[Bilateral vestibular loss. Diagnosis and follow-up]. / Der beidseitige Vestibularisausfall. Diagnostik und Krankheitsverlauf.

BACKGROUND: Atypical symptom in patients with bilateral vestibular loss is head movement-induced oscillopsia. The paucity of precise complaints in many patients is surprising. Therefore, bilateral loss of vestibular function is often undiagnosed. PATIENTS: We report on the long-term follow-up in 29 patients. They were monitored for 2-7 years (mean: 4.5 years). RESULTS: Of the 29 patients 16 described oscillopsia. All symptomatic patients had acute bilateral vestibular loss.Patients described that their symptoms improved over a period of 1-2 years. Improvement was not age dependent. CONCLUSIONS: Otoneurologists should be aware of the particular clinical symptoms in bilateral vestibular loss. Regarding clinical features, compensation of bilateral vestibular loss seems to be unlikely only based on central compensatory eye movement reflexes. More likely perceptual adaptations and restriction of head movement are responsible for subjective improvement.

[Pseudoemissions and false positive findings in measurement of transiently evoked otoacoustic emissions (TEOAE)]. / Pseudoemissionen und falsch positive Befunde in der Messung transitorisch evozierter otoakustischer Emissionen (TEOAE)1.

BACKGROUND: Recording procedure of transiently evoked otoacoustic emissions is an important part of diagnostics in pediatric audiology. As a rule of thumb measurable TEOAE excludes more than slight hearing impairment. Nevertheless any interpretation of these measurements in a clinical setting must consider supposed false positive findings (so called pseudoemissions) and real false positive findings in cases of profound hearing loss with reproducible TEOAE and missing auditory evoked potentials. PATIENTS AND METHODS: TEOAE recordings in 512 patients were evaluated for recording procedure failure. Possible types of recording procedure failure were divided into failures conditioned by the patients and stimulus or probe dependent failures. In case of insufficient test procedure and absent TEOAE recording procedure was improved and repeated. RESULTS: In 2 patients with severe to profound hearing loss we discovered reproducible TEOAE whereas auditory evoked potentials were missing. As a stimulus and probe dependent recording procedure failure we saw reproducible pseudoemissions in 3 other patients with profound hearing loss. CONCLUSIONS: These results indicate that conclusions concerning hearing ability on the base of TEOAE should keep in mind possible pseudoemissions as a result of recording procedure failure. Reported cases with absent auditory evoked potentials and reproducible TEOAE showed that TEOAE recordings in these cases indicate substantially preserved outer hair-cell function independent of profound hearing loss.

[Surgery of the external auditory canal in familial bilateral auditory canal atresia]. / Die Chirurgie des äusseren Gehörgangs bei familiärer bilateraler Gehörgangsatresie.

BACKGROUND: Inherited isolated bilateral atresia of the external auditory canal is rare. Ear canal surgery procedure is difficult. METHODS: Basing on a case report of a family with inherited isolated bilateral atresia of the external auditory canal in 4 cases the way of preoperative diagnostics including human genetics and our surgical concept is described. RESULTS: Resulting clinical findings showed complete epithelialization of the ear canal and ear drum with slight conductive hearing loss. CONCLUSIONS: Canaloplasty in atresia can be easily and successfully accomplished by our modified technique.

[Surgical treatment of auditory canal exostoses]. / Die operative Behandlung von Gehörgangsexostosen.

BACKGROUND: Although complications of surgical removal of external auditory canal exostoses are rare, reported surgical complications include tympanic membrane perforation, postoperative hearing loss, canal stenosis, and facial nerve injuries. PATIENTS AND METHODS: We report on our experience in exostosis surgery, consisting of 59 procedures in 48 patients. Preoperative and postoperative complaints and findings, intraoperative complications, and audiologic results are described and discussed. There has been a minimum of one year of follow-up in every case. RESULTS: Postoperative canal stenosis was seen in 2 cases of preoperative severe persistent external otitis. Temporary threshold shift was recorded in 6 patients. Persistent sensorineural hearing loss occurred in 4 patients. Six of the 10 patients with temporary or persistent hearing loss had already shown preoperative sensorineural hearing loss. Intraoperatively tympanic membrane perforation occurred in 3 cases, accidental opening of the mastoid in 1 case. CONCLUSIONS: Exostosis surgery should be reserved for uninfected ear canals. Meatal skin preservation without circular meatal flap incision is recommended to avoid postoperative canal stenosis. Especially in cases of preexisting sensorineural hearing loss, attention should be focused on the intraoperative noise reduction by tympanic membrane protection and pauses of noise exposition.

[Objective criteria for expert assessment of vestibular vertigo]. / Objektive Kriterien für die Begutachtung des vestibulären Schwindels.

BACKGROUND: Even for experienced examiners quantitative and objective medicolegal assessment of vestibular vertigo is difficult. Current medicolegal opinions place disproportionate emphasis of subjective symptoms. METHODS: Based on parameters from spontaneous and provoked vestibular nystagmus with Frenzel's glasses, objective criterias for adequate medicolegal assessment of vestibular disorders are presented. Diagrams in tabular form for unilateral and bilateral vestibular dysfunction and benign peripheral positional vertigo allow assessment of reduction in earning capacity. CONCLUSIONS: The widespread use of subjective criteria in the medicolegal evaluation of vestibular complaints should not be accepted. The qualified ENT specialist is able to evaluate vestibular deficits using objective and reproducible methods.

[Toxic inner ear damage in topical treatment of psoriasis with salicylates]. / Toxischer Innenohrschaden bei topischer Psoriasisbehandlung mit Salizylaten.

BACKGROUND: Whereas cochlear impairment after intravenous ingestions of salicylates is well known, reports of cochlear symptoms after topical application are quite rare. The extent of the ototoxic salicylate impact is increased by diabetes, renal insufficiency, and alcoholism. PATIENT: This study presents a case report of a female patient who suffered a repeated, symmetric, pancochlear, reversible inner ear impairment after two treatments with salicylate containing ointment for psoriasis. The correlation of the salicylate therapy with the observed inner ear lesions is obvious due to the close interval between these incidences and to the audiologic criteria typical for salicylate intoxication. CONCLUSION: Audiologic controls should be carried out during extended local application of salicylate containing ointment.

[Morphologic studies of autologous and homologous ossicles after long-term implantation]. / Morphologische Untersuchungen an autologen und homologen Ossikeln nach Langzeitimplantation.

BACKGROUND: Although ossicular bone implants have been used to restore the middle ear sound conduction mechanism for more than 30 years, controversy still exists regarding their morphology after long-term implantation. METHODS: Fifty-seven ossicular implants that had been in the middle ear for a mean duration of 12 years (ranged from 3-33 years) were removed at the time of revision surgery and prepared for histological study by light microscopy. These revision operations were performed because of failure to control the disease and/or persistent or recurring hearing loss. Each ossicle was examined for the presence of living bone, extended bone resorption, and inflammatory cells. The findings were correlated to origin, duration of implantation, and the reason for revision surgery. RESULTS: More than a half of the specimens with cholesteatoma and chronic otitis media as reasons for revision surgery showed extended bone resorption and inflammatory cells. Even in clinically uninfected ears, inflammation and bone resorption could be observed. Lymphocytic infiltration as an inflammatory pathologic change predominates in autologous implants. CONCLUSIONS: On the basis of these histological observations, we conclude that autologous ossicles from cholesteatoma should not be used in reconstructive middle ear surgery. Furthermore, the use of ossicular implants after revision surgery should be avoided.