Long-term results and quality of life after vibrant soundbridge implantation (VSBs) in children and adults with aural atresia.

PURPOSE: The aim of this study was to evaluate the long-term effectiveness and acceptance of the active middle ear implant system Vibrant Soundbridge (VSB®, MED-EL, Austria) in patients with aural atresia or aplasia (children and adults). METHODS: Data from 51 patients (mean age 13.9 ± 11.3 years), 42 (79.2%) children and adolescents, and 11 (20.8%) adults) who received a VSB implant between 2009 and 2019 at the Department of Otolaryngology at LMU Clinic Großhadern, Munich were included in the study. Pure-tone audiometry, speech recognition in a quiet environment and in a noisy environment were performed preoperatively, during the first fitting of the audio processor, after 1-3 years, after 3-5 years, and after 5 years (if possible). The follow-up period ranged from 11 to 157 months with a mean of 58.6 months (4.8 years). Furthermore, the benefit of the VSB was evaluated by self-assessment questionnaires (Speech, Spatial, and Qualities of Hearing Scale, respectively, for parents). RESULTS: Significant improvements were observed in hearing and speech comprehension immediately after the initial fitting of the VSB system (mean hearing gain 38.4 ± 9.4 dB HL) and at follow-up intervals (1-3, 3-5 and after 5 years) for children and adults (p < 0.01). The values remained stable over the long-term, indicating a sustained functional gain from the VSB (mean hearing gain 38.9 ± 9.2 dB HL). The results of the self-assessments affirm the positive influence on hearing and speech comprehension with the VSB. With the VSB, there was an improvement of 41.3 ± 13.7% in the Freiburg monosyllable test. CONCLUSION: These results (a stable hearing gain over the long term, a good tolerance of the implant and an improvement in quality of life) affirm the recommendation for using the active middle ear implant VSB as early as permitted for aural atresia and aplasia patients. This study represents the audiometric results with the (to date) largest collective of aural atresia patients and with a long follow-up period.

The RonchAP® palatinal device: A conservative approach in treating obstructive sleep apnea syndrome-a randomized, controlled study.

PURPOSE: The aim of the present study was to assess the efficacy of the Ronch®AP palatal device in treating patients with moderate and severe forms of obstructive sleep apnea syndrome. METHODS: In a randomized controlled trial 22 patients were examined with the Ronch®AP palatal device after 4 weeks of usage. Their results were compared to a control group of 30 patients who did not receive any treatment during this time. All patients included did not tolerate CPAP therapy. Among other parameters the apnea-hypopnea index (AHI) was measured using nocturnal cardiorespiratory polysomnography. Daytime sleepiness was assessed using Epworth Sleepiness Scale. Pittsburgh Sleep Quality Index was used to analyze sleep quality. RESULTS: Using the Ronch®AP palatal device AHI was reduced from an average of 35.34 ± 14.9/h to 19.18 ± 14.93/h, whereas the control group only showed a minimal mean reduction from 31.32 ± 12.76/h to 29.37 ± 17.11/h. The difference in reduction between the two randomized groups was highly significant (d = - 14.2, 95% CI 5.9-22.6, t = 3.4, df = 49.9, p = 0.001). Epworth Sleepiness Scale score was lowered from 9.18 ± 4.73 to 7.82 ± 4.14 on average and sleep quality improved by - 1.91 ± 2.31. Both changes were also statistically relevant (p < 0.005). CONCLUSIONS: The Ronch®AP device is an effective alternative treatment option for patients suffering from moderate and severe forms of obstructive sleep apnea syndrome and not tolerating CPAP therapy. TRIAL REGISTRATION NUMBER: 407-16 with approval from the local ethical committee (Ethikkommission der Medizinischen Fakultät der LMU München).

[Vocal tract discomfort and wellbeing of caregivers for the elderly during the pandemic]. / Vokaltraktbeschwerden und Gesundheitserleben von Pflegenden in Senioreneinrichtungen in der Pandemie.

BACKGROUND: During the SARS-CoV2-pandemic, people working in healthcare such as caregives for the elderly face additional burden, e.g. by the use of face masks. METHODS: In a prospective study, the emotional and physical wellbeing as well as the vocal tract discomfort of caregivers of two municipal homes for the elderly were assessed by questionnaires, the Mini-SCL and the Vocal Tract Discomfort Scale (VTDS), and one on personal data (sex, age, lung disease, previous SARS-CoV2-infection) and on voice symptoms. RESULTS: 67% of the questionnaires were answered by 56 women and 11 men aged 45.2 ± 11.5. In the Mini-SCL, increased scores were found in depression in 23.8%, anxiety in 49.3%, somatization in 55.2% and in the global score in 44.7%. 52% showed increased scores in the VTDS. Significant correlations were found in between the subscales of the Mini-SCL and the VTDS as well as to dysphonia symptoms. DISCUSSION: Psychological problems, somatization and vocal tract discomfort is more frequently reported by caregivers for the elderly than in the normal population. The VTDS, voice symptoms and the Mini-SCL scales are significantly related. Training on vocal hygiene should be included in workplace health promotion during the pandemic.

Sources of Aerosol Dispersion During Singing and Potential Safety Procedures for Singers.

INTRODUCTION: With respect to the Covid-19 pandemic, singing is assumed to be associated with a high potential person-to-person transmission. However, it remains unclear how the impulse dispersion varies with different types of articulation, intensity levels of diction, or body position. Furthermore, it has not been understood in detail how to prevent aerosol dispersion during singing. MATERIAL AND METHODS: Single professional singers from the Bavarian Radio Chorus were asked to sing in different head positions, with different articulation patterns and different masks after inhaling the basic liquid of an e-cigarette. The vapor cloud was segmented and tracked over time. RESULTS: Consonants and exaggeration of diction enhanced the distance reached by the impulse dispersion. Furthermore, the greatest dispersion was reached for a neutral head position. All protection masks stopped the initial jet of the aerosols but the FFP2 masks were the most effective. CONCLUSION: Some protection equipment has been identified to be promising in reducing aerosol dispersion. However, systematic effects have to be evaluated in greater collectives.

Vocal tract discomfort in caregivers for the elderly during an interval of the COVID-19 pandemic.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, professional caregivers caring for the elderly may experience more vocal tract problems in addition to regular high vocal demands while wearing face masks/coverings. METHODS AND PARTICIPANTS: Vocal tract discomfort (VTD) was assessed in 64 caregivers in one home for the elderly (64% participation rate) in June 2020 using the German version of the VTD scale. RESULTS: More than one-half of the participating caregivers experienced VTD, described mostly as dryness, irritability, and tightness. Approximately, 80% reported that sensations were not perceived before enhanced infection prevention standards were implemented. CONCLUSIONS: Among caregivers caring for the elderly during the COVID-19 pandemic, special care should be focused on the voice and vocal tract well-being.

The Effect of Water Resistance Therapy on the Impulse Dispersion of Aerosols During Sustained Phonation.

INTRODUCTION: Group singing has been associated with higher transmission risks via exhaled and spread aerosols in the CoVID19 pandemic. For this reason, many musical activities, such as rehearsals and lessons, but also voice therapy sessions, have been restricted in many countries. Consequently, transmission risks and pathways have been studied, such as aerosol amounts generated by exhalation tasks, convectional flows in rooms, or the impulse dispersion of different kinds of phonation. The use of water resistance exercises such as those utilizing LAX VOX®, are common in voice lessons and as vocal warm-ups. With this context, this study investigates the impulse dispersion characteristics of aerosols during a voiced water resistance exercise in comparison to normal singing. METHODS: Twelve professional singers (six male, six female) were asked to phonate a stable pitch through a silicone tube into a bottle filled with water, holding the end of the tube 5 cm below the surface. Before performing the tasks, the singers inhaled the vapor consisting of 0.5 L base liquid from an e-cigarette. The exhaled gas cloud coming out of the bottle was recorded in all three spatial directions and the dispersion was measured as a function of time. RESULTS: At the end of the phonation task, the median distance to the front was 0.55 m and the median of the lateral expansion of the cloud was 0.89 m, the maximum to the front reached 0.88 m, and the maximum of lateral expansion 1.05 m. For the upwards direction of the clouds a median of 1.00 m and a maximum of 1.34 m from the mouth were measured. Three seconds after the end of the task, the medians were declining. CONCLUSION: The exhaled aerosol cloud can expand despite the obstacle of the water when using LAX VOX® during phonation.

Impulse dispersion of aerosols during playing wind instruments.

Musical activities, especially singing and playing wind instruments, have been singled out as potentially high-risk activities for the transmission of SARS CoV-2, due to a higher rate of aerosol production and emission. Playing wind instruments can produce condensation, droplets of saliva, and aerosol particles, which hover and spread in the environmental air's convectional flows and which can be potentially infectious. The aim of this study is to investigate the primary impulse dispersion of aerosols that takes place during the playing of different wind instruments as compared to breathing and to speaking. Nine professional musicians (3 trumpeters, 3 flautists and 3 clarinetists) from the Bavarian Symphony Orchestra performed the main theme from the 4th movement of Ludwig van Beethoven's 9th symphony in different pitches and loudness. The inhaled air volume was marked with small aerosol particles produced using a commercial e-cigarette. The expelled aerosol cloud was recorded by cameras from different perspectives. Afterwards, the dimensions and dynamics of the aerosol cloud were measured by segmenting the video footage at every time point. Overall, the flutes produced the largest dispersion at the end of the task, reaching maximum forward distances of 1.88 m. An expulsion of aerosol was observed in different directions: upwards and downwards at the mouthpiece, at the end of the instrument, and along the flute at the key plane. In comparison, the maximum impulse dispersions generated by the trumpets and clarinets were lower in frontal and lateral direction (1.2 m and 1.0 m towards the front, respectively). Also, the expulsion to the sides was lower.

Impulse dispersion of aerosols during playing the recorder and evaluation of safety measures.

INTRODUCTION: Group musical activities using wind instruments have been restricted during the CoVID19 pandemic due to suspected higher risk of virus transmission. It was presumed that the aerosols exhaled through the tubes while playing would be ejected over larger distances and spread into the room due to jet stream effects. In particular, the soprano recorder is widely used as an instrument in school classes, for beginners of all age groups in their musical education, in the context of leisure activities and in professional concert performances. Understanding the aerosol impulse dispersion characteristics of playing the soprano recorder could assist with the establishment of concepts for safe music-making. METHODS: Five adult professionally trained soprano recorder players (4 female, 1 male) played four bars of the main theme of L. van Beethoven's "Ode to Joy" in low and in high octaves, as well as with 3 different potential protection devices in the high octave. For comparison they spoke the corresponding text by F. Schiller. Before each task, they inhaled .5 L of vapor from an e-cigarette filled with base liquid. The vapor cloud escaping during speaking or playing was recorded by cameras and its spread was measured as a function of time in the three spatial dimensions. The potential safety devices were rated for practicability with a questionnaire, and their influence on the sound was compared, generating a long-term average spectrum from the audio data. RESULTS: When playing in the high octave, at the end of the task the clouds showed a median distance of 1.06 m to the front and .57 m diameter laterally (maxima: x: 1.35 m and y: .97 m). It was found that the clouds' expansion values in playing the recorder with and without safety measures are mostly lower when compared to the ordinary, raised speaking voice of the same subjects. The safety devices which covered the instrument did not show clear advantages and were rated as unpractical by the subjects. The most effective reduction of the cloud was reached when playing into a suction funnel. CONCLUSION: The aerosol dispersion characteristics of soprano recorders seem comparable to clarinets. The tested safety devices which covered holes of the instrument did not show clear benefits.

Effects of surgical masks on aerosol dispersion in professional singing.

BACKGROUND: In the CoVID-19 pandemic, singing came into focus as a high-risk activity for the infection with airborne viruses and was therefore forbidden by many governmental administrations. OBJECTIVE: The aim of this study is to investigate the effectiveness of surgical masks regarding the spatial and temporal dispersion of aerosol and droplets during professional singing. METHODS: Ten professional singers performed a passage of the Ludwig van Beethoven's "Ode of Joy" in two experimental setups-each with and without surgical masks. First, they sang with previously inhaled vapor of e-cigarettes. The emitted cloud was recorded by three cameras to measure its dispersion dynamics. Secondly, the naturally expelled larger droplets were illuminated by a laser light sheet and recorded by a high-speed camera. RESULTS: The exhaled vapor aerosols were decelerated and deflected by the mask and stayed in the singer's near-field around and above their heads. In contrast, without mask, the aerosols spread widely reaching distances up to 1.3 m. The larger droplets were reduced by up to 86% with a surgical mask worn. SIGNIFICANCE: The study shows that surgical masks display an effective tool to reduce the range of aerosol dispersion during singing. In combination with an appropriate aeration strategy for aerosol removal, choir singers could be positioned in a more compact assembly without contaminating neighboring singers all singers.

The Effect of Singers' Masks on the Impulse Dispersion of Aerosols During Singing.

BACKGROUND: During the Covid-19 pandemic, singing activities were restricted due to several super-spreading events that have been observed during rehearsals and vocal performances. However, it has not been clarified how the aerosol dispersion, which has been assumed to be the leading transmission factor, could be reduced by masks which are specially designed for singers. MATERIAL AND METHODS: Twelve professional singers (10 of the Bavarian Radio-Chorus and two freelancers, seven females and five males) were asked to sing the melody of the ode of joy of Beethoven's 9th symphony "Freude schöner Götterfunken, Tochter aus Elisium" in D-major without masks and afterwards with five different singers' masks, all distinctive in their material and proportions. Every task was conducted after inhaling the basic liquid from an e-cigarette. The aerosol dispersion was recorded by three high-definition video cameras during and after the task. The cloud was segmented and the dispersion was analyzed for all three spatial dimensions. Further, the subjects were asked to rate the practicability of wearing the tested masks during singing activities using a questionnaire. RESULTS: Concerning the median distances of dispersion, all masks were able to decrease the impulse dispersion of the aerosols to the front. In contrast, the dispersion to the sides and to the top was increased. The evaluation revealed that most of the subjects would reject performing a concert with any of the masks. CONCLUSION: Although, the results exhibit that the tested masks could be able to reduce the radius of aerosol expulsion for virus-laden aerosol particles, there are more improvements necessary to enable the practical implementations for professional singing.

Aerosol Dispersion During Different Phonatory Tasks in Amateur Singers.

INTRODUCTION: Due to increased aerosol generation during singing, choir rehearsals were widely prohibited in the course of the CoVID-19 pandemic. Most studies on aerosol generation and dispersion focus on professional singers. However, it has not been clarified if these data are also representative for amateur singers. METHODS: Nine non-professional singers (four male, five female) were asked to perform five tasks; speaking (T+), singing a text softly (MT-) and loudly (MT+), singing on the vowel [ə] (M+) and singing with a N95 mask (MT+N95). Before performing the tasks, the singers were asked to inhale 0.5 L vapor produced by an e-cigarette consisting of the basic liquid. The spread of the exhaled vapor was recorded in all three dimensions by high-definition cameras and the impulse dispersion was detected as a function of time. RESULTS: Regarding the median dispersion to the front, all tasks showed comparable distances from 0.69 m to 0.82 m at the end of the tasks. However, the maximum aerosol dispersion showed a larger variety among different subjects or tasks, respectively. Especially in the M+ task a maximum distance of 1.96 m to the front was reached by a single subject. Although singing with a N95 mask resulted in a slightly increased median dispersion to the front, the maximum dispersion was decreased from 1.47 m (MT+) to 1.04 m (MT+N95). CONCLUSION: The maximum dispersion distance to the front of 1.96 m at the end of the M+ task and 1.47 m at the end of the MT+ task showed higher values in comparison to professional singers. Differences in phonation, articulation and mouth opening could lead to greater impulse dispersion. Singing in loud phonation with a N95 mask reduced the maximum impulse dispersion to the front to 1.04 m. Taking all results into consideration, a slightly larger safety distance should be necessary for non-professional singers.