors arising in the heart or in soft tissues. Using a monoclonal antibody specific for the cardiac isoform of α-actin (α-cardiac actin, α-CAA), differential expression patterns in striated muscle tissues were reported previously. The purpose of the present study was to determine whether the α-actin isoform specificity is maintained in rhabdomyomas according to their origin, comparing extracardiac to cardiac rhabdomyomas. We immunohistochemically investigated adult extracardiac (pharyngeal) rhabdomyomas (n = 4) and cardiac rhabdomyomas (n = 7) employing isoform-specific monoclonal antibodies. The extracardiac rhabdomyomas revealed only a few scattered α-CAA-positive tumor cells (antibody cAc1-20.42) while the cardiac rhabdomyomas exhibited abundant expression of α-CAA, indicating a close relatedness to cardiac muscle fibers. The α-skeletal actin (α-SKA) specific monoclonal antibody (3B3) produced the reverse results. General sarcomeric antibodies (HHF35 and Alpha Sr-1) displayed strong positivity in all rhabdomyomas studied. Alpha-smooth muscle actin (α-SMA) was negative or heterogeneously positive in extracardiac and cardiac rhabdomyomas. Our results suggest that despite similar morphology, the intrinsic differential alpha-actin isoform specificity of mature skeletal vs. cardiac muscle is maintained in extracardiac and cardiac rhabdomyomas. Thus, adult extracardiac rhabdomyomas differentiate towards mature skeletal muscle although they may exhibit centrally placed nuclei like cardiac muscle cells, while cardiac rhabdomyomas reflect true cardiac muscle differentiation. Our findings appear to indicate a different biological nature of cardiac and extracardiac rhabdomyomas, probably related to a different cell of origin. To our knowledge, this is the first report suggesting a derivation of extracardiac and cardiac rhabdomyomas from skeletal and cardiac muscle cells, respectively.
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http://dx.doi.org/10.1007/s00428-017-2069-3DOI Listing
March 2017

Intracranial Nasal Dermoid Sinus Cyst: Transnasal Endoscopic Resection by Open Rhinoplasty Approach, With Intraoperative Video.

J Craniofac Surg 2016 Nov;27(8):2110-2112

Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, Solingen, Germany.

Nasal dermoid sinus cysts are rare congenital lesions that may lead to recurrent soft tissue infections and severe intracranial complications. In case of an intracranial extension, the traditional surgical approach includes a frontal craniotomy with significant morbidity. As a less invasive alternative, a transnasal endoscopic approach has been recommended.This report describes the transnasal endoscopic resection of an intracranial nasal dermoid sinus cyst via an open rhinoplasty approach, which achieved a wide surgical exposure with minimal invasivity and ideal aesthetic results. An intraoperative video demonstrates this combination of techniques in this rare skull base/intracranial pathology.
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http://dx.doi.org/10.1097/SCS.0000000000003107DOI Listing
November 2016

Transcervical extirpation of the submandibular gland: the University of Marburg experience.

Eur Arch Otorhinolaryngol 2014 Jul 6;271(7):2009-12. Epub 2013 Oct 6.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany,

Surgical excision of the submandibular gland is the treatment of choice for lesions affecting this gland. The data of 87 patients, who underwent a transcervical extirpation of the submandibular gland as a single operation over the past 10 years at a single institution in Germany, were available for analysis. Sialolithiasis (73.5%) was the most common reason leading to excision, followed by benign (18.5%) and malignant tumors (8%). Complications included temporary palsies of the marginal mandibular branch of the facial nerve (5.7%), the lingual nerve (5.7%), and the hypoglossal nerve (1.1%), and wound infections in the form of hematoma (3.4%) and seroma (1.1%).
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http://dx.doi.org/10.1007/s00405-013-2720-9DOI Listing
July 2014

Incurable recurrences in patients with oropharyngeal and hypopharyngeal carcinomas.

Head Neck 2014 Feb 14;36(2):231-4. Epub 2013 Jun 14.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Marburg, Germany.

Background: Carcinomas of the oropharyngeal and hypopharynx are difficult to treat because of their aggressive tendency to metastasize and their high recurrence rate.

Methods: A retrospective review of 79 patients with recurrences of oropharyngeal or hypopharyngeal carcinomas was performed. The courses of disease from recurrence diagnosis to the valuation date or death were analyzed.

Results: The median survival for patients classified as incurable at recurrence diagnosis amounted to 8 months (95% confidence interval [CI], 5-10 months), patients initially classified as curable at the time of recurrence diagnosis survived an estimated 12 months (95% CI, 8-22 months). No significant differences regarding the survival after diagnosed recurrence could be observed depending on the tumor location or tumor stage.

Conclusion: The knowledge about the courses of disease and especially the remaining lifetime after diagnosed incurability could facilitate the planning of the remaining lifetime in order to achieve the best possible quality of life.
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http://dx.doi.org/10.1002/hed.23289DOI Listing
February 2014

Lymphatic malformations of the orbit.

Clin Exp Otorhinolaryngol 2013 Mar 8;6(1):30-5. Epub 2013 Mar 8.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen & Marburg, Marburg, Germany.

Objectives: Lymphatic malformations of the orbit are rare lesions that constitute approximately 1% to 8% of all orbital masses. They are difficult to treat since they do not remain within anatomic boundaries and tend to penetrate into normal orbital structures. The aim was to analyze clinical courses and therapy options in patients with lymphatic malformations of the orbit.

Methods: Thirteen patients with orbital lymphatic malformations confirmed by magnetic resonance imaging between 1998 and 2009 were enrolled in this study. Patients' charts were retrospectively reviewed to analyze clinical courses and treatment options.

Results: Four patients suffered from isolated intraorbital lymphatic malformations without conjunctival involvement, in three of them the masses were completely resected, in one patient close controls were performed. Three patients had isolated intraorbital lymphatic malformations with conjunctival involvement. Surgical volume reduction of the exterior parts of the lymphatic malformation were performed without any complications and satisfying outcome in these cases. Six patients suffered from intra- and periorbital lymphatic malformations. In 3 patients a watch-and-wait strategy was initiated. In the other 3 patients a surgical therapy was performed, one patient additionally received sclerotherapy with OK-432; however, these 3 patients suffered from residual lymphatic malformations.

Conclusion: The presented cases underline the inconsistencies in the malformations behavior and underscore the inability to make specific recommendations regarding treatment. The treatment decision should be based on the size and location of the lymphatic malformation. The untreated patient must be watched for signs of visual detoriation, which may signal the need for therapeutic intervention.
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http://dx.doi.org/10.3342/ceo.2013.6.1.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604267PMC
March 2013

Interstitial HDR brachytherapy for advanced recurrent squamous cell carcinoma of the head and neck.

Anticancer Res 2013 Jan;33(1):249-52

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg GmbH, Campus Marburg, Baldingerstrasse, 35033 Marburg, Germany.

Background: Surgical treatment remains the mainstay therapy for recurrence of head and neck cancer after previous radiotherapy. In inoperable cases, interstitial high-dose rate brachytherapy is a treatment option for local dose escalation.

Patients And Methods: A retrospective analysis of all patients who were treated solely with brachytherapy for advanced non-resectable recurrences of squamous cell carcinomas of the head and neck and who previously received radiotherapy was performed.

Results: A total of 12 patients with advanced recurrences were treated with interstitial brachytherapy with a fraction dose of 2-3 Gy and a total focal dose of 20-33 Gy. The shortest survival after brachytherapy was 4 weeks. The longest clinical course without evidence of local recurrence is 4 years and 11 months.

Conclusion: In selected cases brachytherapy can be used as the last-line or palliative therapy for patients with advanced recurrence head and neck carcinomas. Possible complications and the reduction of quality of life due to tracheostomy should be considered.
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January 2013

Dermal metastases in squamous cell carcinomas of the head and neck.

Head Neck 2013 Jun 14;35(6):767-71. Epub 2012 May 14.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen & Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, Germany. [email protected] med.uni-marburg.de

Background: Dermal metastases in squamous cell carcinomas of the head and neck are rare. The purpose of this study was to evaluate incidence, site, prognostic significance, and treatment modalities of dermal metastases of squamous cell carcinoma of the head and neck.

Methods: Medical records were retrospectively analyzed. Statistical analysis was performed using Fisher exact test, Cox regression, and Kaplan-Meier curves.

Results: Fifty-one patients with dermal metastases were evaluated. Dermal metastases were located in the neck, face, chest wall, and upper extremities. The median time from diagnosis of the primary tumor to the occurrence of dermal metastases was 16 months. Survival after manifestation of dermal metastases ranged from 1 to 65 weeks. Localization and treatment of dermal metastases did not significantly correlate with survival.

Conclusion: Dermal metastases indicate the terminal phase of disease. No positive effect of certain therapy modalities could be validated. Therefore, invasive therapies should be abandoned in favor of best supportive care.
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http://dx.doi.org/10.1002/hed.23025DOI Listing
June 2013

Prevalence of level V metastases in node-positive head and neck squamous cell carcinoma.

Anticancer Res 2011 Nov;31(11):3959-61

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35033 Marburg, Germany.

Background: The dissection of level V neck lymph nodes often results in a decline of postoperative quality of life due to shoulder dysfunction and pain. The necessity of level V dissection is debatable. The aim of the present study was to evaluate the prevalence of level V metastases in patients with node-positive squamous cell carcinomas of the head and neck.

Patients And Methods: A review of the clinical and pathological reports was conducted to ascertain the prevalence and distribution of cervical metastases according to neck level V. Statistical analysis was performed using Fisher's exact test.

Results: Level V metastases were found in 19 out of 104 (18.3%) patients. There was only one patient with level V metastases without involvement of other levels. There was no statistically significant correlation between level V lymph node metastasis and several clinical factors.

Conclusion: It seems to be feasible to omit dissection of level V in patients without clinical evidence for level V disease without compromising oncological safety.
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November 2011

Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions.

Eur Arch Otorhinolaryngol 2011 Sep 12;268(9):1249-57. Epub 2011 May 12.

Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.

The trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends.
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http://dx.doi.org/10.1007/s00405-011-1620-0DOI Listing
September 2011

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck.

Oral Oncol 2011 May 2;47(5):320-4. Epub 2011 Apr 2.

Department of Otolaryngology, Head and Neck Surgery, Philipps-University of Marburg, Germany.

There is still no consensus on the optimal treatment of the neck in oral cavity cancer patients with clinical N0 neck. The aim of this study was to assess a possible benefit of elective neck dissection in oral cancers with clinical N0 neck. A comprehensive search and systematic review of electronic databases was carried out for randomized trials comparing elective neck dissection to therapeutic neck dissection (observation) in oral cancer patients with clinical N0 neck. A meta-analysis of the studies which met our defined selection criteria was performed using disease-specific death as the primary outcome, and the relative risk (RR) of disease-specific death was calculated for each of the identified studies. Both fixed-effects (Mantel-Haenszel method) and random-effects models were applied to obtain a combined RR estimate, although between-study heterogeneity was not found to be significant as indicated by an I(2) of 8.5% (p=0.350). Four studies with a total of 283 patients met our inclusion criteria. The results of the meta-analysis showed that elective neck dissection reduced the risk of disease-specific death (fixed-effects model RR=0.57, 95% CI 0.36-0.89, p=0.014; random-effects model RR=0.59, 95% CI 0.37-0.96, p=0.034) compared to observation. This reduction in disease-specific death rate supports the need to perform elective neck dissection in oral cancers with clinical N0 neck.
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http://dx.doi.org/10.1016/j.oraloncology.2011.03.009DOI Listing
May 2011

Transoral thyroid and parathyroid surgery--development of a new transoral technique.

Surgery 2011 Jul 31;150(1):108-15. Epub 2011 Mar 31.

Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Marburg, Germany.

Background: Transluminal interventions via so-called natural orifices are gaining interest because they allow operative treatment without any skin incision. We previously described a transoral access for (para-)thyroid resection in pigs. To proceed with the first clinical trials, we evaluated the safety of the new technique.

Methods: Transoral hemithyroidectomies were performed on 10 living pigs using a special cervicoscope and conventional laparoscopic instruments. Follow-up examinations were carried out for 14 days and followed by autopsy, which included macroscopic evaluation, microbiologic investigations, and blood testing. In addition, refinement of the new technique was achieved by developing the techniques in 10 human cadavers. Finally, transoral parathyroidectomies were performed in 2 patients with primary hyperparathyroidism and a preoperatively localized parathyroid adenoma.

Results: All animal transoral hemithyroidectomies were performed without complications. Postoperatively, oral intake, weight gain, and white blood cell count remained normal. At autopsy, the access route, and operative field showed no signs of infection, and microbiologic swabs remained sterile. Based on these results, a transoral parathyroidectomy was performed successfully in 2 female patients with primary hyperparathyroidism; 1 patient experienced a transient palsy of the right hypoglossal nerve.

Conclusion: Transoral parathyroid and thyroid operation is feasible; however, additional controlled clinical studies are required to evaluate the safety and success rates of this new technique.
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http://dx.doi.org/10.1016/j.surg.2010.12.016DOI Listing
July 2011

Head and neck cancer surgery in the elderly: outcome evaluation with the McPeek score.

Ann Otol Rhinol Laryngol 2011 Feb;120(2):110-5

Department of Otolaryngology-Head and Neck Surgery, University of Marburg, Germany.

Objectives: There is international consensus that elderly patients with head and neck cancer should be treated curatively, like younger patients. Because of common comorbidities in elderly patients, perioperative complications are likely. The McPeek postoperative outcome score was used to evaluate the success of surgical interventions in patients with head and neck cancer.

Methods: We included 168 patients in the study (56 in the study group, 75 years of age or more; and 112 in the control group, less than 60 years of age). All patients underwent major surgery for head and neck cancer.

Results: The median McPeek scores were 8 in the study group and 9 in the control group (p = 0.04). Regression analysis revealed that neither age (p = 0.085) nor the American Society of Anesthesiologists physical status score (p = 0.342) were independent predictors of the McPeek score. Synchronous surgical interventions (p = 0.00051) and duration of surgery (p = 0.0015) had a significant impact on McPeek score performance.

Conclusions: The McPeek score seems to be an appropriate tool for comparing major surgeries for head and neck cancer in different age groups. It is possible to assess the influence of anesthetic and surgical interventions and complications that affect the length of hospitalization. The results confirm that the overall complication rate after surgery in elderly patients does not differ significantly from that in their younger counterparts. Therefore, extended surgical treatment should be offered to both age groups when no serious comorbidities are present. The postoperative outcome seems to depend on the duration and extent of the surgical intervention.
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http://dx.doi.org/10.1177/000348941112000207DOI Listing
February 2011

Extracervical approaches to endoscopic thyroid surgery.

Surg Endosc 2011 Apr 16;25(4):995-1003. Epub 2010 Sep 16.

Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.

There is increasing demand for surgical procedures which avoid visible scars while maintaining optimal functional and ideal cosmetic results, without compromising the safety or effectiveness of the procedure. Endoscopic techniques have been adapted to abdominal and pelvic surgery and increasingly employed over the past three decades. Although hampered by the absence of a natural cavity, endoscopic techniques have been adapted to surgery in the neck for the past 15 years, particularly for the thyroid gland. While earlier attempts at endoscopic thyroid surgery were performed through incisions in or near the midline of the neck, recent techniques have been developed to place the incisions and endoscopic ports extracervically, or at least away from the midline region of the neck, rendering the cosmetic result more acceptable. Most of these approaches are through the axilla, breast, chest wall or a combination of approaches. Visualization of the thyroid and rate of complications with these approaches are equal to those attained with older endoscopic approaches. Careful patient selection is important for endoscopic surgery. Complications unique to the endoscopic approach are mostly related to insufflation of cervical tissues with pressurized CO(2).
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http://dx.doi.org/10.1007/s00464-010-1341-2DOI Listing
April 2011

Sclerotherapy of lymphangiomas of the head and neck.

Head Neck 2011 Nov 24;33(11):1649-55. Epub 2010 Aug 24.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.

Lymphangiomas are congenital malformations of the lymphatic system that consist of cysts of varying size. Although they are benign, they can undergo progressive growth with compression and infiltration of adjacent structures. Surgical excision has been the cornerstone of treatment, although total excision of the lymphangioma can be a major challenge and may be associated with severe complications. Therefore, a variety of nonsurgical methods have been proposed to reduce the surgical morbidity and to decrease the recurrence rate. Percutaneous sclerotherapy of lymphangioma involves the injection of sclerosing substances into the lymphangioma cysts. During the past years, different sclerosants and sclerosant techniques have been developed. This review summarizes the current knowledge on sclerotherapy of lymphangiomas of the head and neck.
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http://dx.doi.org/10.1002/hed.21552DOI Listing
November 2011

Early side effects after embolization of a carotid body tumor using Onyx.

J Vasc Surg 2010 Sep 23;52(3):742-5. Epub 2010 Jul 23.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.

The case of a 20-year-old woman with a carotid body tumor of Shamblin class III is reported. Ten hours after preoperative direct intralesional embolization with 20 mL Onyx (ethylene-vinyl alcohol copolymer; Micro Therapeutics, Irvine, Calif), the patient showed symptoms of Horner syndrome and deficits of the hypoglossal and glossopharyngeal nerves. Intraoperative examination 12 hours after Onyx embolization revealed a massive swelling of the hypoglossal and glossopharyngeal nerves. The patient's tongue motility and glossopharyngeal function improved after surgery, but Horner syndrome was still present. Owing to the delayed occurrence of these adverse effects, the optimal time of surgical intervention after Onyx embolization should be discussed and perhaps expedited.
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http://dx.doi.org/10.1016/j.jvs.2010.04.026DOI Listing
September 2010

Cyfra 21-1 as a tumor marker for follow-up of patients with squamous cell carcinoma of the oropharynx.

Anticancer Res 2010 Jun;30(6):2291-6

Department of Otolaryngology, Head and Neck Surgery, University-Hospital Giessen and Marburg, Campus Marburg, Deutschhausstrasse 3, D-35037 Marburg, Germany.

Unlabelled: The aim of this study was to evaluate the importance and potential of Cyfra 21-1 as a tumor marker (TM) for follow-up of patients with squamous cell carcinoma (SCC) of oropharynx.

Patients And Methods: Cyfra 21-1 serum levels of 50 patients with oropharyngeal SCC were evaluated by ECLIA assay. Statistical analysis was performed using the Jonckheere-Terpstra test.

Results: There was no significant correlation between the Cyfra 21-1 level at the time of initial diagnosis, nor with the clinical and pathological parameters: T-stage (p=0.5), lymph node metastasis (p=0.73), and histological grade (p=0.35). The sensitivity and specificity of Cyfra 21-1 as a follow-up tumor marker was 45% and 93.3%, respectively. In cases of local tumor recurrence or distant metastasis, a higher concentration of Cyfra 21-1 during follow-up was observed than at the time of initial diagnosis.

Conclusion: Cyfra 21-1 serum concentration is not suitable for use in early diagnosis of SCC of the oropharynx. An abrupt increase of Cyfra 21-1 during follow-up indicates disease progression or distant metastasis in the individual patient, independently from the cut-off value.
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June 2010

Relevance of oropharyngeal cancer lymph node metastases in the submandibular triangle and the posterior triangle apex.

Anticancer Res 2009 Nov;29(11):4785-90

Department of Otolaryngology, University Hospital Giessen & Marburg, Campus Marburg, Marburg, Germany.

Background: Neck dissection of levels I and IIB is time consuming and can cause several comorbidities. The aim was to analyze whether levels I and IIB need to be dissected in patients with oropharyngeal cancer and clinical N0 or N+ neck.

Patients And Methods: A retrospective analysis of 77 patients with oropharyngeal cancer was carried out with evaluation of the incidence of neck node metastasis in levels I and IIB.

Results: None of the patients with cN0 neck had metastases in level I or IIB; 12.8% of the patients with cN+ neck had metastases in level I, 35.1% in level IIA and 25.6% had metastases in level IIB.

Conclusion: Levels I and IIB should be dissected in cN+ neck in order to achieve maximal oncological safety. The preservation of levels I and IIB in cN0 neck seems to be justified in terms of improving functional results and concomitant reduction of operation time.
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November 2009

Is it necessary to dissect levels I and IIB in hypopharyngeal cancer?

Acta Otolaryngol 2010 Jun;130(6):747-52

Department of Otolaryngology, Head and Neck Surgery, UKGM, Marburg, Germany.

Conclusion: The low incidence of metastases in levels I and IIB in patients with hypopharyngeal cancer in cases of clinical N0 and N+ neck and the fact that all patients with metastases in levels I and IIB received postoperative radiotherapy justifies the preservation of levels I and IIB in patients with hypopharyngeal cancer to improve functional results and reduce the operating time.

Objectives: Neck dissection of levels I and IIB is technically demanding due to the complex local anatomy and can cause several comorbidities. Therefore the aim of the study was to analyze whether levels I and IIB have to be dissected in patients with hypopharyngeal cancer.

Methods: This was a retrospective analysis of all patients who underwent primary surgical treatment for hypopharyngeal cancer and neck dissection, with evaluation of the incidence of metastases in levels I and IIB in cases of cN0 and cN+ neck.

Results: None of the patients with cN0 neck but 2/33 patients with cN+ neck had metastases in level I. Metastases in level IIB were detected in 1/14 patients with cN0 neck and 2/36 patients with cN+ neck. All patients with metastases in levels I and IIB received postoperative radiotherapy due to the N2b and N2c status.
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http://dx.doi.org/10.3109/00016480903384168DOI Listing
June 2010

Microcystic lymphatic malformations of the tongue: diagnosis, classification, and treatment.

Arch Otolaryngol Head Neck Surg 2009 Oct;135(10):976-83

Department of Otorhinolaryngology-Head and Neck Surgery, Philipps-Universität Marburg, Deutschhausstrasse 3, 35037 Marburg, Germany.

Objective: To describe a classification of microcystic lymphatic malformations of the tongue and to investigate different treatment methods.

Design: Retrospective review of patients treated for microcystic lymphatic malformations of the tongue. Lymphatic malformations were classified into the following 4 groups according to their extent: isolated superficial microcystic lymphatic malformations of the tongue (stage I); isolated lymphatic malformations of the tongue with muscle involvement (stage II; stage IIA, involving a part of the tongue; stage IIB, involving the entire tongue); microcystic lymphatic malformations of the tongue and the floor of mouth (stage III); and extensive microcystic lymphatic malformations involving the tongue, floor of mouth, and further cervical structures (stage IV).

Patients: Twenty patients with microcystic lymphatic malformation of the tongue.

Main Outcome Measures: Medical records were reviewed for demographic data and extent and treatment of the lymphatic malformations.

Results: Three patients had stage I disease; 5 patients, stage II; 3 patients, stage III; and 9 patients, stage IV. In 6 patients, the lymphatic malformations could be completely removed by carbon dioxide laser surgery; the remaining 13 patients had persistent disease.

Conclusions: The initial stage seems to predict outcome. Carbon dioxide laser therapy provides good results primarily in stages I and IIA lymphatic malformations. In advanced lymphatic malformations (stages IIB, III, and IV), an interdisciplinary approach is necessary, because complete surgical excision is often impossible owing to the diffuse growth behavior, and therefore recurrence and persistence are common.
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http://dx.doi.org/10.1001/archoto.2009.131DOI Listing
October 2009

Post-tonsillectomy taste disorders.

Eur Arch Otorhinolaryngol 2010 Feb 23;267(2):289-93. Epub 2009 Aug 23.

Department of Otorhinolaryngology, Head and Neck Surgery, Malteser Krankenhaus St.Anna, Albertus Magnus Str. 33, 47259 Duisburg, Germany.

Gustatory dysfunction is an uncommon complication following tonsillectomy with a potential impact on the quality of life. This retrospective study was undertaken to evaluate the incidence of post-tonsillectomy dysgeusia and its relationship to wound healing and pain. A retrospective chart review of 100 patients who had undergone tonsillectomy between June and December 2008 at a single tertiary care institution was performed. Clinical examination included evaluation of the patient's history and psychophysical testing with cottons soaked with chininsulfate (0.075%; 0.2%), glucose (2%; 10%), citric acid (0.5%; 7.5%) and sodium chloride (0.5%; 2.5%) before, as well as 4 days to 3 months following tonsillectomy at a tertiary care hospital. Anatomical peculiarities, intubation problems, operation time, methods to achieve hemostasis were extracted from the charts. Healing was scored by the physician and pain was scored by the patient. Subjective taste dysfunction was registered in 29 patients 4 days after surgery. In all patients this dysgeusia regressed within weeks. Measured taste function showed lateralized and transient changes. No investigated factor such as pain, operating time, anatomical particularities, wound healing or haemostatic technique were associated with the occurrence of dysgeusia. Transient taste perception changes seem to be relatively frequent after tonsillectomy. Although our results indicate no correlation of even transiently altered taste perception and any of the investigated parameters, this further confirms the clinical impression that gustatory symptoms can occur even after uneventful tonsillectomy. Informed consent should include post-tonsillectomy gustatory dysfunction.
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http://dx.doi.org/10.1007/s00405-009-1057-xDOI Listing
February 2010

Cyfra 21-1 as a serum tumor marker for follow-up of patients with laryngeal and hypopharyngeal squamous cell carcinoma.

Anticancer Res 2009 Aug;29(8):3421-5

Department of Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, D-35037 Marburg, Germany.

Aim: To evaluate the importance and potential of Cyfra21-1 as a tumor marker (TM) for follow-up of patients with squamous cell carcinoma (SCC) in laryngeal and hypopharyngeal cancer.

Patients And Methods: Cyfra21-1 serum levels of 50 patients with laryngeal and hypopharyngeal SCC were evaluated by ECLIA assay. Statistical analysis was performed using Kruskal-Wallis and Jonckheere-Terpstra tests.

Results: There was no significant correlation between Cyfra21-1 levels at the time of initial diagnosis and the clinicopathological parameters. The clinical performance of Cyfra 21-1 as an individual tumor marker for follow-up of patients was good. This is shown by the area under the curve (0.873) of their receiver operating characteristic curves. The sensitivity and specificity of Cyfra 21-1 at a cut-off 3.3 ng/ml ere 61.1% and 96.9% respectively.

Conclusion: Cyfra 21-1 is not suitable for early diagnosis of SCC of the larynx and hypopharynx. An abrupt increase of Cyfra 21-1 in serial measurements indicates impending disease progression in individual patients.
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August 2009

Polysomnography outcomes following transoral CO2 laser microsurgery in pediatric patients with laryngomalacia.

Int J Pediatr Otorhinolaryngol 2009 Oct 8;73(10):1339-43. Epub 2009 Jul 8.

Department of Otolaryngology, Head & Neck Surgery, University Hospital of Giessen and Marburg, Campus Marburg, Deutschhausstrasse 3, D-35037 Marburg, Germany.

Objective: Laryngomalacia is the most common cause of stridor in newborns and infants. The aim of the contribution was to present objectified data of the outcome of transoral CO(2) laser microsurgery in patients with laryngomalacia utilizing polysomnography (PSG).

Patients And Methods: This retrospective study comprised 21 patients who were diagnosed to suffer from laryngomalacia. Diagnosis was confirmed by pharyngo-laryngoscopy under spontaneous breathing. If there was evidence for laryngomalacia a transoral CO(2) lasersurgical intervention and/or epiglottopexy was performed in the same session. 8 patients, on whom the following should be focused, received pre- and postoperative PSG which was performed for efficiency control of the applied treatment.

Results: All 21 patients underwent invasive treatment for laryngomalacia (lasersurgical division of the aryepiglottic folds: n=13; epiglottopexy: n=5; combined procedure: n=3). All patients were successfully extubated after surgery. In 20/21 cases breathing improved clearly after one single intervention. Stridor disappeared completely in the further course of the disease. In the 8 patients who received pre- and postinterventional PSG, lasersurgical interventions were performed. Statistical analysis of pre- and postoperative PSG revealed that MOAI/h (mixed obstructive apnea index/hour) improved significantly (p=0.016, Wilcoxon-Signed-Rank Test). Also desaturation/hour improved in the postoperative course (p=0.11).

Conclusion: The presented concept describes an effective and reliable approach for diagnostics and treatment for laryngomalacia. To objectify the success of supraglottoplaty in patients suffering from severe laryngomalacia a pre- and postoperative PSG seems to be useful and advisable. The present results of PSG demonstrate that children with laryngomalacia to benefit from lasersurgical division of the aryepiglottic folds and/or epiglottopexy. This fact is supported by the postoperative improved clinical aspect.
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http://dx.doi.org/10.1016/j.ijporl.2009.06.002DOI Listing
October 2009
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