Rainer Ottis Seidl

Comparison of different vibrant Soundbridge audioprocessors with conventional Hearing aids

Objective To compare the functional gain of different Symphonix Soundbridge audioprocessors (HF-processor and D-processor) to preoperatively fitted conventional hearing aids of patients with mild to severe sensorineural hearing loss in the high-frequency range. Study design In a prospective study, the Symphonix Soundbridge (HF-processor and D-processor) fitting results were evaluated and compared with conventional hearing aids. Postoperative air and bone conductances, the functional gain of warble-tone measurements, speech audiometric, and subjective outcome testing (Abbreviated Profile of Hearing Aid Benefit questionnaire) were studied. Setting Tertiary referral center. Patients Five patients (ages, 54–69 yr) with mild to severe sensorineural deafness in the high-frequency range, but no progression of hearing loss during the last two years, were initially fitted with the so-called HF-processor, then subsequently fitted with the D-processor, which was a fully digital one. Results One year after implantation of the Symphonix Soundbridge device, unchanged, stable air and bone conductances were found (except for one minor change). Over the whole frequency range (0.5–8.0 kHz), a mean gain of 16.1 dB (HF-processor), 27.1 dB (D-processor), and 15.2 dB (hearing aid) was found. The Symphonix Soundbridge device with different audioprocessors led to improved hearing in speech audiometric testing. The data show a significant improvement of hearing compared with conventional hearing aids in quiet, and a better functional gain in noise for the Symphonix Soundbridge system. The Abbreviated Profile of Hearing Aid Benefit questionnaire also revealed that the implant resulted in significant differences compared with conventional hearing aids in almost all subcategories. Conclusion The Symphonix Soundbridge device can improve the hearing benefit of moderately to severely hearing handicapped patients—particularly in those with a high-frequency hearing loss—when compared with the conventional hearing aids of these patients, as evidenced by objective and subjective measurements. The Symphonix Soundbridge D-processor showed further improvements and resulted in an additional hearing benefit that was superior to that of the previously fitted HF-audioprocessor. This is owing to the refinements and upgrades in audioprocessor technology.

Rekonstruktion von traumatischen Schädelbasisdefekten mit einem alloplastischen, resorbierbaren Vlies (Ethisorb)

ZusammenfassungHintergrund und Fragestellung. Bei der Versorgung von frontobasalen Defekten stehen eine Vielzahl von Transplantaten zur Verfügung. Ein potentielles Infektionsrisiko autologer Transplantate macht ein homologes Material sinnvoll.Patienten/Methodik. In einer retrospektiven Untersuchung werden die Ergebnisse von 45 Patienten mit Defekten der vorderen Schädelbasis dargestellt. Die Defekte erfassten alle Regionen der Frontobasis und maßen bis 10 cm2; es wurden 39 Verletzungen mit einer Sandwichtechnik und 12 mit einer Onlaytechik über rhinochirurgische Zugangswege mit Ethisorb®, einem resorbierbaren Vlies, verschlossen. Die Rekonstruktion wurde von endonasal durch eine Ballontamponade für 7 Tage gestützt. Nachuntersuchungen wurden nach 6 Wochen (Endoskopie, β2-Transferrinbestimmung) und nach 6 Monaten (CT-Scans) durchgeführt. Ergebnisse. Hinweise für eine persistierende Liquorrhö, eine Meningo- oder Enzephalozele fanden sich nicht. Wundheilungsstörungen traten in keinem Fall auf. Bei den postoperativen endoskopischen Kontrollen konnte eine vollständige Bedeckung der Defekte mit Schleimhaut beobachtet werden. Schlussfolgerungen. Ethisorb kann zur Versorgung frontobasaler Schädelbasisdefekte bis 10 cm2 empfohlen werden.AbstractBackground and objective. Defects of the frontal skull base can be reconstructed with different types of material. Homologous material possibly involves the risk of infection and thus complicated wound healing. Therefore, alloplastic material seems to be an interesting alternative. Patients/Methods. In the present paper, we report on a series of 45 patients who underwent reconstruction of the anterior skull base. The defects were localized in different regions and had a maximum diameter of 10 cm2. Of the defects, 39 were closed via a sandwich technique and 12 via an onlay. The rhinosurgical approaches were aimed at closing the defects with Ethisorb©, a resorbable collagen texture, and supporting the surgical field with a balloon catheter from below. Postoperative controls were performed after 6 weeks (endoscopy, determination of β2-transferrin) and 6 months (CT scans). Results. All defect reconstructions were stable and tight, i.e., neither a CSF leakage nor a meningoencephalocele was found. The healing was completely normal and the endoscopic controls showed a regular mucosal lining over the defects. Conclutions. We conclude that Ethisorb© is a useful alternative material in the treatment of frontal skull base defects.

Relative value of BAHA testing for the postoperative audiological outcome

BACKGROUND Bone-anchored hearing aids provide a therapy option for patients with conductive and mixed hearing loss, with the possibility of audiological rehabilitation. Test rod and tension headband offer the patient a preoperative impression of their postoperative hearing. The aim of this study was to evaluate the tools available for preoperative assessment of candidates for bone-anchored hearing aids and to ascertain predictive audiometric values. METHODS Following implantation of a BAHA Compact system, sound and speech audiograms were performed in each of 16 patients with the bone-anchored BAHA device and with test rod and tension headband. RESULTS Both with the BAHA and with the test devices, closure of the air-bone gap occurred and resulted in a clear improvement in hearing threshold and speech perception. The threshold increase with the BAHA was 9 dB greater on average (mean) than that measured with the test rod and the tension headband. Examinaation of speech perception indicated a mean advantage of 14-20% for the anchored BAHA system over the tension headband in monosyllabic testing. CONCLUSION Preoperative testing before providing a BAHA system is a good way of predicting what level of hearing and speech perception can be expected after implantation.

Wertigkeit der BAHA-Testung für das postoperative Hörergebnis

BACKGROUND Bone-anchored hearing aids provide a therapy option for patients with conductive and mixed hearing loss, with the possibility of audiological rehabilitation. Test rod and tension headband offer the patient a preoperative impression of their postoperative hearing. The aim of this study was to evaluate the tools available for preoperative assessment of candidates for bone-anchored hearing aids and to ascertain predictive audiometric values. METHODS Following implantation of a BAHA Compact system, sound and speech audiograms were performed in each of 16 patients with the bone-anchored BAHA device and with test rod and tension headband. RESULTS Both with the BAHA and with the test devices, closure of the air-bone gap occurred and resulted in a clear improvement in hearing threshold and speech perception. The threshold increase with the BAHA was 9 dB greater on average (mean) than that measured with the test rod and the tension headband. Examinaation of speech perception indicated a mean advantage of 14-20% for the anchored BAHA system over the tension headband in monosyllabic testing. CONCLUSION Preoperative testing before providing a BAHA system is a good way of predicting what level of hearing and speech perception can be expected after implantation.

Trachealrupturen unter endotrachealer Intubation Diagnostik und Therapie

ZusammenfassungHintergrund. Trachelrupturen entstehen zumeist durch ein stumpfes Thoraxtrauma oder iatrogen durch eine endotracheale Intubation mit Ein- oder Doppellumentuben. Trachealrupturen sind eine seltene, aber lebensbedrohliche Komplikation. Neben der Entwicklung eines Pneumothorax sowie eines Haut- und Mediastinalemphysems sind die Patienten sekundär durch eine Mediastinitis und Pneumonie gefährdet. Tracheobronchiale Verletzungen müssen frühzeitig mittels fiberoptischer Bronchoskopie diagnostiziert und unmittelbar chirurgisch versorgt werden. Methode. In einer retrospektiven Untersuchung (1998–2000) konnten 3 Patienten mit einer Trachealruptur unter endotrachealer Intubation erfasst werden. Sie wurden präoperativ mit einem über die Läsion geführten Tubus und unmittelbar nach Diagnosestellung über eine kollare Inzision chirurgisch versorgt. Für eine anschließende Nachbeatmung wurde ein Tracheostoma angelegt. Die weitere Beatmung erfolgte über einen modifizierten Montgomery-T-Tube. Ergebnisse. Die Entwöhnung vom Respirator verlief in allen Fällen unproblematisch. Alle Patienten konnten in Abhängigkeit von ihren Grunderkrankungen innerhalb von 14 Tagen mit suffizienter Spontanatmung unter Raumluft und verschlossenem Tracheostoma auf Normalstation verlegt werden. Die endoskopischen Nachkontrollen zeigten in allen Fällen eine regelgerechte Trachea.AbstractBackground. Tracheal ruptures are most frequently the result of a blunt trauma to the thorax or of forced intubation. They represent a rare, but life-threatening complication that requires immediate help. Methods. The resulting pneumothorax and the skin/mediastinal emphysema are the most prominent clinical signs. Injuries of the tracheobronchial tract should be diagnosed endoscopically and treated surgically immediately after the trauma. Results. The present paper reports on three cases of tracheal ruptures after forced intubation which could be successfully managed by tracheostomy and subsequent reconstruction of the defects. The postoperative care of the patients is critically discussed.

Selection and Placement of Oral Ventilation Tubes Based on Tracheal Morphometry

Evidence‐based guidelines for the selection of appropriately sized ventilation tubes as well as their placement do not exist, although iatrogenic injuries to the trachea and larynx following endotracheal intubation are not infrequent. Our objective was to provide selection recommendations for ventilation tubes based on anatomic criteria.

Swallow Detection Algorithm Based on Bioimpedance and EMG Measurements

Abstract Image-based swallowing assessment tools like videofluoroscopy and endoscopy allow experts manual investigation of a few individual swallows. However, these tools are expensive and can only be used by clinicians. Systems which utilize easily attachable, inexpensive and non-invasive sensors at the throat could be a real progress for diagnosis and therapy. This contribution investigates the use of a combined electromyography (EMG) and bioimpedance (BI) measurement at the throat to automatically detect swallowing events. The absolute value of the measured BI completely describes the swallowing process, i.e. the closure of the larynx. There is a typical reproducible drop in BI during a swallow. The muscle activity needed for the laryngeal movement during a swallow is measured using EMG. The presented algorithm involves a valley detection in order to perform a segmentation of the BI signal. Additionally, only BI valleys that coincide with EMG activity are selected for feature extraction. In the second part of the algorithm, extracted features of the BI and integrated EMG are fed into a support vector machine (SVM) which is able to separate BI valleys related to swallowing events from valleys which are not caused by swallowing. The detection algorithm has been tested on data from nine healthy subjects. The data set contained 1370 swallows of different bolus sizes and consistency and was effected by other movements and speech. The combined BI/EMG segmentation detected 99.3% of all swallowing events. The subsequently applied classifier showed a sensitivity of 96.1% and a specificity of 97.1% for the test data.

Einfluss der Körperposition auf die Atem-Schluck-Koordination

BACKGROUND To allow passage of food, the swallowing process closes off the larynx and interrupts respiratory flow. Both the timing of the interruption of respiratory flow and the body position can affect the results of the swallowing process. OBJECTIVE The effect of body position on the swallowing process and the coordination of breathing and swallowing is investigated. MATERIALS AND METHOD A combined EMG/bioimpedance measurement system and a piezoelectric sensor were used to investigate coordination of breathing and swallowing of a range of food consistencies in three different body positions (90°, 45° and 0°) in healthy subjects. RESULTS Investigations were carried out on 21 healthy subjects (12 ♂, 9 ♀). 762 swallows were recorded. Changing body position was found to have a statistically significant effect on swallow-related parameters (maximum laryngeal elevation and speed of laryngeal elevation) and breathing pattern (pre- and post-swallow breathing phases). The laryngeal elevation as well as the speed of the laryngeal elevation is influenced significantly by the consistency to be swallowed. The breathing pattern changes from saliva to solid food of inspiration/swallow/inspiration to expiration/swallow/expiration. A change of body position influences the parameters specific for swallowing and the breathing patterns significantly. CONCLUSIONS This study demonstrates that body position affects coordination of breathing and swallowing and swallow-related parameters in healthy subjects. Our results indicate that patients should be enabled to adopt a position in which they are sitting at an angle of at least 45°.

Effect of body position on coordination of breathing and swallowing

BACKGROUND To allow passage of food, the swallowing process closes off the larynx and interrupts respiratory flow. Both the timing of the interruption of respiratory flow and the body position can affect the results of the swallowing process. OBJECTIVE The effect of body position on the swallowing process and the coordination of breathing and swallowing is investigated. MATERIALS AND METHOD A combined EMG/bioimpedance measurement system and a piezoelectric sensor were used to investigate coordination of breathing and swallowing of a range of food consistencies in three different body positions (90°, 45° and 0°) in healthy subjects. RESULTS Investigations were carried out on 21 healthy subjects (12 ♂, 9 ♀). 762 swallows were recorded. Changing body position was found to have a statistically significant effect on swallow-related parameters (maximum laryngeal elevation and speed of laryngeal elevation) and breathing pattern (pre- and post-swallow breathing phases). The laryngeal elevation as well as the speed of the laryngeal elevation is influenced significantly by the consistency to be swallowed. The breathing pattern changes from saliva to solid food of inspiration/swallow/inspiration to expiration/swallow/expiration. A change of body position influences the parameters specific for swallowing and the breathing patterns significantly. CONCLUSIONS This study demonstrates that body position affects coordination of breathing and swallowing and swallow-related parameters in healthy subjects. Our results indicate that patients should be enabled to adopt a position in which they are sitting at an angle of at least 45°.

Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures

Objectives Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR. Methods Experimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height. Results In all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence. Conclusion This experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used.