Vestibular Schwannoma Surgery: Outcome and Complications in Lateral Decubitus Position versus Semi-sitting Position-A Personal Learning Curve in a Series of 544 Cases over 3 Decades

OBJECTIVE

To retrospectively evaluate influence of intraoperative positioning (semisitting vs. lateral decubitus) and surgeon's learning curve with regard to functional outcome of patients with vestibular schwannoma.

METHODS

This study included 544 patients (median age 57 years) and spanned 3 decades: 1991-1999 (n = 103), 2000-2009 (n = 210), and 2010-2019 (n = 231). Surgery was performed in the lateral decubitus position in 318 patients and the semisitting position in 163 patients. Large T3 and T4 tumors were present in 77% of patients.

RESULTS

Complete tumor removal was achieved in 94.3% of patients. A significant reduction in surgery duration and blood loss was observed over 3 decades for T3 (from 325 to 261 minutes, P < 0.001) and T4 (from 440 to 330 minutes, P < 0.001), but not for T1 and T2, tumors. The semisitting position diminished surgical time in T3 and T4 tumors by 1 more hour (P < 0.001). Over 3 decades, facial nerve outcome improved significantly from 59.8% House-Brackmann grade 1-2 in the first decade to 81.7% in the last decade (P < 0.001). Furthermore, hearing was preserved in 45.3%: 23.3% of patients in the first decade and 50.5% in the last decade (P = 0.03). However, neither facial nerve outcome nor hearing preservation significantly differed in patients operated on in the lateral decubitus versus the semisitting position. The most common complication was cerebrospinal fluid leak (6.1%) followed by hemorrhage (3.5%) and pulmonary embolism (2.2%).

CONCLUSIONS

Follow-up over 3 decades illustrates a learning curve with significantly improved results. While the semisitting position accelerates the procedure and is associated with reduced blood loss, it does not significantly influence functional outcome.

Improving biliary stent patency by the use of stent coating - a prospective randomized porcine study

BACKGROUND

Endoscopic stenting of the bile duct is a standard procedure for almost 35 years. In the case of long-term stenting occlusion of the stent is a major concern. Therefore optimizing biliary stents with respect to their patency is of great importance. We tested in an in animal study if coating of self-expanding metal stents with hydrophobin alone or hydrophobin with heparin reduces stent clogging as there were promising results in an in vitro study with this approach.

MATERIAL AND METHODS

In a randomized prospective animal study we implanted self-expanding metal stents either native or coated with hydrophobin alone or coated with hydrophobin and heparin into the bile duct of 15 pigs. After a survival period of 6 weeks we measured which part of the stent surface (%) was covered with clogging material using a commercially available image editing program on scanning electron microscopic images.

RESULTS

We found no differences between the native self-expanding metals stents and those coated with hydrophobin alone or hydrophobin and heparin.

CONCLUSION

There are important differences in the clogging process between in vitro and in vivo models. Coating with hydrophobin with or without heparin is not able to inhibit the clogging process in an animal model.

Laterality of sudden sensorineural hearing loss

It is known that sudden sensorineural hearing loss and other otoneurologic diseases, such as tinnitus or Ménière disease, occur more frequently in the left ear than in the right. We studied lateralization of sudden deafness in 489 patients treated at Radebeul Hospital from January 2004 to December 2009. The male-to-female ratio was 1:1.24; we found a predominance of the left side only in female patients. The cause for this predominance is unclear. The slight asymmetry might indicate a greater vulnerability of the left inner ear in women, suggesting hormonal factors in the genesis of sudden deafness.

Static Magnetic Proximity Effect in Pt/NiFe2O4 and Pt/Fe Bilayers Investigated by X-Ray Resonant Magnetic Reflectivity

The spin polarization of Pt in Pt/NiFe2O4 and Pt/Fe bilayers is studied by interface-sensitive x-ray resonant magnetic reflectivity to investigate static magnetic proximity effects. The asymmetry ratio of the reflectivity is measured at the Pt L3 absorption edge using circular polarized x-rays for opposite directions of the magnetization at room temperature. The results of the 2% asymmetry ratio for Pt/Fe bilayers are independent of the Pt thickness between 1.8 and 20 nm. By comparison with ab initio calculations, the maximum magnetic moment per spin polarized Pt atom at the interface is determined to be (0.6±0.1)  μB for Pt/Fe. For Pt/NiFe2O4 the asymmetry ratio drops below the sensitivity limit of 0.02  μB per Pt atom. Therefore, we conclude, that the longitudinal spin Seebeck effect recently observed in Pt/NiFe2O4 is not influenced by a proximity induced anomalous Nernst effect.

Assessment of visual function during brain surgery near the visual cortex by intraoperative optical imaging

Several functional brain imaging and mapping techniques have been used for the intraoperative identification and preservation of the sensory, motor, and speech areas of the brain. However, intraoperative monitoring and mapping of the visual function is less frequently performed in the clinical routine. To our knowledge, here we demonstrate for the first time that the individual visual cortex can be mapped to the brain surface using a contact-free optical camera system during brain surgery. Intraoperative optical imaging (IOI) was performed by visual stimulation of both eyes using stobe-light flashes. Images were acquired by a camera mounted to a standard surgical microscope. Activity maps could reproducibly be computed by detecting the blood volume-dependent signal changes of the exposed cortex. To the preliminary experience, the new technique seems to be suitable for mapping the visual function in any neurosurgical intervention that requires exposure of the visual cortex. However, the clinical relevance and reliability of the technique need to be confirmed in further studies.

Transverse spin Seebeck effect versus anomalous and planar Nernst effects in Permalloy thin films

Transverse magnetothermoelectric effects are studied in Permalloy thin films grown on MgO and GaAs substrates and compared to those grown on suspended SiN(x) membranes. The transverse voltage along platinum strips patterned on top of the Permalloy films is measured versus the external magnetic field as a function of the angle and temperature gradients. After the identification of the contribution of the planar and anomalous Nernst effects, we find an upper limit for the transverse spin Seebeck effect, which is several orders of magnitude smaller than previously reported.

[Pharmacotherapy of acute and chronic tinnitus]

The aetiology of acute tinnitus is mostly idiopathic like sudden sensorineural hearing loss or caused by noise and rarely infectious or vascular. Therefore there is currently no causal and effective drug therapy available. Although there is a low level of evidence, treatment with glucocorticoids and initially plasma expanding infusions (HES) is recommended for acute tinnitus if there is no spontaneous remission. Intratympanic glucocorticoid therapy can be used as an alternative if there is severe hearing loss together with tinnitus. In chronic tinnitus there is really no indication for pharmacotherapy. Sometimes

Contemporaneous cell spreading and phagocytosis: magneto-resistive real-time monitoring of membrane competing processes

Adhesion and spreading of cells strongly depend on the properties of the underlying surface, which has significant consequences in long-term cell behavior adaption. This relationship is important for the understanding of both biological functions and their bioactivity in disease-related applications. Employing our magnetic lab-on-a-chip system, we present magnetoresistive-based real-time and label-free detection of cellular phagocytosis behavior during their spreading process on particle-immobilized sensor surfaces. Cell spreading experiments carried out on particle-free and particle-modified surfaces reveal a delay in spreading rate after an elapsed time of about 2.2h for particle-modified surfaces due to contemporaneous cell membrane loss by particle phagocytosis. Our associated magnetoresistive measurements show a high uptake rate at early stages of cell spreading, which decreases steadily until it reaches saturation after an average elapsed time of about 100 min. The corresponding cellular average uptake rate during the entire cell spreading process accounts for three particles per minute. This result represents a four times higher phagocytosis efficiency compared to uptake experiments carried out for confluently grown cells, in which case cell spreading is already finished and, thus, excluded. Furthermore, other dynamic cell-surface interactions at nano-scale level such as cell migration or the dynamics of cell attachment and detachment are also addressable by our magnetic lab-on-a-chip approach.

Magnetoresistive-based real-time cell phagocytosis monitoring

The uptake of large particles by cells (phagocytosis) is an important factor in cell biology and also plays a major role in biomedical applications. So far, most methods for determining the phagocytic properties rely on cell-culture incubation and end-point detection schemes. Here, we present a lab-on-a-chip system for real-time monitoring of magnetic particle uptake by human fibroblast (NHDF) cells. It is based on recording the time evolution of the average position and distribution of magnetic particles during phagocytosis by giant-magnetoresistive (GMR) type sensors. We employ particles with a mean diameter of 1.2 μm and characterize their phagocytosis-relevant properties. Our experiments at physiological conditions reveal a cellular uptake rate of 45 particles per hour and show that phagocytosis reaches saturation after an average uptake time of 27.7h. Moreover, reference phagocytosis experiments at 4°C are carried out to mimic environmental or disease related inhibition of the phagocytic behavior, and our measurements clearly show that we are able to distinguish between cell-membrane adherent and phagocytosed magnetic particles. Besides the demonstrated real-time monitoring of phagocytosis mechanisms, additional nano-biointerface studies can be realized, including on-chip cell adhesion/spreading as well as cell migration, attachment and detachment dynamics. This versatility shows the potential of our approach for providing a multifunctional platform for on-chip cell analysis.

[Conservative therapy of chronic sinusitis]

The chronic rhinosinusitis is defined as chronic inflammation of the nose and nasal sinuses, with or without nasal polyps. Patients suffering from chronic rhinosinusitis report about nasal obstruction and secretion, olfactory impairment, head and facial pain. These symptoms cause also considerable impact on quality of life. Therefore, an adequate rhinological diagnostics as well as therapies are essential. This paper reviews the pharmacologic and non-pharmacologic therapy of chronic rhinosinusitis. First choice of therapy should be topical glucocorticoids. The application of glucocorticoids causes anti-inflammatory and certain curative effects. Hypertonic salt solutions improve nasal symptoms. Long-term therapy with oral macrolides might improve median to severe symptoms of chronic rhinosinusitis without nasal polyps. An additional therapy with antihistamines is possible in patients with an allergy. Adaptive desensitization in patients suffering from analgesic-intolerance associating among other with nasal polyps is currently the single causal therapy. Therefore, frequency of endonasal revision surgery is reduced after desensitization.

Tunneling magnetothermopower in magnetic tunnel junction nanopillars

We study tunneling magnetothermopower (TMTP) in CoFeB/MgO/CoFeB magnetic tunnel junction nanopillars. Thermal gradients across the junctions are generated by an electric heater line. Thermopower voltages up to a few tens of μV between the top and bottom contact of the nanopillars are measured which scale linearly with the applied heating power and hence the thermal gradient. The thermopower signal varies by up to 10  μV upon reversal of the relative magnetic configuration of the two CoFeB layers from parallel to antiparallel. This signal change corresponds to a large spin-dependent Seebeck coefficient of the order of 100  μV/K and a large TMTP change of the tunnel junction of up to 90%.

Scaling behavior of the spin pumping effect in ferromagnet-platinum bilayers

We systematically measured the dc voltage V(ISH) induced by spin pumping together with the inverse spin Hall effect in ferromagnet-platinum bilayer films. In all our samples, comprising ferromagnetic 3d transition metals, Heusler compounds, ferrite spinel oxides, and magnetic semiconductors, V(ISH) invariably has the same polarity, and scales with the magnetization precession cone angle. These findings, together with the spin mixing conductance derived from the experimental data, quantitatively corroborate the present theoretical understanding of spin pumping in combination with the inverse spin Hall effect.

Mechanical Properties of CuNi Films

The mechanical properties of resistive CuNi films sputtered on both silicon wafers and flexible Kapton foils are important for reliability and lifetime of resistors. Studies of stress-temperature dependence and stress relaxation, stress-strain measurements and scanning scratch tests were performed to investigate film stresses, elastic properties, plastic flow, stress for crack initiation and film adhesion. The growth and annealing stresses were found to be tensile and can be seen as the reason for resistance degradation by stress relaxation due to plastic flow. The strains for crack initiation of 0.2 % to 0.7 % depending on film thickness and annealing restrict the application in resistors on flexible substrates. The film adhesion can be improved by a NiCr base-layer.

Stress-Strain Curves by Tensile Testing of Thin Metallic Films On Thin Polyimide Foils: Al, AlCu, CuNi(Mn)

For better understanding the mechanical properties of thin films it is helpful to use the same experimental methods as for bulk material, like tensile tests, thereby being able to directly compare the results. However, tensile tests of free-standing metallic thin films are often difficult to perform for reasons of preparation, handling, and stresses in the films. By leaving the metallic film on an elastic substrate tensile tests were performed in a rather simple and precise manner, using a commercial tensile testing machine. Stress-strain curves were determined by separating the force working on the substrate from that working on the film-substrate compound. Those measurements were done at room temperature for Al, AlCu(0. 5 wt %) and Cuo0.57Ni0.42Mn0.01 thin (200–2000 nm) films prepared by magnetron sputtering on 8 μm and 13 μm thick polyimide (Kapton) foils. The film microstructure was characterized by scanning and transmission electron microscopy and X-ray diffraction. The tensile strength of the fine grained films was found to be up to one order of magnitude higher than for the corresponding coarse grained bulk material. Al and AlCu films showed little, CuNi(Mn) films showed no plastical behavior. Crack formation started between 0.3 % and 2 % strain depending on the material, the thermal history, and the grain size.

Ab initio prediction of ferrimagnetism, exchange interactions and Curie temperatures in Mn₂TiZ Heusler compounds

The Heusler compounds Mn(2)TiZ (Z = Al, Ga, In, Si, Ge, Sn, P, As, Sb) are of great interest due to their potential ferrimagnetic properties and high spin polarization. Here, we present calculations of the structural and magnetic properties of these materials. Their magnetic moment follows the Slater-Pauling rule m = N(V) - 24. None of them is actually a perfect half-metallic ferrimagnet, but some exhibit more than 90% spin polarization and Curie temperatures well above room temperature. The exchange interactions are complex; direct and indirect exchange contributions are identified. The Curie temperature scales with the total magnetic moment, and it has a positive pressure dependence. The role of the Z element is investigated: it influences the properties of the compounds mainly via its valence electron number and its atomic radius, which determines the lattice parameter. Based on these results, Mn(2)TiSi, Mn(2)TiGe, and Mn(2)TiSn are proposed as candidates for spintronic applications.

Peritonsillar abscess: is there any evidence of lateralized distribution? An analysis of 294 patients

OBJECTIVE

Generally, peritonsillar abscess (PTA) occurs only on one side. Diseases of paired organs show a distinct asymmetry of occurrence: for instance gynaecomastia, varicocele, trigeminal neuralgia, carcinoma of the breast and carcinoma of the ethmoid sinus. Therefore, the goal of the present study was to investigate a possible dominance of one side in PTA.

MATERIAL AND METHOD

Lateralization of a PTA was studied in 294 patients treated at Radebeul Hospital between January 2004 and December 2009.

RESULT

We found only a slight predominance of the left side in male as well as female patients.

CONCLUSION

The cause of the slight asymmetry is unclear. It is also possible that the non significant dominance is coincidental.

[Development of an emergency room algorithm for treatment of multiple trauma. Wolfsburg model]

Within the framework of restructuring for the certification to a regional trauma centre of the DGU (German Society for Casualty Surgery), a uniform algorithm for multiple trauma was developed in the medical centre of Wolfsburg. The Wolfsburg multiple trauma algorithm is based on ATLS (advanced trauma life support) with integration of FAST (focused assessment with sonography for trauma), as well as the white paper of the DGU and regional-specific features. Thus structural, instrumental, organizational and personnel conditions were created to improve the care of multiply traumatized patients even further. The conditions for transition to a regional trauma centre of the DGU were confirmed by a successful audit.

[Epistaxis: diagnosis and therapy]

Epistaxis or nosebleed is one of the most frequent emergencies in otorhinolaryngology. It is clearly an important condition--not only to the ear-nose-throat (ENT)-specialist but also to any general practitioner. This review looks at the aetiology, associated clinical considerations and evolution of its management. Intractable epistaxis requires a broad armamentarium of different diagnostic and therapeutic options.

Nonlinear hybridization of the fundamental eigenmodes of microscopic ferromagnetic ellipses

We have studied experimentally with high spatial resolution the nonlinear eigenmodes of microscopic Permalloy elliptical elements. We show that the nonlinearity affects the frequencies of the edge and the center modes in an essentially different way. This leads to repulsion of corresponding resonances and to nonlinear mode hybridization resulting in qualitative modifications of the spatial characteristics of the modes. We find that the nonlinear counterparts of the edge and the center modes simultaneously exhibit features specific for both their linear analogues.

Time-resolved demagnetization of Co2MnSi observed using x-ray magnetic circular dichroism and an ultrafast streak camera

The demagnetization dynamics of the Heusler alloy Co(2)MnSi was studied using picosecond time-resolved x-ray magnetic circular dichroism. The sample was excited using femtosecond laser pulses. In contrast to the sub-picosecond demagnetization of the metal ferromagnet Ni, substantially slower demagnetization with a time constant of 3.5 ± 0.5 ps was measured. This could be explained by a spin-dependent band gap inhibiting the spin-flip scattering of hot electrons in Co(2)MnSi, which is predicted to be half-metallic. A universal demagnetization time constant was measured across a range of pump power levels.

Earedness and auricles

No strong relationship was observed between earedness and the asymmetry of prominent auricles, suggesting no important function of the auricles in ear preference.

[Suppurative chronic otitis media: etiology, diagnosis and therapy]

The chronic otitis media is defined as a permanent perforation of the drum membrane, which does not close by itself, and an inflammatory reaction in the mucosa (mucositis) of the middle ear. Two main forms of the chronic otitis media are distinct: the suppurative otitis media and the cholesteatoma. The suppurative otitis media is often accompanied by secretion into the external ear canal (otorrhoe), but "dry ears" are also common. Other frequent, but not obligatory symptoms are hearing impairment, tinnitus, and aural pain or pressure. Although genetically determined microbial and immunological factors, as well as Eustachian tube characteristics, are supposed to be involved in the pathogenesis of chronic suppurative otitis media, many aspects of the pathogenesis still need to be clarified. Ear microscopy will show the perforation in the drum membrane. Further diagnostic tools are audiometry, vestibular testing, radiological examination (high-resolution computed tomography) and microbiological investigation. The curative treatment for chronic suppurative otitis media is surgery (tympanoplasty, i.e. closure of the perforation in the drum membrane and also--if necessary--the reconstruction of the ossicular chain), not conservative antimicrobial therapy.

[Analgesic intolerance: pathogenesis, diagnosis and treatment]

Analgesic intolerance brings on cutaneous, respiratory and/or gastrointestinal reactions. This review provides an overview of sensitivity to nonsteroidal anti-inflammatory-drugs (NSAR) and its management. The full clinical picture of analgetic intolerance--the association of bronchial asthma (with severe acute attacks), sensitivity to NSAR and nasal polyps--is commonly summarized as the "Samter triad". The symptoms include chronic rhinosinusitis with nasal polyps, asthma bronchiale, gastrointestinal ulcers, angioedema, and urticaria. The prevalence of analgetic intolerance in the general population ranges from 0.6 to 2.5%. Clinical reactions after ingestion of NSAR are often obvious in the further progress of disease. In order to initiate early therapy the diagnosis of analgesic intolerance should occur before the complete picture of analgesic intolerance is obvious. Carefully controlled challenge tests with acetyl salicylic acid or other NSAR are performed as the diagnostic but not potential undamaged tool of choice. Adaptive desensitization (Aspirin desensitization therapy) is currently the single causal therapy. Severe asthma and reactions after ingestion of NSAR are avoided. Frequency of endonasal revision surgery is reduced after desensitization.

[Presbyacusis: pathogenesis and treatment]

Although many adults retain good hearing as they age, hearing loss associated with ageing is common among elderly persons. There are a number of pathophysiological processes underlying age-related changes to functional components. Presbyacusis is especially caused by cochlear degeneration, most pronounced in the basal cochlear coil. Factors include physiological ageing processes as well as endogenous or exogenous causes. The common form of hardness of hearing seen in old age is not due to physiological age-related changes, but rather to a complex sensorineural pattern of injury. In the industrial countries, two main exogenous causes are exposure to loud noise and obesity. Pathomechanisms contributing to presbyacusis are hypoxia/ischemia, reactive species formation and oxidative stress, apoptotic and necrotic death of hair cells and spiral ganglion cells as well as inherited and acquired mutations in the mitochondrial DNA. Important for the successful treatment of presbyacusis is a timely fitting of hearing aids on both ears to improve communication, provide the auditory system with acoustic information, and potential prevention of social isolation. At present, several therapeutic interventions are under discussion. The application of antioxidants or caloric restriction is considered to prevent or reduce oxidative stress-induced damage. A further approach may be the overexpression or modulation of the superoxide dismutase 2 (SOD2) within the cochlea. Hair cell regeneration could also be a possible treatment of presbyacusis in the future.

Nonlinear propagation of spin waves in microscopic magnetic stripes

We have studied experimentally with high spatial and temporal resolution propagation of intense spin waves in microscopic Permalloy stripes. We show that the nonlinearity of the spin system of metallic magnetic films together with microscopic-scale confinement effects lead to an anomalous nonlinear magnetic dynamics, such as a nonlinear spatial self-modulation of spin waves characterized by the repulsive nonlinearity. This phenomenon appears to be densely connected with the nonlinear damping in the system. We find that both of these effects develop synchronously on the nanosecond temporal scale.

Biased quasiballistic spin torque magnetization reversal

We explore the ultrafast limit of spin torque magnetization reversal time. Spin torque precession during a spin torque current pulse and free magnetization ringing after the pulse is detected by time-resolved magnetotransport. Adapting the duration of the pulse to the precession period allows coherent control of the final orientation of the magnetization. In the presence of a hard axis bias field, we find optimum quasiballistic spin torque magnetization reversal by a single precessional turn directly from the initial to the reversed equilibrium state.

[Piercing--medical problems from otorhinolaryngological point of view]

Piercing is defined as puncturing an organ in order to place a jewel in the perforated site. There is hardly any external organ in the human body that has escaped piercing. The origin of piercing traces back to the dawn of human history. Piercing is performed for decorative or symbolic purposes. Many different medical specialists are confronted with the increasingly popular practice of body piercing in their daily practice. Until recently body piercing was mainly confined to the ears and/or nose. In the last few years there has been a significant increase in the prevalence of body piercing. There are a lot of side effects, among them especially infections. The most important bacteria cultivated from such patients are Staphylococcus aureus and group A streptococci and Pseudomonas aeruginosa. Viruses which can be transmitted by piercing are especially hepatitis B virus and hepatitis C virus. Besides local complications also systemic infections (sepsis, endocarditis) occur. The main aspects of diagnostics, therapy and prevention are discussed.

[Sialorrhea--causes and treatment options]

Sialorrhea (drooling) is the involuntary spillage of saliva from the mouth. Drooling of saliva appears to be the consequence of a dysfunction in the coordination of the swallowing mechanism, resulting in excess pooling of saliva in the anterior portion of the oral cavity and the unintentional loss of saliva from the mouth. There are specific and symptomatic approaches to manage this condition. Treatment options range from conservative (i.e., observation, postural changes, biofeedback, motoric therapy of the mouth, acupuncture) to more aggressive measures such as medication, radiation, and surgical therapy.

Magnetic vortex core reversal by excitation with short bursts of an alternating field

The vortex state, characterized by a curling magnetization, is one of the equilibrium configurations of soft magnetic materials and occurs in thin ferromagnetic square and disk-shaped elements of micrometre size and below. The interplay between the magnetostatic and the exchange energy favours an in-plane, closed flux domain structure. This curling magnetization turns out of the plane at the centre of the vortex structure, in an area with a radius of about 10 nanometres--the vortex core. The vortex state has a specific excitation mode: the in-plane gyration of the vortex structure about its equilibrium position. The sense of gyration is determined by the vortex core polarization. Here we report on the controlled manipulation of the vortex core polarization by excitation with small bursts of an alternating magnetic field. The vortex motion was imaged by time-resolved scanning transmission X-ray microscopy. We demonstrate that the sense of gyration of the vortex structure can be reversed by applying short bursts of the sinusoidal excitation field with amplitude of about 1.5 mT. This reversal unambiguously indicates a switching of the out-of-plane core polarization. The observed switching mechanism, which can be understood in the framework of micromagnetic theory, gives insights into basic magnetization dynamics and their possible application in data storage.

[Sleep disturbances--aspects of obstructive and sleep-related breathing disorders]

Obstructive sleep apnea (OSA) is a wide spread affliction in industrialised countries. OSA has to be distinguished from simple snoring which is socially annoying but physically harmless, since it does not harm the physical health. Patients with OSA complain about disruptive snoring, daytime sleepiness, and loss of intellectual power. OSA is associated with increased mortality. It is possible to distinguish between complete respiratory pauses or apnoea and periods of too shallow breathing or hypopnoea. History taking, clinical examination, recording of daytime sleepiness, and cardio-respiratory sleep studies are necessary to make a proper diagnosis. OSA should primarily be treated, not so the simple snoring. In sleep apneics the treatment focuses on the removal of the sleep-related breathing disturbances and their health-related consequences. Therefore adjuvants or minimally invasive surgical techniques are favoured. Gold standard treatment of OSA is nasally applied continuous positive airway pressure (nCPAP). Alternative treatment modalities are also used. As conservative approaches oral appliances and conditioning (to avoid supine sleeping position) show promising results. Surgical treatment complies with the severity of the disease and with the anatomical findings. A variety of surgical approaches to the soft palate, the base of tongue, the tonsils, and the upper and lower jaws have been described.

Loss of trigeminal sensitivity reduces olfactory function

The trigeminal and olfactory nerves share overlapping innervation areas in the nasal cavity and seem to work in an interactive way. Loss of olfactory function leads to a decreased trigeminal sensitivity, as shown in anosmic subjects. To report the impact of disturbed trigeminal sensitivity on the olfactory function, we present a patient with unilateral loss of trigeminal function resulting from a meningeoma. Thresholds to a selective olfactory stimulus were elevated by a factor of 64 on the affected side. Recordings of event-related potentials in response to olfactory stimuli showed a significantly reduced response on the affected side. This report indicates that loss of trigeminal function may affect the sense of smell.

[Dry mouth]

Dryness of the mouth (xerostomia) is a serious problem for the affected patients, in particular if it is caused by a reduced salivation. Triggering factors are, e.g., drugs (antihypertensives, neuroleptics), CNS disorders, chronic obstruction of nasal breathing, irradiation therapy of head-neck tumors, Sjögren's syndrome, sarcoidosis, or diabetes mellitus. Patients with xerostomia should be diagnosed and treated on an interdisciplinary basis. Several causal and symptomatic therapeutic options are available, including local stimulation of salivation. In addition, prevention is to be emphasized. In most patients symptomatic improvement and thus an improved quality of life can be achieved.