Andreas Anagiotos

Young age is a positive prognostic factor for residual hearing preservation in conventional cochlear implantation.

Objective To investigate the prognostic significance of various factors in hearing preservation after traditional cochlear implantation (CI). Study design Retrospective case review. Setting Academic tertiary referral center. Patients A total of 153 implantations with mean patient age at implantation of 36 years (from 10 mo to 83 yr) and residual hearing at the frequencies 250, 500, and 1,000 Hz on the unaided preoperative pure-tone audiometry were included. Intervention(s) CI with a conventional full-length electrode. Main outcome measure(s) The changes on the residual hearing 3 months after implantation were analyzed regarding patients’ demographic factors, shape of the preoperative threshold curve, type of the electrode carrier, and approach of electrode insertion in the cochlea. Preservation of residual hearing was defined as measurable postoperative threshold at the frequencies 250, 500, and 1,000 Hz. Results Preservation of residual hearing was observed in almost half of the cases (47%). In more than half of these patients (54%), a maximal to complete hearing preservation (0–10 dB loss) was achieved. About one-third of these implantations (29%) showed a moderate preservation of residual hearing (11–20 dB loss). In the remaining 17%, the preservation of hearing was marginal (>21 dB loss). Hearing preservation and its extent were significantly better in children and adolescents compared with those in adults. Conclusion The preservation of residual hearing after conventional CI is possible. Young age seems to have a positive impact on hearing preservation.

Morphometric and anthropometric analysis of Killian's triangle.

To determine the prevalence and the morphometric characteristics of Killians triangle and to examine their relationship with the anthropometric features of the person.

Insertion of Cochlear Implant Electrode Array Using the Underwater Technique for Preserving Residual Hearing.

Objective: To describe a method of cochlear implantation in which the opening of the cochlea and the electrode array insertion are performed under water (underwater technique). Study Design: Retrospective patient review. Setting: Academic tertiary referral center. Patients: Fifteen implantations in children and adult patients with residual hearing at the frequencies 250, 500, and 1000 Hz on the unaided preoperative pure-tone audiometry were included in this study. Intervention(s): Cochlear implantation with a conventional full-length electrode, in which the opening of the cochlea and the electrode array insertion are performed after the tympanic cavity was filled with body-temperature Ringer solution. Main Outcome Measure(s): Changes on residual hearing 6 to 8 weeks after surgery and at subsequent follow-up appointments were analyzed. Preservation of residual hearing was defined as measurable postoperative threshold at the frequencies 250, 500, and 1000 Hz. Results: Overall postimplant hearing preservation 6 to 8 weeks after implantation was achieved in 13 of the patients (87%). Subsequent follow-up was performed on average 15.2 months after surgery (range, 7–32) in 14 out of 15 patients. At this late postoperative evaluation preservation of hearing was recorded in nine patients (64%), whereas in the remaining five patients (36%) no residual hearing was measured. Conclusion: The underwater technique offers a reliable nontraumatic method for electrode array insertions during cochlear implantation. The method respects the physiology of the cochlea und minimizes the pressure variations during cochlear opening and implantation.

Comparison of digital volume tomography and high-resolution computed tomography in detecting superior semicircular canal dehiscence - a temporal bone study

Abstract Conclusion: In detecting a thin bony coverage of a superior semicircular canal (SSC), digital volume tomography (DVT) scans in Poeschl projection seem to be superior to high-resolution computed tomography (CT) scans. Still, a definite diagnosis of SSC dehiscence (SSCD) is not possible with any radiologic imaging technique. Objective: To compare CT and DVT to find out whether DVT is equal, better or worse in showing a thin bony layer on top of an SCC. Methods: In 11 human temporal bone specimens, the SSC was microscopically blue-lined leaving a thin bony coverage on top of it. All specimens were assessed with both high-resolution CT and DVT. After reconstructing the images in Stenvers and Poeschl projections, all images were evaluated by five independent examiners experienced in radiologic imaging of the temporal bone using a four-point ordinal scale, from 1 (distinct dehiscence) to 4 (distinct coverage). Results: The mean score for all CT scans was 2.58 compared with 3.22 for DVT scans (p = 0.000). Poeschl projection showed a mean score of 3.25 compared with 2.55 for Stenvers projection (p = 0.000). The best imaging modality was found to be DVT scans in Poeschl projections, with a mean score of 3.60.

Long-term symptom control after endoscopic laser-assisted diverticulotomy of Zenker's diverticulum

OBJECTIVE To assess the long-term outcome after endoscopic laser-assisted diverticulotomy. METHODS The medical files of patients who underwent endoscopic Zenkers diverticulum (ZD) surgery were reviewed retrospectively. Patients were interviewed using a questionnaire which assessed symptoms, other relevant disorders and satisfaction after the surgery. RESULTS Mean follow-up period from 62 surgeries was 100 months (range 11-216 months). Follow-up data were obtained from 34 patients (response rate: 55%) in total. The surgery resulted in a significant reduction of symptoms (regurgitation, dysphagia and globus sensation). In four cases (12%) a postoperative impairment of swallowing solid food was reported, whereas, persisted difficulty of swallowing liquids was observed in two patients (6%). There was no reported case of impairment associated with everyday habits. The majority of patients were satisfied with the overall outcome of the surgery (n=31, 91%). CONCLUSION The endoscopic laser-assisted diverticulotomy is an effective method of treating Zenkers diverticulum. The presented long-term results confirm that this technique offers a very high degree of symptom relief and patients satisfaction.

Impact of coupling techniques of an active middle ear device to the round window membrane for the backward stimulation of the cochlea.

Hypothesis Interposed cartilage and the round window coupler (RWC) increase the efficiency of cochlea stimulation with the floating mass transducer (FMT) of a single active middle ear implant (AMEI) placed against the round window membrane. Background Treatment of mixed and conductive hearing loss with an AMEI attached to the round window is effective, yet the best placement technique of its FMT for the most efficient stimulation of the cochlea remains to be determined. Methods Experimental study on human temporal bones with the FMT placed against firstly the unaltered round window niche and then subsequently against the fully exposed round window membrane with and without interposed cartilage and the RWC. Cochlea stimulation is measured by the volume velocities of the stapes footplate using LASER vibrometry. Results At the undrilled round window niche, placement of the FMT by itself and with the RWC resulted in similar volume velocities. The response was significantly raised by interposing cartilage into the undrilled round window niche. Complete exposure of the round window membrane allowed for significantly increased volume velocities. Among these, coupling of the FMT with interposed cartilage yielded responses of similar magnitude compared with the RWC but significantly higher compared with the FMT by itself. Conclusion Good contact to the round window membrane is essential for efficient stimulation of the cochlea. Therefore, interposing cartilage into the undrilled round window niche is a viable option. At the drilled round window membrane, the FMT with interposed cartilage and attached to the RWC are similarly effective.

Loads and Coupling Modalities Influence the Performance of the Floating Mass Transducer as a Round Window Driver.

Hypothesis: High loads forcing the floating mass transducer (FMT) of a single active middle ear implant toward the round window membrane (RWM) affect the backward stimulation of the cochlea. Background: Various factors influence the backward stimulation of the cochlea. We investigated the effects of various loads applied to the FMT together with different coupling techniques at the fully exposed RWM on the vibration transmission. Methods: Experimental study on temporal bones with the FMT linked to a load cell mounted on a translation stage moving it against the fully exposed RWM with increasing loads up to 200 mN by itself, with interposed perichondrium, cartilage or connected to the round window coupler. Cochlear stimulation is measured by the volume velocities of the stapes footplate using LASER-Doppler-vibrometry. Results: Loads ranging from 5 to 20 mN induce the highest volume velocities of the stapes footplate. Increasing loads decrease the transmission of vibration in the low-frequency range but enhance the transmission of high frequencies. The interposition of perichondrium and cartilage proved to be advantageous. Conclusion: The load applied to the FMT distinctly affects the backward stimulation of the cochlea. Although increasing loads have inverse effects on the transmission of low and high frequencies, high loads lead to an overall decrease of cochlear stimulation. Out of the applied coupling techniques interposed perichondrium and cartilage allow for the most efficient stimulation.

Multiple craniocervical chordomas presenting as a parapharyngeal mass

Chordomas are malignant neoplasms of the axial skeleton that have rarely been seen in the cervical area.

Does the hypopharyngeal cavernous body protect the development of Zenker's diverticulum?

OBJECTIVE The aim of this study was to examine the morphology of the cavernous body at the pharyngoesophageal segment. METHODS In 47 cadavers the submucosal vascular plexus of the pharyngoesophageal segment and the cricopharyngeal muscle were examined. RESULTS A vascular plexus which was macroscopically non visible or slightly identified was observed in the majority of the specimens (28 or 59.6%). Fourteen of the cadavers (29.8%) exhibited macroscopically lightly observable blood vessels which were covering a discontinuous area of the hypopharyngeal wall. In the other five specimens (10.6%) the vascular plexus was covering a large part of the dorsal wall of the pharyngoesophageal segment as a compact mass. The grade of dilation of the vascular plexus corresponded to the degree of protrusion of the cricopharyngeal muscle. CONCLUSIONS In the case of a persistent constricted cricopharyngeal muscle, the dilation of the hypopharyngeal cavernous body may protect from developing a Zenkers diverticulum by reinforcing the Killians dehiscence.

Benign cylindroma: a rare differential diagnosis of external ear canal tumour.

Cylindromas are rare adnexal skin tumours that usually occur in the head and neck area. This article reports a case of benign cylindroma arising in the external auditory canal. A 75-year-old man presented with a 3-month history of right aural fullness; no other symptoms were reported. Ear microscopy examination revealed a skin mass on the floor of the external ear canal. Α CT scan of the skull showed a well-circumscribed soft tissue mass, with no signs of underlying cortical bone erosion. Tumour resection through an endaural approach was performed. Histological examination revealed a benign cylindroma with margins free of tumour, so that no further treatment was necessary. 8 months after surgery the patient is asymptomatic with normal findings in the ear microscopy examination. Benign cylindroma has a high recurrence rate and can undergo malignant transformation. Therefore, complete surgical removal and close follow-up are of great importance.