Several therapeutic approaches exist to treat gustatory sweating (Frey's syndrome) following parotidectomy. Because of the lack of effective treatment, a new therapeutic modality using botulinum toxin injections was presented previously by our group. The duration of the demonstrated positive effect was essentially unknown so far. Based on our experiences using this technique since December 1993, the purpose of this clinical investigation was to make an up-to-date report and demonstrate the duration of effect of BOTOX injections in patients with severe gustatory sweating. Nineteen patients with severe gustatory sweating have been treated with BOTOX by intracutaneous injections into the affected skin areas. The maximal follow-up time was 33 months. The results were obtained by interviews and controls using Minor's starch iodine test. In all treated cases (n = 19 patients, 22 treated sides) gustatory sweating ceased completely within 2 days. Side effects were absent. In 12 patients gustatory sweating reappeared. The mean duration of effect was 17.3 months (subjective personal communication of 18 patients). Findings show that intracutaneous injection of BOTOX is a highly effective, safe, and minimally invasive treatment of Frey's syndrome with long-lasting therapeutic effect.

The effectiveness of botulinum toxin injections for the management of Frey's syndrome was studied. Botulinum toxin A (approximately 0.5 Units/cm2) was injected intracutaneously into the affected skin area as determined by Minor's starch iodine test. Gustatory sweating in the treated skin area ceased completely within 1 week and has not reappeared (12 months follow up until now in the first treated case). There have been no side effects. It is concluded that local botulinum toxin injections are a highly effective and safe treatment for Frey's syndrome. Additional study is required to evaluate the duration of the therapeutic effect.

The pathogenic role of hyperlipidemia in sudden hearing loss (SHL) was examined in a prospective study. Twenty-five patients (14 males, 11 females; age range, 23-59 years) with a first event of SHL (group I) were compared with 9 patients (4 males, 5 females; age range, 28-86 years) with a repeated event of SHL (group II). Audiological examination revealed different types of SHL in group I vs group II: high-frequency loss, 76% vs 22%; low-frequency loss, 12% vs 22%; pancochlear hearing loss, 12% vs 56%. Serum lipid patterns and atherogenic risk factors in both groups were not different and corresponded to lipid patterns in the average population. These findings indicate that both hyperlipidemia and atherogenic risk factors are not of major pathological importance in SHL.

Hemifacial spasm is nearly always a unilateral disease of the facial musculature and is characterized by involuntary tonic or clonic cramps that considerably reduce the affected patient's quality of life. In the past, a number of different conservative and operative therapeutic procedures have been applied for the treatment of hemifacial spasm. In many cases these attempts failed to control the disease permanently or resulted in unwanted, sometimes strong, side effects. We report our own experiences with botulinum therapy in 29 patients with hemifacial spasm (78 therapeutic sessions). In our patients the mean duration of an effect after treatment with botulinum toxin was 18.2 weeks. Side effects were rare. Our results since 1990 at the University of Göttingen demonstrate that subcutaneous application of toxin from Clostridium botulinum to involved facial muscles represents a reliable method for successful treatment of hemifacial spasm.

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