Oncological and functional outcome after laryngectomy for laryngeal and hypopharyngeal cancer: a population-based analysis in Germany from 2001 to 2020.

Prognostic factors for overall survival (OS), percutaneous endoscopic gastrostomy (PEG) dependency, and long-term speech rehabilitation via voice prosthesis (VP) after laryngectomy for laryngeal or hypopharyngeal cancer were investigated in a retrospective population-based study in Thuringia, Germany. A total of 617 patients (68.7% larynx; hypopharynx; 31.3%; 93.7% men; median age 62 years; 66.0% stage IV) from 2001 to 2020 were included. Kaplan-Meier and Cox multivariable regression analyses were performed. 23.7% of patients received a PEG. 74.7% received a VP. Median OS was 131 months. Independent factors for lower OS were stage IV (compared to stage II; hazard ratio [HR] = 3.455; confidence interval [CI] 1.395-8.556) and laryngectomy for a recurrent disease (HR = 1.550; CI 1.078-2.228). Median time to PEG removal was 7 months. Prior partial surgery before laryngectomy showed a tendency for independent association for later PEG removal (HR = 1.959; CI 0.921-4.167). Postoperative aspiration needing treatment was an independent risk factor (HR = 2.679; CI 1.001-7.167) for later definitive VP removal. Laryngectomy continuously plays an important role in a curative daily routine treatment setting of advanced laryngeal or hypopharyngeal cancer in Germany. Long-term dependency on nutrition via PEG is an important issue, whereas use of VP is a stable long-term measure for voice rehabilitation.

Impact of Human Papillomavirus-Negative Dominance in Oropharyngeal Cancer on Overall Survival: A Population-Based Analysis in Germany from 2018 to 2020.

The impact of the relation of human papillomavirus (HPV) and smoking status of oropharyngeal squamous cell carcinoma (OPSCC) on overall survival (OS) was investigated in a retrospective population-based study in Thuringia, Germany. A total of 498 patients with OPSCC (76.9% men; mean age 62.5 years) from 2018 to 2020 were included. OPSCC cases were 37.3% HPV-positive (+) (31.2% smokers; mean incidence: 2.91/100,000 population) and 57.8% HPV-negative (63.5% smokers; mean incidence: 4.50/100,000 population). Median follow-up was 20 months. HPV+ patients had significantly better OS than HPV-negative (-) patients (HPV+: 2-year OS: 90.9%; HPV-: 2-year OS: 73.6%; p < 0.001). In multivariable analysis, HPV- patients (hazard ratio (HR) = 4.5; 95% confidence interval (CI): 2.4-8.6), patients with higher N classification (N2: HR = 3.3; 95% CI: 1.71-6.20; N3: HR = 3.6; 95% CI: 1.75-7.31) and with a higher cancer staging (III: HR = 5.7; 95% CI: 1.8-17.6; IV: HR = 19.3; 95% CI: 6.3-57.3) had an increased hazard of death. HPV- smokers formed the majority in Thuringia. Nicotine and alcohol habits had no impact on OS. Optimizing OPSCC therapeutic strategies due to the dominance of HPV- is more important than discussing de-escalation strategies for HPV+ patients.

Effect of the German tonsillitis guideline on indication for tonsil surgery in patients with recurrent acute tonsillitis: a population-based study.

Evidence-based indication for tonsil surgery in patients with recurrent acute tonsillitis (RAT) is an ongoing matter of debate. Since introduction of the German tonsillitis guideline in 2015, the indication criteria for tonsil surgery have become much stricter. It is unclear, if this has changed the indication policy. A retrospective population-based study was performed including all 1398 patients with RAT admitted for tonsil surgery in all Thuringian hospitals in 2011, 2015, and 2019. Changes over the years concerning patients' characteristics, number of tonsillitis episodes in the last 12 months treated with antibiotics (T12), and decision for tonsillectomy or tonsillotomy were analyzed using univariable and multivariable statistics. The surgical rates decreased from 28.56/100,000 population in 2011 to 23.57 in 2015, and to 11.60 in 2019. The relative amount of patients with ≥ 6 T12 increased from 14.1% in 2011 over 13.3% in 2015 to 35.9% in 2019. Most patients received a tonsillectomy (98% of all surgeries). Decision for tonsillotomy was seldom (1.2%). Multinomial logistic regression analysis with the year 2011 as reference showed that compared to the year 2015, the age of the patients undergoing surgery increased in 2015 (Odds ratio [OR] = 1.024; 95% confidence interval [CI] = 1.014-1.034; p < 0.001), and also in 2019 (OR 1.030: CI 1.017-1.043; p < 0.001). Compared to 2011, the number T12 was not higher in 2015, but in 2019 (OR 1.273; CI 1.185-1.367; p < 0.001). Stricter rules led to lower tonsil surgery rates but to a higher proportion of patients with ≥ 6 T12 before surgery. Tonsillectomy remained the dominating technique.

Postoperative adjuvant radiochemotherapy with cisplatin versus adjuvant radiochemotherapy with cisplatin and pembrolizumab in locally advanced head and neck squamous cell carcinoma- the study protocol of the Adrisk trial.

Most of the patients with head and neck squamous cell carcinoma (HNSCC) are diagnosed with locally advanced disease. Standards of care for curative-intent treatment of this patient group are either surgery and adjuvant radio(chemo)therapy (aRCT) or definitive chemoradiation. Despite these treatments, especially pathologically intermediate and high-risk HNSCC often recur. The ADRISK trial investigates in locally advanced HNSCC and intermediate and high risk after up-front surgery if the addition of pembrolizumab to aRCT with cisplatin improves event-free sur-vival compared to aRCT alone. ADRISK is a prospective, randomized controlled investiga-tor-initiated (IIT)-phase II multicenter trial within the German Interdisciplinary Study Group of German Cancer Society (IAG-KHT). Patients with primary resectable stage III and IV HNSCC of the oral cavity, oropharynx, hypopharynx and larynx with pathologic high (R1, extracapsular nodal extension) or intermediate risk (R0 <5 mm; N≥2) after surgery will be eligible. Two hun-dred forty patients will be randomly assigned (1:1) to either standard aRCT with cisplatin (standard arm) or aRCT with cisplatin + pembrolizumab (200 mg iv, in 3-week cycle, max. 12 months) (interventional arm). Endpoints are event-free and overall survival. Recruitment started in August 2018 and is ongoing.

[Mortality risk for oral and oropharyngeal carcinomas in Thuringia: a population-based analysis]. / Sterberisiko für Mundhöhlen- und Oropharynxkarzinome in Thüringen: eine bevölkerungsbasierte Analyse.

OBJECTIVE: This population-based study investigates the impact of HPV association on overall survival (OS) of oral cavity (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) in Thuringia and the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) tumors. METHODS: A total of 308 patients (83.4% men; mean age 57.6 years) with a primary diagnosis of OSCC (38%) or OPSCC (62%) from 2008 were included in the study. Descriptive statistics were obtained for the variables. According to Ang's risk classification, patients were classified as low risk of death (HPV+, nonsmokers), intermediate risk (HPV+, smokers) and high risk of death (HPV-smokers). Kaplan-Meier analyses and Cox multivariable regression analysis were performed to examine OS. RESULTS: 22.5% of OPSCC was HPV+ (incidence: 1.89/100,000 population; thereof 80.1% smokers). The proportion of OSCC with HPV+ was 8.5% (incidence: 0.44/100,000; thereof 78.6% smokers). The median follow-up was 31 months. HPV+ patients had significantly better 5-year OS than HPV- patients (81% vs. 49%; p < 0.001). In multivariable analysis lower OS were associated with: HPV-patients (hazard ratio (HR) = 3.2; 95% confidence interval (CI) = 1.6-6.4; p = 0.001), high risk of death according to Ang (HR = 2.3; 95% CI = 1.0-5.4; p = 0.049), older age (HR = 1.7; 95% CI = 1.1-2.4; p = 0.01), T3/T4-classification (HR = 2.1; 95% CI = 1.3-3.2; p = 0.001) and the presence of distant metastases (HR = 2.7; 95% CI = 1.6-4.4; p < 0.001). CONCLUSIONS: HPV+ non-smokers were minority in Thuringia. The majority of HPV+ patients had an intermediate risk of death due to cigarette smoking.

Early Mortality among Patients with Head and Neck Cancer Diagnosed in Thuringia, Germany, between 1996 and 2016-A Population-Based Study.

Population-based studies on early mortality in head and neck cancer (HNC) are sparse. This retrospective population-based study investigated early mortality of HNC and the influence of patients' tumor and treatment characteristics. All 8288 patients with primary HNC of the German federal state Thuringia from 1996 to 2016 were included. Univariate and multivariate analysis were performed to identify independent factors for 30-day, 90-day, and 180-day mortality. The 30-, 90-, and 180-day mortality risks were 1.8%, 5.1%, and 9.6%, respectively. In multivariable analysis, male sex (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.08-1.84), increasing age (OR 1.81; CI 1.49-2.19), higher T (T4: OR 3.09; CI 1.96-4.88) and M1 classification (OR 1.97; CI 1.43-2.73), advanced stage (IV: OR 3.97; CI 1.97-8.00), tumors of the cavity of mouth (OR 3.47; CI 1.23-9.75), oropharynx (OR 3.01; CI 1.06-8.51), and hypopharynx (OR 3.27; CI 1.14-9.40) had a significantly greater 180-day mortality. Surgery (OR 0.51; CI 0.36-0.73), radiotherapy (OR 0.37; CI 0.25-0.53), and multimodal therapy (OR 0.10; CI 0.07-0.13) were associated with decreased 180-day mortality. Typical factors associated with worse overall survival had the most important impact on early mortality in a population-based setting.

Role of Intraparotid and Neck Lymph Node Metastasis in Primary Parotid Cancer Surgery: A Population-Based Analysis.

This population-based study investigated the prognostic role of intraparotid (PAR) and cervical lymph node (LN) metastasis on overall survival (OS) of primary parotid cancer. All 345 patients (median age: 66 years; 43% female, 49% N+, 31% stage IV) of the Thuringian cancer registries with parotid cancer from 1996 to 2016 were included. OS was assessed in relation to the total number of removed PAR and cervical LN, number of positive intraparotid (PAR+), positive cervical LN, LN ratio, log odds of positive LN (LODDS), as well as including the PAR as LODDS-PAR. PAR was assessed in 42% of the patients (22% of these PAR+). T and N classification were not independent predictors of OS. When combining T with LODDS instead of N, higher T (T3/T4) became a prognosticator (hazard ratio (HR) = 2.588; CI = 1.329−5.040; p = 0.005) but not LODDS (p > 0.05). When combining T classification with LODDS-PAR, both higher T classification (HR = 2.256; CI = 1.288−3.950; p = 0.004) and the alternative classification with LODDS-PAR (≥median −1.11; HR 2.078; CI = 1.155−3.739; p = 0.015) became independent predictors of worse OS. LODDS-PAR was the only independent prognosticator out of the LN assessment for primary parotid cancer.

The log odds of positive neck lymph nodes is a superior lymph node predictor for overall survival in head and neck cancer: a population-based analysis in Germany.

BACKGROUND: This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC). METHODS: 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS). RESULTS: Mean number of LODDS was 0-0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721-31.224; p < 0.001) and LODDS > - 1.0 (HR 2.120; 95% CI 1.129-3.982; p = 0.019) were independently associated with lower OS. CONCLUSION: LODDS was an independent and superior predictor for OS in HNC in a population-based setting with representative real-life data.

30-day readmission rate in pediatric otorhinolaryngology inpatients: a retrospective population-based cohort study.

OBJECTIVES: Analysis of frequency and reasons for planned and unplanned 30-day readmission in hospitalized pediatric otorhinolaryngology patients using German Diagnosis Related Group (G-DRG) system data. METHODS: A retrospective population-based cohort study in Thuringia, Germany, was performed for the year 2015 with 2440 cases under 18 years (55.6% male) out of a total number of 15.271 inpatient cases. The majority of pediatric patients were from 2 to 5 years old (54.5%). The most frequent diagnoses were hyperplasia of adenoids or/and tonsils (26.6%). 36 cases (1.5%) experienced readmission within 30-days. RESULTS: 30-day readmission was planned in 9 cases (25% of all readmission) and was unplanned in 27 cases (75%). The median interval between index and readmission treatment was 8 days. Postoperative bleeding after adenoidectomy, tonsillotomy/tonsillectomy or tracheostomy (33.4%) and infectious complications after surgery like acute otitis media, abscess formation or fever (36.2%) were the most frequent reasons for 30-day readmission. Compared to adults treated in 2015 in Thuringia, the readmission rate was higher in adult patients (8.9%) than in this pediatric cohort. In contrast to children, readmissions in adults were mainly planned (65.1%) with a different spectrum of underlying diseases and reasons for readmission. CONCLUSION: The 30-day readmission rate seemed to be lower for pediatric otolaryngology patients compared to adult patients. Unplanned readmissions dominated in pediatric patients, whereas planned readmissions dominated in adults.

Long-Term Facial Nerve Outcome in Primary Parotid Cancer Surgery: A Population-Based Analysis.

OBJECTIVES/HYPOTHESIS: To determine immediate postoperative and long-term facial nerve dysfunction after parotid cancer surgery, risk factors, and the role of facial reanimation surgery. STUDY DESIGN: Population-based long-term analysis for all new primary parotid carcinoma cases in Thuringia from 1996 to 2019. METHODS: Data of the cancer registries of Thuringia, a federal state in Germany, were analyzed in combination with hospital-based data on facial function. RESULTS: About 477 patients (42.3% women; median age: 68 years) were included. It was observed that 6.7% had a preoperative facial nerve dysfunction, 11.7% received a radical parotidectomy, that is, that 5% had a normal preoperative facial function but needed radical surgery because of intraoperative detection of tumor infiltration into the facial nerve. About 10.2% received facial nerve reconstruction surgery. Immediate postoperative facial nerve dysfunction in the other patients was observed in 34.4% of the patients. Advanced T classification (odds ratio [OR] = 2.140; confidence interval [CI] = 1.268-3.611; P = .004) and neck dissection (OR = 2.012; CI = 1.027-3.940; P = .041) were independent risk factors for immediate postoperative facial nerve dysfunction. In addition, 22.0% showed no recovery during follow-up. Advanced T classification (OR = 2.177; CI = 1.147-4.133; P = .017) and postoperative radiotherapy (OR = 2.695; CI = 1.244-5.841; P = .012) were independent risk factors for permanent postoperative facial nerve dysfunction. CONCLUSION: Patients with primary parotid cancer are at high risk for long-term facial nerve dysfunction. It seems that the possibilities of facial reanimation surgery needs to be utilized even more effectively. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2694-2700, 2021.

Systemic therapy for recurrent and/or metastatic head and neck cancer: a population-based healthcare research study in Thuringia, Germany.

PURPOSE: Systemic therapy choice for patients with recurrent and/or metastatic head and neck cancer (R/M HNC) is a challenge. Not much is known about systemic therapies used in daily clinical routine and their outcome. METHODS: Data of all 283 patients with R/M HNC (89.4% male, median age: 60 years) registered for first-line systemic therapy between 2015 and 2018 in the cancer registries of Thuringia, a federal state in Germany, were included. Patient characteristics and treatment patterns were summarized. Exploratory univariate and multivariate analyses were conducted on select of systemic therapy and prognostic factors for overall survival. RESULTS: The most frequent first-line regimens were platinum-based combinations (71.4%), mainly cetuximab + platinum + 5-fluorouracil (32.5%). 32.5, 13.1, 4.9, and 1.1%, respectively, received, a second, third, fourth, and fifth line of systemic therapy. Median follow-up was 5.5 months. Median real-world overall survival was 16.8 months [95% confidence interval (CI) 11.1-22.6]. Alcohol drinking [hazard ratio (HR) 2.375, CI 1.471-3.831; p < 0.001], no second-line therapy (HR 3.425, CI 2.082-5.635, p < 0.001), and application of three agents compared to one agent in first-line therapy (HR 2.798, CI 1.374-5.697; p = 0.005) were associated to decreased overall survival after start of first-line systemic therapy. Termination of second-line treatment because of deterioration of the general condition was the only independent negative prognostic factor (HR 4.202, CI 1.091-16.129; p = 0.037) after start of second-line systemic therapy. CONCLUSIONS: This study offers useful information, mainly prior to the availability of immunotherapy, on patient characteristics, treatment patterns, and survival in a German real-world population.

Gender Disparities in Epidemiology, Treatment, and Outcome for Head and Neck Cancer in Germany: A Population-Based Long-Term Analysis from 1996 to 2016 of the Thuringian Cancer Registry.

This study determined with focus on gender disparity whether incidence based on age, tumor characteristics, patterns of care, and survival have changed in a population-based sample of 8288 German patients with head neck cancer (HNC) registered between 1996 and 2016 in Thuringia, a federal state in Germany. The average incidence was 26.13 ± 2.89 for men and 6.23 ± 1.11 per 100,000 population per year for women. The incidence peak for men was reached with 60-64 years (63.61 ± 9.37). Highest incidence in females was reached at ≥85 years (13.93 ± 5.87). Multimodal concepts increased over time (RR = 1.33, CI = 1.26 to 1.40). Median follow-up time was 29.10 months. Overall survival (OS) rate at 5 years was 48.5%. The multivariable analysis showed that male gender (Hazard ratio [HR] = 1.44; CI = 1.32 to 1.58), tumor subsite (worst hypopharyngeal cancer: HR = 1.32; CI = 1.19 to 1.47), and tumor stage (stage IV: HR = 3.40; CI = 3.01 to 3.85) but not the year of diagnosis (HR = 1.00; CI = 0.99 to 1.01) were independent risk factors for worse OS. Gender has an influence on incidence per age group and tumor subsite, and on treatment decision, especially in advanced stage and elderly HNC patients.

Hospitalization for epistaxis: a population-based healthcare research study in Thuringia, Germany.

PURPOSE: Epistaxis is the most common ENT emergency. The aim was to determine population-based data on severe epistaxis needing inpatient treatment. METHODS: Retrospective population-based cohort study in the federal state Thuringia in 2016 performed on all 840 inpatients treated for epistaxis in otolaryngology departments (60.1% male, median age: 73 years; 63.9% under anticoagulation). The association between patients' and treatment characteristics and longer inpatient stay (≥ 4 days) as well as readmission for recurrent epistaxis was analyzed using univariable and multivariable statistics. RESULTS: The overall incidence of epistaxis needing inpatient treatment was higher for men (42 per 100,000) than for women (28 per 100,000). The highest incidence was reached for men > 85 years (222 per 100,000). Most important independent predictors for longer inpatient stay were localization of the bleeding not in the anterior nose (OR = 2.045; CI = 1.534-2.726), recurrent bleeding during inpatient treatment (OR = 2.142; CI = 1.508-3.042), no electrocoagulation (OR = 2.810; CI = 2.047-3.858), and blood transfusion (OR = 2.731; CI = 1.324-5.635). Independent predictors for later readmission because of recurrent epistaxis were male gender (OR = 1.756; CI = 1.155-2.668), oral anticoagulant use (OR = 1.731; CI = 1.046-2.865), and hereditary hemorrhagic telangiectasia (OR = 13.216; CI 5.102-34.231). CONCLUSIONS: Inpatient treatment of epistaxis seems to be variable in daily routine needing standardization by clinical guidelines and strategies to shorten inpatient treatment and to reduce the risk of readmission.

30-day unplanned readmission rate in otolaryngology patients: A population-based study in Thuringia, Germany.

PURPOSE: Analyze associations between patients' characteristics and treatment factors with 30-day unplanned readmissions in hospitalized otolaryngology patients in the German Diagnosis Related Group (D-DRG) system. METHODS: A retrospective cohort study was performed on 15.271 otolaryngology admissions of 12.859 patients in 2015 in Thuringia, Germany. The medical records of the 1173 cases (7.6%) with readmission within 30-days were analyzed in detail. RESULTS: The 30-day readmission was planned in 747 cases (4.9%) and was unplanned in 422 cases (2.8%). The median interval between primary and next inpatient treatment was 11 days. The principal diagnosis was the same as during the primary index treatment in 72% of the cases. The most frequent reasons for readmission were: Need for non-surgical therapy (31.2%), need for further surgery (26.3%), post-surgical complaints (16.9%), and recurrence of primary complaints (10.7%). The multivariate analysis revealed that discharge due to patient's request against medical advice was a strong independent factor with high risk for unplanned readmission (Odds Ratio [OR] = 9.62]; confidence interval [CI] = 2.69-34.48). Surgery at index admission (OR = 3.33; CI = 1.86-5.96) was the second important independent risk factor for unplanned readmission. Unplanned readmission had more frequently a non-surgical treatment at readmission than a surgical treatment (OR = 3.92; CI = 2.24-6.84) and needed more frequently further diagnostics (OR = 2.34; CI = 1.34-4.11). The following index International Classification of Diseases (ICD) categories had the highest risk for unplanned readmission: Injury, poisoning and certain other consequences of external causes, ICD: S00-T98 (OR = 66.67; CI = 15.87-333.33), symptoms, signs, abnormal findings, ill-defined causes, not otherwise classified, ICD: R00-R99 (OR = 62.5; CI = 11.76-333.33), blood forming organ diseases, ICD: D50-D90 (OR = 21.276; CI = 3.508-125), and eye/ ear diseases, ICD: H00-H95 (OR = 12.66; CI = 4.29-37.03). CONCLUSIONS: The causes of unplanned 30-day readmission in German otolaryngology inpatients are multifactorial. Specific patient and treatment characteristics were identified to be targeted with health care interventions to decrease unplanned readmissions.

Excitation characteristic of a bipolar stimulus for broadband stimulation in measurements of electrically evoked auditory potentials.

OBJECTIVE: The aim of this study was to determine the optimum electrical stimulation mode for the measurement of electrically evoked potentials. To quantify the broadband excitation electrically evoked compound action potentials were recorded in cochlear implant recipients. The full width half maximum was determined for spread of excitation along the electrode array. DESIGN: Prospective clinical study. STUDY SAMPLE: The study sample consisted of 20 adult cochlear implant users. RESULTS: The applied alternating, intracochlear stimulation mode leads to neural excitation along approximately 80% of the length of the electrode array. The median of the full width at half maximum values covered the range of 18 electrodes on the implant array. CONCLUSION: The bipolar, alternating, and intracochlear stimulation mode would provide a sufficient, broadband excitation of the spiral ganglion to measure electrically evoked auditory potentials.

Parameters for novel incus replacement prostheses.

Prostheses replacing the incus in its normal position and equipped with two joints might transfer sound as effectively as the intact ossicular chain and allow adjustment to quasi-static pressure changes. A prerequisite for prostheses development is the access to dimensions and distances of the ossicular chain which are necessary to conceptualize shape and size. Fifteen cadaveric human temporal bone specimens were investigated by means of micro-CT followed by 3D analysis. Each specimen was scanned three times: after removal of incus, after additional removal of the malleus head, and after approaching the umbo to the promontory. Artificial umbo medialization as a surrogate for quasi-static pressure changes leads to relevant variations in the distance between the upper part of the malleus and the stapes. Prostheses replacing the incus in its normal position should be equipped with a sliding ball joint or similar construction to allow adjustment to quasi-static pressure changes.

Design-Dependent Calculation of the Prosthesis Length in Malleostapedotomy.

OBJECTIVE: The results of a recently published micro-CT study suggested a correlation of the distance between long incus process and stapes footplate and the required prosthesis length in malleostapedotomy. The goal of this study was to test the reliability of that assumption. METHODS: Rectangular and bent prostheses were tested in 11 cadaveric human temporal bone specimens; 1 of them showed a stapedial artery. Prosthesis length was calculated based on the distance between long incus process and stapes footplate. The rate of acceptable prosthesis insertion into the vestibule was investigated. RESULTS: In both prostheses designs, the insertion depth into the vestibule did not exceed 1.0 mm. Two prostheses did not pass the footplate level in bent prostheses (18%) and 1 in rectangular prostheses (9%). CONCLUSION: A rough estimation of the required prosthesis length in malleostapedotomy seems possible if the distance between long incus process and stapes footplate is known and a design-dependent equation exists.

Geometric parameters of the ossicular chain as a function of its integrity: a micro-CT study in human temporal bones.

HYPOTHESIS: Determining the spatial distribution of the malleus handle in relationship to the stapes as a function of the condition of the ossicular chain. BACKGROUND: The position of replacement prosthesis and by association the direction of the force vectors exerted on the stapes head or footplate depends on the location of the malleus handle in relationship to the stapes and the contact point of the prosthesis at the malleus. Ideally, the force of prosthesis is conducted along an imaginary line through the center of the footplate and the stapes head. METHODS: Fifteen cadaveric human temporal bone specimens were investigated by means of micro-CT followed by 3D analysis. For different contact points, the angulation of a virtual rod prosthesis compared with the ideal reconstructive situation was determined. RESULTS: In case of missing incus, angulation of an imaginary line from stapes head to the most medially located point of the malleus handle (on average, 0.6 mm above the malleus tip) averages 85 ± 8 degrees (95% CI, 80-89 degrees) and to the upper end of the malleus handle 69 ± 7 degrees (95% CI, 65-73 degrees). Angulation from the center of the footplate to the malleus tip averages 37 ± 7 degrees (95% CI, 33-41 degrees) and to the upper end of the malleus 33 ± 5 degrees (95% CI, 30-36 degrees). The differences of the spatial distribution of the malleus handle in relationship to the stapes in different conditions of the ossicular chain are not relevant. CONCLUSION: In contrast to the ideal reconstructive situation, the present data show a malleus-stapes offset with particular unfavorable angles for a stapes head to malleus tip assembly.

Hemostatic management of patients undergoing ear-nose-throat surgery.

Perioperative hemostatic management is increasingly important in the field of otolaryngology. This review summarizes the key elements of perioperative risk stratification, thromboprophylaxis and therapies for bridging of antithrombotic treatment. It gives practical advice based on the current literature with focus on patients undergoing ENT surgery.

Is the prosthesis length in malleostapedotomy for otosclerosis revision surgery predictable?

HYPOTHESIS: The prosthesis length in malleostapedotomy for otosclerosis revision surgery can be calculated if the prosthesis length of previous conventional incus stapedotomy is known. BACKGROUND: Malleostapedotomy is used in revision surgery for otosclerosis in case of severe incus erosion and malleus or incus fixation. METHODS: Fifteen cadaveric human temporal bone specimens were investigated by means of micro-CT followed by 3D analysis. The distance between the incus and the stapes footplate as well as distances between the malleus and the footplate were measured and compared. RESULTS: The required length of virtually bent prostheses corresponded approximately to the 1.5-fold of virtual stapes prostheses in 93%. The addition of 2 mm predicted the required prostheses length almost correctly in 80%. CONCLUSION: The clinical practice will show whether a preoperative calculation of expected prosthesis length in MS based on the length of the formerly used stapes prosthesis is possible and helpful.