Jan Christoffer Luers

Vibroplasty for mixed and conductive hearing loss.

Objective To summarize new application methods of an active middle ear implant (Vibrant Soundbridge) in patients with conductive or mixed hearing loss. Data Sources Publications listed in the Medline/PubMed database. Study Selection All publications published in English language; search term Vibrant Soundbridge AND floating mass transducer in all fields. Data Extraction Structured analysis of all publications. Data Synthesis Extraction of significant findings and conclusions and audiometric data. Conclusion Modern application methods of an active middle ear implant (VSB) open new therapeutic options for patients with various outer and middle ear diseases resulting in conductive or mixed hearing loss. Titanium couplers can help to couple the active middle ear implant in a standardized way to remnants of the ossicular chain or to the round window. Thus, the active middle ear implant has been established as an alternative treatment option for patients with mixed and conductive hearing. However, the heterogeneity of the studies published so far complicates the analysis of the audiometric results, and thus, the functional hearing gain after VSB implantation varies a lot.

The Learning Curve of Sialendoscopy With Modular Sialendoscopes A Single Surgeon's Experience

OBJECTIVEnTo assess the learning curve of sialendoscopy with modular endoscopes based on operative parameters and a postoperative performance rating.nnnDESIGNnProspective study, case series.nnnSETTINGnTertiary referral hospital.nnnPATIENTSnThe study included 50 consecutive patients who underwent sialendoscopy by a single surgeon (J.C.L.) between September 2007 and March 2009 at University Hospital of Cologne, Cologne, Germany. The patients were chronologically arranged into 5 groups of 10 patients.nnnINTERVENTIONSnDiagnostic and interventional sialendoscopy using local anesthesia.nnnMAIN OUTCOME MEASURESnOperative parameters and postoperative performance ratings.nnnRESULTSnThe average operative time was 39 minutes, with a ratio of diagnostic to interventional sialendoscopy of 62%:38%. There was a significant improvement in the average operative time (P < .001) and in the average performance rating (P = .007) after the first 10 patients and again after the first 30 patients (P = .003 and P = .01, respectively). A continuous decrease in operation time was measurable up to the last patients. Performance ratings reached a level of excellence within the last group of patients.nnnCONCLUSIONSnThe performance of sialendoscopy improves with time and experience. With endoscopes of a modular design, the surgeons have a remarkable learning curve. The surgeons learning curve in this study required 30 cases to reach satisfactory operation times and performance ratings. Both parameters showed continuous improvement and a leveling off after 50 cases.

Sialoendoscopy: prognostic factors for endoscopic removal of salivary stones.

OBJECTIVEnTo detect prognostic factors for successful sialoendoscopic removal of salivary stones.nnnDESIGNnRetrospective case series.nnnSETTINGnTertiary referral hospital.nnnPATIENTSnForty-nine consecutive patients who underwent sialoendoscopy for sialolithiasis between January 1, 2008, and January 1, 2010, at University Hospital of Cologne, Cologne, Germany.nnnINTERVENTIONSnDiagnostic and interventional sialoendoscopy using local anesthesia.nnnMAIN OUTCOME MEASURESnStone removal rate, size, mobility, shape, and location, as well as clinical follow-up data.nnnRESULTSnSixty-one percent (39 of 64) of all salivary stones were removed endoscopically. The cutoff point for endoscopic removal was between 5 and 6 mm in stone diameter. Small size, good mobility, round or oval, and distal location of a salivary stone were positive prognostic factors for sialoendoscopic removal, with sialolith mobility having the greatest effect in multivariate analysis.nnnCONCLUSIONnSmall size, good mobility, round or oval, and distal location of a salivary stone in the main duct predict significantly greater probability of endoscopic removal and consequently are positive prognostic factors.

Clip vibroplasty: experimental evaluation and first clinical results.

Objective: To describe an active auditory rehabilitation method (clip vibroplasty) for conductive or mixed hearing loss in cases of a preserved stapes superstructure. Patients: After temporal bone experiments, the new clip vibroplasty was clinically used in 4 patients with chronic otitis media. Interventions: A new titanium double clip device (clip vibroplasty) was developed for a standardized and effective coupling of the floating mass transducer of the Vibrant Soundbridge to the intact stapes. Temporal bone experiments using laser Doppler vibrometry were performed to evaluate the devices acoustic efficiency. The audiologic outcomes of the first 4 patients were analyzed. The subjective benefits and satisfaction were assessed using the standardized International Outcome Inventory for Hearing Aids in all patients. Main Outcome Measures: Transfer characteristics of laser Doppler vibrometry experiments; audiologic outcomes of the 4 patients. Results: In the temporal bone experiment, coupling of the FMT using the titanium double clip support produced transfer characteristics across all tested frequencies comparable to our former total ossicular reconstruction prosthesis or an optimal round window application. The intraoperative application of the clip vibroplasty was uneventful in all cases. No signs of prosthesis dislocation were noted within the follow-up period of approximately 12 months. The audiologic outcome of the first patients showed good hearing gain in pure-tone and speech audiometry, with results that are unobtainable using a conventional air conduction hearing aid. Conclusion: The concept of a partial ossicular reconstruction prosthesis vibroplasty using a titanium clip support entails a straightforward procedure similar to a classic partial ossicular reconstruction prosthesis tympanoplasty. The unoccluded ear canal and the superior auditory performance offer an advantageous application of this power clip in cases of chronic middle ear dysfunction.

Sialendoscopy for sialolithiasis: Early treatment, better outcome

The objective of this study was to investigate whether patients with a short‐term and long‐term disease course of sialolithiasis show differences in the clinical picture and the outcome after sialendoscopy.

Titanium angular clip: a new prosthesis for reconstruction of the long process of the incus.

Objectives: To describe a new titanium angular clip prosthesis for bridging the incudostapedial joint in the event of an isolated lesion of the distal end of the long process of the incus. Study Design: Clinical retrospective study. Methods: We retrospectively reviewed the course of 22 patients with isolated defects of the long process of the incus where the ossicular chain was reconstructed by a titanium angular clip prosthesis. Results: The placement of the prosthesis was successful in all patients, and no complication was encountered during its installation. At the first follow-up visit after 3 weeks, the mean air-bone gap (ABG) was reduced by around 10 dB from a mean of 26 dB preoperatively to 16 dB postoperatively. The mean postoperative hearing result of patients with a Type A tympanogram (7-dB ABG) was consistently better than for patients with a Type B or a Type C tympanogram (19-dB ABG in both). Conclusion: Despite the limited number of patients, this preliminary study demonstrates the effectiveness of the angular clip prosthesis in reconstructing the ossicular chain. In cases of a normal aeration of the tympanic cavity, this reliable reconstruction of the biological chain offers a near-to-normal hearing restoration.

Occurrence of lymph node metastasis in early-stage parotid gland cancer

Lymph node metastasis is one of the most important factors in therapy and prognosis for patients with parotid gland cancer. Nevertheless, the extent of the primary tumor resection and the necessity of a neck dissection still is a common issue. Since little is known about lymph node metastasis in early-stage parotid gland cancer, the purpose of the present study was to evaluate the occurrence of lymph node metastases in T1 and T2 carcinomas and its impact on local control and survival. We retrospectively analyzed 70 patients with early-stage (T1 and T2) primary parotid gland cancer. All patients were treated with parotidectomy and an ipsilateral neck dissection from 1987 to 2009. Clinicopathological and survival parameters were calculated. The median follow-up time was 51.7xa0months. A positive pathological lymph node stage (pN+) was found in 21.4% of patients with a significant correlation to the clinical lymph node stage (cN) (pxa0=xa00.061). There were no differences in the clinical and histopathological data between pN− and pN+ patients. In 73.3% of pN+ patients, the metastases were located intraparotideal. The incidence of occult metastases (pN+/cN−) was 17.2%. Of all patients with occult metastases, 30.0% had extraparotideal lymphatic spread. A positive lymph node stage significantly indicated a poorer 5-year overall as well as 5-year disease-free survival rate compared to pN− patients (pxa0=xa00.048; pxa0=xa00.011). We propose total parotidectomy in combination with at least a level II–III selective neck dissection in any case of early-stage parotid gland cancer.

Comparative analysis of sialendoscopy, sonography, and CBCT in the detection of sialolithiasis

The diagnosis of sialolithiasis is, along with clinical presentation, based on different imaging techniques and more invasive procedures such as sialendoscopy. The aim of the study was to analyze the potential of cone beam computed tomography (CBCT) for the diagnosis of sialolithiasis and to compare the results with those of sonography and sialendoscopy.

Tolerability of Sialendoscopy under Local Anesthesia

Objectives: We sought to investigate patients tolerance of sialendoscopy of the parotid and submandibular glands with local anesthesia. Methods: In a retrospective case series of 84 adult patients who underwent sialendoscopy with local anesthesia at an academic tertiary referral hospital, we analyzed patients demographic data, American Society of Anesthesiologists (ASA) status score, perioperative cardiovascular parameters, and results on a 2-question survey. Results: Of the 84 patients, 44 were female and 40 were male (mean age, 48.6 years). The patients had a mean ASA status score of 1.57. On average, 2.16 mL of local anesthetic was used. The mean systolic blood pressure was 137 mm Hg, and the mean diastolic blood pressure was 80 mm Hg. The duration of the procedure showed a significant correlation with the maximum systolic blood pressure (r = 0.35; p = 0.001), the mean systolic blood pressure (r = 0.25; p = 0.02), the maximum diastolic blood pressure (r = 0.37; p = 0.001), and the mean diastolic blood pressure (r = 0.31; p = 0.005). The mean heart rate was 77 beats per minute. The majority of patients considered the procedure to be tolerable. In this series, the indications for conducting sialendoscopy under general anesthesia were procedures of greater invasiveness and complex situations with multiple sialolithiases, difficult anatomic preconditions, or a very long expected operation time. Conclusions: Sialendoscopy performed with local anesthesia is well tolerated, provided that the patient has a good general health status and the operative procedure is not expected to be complex or long-lasting.

Do the blinds smell better

If people lose a sense organ, there is thought to be an increase in the remaining sensory functions. Previous studies showed ambiguous results on this topic. In a prospective matched pair case-control study on 46 blind and 46 normal-sighted subjects, the olfactory performance was examined using the Sniffin’ Sticks Test [threshold-discrimination-identification (TDI) test], determining the olfactory threshold, the identification and the discrimination performance. There was no significant difference between the groups. Neither the overall olfactory performance (TDI score) nor any of its subtests did correlate with the vision or with the duration of blindness. The study could not detect any superior smell abilities of blind subjects as compared to sighted subjects.