Assessment of the peripheral hearing system of sport divers.

OBJECTIVE: To investigate the effect of regular scuba diving on the hearing thresholds of sport divers who have no history of noise exposure or ear-related accidents. Comprehensive topographic examination of the peripheral hearing system of sport divers. DESIGN: Cross-sectional study. SETTINGS: General sport diving community. PARTICIPANTS: 81 sport divers with a mean of 300 dives each were compared to a control group of 81 non-divers. MAIN OUTCOME MEASURE: Participants were classified into three age groups. Examination included microscopic otoscopy, tympanometry, pure-tone audiometry (PTA) including air and bone conduction, speech audiometry and otoacoustic emissions (OAE). RESULTS: PTA suggested significant differences of the hearing thresholds at several frequencies between sport divers and non-divers in all age groups, although a Bonferroni correction for multiple testing was applied. Interestingly, the results were contradictory. Divers obtained better hearing results in air conduction, whereas non-divers showed better results in bone conduction. Speech audiometry and OAE did not reveal significant differences. CONCLUSION: There are no published studies of the peripheral cochlear system of divers that have used a combination of PTA, speech audiometry and OAE. All studies suggesting hearing impairment in divers were based on PTA and might have been influenced by a lack of accuracy of PTA. Our results suggest that diving does not adversely affect the hearing system of sport divers. A thorough test battery of audiological methods implying PTA, speech audiometry and OAE may contribute to offer more reliable results to answer the question of whether commercial or military divers are at higher risk for hearing detoriation.

Assessment of the central hearing system of sport divers.

OBJECTIVE: To investigate the effect of regular scuba diving on central processing sequences of sport divers who have no history of noise exposure or ear-related accidents using a comprehensive topographic examination of the central hearing system. DESIGN: Cross-sectional controlled comparison study. SETTINGS: General sports diving community. PARTICIPANTS: 81 sport divers with a mean of 300 dives each were compared with a control group of 81 non-divers. MAIN OUTCOME MEASURE: The participants were classified into three age groups. Hearing test results were combined for both ears. Examination included brainstem evoked response audiometry (BERA), cortical evoked response audiometry (CERA) and dichotic listening tests to screen for retrocochlear and central hearing disorders. Testing of brainstem latencies was performed in a gender-dependent manner. RESULTS: BERA showed a pathological extension of the I-V-latency in one diver. Magnetic tomographic imaging ruled out brainstem lesions. No reason for the measured latency could be detected. All other latencies (I-III, III-V and I-V) in both gender groups were within normal limits. No statistically significant differences between divers and non-divers could be detected. Dichotic listening showed no clinical abnormalities in any of the participants, but in the age group 18-29 years divers performed significantly better than non-divers (p = 0.01). CERA revealed no significant differences between divers and non-divers in the age group 18-29 years and 30-39 years, whereas divers in the age group 41-50 demonstrated significantly better test results (p = 0.045) (difference of the means: 4.18 dB). CONCLUSION: Dichotic listening and CERA did not reveal a significant reduction of central hearing performance in divers. Persistent on-shore BERA wave latency prolongations that were present in one study could not be confirmed in our study group. This first comprehensive topographic examination of the central hearing system of divers showed no abnormalities.

[Chronic rhinosinusitis. Subjective assessment of benefit 1 year after functional endonasal sinus surgery]. / Chronische Rhinosinusitis. Subjektive Nutzenbewertung 1 Jahr nach funktioneller endonasaler Nasennebenhöhlenoperation.

BACKGROUND: Against the background of constantly intensifying economic pressure in the healthcare sector, in the future confirmation of subjective and economic benefit of different forms of therapy will be the criterion applied by the health insurance companies to decide whether to reimburse the costs they involve. The aim of this study was to provide confirmation that patients with chronic rhinosinusitis (CRS) do benefit from functional endonasal sinus surgery (FESS). PATIENTS AND METHODS: One year after undergoing FESS for the treatment of CRS, 82 patients completed various questionnaires. The Glasgow Benefit Inventory (GBI) was used, as it is a validated instrument for the assessment of benefit. In addition, the patients were asked to complete questionnaires relating to pre- and postoperative use of resources (use of antibiotics, visits to their doctors and time unfit for work) and also to give an overall rating of their satisfaction with the outcome, the difference in their symptoms after FESS and the likelihood that they would recommend this treatment to friends or relatives. RESULTS: Three out of four GBI scales [total score (+22.6), general benefit (+26.8), physical functioning (+23.7)] indicated that patients experienced significant benefit. The frequency of visiting their doctors, their intake of antibiotics and the amount of time off work were all significantly reduced. The vast majority of patients were satisfied with the overall result and the level of symptom relief achieved and would recommend FESS to friends and relatives. CONCLUSION: The vast majority of these patients with CRS experienced FESS as highly beneficial. A significant reduction of resource usage was reported after the operation.

Restoring hearing with active hearing implants.

Due to shortcomings of conventional hearing aid technology, such as unsatisfactory sound quality due to limited frequency range and undesired distortion, occlusion of the outer ear canal, and acoustic feedback with high amplification, but also psychological aspects of stigmatization, a significant of patients in need of hearing aids are actually not wearing them. Active hearing implants can be distinguished in: (1) impedance transformation implants (ITI), (2) cochlear amplifier implants (CAI), (3) cochlear implants (CI), and (4) brain stem implants (BSI). Whereas ITI are designed for patients with middle ear hearing loss, CAI are intended to restore hearing in patients with inner ear hearing loss. Advantages of CAI may be: (1) improved sound fidelity, (2) no occlusion of the outer ear canal, (3) no feedback, and (4) invisibility. However, not all features are true for every device. CI replace inner ear function in deaf or almost deaf patients. This article gives an overview on the range of active hearing implants to restore hearing and outlines the future use of computer and robot aided surgery.

[Telemedicine in phoniatrics and pediatric audiology--possible applications, technical implementation, economic aspects]. / Telemedizin in der Phoniatrie und Pädaudiologie--Anwendungsmöglichkeiten, technische Realisierung, ökonomische Aspekte.

BACKGROUND: Phoniatrics and Paedaudiology investigate and treat disorders of communication more than other medical specialties and are indicated by a distinctive interdisciplinary character. The methods of diagnosis and therapy are concentrated on a few specialists and produce a large quantity of multi-media data from daily clinical practice and research. For the cooperation between the specialists of these and neighboring branches and to reduce the costs for a second opinion these data must be available anywhere and any time using modern telecommunication and information technologies. METHODS: Following applications for a bi- or multidirectional data transmission are possible: Teleconsulting (second opinion of a far located specialist). Teleteaching (use of different data sources for education) and Teleroboting (remote control of medical equipment). Data sources can be: speaking and singing voice, sound, pictures (X-ray, CT, MR, ultrasound, voice range profile, audiogramm), video signals (stroboscopy, cinematography, intraoperative pictures) and written information (computer presentations) in all combinations. The transmission can be carried out synchronously or asynchronously, i.e. at the time for their generation or independent of this. This paper discusses the basics and the advantages and disadvantages of the available technologies and compares it for phoniatric/paedaudiologic applications in an experimental transmission. RESULTS: Use of the different technologies should be carried out depending upon the required quality, the availability and the costs considering medico-legal aspects. Relatively cheap and always available technologies are suitable for many applications in Phoniatrics and Paedaudiology. High costs for acquisition of the equipments could lowered by a common use of different medical branches. Expensive procedures with excellent communication quality are confined to special applications at the moment. CONCLUSION: Telemedicine can optimize quality and extend of the medical care and education in Phoniatrics and Paedaudiology with a simultaneous cost reduction and should increasingly be used in this branch.

[Audiovisual telecommunication by multimedia technology in HNO medicine. ISDN--internet--ATM]. / Audiovisuelle Telekommunikation durch Multimediatechnologien in der HNO-Heilkunde. ISDN--Internet--ATM.

Telemedicine includes all medical activities in diagnosis, therapeutics, or social medicine undertaken by means of an electronic transfer medium, enabling the transmission of visual and acoustic information over long distances to doctors not personally present at the place of the requested consultation. Most experience with telemedicine applications has been gained in the field of diagnosis (teleconsultation, teleradiology, telepathology) and is expanding to quality control and quality assurance. Decisive for each form of application is its availability, practicability, cost, safety, and especially quality of audiovisual transmission. For telesurgical applications, particularly the use of minimally invasive techniques in otorhinolaryngology, head, and neck surgery, the high quality transmission of audiovisual data in real time is necessary. Rapid expansion and further developments in transmission technologies and networks in the last decade have created several technologies with increased quality and costs. In this paper, we tested different transmission media for audiovisual telecommunication--integrated services digital network (ISDN), Internet, and asynchronous transfer mode (ATM)--using real time video transmission of typical operations in otorhinolaryngology. Their applications, costs, and future perspectives are discussed.

[Recording otoacoustic emissions in expert evaluation of chronic noise-induced hearing loss]. / Die Ableitung otoakustischer Emissionen bei der Begutachtung der chronischen Lärmschwerhörigkeit.

In order to assess occupational hearing loss, damage to outer hair cell function must be demonstrated. Measurements of transiently evoked otoacoustic emissions (TEOAE) and distortion products (DPOAE) allow clinicians to investigate objectively the cochlear amplification process. In this prospective study, 50 persons with suspected occupational hearing losses were tested with pure-tone and speech audiometry. Additionally, TEOAE and DPAOE were determined. Significant linear correlations were observed when comparing hearing thresholds and speech discriminations with evoked emissions. Three groups were formed based on the OAE results: group A, TEOAE- and DPOAE-positive; group B, TEOAE-negative, DPOAE positive; group C, TEOAE- and DPOAE-negative. The groups were compared with regard to the weighted and simple discrimination scores and percentage of hearing loss computed according to the Boenninghaus-Röser tables. Analysis of variance showed significant differences in hearing losses among the three groups, allowing an objective statement to be made about the degree of work compromise: group A, < 10%; group B, 10-15% group C, > or = 20%.