Wolfgang Stoll

Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity

Maladaptive auditory cortex reorganization may contribute to the generation and maintenance of tinnitus. Because cortical organization can be modified by behavioral training, we attempted to reduce tinnitus loudness by exposing chronic tinnitus patients to self-chosen, enjoyable music, which was modified (“notched”) to contain no energy in the frequency range surrounding the individual tinnitus frequency. After 12 months of regular listening, the target patient group (n = 8) showed significantly reduced subjective tinnitus loudness and concomitantly exhibited reduced evoked activity in auditory cortex areas corresponding to the tinnitus frequency compared to patients who had received an analogous placebo notched music treatment (n = 8). These findings indicate that tinnitus loudness can be significantly diminished by an enjoyable, low-cost, custom-tailored notched music treatment, potentially via reversing maladaptive auditory cortex reorganization.

Cortical reorganization in patients with high frequency cochlear hearing loss.

Animal research has shown that tonotopic representation in the auditory cortex is not statically fixed in the adult organism but can be altered after deafferentation. The present study examines the plasticity of the human auditory cortex in patients with high frequency cochlear hearing loss by means of magnetoencephalographic measurements. The data show that the cortical map can reorganize such that cortical neurons deprived of their usual most sensitive afferent input now respond to tone frequencies adjacent to the frequency range of the partial hearing loss. The results suggest that deafferentation due to cochlear damage in adults may lead to functional reorganization of auditory cortical structures.

Cytokines in nasal polyposis, acute and chronic sinusitis.

Cytokines are potent biologic factors involved in the regulation of inflammation, immune defense, and wound healing. Recently, growing interest has developed in the role of cytokines in chronic sinusitis and nasal polyposis. In the present study, we investigated the cytokine profile of different types of rhinosinusitis in order to evaluate whether a specific form of rhinosinusitis is associated with the expression of a certain cytokine profile. Sinus mucosa from patients with acute sinusitis (n = 10), chronic sinusitis (n = 7), antrochoanal polyp (n = 10), nasal polyps (n = 8) and controls of turbinate mucosa (n = 7) were sampled. The cytokine protein content (IL-1β, JL-3, IL-4, IL-5, IL-6, JL-8, IL-13, GM-CSF, interferon-γ) of tissue homogenates was measured using ELISA technique. In acute sinusitis, the synthesis of proinflammatory cytokines and of the neutrophil chemokine IL-8 and IL-3 appeared to be upregulated. Chronic sinusitis mucosa demonstrated no significantly increased concentrations of the measured cytokines. In bilateral nasal polyposis, but not in antrochoanal polyps, the eosinophil related cytokine IL-5 was strongly upregulated. From these findings, it appears that specific cytokine patterns are found in different forms of sinusitis, and that IL-5 may represent the most important cytokine responsible for tissue eosinophilia in nasal polyposis.

Efficacy of Botulinum Toxin A for Treatment of Upper Esophageal Sphincter Dysfunction

Objectives To investigate the efficacy of botulinum toxin A (BTA)–induced chemodenervation of the upper esophageal sphincter (UES) in patients with dysphagia and UES dysfunction.

Evaluation of treatment results with regard to initial anterior commissure involvement in early glottic carcinoma treated by external partial surgery or transoral laser microresection

Modalities of surgical treatment of early glottic carcinoma include transoral laser microresection and external partial surgery.

A Pilot Study of Autofluorescent Endoscopy for the in Vivo Detection of Laryngeal Cancer

Objectives To determine the advantage of autofluorescent endoscopy for the identification of laryngeal cancer.

Optic nerve decompression in the comatose and conscious patients after trauma

Objective To investigate the efficacy of early optic nerve decompression in comatose and conscious patients with indirect traumatic optic neuropathy.

Induction of CXC chemokines in A549 airway epithelial cells by trypsin and staphylococcal proteases − a possible route for neutrophilic inflammation in chronic rhinosinusitis

While various microorganisms have been recovered from patients with chronic rhinosinusitis, the inflammatory impact of virulence factors, in particular proteases from Staphylococcus aureus and coagulase negative staphylococci on the nasal epithelium, has not yet been investigated. Expression of CXC chemokines was determined in the epithelium of patients with chronic rhinosinusitis by immunohistochemistry. In a cell culture system of A549 respiratory epithelial cells, chemokine levels were quantified by enzyme‐linked immunosorbent assay (ELISA) after stimulation with supernatants originating from three different staphylococcal strains or with trypsin, representing a serine protease. Inhibition experiments were performed with prednisolone, with the serine protease inhibitor 4‐(2‐aminoethyl)‐benzenesulphonylfluoride (AEBSF) and with the nuclear transcription factor (NF)‐κΒ inhibitor (2E)‐3‐[[4‐(1,1‐dimethylethyl)phenyl]sulphonyl]‐2‐propenenitrite (BAY) 11–7085. Electromobility shift assays (EMSA) were used to demonstrate NF‐κB‐dependent protein synthesis. CXC chemokines interleukin (IL)‐8, growth‐related oncogene alpha (GRO‐α) and granulocyte chemotactic protein‐2 (GCP‐2) were expressed in the patients’ epithelium whereas epithelial cell‐derived neutrophil attractant 78 (ENA‐78) was rarely detected. In A549 cells, chemokines IL‐8, ENA‐78 and GRO‐α but not GCP‐2 were induced by trypsin and almost equal levels were induced by staphylococcal supernatants. IL‐8, GRO‐α and ENA‐78 synthesis was suppressed almost completely by AEBSF and BAY 11–7085, whereas prednisolone reduced chemokine levels differentially dependent on the supernatant added. CXC chemokines were detectable in the epithelium of patients with chronic rhinosinusitis. Staphylococcal serine proteases induced CXC chemokines in A549 cells, probably by the activation of proteases activated receptors, and thus might potentially be involved in neutrophilic inflammation in chronic sinusitis.

Effect of prednisolone on cytokine synthesis in nasal polyps.

To investigate steroid effects on eosinophils and their associated cytokines in nasal polyps, we sampled nasal polyp tissue from 20 subjects during routine surgery. Freshley removed polyps were cut into small pieces and incubated in culture medium for 24 h in different concentrations of prednisolone (10(-2)-10(-6) mol/L). Cell viability was assessed by means of trypan dye exclusion of the supernatants. The number of eosinophils was quantified by means of cytocentrifuge smears stained by May-Giemsa-Grunwald stain. The cytokine protein content of interleukin-5 (IL-5), IL-3, and granulocyte-macrophage colony-stimulating factor (GM-CSF) was measured by ELISA technique in supernatants and in homogenates of nasal polyp tissue. Our results revealed a significant reduction in the number of eosinophils and total number of vital cells at concentrations of 10(-3) and 10(-2) mol/L. GM-CSF and IL-5 protein levels were significantly reduced in supernatants and in homogenates after treatment with prednisolone, whereas IL-3 synthesis was not diminished. Corticosteroid effects known to inhibit synthesis of eosinophil-associated cytokines could be measured in terms of a significant decrease in IL-5 and GM-CSF protein level as well as in a decrease in the number of vital cells.

Neither MRI, CT nor US is superior to diagnose tumors in the salivary glands – an extended case study

ObjectivesUltrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most common radiological procedures for the diagnosis of tumor-like lesions of the salivary glands. The aim of the present study was to determine whether MRI or CT provide additional information besides that delivered by US.Study design/Methods109 patients with a tumor-like lesion of the salivary glands underwent surgery. MRI and CT were arranged in 73 and in 40 patients respectively, whereas all 109 patients were prospectively diagnosed by US. The results of CT, MRI and US were compared with the histological outcome. Furthermore, the recent rise in the number of CT and MRI studies was investigated.ResultsOn CT and MRI, there was no rise in the percentage of malignant tumors or advanced surgical procedures. In respect of the radiological assessment of the lesion (benign/malignant) and the correct diagnosis, CT, MRI and US were comparable in terms of sensitivity, specificity and accuracy. No significant difference was found in the Chi-square test (p > 0.05).ConclusionThe evaluation of the preoperative results of CT, MRI and US revealed no advantage for CT or MRI; these procedures are only required in specific cases. An update or revision of the current preoperative diagnostic management is deemed necessary.