Short-time cold atmospheric pressure plasma exposure can kill all life stages of the poultry red mite, Dermanyssus gallinae, under laboratory conditions.

In the present study, the acaricidal effects of cold atmospheric pressure plasma treatment on poultry red mites of different developmental stages have been investigated under laboratory conditions using a dielectric barrier discharge system. A total of 1890 poultry red mites and 90 mite eggs, respectively, were exposed to the plasma under various parameter settings with a single plasma pulse generated using the gas mixture of the ambient air at atmospheric pressure. The results showed that all developmental stages of the poultry red mite could be killed by cold atmospheric pressure plasma treatment. Plasma exposure to mite eggs resulted in a complete 100% hatch inhibition regardless of the parameter settings. Post-exposure mortality rates of larvae, nymphs and adults showed significant differences after utilization of plasma at 10 W for 1.0 s. In addition, the mortality rate increased with progressing time after plasma exposure. An average mortality rate of 99.7% was observed after 12 h in all mites exposed to plasma, regardless of the selected plasma parameter, developmental stage, and nutritional status of the mites. Cold atmospheric pressure plasma has an acaricidal effect on all developmental stages of Dermanyssus gallinae, suggesting that it could be developed to an effective method for the control of poultry red mites in laying hen husbandry.

Influence of Cochlear Implantation on Postural Control and Risk of Falls.

BACKGROUND: Cochlear implantation is an important method of hearing rehabilitation. Earlier studies have shown the influence of implantation on the vestibular system. However, until now, the effect of hearing rehabilitation with cochlear implants (CI) on postural control and body stability has not been sufficiently studied. OBJECTIVE: To analyse the effect of hearing rehabilitation with activated CI and different sound inputs (music, speech text, and white noise) on postural control and risk of falls after implantation. METHODS: This was a prospective clinical trial that included 33 adult patients with at least 6 months' use of a CI (mean time after implantation = 23 months). All patients underwent a standard or geriatric (for patients >60 years) balancing deficit test protocol with a mobile posturography system (VertiGuard®) in different situations (CI deactivated/activated and different sound inputs). As the main outcome measure, the risk of falls (%) after each protocol was calculated by evaluating body sway both forward to backward and side to side (°/s). RESULTS: With the CI deactivated, the mean risk of falls was 45.5%. After activation of the CI, there was a small decrease in the mean risk of falls, but it was statistically significant. With an additional sound input (music or speech text) this decrease was more pronounced: 42.0 and 42.4%, respectively. This effect seems to be more pronounced in older patients. Regarding the individual patients, 72% had an improvement in the risk of falls with an activated CI, and 28% had a slight deterioration. An activated CI accompanied by sound input (music) further improved the individual risk of falls. CONCLUSIONS: Compared with prior research, this study found that the risk of falls after implantation decreased over a longer time period. Furthermore, the use of a CI and different sound inputs had a positive effect on postural control. These findings support the need for optimal hearing rehabilitation, especially in elderly patients. Although this effect is relatively small, it is important to consider for further studies that rehabilitation with CI may reduce the risk of falls. While the auditory system supposedly contributes to postural control only to a small degree and the mechanism is still poorly understood, further studies with bigger samples are warranted to clarify these effects.

A Comparison of Distortion Product Otoacoustic Emission Properties in Ménière's Disease Patients and Normal-Hearing Participants.

OBJECTIVES: Postmortem examination of temporal bones of Ménière's disease patients consistently show dilated endolymphatic spaces of the inner ear, for which the term endolymphatic hydrops has been coined. During the past decade, magnetic resonance imaging techniques for the inner ear appeared, advancing the diagnosis of Ménière's disease. They require, however, a field-strength of at least 3 T, are costly and not universally available. Alternative, noninvasive, cost-effective tests with high sensitivity and specifity for endolymphatic hydrops are desirable. In this study, we test the suitability of distortion product otoacoustic emissions (DPOAEs) for endolymphatic hydrops detection. Previous measurements of the commonly recorded cubic DPOAEs mainly register cochlear hearing loss and are not specific for Ménière's disease. Simultaneous recordings of cubic and quadratic DPOAEs might be more suitable to detect endolymphatic hydrops, because both DPOAE orders react differently to changes of the cochlear operating point as they might occur in Ménière's disease patients. DESIGN: Cubic and quadratic DPOAEs were recorded in normal-hearing participants (N = 45) and in the affected and unaffected ears of patients with a diagnosis of definite Ménière's disease (N = 32). First, to assess the integrity of DPOAE-generating mechanisms, cubic DPOAE-grams were obtained with primary tone frequencies f2 between 1 and 8 kHz with primary tone levels l1 = 60 dB SPL and l2 = 50 dB SPL, and a fixed primary tone frequency ratio of 1.22. Then, cubic and quadratic DPOAEs were simultaneously recorded with primary tone levels l1 = l2 = 65 dB SPL and at primary tone frequencies f2 = 4 and 5 kHz, where f1 was successively varied such that the ratio f2/f1 ranged between 1.1 and 1.6 in 0.04 steps while quadratic and cubic DPOAE levels were extracted from the same recording. RESULTS: Cubic DPOAEs were significantly reduced in the affected ears of Ménière's disease patients, and slightly reduced in the unaffected ears of Ménière's disease patients, relative to the ears of normal-hearing participants. In contrast, no significant changes could be seen in quadratic DPOAEs across the ears of normal-hearing participants and Ménière's disease patients. CONCLUSIONS: We could identify a relatively good preservation of quadratic DPOAE levels in relation to a reduction of cubic DPOAE levels as a potential noninvasive diagnostic approach in the early stage of suspected Ménière's disease. Future studies validating the differential diagnostic power of this parameter in control groups with nonhydropic forms of hearing loss are warranted.

Laser-assisted fixation of a nitinol stapes prosthesis.

BACKGROUND AND OBJECTIVE: Otosclerosis is an inner ear bone disease characterized by fixation of the stapes and consequently progressive hearing loss. One treatment option is the surgical replacement of the stapes by a prosthesis. When so called "smart materials" like nitinol are used, prosthesis fixation can be performed using a laser without manual crimping on the incus. However, specific laser-prosthesis interactions have not been described yet. The aim of the present study was to elucidate the thermo-mechanical properties of the NiTiBOND® prosthesis as a basis for handling instructions for laser-assisted prosthesis fixation. STUDY DESIGN AND MATERIALS AND METHODS: Closure of the NiTiBOND® prosthesis was induced ex vivo by either a diode laser emitting at λ = 940 nm or a CO2 laser (λ = 10,600 nm). Total energy for closure was determined. Suitable laser parameters (pulse duration, power per pulse, distance between tip of the laser fiber and prosthesis) were assessed. Specific laser-prosthesis interactions were recorded. RESULTS: Especially the diode laser was found to be an appropriate energy source. A total energy deposit of 60 mJ by pulses in near contact application was found to be sufficient for prosthesis closure ex vivo. Energy should be transmitted through a laser fiber equipollent to the prosthesis band diameter. Specific deformation characteristics due to the zonal prosthesis composition have to be taken into account. CONCLUSION: NiTiBOND® stapes prosthesis can be closed by very little energy when appropriate energy sources like diode lasers are used, suggesting a relatively safe application in vivo. Lasers Surg. Med. 50:153-157, 2018. © 2017 Wiley Periodicals, Inc.

Patient benefit from Cochlear implantation in single-sided deafness: a 1-year follow-up.

The objective of the study was to evaluate the quality of life and benefit in patients with single-side deafness before and 1 year after cochlear implantation. In a prospective observational study design, ten adult patients with single-sided deafness undergoing cochlear implantation were included. All patients had on the implantation side no speech discrimination with normal hearing aids. The contralateral side was normal or marginal hearing loss. For determining the subject benefit from cochlear implantation, each patient answered standardized questionnaires directly before implantation and 1 year after. Regarding the questionnaire Speech, Spatial and Qualities of Hearing (SSQ), the tests yielded a significant difference in the subdomains "speech intelligibility" and "spatial hearing". The Nijmegen Cochlear Implant Questionnaire (NCIQ) showed a significant difference in the subdomain "basic sound perception", but not in the total score. The Glasgow Hearing Aid Benefit Profile (GHABP) showed on average moderate satisfaction in the subdomains "hearing aid benefit" and "residual disability". In general quality of life, no significant difference was found measured by the questionnaire EQ-5D-3L. One year after cochlear implantation, most patients with single-sided deafness showed benefits in hearing as measured by validated questionnaires However, not all patients reported a significant improvement in general quality of life. Therefore, it is important to inform patients adequately and offer alternative treatments before implantation.

Responses of the Human Inner Ear to Low-Frequency Sound.

The perceptual insensitivity to low frequency (LF) sound in humans has led to an underestimation of the physiological impact of LF exposure on the inner ear. It is known, however, that intense, LF sound causes cyclic changes of indicators of inner ear function after LF stimulus offset, for which the term "Bounce" phenomenon has been coined.Here, we show that the mechanical amplification of hair cells (OHCs) is significantly affected after the presentation of LF sound. First, we show the Bounce phenomenon in slow level changes of quadratic, but not cubic, distortion product otoacoustic emissions (DPOAEs). Second, Bouncing in response to LF sound is seen in slow, oscillating frequency and correlated level changes of spontaneous otoacoustic emissions (SOAEs). Surprisingly, LF sound can induce new SOAEs which can persist for tens of seconds. Further, we show that the Bounce persists under free-field conditions, i.e. without an in-ear probe occluding the auditory meatus. Finally, we show that the Bounce is affected by contralateral acoustic stimulation synchronised to the ipsilateral LF sound. These findings clearly demonstrate that the origin of the Bounce lies in the modulation of cochlear amplifier gain. We conclude that activity changes of OHCs are the source of the Bounce, most likely caused by a temporary disturbance of OHC calcium homeostasis. In the light of these findings, the effects of long-duration, anthropogenic LF sound on the human inner ear require further research.

Influence of insertion depth in cochlear implantation on vertigo symptoms and vestibular function.

OBJECTIVES: The aim of the present study was to investigate the effect of the electrode insertion depth in vestibular function after cochlear implantation. MATERIAL AND METHODS: In a retrospective observational study design, 41 adult patients who had undergone cochlear implantation between 2006 and 2012 at a tertiary referral university hospital were included. The postoperative performed radiograph images of the petrous bone were acquired according to the Stenvers method. These were analyzed to determine electrode insertion depth. Pre- and postoperative subjective vertigo symptoms were assessed by a questionnaire. The function of the horizontal semi-circular canal was evaluated by caloric irrigation and the function of the sacculus was tested by using cervical vestibular evoked myogenic potentials pre- and postoperatively. RESULTS: The average electrode insertion depth was 464°. A certain variability of insertion depth existed among the different electrodes according to their designs. No statistical difference of the insertion depth was found between patients with or without vertigo. There was also no correlation between electrode insertion depth and alterations of the measurable vestibular function. CONCLUSION: In our study the variability of insertion depth didn't have a significant influence on subjective vertigo, horizontal semi-circular canal function or saccular function. Plain radiography is a rapid, simple and cost-effective method to determine electrode insertion depth after implantation. However the scalar position of the electrode cannot be analyzed in plain radiography, so that an interscalar dislocation as a possible influence in vestibular function remains undetected.

Endonasal resection of early stage squamous cell carcinoma of the nasal vestibule.

The squamous cell carcinoma of the nasal vestibule (SCCNV) is a comparatively rare malignant disease. It occurs in the transition zone at the limen nasi. The choice of treatment for small tumors is a matter of controversy. Due to better cosmetic results, radiation therapy is usually recommended, however some recent reports have suggested that early stage tumors are equally or even more effectively managed by surgery. There was no standardized surgical procedure applied in these studies, though. The goal of our investigation was the retrospective evaluation of patients with a T1 or T2 carcinoma of the nasal vestibule who were treated surgically with an endonasal, endoscope-controlled approach at our ENT clinic between 2008 and 2010. Given the rarity of SCCNV, the 10 included cases represent the largest group of patients with early stage SCCNV treated primarily surgically by an endonasal approach so far. Our study shows that the endonasal resection of an early stage vestibular carcinoma seems adequate as a possible therapy. In the follow-up observation period no local or loco-regional recurrence was observed. The external cosmetic damage and endonasal scarring do not appear to be pronounced even following cartilage resection and were regarded as not seriously disadvantageous.

Endolymphatic hydrops in patients with vestibular migraine and auditory symptoms.

Vertigo patients exhibiting features of vestibular migraine (VM) and Menière's disease (MD) present a difficult diagnostic challenge to the clinician, and the two entities are likely to overlap. The aim of the present study was to investigate the occurrence of endolymphatic hydrops in patients with VM and auditory symptoms. This was an observatory diagnostic study. At an academic interdisciplinary dizziness centre, nineteen consecutive patients with definite or probable VM and auditory symptoms were examined by locally enhanced inner ear MR imaging. MR images were evaluated for the presence of endolymphatic hydrops. Of the 19 included patients, four patients (21 %) demonstrated evidence of cochlear and vestibular endolymphatic hydrops on locally enhanced inner ear MR imaging (three with "definite VM", one with "probable VM"). Locally enhanced inner ear MR imaging may be useful in the diagnostic evaluation of patients with VM and auditory symptoms, as some of these patients have signs of endolymphatic hydrops. Whether these patients suffer from MD only and are misdiagnosed as VM or suffer from both, VM and MD or whether endolymphatic hydrops is a consequence of inner ear damage due to VM are clinically relevant questions that can be evaluated by application of this technique.

Prevalence of labyrinthine ossification in CT and MR imaging of patients with acute deafness to severe sensorineural hearing loss.

OBJECTIVE: To evaluate the prevalence of labyrinthine ossification, and especially cochlear ossification, in a cohort of patients with unilateral sudden deafness or severe sensorineural hearing loss. DESIGN: Retrospective data collection. STUDY SAMPLE: Sixty-four consecutive patients with unilateral sudden deafness or severe sensorineural hearing loss and either high-resolution CT (HRCT) of the temporal bone (isotropic spatial resolution ≤ 0.8 mm; n = 18) or high resolution CISS MRI (isotropic spatial resolution ≤ 1 mm; n = 55) were included. Nine patients underwent both imaging modalities. A standardized reading regarding labyrinthine ossifications was performed by an experienced head and neck radiologist blinded to clinical symptoms. RESULTS: Radiologic signs of cochlear ossification were present in 14 patients (12 CT and 2 MRI). Eight patients showed unilateral and six patients bilateral signs of cochlear ossification. In all except one of the unilateral cases, the deafened ear was affected. CONCLUSIONS: Signs of cochlear ossification were found in an unexpectedly high rate (14/64, 22%) of patients with acute deafness. The data suggest HRCT of the temporal bone to be more sensitive to detect labyrinthine ossification than MRI. HRCT of the temporal bone should therefore be considered in patients with impaired recovery of acute deafness to exclude cochlear ossification; if present, and, in cases of early signs, the patient should be evaluated further to facilitate early cochlear implantation before progression impedes electrode insertion, reflecting latest developments considering cochlea implants for single-sided deafness to be effective.

Septal injection of botulinum neurotoxin A for idiopathic rhinitis: a pilot study.

PURPOSE: Botulinum neurotoxin A (BTA) is a promising therapeutic option in the treatment of idiopathic rhinitis (IR), a disease characterized by nasal obstruction and hydrous rhinorrhea. The conventional localization for the injection of BTA in IR is the nasal turbinates. In our own clinical experience, submucoperichondrial injection of BTA in the nasal septum is an alternative that is easy to perform for the therapist and also well tolerated by the patient. MATERIAL AND METHODS: Five patients received an injection of in total 80 mouse units Dysport (Ipsen Pharma, Ettlingen, Germany) in the nasal septum. The unpleasantness of the nasal injection of BTA was measured on a visual analogue scale. Over the course of 14 days, nasal symptoms (rhinorrhea, nasal obstruction, urge to sneeze, nasal pruritus), the number of facial tissues used daily, and possible complications were evaluated. RESULTS: The unpleasantness of the injection of BTA into the nasal septum after local anesthesia was rated low (visual analogue scale, 0.76 on average). A good subjective symptom control was achieved in 3 patients concerning rhinorrhea and in all patients concerning nasal obstruction. The number of facial tissues used daily as a parameter for rhinorrhea was on average 21.0 before the injection of BTA, decreased in 4 patients over the course of time, and was on average 5.8 after 14 days. No patient reported any adverse effects after the injection of BTA. CONCLUSIONS: This pilot study demonstrates that septal injection of BTA in patients with IR can achieve good symptom control and patient comfort and should be compared in further studies to the conventional turbinal injection technique.

Short-term audiologic effect of intratympanic gadolinium contrast agent application in patients with Ménière's disease.

OBJECTIVES: The aim of this study was to assess whether gadolinium-based contrast agent influences short-term hearing function in patients with Ménière's disease undergoing intratympanically enhanced inner-ear magnetic resonance imaging. DESIGN: This is a prospective cohort study. SETTING: This study was conducted a tertiary referral university hospital, ENT department. PARTICIPANTS: In this study, 21 adult patients with definite, unilateral Ménière's disease were included. According to the criteria of the Committee on Hearing and Equilibrium, all patients were in stage 1 or 2 of the disease, with largely preserved hearing function. OUTCOMES: All patients underwent clinical and audiologic testing before and 24 hours after intratympanic application of gadolinium-based contrast agent. The effects of the contrast medium on the hearing function were assessed by analysis of frequency thresholds, pure-tone average from 500 Hz to 3 kHz, and speech audiometry. RESULTS: Pure-tone average and single-frequency thresholds in audiometry showed no statistically significant difference after the application of intratympanic gadolinium-based contrast agent. Furthermore, speech audiometry scores remained stable after the application of the contrast agent. CONCLUSIONS: This study did not demonstrate clinically significant short-term effects of intratympanic application of gadolinium-based contrast agent on hearing function in patients with Ménière's disease in initial stages.

In vivo visualization of endolyphatic hydrops in patients with Meniere's disease: correlation with audiovestibular function.

Our objective is to determine whether the degree of endolymphatic hydrops as it is detected in vivo in patients with definite Meniere's disease correlates with audiovestibular function. In this prospective study, 37 patients with definite Meniere's disease according to AAO-HNS criteria were included. Intratympanic contrast enhanced temporal bone MRI was performed using a 3D FLAIR protocol. The degree of endolymphatic hydrops in the cochlea and the vestibulum was graded on a Likert scale (0-3). The degree of hydrops was then analyzed with respect to its correlation with audiometric hearing levels, electrocochleographic SP/AP ratios, interaural amplitude ratios of vestibular evoked myogenic potentials and degree of horizontal semicircular canal paresis on caloric irrigation. There was a significant correlation between the degree of hydrops on the one hand and the averaged hearing level at 0.25-1 and 0.5-3 kHz and the vestibular evoked myogenic potential interaural amplitude ratio on the other hand. A trend toward a correlation was noticed between the hydrops and the caloric response, no correlation was noticed between the hydrops and the SP/AP ratio. The degree of endolymphatic hydrops correlates with a progressive loss of auditory and sacculus function in patients with Meniere`s disease.

Difference in outcome of botulinum toxin treatment of essential palatal tremor in children and adults.

PURPOSE: The objective of this clinical study was to investigate the history and clinical findings in 10 patients having an essential palatal tremor. Furthermore, a botulinum toxin A (BTA) therapy in 5 cases was carried out, and the outcome was analyzed. MATERIALS AND METHODS: Seven adult and 3 pediatric patients with essential palatal tremor were examined at presentation, before and after start of treatment, and every 3 months or when symptoms recurred. Findings were documented by endoscopic video recordings, electromyography, tympanometry, and ear canal microphone recording. The BTA injections were performed in local or general anesthesia, under elecromyographic guidance. RESULTS: The BTA therapy in all 5 patients was successful. Surprisingly, 2 of these patients, aged 10 and 6 years, remained in remission for several years after a single successful injection. CONCLUSION: Botulinum toxin therapy is a safe and effective treatment of essential palatal tremor and seems to be especially useful in pediatric patients. The long lasting effect in children hints toward a pathophysiologic difference between pediatric and adult essential palatal tremor.

Patient benefit from treatment with botulinum neurotoxin A for functional indications in otorhinolaryngology.

The objective of the study was to evaluate patient benefit and health-related quality of life after use of botulinum neurotoxin (BoNT) A for various otorhinolaryngological, functional (non-cosmetic) indications. The design consisted of a survey study of a patient cohort (n = 40) treated with BoNT A for functional indications. Patients were asked to answer the Glasgow Benefit Inventory (GBI), a retrospective questionnaire well validated for measuring the effect of otorhinolaryngological interventions on the health-related quality of life. GBI scores can range from -100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). A total of 29 patients (72.5%) returned a valid questionnaire. Mean total GBI scores for the particular indications were 1.2 (sialorrhea, n = 7), 22.6 (gustatory sweating, n = 8), 20.6 (palatal tremor, n = 5), 15.0 (postlaryngectomy voice disorders due to pharyngoesophageal spasm, n = 5), 38.9 (adductor spasmodic dysphonia, n = 2) and 27.8 (oromandibular dystonia, n = 2), showing a mean overall positive effect of BoNT A treatment on the health-related quality of life, respectively. A varying percentage of patients reported an increase in their health-related quality of life, indicated by positive total GBI scores: sialorrhea 28.6%, gustatory sweating 87.5%, palatal tremor 60%, postlaryngectomy voice disorders 60%, spasmodic dysphonia 100% and oromandibular dystonia 100%. Use of BoNT A can be considered an effective therapeutic option for all the indications investigated. However, the possibility of raising patients' health-related quality of life with this kind of therapy varies significantly for different indications. Further studies are needed to analyze the patients who will benefit most from a treatment with BoNT A.

Identification of risk factors for residual cholesteatoma in children and adults: a retrospective study on 110 cases of revision surgery.

INTRODUCTION: Residual disease after cholesteatoma removal is still a challenge for the otorhinolaryngologist. Scheduled "second-look" surgery and, more recently, radiological screenings are used to identify residual cholesteatoma as early as possible. However, these procedures are cost-intensive and are accompanied by discomfort and risks for the patient. OBJECTIVE: To identify anamnestic, clinical, and surgery-related risk factors for residual cholesteatoma. METHODS: The charts of 108 patients, including children as well as adults, having undergone a second-look or revision surgery after initial cholesteatoma removal at a tertiary referral hospital, were analyzed retrospectively. RESULTS: Gender, age, mastoid pneumatization, prior ventilation tube insertion, congenital cholesteatoma, erosion of ossicles, atticotomy, resection of chorda tympani, different reconstruction materials, and postoperative otorrhea did not emerge as statistically significant risk factors for residual disease. However, prior adenoid removal, cholesteatoma growth to the sinus tympani and to the antrum and mastoid, canal-wall-up 2 ways approach, and postoperative retraction and perforation were associated with a statistically higher rate of residual disease. A type A tympanogram as well as canal-wall-down plus reconstruction 2 ways approach for extended epitympanic and for extended epitympanic and mesotympanic cholesteatomas were associated with statistically lower rates of residual disease. A score including the postoperative retraction or perforation of the tympanic membrane, the quality of the postoperative tympanogram and the intraoperative extension of the cholesteatoma to the sinus tympani and/or the antrum was elaborated and proved to be suitable for predicting residual cholesteatoma with acceptable sensitivity and high specificity. CONCLUSION: Cholesteatoma extension to the sinus tympani, antrum and mastoid makes a residual disease more likely. The canal-wall-down plus reconstruction 2 ways approach seems safe with similar rates of residual cholesteatoma and without the known disadvantages of canal-wall-down surgery. The described score can be useful for identifying patients who need a postoperative radiological control and a second-look surgery.

Influence of cochlear implantation on sacculus function.

OBJECTIVES: To examine the influence of cochlear implantation (CI) on the sacculus function and to analyze a possible correlation with resulting vertigo symptoms. METHODS: In a prospective study including 25 patients undergoing CI, preoperative and postoperative assessment of vestibular evoked myogenic potentials (VEMP), caloric horizontal semicircular canal (hSCC) response, and subjective vertigo symptoms were assessed. The patients with postoperative vertigo were compared to the patients without postoperative vertigo with regard to the findings of VEMP responses and caloric testing. RESULTS: Nine patients reported postoperative vertigo. Before surgery, eight of 23 patients (35%) had regular VEMP responses. Two months after CI, four patients had a new loss of sacculus function on VEMP testing. The CI represents a significant risk factor for sacculus impairment. In seven of 12 patients with preoperatively preserved caloric response, this decreased after the operation. The impaired vestibular function did not correlate with vertigo symptoms. When comparing the patient group with vertigo and the group without vertigo after CI, there is a significant difference in the patients' age. CONCLUSIONS: Although CI can cause damage to sacculus and hSCC function, this is probably not the only cause for postoperative vertigo. Advanced age is a significant risk factor for vertigo after CI.

Botulinum toxin A prolongs functional durability of voice prostheses in laryngectomees with pharyngoesophageal spasm.

PURPOSE: Laryngectomized patients with pharyngoesophageal spasm frequently have poor voice quality and dysphagia. Local botulinum toxin A (BTA) injection can relieve muscular hypertonicity and improve symptoms. This procedure should also prolong the functional life span of the tracheoesophageal voice prosthesis. MATERIALS AND METHODS: This study evaluates 33 BTA treatments in 11 laryngectomees. All patients were having poor voice quality; 6 patients had additional dysphagia. In 10 patients, the BTA injection has been carried out during rigid pharyngoscopy under general anesthesia. One patient was treated in local anesthesia. RESULTS: A subjective improvement of voice quality was reported in 94%. This lasted on average for 20 weeks. The swallowing function improved moderately. For the first time, the functional life span of voice prostheses was examined. After treatment of pharyngoesophageal spasm, their durability was almost tripled. The BTA therapy has a significant effect. CONCLUSIONS: The BTA treatment improves voice quality and prolongs functional durability of voice prostheses in laryngectomees with pharyngoesophageal spasm. The success of treatment is of limited duration but can be repeated in the long-term.

Effect of cochlear implantation on horizontal semicircular canal function.

The objective of this study was to assess the influence of a cochlear implant (CI) on horizontal semicircular canal (hSCC) function, to test the correlation with symptomatic vertigo and to identify possible risk factors for a postoperative vestibular impairment. In a prospective observational study design, forty-seven adult patients who had undergone cochlear implantation at Cochlear Implant Center at a tertiary referral university hospital, Munich, between 2003 and 2007, were studied. Postoperative vertigo symptoms were assessed using a questionnaire followed by a structured interview. Patients were subjected to caloric and rotational chair vestibular function tests pre- and postoperatively. The CI operation was performed with a retroauricular transmastoidal approach by three different surgeons. Thirty-six implants were Cochlear Nucleus 24 devices and 11 implants were MedEl devices. Twenty-one (45%) patients reported vertigo symptoms after CI. Functional testing of the hSCC yielded valid results in 45 of the 47 patients. Thirty-two percent of patients had a substantially reduced hSCC function after CI. Responses of caloric irrigation showed a significant worsening postoperatively in the CI ears. No direct correlation between a decrease in caloric response and risk of postoperative vertigo symptoms could be established. For the criteria age, sex, implant type, surgeon, cause of deafness, petrous bone CT findings and preoperative vertigo, there were no significant differences between the patients with and the patients without postoperative vertigo. Besides morphological changes, a cochlear implantation also causes functional damage of vestibular parts of the labyrinth. Our study showed a significant worsening of the caloric response. However, this alteration did not lead to vertigo complaints in all patients. It is therefore presumed that additional damage to sensory or visual afferents and central vestibular compensatory mechanisms play a role.