Medical Radiology Diagnostic Imaging
Series Editors Maximilian F. Reiser Hedvig Hricak Michael Knauth
Editorial Board Andy Adam, London Fred Avni, Brussels Richard L. Baron, Chicago Carlo Bartolozzi, Pisa George S. Bisset, Durham A. Mark Davies, Birmingham William P. Dillon, San Francisco D. David Dershaw, New York Sam Sanjiv Gambhir, Stanford Nicolas Grenier, Bordeaux Gertraud Heinz-Peer, Vienna Robert Hermans, Leuven Hans-Ulrich Kauczor, Heidelberg Theresa McLoud, Boston Konstantin Nikolaou, Munich Caroline Reinhold, Montreal Donald Resnick, San Diego Rüdiger Schulz-Wendtland, Erlangen Stephen Solomon, New York Richard D. White, Columbus
For further volumes: http://www.springer.com/series/4354
Olle Ekberg Editor
Dysphagia Diagnosis and Treatment Foreword by Maximilian F. Reiser
123
Editor Olle Ekberg Department of Clinical Sciences Skåne University Hospital Lund University Malmö Sweden
ISSN 0942-5373 ISBN 978-3-642-17886-3 ISBN 978-3-642-17887-0 DOI 10.1007/978-3-642-17887-0
(eBook)
Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2012945741 Ó Springer-Verlag Berlin Heidelberg 2012 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)
To my wife Guje with romance, felicity and affection Olle Ekberg
Foreword
Dysphagia is a symptom of many and diverse diseases causing serious derogation of the quality of life. Diagnosis and treatment of dysphagia requires knowledge and experience of specialists from multiple disciplines, such as ENT specialists, neurologists, gastroenterologists and various other disciplines. For the radiologists involved in interdisciplinary teams, which are devoted to the diagnosis and treatment of dysphagia, knowledge of the anatomy and physiology is fundamental. Familiarity with the clinical background and available treatment options is mandatory. The curriculum of most postgraduate institutions does not include profound training in specialized examinations of dysphagia. Professor Ekberg and the other authors of this book have great merits by providing comprehensive information covering anatomy, physiology, pathophysiology, pathology and clinical background. This book includes chapters on gastroesophageal reflux disease, globus and dysphagia, pediatric aspects on dysphagia, dysphagia in systemic disease, the geriatric pharynx and esophagus, voice and dysphagia as well as psychiatric aspects of dysphagia. The functional and cross-sectional imaging methods for the assessment of swallowing and its disorders are described in detail. After the first edition in 2004 this second edition incorporates all newly discovered knowledge in this rapidly advancing field. On behalf of the series editors of Medical Radiology—Diagnostic Imaging I would like to extend our sincere thanks to Prof. Ekberg and his co-workers for this extraordinary work. We are sure that it will be a great help for those interested in dysphagia and treatment of patients suffering from this symptom. In addition to radiologists, specialists of various other medical disciplines can obtain most valuable information. Munich
Maximilian F. Reiser
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Preface
In preparing this volume, my aim has been to organize and set down, as concisely as possible, what may be considered the basic facts concerning the diagnosis and treatment of dysphagia. A principal focus is how to analyze the symptom of dysphagia, which is of the utmost importance and forms the basis for selection of any further steps in evaluation. In the clinical work-up, radiology is crucial. This was the topic of the book Radiology of the Pharynx and Esophagus, published by Springer in 2004. The continued rapid advances in dysphagology in the intervening period have prompted me to revise and expand that book. Seventeen chapters have been updated and refreshed, while 19 are completely new and place dysphagia in an even broader and deeper context. Particularly the consequences like malnutrition and dehydration are thoroughly described. The current book therefore contains detailed information on anatomy, physiology, pathophysiology, pathology and clinical background as well as different aspects of nutrition and malnutrition. It bridges the gap between basic anatomy and physiology and the clinical management of patients with dysphagia. The authors of the individual chapters are experts in their fields and most of them are engaged in hands-on practical work with patients. The skilful assistance provided by Ms. Eva Prahl has been invaluable in bringing together all the loose ends to create what I hope will be a well-received volume. I also wish to thank all the contributors to the volume and, particularly, Ms. Corinna Schaefer and Ms. Daniela Brandt of the publisher’s staff. Their enthusiasm and skilful guidance have been invaluable. Olle Ekberg
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Contents
Part I
Anatomy and Physiology
Anatomy and Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Olle Ekberg and Göran Nylander
3
Saliva and the Control of Its Secretion. . . . . . . . . . . . . . . . . . . . . . . . . Jörgen Ekström, Nina Khosravani, Massimo Castagnola, and Irene Messana
19
Feeding and Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Olle Ekberg, Anna I. Hårdemark Cedborg, Katarina Bodén, Hanne Witt Hedström, Richard Kuylenstierna, Lars I. Eriksson, and Eva Sundman
49
Oral and Pharyngeal Function and Dysfunction . . . . . . . . . . . . . . . . . . Olle Ekberg
55
Part II
Clinical Evaluation
Evaluation of Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Doris-Maria Denk-Linnert
71
Neurology of Swallowing and Dysphagia . . . . . . . . . . . . . . . . . . . . . . . Mario Prosiegel
83
Gastroesophageal Reflux Disease, Globus, and Dysphagia . . . . . . . . . . . Jacqui Allen and Peter C. Belafsky
107
Pediatric Aspect of Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pascale Fichaux Bourin, Michèle Puech, and Virginie Woisard
133
Dysphagia in Systemic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thomas Mandl and Olle Ekberg
155
The Geriatric Pharynx and Esophagus. . . . . . . . . . . . . . . . . . . . . . . . . Olle Ekberg
165
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Contents
Voice and Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Daniele Farneti
175
Psychiatric Aspects of Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Margareta Bülow
191
Part III
Imaging and other Examination Techniques
The Clinical and Radiological Approach to Dysphagia . . . . . . . . . . . . . Peter Pokieser and Martina Scharitzer Imaging Techniques and Some Principles of Interpretation (Including Radiation Physics) . . . . . . . . . . . . . . . . . . Olle Ekberg
201
237
Pharyngeal Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stephen E. Rubesin
253
Morphology of the Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marc S. Levine and Arastoo Vossough
281
The Pediatric Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jane E. Benson
301
Pharyngeal Manometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rolf Olsson
315
Esophageal Manometry and Gastroesophageal Reflux Monitoring. . . . . Karin Aksglæde, Per Thommesen, and Peter Funch-Jensen
323
Impedance Planimetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Johannes Lenglinger
329
Radiologic Evaluation of Esophageal Function . . . . . . . . . . . . . . . . . . . Wolfgang Schima, Edith Eisenhuber, and Christiane Kulinna-Cosentini
339
Neuroimaging in Patients with Dysphagia . . . . . . . . . . . . . . . . . . . . . . Kasim Abul-Kasim
359
Cross-Sectional Imaging of the Oesophagus Using CT and PET/Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ahmed Ba-Ssalamah, Barbara J. Fueger, and Wolfgang Schima Endoscopy of the Pharynx and Esophagus . . . . . . . . . . . . . . . . . . . . . . Doris-Maria Denk-Linnert and Rainer Schöfl
369
391
Contents
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Part IV
Treatment
The Therapeutic Swallowing Study . . . . . . . . . . . . . . . . . . . . . . . . . . . Margareta Bülow and Bonnie Martin-Harris Surgical Aspects of Pharyngeal Dysfunction, Dysphagia, and Aspiration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hans F. Mahieu and Martijn P. Kos The Post-Operative Pharynx and Larynx . . . . . . . . . . . . . . . . . . . . . . . Anita Wuttge-Hannig and Christian Hannig Dysphagia Evaluation and Treatment After Head and Neck Surgery and/or Chemo-radiotherapy for Head and Neck Malignancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antonio Schindler, Francesco Mozzanica, and Filippo Barbiera Behavioural Treatment of Oropharyngeal Dysphagia: Bolus Modification and Management, Sensory and Motor Behavioural Techniques, Postural Adjustments, and Swallow Manoeuvres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Renée Speyer
411
425
445
459
477
Rheological Aspects of Swallowing and Dysphagia . . . . . . . . . . . . . . . . Edmundo Brito-de la Fuente, Olle Ekberg, and Críspulo Gallegos
493
The Dietitian’s Role in Diagnosis and Treatment of Dysphagia . . . . . . . S. Burton, A. Laverty, and M. Macleod
507
Direct and Indirect Therapy: Neurostimulation for the Treatment of Dysphagia After Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Satish Mistry, Emilia Michou, Dipesh H. Vasant, and Shaheen Hamdy
519
Intervention on the Esophagus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jason D. Conway, David J. Ott, and Michael Y. Chen
539
The Importance of Enteral Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . Christina Stene and Bengt Jeppsson
555
Part V Complications Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Silvia Carrión, Eric Verin, Pere Clavé, and Alessandro Laviano
575
Dehydration in Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Zeno Stanga, Samuel Hannes Baldinger, and Pere Clavé
601
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
611
Contributors
Kasim Abul-Kasim Faculty of Medicine, Diagnostic Centre for Imaging and Functional Medicine, Ska˚ne University Hospital, Malmo¨, Sweden; Lund University, Malmo¨, Sweden Karin Aksglæde Division for Gastrointestinal Motility Disorders, Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark, e-mail:
[email protected] Jacqui Allen Department of Otolaryngology, North Shore Hospital, Takapuna, Auckland, New Zealand, e-mail:
[email protected]; Jacqueline.
[email protected] Samuel Hannes Baldinger University Polyclinic for Endocrinology, Diabetes and Clinical Nutrition, University Clinic for General Medicine, University Hospital, Bern, Switzerland Filippo Barbiera Unita` Operativa di Radiologia ‘‘Domenico Noto’’, Azienda Ospedali Civili Riuniti ‘‘Giovanni Paolo II’’, 92019, Sciacca, Italy Ahmed Ba-Ssalamah Department of Radiology, Medical University of Vienna, Vienna, Austria, e-mail:
[email protected] Peter C. Belafsky Center for Voice and Swallowing, University of California, Davis, Sacramento, CA, 95817, USA, Unita` Operativa di Radiologia ‘‘Domenico Noto’’, Azienda Ospedali Civili Riuniti ‘‘Giovanni Paolo II’’, 92019 Sciacca, Italy Jane E. Benson Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21205, USA, e-mail:
[email protected] Katarina Bodén Department of Diagnostic Radiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Edmundo Brito-de la Fuente Innovation and Development Centre Clinical Nutrition and Pharmaceuticals, Science Production and Technology, Fresenius Kabi Deutschland GmbH, 61440, Oberursel, Germany, e-mail: edmundo.
[email protected] Margareta Bülow Neurological Department and Diagnostic Centre of Imaging and Functional Medicine, Ska˚ne University Hospital, 205 02 Malmo¨, Sweden, e-mail:
[email protected]
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S. Burton Abteilung Neurologie, m&i-Fachklinik Bad Heilbrunn, Wo¨rnerweg 30, 83670 Bad Heilbrunn, Germany Silvia Carrión Unidad de Exploraciones Funcionales Digestivas, Hospital de Mataro´, Universitat Auto`noma de Barcelona, Barcelona, Spain, Centro de Investigacio´n Biome´dica en red de Enfermedades Hepa´ticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, Madrid, Spain Massimo Castagnola Istituto di Biochimica e Biochimica Clinica, Facolta` di Medicina, Universita` Cattolica and Istituto per la Chimica del Riconoscimento Molecolare, CNR, Rome 00168, Italy Michael Y. Chen Department of Radiology, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA Pere Clavé Centro de Investigaeio´n Biome´dica, Universitat Auto`noma de Barcelona, Hospital de Mataro´, Barcelona, Spain Jason D. Conway Department of Gastroenterology, Medical Center Boulevard, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA, e-mail:
[email protected] Doris-Maria Denk-Linnert Section of Phoniatrics, Department of Otorhinolaryngology, Vienna Medical School, Medical University of Vienna, Wa¨hringer Gu¨rtel 18-20, 1090 Vienna, Austria, e-mail: doris-maria.denk-linnert@ meduniwien.ac.at Edith Eisenhuber Krankenhaus Goettlicher Heiland, Dornbacher Strasse 20-28, 1170, Vienna, Austria Olle Ekberg Department of Clinical Sciences/Medical Radiology, Shane University Hospital, Lund University, 205 02 Malmo¨, Sweden; Diagnostic Centre of Imaging and Functional Medicine, Ska˚ne University Hospital, 205 02 Malmo¨, Sweden; Department of Diagnostic Radiology, Malmo¨ University Hospital, 205 02 Malmo¨, Sweden, e-mail:
[email protected] Jörgen Ekström Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Box 431, SE-405 30, Go¨teborg, Sweden, e-mail:
[email protected] Lars I. Eriksson Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Daniele Farneti Voice and Swallowing Center, ‘‘Infermi’’ Hospital, Rimini, Italy, e-mail:
[email protected] Pascale Fichaux Bourin Unite´ de la Voix et de la De´glutition, Department of Ear‘ Nose and Throat, CHU de Toulouse, Hoˆpital Larrey, 31059 Toulouse Cedex 9, France, e-mail: fi
[email protected] Barbara J. Fueger Department of Radiology, Medical University of Vienna, Vienna, Austria
Contributors
Contributors
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Peter Funch-Jensen Division for Gastrointestinal Motility Disorders, Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark, Aleris-Hamlet Hospital, and Clinical Institute, Aarhus University, Aarhus C, Denmark Críspulo Gallegos Departamento de Ingenierı´ a Quı´ mica, Universidad de Huelva, 21071 Huelva, Spain Shaheen Hamdy Department of Inflammation Sciences, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, M6 8HD, UK; Department of GI Sciences (Clinical Sciences Building), Salford Royal NHS Foundation Trust, Inflammation Sciences Research Group, University of Manchester, Manchester, M6 8HD, UK, e-mail: e-mail: shaheen.hamdy@ manchester.ac.uk Christian Hannig Institut fu¨r Ro¨ntgendiagnostik des Klinikums rechts der Isar, Technische Universita¨t Mu¨nchen, Ismaningerstrasse 22, 82756, Munich, Germany Anna I. Hårdemark Cedborg Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Hanne Witt Hedström Department of Neuroradiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Bengt Jeppsson Department of Surgery, University Hospital of Skane-Malmo¨, Institute of Clinical Sciences, Lund University, Malmo¨, Sweden Nina Khosravani Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Box 431, SE-405 30, Go¨teborg, Sweden Martijn P. Kos ENT Department, Waterland Hospital, Purmerend, The Netherlands Christiane Kulinna-Cosentini Department of Radiology, Medical University of Vienna, Wa¨hringer Gu¨rtel 18-20, 1090, Vienna, Austria Richard Kuylenstierna Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden A. Laverty Abteilung Neurologie, m&i-Fachklinik Bad Heilbrunn, Wo¨rnerweg 30, 83670 Bad Heilbrunn, Germany Alessandro Laviano Department of Clinical Medicine, Sapienza University, Rome, Italy Johannes Lenglinger Motility Laboratory, Department of Surgery, Medical University of Vienna, Vienna, Austria, e-mail: johannes.lenglinger@meduniwien. ac.at Marc S. Levine Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA, e-mail: marc.
[email protected]
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M. Macleod Abteilung Neurologie, m&i-Fachklinik Bad Heilbrunn, Wo¨rnerweg 30, 83670 Bad Heilbrunn, Germany, e-mail: marjorymacleod1950@ yahoo.co.uk Hans F. Mahieu ENT Department, Meander Medical Center, Amersfoort, The Netherlands, e-mail:
[email protected] Thomas Mandl Department of Rheumatology, Ska˚ne University Hospital, 205 02 Malmo¨, Sweden Bonnie Martin-Harris MUSC Evelyn Trammell Institute for Voice and Swallowing Disorders, Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA Irene Messana Dipartimento di Scienze Applicate ai Biosistemi, Universita` di Cagliari, Cittadella Universitaria Monserrato, 09042 Cagliari, Monserrato, Italy Emilia Michou Department of Inflammation Sciences, Salford Royal NHS Foundation Trust, University of Manchester, Manchester M6 8HD, UK Satish Mistry Department of Inflammation Sciences, Salford Royal NHS Foundation Trust, University of Manchester, Manchester M6 8HD, UK Francesco Mozzanica Department of Biomedical and Clinical Sciences ‘‘L. Sacco’’, University of Milan, Via GB Grassi, 74 20157 Milan, Italy Göran Nylander Diagnostic Centre of Imaging and Functional Medicine, Ska˚ne University Hospital, 205 02 Malmo¨, Sweden Rolf Olsson Diagnostic Centre of Imaging and Functional Medicine, Ska˚ne University Hospital, 205 02 Malmo¨, Sweden, e-mail:
[email protected] David J. Ott Department of Radiology, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA Peter Pokieser Department of Radiology, University of Vienna, Wa¨hringer Gu¨rtel 18-20, 1090 Vienna, Austria, e-mail:
[email protected] Mario Prosiegel Abteilung Neurologie, m&i-Fachklinik Bad Heilbrunn, Wo¨rnerweg 30, 83670 Bad Heilbrunn, Germany, e-mail: mario.prosiegel@ fachklinik-bad-heilbrunn.de Michèle Puech Unite´ de la Voix et de la De´glutition, Department of Ear‘ Nose and Throat, CHU de Toulouse, Hoˆpital Larrey, 31059 Toulouse Cedex 9, France Stephen E. Rubesin Department of Radiology, University of Pennsylvania School of Medicine, MRI Building 1-08, University of Pennsylvania Medical Center, 3400 Spruce St., Philadelphia, PA 19104-4283, USA, e-mail: Stephen.
[email protected] Martina Scharitzer Department of Radiology, University of Vienna, Wa¨hringer Gu¨rtel 18-20, 1090 Vienna, Austria
Contributors
Contributors
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Wolfgang Schima Department of Radiology, Krankenhaus Goettlicher Heiland, Dornbacher Strasse 20-28, 1170 Vienna, Austria, e-mail: wolfgang.
[email protected];
[email protected] Antonio Schindler Department of Biomedical and Clinical Sciences ‘‘L. Sacco’’, University of Milan, Via GB Grassi, 74 20157, Milan, Italy, e-mail: antonio.
[email protected] Rainer Schöfl 4th Department of Internal Medicine, Hospital of the Elisabethinen, Fadingerstraße 1, 4020 Linz, Austria Renée Speyer Mozartstraat 47, 6521 GB, Nijmegen, The Netherlands, e-mail:
[email protected] Zeno Stanga University Polyclinic for Endocrinology, Diabetes and Clinical Nutrition, University Clinic for General Medicine, University Hospital, Bern, Switzerland, e-mail:
[email protected] Christina Stene Department of Surgery, A¨ngelholm Hospital, Institute of Clinical Sciences, Lund University, Malmo¨, Sweden, e-mail: christina.stene@ med.lu.se Eva Sundman Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Per Thommesen Division for Gastrointestinal Motility Disorders, Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark Dipesh H. Vasant Department of Inflammation Sciences, Salford Royal NHS Foundation Trust, University of Manchester, Manchester M6 8HD, UK Eric Verin Service de Physiologie, Hoˆpital Charles Nicolle, CHU de Rouen, Rouen, France, Arastoo Vossough Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA Virginie Woisard Unite´ de la Voix et de la De´glutition, Department of Ear‘ Nose and Throat, CHU de Toulouse, Hoˆpital Larrey, 31059 Toulouse Cedex 9, France Anita Wuttge-Hannig Gemeinschaftspraxis fu¨r Radiologie, Strahlentherapie und Nuklearmedizin, Dres. Wuttge-Hannig-Rosskopf-Schepp-Sindelar, Karlsplatz 3-5, 80335 Munich, Germany, e-mail:
[email protected]
