Jan Peter Thomas

Current aspects of etiology, diagnosis and therapy of otosclerosis

The presented article shows the current scientific concept including diagnostics and therapy of otosclerosis with an emphasis on surgical treatment options. The three main proposed causes for otosclerosis are viral and hormonal origin as well as a genetic predisposition. In 25 to 50% a familiar accumulation can be seen. Usually patients become aware of clinical problems by a progressive middle ear hearing loss in the young adulthood. In up to 80% of cases both ear become affected during lifetime. Surgical options of therapy are the stapedotomy, stapedectomy and the laser-assisted stapedotomy. In every case the alternative use of a hearing aid must be offered during the consultation. Typical surgical complications are rare but can be persistent vertigo, secondary facial palsy and a sensorineural hearing loss up to complete single-sided deafness in up to 1% of the cases. The most common finding which necessitates stapes revision surgery is the necrosis of the long incus process with dislocation of the stapes piston.

Human β-Defensins in different states of diseases of the tonsilla palatina

Tonsils are believed to play an important role during the development of the immune system. Although diseases of the tonsils like hypertrophy of the tonsil, acute tonsillitis, chronic tonsillitis or peritonsillar abscess are common, little is known about the underlying pathophysiology. Little is known about antimicrobial peptides produced by the tonsils. The human β-Defensins 1-3 (hBD1-3) are naturally produced “antibiotics” with antimicrobial activity against different bacteria, fungi, and viruses. The objective of the study was to determine the concentrations for hBD1-3 in different states of diseases of the tonsilla palatina. After tonsillectomy and tissue fixation in formalin, total proteins were isolated from 38 samples (11 hypertrophy of the tonsil, 8 acute tonsillitis, 11 chronic tonsillitis, 8 peritonsillar abscesses). The protein concentration was determined and ELISA for hBD1-3 were performed. We also conducted immunofluorescence double stainings for the co-expression of streptococcus group A and hBD1-3. We could verify a significant difference for the mean hBD1 score of the acute tonsillitis in comparison to the hyperplastic tonsil, the chronic tonsillitis, and the peritonsillar abscess. There was no statistically significant difference in the hBD2 and hBD3 concentrations between the four groups. The immunofluorescence stainings showed that hBD1-3 and the streptococcus group A in the same place. We conclude that in the hyperplastic tonsilla palatina hBD1-3 play an important role. The mouth is constantly faced with a high bacterial load. During a tonsillitis, the hBD1 concentration is lower than in the non-acute infected tonsil because hBD1 is being consumed for fighting the bacterial infection. But, the existence of hBD1-3 in the tonsil cannot prevent the tonsillitis to become chronic.

Acute otitis media--a structured approach.

BACKGROUND Two-thirds of all children have an episode of acute otitis media (AOM) before their third birthday. Antibiotic treatment is often given immediately, even though adequate scientific evidence for this practice is lacking. METHOD This review is based on a selective literature search including previously published evidence-based recommendations, particularly those of the current American guidelines. RESULTS A purulent tympanic effusion, possibly associated with inflammation of the tympanic membrane, is indicative of AOM. Only some patients with AOM need immediate antibiotic treatment: children with severe otalgia and/or fever of 39.0°C or above, infants under 6 months of age, and children with certain specific risk factors, including immune deficiency and Down syndrome. In other cases, symptomatic treatment is appropriate. Antibiotic therapy (preferably with amoxicillin) should be initiated only if the symptoms and signs do not improve within two to three days. CONCLUSION As the currently available data are not fully consistent, there is still a need for controlled trials with well-defined endpoints to determine the relative benefits of immediate antibiotic treatment versus two to three days of watchful waiting.

Cochlear Implantation in Children With Congenital Single-sided Deafness

OBJECTIVE To determine audiological and clinical results of cochlear implantation in children with congenital single sided deafness (SSD), with an emphasis on children implanted before and after 6 years of age. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. SUBJECTS Twenty one children with congenital SSD who were implanted aged 10 months to 11;3 years. INTERVENTION Unilateral cochlear implantation. MAIN OUTCOME MEASURES Speech recognition in noise via the German Oldenburg Sentence Test for Children (OlKiSa), lateralization ability, and subjective evaluation of hearing results using self- and third-party assessment questionnaires. RESULTS Significant improvements of all three aspects of true binaural hearing were found. The most striking improvement was the combined head shadow effect by 2.11 dB (squelch effect: 0.95 dB, summation effect 0.98 dB). An improvement of lateralization ability was also demonstrated. Parents had a high overall level of satisfaction with their childrens cochlear implantation. Subjective benefit was verified in all three subscales of the Speech, Spatial, and Qualities of Hearing Questionnaire. No significant difference was found between subjects implanted before the age of 6 with those implanted later. Three of the five subjects with a follow-up of greater than 3 years were limited users or nonusers. CONCLUSIONS Cochlear implant (CI) provision provides children with congenital SSD with significant audiological and subjective benefits which can be seen even in children implanted after the age of 3;6. The problem of limited use and nonuser, however, should not be ignored and has to be considered for further studies.

Off the ear with no loss in speech understanding: comparing the RONDO and the OPUS 2 cochlear implant audio processors

The RONDO is a single-unit cochlear implant audio processor, which omits the need for a behind-the-ear (BTE) audio processor. The primary aim was to compare speech perception results in quiet and in noise with the RONDO and the OPUS 2, a BTE audio processor. Secondary aims were to determine subjects’ self-assessed levels of sound quality and gather subjective feedback on RONDO use. All speech perception tests were performed with the RONDO and the OPUS 2 behind-the-ear audio processor at 3 test intervals. Subjects were required to use the RONDO between test intervals. Subjects were tested at upgrade from the OPUS 2 to the RONDO and at 1 and 6 months after upgrade. Speech perception was determined using the Freiburg Monosyllables in quiet test and the Oldenburg Sentence Test (OLSA) in noise. Subjective perception was determined using the Hearing Implant Sound Quality Index (HISQUI19), and a RONDO device-specific questionnaire. 50 subjects participated in the study. Neither speech perception scores nor self-perceived sound quality scores were significantly different at any interval between the RONDO and the OPUS 2. Subjects reported high levels of satisfaction with the RONDO. The RONDO provides comparable speech perception to the OPUS 2 while providing users with high levels of satisfaction and comfort without increasing health risk. The RONDO is a suitable and safe alternative to traditional BTE audio processors.

Verletzungen im HNO-Bereich

ZusammenfassungVerletzungen des Kopf-Hals-Bereiches können sowohl isoliert als auch im Rahmen eines Polytraumas auftreten. Bei der Erstversorgung stehen die Erkennung und Versorgung lebensbedrohlicher Zustände im Vordergrund, erst nach Stabilisierung des Patienten folgen im interdisziplinären Vorgehen die weitere Diagnostik und Therapie. Im vorliegenden Beitrag werden in Abhängigkeit vom Ort der Verletzung – Ohr und Laterobasis, Mittelgesicht, Kopfspeicheldrüsen, Larynx, Ösophagus – das symptomorientierte strukturierte diagnostische und therapeutische Vorgehen erläutert. Primäre Leitsymptome von Verletzungen im HNO-Bereich (Hals-Nasen-Ohren-Bereich) sind offensichtliche, von außen erkennbare Defekte, Blutungen aus Ohr, Nase und Mund, Rhino- oder Otoliquorrhö. Im Verlauf kann es zu weiteren Symptomen, wie Beeinträchtigung des Hör- und Riechvermögens, Schwindel, Diplopie, Dysgnathie, Störungen des Visus oder der Gesichtsmotilität usw., kommen. Die adäquaten therapeutischen Maßnahmen hängen von der Art der Verletzung ab, es können sowohl konservative als auch operative Vorgehensweisen erforderlich sein.AbstractInjuries to the ear, nose and throat area can be either isolated or part of polytrauma. In the initial emergency response, recognizing and treating life-threatening injuries takes priority; only once the patient has been stabilized further interdisciplinary diagnostic and therapeutic measures can be undertaken. The presented article discusses a symptom-oriented and structured diagnostic and therapeutic procedure depending on injury location: ear and laterobasis, midface, major salivary glands, larynx, esophagus. The primary symptoms of ENT injury are apparent, externally visible defects, bleeding from the ear, nose and mouth, as well as rhino- and otoliquorrhoea. In due to course, further symptoms may appear, such as impaired hearing and olfactory function, dizziness, diplopia, dysgnathia, visual acuity or facial motility disorders, etc. Appropriate therapeutic measures depend on the type of injury, which may require either a conservative or surgical approach.

Transmastoid implantability of an active transcutaneous bone conduction implant in adults with regard to the underlying pathology: a radiological simulation study

Abstract Objectives: To compare the feasibility of transmastoid implantation of an active transcutaneous bone conduction device (BCD) in the most important pathologies of the temporal bone and the impact of implant lifts in adulthood. Methods: First, clinical predominant pathologies for implantation of this BCD were evaluated by a literature review. Then, high-resolution CT of 240 temporal bones with neuro-otologic diseases (NOD), chronic otitis media (COM), or cholesteatoma, respectively, were investigated regarding their implantability, using a radiological simulation program. Results: Chronic inflammatory diseases (CID) of the temporal bone with or without cholesteatoma account for most adults scheduled for an active BCD. Complete implantation was possible in almost all cases with NOD as well as COM, requiring an implant lift in 50% of COM and 20% of NOD (p = .025) cases. In contrast, in subjects with cholesteatoma, implantation required an additional tool in 92% of cases, leading to 59% implantability rate in these temporal bones. Conclusion: Adult subjects with CID of the temporal bone show more limiting anatomical conditions for transmastoid placement of an active transcutaneous BCD than those with single-sided deafness. Implant lifts increase the implantability significantly in subjects with COM and particularly in those with cholesteatoma.

Application of a computer-based neurocognitive assessment battery in the elderly with and without hearing loss

Introduction Due to demographic changes, the number of people suffering not only from dementia illness but also from hearing impairment with the need for hearing rehabilitation have increased noticeably. Even with the association between hearing, age, and cognitive decline being well known, this issue has so far not played an important role in daily clinical Ear Nose Throat settings. The aim of the present study was to evaluate the use of a computer-based battery of tests of neurocognitive abilities in older patients with and without hearing loss. Patients and methods A total of 120 patients aged 50 years and older were enrolled in this prospective clinical study: 40 patients suffered from severe bilateral hearing loss and were tested before cochlear implantation and 80 patients showed normal hearing thresholds between 500 and 4,000 Hz bilaterally. The test battery covered a wide range of cognitive abilities such as long- and short-term memory, working memory (WM), attention, inhibition, and other executive functions. Individuals with severe depression or cognitive impairment were excluded. Results Hearing status was a significant predictor of performance on delayed recall (P=0.0082) and verbal fluency after adjusting for age (P=0.0016). Age predominantly impacted on inhibition (P=0.0039) and processing speed (P<0.0001), whereas WM measured by the Operation Span task (OSPAN) and the attention were influenced by both age and hearing. The battery of tests was feasible and practical for testing older patients without prior computer skills. Conclusion A computerized neurocognitive assessment battery may be a suitable tool for the elderly in clinical practice. While it cannot replace a thorough neuropsychological examination, it may help to draw the line between cognitive and hearing impairment in the elderly and enable the development of individual strategies for hearing rehabilitation.

[Development of a computed tomography data-based Vibrant Bonebridge viewer].

BACKGROUND Because of the anatomy of the mastoid and the size of the actuator, positioning of the Vibrant Bonebridge B-FMT can be difficult without prior evaluation of the individual computed tomography (CT) scan of the temporal bone. Development of a user-friendly CT data viewer to enable positioning of the B-FMT in the temporal bone model, whilst identifying individual, potential anatomic conflicts and offering possible solutions could provide a useful tool for preoperative positioning. OBJECTIVES Aim of the study was to define the requirements of a Vibrant Bonebridge viewer and construct a prototype. MATERIALS AND METHODS Based on a ZIBAmira software version and inclusion of a B-FMT model upon creation of a model of the temporal bone-which allows the intuitive estimation of individual, anatomic conflicts-a Vibrant Bonebridge viewer was constructed. RESULTS The segmentation time of the individual digital imaging and communications in medicine (DICOM) data set is about 5 min. Positioning within the individual three-dimensional temporal bone model allows quantitative and qualitative estimation of conflicts (sigmoid sinus, middle cranial fossa) and determination of a preferred position for the B-FMT. Lifting of the B-FMT can be simulated with the help of a virtual washer. CONCLUSION The Vibrant Bonebridge viewer reliably allows simulation of B-FMT positioning. The clinical value of the viewer still has to be evaluated.

Entwicklung eines CT-Daten-basierten Vibrant-Bonebridge-Viewers

BACKGROUND Because of the anatomy of the mastoid and the size of the actuator, positioning of the Vibrant Bonebridge B-FMT can be difficult without prior evaluation of the individual computed tomography (CT) scan of the temporal bone. Development of a user-friendly CT data viewer to enable positioning of the B-FMT in the temporal bone model, whilst identifying individual, potential anatomic conflicts and offering possible solutions could provide a useful tool for preoperative positioning. OBJECTIVES Aim of the study was to define the requirements of a Vibrant Bonebridge viewer and construct a prototype. MATERIALS AND METHODS Based on a ZIBAmira software version and inclusion of a B-FMT model upon creation of a model of the temporal bone-which allows the intuitive estimation of individual, anatomic conflicts-a Vibrant Bonebridge viewer was constructed. RESULTS The segmentation time of the individual digital imaging and communications in medicine (DICOM) data set is about 5 min. Positioning within the individual three-dimensional temporal bone model allows quantitative and qualitative estimation of conflicts (sigmoid sinus, middle cranial fossa) and determination of a preferred position for the B-FMT. Lifting of the B-FMT can be simulated with the help of a virtual washer. CONCLUSION The Vibrant Bonebridge viewer reliably allows simulation of B-FMT positioning. The clinical value of the viewer still has to be evaluated.