Benjamin Loader

Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's disease

Abstract Conclusions: Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude tenotomy to be effective in unilateral, definite Menieres disease – laying the foundation for future prospective, randomized controlled trials. Objectives: This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Menieres disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective. Methods: This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Menieres disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2–9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each. Results: A statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013).

Milk allergy is frequent in patients with chronic sinusitis and nasal polyposis.

Background Chronic sinusitis and nasal polyps with subsequent nasal blocking, anosmia, and relapsing infections are frequent in the rhinological practice. Often, recurrent disease necessitates repetitive conservative therapy and surgical treatment (functional endoscopic sinus surgery). This study was initiated to scrutinize the relationship of wheat and milk allergies to chronic polypoid sinusitis (CPS) and recurrent disease. Methods Blood samples of 50 healthy controls and 50 patients with clinically and radiologically diagnosed CPS and nasal polyposis were screened for common food allergies including wheat and milk allergy. On inclusion into the study, none of the patients reported a symptomatic food allergy. Results Fifteen of 100 tested subjects (15%) revealed a previously undiagnosed allergy to inhalant (dust, rye, and pollens) and other food allergens (corn and egg white). Six of 50 patients (12%) with CPS exhibited a wheat allergy, and a milk allergy could be identified in 7 patients (14%). In the control group, seven healthy subjects (14%) showed a wheat allergy and no case of milk allergy could be identified (p = 0.0125). Conclusion In contrast to previous studies in other countries presenting a food allergy incidence of ∼75% in patients with nasal polyposis, we could not show such a high incidence. In the group with chronic polyposis 14% of the patients were positive for milk allergy compared with none of the tested healthy subjects, resulting in a strong statistical significance. Therefore, we conclude that cows milk but not wheat allergy might be a relevant pathogenetic entity in chronic nasal polyps.

Tenotomy of the stapedius and tensor tympani muscles reduces subjective dizziness handicap in definite Meniere's disease

Abstract Conclusion: Tenotomy is a promising surgical alternative with a high reduction in dizziness handicap in the short and long term. Objectives: To investigate the immediate and the long-term effect of tenotomy of the stapedius and tensor tympani muscles on subjective dizziness as measured by the Dizziness Handicap Inventory (DHI). Methods: A retrospective follow-up study of 42 patients with definite, unilateral Menieres disease (19 males, 23 females, average age = 58.1 ± 14.1 years) had undergone tenotomy under general anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients, with postoperative follow-up ranging from 6 months to 9 years. Additionally, results were divided into three postoperative subgroups (A = 0–3 years, B = 3–6 years, C = 6–9 years). Results: A statistically significant reduction of 48 DHI points, from a median preoperative DHI = 52 to DHI = 4 postoperatively, was noted (p < 0. 001). In all, 40/42 patients reported a reduction of dizziness handicap, while in 33/42 the difference was > 12 points. A statistically significant reduction of DHI scores was noted (A = 60, B = 34, C = 33) in all subgroups. It was also noted that the higher the preoperative DHI score, the greater the subjective success of the surgery.

Combined analysis of audiologic performance and the plasma biomarker stromal cell-derived factor 1a in type 2 diabetic patients.

Objective: This study presents a potentially novel method of screening for pathogenetic factors in diabetic audiopathy by comparing the absolute plasma concentration of a microangiopathy biomarker, stromal cell-derived factor 1a (SDF-1a), with frequency-specific audiometric results. Background: Impaired hearing function in diabetic patients has, to date, remained a controversial and poorly understood theme with sparse clinical data. This is in contrast to more established components of the disease such as diabetic retinopathy, where diabetic microangiopathy is thought to be of pathogenetic relevance, and specific molecules such as SDF-1a have been assigned a relevant role. Clinical Setting: Out patient clinic, Vienna General Hospital, Medical University of Vienna. Patients: 18 Type 2 diabetic patients and 18 nondiabetic controls. Materials and Methods: Pure-tone audiometry and Freyburger number tests were used to evaluate hearing function. Blood plasma values of SDF-1a were analyzed using an enzyme-linked immunosorbent assay. Statistical comparison of functional audiometric data and the absolute SDF-1a values was performed for all frequencies. Results: A significantly higher plasma SDF-1a concentration (p < 0.005) in Type 2 diabetic patients, who also presented with higher pure-tone audiometry thresholds compared with nondiabetic subjects, was noted. Furthermore, an association between SDF-1a and audiometric performance, body mass index, and duration of diabetes was observed. Conclusion: We hypothesize that diabetic microangiopathy and its biomarker SDF-1a should be considered as potential pathogenetic factors for altered diabetic hearing, warranting further investigation.

Impact of Sonic Hedgehog Pathway Expression on Outcome in HPV Negative Head and Neck Carcinoma Patients after Surgery and Adjuvant Radiotherapy.

Introduction HPV positive patients suffering from head and neck cancer benefit from intensified radiotherapy when applied as a primary as well as an adjuvant treatment strategy. However, HPV negative patients treated with surgery and adjuvant radiotherapy lack validated prognostic biomarkers. It is therefore important to define prognostic biomarkers in this particular patient population. Especially, ´high-risk groups´ need to be defined in order to adapt treatment protocols. Since dysregulation of the sonic hedgehog pathway plays an important role in carcinogenesis, we aimed to assess whether members of the sonic hedgehog-signaling pathway may act as prognostic factors in patients with HPV negative head and neck squamous cell carcinoma. Materials and Methods In this prospective study, pretreatment tumor biopsies of patients with head and neck squamous cell carcinoma were taken during panendoscopy (2005 to 2008). All patients were treated with surgery and postoperative radiotherapy. After assessment of HPV and p16 status, protein expression profiles of the Sonic hedgehog-signaling pathway were determined by immunohistochemistry and tissue microarray analyses in 36 HPV negative tumor biopsies. Expression profiles of Sonic hedgehog, Indian hedgehog, Patched, Smoothened, Gli-1, Gli-2 and Gli-3 were correlated with patients´ clinical data, local-control rate, disease-free as well as overall survival. Data from The Cancer Genome Atlas databank were used for external validation of our results. Results Gli-1 (p = 0.04) and Gli-2 (p = 0.02) overexpression was significantly linked to improved overall survival of HPV negative patients. Gli-2 (p = 0.04) overexpression correlated significantly with prolonged disease-free survival. Cox-multivariate analysis showed that overexpression of Gli-2 correlated independently (HR 0.40, 95% CI 0.16–0.95, p = 0.03) with increased overall survival. Discussion Gli-1 and Gli-2 overexpression represents a substantial prognostic factor for overall and disease-free survival in patients with locally advanced HPV negative head and neck cancer undergoing surgery and postoperative radiotherapy.

Sealing of the round and oval window niches with triamcinolone-soaked fascia as salvage surgical therapy in sudden sensorineural hearing loss

Abstract Conclusions: Triamcinolone-soaked fascia seems to show better hearing improvement when added to tympanotomy for sudden idiopathic sensorineural hearing loss (SSHL), compared to fascia round window occlusion without triamcinolone. Objectives: To analyse if adding triamcinolone to sealing the round and oval window niches with fascia results in improved audiological outcome for acute SNHL. Methods: Fifty-three patients (27m:43 ± 12 years, 26f:45 ± 14 years) with acute SSHL ≥50dB over 3 frequencies, who failed primary therapy, underwent transcanal tympanotomy. Twenty-five patients (Group A;cortisone:14m, 11f:46 ± 9 years) received sealing of the round and oval window with fascia soaked in triamcinolone (1ml; 40mg/ml) and 28 controls (Group B;no-cortisone:13m, 15f, 42 ± 12 years) without triamcinolone. Frequency specific and pure tone average (PTA =500–1000–2000–3000Hz) results were compared between Group A and B pre- and postoperatively. Results: In Group A the PTA improved by ≥10dB in 21/25(83%) cases; in Group B 18/28(63%). Group A showed a statistically significantly better improvement across all frequencies, while linear regression revealed a significant decrease of posttherapeutic PTA to 94.96% of the initial PTA (p = .037). The overall PTA improved by 24dB. Group A improved from 73dB to 41dB(-32dB) PTA, Group B improved from 76dB to 56dB PTA (-20dB) (p < .05). Group A showed a significant additional decrease of 12.8dB (p < .001).

Direct comparison of mastoidal and retrosigmoidal placement of a transcutaneous bone conduction device after canal wall down tympanoplasty

Cholesteatoma and chronic otitis media are common and regularly treated in surgical otology centers. Repeated surgeries are often required in order to eliminate residual disease and reconstruct functional hearing. Frequently, the posterior wall of the auditory canal has to be resected resulting in a canal wall down (CWD) technique with variable hearing outcome. This article is protected by copyright. All rights reserved.

Hearing outcomes of Incus-Interposition versus Titanium-partial ossicular replacement prostheses – Our experience in 115 Patients

Both, PORP and incus interpositions, are valuable techniques for the reconstruction of the conductive mechanism. In our study we were able to show that, in certain aspects, the audiological outcome was better in incus remodelling reconstruction than in PORP placement. A detailed analysis of all frequencies showed significantly better results in the incus group especially for the frequencies 250Hz, 1000Hz, 2000Hz and 3000Hz. If clinical conditions warrant it, a reconstruction of the ossicular chain with incus interposition may be preferred to PORP. Unexpectedly, no significant correlation between age and outcome for both groups was noted. Hence age is not to be considered as a limiting factor for partial ossicular reconstruction. This article is protected by copyright. All rights reserved.

Cognitive and emotional demands of black humour processing: the role of intelligence, aggressiveness and mood.

Humour processing is a complex information-processing task that is dependent on cognitive and emotional aspects which presumably influence frame-shifting and conceptual blending, mental operations that underlie humour processing. The aim of the current study was to find distinctive groups of subjects with respect to black humour processing, intellectual capacities, mood disturbance and aggressiveness. A total of 156 adults rated black humour cartoons and conducted measurements of verbal and nonverbal intelligence, mood disturbance and aggressiveness. Cluster analysis yields three groups comprising following properties: (1) moderate black humour preference and moderate comprehension; average nonverbal and verbal intelligence; low mood disturbance and moderate aggressiveness; (2) low black humour preference and moderate comprehension; average nonverbal and verbal intelligence, high mood disturbance and high aggressiveness; and (3) high black humour preference and high comprehension; high nonverbal and verbal intelligence; no mood disturbance and low aggressiveness. Age and gender do not differ significantly, differences in education level can be found. Black humour preference and comprehension are positively associated with higher verbal and nonverbal intelligence as well as higher levels of education. Emotional instability and higher aggressiveness apparently lead to decreased levels of pleasure when dealing with black humour. These results support the hypothesis that humour processing involves cognitive as well as affective components and suggest that these variables influence the execution of frame-shifting and conceptual blending in the course of humour processing.