[Incision-suture times in endoscopic ear surgery]. / Schnitt-Naht-Zeiten bei der endoskopischen Ohrchirurgie.

BACKGROUND: Endoscopic ear surgery (EES) is increasingly used internationally instead of microscopic ear surgery (MES), but has not yet become established as a routine procedure everywhere in Germany. OBJECTIVE: The incision-suture time and practicability of EES in the setting of a German clinic were investigated. MATERIALS AND METHODS: In a retrospective study, 60 consecutive MES patients from 2015 were compared with 60 consecutive EES patients from 2018. Hearing results, tympanic membrane findings after 3 weeks, and incision-suture times were compared. RESULTS: In EES, access was mostly transmeatal and bone of the anterior auditory canal wall had to be removed less often than in MES. There was no statistically significant difference in surgery times between the two groups. Perforation closure was achieved in 57/60 and 59/60 ears in the MES and EES groups, respectively. Hearing was improved in both groups. There was no statistical difference in hearing improvement between the two groups. CONCLUSION: EES is a time efficient and minimally invasive method which represents a viable alternative to MES with comparable results.

Induction chemotherapy (IC) followed by radiotherapy (RT) versus cetuximab plus IC and RT in advanced laryngeal/hypopharyngeal cancer resectable only by total laryngectomy-final results of the larynx organ preservation trial DeLOS-II.

Background: The German multicenter randomized phase II larynx organ preservation (LOP) trial DeLOS-II was carried out to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC). Patients and methods: Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF [docetaxel (T) and cisplatin (P) 75 mg/m2/day 1, 5-FU (F) 750 mg/m2/day days 1-5] followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24 months LFS above 35% in arm B. Results: Of 180 patients randomized (July 2007 to September 2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24 months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). One hundred and twenty-three early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A versus 80%/86.0% in B. The 24 months overall survival (OS) rates were 68.2% and 69.3%. Conclusions: Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24 months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS. Clinical trial information: NCT00508664.

Endoscopic ear surgery - a complement to microscopic ear surgery.

Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high-definition, 4K, and 3­dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragm can be visualized far better using an endoscope than with a microscope. Going through the external meatus, surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handedly, which is awkward. In cases of extensive bone removal or excessive bleeding, the view through the endoscope lens is obscured; therefore; the endoscope cannot fully substitute the microscope. It is, however, an interesting adjunct to microscopic ear surgery.

[Endoscopic ear surgery - complement to microscopic ear surgery]. / Endoskopische Ohrchirurgie ­ eine Weiterentwicklung der modernen Ohrchirurgie.

Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high definition, 4­k, and 3­dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragma can be visualized far better by using an endoscope rather than a microscope. Going through the external meatus surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handed, which is awkward. In case of extensive bone removal or excessive bleeding the view through the endoscope lense is obscured, the endoscope therefore cannot fully substitute the use of the microscope. It is however an interesting adjunct to microscopic ear surgery.

Influence of lysophosphatidylcholine on the C-apolipoprotein content of rat and human triglyceride-rich lipoproteins during triglyceride hydrolysis.

Remnants produced from rat chylomicrons in hepatectomized rats or from human chylomicrons by incubation in postheparin plasma contained much less C-apolipoproteins, but more lysophosphatidylcholine than the parent chylomicrons. A phospholipid-triglyceride emulsion absorbed C-apolipoproteins during incubation in serum, yet not in postheparin plasma, which led to lipid-hydrolysis and increased in lysophosphatidylcholine. The fraction d = 1.006-1.019 g/ml of human serum comprised more lysophosphatidylcholine and less C-apolipoproteins than the fraction d less than 1.006 g/ml. Injection of heparin induced hydrolysis with an increase in lysophosphatidylcholine and loss of C-apolipoproteins in both fractions. These inverse changes of lysophosphatidylcholine and C-apolipoproteins during lipid-hydrolysis suggest a causal relationship, which is strongly supported by the induction of loss of C-apolipoproteins from rat chylomicrons and human triglyceride-rich lipoproteins by addition of lysophosphatidylcholine in vitro. Apolipoprotein C-II was more affected than C-III. These results may elucidate a mechanism for the regulation of the termination of the triglyceride hydrolysis and the final hepatic uptake of remnants.

Abolition of the receptor potential response of isolated mammalian outer hair cells by hair-bundle treatment with elastase: a test of the tip-link hypothesis.

To test the hypothesis that the tip-links of hair-cell stereocilia are essential for mechanoelectrical transduction, tip-links of isolated outer hair cells (OHCs) of the guinea-pig cochlea were eliminated with a proteolytic enzyme, elastase, and the influence on the receptor potential measured with the whole-cell patch-clamp technique. Within 45 s of immersion of the hair bundle in 20 IU/ml elastase, the receptor potential in response to direct deflection of the hair bundle was irreversibly abolished. The electrical input impedance of the cell remained unchanged, implying that the channels of the basolateral membrane were not affected by elastase. The effect of elastase on the receptor potential was comparable to changes seen after mechanically induced hair-bundle damage. As a further control, a putative transduction-channel blocker, dihydrostreptomycin (68 microM), which does not affect tip-links, was applied to the hair bundle. Although the receptor potential was also blocked by dihydrostreptomycin, the effect was reversible. The results suggest that tip-links are required for mechanoelectrical transduction of mammalian OHCs.

Distortion product otoacoustic emissions in human hypercholesterolemia.

Epidemiological and experimental studies suggest that hypercholesterolemia promotes the development of sensorineural hearing loss; however, the underlying cellular pathomechanism remains obscure. In the present study, 20 healthy subjects and 20 patients with familial hypercholesterolemia were compared with respect to their hearing function. None of the 40 persons reported any history of hearing disorder. In accordance with this subjective impression, mean hearing thresholds were within the normal, age-dependent ranges in both groups. In contrast, the single-generator distortion product otoacoustic emissions (sgDPOAE) were reduced at and above 4 kHz. Input-output functions of DPOAE could be subdivided into three groups: (i) normal, with unity slope at low intensities and slope less than unity (0.24+/-0.07 dB/dB at higher intensities; (ii) pathologic, described by a single straight line; (iii) ill-defined, with data usually indistinguishable from the background noise level. The ill-defined DPOAE behavior was only found in patients with hypercholesterolemia; namely, for 25% of patients at f(2)=1.5 kHz and for 50% at f(2)=4 kHz. Patients belonging to the pathologic and ill-defined DPOAE groups had significantly (P<0.05) higher total serum cholesterol and LDL-cholesterol levels compared with subjects from the normal DPOAE group. While hearing thresholds of patients with ill-defined growth functions were not statistically different from those of normal subjects, speech scores were significantly reduced in these cases. The data imply that nonlinear mechanical processes in the cochlea are compromised in hypercholesterolemic patients.

Frequency response of mature guinea-pig outer hair cells to stereociliary displacement.

Outer hair cells (OHC) were isolated from the apical two turns of the guinea-pig cochlea and their hair-bundle stimulated mechanically by a glass probe. In accordance with in vivo data (Dallos, 1985), the resting membrane potential was typically -64 mV (N = 200). The maximum amplitudes of the receptor potentials were between 0.4 and 5.2 mV peak-to-peak, with mean of 1.5 mV +/- 0.9 mV (N = 81). The sensitivity was 0.015 mV/nm or 2 mV/deg. The frequency response of the receptor potential followed a first order low-pass filter characteristic with a corner frequency of about 63 Hz. For frequencies up to at least 1.6 kHz, the frequency response of mechanoelectrical transduction was dominated by the electrical input impedance of the cell. The presence of a single time constant in the voltage response to stereociliary deflection implies that the frequency response of mechanoelectrical transduction far exceeds that of the electrical input impedance of the cell; its time constant must be faster than 100 microseconds. Under in vivo conditions, OHC should be capable of providing a sufficiently large receptor potential to supply enough energy for electromechanical feedback.

Acoustomechanical properties of open TTP titanium middle ear prostheses.

OBJECTIVE: The purpose of the study was to identify acoustcomechanical properties of various biostable and biocompatible materials to create a middle ear prosthesis with the following properties: (i) improved handling including a good view of the head of the stapes or footplate and adjustable length, (ii) improved acoustical characteristics that are adequate for ossiculoplastic. The identified material should serve to build CE and FDA approved prostheses for clinical use in patients. METHODS: Test models made of Teflon, polyetheretherketone, polyethylenterephtalate, polysulfone, gold, Al2O3 ceramics, carbon and titanium were investigated for their potential to fulfill the requirements. Acoustical properties were investigated by laser Doppler velocimetry (LDV) in mechanical middle ear models (MMM). Measured data were fed in to a recently created computer model of the middle ear (multibody systems approach, MBS). Using computer-aided design (CAD) measured and computed data allowed creation and fine precision of titanium prostheses (Tübingen Titanium Protheses, TTP). Their handling was tested in temporal bones. Acoustomechanical properties were investigated using the MBS and mechanical middle ear models. MAIN OUTCOME MEASURES: Input impedance, mass, stiffness, and geometry of test models and prostheses were determined. Furthermore, their influence on the intraprosthetic transfer functions and on coupling to either tympanic membrane or stapes was investigated. RESULTS: Final results were FDA- and CE-approved filigreed titanium prostheses with an open head that fulfilled the four requirements detailed above. The prostheses (TTP) were developed in defined lengths of between 1.75 and 3.5 mm (partial) and 3.0 and 6.5 mm (total) as well as in adjustable lengths (TTP-Vario). CONCLUSIONS: The results suggest acoustomechanical advantages of TTPs because they combine a significantly low mass with high stiffness. In contrast to closed prostheses, the open head and filigreed design allow an excellent view of the prosthesis foot during coupling to the head or footplate of stapes, contributing to an improved intraoperative reliability of prosthesis coupling.

Glial lesion of the infratemporal fossa presenting as a soft tissue middle ear mass - rudimentary encephalocele or neural crest remnant?

We report about ectopic glial tissue of the skull base and the parapharyngeal space presenting as a soft tissue mass in the middle ear. An 11-year-old boy presented with bilateral conductive hearing loss since early childhood. The history included previously removed lesions consistent with ectopic neuroglial tissue of the tongue and the parapharyngeal space soon after birth, as well as surgery for cleft palate. High resolution computed tomography of the petrous bone and magnetic resonance imaging were useful in identifying the skull base defect and in characterizing the lesion's relation to the brain. There was no clinical, radiological or surgical evidence of any associated dural defect. The lesion was removed via a modified infratemporal approach. Histology revealed neuroglial tissue with calcifications without any signs of mesodermal or entodermal origin. On the basis of this case the pathogenesis and diagnosis of ectopic brain tissue and its relation to the more commonly encountered meningoencephalic herniations are reviewed. Furthermore therapeutical implications are discussed.

Benign supraclavicular tumorous lymphangiectasia--a new disease?

We describe an isolated recurrent non-inflammatory tumorous swelling of the supraclavicular fossa in four premenopausal women. Ultrasonography, magnetic resonance imaging and computer tomography of the neck each suggested an inhomogeneous mass consistent with "lymphangioma." In each patient the clinical course and histopathologic findings suggested that the swellings were due to chronic localized lymph stasis with subsequent lymphangiectasia, possibly initiated by intermittent obstruction of the juncture of the thoracic or right lymph duct with the internal jugular vein. Enlargement may have been hormonally triggered by estrogens as each woman was taking oral contraceptive pills at the onset of the disease. To characterize this unique entity, we have termed the disorder benign supraclavicular tumorous lymphangiectasia.

[Ophthalmologic findings in patients with sudden deafness]. / Ophthalmologische Befunde bei Patienten mit Hörsturz.

UNLABELLED: The etiology of sudden hearing loss is still not known. Among other pathomechanisms, vascular disorders have been proposed as an underlying cause. We investigated patients with sudden hearing loss for signs of microcirculation disorders. PATIENTS: Thirty-one patients (15 males and 16 females, mean age 37.5 years) were admitted because of sudden hearing loss. In addition, all patients underwent thorough ophthalmologic examination. RESULTS: Refraction, vision, intraocular pressure and excavation of the optic nerve were normal. In 81% of all cases abnormal conjunctival vascular ectasia were detected. The fundus of 53% of the patients was characterized by slight tortuosity of arterial retinal vessels. The first 11 patients received an ocular electrophysiological examination and showed normal ERG, P-VEP and dark adaptation. Standard perimetry (TAP 2000 ct) revealed no abnormalities in 29 patients, 2 glaucoma patients had small arcuate scotomas. However, 90% of all 29 scotoma-free patients were abnormal in the white-noise campimetry (TEC, Oculus). Testing for color vision (Roth 28 HUE, desat.) revealed abnormally high values (right 120, left 131). CONCLUSION: Although patients with sudden hearing loss appeared healthy in the standard eye examination, the more sensitive tests of white-noise campimetry and color vision, together with the conjunctival vascular ectasia and the tortuosity of arterial retinal vessels, indicated a disturbed microcirculation.

[Fulminant process of an orbital Mucoracea infection]. / Fulminanter Verlauf einer orbitalen Mucoracea-Infektion.

Rhinoorbitocerebral mucormycosis is a rare invasive fungal infection that is fatal when untreated. We describe an immunosuppressed patient with chronic lymphatic leukaemia who developed a severe rhinoorbitocerebral mucormycosis after allogeneic bone marrow transplantation. Due to the potentially fulminant course and fatal outcome, radical excision of the necrotic area in combination with antifungal therapy is necessary in the presence of suspicious clinical signs of mucormycosis despite a lack of histopathologic confirmation.

[Acetylsalicylic acid does not alter the mechanoelectrical transduction of mammalian outer hair cells in vitro]. / Die mechanoelektrische Transduktion der äusseren Haarzelle wird durch Azetylsalizylsäure in vitro nicht beeinflusst.

BACKGROUND: High doses of acetylsalicylic acid (ASS) induce tinnitus and hearing loss. This ototoxic side effect of ASS is characterized by a decrease in spontaneous and evoked otoacoustic emissions. A decrease in otoacoustic emissions is found not only in mammals, but also in non-mammalian ears without electromotile outer hair cells. The molecular mechanism underlying ASS ototoxicity seems to be competitive binding to and a block of the motor molecule prestin. In non-mammalian species, ASS ototoxicity is possibly explained by an effect on the hair bundle. RESULTS: The present data from the outer hair cells of the adult guinea pig cochlea show a reduction in the membrane capacitance by maximally 42%, probably as a result of ASS binding competitively to the motor molecule. However, spontaneous and evoked receptor currents were not modulated by ASS. CONCLUSION: The results suggest an influence of ASS on outer hair cell somatic electromotility, without a concomitant effect on hair-bundle function.

[Routine otorhinolaryngological examination in patients with cystic fibrosis]. / Standardisierte HNO-Untersuchung bei Patienten mit Mukoviszidose.

OBJECTIVES: Data on the prevalence of otorhinolaryngological (ORL) symptoms in patients with cystic fibrosis (CF) are limited. A standard annual examination would be useful for definition of risk factors and/or management alternatives for these symptoms. STUDY DESIGN: Prospective observational study of an unselected group of CF patients. PATIENTS AND METHODS: Between 1997 and 2004, 123 CF patients were routinely examined. The examinations included nasal endoscopy and audiological evaluation. RESULTS: All patients who were approached to take part in the study gave their consent and were extremely cooperative. In 40% of the patients nasal polyps were found endoscopically. In 22% rhinological surgery had already been performed. Of the 123 patients, 13 (12%) showed different grades of sensorineural hearing loss, and all of these patients had received aminoglycoside antibiotics. CONCLUSIONS: CF patients demonstrate a high prevalence of ORL symptoms. Therefore, an annual standard examination would provide data for identifying potential risk factors and for optimizing the management of these symptoms in CF patients.

[Electronic surveillance of nosocomial infections in head and neck surgery and stapes surgery]. / Elektronische Erfassung nosokomialer Infektionen bei Halsweichteileingriffen und Stapesplastiken (CISS).

BACKGROUND: Nosocomial infection is generally regarded as the most important postoperative complication. Therefore, on 28 December 2002 a German law was implemented requiring the surveillance of postoperative infections in all hospitals. METHODS: The authors propose using stapes and thyroid surgery to monitor the infection rate in a typical Head and Neck Department. A versatile software (CISS) based on MS Word and MS Excel was developed for this purpose. RESULTS: Postoperative infections were retrospectively analyzed for three subsequent years. The present data confirm the results of previous studies that surveillance itself is a powerful tool in reducing the postoperative infection rate. CONCLUSION: The newly developed software provided an easy tool for the collection of infection data. The reported infection rates in stapes and thyroid surgery are representative of ENT clinics in Germany.

[Effect of weather on the incidence of sudden deafness]. / Der Einfluss des Wetters auf die Hörsturzinzidenz.

BACKGROUND: The etiology of sudden idiopathic hearing loss is not known. Among other causes, vascular disease is discussed as a possible pathomechanism in sudden hearing loss. Since other vascular diseases such as myocardial infarction, migraine, and open-angle glaucoma show a clear meteorotropy, it was the aim of the present prospective study to investigate the dependence of sudden hearing loss on weather parameters. PATIENTS AND METHODS: The incidence, the extent, and the remission of sudden idiopathic hearing loss in 128 patients were correlated with atmospheric pressure and temperature during a period of 12 months. RESULTS: The group of patients with a complete recovery of hearing thresholds was characterized by the smallest changes of atmospheric pressure and temperature, whereas patients with no recovery of hearing had the highest values for atmospheric pressure and temperature changes. However, a statistically significant correlation of sudden hearing loss with absolute values or relative changes of atmospheric air pressure or temperature was not found. Likewise, there was no seasonal dependence. CONCLUSION: The results indicate that sudden idiopathic hearing loss occurs independently of weather parameters.