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The article reports on the results of a feasibility study in 15 patients who had piezoelectric device for bone work in endoscopic anterior skull base surgery. Endoscopic transsphenoidal pituitary surgery has become the norm in the surgical treatment of most pituitary lesions. Despite excellentresults and postoperative CSF-leaks and skull base reconstructionsare still considerable issues.

Objective: Timing for sexual intercourse is important in achieving pregnancy in natural menstrual cycles. Different methods of detecting the fertile window have been invented, among them luteinization hormone (LH) to predict ovulation and biphasic body basal temperature (BBT) to confirm ovulation retrospectively. The gold standard to detect ovulation in gynecology practice remains transvaginal ultrasonography in combination with serum progesterone. In this study we evaluated a wearable temperature sensing patch (femSense®) using continuous body temperature measurement to confirm ovulation and determine the end of the fertile window., Methods: 96 participants received the femSense® system consisting of an adhesive axillary thermometer patch and a smartphone application, where patients were asked to document information about their previous 3 cycles. Based on the participants data, the app predicted the cycle length and the estimated day of ovulation. From these predictions, the most probable fertile window and the day for applying the patch were derived. Participants applied and activated the femSense® patch on the calculated date, from which the patch continuously recorded their body temperature throughout a period of up to 7 days to confirm ovulation. Patients documented their daily urinary LH test positivity, and a transvaginal ultrasound was performed on day cycle day 7, 10, 12 and 14/15 to investigate the growth of one dominant follicle. If a follicle reached 15 mm in diameter, an ultrasound examination was carried out every day consecutively until ovulation. On the day ovulation was detected, serum progesterone was measured to confirm the results of the ultrasound. The performance of femSense® was evaluated by comparing the day of ovulation confirmation with the results of ovulation prediction (LH test) and detection (transvaginal ultrasound)., Results: The femSense® system confirmed ovulation occurrence in 60 cases (81.1%) compared to 48 predicted cases (64.9%) with the LH test ( p  = 0.041). Subgroup analysis revealed a positive trend for the femSense® system of specific ovulation confirmation within the fertile window of 24 h after ovulation in 42 of 74 cases (56.8%). Cycle length, therapy method or infertility reason of the patient did not influence accuracy of the femSense® system., Conclusions: The femSense® system poses a promising alternative to the traditional BBT method and is a valuable surrogate marker to transvaginal ultrasound for confirmation of ovulation., Competing Interests: The study was financed by the SteadySense GmbH (Austria). WK is the founder/CEO of SteadySense GmbH and KS is employed by SteadySense GmbH. The funder had the following involvement with the study: data collection, data analysis, study design, preparation of the manuscript and decision to publish. MS is CEO of Das Kinderwunsch Institut Schenk GmbH. NR and GW are employed by Das Kinderwunsch Institut Schenk GmbH., (© 2022 Weiss, Strohmayer, Koele, Reinschissler and Schenk.)

Since the human body reacts to a variety of different diseases with elevated body temperature, measurement of body temperature remains relevant in clinical practice. The absolute temperature value for fever definition is still arbitrary and depends on the measuring site, as well as underlying disease and individual factors. Hence, a simple threshold for fever definition is outdated and a definition which relies on the relative changes in the individual seems reasonable as it takes these individual factors into account. In this prospective multicentric study we validate an adhesive axillary thermometer (SteadyTemp®) which allows continuous non-invasive temperature measurements. It consists of a patch to measure temperature and a smartphone application to process and visualize gathered data. This article provides information of the new diagnostic possibilities when using this wearable device and where it could be beneficial. Furthermore, it discusses how to interpret the generated data and when it is not practical to use, based on its characteristics and physiological phenomena., Competing Interests: The study was financed by the SteadySense GmbH, Seiersberg-Pirka, Austria. JE, KS, MF, and WK is employed by SteadySense GmbH. This study received funding from SteadySense GmbH. The funder had the following involvement with the study: data collection, data analysis, study design, preparation of the manuscript and decision to publish. MS and GW is employed by Das Kinderwunsch Institut Schenk GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Boyer, Eckmann, Strohmayer, Koele, Federspiel, Schenk, Weiss and Krause.)

Chordomas are rare malignant tumors that develop from embryonic remnants of the notochord and arise only in the midline from the clivus to the sacrum. Surgery followed by radiotherapy is the standard treatment. As chordomas are resistant to standard chemotherapy, further treatment options are urgently needed. We describe the establishment of a clivus chordoma cell line, MUG-CC1. The cell line is characterized according to its morphology, immunohistochemistry, and growth kinetics. During establishment, cell culture supernatants were collected, and the growth factors HGF, SDF-1, FGF2, and PDGF analyzed using xMAP(®) technology. A spontaneous lymphoblastoid EBV-positive cell line was also developed and characterized. MUG-CC1 is strongly positive for brachyury, cytokeratin, and S100. The cell line showed gains of the entire chromosomes 7, 8, 12, 13, 16, 18, and 20, and high level gains on chromosomes 1q21-1q24 and 17q21-17q25. During cultivation, there was significant expression of HGF and SDF-1 compared to continuous chordoma cell lines. A new, well-characterized clival chordoma cell line, as well as a non-tumorigenic lymphoblastoid cell line should serve as an in vitro model for the development of potential new treatment strategies for patients suffering from this disease.

Objectives/hypothesis: Fungus balls are a common disease of the paranasal sinuses, usually involving the maxillary sinus. To clarify the pathology, we analyzed patients treated for maxillary sinus fungus balls to see whether the latter correlated with dentogenic factors., Study Design: Retrospective case analysis., Methods: Cases of maxillary sinus fungus balls diagnosed between January 2000 and December 2013 were analyzed retrospectively. Patients' charts were reviewed for diagnosis, gender, and age. Paranasal sinus computed tomography (CT) scans were reviewed according to the side of the fungus ball, calcifications/opacifications, and dentogenic factors., Results: In 98/102 patients (96.1%), 157 dentogenic factors could be identified on the side affected by a fungus ball. On the contralateral healthy side, there were 125 dentogenic factors. In four (3.9%) of the patients, no dentogenic pathology was identified on the CT scan. The presence of dentogenic factors (regardless of number) was significantly associated with a fungus ball compared to the healthy side (P = .024, χ(2) test, odds ratio: 2.72 [95% confidence interval: 1.02-7.23])., Conclusions: Dentogenic factors regardless of type potentially correlate with the presence of maxillary sinus fungus ball. Unlike the overall presence of dentogenic factors, the particular dentogenic factors in an individual patient do not significantly influence the development of fungus balls. After diagnosis of dentogenic pathology in penetrated maxillary sinus floors, patients should be closely monitored and informed about their higher risk of developing a fungus ball., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

The benefit of fibrin glue for reduction of postoperative CSF-leaks after endoscopic skull base surgery is not clearly evident in literature. However, its use is supposed to be beneficial in fixing grafting material. As of today there is no specific data available for otolaryngological procedures. A retrospective data analysis at a tertiary care referral center on 73 patients treated endoscopically transnasally for CSF-leaks at the ENT-department Graz between 2009 and 2012 was performed. Primary closure rate between conventional fibrin glue and autologous fibrin glue were analyzed. The Vivostat(®) system was used in 33 CSF-leak closures and in 40 cases conventional fibrin glue was used. Comparing the two methods the primary closure rate using the autologous Vivostat(®) system was 75.8 and 85.0 % with conventional fibrin glue. The secondary closure the rates were 90.9 % with Vivostat(®) 92.5 % with conventional fibrin glue. The Vivosat(®) system is a useful adjunct in endoscopic CSF-leak closure. Its advantages over conventional fibrin glue are its application system for fixation of grafting material particularly in underlay techniques. Despite this advantage it cannot replace grafting material or is a substitute for proper endoscopic closure which is reflected by the closure rates.

Objective: Endoscopic transsphenoidal approach has become the gold standard for surgical treatment of treating pituitary adenomas or other lesions in that area. Opening of bony skull base has been performed with burrs, chisels, and hammers or standard instruments like punches and circular top knives. The creation of primary bone flaps-as in external craniotomies-is difficult.The piezoelectric osteotomes used in the present study allows creating a bone flap for endoscopic transnasal approaches in certain areas. The aim of this study was to prove the feasibility of piezoelectric endoscopic transnasal craniotomies. Study Design. Cadaveric study., Methods: On cadaveric specimens (N = 5), a piezoelectric system with specially designed hardware for endonasal application was applied and endoscopic transsphenoidal craniotomies at the sellar floor, tuberculum sellae, and planum sphenoidale were performed up to a size of 3-5 cm(2)., Results: Bone flaps could be created without fracturing with the piezoosteotome and could be reimplanted. Endoscopic handling was unproblematic and time required was not exceeding standard procedures., Conclusion: In a cadaveric model, the piezoelectric endoscopic transsphenoidal craniotomy (PETC) is technically feasible. This technique allows the surgeon to create a bone flap in endoscopic transnasal approaches similar to existing standard transcranial craniotomies. Future trials will focus on skull base reconstruction using this bone flap.

Objective: Cholesterol granulomas are benign lesions that sometimes occur on the petrous apex (PA). We report our experience using an endoscopic endonasal approach to remove PA cholesterol granulomas., Material and Methods: A retrospective patient chart analysis was conducted at a tertiary care university hospital., Results: Four patients (3 females, 1 male) were included in this study. Patients' ages ranged from 27 to 78 years. Computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis and computer-assisted navigation were performed. The most common symptom was abducens nerve palsy. The largest granuloma measured 5 x 2 cm and was located on the left side. An endoscopic endonasal approach was chosen and navigation was applied (3/4 patients) to identify the optimal area for opening the granuloma. No complications occurred, and patients were free from recurrence during the follow-up period., Conclusion: The endoscopic endonasal approach to PA cholesterol granulomas is feasible and safe. Intra-operative navigation is recommended to identify the position of the internal carotid artery and determine the safest area for opening the granuloma without damaging the artery. Another advantage of this approach is an easier follow-up through diagnostic nasal endoscopy.

Introduction: Malignant peripheral nerve sheath tumours (MPNSTs) are rare neoplasias, often having progressive growth and an unfavourable outcome. Patients relapse regularly and the tumour metastasizes frequently. Early diagnosis and intense therapy, including radical resection and adjuvant radio- and chemotherapy, are necessary to achieve cure or prolonged survival., Case Report: A woman aged 60 years, survived 137 months from an initial diagnosis of fibroma of the sinus, which later proved to be intracerebral progressive malignant metastasized nerve sheath tumour., Discussion: A literature review and various case reports showed that MPNSTs are generally highly malignant, and often cannot be cured. Patients can be cured if the tumour is completely removed following adjuvant radio- and chemotherapy, depending on the tumour location.

Objectives/hypothesis: The aim of this study was to measure the temperature generated by light sources in conjunction with angulated endoscopes and to analyze whether the heat generated at the endoscopes' tips harbors potential damage to mucosa or highly sensitive structures like the optic nerve or brain when in direct contact, considering a beginning necrosis of human protein starting at 40°C., Study Design: Laboratory setting, prospective., Methods: Brand new 4-mm, 0° and 30° rigid nasal endoscopes were measured each with halogen, xenon, and light-emitting diode (LED) light sources, respectively, at different power levels for tip contact temperature., Results: The highest temperatures were reached with a xenon light source at a maximum of 44.3°C, 65.8°C, and 91.4°C at 33%, 66%, and 100% power levels, respectively, for 4-mm, 0° endoscopes. For 30° endoscopes, temperatures of 47.0°C, 75.1°C, and 95.5°C were measured at 33%, 66%, and 100% power levels (P < .001; 0° vs. 30°), respectively. At 5-mm distance from the tip, temperatures were below body temperature for all light sources (<36°C) at all power settings. Within 2 minutes after switching off light sources, temperatures dropped to room temperature (22°C)., Conclusions: Xenon light sources have the greatest illumination potential; however, at only 33% power level, potentially harmful temperatures can be reached at the tips of the endoscopes. Power LED and halogen have the highest safety; however, only LED has very good illumination. In narrow corridors, direct contact to tissues or vital structures should be avoided, or endoscopes should be cooled during surgical procedures., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)

Problem: Syphilis is a sexually-transmitted disease caused by the spirochete Treponema pallidum, and is transmitted either through sexual contact or vertically across the placenta. Rates of infection were at a low point in the early 1990s. Since then, increasing numbers of new cases of infections have been observed in all Western countries., Aim: Presentation of three patients with syphilis who presented within a short period of time in an ENT outpatient clinic., Conclusions: One must be aware of the increasing incidence of syphilis, even in head and neck disciplines. Typical symptoms of an early infection are an ulcerous lesion in the mouth, with or without cervical lymphadenopathy. The main therapy is high doses of penicillin G administered intramuscularly. Other simultaneous sexually-transmitted diseases, especially HIV infection, must be excluded. Unnoticed and untreated patients may develop late and life-threatening complications.

Inverted papillomas (IP) are considered benign lesions with a prevalence up to 4% among all sinunasal tumors; however, invasive growth and varying tendency for malignization are reported in literature. We report the case of a 69-year-old woman suffering from a large, aggressively growing IP invading the orbit, skull base, and frontal lobe of the brain. Within only 3 months' time the papilloma showed transformation into an invasive carcinoma, leaving surgical therapy in vain due to explosive recurrence. Intracranial and intraorbital expansion by IP is possible despite histology not showing signs of malignancy initially. In "regular" IP close endoscopic follow-up is mandatory to not overlook recurrence harboring malignancy.

Background: Paranasal Sinus (PNS) CT- scans are routinely performed for screening of sinusitis in patients scheduled for organ transplant at the University Hospital Graz. This study was performed to evaluate whether routine PNS CT-scans are necessary in every transplant patient or in selected cases only, because clear evidence is missing in literature., Material/methods: 142 patients (113 male, 29 female) were included in this retrospective patient chart study., Results: The majority of patients (n=142) were scheduled for liver transplant (n=79). Of all patients (n=142), 50 (35.2%) had normal PNS CT-scans and 92 (64.8%) had a pathologically changed PNS-scan. Seventy-one out of these 92 (77.2%) patients did not show clinical symptoms of sinusitis nor changes in diagnostic endoscopy, 21 (22.8%) patients did have symptoms of sinusitis and diseased PNS CT-scans. Three out of 71 (4.2%) without symptoms but pathologic CT-scans compared to 7/21 (33.3%) patients with symptoms and pathological CT-scans underwent endoscopic paranasal sinus surgery (FESS). All patients operated suffered from chronic sinusitis, none had mycotic or neoplastic disease in definite histology., Conclusions: Since there was a high rate (77.2%) of pathological CT scans unrelated to sinusitis symptoms these findings should be considered as accidental. In our opinion routine paranasal sinus CT scans are not feasible in patients scheduled for organ transplant according to high rate of false positive results.

Objectives/hypothesis: Topical antifungal treatment is a subject of discussion in the treatment of chronic rhinosinusitis. The aim of this research was to study the effects of antifungal drugs on ciliary beat frequency (CBF) of human nasal mucosa under in vitro conditions., Study Design: Case series of in vitro experiments and in vitro study of cultured ciliated cells of human nasal mucosa., Methods: Human nasal mucosa was acquired during routine endoscopic sinus surgery. Cells were cultivated on object slides and exposed to different antifungal drugs in a newly developed test system. This system allowed continuous and reproducible exposure to different drugs at constant temperature, pH value, and osmolarity. The drugs were amphotericin B in two different concentrations and itraconazole., Results: Rinsing with higher concentrations of amphotericin B led to an immediate decrease of CBF, with a total stop after 15 minutes. A different result was seen in the group with lower concentrations; CBF decreased again quickly after rinsing with the test drug, but all of them recovered after rinsing with neutral solution. When using itraconazole a decline in CBF was observed again; one half of the samples returned to activity., Conclusions: Our in vitro results demonstrate a dose-dependent effect of the antifungal drugs amphotericin B and itraconazole on ciliary beat frequency of human nose epithelium.

Introduction: Though clear indications for its clinical application are not established yet, balloon sinuplasty technology per se is considered safe and very few severe complications have been mentioned in literature as of today., Case Report: We report the case of a 36-year-old female patient who presented with right sided rhinorrhea from a CSF-leak in the ethmoidal roof after balloon sinuplasty, aimed at her right frontal sinus. Apparently, the surgeon was unaware of having penetrated the skull base through the lateral lamella of the cribriform plate intraoperatively. CSF rhinorrhea became evident 3 weeks postoperatively only when fever, headaches and moderate nausea developed. Upon revision, diameter, size and shape of the bony defect exactly matched with the tip of a standard sinus balloon catheter device, as could be demonstrated and documented. A small posttraumatic encephalocele had intermittently blocked the leak. Endoscopic surgery and duraplasty were performed under intrathecal fluorescein control, applying CT image-guided navigation. Since two-layer fascia lata closure of the defect, the patient has remained free of symptoms without any evidence of CSF leakage., Conclusion: Balloon sinuplasty per se is considered a safe technique, though in inexperienced hands or wrongly applied, complications may occur, as with any surgical tool rigid enough to breach through skull base.

Objective: To evaluate the long term outcome after endoscopic endonasal resection of juvenile nasopharyngeal angiofibromas (JNA)., Methods: Retrospective study of a series of 21 consecutive patients undergoing endoscopic resection of JNA (type I - IIIa according to Fisch) at two Hospital Centers between 1993 and 2002. Mean follow-up was 51.7 months (range 5-120). Extension to the medial aspect of infratemporal fossa and retromaxillary space was no contraindication against an endonasal endoscopic approach. In three cases of type IIIa tumours a computer assisted intraoperative guiding system was applied (ENTrak, GE Medical, Lawrence, USA)., Results: Fifteen patients (71.4%) were free of disease after one endoscopic resection. Three patients (14.3%) had an unmistakable recurrence with the need for further treatment at 6, 14, and 23 months, respectively. Two of the three recurrent tumours have been successfully resected endoscopically, one case was treated with gamma knife. In three patients (14.3%) postoperative MRI showed localized enhanced signal, presumably minimal persistent tumour tissue. Without further treatment all of these patients remained free of symptoms and MRI follow up showed no tumour growth over three, five and ten years, respectively. No postoperative long term sequela was observed., Conclusions: Resection of nasopharyngeal angiofibromas type I-IIIa can be safely achieved endoscopically. The advantage of this minimally invasive technique is avoidance of external scars and low morbidity. The intraoperative computer assisted guiding system ENTrak was highly accurate and provided substantial help in selected cases.

We report on our experience with navigational tools in paranasal sinus and anterior skull base surgery, especially with electromagnetic guidance systems. During the last five years we operated over 80 selected cases with the InstaTrak system from VTI (Lawrence, MS, USA). Applicability and user friendliness were explored. The InstaTrak 3500 employs a Sun Workstation and is a frameless and free-arm and navigation system. Two different suction devices, used as sensors (receivers), and one transmitter are interconnected to this workstation. The position of the tip of the aspirator is displayed as a pair of crosshairs on the screen in axial, coronal and sagittal planes of the patient's CT-scan on the computerscreen online. Our results showed high accuracy-level, usually better than one millimeter and a setup-time less than ten minutes, on average. No additional personnel is required in the OR. We believe that the system enhances efficacy in selected cases like revision surgery, tumor surgery or difficult anterior skull base surgery. However, one should consider that medicolegal responsibility stays always with the surgeon and not with any navigation system.

Accurate knowledge of age-related development and pneumatisation of the paranasal sinuses has become an important issue in diagnosing paranasal sinus diseases in infants and young adults. Magnetic resonance imaging (MRI) has the potential to assess bone marrow conversion and pneumatisation of the paranasal sinuses. We retrospectively reviewed 800 children aged 0-14 years undergoing brain MRI for various indications. T1-weighted sagittal and T2-weighted axial scans were evaluated for bone marrow conversion and development of pneumatisation of the sphenoid sinus. The sphenoid sinus had a uniformly low signal intensity on T1-weighted images in all children less than four months old. Signal intensity began to change to hyperintense marrow at the age of four months. Onset of pneumatisation was observed in 19% at the age of 12-15 months. Pneumatisation was complete in all patients older than 10 years. In conclusion, these data can be used as baseline standards of normal age-related development of the sphenoid sinus and can be of great value for the diagnostic and therapeutic management of pathologic conditions of the child's sphenoid sinus and its surrounds.

We present the first case report of an endoscopic removal of a living worm, species Dirofilaria repens, from the orbital cavity. As of today, over 410 cases of Dirofilaria repens infections in man are recorded in world literature, six of which were localized in the orbital cavity. In Austria we know of four cases of an infection with this parasite, but none in the orbit. Dirofilaria repens is widespread only in the Old World, particularly in Southern and Eastern Europe, in Asia Minor, and in Central and Southern Asia. The highest prevalence of the disease is recorded in Italy (181 cases). In clinical practice, the infections have mostly been misdiagnosed as a neoplasia, usually benign but sometimes malignant. Under the assumption of an intraorbital tumor, the endoscopic transnasal revision of the orbital cavity was performed, as this approach promised to be least traumatic and best suited for the lesion, resulting in complete removal of the live worm. In unclear lesions in the head and neck, and infection with Dirofilaria repens should be considered as a differential diagnosis.