Roman D. Laske

Subjective and objective results after bilateral cochlear implantation in adults.

Objective: To assess and compare subjective and objective results after bilateral cochlear implantation with a special emphasis on time interval between the first and second implant. Study Design: Clinical trial. Setting: Tertiary referral center. Patients: All consecutively bilaterally implanted adult patients who had used the second implant for more than 6 months were selected for the study. They had to have the mental capacity to answer questions regarding their hearing abilities and fill out a questionnaire (n = 34). Twenty-nine patients (85%) finally could be included in the study (age at first implantation, 31.0 ± 16 yr [mean ± standard deviation {SD}], time to second implantation, 5.6 ± 5.7 yr [mean ± SD]). In all patients, a full insertion (21 electrodes) of the implant was achieved. For the subjective part of the study, the patients were matched with unilaterally implanted subjects selected according to specified criteria. Interventions: Sequential or simultaneous cochlear implantation with a Nucleus device. Main Outcome Measures: Speech comprehension measures were performed using the Oldenburger sentences in quiet and in noise with unilateral and bilateral implant use. Summation effect, head shadow effect, squelch effect, and interaural difference in quiet and noise were calculated. Advantage for binaural stimulation with respect to the unilateral condition was assessed for each individual. Additionally, a localization test was performed using 12 speakers arranged in a circle. Subjective benefit was assessed by a questionnaire (The Speech, Spatial and Qualities of Hearing Scale). Results were analyzed with special emphasis on effects of timing and intervals. Results: There was a statistically significant advantage for the head shadow effect test (p < 0.05) when the sound source was located on the activated side. There was also a statistically significant correlation of the subjective and objective results and a strong correlation of the interaural difference of speech intelligibility in quiet and the time interval between the first and the second implant (p < 0.001; r2 = 55%). In the bi-implanted state, an interaural difference of 18 ± 27% and 3 ± 2.2 dB signal-to-noise ratio (mean ± SD) was measured in quiet and noise, respectively. The mean results for the bilateral condition for the summation effect, the squelch effect, and speech discrimination in quiet were better than in the unilateral condition but were not statistically significant. The subjective results of the bilateral group were better in all categories than the results of the unilateral group but were just below statistical significance. Conclusion: Speech understanding in noise is improved with bilateral cochlear implantation with unambiguous evidence that the second implant expands the sound field for effective speech recognition. Communication in daily life is facilitated, as determined by the subjective Speech, Spatial and Qualities of Hearing Scale test. The correlation of the subjective and objective results confirms the practical benefits in daily activities. Although there was improvement with a second Cochlear implant even after a long implantation interval, short intervals lead to better results.

Functional Results and Subjective Benefit of a Transcutaneous Bone Conduction Device in Patients With Single-Sided Deafness.

Objective To analyze speech discrimination scores and subjective benefit of a transcutaneous bone conduction device (tBCD) in adults with single-sided deafness (SSD). Study Design Prospective cohort study. Setting Tertiary referral center. Patients Nine adults with SSD for more than 1 year and normal hearing on the contralateral side (PTA <30 dB HL) were implanted with a tBCD. Interventions Transmastoidal implantation of a Bonebridge (BB, MED-EL) tBCD. Main Outcome Measures Aided and unaided speech discrimination scores in three different spatial settings were measured using the Oldenburg sentence test (OLSA). Quality of life was assessed by two questionnaires, the Bern Benefit in Single Sided Deafness Questionnaire (BBSS) and the Speech, Spatial and Qualities of Hearing scale for benefit questionnaire (SSQ-B). Results Speech discrimination scores measured by OLSA showed a mean signal-to-noise ratio improvement of 1.7 dB SPL for the aided condition compared with the unaided condition in the setting where the sound signal is presented on the side of the implanted ear and the noise is coming from the front (p < 0.05). In the other two settings (signal and noise from front; signal from normal hearing ear and noise from front), the signal-to-noise ratio did not change significantly. This benefit became manifest after 6 months. Good satisfaction was indicated by positive results on the questionnaires. Conclusion Speech discrimination in noise for patients implanted with the BB is comparable with patients with other bone conduction hearing aids. A learning curve is clearly detectable. The subjective benefit was rated positively by the patients. With the advantage of intact skin conditions after implantation, the BB is an adequate option for patients with SSD.

Perineural Invasion in Squamous Cell Carcinoma of the Oral Cavity: Histology, Tumor Stage, and Outcome

To analyze the impact of different types of perineural invasion (PNI) in squamous cell carcinoma (SCC) of the oral cavity on overall survival and recurrence rate, with a special focus on histologic subtypes and tumor stage.

Ballistic Reconstruction of a Migrating Bullet in the Parapharyngeal Space.

A 21-year-old male suffering from severe throat pain after being hit by a bullet in Syria claimed that he was shot through his eye and that the bullet subsequently descended behind his throat. Even though the first medical report stated that this course is implausible, meticulous workup provided evidence that the bullet might have entered the parapharyngeal space in a more cranial position than the one it was found eight months later. Our case highlights that bullets are able to move within the body, rendering ballistic reconstruction difficult. However, after removal of the bullet the patients symptoms completely resolved.

The Role of Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Primary Cholesteatoma and Cholesteatoma Recidivism as an Adjunct to Clinical Evaluation

Introduction: The aim of this study was to analyze the sensitivity and specificity of non-echoplanar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of cholesteatoma, with a focus on its value as an adjunct to clinical examination. Methods: In a prospective cohort study, 92 cases were divided into 2 groups: “clinically cholesteatoma” (n = 79) and “clinically no cholesteatoma” (n = 13). Non-EPI DW MRI was performed preoperatively in all cases. The presence of a cholesteatoma was assessed by clinicians otoscopically, by neuroradiologists on non-EPI DW MRI, by the surgeon intraoperatively, and finally by the pathologist postoperatively. Data analysis was performed for specificity, sensitivity, positive predictive value, negative predictive value, and interrater variability. Results: The sensitivity and specificity were 89.3% and 75%, respectively, in the “clinically cholesteatoma” group and 0% and 100% in the “clinically no cholesteatoma” group. Non-EPI DW MRI had a positive predictive value of 98.5% when cholesteatoma was suspected clinically and a negative predictive value of 84.6% when cholesteatoma was not suspected clinically. Conclusion: If cholesteatoma is suspected clinically, non-EPI DW MRI is not necessary. If there is no clinical suspicion of cholesteatoma in second-look situations, sensitivity is low and serial follow-up MRI with long intervals is advised.

Delayed diagnosis of sinonasal lymphoma due to bilateral manifestation

The objective of this study is to analyze the presenting symptoms, the time to correct diagnosis and outcome of a European patient cohort with sinonasal lymphoma focusing on unilateral vs. bilateral sinonasal involvement. In a retrospective setting in a European tertiary referral center, eleven patients (9 males, 2 females) with sinonasal lymphoma diagnosed between 2002 and 2015 were identified and divided into a unilateral and bilateral group according to their CT finding. Clinical findings on first presentation, the presence of B symptoms, the radiologic findings, overall survival and disease-specific survival were assessed. 55 % of the patients suffered from bilateral manifestation, which was associated with a delayed diagnosis (10 vs. 1.5 months, p < 0.05). B symptoms (67 vs. 0 %) and death of disease (50 vs. 0 %) were observed only in the bilateral group. Nasal NK/T-cell lymphoma was the most frequent diagnosis, followed by diffuse large B-cell lymphoma. Bilateral mucosal manifestation with B symptoms was shown to be common within the rare entity of sinonasal lymphomas and patients with bilateral sinonasal manifestation are at risk for a delayed diagnosis with worse outcome.

Detection of Helicobacter pylori in patients with head and neck cancer: Results from a prospective comparative study combining serology, polymerase chain reaction, and rapid urease test

The purpose of this study was to evaluate prospectively the presence and impact of the gastric carcinogen Helicobacter pylori (H. pylori) in the upper aerodigestive tract. Previous studies suggested it could represent a risk factor for head and neck squamous cell carcinoma (HNSCC).

Sound localization measured by eye-tracking.

Abstract Objective: To introduce a new method of measuring sound localization ability based on eye-tracking and to test this method by analysing the influence of mild induced conductive hearing loss on sound localization. Design: Sound signals were presented from different angles, and the participants responses were measured using an eye-tracking device. For validation, a comparison of responses to visual stimuli was performed. To test the clinical application of this method, a mild conductive hearing loss was simulated, and the impact of this change on sound localization was measured. Study sample: Fifteen participants. Results: The system provided repeatable measurements, and there was a good correlation of sound and visual signals. A large number of trials could be completed fairly rapidly. Following the induced conductive hearing loss, a decline of 5.5° in the accuracy of sound localization in the horizontal plane was found towards the side of the non-impaired ear for frontal presentations. Conclusions: Quantifying sound localization by eye-tracking was found to be feasible, fast and accurate. A mild conductive hearing loss caused a slight degradation of sound localization accuracy within the 30° frontal sector, which is in good agreement with results found using methods requiring more extensive instrumentation.

Secondary voice prosthesis insertion in patients without direct access to the upper esophagus

Laryngoscope, 124:469–471, 2014