Martin Westhofen

Fallopian canal dehiscences: a survey of clinical and anatomical findings

This survey investigates fallopian canal dehiscences in order to assess the risk of encountering an unprotected facial nerve during routine ear surgery. In a prospective non-randomized study, the intraoperative appearance of the facial canal in 357 routine ear operations was compared with 300 temporal bone specimens from 150 autopsies. Intraoperatively, a dehiscence was detected in 6.4% (23/357) of the operations, most frequently at the oval niche region (16/23 cases). The incidence increased with the number of operations (P<0.0002). Cholesteatoma surgery had the highest relative risk (RR 4.6) of exposing an unprotected facial nerve. Postoperatively, no persistent facial paralysis was observed. In four of five cases with a transient facial palsy due to local anesthetics, a bony dehiscence could be found. The anatomical study revealed fallopian canal dehiscences in 29.3% (44/150) of the autopsies. One-third (15/44) of the individuals affected displayed bilateral findings, thus resulting in 19.7% (59/300) of temporal bones affected. A total of 17/59 bones showed microdehiscences, and most (55/59) were located at the oval niche. The actual prevalence of fallopian canal dehiscences is significantly higher than intraoperative findings suggest. The oval niche is the most affected region. High-resolution computed tomography is of diagnostic value only in selected cases. Facial paralysis following local anesthesia is the most significant clinical sign. Vigilance in acute facial palsy after local anesthetics and in cholesteatoma surgery and adequate intraoperative exposure help to prevent iatrogenic injury of the uncovered nerve. In unclear cases, nerve monitoring can facilitate a safe outcome.

Relationship between matrix metalloproteinases MMP-2, MMP-9, tissue inhibitor of matrix metalloproteinases-1 and IL-5, IL-8 in nasal polyps

Background:  Nasal polyps (NP), a subgroup of chronic rhinosinusitis, are characterized by interleukin 5 (IL‐5) mediated infiltration of eosinophils in sinus mucosa, leading to pseudostratified ciliated columnar epithelium, thickening of the epithelial basement membrane and tissue edema. Matrix metalloproteinases (MMP) constitute a large group of Zn2+ dependent endopeptidases with the ability to degrade extracellular matrix and are possibly responsible for the development of tissue edema in chronic sinusitis.

Speech perception in elderly patients following cochlear implantation

Conclusions. Elderly patients benefit from cochlear implantation in terms of speech perception and quality of life. Age alone should be no contraindication for implantation. Objective. There have been concerns whether elderly patients may perform poorly after cochlear implantation due to degenerative processes in the central and peripheral auditory systems. The purpose of this study was to analyze the benefits of cochlear implantation in elderly patients in comparison to younger recipients. Material and methods. We examined 26 postlingually deafened adults aged > 65 years who received a cochlear implant at our center regarding preoperative findings, comorbidities, postoperative complications and quality of life. Speech perception was assessed by means of multi- and monosyllabic word recognition and compared to the results obtained by younger patients. Results. The surgical procedure was well tolerated by all patients without notable perioperative complications. In terms of speech perception, no significant differences between the elderly patients and younger recipients were noted. All patients found that cochlear implantation had a positive impact on their quality of life.

Autosomal recessive postlingual hearing loss (DFNB8): compound heterozygosity for two novel TMPRSS3 mutations in German siblings

Mutations in the transmembrane protease, serine 3 (TMPRSS3) gene, encoding a transmembrane serine protease, cause autosomal recessive deafness childhood (DFNB8) or congenital onset (DFNB10). TMPRSS3 mutations have been mainly identified in patients from Asian and Mediterranean countries and seem to be a rare finding in the Northern European population so far. The identification of two novel pathogenic TMPRSS3 mutations (c.646C→T − R216C; c.916G→A − A306T) is described in four affected siblings of German origin with postlingual hearing loss, treated by bilateral cochlear implantation with good results. Although TMPRSS3 mutations are supposed to be a rare cause of autosomal recessive hearing loss, in families with postlingual disease onset TMPRSS3 is the most favourable candidate gene after exclusion of GJB2 mutations.

Development and validation of the Rasch-based depression screening (DESC) using Rasch analysis and structural equation modelling

Questionnaires for the assessment of depression benefit from modern test construction like item-response-modelling. We developed two parallel 10 item depression questionnaires, the Rasch-based Depression Screening version 1 (DESC-I) and 2 (DESC-II), by combining Rasch analysis and structural equation modelling on patient samples suffering primarily from a mental disorder or from somatic diseases. Both scales base upon a Rasch homogeneous item bank and proved unidimensionality and good model fit. Cut-off scores with good sensitivity and specificity were developed using ROC analyses. Results suggest that DESC may be appropriately used to screen for depression and may be beneficial for repeated measurements.

Long-term results of cochlear implantation in children

OBJECTIVES: Since the first implantation of a multichannel cochlear implant over 15 years ago there have been improvements in implant devices, surgical techniques, speech coding strategies and rehabilitation matters. There also have been concerns, whether the first implanted systems are stable and the benefit for the patients is constant over a long time. This study analyzes long-term results of prelingually deaf children who were implanted at Aachen University Hospital. STUDY DESIGN AND SETTING: We examined 16 prelingually deaf children, who underwent cochlear implantation at our department between 1990 and 1993 over a time period of 10 to 13 years. The indication, perioperative complications, technical parameters, speech test results as well as the psychosocial development of the children were analyzed. A questionnaire containing questions about the daily use, expectations and the personal evaluation of the procedure was sent to all patients. RESULTS: The mean age of all patients was 9 years at time of implantation. In two cases we saw postoperative complications which needed an intervention. The speech test results remained stable after reaching a plateau after 5 years. Eighty-eight percent of all patients would undergo the procedure again and 94% would recommend cochlear implantation to others. CONCLUSION: Cochlear implantation in cases of prelingual deafness is feasible without severe complications and leads to an increasing quality of life demonstrated by long-term observation.

Vestibular rehabilitation using the Nintendo® Wii Balance Board – a user-friendly alternative for central nervous compensation

Abstract Conclusion: The Nintendo® Wii Balance Board is a cost-effective and user-friendly alternative to other popular frequently used systems that aid vestibular compensation, particularly in elderly patients. In addition, further treatment in the home environment is possible. Objective: This cohort study was designed to investigate the impact of the Nintendo® Wii Balance Board as a visual compensation device after acute vestibular neuritis. Methods: Subjects were randomly assigned to one of two treatment groups. Group A (n = 37) performed customized exercises with the Nintendo® Wii Balance Board. Group B (n = 34) performed only two elected exercises as a control group for comparison of the results. Both groups underwent additive therapy with steroids (intravenous) in decreasing doses (250 mg decreasing to 25 mg over 10 days). The Sensory Organization Test (SOT), Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), and Tinneti questionnaire were evaluated immediately before treatment (baseline), at the end of treatment, i.e. at day 5, and after 10 weeks. Results: The early use of a visual feedback system in the context of the balance training supports the central nervous vestibular compensation after peripheral labyrinthine disorders. Patients in group B (without training) required a longer in-patient stay (average 2.4 days, SD 0.4) compared with patients following early Wii rehabilitation. The absence of nystagmus under Frenzels goggles in group A was observed 2.1 days (SD 0.5) earlier than in group B. Group A showed significantly better results in the SOT, DHI, VSS, and Tinneti questionnaire at all time points measured (p < 0.05).

Colour texture analysis for quantitative laryngoscopy.

Objective—Whilst considerable progress has been made in enhancing the quality of indirect laryngoscopy and image processing, the evaluation of clinical findings is still based on the clinicians judgement. The aim of this paper was to examine the feasibility of an objective computer-based method for evaluating laryngeal disease. Material and Methods—Digitally recorded images obtained by 90 degree- and 70 degree-angled indirect rod laryngoscopy using standardized white balance values were made of 16 patients and 19 healthy subjects. The digital images were evaluated manually by the clinician based on a standardized questionnaire, and suspect lesions were marked and classified on the image. Following colour separation, normal vocal cord areas as well as suspect lesions were analyzed automatically using co-occurrence matrices, which compare colour differences between neighbouring pixels over a predefined distance. Results—Whilst colour histograms did not provide sufficient information for distinguishing between healthy and diseased tissues, consideration of the blue content of neighbouring pixels enabled a correct classification in 81.4% of cases. If all colour channels (red, green and blue) were regarded simultaneously, the best classification correctness obtained was 77.1%. Conclusions—Although only a very basic classification differentiating between healthy and diseased tissue was attempted, the results showed progress compared to grey-scale histograms, which have been evaluated before. The results document a first step towards an objective, machine-based classification of laryngeal images, which could provide the basis for further development of an expert system for use in indirect laryngoscopy.

Potassium currents in vestibular type ii hair cells activated by hydrostatic pressure

An elevated hydrostatic pressure in the endolymphatic space of the inner ear is discussed as pathophysiological factor in hydrops-related diseases of the inner ear. An increase in pressure by fractions of 1 cm H(2)O is sufficient to induce vertigo-like symptoms in animal models. To establish a link between hydrostatic pressure and the function of vestibular hair cells, we studied potassium currents in isolated vestibular type II hair cells from guinea-pig utricles when the hydrostatic pressure was increased by raising the height of the bath from 0.2-0.5, 0.7 or 1.0 cm. Elevated pressure enhanced K(+) currents significantly; a rise in pressure from 0.2-0.5 cm H(2)O increased the total K(+) current at +40 mV by 22+/-14% (+/-S.D.). The pressure-sensitive current I(K,p) was non-inactivating during depolarizing pulses. It was maintained when the pressure was kept elevated for several minutes and receded promptly after return to a pressure of 0.2 cm H(2)O. Voltage-gated Ca(2+) currents, in contrast, were not altered by hydrostatic pressure. A pharmacological characterization of I(K,p) revealed that tetraetylammonium (100 mM) abolished all outward currents including I(K,p). I(K,p) was partly and reversibly inhibited by 4-aminopyridine. Dihydrostreptomycin, a blocker of the transduction channel, left I(K,p) unaffected. Charybdotoxin (100 nM), a blocker of Ca(2+)-dependent K(+) channels, completely yet reversibly abolished I(K,p). We conclude that small elevations in hydrostatic pressure evoke a charybdotoxin-sensitive, probably Ca(2+)-dependent K(+) current in vestibular hair cells. This is likely to alter their frequency response and may be a relevant mechanism how hydrostatic pressure disturbs transduction.

Expression of interleukin-5, interleukin-8, and interleukin-10 mRNA in the osteomeatal complex in nasal polyposis.

Background Several cytokines are expressed in chronic sinusitis with and without underlying allergy. Their local production and regulation in the osteomeatal complex, the key area of paranasal sinuses, still is not fully understood. This study was performed to investigate differences of cytokine messenger RNA (mRNA) expression between the medial and the lateral part of the middle turbinate and anterior ethmoid mucosa of allergic and nonallergic patients. Methods Using the LightCycler system for real-time reverse-transcription polymerase chain reaction, we investigated the content of interleukin (IL)-5, IL-8, and IL-10 mRNA in tissue samples from middle turbinates and anterior ethmoids of 18 patients with chronic sinusitis and nasal polyps. Inferior turbinate mucosa of six control subjects without sinusitis and allergy served as control. Results IL-5 mRNA was detectable in 32 (60%) of 54 samples (two of six controls) in significant different amounts between the various locations (p ≤ 0.001). Anterior ethmoid mucosa (0.96 ± 0.99) expressed the highest amount of IL-5 mRNA followed by the lateral (0.37 ± 0.54) and the medial portion of the middle turbinate (0.12 ± 0.29) with no difference between allergic and nonallergic subgroups. IL-8 was detected in significant higher amounts in all three origins with no significant difference in concentrations between the examined locations as compared with controls. Patients expressed either IL-5 or IL-8 or both cytokine mRNA. IL-10 was expressed in all three specimens from five of eight allergic patients. All five individuals with clinical symptoms of allergy at the time of operation expressed IL-10 in at least one specimen. Conclusions IL-5 cytokine expression in the osteomeatal complex is linked to the presence of nasal polyps, whereas IL-8 is up-regulated without distinct correlation to nasal polyps. IL-10 expression was detectable in five of eight allergic patients.