Head and Neck Cancer: A Study on the Complex Relationship between QoL and Swallowing Function.

Head and neck squamous cell carcinoma (HNSCC) is linked to significant morbidity, adversely affecting survival and functional capacity. Post-treatment challenges such as pain, dysphonia, and dysphagia are common, prompting increased attention in survivorship research. Quality of Life (QoL) questionnaires, especially the MD Anderson Dysphagia Inventory (MDADI), are prevalent outcome measures in clinical studies but often lack parallel objective swallowing function evaluations, leading to potential outcome discrepancies. This study aimed to illuminate the relationship between subjective QoL (EQ-5D-5L and MDADI) measures and objective swallowing function (evaluated via Fiberoptic Endoscopic Evaluation of Swallowing, FEES) in patients with HNSCC. The analysis revealed a notable discordance between objective measures of swallowing function, such as the Penetration-Aspiration Scale (PAS) and residue ratings in the vallecula or piriform sinus, and patients' subjective QoL assessments (p = 0.21). Despite the lack of correlation, swallowing-related QoL, as measured by the MDADI, was more indicative of disease severity than generic QoL assessments. Generic QoL scores did not demonstrate substantial variation between patients. In contrast, MDADI scores significantly declined with advancing tumor stage, multimodal therapy, and reliance on feeding tubes. However, the clinical significance of this finding was tempered by the less than 10-point difference in MDADI scores. The findings of this study underline the limitations of QoL measures as standalone assessments in patients with HNSCC, given their reliance on patient-perceived impairment. While subjective QoL is a crucial aspect of evaluating therapeutic success and patient-centric outcomes, it may fail to capture critical clinical details such as silent aspirations. Consequently, QoL assessments should be augmented by objective evaluations of swallowing function in clinical research and practice to ensure a holistic understanding of patient well-being and treatment impact.

Surgical approach for complete cochlear coverage in EAS-patients after residual hearing loss.

INTRODUCTION: In cases with residual-hearing (RH) loss after cochlear implantation, a safe method is needed to provide full spectral resolution and as much auditory information as possible without implant replacement. Aim of this study was to prove the feasibility of accessing a partially inserted cochlear-implant-electrode for complete insertion to its maximum length through the external ear canal using a transcanal approach. METHODS: Two CI electrodes were customized with 18 stimulating channels. The electrode design enables the use of 12 active channels available for electrical stimulation inside the cochlea both after partial and full insertion. 10 CI electrodes were implanted in 10 fresh human cadaveric temporal bones. After initial partial insertion by posterior tympanotomy, the electrode was inserted to its maximum length via a transcanal approach. Radiographs and CT scans were performed to confirm the electrode position. The electrodes were investigated via x-ray after removal. RESULTS: X-ray and CT-scans confirmed the electrode prototypes covering an angular insertion depth between 236° to 307° after initial insertion. Accessing the electrode in the middle ear space was feasible and insertion to its full length was successful. Post-insertion CT confirmed insertion of the 28mm and 31.5mm electrode arrays covering an angular insertion depth between 360° and 540° respectively. No tip foldovers were detected. CONCLUSION: This study confirms the feasibility of extending the electrode insertion to its maximum insertion length using a transcanal approach in temporal bone specimens. This constitutes a second stage procedure on demand in EAS-surgery. This may be beneficial for EAS-patients providing electrical stimulation beyond the basal turn of the cochlea once the functional residual hearing is lost, without replacing the entire CI.

Pathophysiology of esophageal impairment due to button battery ingestion.

BACKGROUND: The increased use of button batteries with high energy densities in devices of daily life presents a high risk of injury, especially for toddlers and young children. If an accidental ingestion of a button battery occurs, this foreign body can become caught in the constrictions of the esophagus and cause serious damage to the adjacent tissue layers. The consequences can be ulcerations, perforations with fistula formation and damage to the surrounding anatomical structures. In order to gain a better understanding of the pathophysiology after ingestion, we carried out systematic studies on fresh preparations of porcine esophagi. METHODS: The lithium button battery type CR2032, used most frequently in daily life, was exposed in preparations of porcine esophagi and incubated under the addition of artificial saliva at 37 °C. A total of eight esophagi were analysed by different methods. Measurements of the pH value around the battery electrodes and histological studies of the tissue damage were carried out after 0.5-24 h exposure time. In addition, macroscopic time-lapse images were recorded. Measurements of the battery voltage and the course of the electric current supplemented the experiments. FINDINGS: The investigations showed that the batteries caused an electrolysis reaction in the moist environment. The positive electrode formed an acidic and the negative electrode a basic medium. Consequently, a coagulation necrosis at the positive pole, and a deep colliquation necrosis at the minus pole occurred. After an exposure time of 12 h, tissue damage caused by the lye corrosion was observed on the side of the negative electrode up to the lamina muscularis. The corrosion progressed up to the final exposure time of 24 h, but the batteries still had sufficient residual voltage, such that further advancing damage would be expected. CONCLUSIONS: Button battery ingestion in humans poses an acute life-threatening danger and immediate endoscopic removal of the foreign body is essential. After only 2 h exposure time, significant damage to the tissue could be detected, which progressed continuously to complete esophageal perforation. The primary prevention of battery ingestion is therefore of particular importance.

Vibro-EAS: a proposal for electroacoustic stimulation.

HYPOTHESIS: In situ evaluation of the vibration performance of a hybrid system for intracochlear fluid stimulation, constructed from a floating mass transducer (FMT) coupled to an electric acoustic stimulation (EAS) cochlea implant (CI) electrode. BACKGROUND: EAS uses both CI technology to restore severe-to-profound hearing loss at high frequencies and acoustic amplification for mild-to-moderate hearing loss in the low-to-mid frequency range. More patients with residual hearing are becoming candidates for EAS surgery because of the improved techniques for hearing preservation. Most patients with partial deafness fulfill the audiological criteria at low and mid-frequencies for the active middle-ear implant with FMT (VSB). The FMT of the VSB is a potential device for acoustical stimulation in EAS. METHODS: In seven fresh human temporal bones, stapes amplitude responses for fixation of a FMT to the long incus process (standard coupling) was compared with those for FMT fixation to a 20-mm inserted standard cochlea electrode array (31.5 mm) via the round window (Vibro-EAS). Vibration of the stapes footplate was measured by laser Doppler vibrometry. RESULTS: For 0.316 Vrms drive voltage, stimulation of the intracochlear fluid using a FMT-driven CI electrode (Vibro-EAS) yielded stapes amplitude responses comparable to those for acoustic stimulation with 84 dB SPL. These amplitude responses are 30 to 42 dB lower at frequencies up to 4 kHz than those for VSB standard coupling. CONCLUSION: Intracochlear combined electrical and mechanical stimulation may be a viable technique for electroacoustic stimulation. A reliable technique for attachment or integration of the FMT to the cochlea electrode array has yet to be developed.

Alternative fixation of an active middle ear implant at the short incus process.

INTRODUCTION: Since 1996, the preferred approach for positioning the active middle-ear implant Vibrant Soundbridge© is a mastoidectomy and a posterior tympanotomy. With this device, placement of the floating mass transducer (FMT) on the long incus process is the standard method for treatment of mild-to-severe sensorineural hearing loss in the case of normal middle-ear anatomy. The aim of this study was to determine the vibrational effectiveness of FMT placement at the short incus process. MATERIALS AND METHODS: An extended antrotomy and a posterior tympanotomy were performed in 5 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane were (sequentially) measured by laser Doppler vibrometry. Vibration responses for coupling of an FMT to the long incus process (standard coupling) were compared to those for coupling to the short incus process. RESULTS: Apart from narrow frequency bands near 3 and 9 kHz for the stapes footplate and RW membrane, respectively, the velocity responses presented no significant differences between standard coupling of the FMT and coupling to the short incus process. CONCLUSION: Coupling the FMT to the short incus process may be a viable alternative in cases where the surgical approach is limited to an extended antrotomy. A reliable technique for attachment to the short incus process has yet to be developed.

Conditions for highly efficient and reproducible round-window stimulation in humans.

Round-window stimulation is a new clinical approach for the application of active middle-ear implants. To investigate factors influencing the efficiency of round-window stimulation, experiments in 6 human temporal bones were performed with different actuator geometries and coupling conditions. The experiments show that the amplitude ratio between stapes and round-window actuator vibration is most efficient when using a 1.0-mm diameter rod with a 30° inclined tip geometry and an attached silicone pad. In this case, the amplitude ratio is 0.34 for frequencies up to 1.5 kHz and 0.27 for frequencies up to 20 kHz, with a standard deviation of only 4-6 dB at most frequencies. The analysis of data presented here and in a companion paper suggests that control of proper round-window membrane pretension as well as the inclined tip geometry are the major requirements for maximal performance.