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Die postoperative Behandlung stellt einen entscheidenden Aspekt fur den Erfolg von Nasennebenhohleneingriffen dar. Zu den grundlegenden Masnahmen gehoren Nasenspulungen mit Salzlosung, mit denen bereits am ersten postoperativen Tag begonnen werden sollte, die topische Steroidapplikation und die Gabe von Antibiotika im Fall einer Infektion. Zur arztlichen Versorgung gehort das Absaugen des unteren Nasengangs in der ersten Woche. Die Krustenentfernung im Op.-Bereich sollte unter endoskopischer Kontrolle in der zweiten Woche beginnen. Dabei werden die Intervalle individuell festgelegt. Die Okklusion der Nase fur die Zeit der Epithelregeneration halt den ethmoidalen Raum feucht, was zu einer besseren Wundheilung fuhrt.

Objective: Multidisciplinary endoscopic approaches in pituitary surgery are increasing despite a lack of high-quality evidence favoring transsphenoidal endoscopic over transsphenoidal microscopic or transcranial microscopic techniques. The goal of our analysis was to compare these techniques in a retrospective [for full text, please go to the a.m. URL]

Background and objectives Hereditary hemorrhagic telangiectasia (HHT) is a hereditary condition that is associated with arteriovenous malformations. A common site for these malformations is the nasal mucosa, which is associated with severe epistaxis and debilitation for affected patients. We evaluated the efficacy and safety of blue light laser technology in treating these endonasal manifestations in a retrospective chart analysis. Additionally, we compared blue light laser technology to bipolar coagulation in an animal model. Study design/materials and methods We performed a retrospective chart analysis of all patients that were diagnosed with HHT and received endonasal blue light laser treatment between 10/2017 and 04/2019. In addition, we performed bipolar or blue light laser coagulation of all macroscopically visible vessels on thyroid gland lobes (n = 4) from Dunkin-Hartley Guinea Pigs. Hematoxylin-eosin (HE) staining was then used to visualize depth and area of coagulation surrounding these vessels. Results One hundred and fifty-one treatments in 23 patients were analyzed. Under regular blue light laser treatment, quality of life (QOL), indicated on a visual analog scale from 1 to 10, gradually increased significantly from 5.6 ± 0.5 (before the first treatment) to 7.5 ± 0.9 (after the second treatment). Following this, QOL remained steady throughout additional treatments. Adverse effects were not recorded. HE staining showed that coagulation depth (162 ± 56 vs. 586 ± 192 µm) and area (74 ± 35 vs. 1015 ± 449 µm2 ) were significantly lower after laser treatment. Conclusion Blue light laser therapy is safe and efficient in treating HHT. Damage to the surrounding tissue is significantly lower compared with bipolar coagulation. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Endonasal surgery has emerged as the standard procedure for the majority of nasal and paranasal sinus pathologies. However, some pathological changes beyond the maxillary sinus seem to be out of the instrumental range and are addressed by open approaches. The prelacrimal approach to the maxillary sinus published by Zhou and coworkers has stimulated a rapid development of various procedures in this field. In the current work, the possibilities of the prelacrimal approach are illustrated by means of three clinical cases. The prelacrimal approach enables isolated fractures of the orbital floor to be reconstructed without the risk of lower eyelid complications. Meningo- or encephaloceles in the far lateral aspects of the sphenoid sinus are comparatively well reached via endonasal, transantral, and transpterygoid approaches. Until recently, tumors beyond the maxillary sinus were the domain of open surgery, particularly when they extended laterally of the maxillary sinus. The technique of choice was either a Caldwell-Luc or a midfacial degloving approach. Many of these operations can now be performed via the endonasal prelacrimal approach, with lower morbidity and more rapid postoperative healing. The approach described herein is equal if not superior to the traditional approaches in terms of overview and accessibility.

Gefasanomalien sind insgesamt sehr selten, konnen aber sowohl bei Kindern als auch bei Erwachsenen in fast jeder Korperregion auftreten. Aufgrund der Komplexitat dieser vielgestaltigen Erkrankungen ist der Weg zur Diagnosestellung oft sehr schwierig und Bedarf haufig eines interdisziplinaren Teamworks mit engen Absprachen zwischen den einzelnen Behandlungspartnern. Ebenso empfiehlt sich auch fur die Therapieplanung und Durchfuhrung ein Austausch zwischen den einzelnen Disziplinen. Dieser Artikel liefert eine Ubersicht der verschiedenen Haupttypen der Gefasmalformationen aus klinischer, bildgebender und histologischer Sicht in Anlehnung an die aktuelle Klassifikation der Internationalen Gesellschaft zum Studium vaskularer Anomalien (ISSVA).

For dielectric elastomer actuators (DEAs) to find more widespread adoption in commercial products, a better understanding of their durability is needed. By determining the different mechanisms contributing to ageing and breakdown in DEAs, new methods for improving their lifetime could be devised. Using a newly-developed setup for performance and lifetime evaluation of DEAs, we investigate how the choice of electrode material and application process influence lifetime. Our investigation is focused on DEAs made from a slide ring material (SRM) as the dielectric. SRM is an interesting candidate for DEAs as it offers a much higher permittivity (er < 7) than commonly used silicone rubbers. However, the log-term durability of SRM DEAs, and how it is influenced by external factors such as the type of electrode material, has not yet been thoroughly studied. We tested SRM DEAs made with various carbon-based electrode materials, different application methods including blade casting, inkjet- and pad-printing, and ink formulations with different solvents. Average lifetime of the DEAs at 50 Hz and 40 V/μm varied from under 1 h (160,000 cycles) to over 100 h (16,000,000 cycles) between the different electrode types. Our experiments show that not only the type of material but also the thickness and topology of the electrode layer can greatly influence lifetime. We observed that some solvents such as isopropyl alcohol cause swelling and wrinkling of the SRM membrane, but that this has no negative impact on lifetime. We propose that high electrode resistance can improve lifetime by limiting current and reducing the damage from heating, arcing, or partial discharge. This effect can also be achieved by addition of an external resistor. Our results suggest that charge and discharge current of DEAs should always be limited to the very minimum needed for the intended application in order to reduce degradation.

Unilateral diseases of the maxillary sinus are among the most common rhinologic diagnoses. The diversity of these diseases can represent a challenge for the treating physician. The spectrum ranges from harmless maxillary sinus cysts that seldom require treatment, to highly aggressive malignant tumors. Special attention should be given to the management of inverted papilloma. These benign tumors are characterized by high recurrence rates and the potential for malignant transformation. The key to minimizing recurrence is precise surgical intervention. Other unilateral maxillary sinus diseases such as the antrochoanal polyp and the fungus ball (aspergilloma) are also discussed in depth.Einseitige Erkrankungen der Kieferhöhle zählen zu den häufigsten rhinologischen Diagnosen. Die Vielfalt dieser Erkrankungen kann eine potenzielle Herausforderung für den behandelnden Arzt werden. Das Spektrum der Diagnosen erstreckt sich von harmlosen Kieferhöhlenzysten, die selten eine Therapie benötigen, bis zu hoch aggressiven Malignomen. Von großer Bedeutung sind die Diagnose und Therapie des invertierten Papilloms. Das Besondere dieses benignen Tumors sind die hohen Rezidivraten und eine mögliche maligne Entartung. Der Schlüssel zur Vermeidung eines Rezidivs ist eine gezielte Operation. Weitere Erkrankungen wie der Antrochoanalpolyp und der Pilzball (Aspergillom) der Kieferhöhle werden ausführlich diskutiert.

Perivascular epithelioid cell neoplasms (PEComas) are a family of mesenchymal neoplasms with features of both melanotic and smooth muscle differentiation. PEComa morphology is highly variable and encompasses epithelioid to spindle cells often with clear cytoplasm and prominent nucleoli. Molecularly, most PEComas are defined by a loss of function of the TSC1/TSC2 complex. Additionally, a distinct small subset of PEComas harboring rearrangements of the TFE3 (Xp11) gene locus has been identified. By presenting a series of three case reports with distinct features, we demonstrate diagnostic pitfalls as well as the importance of molecular work-up of PEComas because of important therapeutic consequences.

ZusammenfassungIn der endonasalen endoskopischen Chirurgie kam es im letzten Jahrzehnt zu Fortschritten durch ein verbessertes Verständnis der Mikroanatomie, den Zugewinn additiver medikamentöser Therapieoptionen und die Optimierung der instrumentellen Technik. In den gleichen Kontext kann die Weiterentwicklung und Beforschung röhrenförmiger oder solider Platzhalter („stents“ oder „spacer“) mit und ohne simultane Freisetzung von Medikamenten gestellt werden – der vorliegende Übersichtsbeitrag stellt den aktuellen Stand dieser Entwicklungen vor.

Surgical management of lacrimal duct obstruction beyond the canaliculi proves to be a promising endeavor in most cases. To realize the full potential of endonasal dacryocystorhinostomy, some aspects of diagnosis and differential indication setting should be considered in order to avoid errors and problems during patient selection, execution of the technical procedure, and communication with ophthalmologists. These issues are described according to the clinical management of patients; current literature is cited.

Osler's disease is an autosomal dominant hereditary syndrome which belongs to the group of orphan diseases. Affected patients suffer primarily from severe epistaxis. Diagnosis is based on the Curacao criteria and molecular genetic tests. Organ manifestations can be found in the form of arteriovenous shunts in the lung, liver, and gastrointestinal tract; more rarely also in the central nervous system (CNS) and other parts of the body. Many patients with gastrointestinal and other organ manifestations are frequently clinically asymptomatic; therefore, organ screening is essential to avoid later complications and should be performed in centers with particular expertise. No curative therapy currently exists. From the otolaryngologist's perspective, nasal mucosa treatments and endonasal laser applications are important and effective therapeutic approaches to epistaxis. Pharmacological interventions are focused on compensation of haploinsufficiency as well as antiangiogenetic approaches. Severe side effects have to be considered.

Vascular anomalies are very rare, but can occur in children and adults in almost every region of the body. Due to the complexity of this disease, the path to a definitive diagnosis is often difficult. It requires interdisciplinary teamwork with close exchange of information between the individual treatment partners to reach the correct diagnosis and then to start the best therapy. This article provides an overview of the main types of vascular malformations from a clinical, imaging, and histological point of view, following the current classification of the International Society for the Study of Vascular Anomalies (ISSVA).

Perivascular epithelioid cell neoplasms (PEComas) are a family of mesenchymal neoplasms with features of both melanotic and smooth muscle differentiation. PEComa morphology is highly variable and encompasses epithelioid to spindle cells often with clear cytoplasm and prominent nucleoli. Molecularly, most PEComas are defined by a loss of function of the TSC1/TSC2 complex. Additionally, a distinct small subset of PEComas harboring rearrangements of the TFE3 (Xp11) gene locus has been identified. By presenting a series of three case reports with distinct features, we demonstrate diagnostic pitfalls as well as the importance of molecular work-up of PEComas because of important therapeutic consequences.

We present an automated test setup for the systematic performance and lifetime evaluation of dielectric elastomer actuators (DEAs). This setup, called the MAPLE setup, performs accelerated aging tests and allows quantifying how material choice, fabrication methods, voltage waveform, and environmental conditions influence DEA lifetime, an important step for commercial use of DEAs. The setup continuously monitors strain and electrode resistance of multiple DEAs under a wide range of environmental conditions (up to 85 °C and 85% relative humidity), with automatic breakdown detection to record device lifetime. To illustrate a use case, we investigate the lifetime of DEAs made of two different elastomer materials, comparing fixed polarity (FP) vs. periodically reversing the polarity of the actuation voltage. For DEAs made from a slide-ring material, lifetime improvements around 10× were observed at alternating polarity compared to FP. For DEAs made from silicone rubber, no improvement in lifetime was observed. This indicates that different degradation mechanisms are causing failure in the two materials.

Hintergrund Die Epworth-Schlafrigkeits-Skala (ESS) ist ein haufig benutztes Messinstrument, um das Ausmas von Tagesschlafrigkeit bei Patienten mit schlafbezogenen Atmungsstorungen zu erfassen. Inwieweit die Tagesschlafrigkeit bedingt durch tageszeitabhangige Vigilanzschwankungen zum Zeitpunkt der Beantwortung der ESS-Fragen einen Einfluss auf den Summenwert der ESS hat, ist bisher noch nicht umfassend geklart.

The objective is to use anatomical determinations of nasal septum shape and surface area in adults as a design basis for silastic septal splints of universal size and fit and offering maximum possible surface coverage. The objective is also to devise a method of securing the septal splints, so that surface pressure on septal mucosa is distributed as evenly as possible while not interfering with capillary perfusion. Nasal septum area was determined in 21 Caucasian body donors, and nasal septum thickness was measured in 20 CT scans. Septal splints of universal size and shape were prepared from silastic sheeting. The holding force of various neodymium-iron-boron (NdFeB) magnets, and the surface pressure exerted by magnet-containing septal splints was calculated. These septal splints of novel design offer a satisfactory fit in routine clinical practice. The splints can be securely attached with built-in NdFeB magnets, and surface pressure can be distributed evenly across the nasal septum while not interfering with mucosal tissue perfusion. With their simple intranasal insertion, these magnet-containing septal splints of universal size and optimised shape offer maximum possible septum coverage following septoplasty/septorhinoplasty. The absence of interference with septal tissue perfusion means that they are likely to be associated with fewer postoperative complications and better outcomes.

The aim of classical surgical correction for nasal breathing impairment is to harmonically extend the physiological space in the nose by an operation of the nasal septum and inferior nasal turbinate. In this way the airflow character should be maintained and the mucosa protected in order not to endanger the respiratory function of the nose. This article presents an operative approach developed stepwise a few years ago in which the different operative steps are carried out depending on the individual anatomical situation and the underlying mucosal disease. The focus is on partial anteromedial maxillectomy.

Surgical management of lacrimal duct obstruction beyond the canaliculi proves to be a promising endeavor in most cases. To realize the full potential of endonasal dacryocystorhinostomy, some aspects of diagnosis and differential indication setting should be considered in order to avoid errors and problems during patient selection, execution of the technical procedure, and communication with ophthalmologists. These issues are described according to the clinical management of patients; current literature is cited.

Osler's disease is an autosomal dominant hereditary syndrome which belongs to the group of orphan diseases. Affected patients suffer primarily from severe epistaxis. Diagnosis is based on the Curaçao criteria and molecular genetic tests. Organ manifestations can be found in the form of arteriovenous shunts in the lung, liver, and gastrointestinal tract; more rarely also in the central nervous system (CNS) and other parts of the body. Many patients with gastrointestinal and other organ manifestations are frequently clinically asymptomatic; therefore, organ screening is essential to avoid later complications and should be performed in centers with particular expertise. No curative therapy currently exists. From the otolaryngologist's perspective, nasal mucosa treatments and endonasal laser applications are important and effective therapeutic approaches to epistaxis. Pharmacological interventions are focused on compensation of haploinsufficiency as well as antiangiogenetic approaches. Severe side effects have to be considered.

Schnarchen wird vom Partner oft als Larm empfunden. Es hat das Potenzial, Gesundheitsschaden hervorzurufen. Bei vielen Schnarchern wird der Grenzwert der Larmpegelbelastung, den das Bundesumweltamt fur unbedenklich halt, uberschritten. Daraus ergibt sich die Forderung nach einer Therapie des Schnarchers, die in der gesundheitlichen Bedrohung des Partners begrundet ist. Schnarchen ist anders als z. B. weises Rauschen gleichen Pegels mit Information beladen. Diese Information kann den belastigenden Charakter des Gerausches verstarken oder vermindern. Der Mensch verknupft mit den akustischen Wahrnehmungen affektive Wirkungen, die einen ruckkoppelnden Effekt haben. Schnarchen eines geliebten Menschen ist weniger eine Belastigung als Schnarchen eines Menschen, der bereits im Wachzustand eine Belastung ist.

Aerosinusitis more frequently affects the frontal sinus than the maxillary sinus and mostly occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. In part 2, diagnostic measures, drug therapy, balloon dilatation and endoscopic sinus surgery are presented, along with a discussion regarding when flight attendants and pilots are able to resume their work. Endoscopic surgery to expand the natural drainage pathways of the affected sinuses with minimal surgical trauma to the healthy mucous membranes is largely successful.

The relevance of aerosinusitis stems from the high number of flight passengers and the impaired fitness for work of the flight personnel. The frontal sinus is more frequently affected than the maxillary sinus and the condition generally occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. Part 1 presents the pathophysiology, symptoms, risk factors, epidemiology and prophylaxis of aerosinusitis. In part 2, diagnosis, conservative and surgical treatment will be discussed.

The Epworth Sleepiness Scale (ESS) is frequently used to determine daytime sleepiness in patients with sleep-disordered breathing. It is still unclear whether different levels of alertness induced by the circadian rhythm influence ESS score.The aim of this study is to investigate the influence of circadian rhythm-dependent alertness on ESS performance.In a monocentric prospective noninterventional observation study, 97 patients with suspected sleep-disordered breathing were investigated with respect to daytime sleepiness in temporal relationship to polysomnographic examination and treatment. The Karolinska Sleepiness Scale (KSS) and the Stanford Sleepiness Scale (SSS) served as references for the detection of present sleepiness at three different measurement times (morning, noon, evening), prior to and following a diagnostic polysomnography night as well as after a continuous positive airway pressure (CPAP) titration night (9 measurements in total). The KSS, SSS, and ESS were performed at these times in a randomized order.The KSS and SSS scores revealed a circadian rhythm-dependent curve with increased sleepiness at noon and in the evening. Following a diagnostic polysomnography night, the scores were increased compared to the measurements prior to the night. After the CPAP titration night, sleepiness in the morning was reduced. KSS and SSS reflect the changes in alertness induced by the circadian rhythm. The ESS score war neither altered by the intra-daily nor by the inter-daily changes in the level of alertness.According to the present data, the ESS serves as a reliable instrument to detect the level of daytime sleepiness independently of the circadian rhythm-dependent level of alertness.

Wir berichten uber die submukose Injektion von Bevacizumab (Avastin) in einer Dosierung von 0,3–3,75 mg pro Seite bei einer Patientin mit M. Osler. In der Literatur ist die Anwendung einer solch niedrigen Menge bis jetzt noch nicht beschrieben. In dem dargestelltem Fallbericht zeigte sich eine positive Wirkung auf die mit anderen nichtinvasiven Therapien kaum beherrschbare Epistaxis. Nebenwirkungen traten nicht auf.

Angst und mogliche Schmerzen spielen bei vielen Patienten im Vorausblick auf einen rhinochirurgischen Eingriff und im Kontext mit einer Nasentamponade eine grose Rolle. Dieser Sachverhalt wird in einer prospektiven Studie objektiviert. Prospektive, kontrollierte, randomisierte Studie mit Vergleich von 3 verschiedenen Nasentamponaden im Hinblick auf Angst und Schmerz. Die Patienten litten an einer polyposen chronischen Pansinusitis und wurden einer Pansinus-Operation unterzogen. Sie wurden taglich uber einen Zeitraum von 5 Tagen mit standardisierten Fragebogen (u. a. FPI-R, KASA, STAI) untersucht, erganzt durch Vorlage visuell-analoger Skalen. Die Tamponaden wurden am 2. postoperativen Tag entfernt. Es konnten die Daten von 73 Patienten ausgewertet werden (Polyvinyl-acetat-Tamponade N=14; Fingerling-Tamponade N=37, Fingerling-Tamponade mit Atemhilfsrohrchen N=22). Weibliches Geschlecht, eine grundsatzlich eingeschrankte Stimmungslage, fehlende praoperative Schmerzen sowie ein erweiterter Informations-Austausch mit Laien vor dem Eingriff waren mit einem hoheren praoperativen Angstzustand verbunden. Patienten hatten signifikant weniger Angst, wenn eine Nasentamponade mit Atemhilfsrohrchen in Aussicht gestellt wurde. Ein hoheres Risiko fur vermehrte perioperative Angste haben Patientinnen, die sich Rat uber die bevorstehende Operation im Familien- oder Bekanntenkreis einholen oder Patientinnen mit praoperativ ungunstiger Gemutslage. Das Angebot auf eine zumindest teilweise erhaltene Nasenatmung nach dem Eingriff vermag diesen Zustand zu bessern.

Summary It was of interest to determine the impact of FDG-PET/CT on general therapy management and radiotherapy (RT) planning in patients with stage IV head and neck tumours. The study was conducted prospectively between March 2006 and March 2007 in 35 patients with histologically confirmed, locally advanced squamous cell carcinomas of the head and neck. Prior to primary radiochemotherapy, whole-body and head/neck FDG-PET/CT was performed. The FDG-PET information was integrated into RT planning. By comparison with anatomical imaging, the FDG-PET/CT yielded the following additional information: distant metastases in 17.1% (6/35), second primary tumours in 11.4% (4/35), and changes in nodal status based on metabolic activity, i.e. upstaging in 34.3% (12/35) or downstaging in 22.9% (8/35). As a result, treatment strategy was changed from curative to palliative in six patients, and additional curative therapy was implemented following exclusion of distant metastases in two patients with a simultaneous local second primary tumour. The discordant nodal status found with head/neck FDG-PET/CT compared with anatomical imaging led to modification of radiotherapy volume and dose in 20 patients (57.1%). From the radiotherapist’s perspective FDG-PET/CT is therefore useful and justifiable in the management of stage IV head and neck tumours.

Hereditary haemorrhagic telangiectasia (HHT) is a familial, autosomal, dominant, multi-system, vascular, dysplasia. Besides repetitive epistaxis, cutaneous eruptive macules and nodules lead to recurring bleeding and cosmetic problems. We report on a pilot study of four cases of HHT in which cutaneous lesions were treated with a pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser (1,064 nm). Pulsed Nd:YAG laser treatment, without anaesthesia, was performed several times on eruptive angiomas on palmar and facial skin. Lesions on fingers and face mostly showed very good, or even complete, clearing after the first laser treatment. Several macules required multiple treatment; only a few lesions showed no effect. Pulsed Nd:YAG laser therapy (1,064 nm) appears to be an effective and safe treatment option for hereditary haemorrhagic telangiectasia on the skin of face and extremities.

In einer prospektiv angelegten Pilotstudie wurde bei 12 Patienten gepruft, ob sich der M.-temporalis-Lappen unter den erschwerten Bedingungen eines Entwicklungslandes als sicheres und einzeitiges Verfahren eignet, Wangendefekte kombiniert mit fibrosen oder ossaren Kontrakturen des Kiefergelenks zu therapieren. Die Eingriffe erfolgten in den Jahren 1998, 1999 und 2000 im Hospital National du Niamey (Republik Niger). Alle Transplantate heilten primar ein. 7 Patienten konnten 12 bzw. 24 Monate spater klinisch und rontgenologisch vor Ort (Niger) nachuntersucht werden. Die Mundoffnung betrug konstant mindestens 1,5 cm, obwohl physiotherapeutische Masnahmen zur Vermeidung der Narbenschrumpfung praktisch nicht angewendet wurden. Im Gegensatz zu kostenaufwandigen und chirurgisch komplexeren Rekonstruktionen kann mit dem von uns angewendeten Verfahren auch unter Verzicht auf maximalmedizinische Bedingungen dauerhaft ein zufrieden stellendes funktionell-asthetisches Resultat erzielt werden.

The use of a split-scar cheek flap is demonstrated for restoration of lining in reconstructing the oral commissure in cases of noma.

Dacryocystocele may represent a rare type of connatal stenosis of the lacrimal duct. If conservative measures fail and in case of secondary inflammation, probing or regular surgery is usually recommended. We report on 15 neonates suffering from 18 connatal dacryocystoceles which were presented to the clinic of ophthalmology at the 16th (6 - 44) day of life. There was a definite female preponderance (65 %). Conservative treatment (external massage, at times i. v. antibiotic therapy) had proven to be ineffective. The neonates were subjected to outpatient nasal endoscopy and the ballooning cyst of the inferior nasal meatus was managed by endoscopic marsupialization in 14 cases applying local anesthesia. Two nasal cysts had to be operated on in general anesthesia due to obstructing local anatomy which obviated endoscopical microsurgery. Three additional dacryocystoceles have been detected incidentally in 2 neonates being subjected to surgery in general anesthesia for choanal atresia and lacrimal probing respectively. The corresponding dacryocystoceles were managed by concomitant endonasal microsurgery. We advocate interdisciplinary (ophthalmological and rhinological) outpatient examination in all neonates with suspected dacryocystoceles. Diagnosis is based on palpation, probing and nasal endoscopy applying local anesthesia together with mucosal decongestion. Microsurgical marsupialization immediately follows and will lead to persisting relief of symptoms.

Aerosinusitis more frequently affects the frontal sinus than the maxillary sinus and mostly occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. In part 2, diagnostic measures, drug therapy, balloon dilatation and endoscopic sinus surgery are presented, along with a discussion regarding when flight attendants and pilots are able to resume their work. Endoscopic surgery to expand the natural drainage pathways of the affected sinuses with minimal surgical trauma to the healthy mucous membranes is largely successful.