[S1 Clinical guideline"adenoids and adenoidectomy"]. / S1-Leitlinie "Adenoide Vegetationen/Rachenmandelhyperplasie".

On behalf of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, a clinical guideline for adenoids and adenoidectomy was developed in 5 consensus meetings after taking into consideration the current literature. This guideline was released by the presidium on 13 April 2011. Anatomy, pathology and pathophysiology, symptoms, diagnosis, therapy, and course are presented.

[Anomalies of the first branchial cleft - a review]. / Fehlbildungen der ersten Kiemenfurche - eine Übersicht.

BACKGROUND: Fistulas, sinus or cysts which trace back to anomalies of the first branchial cleft are seldom compared to lateral neck cysts and fistulas. For their accurate diagnosis and safe treatment special embryological and anatomical knowledge is necessary. MATERIAL AND METHODS: Embryology, anatomy, diagnosis and therapy are described and explained by 2 case studies in context to the current literature. RESULTS AND CONCLUSION: Sonography and contrast-enhanced radiological methods represent the fundamental pillar of the diagnosis. Therapeutically, the complete extirpation is the first choice. Surgeries on children, patients with extended fistulas and special cases of fistula routes require particular carefulness. In certain cases with pronounced findings and low levels of symptoms a "wait-and-see" strategy can be justified. Surgically, protection of the facial nerve and prevention of recurrences are the greatest challenge.

[Influence of mixing ratios of a FM-system on speech understanding of CI-users]. / Untersuchungen zum Einfluss des Mischungsverhältnisses der FM-Anlage auf das Sprachverständnis im Störschall bei CI-Patienten.

BACKGROUND: At school we find two major acoustic situations: (first) the "teacher is talking" being disturbed by the pupils making noise and (second) another "pupil is talking" disturbed by other pupils. The understanding of words and sentences in hearing impaired patients with a cochlear implant (CI) in a noisy situation can be improved by using a FM system. The aim of this study is to test speech understanding depending on mixing ratios between FM input and microphone input to the speech processor in different circumstances. METHODS: Speech understanding was evaluated using the adaptive Oldenburger sentence test (OLSA) in background noise. CI patients used the FM system Microlink for Freedom CIs together with a Campus transmitter (Phonak AG). PATIENTS: 17 postlingually deafened adults were tested, using unilateral Freedom cochlear implant systems (Cochlear Ltd). A group of eight normally hearing adults was used as a control group in the same setup. RESULTS: We found that the median value of L (50)=1.6 dB in CI patients without a FM system is higher than the median value of L(50)=-13 dB in normally hearing subjects. The sentence recognition in CI patients with FM system increased with increasing mixing ratio. The benefit using the FM system to understand the teacher is of high advantage in any mixing ratio. The difference between the L(50) values in situations with or without a FM-system is 15 dB for the mixing ratio 3:1 (FM to microphone). If we take into account an increase of 15% per dB in the OLSA (at L(50)) in CI patients, the difference of 15 dB means a calculated advantage of 225%. The speech understanding during the second condition ("pupil is talking") however remained nearly the same in all used mixing ratios. The calculations showed no statistical difference between these situations with and without a FM system. CONCLUSION: The speaker comprehension for the two investigated listening conditions showed different results. Understanding in the "teacher is talking" situation increased with increasing mixing ratio (FM to microphone) and in the "pupil is talking" situation remained on the same level. We could not find an optimal FM setting for both listening conditions. This leads to different suggestions for different listening conditions. All patients showed an increased speech understanding in noisy environments. This result strongly encourages the use of a FM-system in a classroom.

Electrically evoked auditory brainstem response in cochlear implant users.

The waveforms and parameters of electrically evoked auditory brainstem responses, eeABRs, registered in cochlear implant users, were compared with those of acoustically evoked auditory brainstem responses, aeABRs, recorded in normally hearing subjects. The eeABRs, in contrast to the aeABRs, contained dubious Wave IV, while missed Waves VI and VII. The eeABRs possessed also shorter peak-latencies, shorter inter-peak intervals, and greater amplitudes. The revealed differences have been explained by the lack of cochlear mechanisms in cochlear implant recipients. On the other hand, eeABRs and aeABRs exhibited similar stimulus intensity dependence. Both had also lower thresholds, shorter peak-latencies, and greater amplitudes in females than in males.

[Electromagnetic fields of mobile telephone systems--thresholds, effects and risks for cochlear implant patients and healthy people]. / Elektromagnetische Felder des Mobilfunks--Grenzwerte, Effekte und Risiken für CI-Träger und Gesunde.

Every day life is detectably affected by manifold natural sources of electromagnetic fields (EMF), e. g. infrared radiation, light and the terrestrial magnetic field. However, there is still uncertainty about the consequences or hazards of artificial EMF, which emerge from mobile phone or wireless network (wireless local area network [WLAN]) services, for instance. Following recommendations of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) the German Commission on Radiation Protection (SSK) defined corresponding thresholds for high frequency electromagnetic fields (HF-EMF) in 2003. By observing those thresholds HF-EMF is thought to be innocent so far. However, there is still controversial discussion about induction of cancer or neurovegetative symptoms due to inconsistent study results. Patients with cochlea implants are of particular interest within the speciality of otorhinolaryngology due to specific hazards, which arise during mobile telephone use from the distance between brain and inductive metal implants (electrode) on the one hand and the electronic system of the cochlear implant and the source of HF-EMF on the other hand. Besides many studies about the impact of HF-EMF on common welfare, there are only very few surveys (n = 6) covering the effects on patients with cochlear implants. The purpose of this paper is to overview sources, thresholds and subsequently harmful or harmless effects of HFEMF. Due to the current state of knowledge about the impact of mobile phone use on health, we assume, that HF-EMF are harmless both for healthy people and patients with cochlea implants, provided that legal thresholds are observed.

[Recurrent facial paresis with facial neurinoma]. / Rezidivierende periphere Fazialisparese bei Fazialisneurinom.

PATIENT: A clinical case of a 49-year-old man is described who presented with a right facial paresis for 4 weeks. The patient had undergone a decompression of facial nerve and a radical mastoidectomy elsewhere in 1998 because of a facial paresis and acute mastoiditis. In the following years a complete right facial paresis occurred several times improving with prednisolone. In addition to topognostic examinations a high resolution computed tomography of the temporal bone was made. CT showed a mass in the right tympanic cavity with close contact to the ossicular chain. Diagnostic tympanotomy disclosed a tumor of the tympanic segment of the facial nerve. Pathological examination indicated a diagnosis of neurinoma with an Antoni B architecture. In a second operation the tumor was resected totally and a facial nerve reconstruction was performed by a greater auricular nerve interposition graft. Seven month postoperative beginning nerve reinnervation was seen proceeding continually until the control examination after 1 1/2 year. DISCUSSION: Facial neurinoma are a rare course of facial paresis. There are no specific symptoms. That's why the diagnosis is difficult. But it is necessary to think of with differential diagnosis of facial paresis.

[Reconstruction of the ossicular chain with titanium implants. Results of a multicenter study]. / Rekonstruktion der Gehörknöchelchenkette mit Titan-Implantaten. Ergebnisse einer Multicenter-Studie.

BACKGROUND: For decades, oto-surgeons have been trying to find suitable alloplastic materials for replacing ossicles in the case of morphological and functional disorders in the middle ear. The focus of attention has been on tissue tolerance and functionality. PATIENTS: A retrospective analysis of the implantation of titanium prostheses is presented (Type "Duesseldorf", Heinz Kurz GmbH, Dusslingen, Germany) in 528 patients operated in 14 ENT hospitals. The hospitals involved are ENT hospitals with different fields of specialization presenting a representative cross-section of surgical ENT treatment. Evaluated were healing results, hearing gain and surgical handling of the implants. RESULTS: Despite pathological middle ear conditions, the tissue-implant healing rate was very high. In 4.4% of the patients the implants were rejected. In the case of partial ossicular reconstruction, an average hearing gain between 10 and 20 dB was achieved. Total reconstruction of the ossicular chain showed even better audiological results (15 to 20 dB on average). CONCLUSION: Due to the good morphological and functional results achieved, titanium implants have proven their worth for middle ear micro-surgery. Their advantages are their light weight and delicate structure, facilitating very good micro-surgical handling. It is advisable to place a thin layer of cartilage between the prosthesis headplate and the tympanic membrane. In this manner, the number of material extrusions can be safely reduced, however, extrusions cannot completely be avoided.

[Otosialorrhoea - diagnostics and therapy of a salivary fistula of the external auditory canal]. / Otosialorrhö - Diagnostik und Therapie einer Speichelfistel des äusseren Gehörganges.

PATIENT: We report the case of a 49 year old female patient who suffered from frequent secretion of the left external canal of the ear after the treatment of a chronic mycotic otitis externa. The secretion was seen in connection with food intake. An operative revision in another hospital remained without success. The diagnostics covered the biochemical verification of saliva-amylase in the secretion, but also a high resolution MRI of the parotid gland. By this diagnostics it was easy to locate the salivary fistula during the operation. DISCUSSION: Salivary fistulas of the parotid gland to the external ear-canal are very rare. These fistulas develop after injury of the parenchyma or the gland ductus and also after surgery of the head- and neck-region. A otosialorrhoea rarely originates from a chronic inflammatory of the ear canal. These fistulas are assigned to the fissures of Santorini and the foramen of Huschke. The therapy of salivary fistulas to the external ear canal reaches from clossure of the fistula to total parotidectomy. But also a medicamental suppression of salivation, irradiation and a tympanic neurectomy are discussed in the literature.

[Practice surgery on the artificial temporal bone. Development of temporal bone facsimiles with stereolithography]. / Präparierübungen am künstlichen Felsenbein. Herstellung von Felsenbeinfaksimiles durch Stereolithographie.

Learning microsurgery of the middle ear requires preparations of temporal bones. Ethical and moral restrictions in obtaining specimens make training and research with temporal bone preparations increasingly more difficult. Due to the complex structure of the temporal bone with its communicating cavities, the manufacture of facsimiles up to now has been impossible. Rapid prototyping techniques must be able to produce identical objects from an original one. By using CT scans of temporal bones from anatomic preparations and patients we have been able to reconstruct 3D pictures on a CAD workstation. We are now able to incorporate data in a stereolithographic system to create an anatomic facsimile of the temporal bone. It is possible to produce a considerable number of these facsimiles from the same real object. With this method we can produce models of human structure for medical teaching, training and research. Our artificial preparations of temporal bones correspond to both the material characteristics and anatomic details of human structures, allowing various surgical exercises to be carried out.

Artificial petrous bone produced by stereolithography for microsurgical dissecting exercises.

Training in microsurgery of the middle ear requires dissecting to be carried out on petrous bone. Human petrous bone structures are not available in adequate quantity to permit extensive practicing. Using synthetic resins, true reproductions of petrous bone can be obtained by means of a stereolithographic method, yielding structures of the petrous part which are highly similar to human bone. Digital data sets are obtained from spiral CT scans, and transferred to CAD systems such that, using stereolithography, petrous bone facsimiles are produced on the parametric model. Any number of such models of an original can be produced. Thus, identical structures can be made available for a wide range of uses. Exercises conducted on artificial petrous bone so produced are equivalent to those carried out on human structures, in terms of material properties and visualisation of anatomic details.

[Systematic hearing diagnosis in the premature infant. The Magdeburg model]. / Systematische Hördiagnostik bei Frühgeborenen. Das Magdeburger Modell.

Almost 50% of all hearing disorders found in children are acquired. To a large extent these hearing disorders are caused by premature birth and can be detected by suitable screening. Two methods have proved useful for such testing: (1) Reflex audiometry with a standardized stimulus generator; and (2) bedside recording of brainstem potentials. Having tested the method of bedside recording of brainstem potentials we examined a group of 60 infants of varied body weights and otherwise normal findings as a "normal" control group. At all click intensities measured, premature infants weighing from 1500 to 2000 g showed a latency increase by about 0.7 ms when compared to infants weighing in excess of 2000 g. Premature infants showing signs of maturation adequate for gestational age were not at greater risk for hearing disorders. In contrast, premature infants weighing less than 1500 g and having marked hyperbilirubinemia as week as extensive intracranial bleeding always showed increased wave V latencies. Ten percent of these infants had severe hearing disorders requiring special pecaudiological training. Overall findings showed the great usefulness of audiometric screening in a pediatric hospital center for detecting hearing disorders in premature infants.

[Effect size on resonance of the outer ear canal by simulation of middle ear lesions using a temporal bone preparation]. / Untersuchung von Einflussgrössen auf das Resonanzverhalten des äusseren Gehörganges durch Simulation von Mittelohrzuständen am Felsenbeinpräparat.

By means of a model of the external and the middle ear it is possible to simulate various, exactly defined pathological conditions of the middle ear and to describe their influence on ear canal resonance. Starting point of the investigations are fresh postmortem preparations of 8 human temporal bones with an intact ear drum and a retained skin of the ear canal. The compliance of the middle ear does not significantly differ from the clinical data of probands with healthy ears. After antrotomy it is possible to simulate pathological conditions of the middle ear one after the other at the same temporal bone. The influence of the changed middle ear conditions on ear drum compliance, ear canal volume and on the resonance curve of the external ear canal was investigated. For example, the middle ear was filled with water to create approximately the same conditions as in acute serous otitis media. In this middle ear condition a significant increase of the sound pressure amplification was found, on an average by 4 decibels compared to the unchanged temporal bone model. A small increase in resonance frequency was also measured. The advantages of this model are the approximately physiological conditions and the constant dimensions of the external and middle ear.

Observation of eardrum movements during quasi-static pressure changes by high-speed digital imaging.

Under specific quasi-static pressure conditions during the Valsalva manoeuvre, high-speed digital video pictures of eardrum displacements were recorded using an endoscope and a Kodak Image Ektapro 1000 Motion Analyzer. A new type of data interface enabled the complete videoclip to be saved and processed digitally, and, with special mathematical algorithms, it is possible to generate three-dimensional computer animations of eardrum movements under quasi-static pressure. The present study describes patterns of eardrum movements under static pressure changes (Valsalva manoeuvre). These patterns were consistent with the results of finite-element simulations of highly similar eardrum displacements reported by other workers.

[Acceptance and hearing aid use by patients of retirement age (in the Magdeburg clinical area)]. / Akzeptanz und Tragegewohnheiten von Hörgeräten bei Patienten im Rentenalter (im Versorgungsbereich Magdeburg).

Providing patients with hearing aids in the former German Democratic Republic was carried out in audiological centers by otolaryngologists and authorized audiologic-phonatric assistants. The available selection of hearing aids was limited. A randomized group of 119 patients rehabilitated with hearing aids was examined. The current study includes persons older than 65 years. In 78.4% of the patients treated, the quality of life was improved with the hearing aids. In contrast, the other patients reported the aids to be useless. Nearly 90% of all patients had no problems in managing their hearing aids. About 75% of the patients used the hearing aid the whole day. In addition to the hearing aid prescribed, 33 patients also have had to read lips and only a combination of both allows these patients to have adequate communication. Patients reported that 80% of the hearing aids worked well or were rarely out of order. Further, 68% of the people questioned reported a positive attitude of their fellow citizens. Only 6% mentioned that the use of hearing aids to treat presbycusis disturbed social communications. Since hearing loss can be progressive and to avoid interference in early rehabilitation, frequent follow-ups by otorhinolaryngologists are required. The evaluation of patients with hearing disorders requires the collaboration of physicians and hearing aid acousticians in order to give patients the most information and understanding of their deafness.

[Bilateral genuine cholesteatoma--a case report]. / Bilaterales genuines Cholesteatom--eine Fallbeschreibung.

We report on a patient who has been in otorhinolaryngological treatment for more than 24 years owing to recurrent infra-auricular fistulation. Early hospital admissions were due to suspected abscess-forming parotitis or lymphadenitis. As far as could be discerned, no sonographical or radiological diagnostics were conducted. Complications in the sense of meningitis or labyrinthitis were not reported. In the case of the aforementioned patient a bilateral anomaly in the area of the external auditory canal went hand in hand with the development of a bilateral genuine cholesteatoma. The auriculae were configurated normally. Corrective radical surgery was conducted on both sides, first the left, then the right side. What seems remarkable in this context is the fact that despite a over two decades old cholesteatoma there was no erosion of the osseous boundaries of the eardrum towards the labyrinth and cochlea and the osseous cover of the canalis facialis. The patient was diagnosed with a high degree loss of hearing. It was not possible to derive reproductive acoustic potentials intraoperatively, which pointed to deafness. Whether this deafness was congenital or developed in the course of time based on a growing sensory hearing loss could not be ascertained.