International Journal of Pediatric Otorhinolaryngology 73 (2009) 1228–1233

History and development of pediatric otorhinolaryngology in Hungary

Jeno Hirschberg a,*, Zoltan Labas b, Istvan Lellei a, Zsolt Farkas c, Monika Sultesz c, Gabor Katona c

a Saint John’s Hospital, Division of Pediatric Otorhinolaryngology and Bronchology, Diosarok ut 1, H-1125 Budapest, Hungaryb Bethesda Children’s Hospital, Department of Pediatric Otorhinolaryngology and Bronchology, Bethesda ut 3-5, H-1146 Budapest, Hungaryc Heim Pal Hospital for Sick Children, Department of Otorhinolaryngology and Bronchology, Delej utca 13, H-1089 Budapest, Hungary

A R T I C L E I N F O

Article history:

Received 2 May 2009

Accepted 10 May 2009

Available online 23 June 2009

Keywords:

History

Hungary

Pediatric otorhinolaryngology

A B S T R A C T

The first pediatric otorhinolaryngological department was set up in Hungary at the Heim Pal Children’s

Hospital, Budapest in 1948. The first head of the department and the founder of Hungarian pediatric

otorhinolaryngology was Ferenc Kallay. He was followed in leadership by Jeno Hirschberg, and at present

Gabor Katona. In Budapest 10 pediatric otolaryngological departments and in other parts of the country

seven departments have been working until recently with overall 344 beds. The Pediatric

Otorhinolaryngological Section was developed in 1977. The discipline is independent specialty since

1978. Conferences with various special topics have been organized every year since then. Two

international congresses were held in Hungary: the first one in Eger, 1986 presided by Jeno Hirschberg

and Zoltan Labas; and the second in Budapest in 2008, organized by Gabor Katona. The Hungarian

pediatric otorhinolaryngologists assumed initiative role in the development of this special discipline six

decades ago, early joined in the international life and have had important positions in several

international associations (IFOS, ESPO, UEP, IALP, IAP) as president, board member or chairman of

committees. Besides the organizational work, they have taken part in the scientific and research work as

well: in the present paper the authors detail the results achieved by them in several topics of pediatric

otorhinolaryngology.

Published by Elsevier Ireland Ltd.

Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology

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1. Introduction

Why pediatric otolaryngology? Why pediatric otolaryngology isrequired and if it is actually needed? These questions were set in1990 by the editorial comment of Archives of Otolaryngology [1].The question has repeatedly arisen since then [2], triggering oftenfervid debate between the participants at international congressesand symposia. Our response is unequivocal. Not only theanatomical relations, which are different from the adults’ andalters with the age, and the miniature sizes requiring specialtechnique and devices need specific awareness, but the fact thatwhile treating certain diseases and alterations, the child’sdevelopment, psychic and environmental factors also should beincreasingly considered, paying special attention to adjudge thefunctions: hearing, speech and language development. Thepediatric otolaryngology has developed during the past century,as it was written by Ruben et al. [3] in the first issue of thediscipline’s international press organ, the International Journal of

Pediatric Otorhinolaryngology which celebrates its 30th birthdaythis year. At the end of the 19th century and at the beginning of the

* Corresponding author. Tel.: +36 1 458 4595.

E-mail address: hirchbergjeno@gmail.com (J. Hirschberg).

0165-5876/$ – see front matter . Published by Elsevier Ireland Ltd.

doi:10.1016/j.ijporl.2009.05.011

1900s infections were the greatest enemies of children’s life.Diphtheria victimized thousands of children and the only weaponfor the physicians was the tracheotomy performed mainly amongprimitive circumstances which has taken many lives. In this periodforeign body aspiration also meant certain death in the majority ofthe cases. Development of endoscopes, extension of antibiotics andspread of prevention methods have brought the first revolutionalchanges in our profession, but its real development has beencommenced in the past 4–5 decades, by the penetration ofchemistry, computer science, technology, genetics, biology andnew surgical procedures. This development has predominated inseveral area of the Hungarian pediatric otolaryngology as well;their different aspects will be discussed in the present publication.

2. Historical background

The roots of pediatric otolaryngology in Hungary go back to farcenturies [4]. The oldest data in our country are connected with theprevention of death by suffocation. The first successful tracheot-omy was performed by Janos Balassa in 1845, the use of O’Dwyertube is attached to name of Jr. Janos Bokay, who applied thisprocedure in 1891 in children with diphtheria. Publicationswritten about pharyngeal abscess, laryngeal stridor, lye (sodiumhydroxide) ingestion and stenting of esophageal strictures are

J. Hirschberg et al. / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1228–1233 1229

attached to his name in this period. Specifically pediatric otologypublications were published by Erno Valy: ‘Acute purulent otitis inchildren’ in 1884, ‘Ear diseases and their care in new-borns’ in1885. The first foreign body removal by bronchoscopy wasperformed by Henrik Alapy in 1906, after tracheotomy throughthe stoma. Foreign body was removed first by upper bronchoscopyby M. Arnold Winternitz in 1908. In the period between the twoworld wars the professional and scientific work was made in thecapital and county otorhinolaryngological units of pediatric clinicsand infectious hospitals, in many cases by consultants. In thisperiod tracheotomy, treatment of airways with foreign bodies,tuberculous lymph nodes invading to the airways, lye intoxication,otogenous brain processes and complications of sinusitis meantthe most problem. In the 1930s diphtheria has not caused majorproblem any more, but the number of esophagus stricture due tolye ingestion was high (until the retail trade of caustic potash wasprohibited in Hungary in 1940). In 1936 the mortality ofpseudocroup was 70%, and that time the foreign body aspirationalso led to death in half of the cases. At the end of the 1930s wecannot speak about pediatric otolaryngology specialization, butthe above listed historical backgrounds have significantly con-tributed to the development of the national bases of the discipline.

3. The results of everyday practice and scientific workafter the 2nd world war

3.1. Otology

In the years after the 2nd world war the diagnosis andtreatment of otitis and mastoiditis in infants was the major activityin our country, alike in other parts of the world. Between 1948 and1969 in only one pediatric otorhinolaryngological department, inthe Heim Pal Children’s Hospital in Budapest 4000 mastoidec-tomies were performed in 2035 infants [5]. The frequency peakedin 1954–1955 when 350 operations were performed during 1 year.Due to the introduction of antibiotics the number of operations ininfancy has decreased, but at the beginning of the 1970s thenumber of mastoidectomies was around 200 yearly in the same 40-bed department. As the result of the more modern and targetedantibiotic treatment in 2008 mastoidectomies were performedonly in 27 cases in patients under the age of 1.5 years. The questionof treatment of chronic processes has early come to the front for us.In Hungary we have published papers among the first ones aboutthe surgical treatment of pediatric otogenous facial pareses in 1959[6], then about the result of 72 tympanoplasties performed inchildren in 1966 [7]. The first data reported 78% anatomicalrecovery and 59% functional improvement. We deem it as a greatresult that the first cochlear implantation in child was carried outby pediatric otolaryngologists in Hungary in 1989 in a 3.5-year-oldpreverbally deaf girl [8]. This was the first pediatric CI that time inthe eastern block of Europe as well. The national introduction androutine application of BAHA is kept also as a pioneer proposal fromthe pediatric otolaryngologists [9]. During the last 5 years BAHAsurgery was carried out in 14 patients with the indication ofauditory canal atresia.

3.2. Rhinology

The treatment of developmental anomalies, complications ofsinusitis and allergy means the greatest challenge nowadays in thearea of pediatric rhinology. Regarding the anomalies, theHungarian experts concerned first of all about the surgicaltreatment of choanal atresia, which is associated with CHARGEsyndrome in most cases. At the beginning transpalatinal surgicaltreatment was suggested [10], currently transnasal technique ispreferred [11]. In the Department of Otorhinolaryngology and

Bronchology of the Heim Pal Children’s Hospital, Budapestbetween 1996 and 2008 solution of choanal atresia was performedin 44 patients with transnasal surgical technique: this method – incase of bilateral obstruction – can be applied in new-borns as well.Applying portex stent the rate of restenosis was only 3%. Theprocedure can be combined with the use of Mitomycin C andshaver; in selected cases the stent is omissible. FESS was started toperform in the 1980s in the Hungarian practice. Hungarian authorskeep this procedure as essential in the treatment of prolonged andcomplicated sinusitis. By its application significant improvementwas also attained in the management of cystic fibrosis. In thetreatment of conventionally unhealed and complicated sinusitisthe punction of maxillary sinus may be gradually surpassed, andbeside the extensive use of antibiotics FESS comes to the frontincreasingly. According to the data of the last survey in the HeimPal Children’s Hospital among 339 children with prolonged andtherapy resistant sinusitis between 1997 and 2008 only twointracranial complications, one case of mucocele and four cases ofosteomyelitis were observed. As the result of adequate antibiotictreatment and FESS there was no mortality, optic nerve neuritisoccurred in two patients [12]. The prevalence of allergic rhinitis –according to the answers to 3933 questionnaires – has increasedgradually in Budapest in the past decades; the present ratio in 6–12-year-old school-children is: 26% [13]. Atopic disease of closerelatives, upper airway catarrhs accompanied by regular fever,recurrent maxillary sinusitis, use of antibiotics under the age of 1year and take of paracetamol under 1 year – according to the dataof the survey confirmed with statistical significance – can be therisk factors of allergic rhinitis. Miriszlai [14] emphasized first theimportance of nasal hygiene and nasal suction in infants; his nasalsuction devices developed for home usage are applied efficientlyalso nowadays beyond the frontier.

3.3. Laryngology

In the area of pediatric laryngology important and interna-tionally acknowledged results were attained by Hungarian experts,mainly in the treatment of airway stenosis and in the area ofacoustic and imaging analysis of pathological sound phenomenawith respiratory origin (pathological crying, stridor and cough).We have published papers regarding the treatment of respiratorypapillomatosis [15], malignant papillomas invading to the bronchi[16], surgical treatment of subglottic and lower airway stenoses[17,18], treatment of subglottic hemangioma [19], diagnosis andtherapy of tracheal stenosis [20]. Our books ‘‘Pathological Cry,Stridor and Cough in Infants’’ [21], and ‘‘Pediatric Airway – Cry,Stridor, and Cough’’ [22] evaluate the diagnostic value of the dataprovided by conventional (endoscopic, roentgen, CT and MRI,neurological and electrophysiological) examinations and variousacoustic analyses (spectrography, fundamental frequency mea-surement, digital procedures, investigation of melody of the infantcry, nasometry) based on multidisciplinary cooperation – apartfrom Hungarian and American (P.J. Koltai, Stanford) pediatricotorhinolaryngologists – with the contribution of pediatrician,cardiologist, acoustician, phonetician, electrical engineer, bioin-formatician and speech pathologist. In the attached CD of the latterbook 170 various – occurring due to respiratory, neurological orgenetic alteration – pathological sound phenomena can be heard;these can be well compared with the clinical findings. Pathologicalsounds originating from the airways (cry, stridor, cough) – invarious combinations – occur in more than 50 clinical pictures. Theauthors also discuss the therapeutical possibilities of thesediseases, and anomalies in their publication, thus provide overallpicture about all aspects of pediatric laryngology. Our several otherpublications, discussing the same topic, provide similar purposes[23–25].

J. Hirschberg et al. / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1228–12331230

3.4. Broncho-esophagology

The two founders of Hungarian pediatric bronchology are:Dezso Kassay and Ferenc Kallay. They have established the citadelof the Hungarian bronchology in the 1950s, being ahead of theirtime; both were pediatric otolaryngologists. Not debating theinterdisciplinarity of this specialty (frontier of pulmonology,pediatrics, intensive care and laryngology), it can be stated thatin Hungary the representatives of our profession have created thepractical and scientific bases of bronchology, which has developedunbroken since then on the path of the activity of disciples andcolleagues. Kassay was Chevalier Jackson’s disciple, Kallay devel-oped his own device after a study tour in Europe [26]. He hasintroduced in Hungary the endoscopy performed in relaxation atthe end of the 1950s, then he organized the so-called airwayforeign body service covering the whole country. The latter makespossible that the aspirated child always gets the required care in aproperly equipped department: this system of foreign bodyremoval is still working. Kallay et al., then his followers presentedtheir results in several publications [27,28]. The removal techniqueof bronchoscopically unseen lower airway foreign bodies and thetreatment of laryngological–bronchological aspects of esophagealstenoses [29,30] was an important national result of his time, andthe pediatric laryngologists also had leading role in the emergencytreatment of infants with apnoe, particularly in the period beforethe establishment of pediatric intensive care units [31].

3.5. Phoniatrics and pedaudiology

The pediatric otolaryngologists also set down the bases ofphoniatrics and pedaudiology in Hungary. The first pediatricphoniatric-pedaudiologic outpatient clinic of the country wasdeveloped in the Heim Pal Children’s Hospital in 1962. The mainlines and topics of this specialty were very diverse since then: voicedisorders in children [32], differentiation of hoarseness anddysphonia [33], treatment of pediatric dysphonia [34]. We describedthe clinical picture of neonatal encephalopathic dysphonia, causedby immature innervation of vocal cords due to cerebral lesion orperinatal injury [35], the possibility of conservative and surgicaltreatment of hypernasality [36–38], the indication of phonosurgery[39,40]. New speech intelligibility test was worked out [41] and weanalyzed the practical value of different instrumental procedures[42]. Regarding the pedaudiology we have determined the logopedicand phoniatric aspects of cochlear implantation [43], we introducedthe application possibilities of TEOAE [44] and new diagnosticprocedures were worked out: G–O–H measuring system usingsynthetic speech [45] which provides the evaluation of speechperception in small children, and we developed a new method forhearing screening with acoustic analysis of the infant cry [46,47]which means a promising method for the early hearing screening. Inthe area of perfecting and widening of pedaudiological methodsextended cooperation has developed between physicians, acousti-cians, phoneticians, speech therapists and bioinformaticians. Basedon these, we see the future possibility of the early hearing screeningthat at far places, where objective audiological methods are notavailable, the crying baby’s sound can be recorded by anyone, andthrough the Internet the record can be passed to a center where thesound is analyzed. The results of Hungarian pediatric otolaryngol-ogists attained in the area of examination and treatment of voice,speech and hearing disorders are appreciated by internationalforums, like as a notable activity made for the development ofuniversal phoniatrics and pedaudiology [48–50]. There is no doubtand we completely agree with Ruben [2] that the pediatricotolaryngology is of essential importance regarding that it enhancescommunication-language – through the vehicles of hearing, voice,and speech.

3.6. Cleft lip/palate surgery, velopharyngeal insufficiency

The management and care of children with cleft lip/palate is thetask of different specialities in every country, depending on theconventionality and developed practice. In Hungary the pediatricotolaryngologists hold the first place in this area as well. Of course,every other profession has the competency and reason regardingthe management of this anomaly. The oral surgeons – rightly – say:it is a surgical work performing in the mouth. The pediatricsurgeons’ standpoint is: we treat children with surgical methods.According to the plastic surgeons, the name of operations alsoproves their right: lip and palate plastics. According to our opinionnot the profession is determinant; it is important that the specialistwho assumes the care should provide the cooperation of therepresentatives of those professions who are concerned in thetreatment, he/she should know not only the anatomy of the surgicalarea, but its function also, and appropriate number of surgeriesshould be performed regularly. These terms perfectly fit to thepediatric otolaryngologists who have enough skills in the area of thefunctions (speech, hearing, swallowing) as well. Based on thesearguments and having proper facilities, in Hungary the firstmultidisciplinary cleft team was formed in the Department ofOtorhinolaryngology and Bronchology in the Heim Pal Children’sHospital in 1962. The work group has broadened gradually sincethen [51], newer surgical methods were introduced, and madeinternationally acknowledged activity mainly in the area of theetiology, therapy and surgical solution of velopharyngeal insuffi-ciency [27,52–55]. In Hungary with population of 10 millioninhabitants presently seven Cleft Centers are in function, underpediatric surgeon or pediatric otolaryngologist leadership, in theframe of children’s hospital and pediatric clinics. All of them providethe possibility of interdisciplinary coordination: the contribution oforal surgeon, orthodontist, speech therapist, psychologist, nursesand parents. The work of Cleft Centers is coordinated by theNational Cleft Palate Working Group which was founded in 2006;the pediatric otolaryngologists take leading activity in its work. Thenationally [56,57] and internationally [58–60] propagated andproposed practice which was worked out by us during 50 years – inall questions of the date and method of surgeries and care –corresponds with all universal and modern principles [61].

3.7. Prevention

From the four topics of medicine (prevention, diagnostics,treatment, care) the prevention increasingly comes to the front:this is the rudder of our age and future. Prevention means not onlyprophylaxis, if we speak about primary, secondary and tertiaryprevention according to the WHO classification [62]. In the spreadand accomplishment of prevention procedures pediatric otolar-yngologists also have to take part. In the area of primaryprevention – concerning our profession – our tasks are thefollowing: medical information (fight against air pollution,accident prevention, prevention and decrease of noise, psychicharms); increased application of genetic methods (human genomeproject, fetal diagnostics, optimal family-planning, euphenicprogram); effective screening tests to screen the voice, speech,language and hearing disorders; extended immunization; epide-miological, statistical surveys. Secondary prevention is provided bythe perfection of diagnostic procedures and technologies(increased computerization of imaging techniques, electronicstorage of pictures, positron emission tomography, developmentand miniaturization of endoscopic devices, propagation of virtualbronchoscopy). Tertiary prevention is the adequate early treat-ment, chemoprophylaxis, improvement of implantation andtransplantation methods, decrease the complication risk ofsurgical interventions, perfection of (re)habilitation procedures.

Fig. 1. Dr. Ferenc Kallay, founder of pediatric otorhinolaryngology in Hungary.

J. Hirschberg et al. / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1228–1233 1231

Miriszlai [14] emphasized in the prevention of pediatric otolar-yngology diseases the importance of suction of stagnant nasaldischarge beside the prevention of environment pollution, because‘the cold frequently ends in the lungs in young infants’. TheHungarian specialists have summarized their results attained inthe area of prevention in national publications [63,64] andinternational forums [65].

4. Organization, international activity, participation in the lifeof scientific associations

In the last decades the Hungarian pediatric otorhinolaryngol-ogists took part beside the scientific work in the modern training ofeveryday medical attendance, establishment of proper organiza-tional frames, teaching work and international collaboration aswell. The first and biggest pediatric otorhinolaryngologic depart-ment was founded in 1948 in Hungary with 40 beds in the Heim PalChildren’s Hospital in Budapest. The first head of department andthe founder of Hungarian pediatric otolaryngology was FerencKallay (Figs. 1 and 2). During decades, until recently in the capitaleight independent pediatric otolaryngologic departments and twopediatrician clinic units, in other parts of the country sevendepartments have been working in the frame of pediatric hospitalsand clinics with overall 344 beds. One year before the medicalgovernment has decreased the number of independent depart-ments and beds. The registered number of otolaryngologists is 979for the 10 million inhabitants of Hungary; 10% of them haspediatric otolaryngological specialty and seven of them havescientific qualification. The first pediatric otolaryngology text bookin Hungarian language was published by Kollar [66]. Miriszlaiwrote a volume for general practitioners [64], Hirschberg [67] forparents about ear, nose and larynx diseases in children. Thepediatric otolaryngologic working group was founded in 1977 forthe initiation of Jeno Hirschberg, Dezso Kollar, Zoltan Labas andErno Miriszlai, which was developed for independent Section ofthe Society of Hungarian Otorhinolaryngologists in 1980. TheSection voted Zoltan Labas as first president, he was followed byIstvan Lellei, then Gabor Katona in the chair. The Section organizescongress every year, in either year independently, in the other yearin the frame of the congress of Society of Otorhinolaryngologists, inmany cases with international participation. About the mostimportant professional, practical, organizational and personal

Fig. 2. Members of the former team of the Department of Pediatric Otorhinolaryngology, B

for Sick Children, Budapest (from left: L. Pataki, G. Katona, J. Hirschberg, Cs. Reti, I. Lel

questions the ‘Pediatric Otolaryngological Letter’ informs theinterested colleagues every year. The working group had majorrole in that the pediatric otorhinolaryngology was acknowledgedas independent discipline by the medical government in 1978.Specialty exam can be taken 2 years after the otolaryngologicalbasic education in case of appropriate preparation (similarsubspecialty are the phoniatrics and the audiology in Hungary).In 1999, according to Verwoerd and Verwoerd-Verhoef’s [68] datain Europe only in four countries: in Czech Republic, Slovakia,Poland and Hungary is pediatric otorhinolaryngology officiallyrecognized as a specialization. The Hungarian pediatric otolar-yngologists early joined in the international life. They participatedin the first congress of European Working Group in PediatricOtorhinolaryngology (EWGPO) in Sirmione, Italy and in allfollowing congresses. At the third international meeting in BathJeno Hirschberg was requested to organize the following congress.The IVth Pediatric Otorhinolaryngological World Congress – in theorganization of Jeno Hirschberg, as the president of EWGPO andZoltan Labas, the president of the Hungarian Section – was held inEger (Hungary) in 1986. The congress – although the participationwas withdrawn by number of persons because of the atomic

ronchology, Phoniatrics and Pedaudiology & Cleft Palate Center in Heim Pal Hospital

lei, M. Dory, Zs. Farkas), on a congress in 2001.

Fig. 3. Paediatric Otorhinolaryngology, Proceedings of the IVth International

Congress of Paediatric Otorhinolaryngology, Eger/Hungary in 1986.

J. Hirschberg et al. / International Journal of Pediatric Otorhinolaryngology 73 (2009) 1228–12331232

reactor catastrophe in Chernobyl – had nearly 500 participants.The whole scientific topic of the congress was published [69](Fig. 3). The EWGPO has been transformed into society in 1994; theHungarian specialists have participated and presented lectures inall congresses. As appreciation of our continuous work in 2008 wecould organize the congress of the European Society of PediatricOtorhinolaryngology (ESPO), with the leading of Gabor Katona andIstvan Sziklai in Budapest. In the meeting 679 specialists haveparticipated from 54 countries: main lectures, round tablediscussions, instructional sessions, poster presentations havecovered all topics of pediatric otolaryngology [70]. After thesuccessful congress Gabor Katona was elected to be a boardmember of ESPO for 2 years. The organization of several otherinternational meetings is connected to the name of pediatricotolaryngologists as well, these were the following: SpeechSymposium, Szeged 1971 [71], Congress of the Union of theEuropean Phoniatricians, Koszeg 1979 [72] and Budapest 1986;Conference on Cleft Lip/Palate and Velopharyngeal Insufficiency,Budapest 1989 and Visegrad 1997 [54]; Int. Meeting on Infant CryResearch, Visegrad 1994. The Hungarian pediatric otolaryngolo-gists have taken part in the activity of life of other national medicalsocieties. Several of them are in the board of the Society ofOtorhinolaryngologists. The president of the Hungarian Bronch-ological Society and the Hungarian Association of Phonetics,Phoniatrics and Logopedics was pediatric otolaryngologist. Ourmembers have (had) important position in international associa-tions (IFOS, ESPO, UEP, IALP, IAP) as president, board member orchairman of committees. Several of them are editors, reviewers ofinternational journals (among others of International Journal of

Pediatric Otorhinolaryngology), honorary members of many foreignsocieties (e.g. ASPO). We feel that the words of Reilly [73], thepresident of ASPO described on the occasion of the election of JenoHirschberg as a honorary member, mean the acknowledgement ofthe whole Hungarian pediatric otorhinolaryngology: ‘‘As a leaderand past President of all the major European medical societiesinvolved in the care of pediatric otolaryngologic problems, he hasbeen keynote lecturer, invited speaker, panel member andmoderator of numerous international congresses in 30 countriespresenting over 700 papers throughout his illustrious career.Perhaps equal to his scientific contributions to our field, has beenhis singular ambassadorial role as the leader and conduit ofcommunication regarding developments in Pediatric Otolaryngol-ogy between Eastern Europe and the rest of the world during thepenumbra of the Cold War’’. Jeno Hirschberg could assume andaccomplish this noble task with the cooperation help of hiscolleagues and the whole Hungarian pediatric otolaryngologicsociety.

5. Discussion

About the Hungarian past, present and future plans of pediatricotorhinolaryngology several papers were published in the pastyears [4]. Based on these it can be established that the Hungarianspecialists assumed initiative role in the development of thisspecial discipline six decades ago, and they continuouslycontribute to the further development of several areas of pediatricotolaryngology, at international level as well. We would like toshare our results and experience with the readers of International

Journal of Pediatric Otorhinolaryngology on its 30th birthday.Durenmatt (1921–1990) said in the last century: the content ofphysics is the concern of physicists, its effect the concern of allmen. We refer this to the medicine and pediatric otolaryngology:the content is the concern of physicians, but its result the concernof all: the common treasure of the whole humanity.

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[24] J. Hirschberg, Acoustic analysis of pathological cries, stridors and coughingsounds in infancy, Int. J. Pediatr. Otorhinolaryngol. 2 (1980) 287–300.

[25] J. Hirschberg, The value of the acoustic analysis of pathological infant cry andbreathing noise in everyday practice, Early Child Dev. Care 12 (1990) 491–502.

[26] F.Kallay,Agyurutukroslaryngoscop,(Ringmirrorlaryngoscope),Ful-orr-gegegyogy.14 (1968) 251–256.

[27] F. Kallay, J. Hirschberg, Gy. Csermely, Erfahrungen uber die in der Beatmungs-bronchoskopie durchgefuhrten Bronchialfremdkorper-Extraktionen im Sau-glings- und Kindesalter, HNO (Berl.) 16 (1968) 245–247.

[28] F. Kallay, J. Hirschberg, Gy. Csermely, Treatment of Airways with Foreign Bodies inInfants, Arch. Otolaryng. 88 (1968) 101–104.

[29] Z. Labas, Bronchoscoppal nem lathato leguti idegentestek, (Airway foreign bodiesnot visible with the aid of bronchoscope), Orv. Hetil. 113 (1972) 632–634.

[30] Z. Labas, J. Denes, A veleszuletett nyelocsoelzarodas kezelesenek gegeszeti-bronchologiai vonatkozasai, (Laryngeal-bronchological aspects of the manage-ment of congenital esophagus atresia), Ful-orr-gegegyogy. 18 (1972) 219–224.

[31] J. Hirschberg, Tracheotomie – Intubation – Notfallbronchoskopie? (Alternativenbei Kindern mit lebensbedrohlichen Zustanden), HNO-Praxis 5 (1980) 207–211.

[32] J. Hirschberg, P.H. Dejonckere, M. Hirano, K. Mori, H.-J. Schultz-Coulon, K. Vriticka,Voice disorders in children, Int. J. Pediatr. Otorhinolaryngol. 32 (Suppl.) (1995)109–125.

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[55] Sz. Horvath, L. Pataki, J. Hirschberg, Methodes electrophysiologiques et histolo-giques en cas d’insuffisance velopharygee, Acta Phon. Lat. 9 (1) (1987) 13–21.

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[66] D. Kollar, Ful-, orr-, gegebetegsegek gyermekkorban, (Ear, nose and larynx dis-eases in childhood), Medicina, Budapest, 1977.

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