The nasal cycle before and after nasal septoplasty.

PURPOSE: Septoplasty is one of the most frequently performed operations in patients with septal deviation of the nose. The aim of this surgical intervention is to reduce nasal obstruction and to achieve a physiological nasal breathing. The nasal cycle plays a crucial role in this. The aim of this study was to investigate nasal breathing and the nasal cycle after septoplasty over a long period of time and under everyday conditions. METHODS: We examined 22 healthy subjects and 19 patients with nasal septal deviation. They participated in two sessions separated by an interval of three months. Shortly after the first session patients received nasal septoplasty. Testing included multiple questionnaires regarding nasal breathing and olfactory function, anterior rhinoscopy, rhinomanometry, acoustic rhinometry, and long-term rhinoflowmetry over 24 h. RESULTS: Nasal septoplasty was associated with subjectively improved nasal breathing and nasal patency comparable to that in healthy subjects. The severity of nasal obstruction was reduced. Nasal airflow and the hydraulic diameter increased on the deviated side of the nose while the inspiratory resistance did not significantly change. In addition, the number of phases of the nasal cycle decreased on the nondeviated side. Hence, the surgery was associated with a more even distribution of phases on both sides of the nose. CONCLUSION: Nasal septoplasty leads to a subjectively satisfactory result in patients with pathological septal deviation of the nose. In particular, septoplasty appears to be accompanied by a more even distribution of the nasal cycle across the two nasal cavities.

Measurement of middle ear transfer function in temporal bones using electromagnetic excitation: Comparison to sound excitation and evaluation of influencing factors.

Hearing a sound produces vibrations of the ossicles in the middle ear, which can be measured in the micrometer to nanometer range. Destruction of middle ear structures results most commonly from chronic inflammatory diseases. In these cases, passive and active middle ear implants are used for reconstruction of the ossicular chain. The positioning of the implants depends primarily on the surgeon's experience. So far, no objective assessment has been conducted to affirm if the chosen positioning is the best in each specific case. We have established a new method, allowing us to measure the middle ear transfer function (METF) intraoperatively. Using the new method, a magnet is placed on the umbo of the malleus handle and is stimulated by a coil positioned underneath the head. The resulting vibration is measured on the stapes footplate using Laser Doppler vibrometry (LDV). Acoustic and electromagnetic excitation show comparable METF in lower frequencies, which differ up to 10 dB in frequencies over 1 kHz. The position of the coil does not play a relevant part in the METF, whereas the location of the magnet on the tympanic membrane highly impacts the METF. This technique demonstrates reproducible results. Electromagnetic excitation is comparable to sound excitation and is suited for measuring the METF. A stable positioning of the magnet on the umbo is essential in order to acquire valid data.

Insertion depth angles of cochlear implant arrays with varying length: a temporal bone study.

HYPOTHESIS: The aim of the study is to investigate the insertion depth angles for different types of electrode arrays and its variability depending on the individual cochlear size. BACKGROUND: Preoperative estimation of the insertion depth angles for different electrode arrays can help surgeons choose the optimal electrode length, especially for low-frequency residual hearing preservation. METHODS: Four different electrode arrays varying in lengths (20, 24, 28, and 31 mm) were inserted in 10 temporal bones to quantify the insertion depth angle of each inserted electrode. High-resolution 3D radiographs provided by Flat Panel Computed Volume Tomography (FPCT) were used to determine electrode array insertion depth angle and diameter of the cochlea's basal turn. RESULTS: The high-resolution FPCT images from all electrode arrays inserted into the temporal bones allowed reliable measurements of insertion depth angles. In particular, statistically significant different insertion depth angles between the various array types were identified. The insertion of the 20-, 24-, 28-, and 31-mm arrays yielded a mean insertion depth angle of 341 degrees (SD, 22 degrees), 477 degrees (SD, 36 degrees), 587 degrees (SD, 42 degrees), and 673 degrees (SD, 38 degrees), respectively. Furthermore, a statistically significant negative correlation between insertion depth angle and diameter of the cochlea's basal turn was found for the 20- and 31-mm arrays. CONCLUSION: The results suggest an individually adapted length of electrode arrays, which should be taken into account for an improved decision paradigm for patients scheduled for cochlear implantation. This is of particular importance for patients with low-frequency residual hearing.