Evaluation of a non-auditory neurocognitive test battery in hearing-impaired according to age.

PURPOSE: Due to the demographic shift, the number of older people suffering from hearing loss and from cognitive impairment increases. Both are closely related and hard to differentiate as most standard cognitive test batteries are auditory-based and hearing-impaired individuals perform worse also in non-auditory test batteries. Therefore, reference data for hearing-impaired are mandatory. METHODS: The computer-based battery ALAcog assesses multiple cognitive domains, such as attention, (delayed) memory, working memory, inhibition, processing speed, mental flexibility and verbal fluency. A data set of 201 bilaterally hearing-impaired subjects aged ≥ 50 (mean 66.6 (SD 9.07)) was analysed. The LMS method, estimated curves for the 10th, 25th, 50th, 75th and 90th percentile were calculated, and classified according to age, starting from the age of 50. RESULTS: Cognitive function shows a decline in all subtests as people age, except for verbal fluency, which remains almost stable over age. The greatest declines were seen in recall and delayed recall and in mental flexibility. Age and hearing ability did not correlate (p = 0.68). However, as people age, inter-subject variability of cognitive test results increases. This was especially the case for inhibition. Cognitive function was not correlated with hearing ability (each p ≥ 0.13). CONCLUSION: The present results make an approach to establish reference data for a comprehensive non-auditory test battery in a large sample of elderly hearing-impaired people which can be used as a simple tool to better contextualise cognitive performance beyond mean and median scores.

[O-DEM: a new cognitive screening in patients with hearing loss]. / O-DEM: ein neues kognitives Screening bei Schwerhörigkeit.

BACKGROUND: Hearing loss is a significant risk factor for dementia. To date, cognitive impairment and dementia in patients with hearing impairment (HI) cannot be adequately diagnosed by commonly administered cognitive screening tests due to sensory impairments. Therefore, an adapted screening is needed. The aim of the present study was to develop and evaluate a cognitive screening for people with HI. MATERIALS AND METHODS: The new cognitive screening, called O­DEM, entails a word fluency test, the Trail Making Test A (TMT-A), and a subtraction task. First, the O­DEM was tested in a large clinical sample (N = 2837) of people without subjective HI. In a second step, the O­DEM was evaluated in 213 patients with objectively assessed HI and compared with the Hearing-Impaired Montreal Cognitive Assessment (HI-MoCA). RESULTS: The results indicate that the O­DEM subtests significantly discriminate between participants with no, mild, and moderate to severe cognitive impairment. Based on the mean and standard deviation of the participants without cognitive impairment, a transformation of the raw scores was performed and a total score with a maximum value of 10 was determined. In the second part of the study, the O­DEM was shown to be as sensitive as the HI-MoCA in differentiating between people with and without cognitive impairment. CONCLUSION: Compared to other screenings, the O­DEM is a quickly administrable screening for the detection of mild and moderate cognitive impairment in people with HI.

The shifting shelf task: a new, non-verbal measure for attentional set shifting.

Attentional set shifting is a core ingredient of cognition, allowing for fast adaptation to changes in the environment. How this skill compares between humans and other primates is not well known. We examined performance of 3- to 5-year-old children and chimpanzees on a new attentional set shifting task. We presented participants with two shelves holding the same set of four boxes. To choose the correct box on each shelf, one has to switch attention depending on which shelf one is currently presented with. Experiment 1 (forty-six 3- to 5-year olds, predominantly European White) established content validity, showing that the majority of errors were specific switching mistakes indicating failure to shift attention. Experiment 2 (one hundred and seventy-eight 3- to 6-year olds, predominantly European White) showed that older children made fewer mistakes, but if mistakes were made, a larger proportion were switching mistakes rather than 'random' errors. Experiment 3 (52 chimpanzees) established suitability of the task for non-human great apes and showed that chimpanzees' performance was comparable to the performance of 3- and 4-year olds, but worse than 5-year olds. These results suggest that chimpanzees and young children share attentional set shifting capacities, but that there are unique changes in the human lineage from 5 years of age.

[New ways in hearing rehabilitation after cochlear implantation]. / Neue Wege in der Hörrehabilitation nach Cochleaimplantation.

INTRODUCTION: After cochlear implantation, auditory and speech training is usually necessary. Up until now, this has been performed on an out- or inpatient basis in direct contact with a therapist. Due to technical advances but also particularly because of an increasing use of digital media and a desire for mobility and independence, the demand for digital training programs is increasing in the field of hearing rehabilitation. MATERIALS AND METHODS: In a first step, the most important elements of auditory training were determined on the basis of commonly used auditory and speech processing models, and the core features of a computer-based teletherapeutic hearing platform were defined. This process considered motivational elements and adaptive mechanisms as regularly used in educational and speech and language therapy. In a second step, an initial prototype of the "train2hear" teletherapeutic hearing platform was developed by an interdisciplinary research team. RESULTS: The core of the train2hear platform is an initial analysis according to the International Classification of Functioning, Disability, and Health (ICF), on the basis of which an individual training plan is designed. Various adaptive mechanisms enable the level of difficulty to be continually adapted to the individual user's learning progress. A videoconference tool enables contact between the patient and the therapist. CONCLUSION: The train2hear platform represents a first prototype of a computer-based auditory rehabilitation program in German. Further evaluation and development in a clinical study are needed to determine the feasibility and efficacy of the platform.

[Computer-based auditory training for hearing rehabilitation of adult cochlear implant users]. / Computerbasiertes Hörtraining in der Hörrehabilitation Erwachsener nach Cochleaimplantation.

BACKGROUND: Digitalization has become a part of everyday life and digital applications offer an opportunity to promote health. In Germany, hearing rehabilitation after cochlear implantation (CI) typically takes place in specialized audiology centers. However, a variety of new auditory training programs have been developed and although most are for hearing aid users, some are suitable for CI patients. The purpose of this study is to give an overview of CBAT schedules and their effectiveness. MATERIALS AND METHODS: Currently available English and German CBAT programs for adult CI users identified in searches of Google, Google App Store, and Google Play Store were analyzed. A systematic literature search on studies dealing with CBAT in adult CI recipients from 2000 to 2019 was performed in PubMed, LIVIVO, and Google Scholar. RESULTS: German and English CBAT for adult hearing aid and CI users are generally intended to complement face-to-face therapies. The content of the programs differs primarily in terms of complexity and quantity of tasks, graphic design, allowed time and the device used. In contrast to the nine available German programs, some of the English CBAT include advanced concepts of adaptivity and feedback. Studies on the effectiveness of CBAT have mainly been conducted for the English versions and generally analyze only individual therapeutic subfunctions. All investigations show a short-term improvement of the auditory subfunction shortly after training. Unfortunately, the quality of the studies is low and follow-up results are only available in two cases. CONCLUSION: CBAT programs might be an effective option for auditory rehabilitation in CI patients. However, suitable German-language programs conceived as an alternative to face-to-face training and studies on longterm effects of CBAT are still lacking.

[Dementia: relevant aspects for otorhinolaryngologists]. / Demenzerkrankungen: Relevantes für den HNO-Arzt.

The aging of society observed during the past century in industrialized countries has not only led to a longer life expectancy, but also an increased frequency of age-related diseases and multimorbidity. In addition to dysphagia and vertigo, sensory deficits such as olfaction and hearing disorders are common in elderly persons and have a significant influence on quality of life. Alzheimer's disease is the most common form of dementia. Epidemiological studies have recently shown that disorders of olfaction and hearing are not only associated with dementia, but also represent specific risk factors for development and progression of the disease. Recognition and adequate treatment, e.g., of hearing loss, by otorhinolaryngologists is thus assuming an increasingly important role, not only to preserve patients' quality of life, but also to reduce the risk of developing dementia in the future.

[Hearing and cognition: neurocognitive test batteries in otorhinolaryngology]. / Hören und Kognition: neurokognitive Testbatterien in der HNO-Heilkunde.

BACKGROUND: Hearing and cognition are closely related to each other. Particularly in suboptimal listening situations, cognitive abilities become important to enable speech comprehension. Besides, studies have indicated that hearing impairment is associated with a more rapid mental decline compared to persons with normal hearing. However, hearing loss also has an impact on neurocognitive testing, which is generally based on auditive stimuli. With increasing age, the risk of sensory but also of cognitive impairments increases. So far this comorbidity receives little consideration in otorhinolaryngology. MATERIALS AND METHODS: The paper presents an overview and evaluation of widely used German neurocognitive test batteries for older patients, with regard to the different test modalities and their focus. RESULTS: A multitude of different neurocognitive screening tests and detailed test batteries are available, particularly in the field of dementia. So far, sensory deficits have not been considered in neurocognitive testing, neither concerning application nor interpretation. Normative data adapted to the hearing impaired are still missing. CONCLUSION: With regard to demographic changes and the well-known bias between hearing and cognition, screening of neurocognitive functions should be implemented in basic otorhinolaryngologic diagnostics. More comprehensive test batteries might be useful for research purposes or speech therapy.

Social manipulation in nonhuman primates: Cognitive and motivational determinants.

Social interactions are the result of individuals' cooperative and competitive tendencies expressed over an extended period of time. Although social manipulation, i.e., using another individual to achieve one's own goals, is a crucial aspect of social interactions, there has been no comprehensive attempt to differentiate its various types and to map its cognitive and motivational determinants. For this purpose, we survey in this article the experimental literature on social interactions in nonhuman primates. We take social manipulation, illustrated by a case study with orangutans (Pongo abelii), as our starting point and move in two directions. First, we will focus on a flexibility/sociality axis that includes technical problem solving, social tool-use and communication. Second, we will focus on a motivational/prosociality axis that includes exploitation, cooperation, and helping. Combined, the two axes offer a way to capture a broad range of social interactions performed by human and nonhuman primates.

[Speech perception in noise with the "wuerzburg speech test for children"]. / Sprachverstehen im Störlärm mit dem Würzburger Kindersprachtest.

BACKGROUND: Patients with hearing loss complain of a reduced speech perception in noise. For school children and adults there are several standardized audiometric tests available to measure the outcome in background noise like the HSM-Test, OlSa or OlKiSa. However, for kindergarden and preschool children a comparable speech perception test in noise does not exist. The aim of this study was to evaluate and standardize the recently developed "wuerzburg speech test for children" in noise. MATERIALS AND METHODS: 24 children aged 5-9 years with bilateral normal hearing were included. They have been tested with the test IV of the "wuerzburg speech test for children" in noise. This test consists of 3 lists, each with 20 two-syllable words. For the background noise, a 32 time delayed interference of the speech items were used. RESULTS: The speech perception threshold (SRT) at 60 dB (SPL) depending on the signal to noise ratio (SNR) was measured for each child. The overall averaged SNR was -8.3 dB. Furthermore a small, non-significant influence by the age of the children to the test results was seen. CONCLUSION: The "wuerzburg speech test for children" is suitable to measure the individual speech perception in noise. It is appropriate for kindergarden, preschool and school children. The test material consists of the uptodate vocabulary of children. The average SRT was -8.3 dB SNR, which is comparable with the published literature.

Parameters assessing neurological status in malignant glioma patients: prognostic value for survival and relapse-free time.

Malignant gliomas are the commonest primary brain tumours in adults and harbour a dismal prognosis. So far, established parameters with predictive significance for prognosis do not include the neurological functional assessment of patients. The aim of this study was to investigate the prognostic value of parameters assessing neurological status in malignant glioma patients for outcome and survival. Evaluation of neurological status included the Sawaya Functional Grade (SFG) and the Neurological Performance Scale (NPS). Moreover, the Karnofsky Performance Status (KPS), medical risk factors, extension of resection, postoperative complications, and the predictive value of these variables for outcome and survival were studied. For this purpose, we have analysed 110 consecutive patients with malignant gliomas who were treated at our institution. As expected, age (p <0.001), KPS (p = 0.003) and extent of resection (p <0.001) were good predictors of survival. Strikingly, SFG and NPS showed the highest significant correlation with survival (both p <0.0001) and, furthermore, they were the only predictors of the relapse-free time (p = 0.035 and p = 0.004, respectively). Our data strongly suggests that SFG and NPS accurately predict both survival and relapse-free time, which may add a valuable tool for tailoring individual therapy strategies.

[Predictors of nodal metastasising in laryngeal squamous cell carcinomas as decision support for neck dissection: comprehensive analysis of literature]. / Prädiktoren der nodalen Metastasierung des Larynxkarzinoms als Entscheidungshilfe bei der Neck Dissection: Literaturanalyse zur Frage zuverlässiger Parameter.

BACKGROUND: A subset of advanced laryngeal squamous cell carcinomas (SCC) does not metastasize in regional lymph nodes (pN0). However, more than 30 % of tumors without signs of metastasizing in the clinical examination (cN0) show occult metastases. The guidelines of the German ENT-Society intend the extent of neck dissection (ND) depending on clinical stage of tumor and lymph nodes. If laryngeal surgery is followed by an adjuvant radiation/chemotherapy, ND is not always necessary. Histomorphological, immunohistochemical, or molecular parameters with predictive value for nodal metastasizing could support the planning for ND, especially in patients with cN0. METHODS: Within the last 20 years there were many publications concerning this problem. Herein, we analyzed the results of 455 publications. We have chosen studies regarding the predictive value of tumor stage, grading, peritumorous inflammation, invasion of lymphatic vessels, angioneogenesis, proliferation, overexpression of p53 or cyclin D1, inhibitors of cyclin-dependent kinases, growth factors, apoptosis, cell-adhesion, nm23, metalloproteinases, DNA/ploidy as well as tumor genetics. RESULTS: All examined parameters did not allow a fail-safe prediction of the risk for nodal metastasizing. CONCLUSIONS: Up to now, reliable predictors do not exist. The investigation of above mentioned parameters in pre-operative tumor biopsies is not helpful for the planning of ND in the stage cN0 (out of T1).

[Clinical and audiological findings in children with auditory neuropathy]. / Klinische und audiologische Befunde von Kindern mit auditorischer Neuropathie und ihre Versorgung mit einem Cochlea-Implantat.

BACKGROUND: Auditory neuropathy is a disorder characterised by preservation of outer hair cells function with normal otoacoustic emissions (OAEs), but with absent auditory brainstem responses (ABR). Perisynaptic synchronisation disorder is one of the possible pathogenesis underlying auditory neuropathy. In this paper we describe the clinical presentation and audiological findings in pediatric auditory neuropathy and its management. PATIENTS AND METHODS: 9 children with auditory neuropathy could be included in the study. An audiological evaluation was performed in all children including behavioural audiometry, measurement of the OAEs as well as electrocochleography (ECoG) and ABR recordings. Children who failed to get any benefit from conventional amplification received a cochlear implant. Prior to implantation the responses to electrical stimuli were examined with the promontory test and with the electrically evoked ABR. RESULTS: One child showed auditory neuropathy only on one side with normal hearing thresholds on the contralateral ear. Another child had normal hearing thresholds after the follow up period. Four children received a hearing aid. But variable hearing reactions were observed. Thus in three cases a CI is planned. In three children cochlea implantation was done. Following implantation a remarkable improvement in hearing/speech capabilities with the CI compared to conventional hearing aids were observed in all three cases. Beside, these three children developed open set speech discrimination and are using now oral language for communication. CONCLUSIONS: Auditory neuropathy is a disorder which presents with different clinical and audiological findings. Thus the management of this disorder must be an individual one. In light of our findings we support the use of cochlear implants as an option for children with auditory neuropathy in cases where conventional amplification does not work sufficiently.

[Development of a new test for speech audiometry in children and results in CI children]. / Entwicklung eines neuen Kindersprachtests und Erprobung an CI-Kindern.

BACKGROUND: Speech audiometry plays an important role for hearing evaluation in children. Hearing impaired children, such as those with cochlear implant (CI) who frequently undergo testing, learn the test words by heart. Furthermore, the standard tests use words of former time. PATIENTS AND METHODS: Using the most frequently words of modern children's literature a speech assessment test was developed for children between 1 to 8 years. The material was first evaluated on normal hearing children. In a second step the phoneme and word perception scores of 35 CI children were measured using 60 - 100 dB SPL according to the most comfortable level (MCL) in free sound field. RESULTS: The performance-intensity function for the single words were highly comparable with those of the Freiburger or Göttinger speech perception test. The average speech reception threshold in CI children was 44 % (test I), 36 % (test II), 63 % (test III) and 69 % (test IV), respectively. Compared to the Mainzer and Göttinger speech perception test the new words were more difficult to understand than those of the known tests. However, a statistically significant difference could be noted only for test II. CONCLUSIONS: The new developed "Würzburger speech perception test" appears to be a useful additional tool for the evaluation of hearing impaired children in addition to the standard test procedures.

[Malignant paranasal sinus tumors. Diagnosis, therapy and results]. / Maligne Nasennebenhöhlentumoren. Diagnostik, Therapie und Ergebnisse.

BACKGROUND: Malignant neoplasmas of the paranasal sinuses are rare and present usually in advanced tumor stage due to the lack of early clinical symptoms. PATIENTS AND METHODS: In the last 10 years, 63 patients with paranasal malignancies were treated at the Department of Otolaryngology, Head and Neck Surgery of the University of Würzburg. 33% of the patients showed an occupational exposition (wood-processing or metal industry). At the time of the first visit to our institution 95% of the patients presented with an extensive disease, staged T3 and T4. Adenocarcinoma (24%), squamous cell carcinoma (22%) and malignant melanoma (19%) were the most common histologies. Surgery combined with radiotherapy was the treatment strategy in 55 patients (87%). RESULTS: Patients with a complete surgical resection showed a higher 5-year-survival rate (77%) than patients with an incomplete resection (56%). In 38% (n=21) of the patients treated with surgery and radiotherapy, a local recurrence of the tumor was observed. This recurrence localised in the skull base and/or the orbita/periorbita occurred most frequently in the first (46%) or the second year (31%). CONCLUSION: The prognosis of malignant paranasal tumors depends mainly on the control of the local tumor growth. Modern strategies of surgical treatment in combination with radiotherapy need to be implemented in an effort to achieve a continuous remission.

Frequent detection of Mycoplasma pneumoniae in Bell's palsy.

The cause of Bell's palsy (BP) remains unknown despite various hints to an infectious etiology. Mycoplasma pneumoniae is a common pathogen of the respiratory tract causing pharyngitis, tracheobronchitis or pneumonia. Neurological complications are the most frequent extrapulmonary manifestation. So far, only a few case reports suggested an association between cranial nerve palsy and M. pneumoniae infection. Patients with a BP who were admitted to the Department of Otorhinolaryngology or Neurology of the University of Wuerzburg between 2000 and 2002 were tested serologically for the presence of antibodies against Borrelia burgdorferi, herpes viruses (HSV-1/2, VZV) and M. pneumoniae. The diagnosis of mycoplasmal infection was made when at least one of the following criteria was met: a threefold rise or more in the titer of antibody of M. pneumoniae in paired sample or a microparticle agglutination assay (MAG) of > or =1:40 and the detection of IgA and/or IgM antibodies in the acute phase serum. Ninety-one consecutive patients could be included. Fifteen patients showed a reactivation of a VZV ( n=12) or of a HSV-1 ( n=3) infection. In six cases the immunoblot revealed specific antibody bands for B. burgdorferi. In 24 patients (26.4%) a seroconversion of M. pneumoniae could be detected. Only two patients complained of mild respiratory symptoms. According to our results, M. pneumoniae is frequently associated with Bell's palsy. Thus, a routine screening for this pathogen, even in the absence of respiratory symptoms, is necessary.

[Diagnosis, treatment and results of malignant skull base tumours]. / Diagnostik, Therapie und Ergebnisse in der Behandlung maligner Schädelbasistumoren1.

BACKGROUND: Malignant tumours of the cranial base are rare and present usually in advanced tumour stage due to the lack of early clinical symptoms. PATIENTS AND METHODS: Sixty patients with malignant tumours infiltrating the skull base were treated at the Department of Otorhinolaryngology Head and Neck Surgery, University of Würzburg between 1987 and 1999. Most of the tumours (n = 51) originated from the nose or paranasal sinuses, the epipharynx, the outer ear canal or the middle ear. Seven tumours were malignant brain tumours infiltrating the bony structures of the skull base or originated from the cranial base itself. Two patients suffered from metastases of an adenocarcinoma of the prostata. The histological diagnosis was confirmed in 53 patients preoperatively and in seven patients during tumour resection. Squamous cell carcinoma (n = 24), adenocarcinoma (n = 10) and sarcoma (n = 7) were the most common histologies found. RESULTS: A radical en bloc resection of the tumour was only possible in 26 out of 60 cases. A surgical tumour reduction with postoperative radiation therapy was performed in seven patients as a palliative approach. Eight patients underwent a combined radio- and chemotherapy according to the histological diagnosis. Primary radiotherapy was the treatment of choice in eleven patients, where the tumours were located in the central area of the cranial base. Palliative radiotherapy or solely medical pain control were applied to eight patients who presented either with distant metastases or an advanced tumour growth. The mean postoperative survival following radical surgery was 48 months and after primary radiotherapy 27 months. DISCUSSION: A statistical analysis of the results is not applicable due to the great variety of the disease concerning the histological diagnosis, the tumour size and the location as well as the small number of patients.

[Detection of loudness recruitment in patients with retrocochlear lesions using the "Würzburger Hörfeld" loudness scaling]. / Rekruitmentnachweis bei retrokochleären Raumforderungen mit der Lautheitsskalierung im "Würzburger Hörfeld".

BACKGROUND: The pathogenesis of hearing loss caused by cerebellopontine angle tumors such as acoustic neuromas is unknown. The lack of loudness recruitment is thought to be one of the features of retrocochlear hearing impairment. In contrast to conventional suprathreshold tests, the categorial loudness scaling using the "Würzburger Hörfeld" is a valuable tool to describe the individual perception of sound. The aim of the present study was to analyze the loudness growth rate in patients with acoustic neuroma. PATIENTS AND METHOD: Pure tone and speech audiometry as well as auditory brainstem response and bilateral categorial loudness scaling were performed preoperatively in 54 patients with acoustic neuroma. Loudness scaling was done in free field switching off the contralateral ear by using an ear-plug. RESULTS: An abnormal rapid loudness growth function was found in 38 of the 54 patients (70.4%) at least at one frequency on the tumor side. The contralateral side was effected only in 57.4% of the patients. The incidence of a recruitment depended on the frequency with a maximum at 4 kHz. The slope of the loudness function showed a tendency to increase with increasing hearing loss. CONCLUSIONS: Loudness recruitment is not a rare phenomenon in patients with acoustic neuroma. The underlying cause (a preexisting hair cell damage, hair cell changes resulting from an obstruction of the cochlear blood supply or a disruption of the cochlear efferents) still remains unclear.

[Effect of fibroblast growth factor-1 (FGF-1) on spiral ganglion cells of the mammalian cochlea]. / Die Wirkung von Fibroblastenwachstumsfaktor-1 (FGF-1) auf Spiralganglienzellen der Säugetiercochlea.

Transient expression by hair cells, increasing levels of FGF-1 mRNA in neonatal rat spiral ganglion neurons and strong expression in adulthood, make FGF-1 a candidate to be associated with development and maintenance of the mammalian spiral ganglion. To test this hypothesis, dissociated spiral ganglion cells from 5 day old rats were cultured in the presence of FGF-1 at 100 ng/ml plus heparan sulfate proteoglycans (HSPG) at 500 ng/ml for 72 hours. Spiral ganglion cells incubated with FGF-1/HSPG achieved an average neurite length of 323 microns while control cells gained an average neurite length of 203 microns. The results of this study are consistent with our previous findings in whole spiral ganglion explants (3) where FGF-1 incubation significantly stimulated neurite outgrowth at about the same range. However, stimulation of neurite outgrowth in dissociated spiral ganglion cells suggests that FGF-1 directly binds to FGF receptors on the surface of spiral ganglion neurons and/or neurites instead of acting via intermediate cells such as glia. Since FGF receptor mRNA was found to be expressed only at very low levels in neonatal spiral ganglion neurons (7) it is possible that the receptors are highly localized, perhaps to neurite growth cones. Alternatively, an unknown FGF receptor or splice variant may be expressed in these cells. Adequate FGF-1 application to the human inner ear may stimulate spiral ganglion cell survival and neurite extension after hair cell loss in patients suitable for cochlear implant treatment. By creating a closer contact between spiral ganglion cells and the electrode, FGF-1 might also improve the efficacy of cochlear implants.

[Inner ear depression after middle ear interventions]. / Innenohrdepression nach Mittelohreingriffen.

BACKGROUND: Any type of otosurgical procedure involves the risk of inner ear damage. As middle ear surgery is also performed for functional reasons this risk should be taken into consideration. The aim of this study was to analyse the frequency and the nature of sensorineural hearing loss following chronic ear surgery. PATIENTS: A total of 3989 middle ear cases operated on between 1991 and February 1999 at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Würzburg, Germany were studied retrospectively: 781 type I tympanoplasties, 2408 type III tympanoplasties and 800 cases of stapes surgery. The pre- and the postoperative audiograms in the frequency range between 500 and 8000 Hz were analysed and correlated to the different intraoperative findings. RESULTS: Sensorineural hearing loss occurred in a total of 1.3% of 2224 patients with normal preoperative bone conduction thresholds: 0.2% became deaf, 0.8% acquired a high tone loss at 4 kHz and in 0.3% patients also 2 kHz was affected. None of the documented intraoperative complications such as bleeding, unexpected opening of a semicircular canal, extensive manipulation at the ossicular chain or a gusher phenoma showed a relevant effect on postoperative bone conduction thresholds. The incidence of high tone loss was not increased in cases of extensive drilling of the temporal bone. An unexpected opening of the vestibulum led to a small, but statistically significant change in postoperative bone conduction thresholds. CONCLUSIONS: Our results demonstrated that the risk for sensorineural hearing loss caused by middle ear surgery is low. None of the analysed factors seems to be a relevant prognostic risk factor for postoperative inner ear depression.