Patrick Zorowka

Effects of a hearing protection campaign on the discotheque attendance habits of high-school students.

This study investigated whether a hearing education campaign would prompt adolescents to display hearing-protective behaviour when attending a discotheque. A sample of 169 high-school students participated in the campaign. A questionnaire was administered to them before and 1 year after the campaign, asking for the frequency of discotheque attendance within the past 6 months, and whether they used earplugs in the discotheque. The percentage of subjects who went to discotheques more than 10 times within 6 months decreased from 34% to 24% after the campaign. The overall difference between pre-and postcampaign frequencies of discotheque attendance, however, was not significant. The percentage of subjects using earplugs in the discotheque rose from 0% before to 3.7% after the campaign. In essence, the campaign had little effect in inducing hearing-protective behaviour in adolescents when attending discotheques. The need for sound level limitations in discotheques is highlighted. Sumario El estudio investigó si una campaña educativa podia motivar a los adolescenles para adopter una conducta de protección auditiva al asistir a una discoteca. Participó en la campaña una muestra de 169 alumnos de educaeión media. Se les aplicó un cuestionario antes y un año despucs de la campaña, en el que se les preguntó la frccuencia con la que asistieron a discotecas en el curso de los últimos seis meses y si usaron tapones dc oidos. El porcentaje de sujetos que fucron a discotecas más de 10 veces en esos últimos seis meses descendió dc 34 a 24% después de la campaña. No obstante, la difercncia global dc la frecucncia de asistencia a discotecas antes y después de la campaña, no fue significativa. El porcentaje de sujetos que usaron tapones de oido en las discotecas aumentó del 0% antes, al 3.7% despucs de la campaña. En eseneia, la campaña tuvo sólo un minimo efecto en la inductión de conductas de protección auditiva en adolescentes que van a discotecas. Se destaca la necesidad de limitar los niveles sonoros en las discotecas.

Surgical Voice Rehabilitation after Laser Surgery for Glottic Carcinoma

Transoral laser surgery today is the mainstay of treatment for T1 and T2 glottic carcinoma. The vocal ability remains sufficient in the majority of patients. However, in some cases, a significant glottic gap may persist, leading to poor voice quality. We report a special technique of medialization thyroplasty using autologous cartilage specifically adapted for vocal rehabilitation after laser resection. Six patients with a significant glottic gap following laser surgery were treated. For vocal rehabilitation, a special medialization technique was performed. The superior rim of the thyroid cartilage of the resected side was exposed. A 1 × 2-cm piece of cartilage was harvested and reimplanted into a subperichondrial pouch created on the inner side of the thyroid cartilage. When phonation was optimal, this cartilaginous strut was sutured and/or glued in place. In all 6 cases, the vocal function improved significantly. The dysphonia index (0 = normal, 3 = aphonia), which includes objective parameters as well as expert voice ratings and the patients perception, increased by 1.1 on average (range, 0.4 to 1.6). The results have been lasting. The established medialization techniques are of limited value in a larynx scarred by laser surgery. Injection augmentation is often futile because the tight scar tissue does not lend itself to augmentation. Implantation of nonorganic material may cause problems if revision surgery for tumor recurrence should become necessary or if the implant protrudes into the scarred endolarynx. The technique reported avoids these pitfalls and leads to voice quality improvement comparable to that of established medialization procedures.

Assessment of Auditory Skills in 140 Cochlear Implant Children Using the EARS Protocol

Auditory performance of cochlear implant (CI) children was assessed with the Listening Progress Profile (LiP) and the Monosyllabic-Trochee-Polysyllabic-Word Test (MTP) following the EARS protocol. Additionally, the ‘initial drop’ phenomenon, a recently reported decrease of auditory performance occurring immediately after first fitting, was investigated. Patients were 140 prelingually deafened children from various clinics and centers worldwide implanted with a MEDEL COMBI 40/40+. Analysis of LiP data showed a significant increase after 1 month of CI use compared to preoperative scores (p < 0.01). No initial decrease was observed with this test. Analysis of MTP data revealed a significant improvement of word recognition after 6 months (p < 0.01), with a significant temporary decrease after initial fitting (p < 0.01). With both tests, children’s auditory skills improved up to 2 years. Amount of improvement was negatively correlated with age at implantation.

Ätiologie mittel- und hochgradiger Schwerhörig- keiten im Kindesalter

ZusammenfassungFragestellung: Die vorliegende Studie geht der Frage nach, welche Ursachen heute in Deutschland hochgradige, irreversible und beidseitige Hörstörungen des Kindesalters bedingen und ob sich, bedingt durch die Fortschritte der Medizin oder andere Faktoren, Veränderungen des ätiologischen Spektrums im Vergleich zu früheren Studien identifizieren lassen. Patienten und Methoden: Die pädaudiologischen Befunde von 314 Schülern der Rheinischen Schulen für Schwerhörige und für Gehörlose in Köln wurden bezüglich der audiologischen Diagnose ausgewertet und durch anamnestische Angaben der Familien und eigene Recherchen ergänzt. Ergebnisse: Bei 218 Kindern konnte die Ursache der Hörstörung ermittelt werden, wobei 82 Kinder eine genetisch bedingte und 136 Kinder eine erworbene Schwerhörigkeit aufwiesen. Bei 96 Kindern blieb die Ursache der Hörstörung unbekannt. Die hereditären Ätiologien setzten sich aus 34 autosomal-dominanten und 46 autosomal-rezessiven sowie 2 genetisch bedingten, aber nicht nach Mendel vererbten Hörstörungen zusammen. Der im Vergleich zur Gesamtbevölkerung im Regierungsbezirk Köln stark überdurchschnittliche Ausländeranteil an der Schule war für das überdurchschnittliche Auftreten hereditärer Hörstörungen, speziell der rezessiven Erbgänge verantwortlich. Erworbene Schwerhörigkeiten wurden in die Gruppen pränatal, perinatal und postnatal untergliedert. Eine pränatale Ursache lag bei 32 Kindern vor; mit 21 Kindern dominierte die Rötelembryopathie diese Gruppe. Auffällig war der Rückgang dieser Ätiologie bei jüngeren Kindern. Perinatale Hördefekte traten bei 60 Kindern auf. Die Stärke dieser Gruppe wurde vor allem durch das Auftreten von Hypoxie, Frühgeburtlichkeit und möglicherweise erhöhten Bilirubinwerten und deren Kombinationen (multifaktoriell) bedingt. Im jüngeren Untersuchungszeitraum (1986–1991) stieg der Anteil perinataler Hörstörungen um 10% an. Bei 44 Kindern konnten postnatale Hörstörungen festgestellt werden, wobei die durch eine Meningitis bedingte Schwerhörigkeit mit 31 Kindern diese Gruppe dominierte. Schlußfolgerung: Die vorliegende Untersuchung stellt eine Bestandsaufnahme der Ursachen kindlicher Hörstörungen an der Schule für Schwerhörige und Gehörlose in Köln dar. Im Vergleich mit ähnlichen Studien überblickt sie eine relativ große Stichprobe und aktualisiert den Wissenstand über die Ätiologie kindlicher Schwerhörigkeit in Deutschland. Sie zeigt einen Wandel in der Bedeutung einzelner Ursachen von Hörstörungen und verdeutlicht den Einfluß von medizinischen, sozialen und kulturellen Einflußgrößen.SummaryThe present study sought to determine the etiology of bilateral profound hearing losses in children living in Germany. Additionally, a comparison with the data of previous investigations in the available literature was used to update causes now known through medical progress. Patients and methods: The medical charts of 314 profoundly hearing-impaired pupils at schools for the deaf in Cologne, Germany, were reviewed. All available data on possible etiological factors were collected. In addition, the families of these children were interviewed using a standardized questionnaire. Results: Sixty children were found to have bilateral sensorineural hearing losses averaging 30 to 60 dBHL within the frequency ranges of 500–2000 HZ, while 254 had bi- lateral hearing impairments of 60 dBHL or greater. The etiology of the hearing disorder could be determined in 218 of the children. Eighty-two children suffered from hereditary deafness and 136 from acquired hearing losses. The etiology could not be determined in 96 children. Hereditary causes included 34 children with mendelian autosomal dominant losses, 46 with autosomal recessive losses and two children with genetic but non-mendelian causes. Immigrants to Germany (mostly from Turkey and the former Soviet Union) were found significantly more frequently among the students of these schools than among the total population of the Cologne area. In this group of students, autosomal recessive deafness was particularly common as compared to the overall native population. Acquired hearing disorders were broken down into three subgroups: prenatal, perinatal and postnatal disorders. A prenatal etiology was considered in 32 children, 21 of whom had known congenital rubella infection. This entity was significantly less common among younger children. A perinatal etiology was considered in 60 children. Causative factors were birth asphyxia, apnea and/or hyperbilirubinemia. Forty-four children had deafness attributed to postnatal causes, with bacterial meningitis (n=31) being the most important single factor. The findings reported indicate changing trends for causes of hearing loss in children with severe hearing impairment in Germany.

Visualizing Phase Relations of the Vocal Folds by Means of High-Speed Videoendoscopy

OBJECTIVES To present a method called Fourier image (FI) for analyzing high-speed videoendoscopy recordings. These false-color images visualize functional vocal fold properties and allow the quantification of phase relations. Furthermore, reference data for phase asymmetries in normophonic speakers as assessed with this method are provided. STUDY DESIGN Prospective study. METHODS Phase relations between parts of the vocal folds were assessed using Fourier analysis of the grayscale fluctuations of corresponding pixel within the endoscopic high-speed videos. This phase information was displayed by means of colors and can thus be used to quantify left-right or anterior-posterior phase asymmetries. These phase relations were assessed in 11 normophonic speakers. RESULTS Several instructive examples are given, which demonstrate how the FIs can be interpreted. From the cohort of clinically normophonic speakers, all but one displayed at least some extent of phase asymmetry. CONCLUSIONS The method presented herein can be used to display functional vocal fold properties including the absence of oscillation, glottal insufficiency, and phase relations within one single image. The reference data showed that phase asymmetries seem to be frequent even in normophonic speakers.

Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions - a prospective multicenter cohort study

BackgroundSevere malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above.MethodsThis prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate.ResultsIn the control group, 92.6 % (n = 108, 95 % confidence interval 86.19–6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4–67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1–75.5 %) at follow up 14–28 days after diagnosis of malaria.The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59–83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3–7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3–7, 95 % confidence interval 16.3–56.3 %; p = 0.031 at day 14–28, 95 % confidence interval 24.5–66.3 %).ConclusionThe presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies.

Neuromonitoring in Thyroid Surgery: The View of the Laryngologist

SummaryBACKGROUND: In thyroid surgery, identifying the recurrent laryngeal and the superior laryngeal nerve under direct vision reduces the incidence of nerve injury. METHODS: Neuromonitoring, consisting of the continuous depiction of electromyography (EMG) signals and discontinuous nerve stimulation and interpretation during the surgical procedure, is an established part of standard ENT procedures, e.g. surgery of the parotid gland with monitoring of the facial nerve. This technique has been introduced into surgical procedures for the thyroid gland in many surgical centres. RESULTS: Also in thyroid surgery, neuromonitoring can be a useful tool for identifying and monitoring the laryngeal nerves. Reported limitations of neuromonitoring in thyroidectomy are often caused by inadequate use of the equipment and lack of knowledge about neurophysiology in EMG monitoring. Recent studies have raised questions and pointed out pitfalls concerning technical procedure, sensitivity, postoperative outcome, and documentation; these issues are addressed by the laryngologist with many years of experience in recurrent nerve palsy, its clinical diagnosis, and its conservative and surgical treatment. CONCLUSIONS: By understanding and using neuromonitoring techniques, the surgeon is able to minimize the risk of recurrent and superior laryngeal nerve injury.ZusammenfassungGRUNDLAGEN: Die direkte Darstellung und Identifizierung des N. laryngeus recurrens und des N. laryngeus superior reduziert die Inzidenz einer Läsion dieser Nerven. METHODIK: Neuromonitoring – bestehend aus einer kontinuierlichen Erfassung und Darstellung des gemessenen EMG-Signals und der diskontinuierlichen Nervstimulation – hat sich als wertvolles Hilfsmittel bei Standard-HNO-Eingriffen wie z. B. der Chirurgie der Glandula parotis mit dem Monitoring des N. facialis etabliert. Diese Technik wurde mittlerweile in vielen chirurgischen Zentren bei operativen Eingriffen an der Schilddrüse eingesetzt. ERGEBNISSE: Auch in der Schilddrüsenchirurgie kann Neuromonitoring ein nützliches Verfahren in der Identifikation und im Monitoring der laryngealen Nerven darstellen. Oft sind berichtete Grenzen des Neuromonitorings bei der Schilddrüsenchirurgie durch den inadäquaten Gebrauch der Ausrüstung und einen Mangel an Wissen über die Neurophysiologie im EMG-Monitoring verursacht. Fragen und Fehlerquellen, die den technischen Ablauf, die Sensitivität, postoperative Ergebnisse, Dokumentation betreffen, welche im Zusammenhang mit aktuellen Studien aufgetaucht sind, werden durch den Laryngologen, der eine lange Erfahrung mit Stimmlippenlähmungen, ihrer klinischen Diagnose und ihrer konservativen und chirurgischen Behandlung hat, beantwortet. SCHLUSSFOLGERUNGEN: Durch das Verständnis und die Benutzung von Neuromonitoring-Techniken ist der Chirurg in der Lage, das Risiko von Verletzungen des N. laryngeus recurrens und des N. laryngeus superior zu verringern.

Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide

Objectives: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation. Methods: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children? Summary: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.

Release of intracranial pressure leads to improvement of otoacoustic emissions--a case report of a Kenyan child with complicated tuberculous meningitis.

Intracranial pressure usually is measured with invasive techniques. The usability of transient evoked otoacoustic emissions as non-invasive approach has been evaluated only once by Frank et al. This article presents the case of a Kenyan boy with tuberculous meningitis and an active malresorptive hydrocephalus. At this stage, the otoacoustic emissions did show very low correlations. After releasing pressure, the otoacoustic emissions improved significantly. This case report points out the possible usability of otoacoustic emissions in intracranial pressure monitoring.

Electrically evoked compound action potentials are different depending on the site of cochlear stimulation.

One of the many parameters that can affect cochlear implant (CI) users’ performance is the site of presentation of electrical stimulation, from the CI, to the auditory nerve. Evoked compound action potential (ECAP) measurements are commonly used to verify nerve function by stimulating one electrode contact in the cochlea and recording the resulting action potentials on the other contacts of the electrode array. The present study aimed to determine if the ECAP amplitude differs between the apical, middle, and basal region of the cochlea, if double peak potentials were more likely in the apex than the basal region of the cochlea, and if there were differences in the ECAP threshold and recovery function across the cochlea. ECAP measurements were performed in the apical, middle, and basal region of the cochlea at fixed sites of stimulation with varying recording electrodes. One hundred and forty one adult subjects with severe to profound sensorineural hearing loss fitted with a Standard or FLEXSOFT electrode were included in this study. ECAP responses were captured using MAESTRO System Software (MED-EL). The ECAP amplitude, threshold, and slope were determined using amplitude growth sequences. The 50% recovery rate was assessed using independent single sequences that have two stimulation pulses (a masker and a probe pulse) separated by a variable inter-pulse interval. For all recordings, ECAP peaks were annotated semi-automatically. ECAP amplitudes were greater upon stimulation of the apical region compared to the basal region of the cochlea. ECAP slopes were steeper in the apical region compared to the basal region of the cochlea and ECAP thresholds were lower in the middle region compared to the basal region of the cochlea. The incidence of double peaks was greater upon stimulation of the apical region compared to the basal region of the cochlea. This data indicates that the site and intensity of cochlear stimulation affect ECAP properties.