Steffen Knopke

Impact of cochlear implantation on quality of life and mental comorbidity in patients aged 80 years

The objective of this study was to evaluate the outcome of cochlear implantation in elderly patients (80 or older) with progressive bilateral deafening. The measured outcomes included the quality of life, speech understanding, tinnitus distress, stress level, anxiety, and depressiveness.

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.

Rapid Positive Influence of Cochlear Implantation on the Quality of Life in Adults 70 Years and Older

The deteriorating ability to communicate has a negative impact on quality of life in the aging population. Cochlear implantation is increasingly used to treat hearing impairment and to restore the ability to communicate. Here, in a sample of 79 adults (70 years and older), we explored the effect of cochlear implantation on the health-related quality of life via the Nijmegen Cochlear Implant Questionnaire, auditory performance for speech recognition comparing scores on the Freiburg Monosyllabic Test and Oldenburg Inventory and tinnitus-related distress using the German version of the Tinnitus Questionnaire. We observed that the health-related quality of life and auditory performance increased significantly after cochlear implantation for the study cohort. After implantation, tinnitus-related distress declined significantly for the group. Our results support the concept of cochlear implantation treatment positively influencing the quality of life, restoring the auditory performance in older adults and reducing stress related to tinnitus. Importantly, positive effects were seen as early as 6 months after cochlear implantation, corroborating the rationale for cochlear implantation in adults 70 years and older.

Cochlear Implantation of Bilaterally Deafened Patients with Tinnitus Induces Sustained Decrease of Tinnitus-Related Distress

Objective Tinnitus is a common symptom of hearing impairment. Patients who are bilaterally hard of hearing are often affected by tinnitus. However, they cannot undergo any of the standard tinnitus therapies, since they rely on hearing. Cochlear implantation (CI) used to treat severe hearing disabilities, such as bilateral hearing loss, was also shown to reduce tinnitus. Our goal was to determine if CI induces sustained reduction of tinnitus. We performed prospective, longitudinal analyses of tinnitus-related distress in a uniform group of bilaterally deafened patients after CI. Patients and Methods The homogenous sample consisted of 41 patients who met the inclusion criteria and were consecutively included in this study. The impact of unilateral CI on tinnitus-related distress, health-related quality of life (HRQoL), and hearing abilities was studied with validated instruments. The follow-up appointments were scheduled at 6, 12, and 24 months after CI surgery. During the appointments, hearing abilities were estimated with monosyllabic Freiburg test, whereas the tinnitus-related distress, the HRQoL, and the subjective hearing were measured with standard questionnaires [Tinnitus Questionnaire (TQ), Nijmegen Cochlear Implantation Questionnaire, and Oldenburg Inventory, respectively]. Results Tinnitus-related distress decreased significantly from the mean TQ score of 35.0 (SD = 19.6) prior to surgery to the mean TQ = 27.54 (SD = 20.0) 6 months after surgery and remained sustained low until the end of follow-up period. In addition, CI significantly improved the hearing abilities and the HRQoL of all patients. Conclusion The results from our prospective study suggest that in a homogenous sample of bilaterally deafened, implanted patients who report having tinnitus prior to surgery, CI alone not only improves the hearing abilities but also significantly reduces the tinnitus-related distress and improves the HRQoL in a sustained way.

Ohnmachtsanfälle bei der Nahrungsaufnahme

MEDICAL HISTORY A 49-year-old woman was referred to the ENT department with a 1.5-year history of dysphagia accompanied by globus sensation and regurgitation as well as recurrent syncopal attacks associated with swallowing solid foods. CLINICAL FINDINGS Endoscopic examination revealed hyperplasia of the tongue base and redness of the aryepiglottic region. An axial hiatal hernia (> 3 cm) was seen on esophago-gastro-duodenoscopy. Esophageal manometry showed a diffuse esophageal spasm. Holter monitoring (24 h) revealed a third-degree atrioventricular block. THERAPY The patient’s symptoms resolved following placement of a permanent cardiac pacemaker. Globus sensation and regurgitation persisted. Treatment with proton pump inhibitors was successful. The final functional endoscopic evaluation of swallowing revealed no relevant findings. CONCLUSION We describe a case of a rare and extreme form of a vagal reflex. Deglutition syncope can be successfully treated by a multidisciplinary team consisting of otorhinolaryngologists, neurologists and cardiologists.

Fainting during ingestion. Deglutition syncope

MEDICAL HISTORY A 49-year-old woman was referred to the ENT department with a 1.5-year history of dysphagia accompanied by globus sensation and regurgitation as well as recurrent syncopal attacks associated with swallowing solid foods. CLINICAL FINDINGS Endoscopic examination revealed hyperplasia of the tongue base and redness of the aryepiglottic region. An axial hiatal hernia (> 3 cm) was seen on esophago-gastro-duodenoscopy. Esophageal manometry showed a diffuse esophageal spasm. Holter monitoring (24 h) revealed a third-degree atrioventricular block. THERAPY The patient’s symptoms resolved following placement of a permanent cardiac pacemaker. Globus sensation and regurgitation persisted. Treatment with proton pump inhibitors was successful. The final functional endoscopic evaluation of swallowing revealed no relevant findings. CONCLUSION We describe a case of a rare and extreme form of a vagal reflex. Deglutition syncope can be successfully treated by a multidisciplinary team consisting of otorhinolaryngologists, neurologists and cardiologists.

Posttraumatische laryngotracheale Separation

ZusammenfassungLaryngotracheale Traumen sind selten und können durch die Verlegung der Atemwege zu lebensbedrohlichen Situationen führen. Wir berichten über eine Patientin, bei der es infolge eines Reitunfalls zu einer laryngotrachealen Separation kam. Die frühe Intubation sicherte die rechtzeitige Schienung der Atemwege und das Leben der Patientin.AbstractLaryngotracheal trauma is rare and may lead to airway obstruction and life-threatening situations. We present a case report of laryngotracheal separation after a horse riding accident. In this case, early intubation secured the respiratory passage and the life of the patient.

Pseudarthroses of the cornu of the thyroid cartilage

OBJECTIVE: Injuries to the cartilaginous larynx are rare disorders that usually undergo good spontaneous healing and rarely require surgery. STUDY DESIGN: Case series with chart review from patients with pseudarthrosis of the cornu of the thyroid cartilage. SETTING: ENT department of a level I trauma center. SUBJECTS AND METHODS: We examined the medical records of seven patients treated for impaired healing of the cornu of the thyroid cartilage at a level I trauma center between 1997 and 2009. RESULTS: Seven patients were treated as a result of impaired healing of injuries to the cornu of the thyroid cartilage caused by trivial trauma (e.g., car accidents). The principal symptom was odynophagia. Computed tomography was used to confirm the diagnosis. Treatment involved resecting the cornu of the thyroid cartilage. Histology showed a hypertrophic pseudarthrosis at the base of the cornu. All patients were free of symptoms 10 days after resection. CONCLUSION: Pseudarthrosis of the cornu of the thyroid cartilage is a previously undescribed condition. Pseudarthrosis of the laryngeal skeleton should be excluded in patients with odynophagia.

Fatal case of ataxia-telangiectasia complicated by severe epistaxis due to nasal telangiectasia in a 12-year-old boy

8. Venter C, Patil V, Grundy J, et al. Prevalence and cumulative incidence of food hypersensitivity in the first 10 years of life. Submitted. 2015. 9. Grimshaw KEC, Bryant T, Oliver EM, et al. Incidence and risk factors for food hypersensitivity in UK infants : results from a birth cohort study. Clin Transl Allergy. 2016;6:1. 10. Pereira B, Venter C, Grundy J, Clayton CB, Arshad SH, Dean T. Prevalence of sensitization to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. J Allergy Clin Immunol. 2005;116:884-892. 11. Sampson HA, Gerth Van Wijk R, Bindslev-Jensen C, et al. Standardizing doubleblind, placebocontrolled oral food challenges: American Academy of Allergy, Asthma & ImmunologyEuropean Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012;130:1260-1274. 12. Venter C, Pereira B, Grundy J, et al. Incidence of parentally reported and clinically diagnosed food hypersensitivity in the first year of life. J Allergy Clin Immunol. 2006;117:1118-1124. 13. Schoemaker AA, Sprikkelman AB, Grimshaw KE, et al. Incidence and natural history of challengeproven cow’s milk allergy in European children EuroPrevall birth cohort. Allergy. 2015;70:963-972.

Meta-analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation: Cochlear Implantation and Complaints of Vertigo

Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates.