[Communication and noise. Speech intelligibility of airplane pilots with and without active noise compensation]. / Kommunikation und Lärm. Sprachverständnis bei Luftfahrzeugführern mit und ohne aktive Lärmkompensation.

Noise exposure measurements were performed with pilots of the German Federal Navy during flight situations. The ambient noise levels during regular flight were maintained at levels above a 90 dB A-weighted level. This noise intensity requires wearing ear protection to avoid sound-induced hearing loss. To be able to understand radio communication (ATC) in spite of a noisy environment, headphone volume must be raised above the noise of the engines. The use of ear plugs in addition to the headsets and flight helmets is only of limited value because personal ear protection affects the intelligibility of ATC. Whereas speech intelligibility of pilots with normal hearing is affected to only a smaller degree, pilots with pre-existing high-frequency hearing losses show substantial impairments of speech intelligibility that vary in proportion to the hearing deficit present. Communication abilities can be reduced drastically, which in turn can affect air traffic security. The development of active noise compensation devices (ANC) that make use of the "anti-noise" principle may be a solution to this dilemma. To evaluate the effectiveness of an ANC-system and its influence on speech intelligibility, speech audiometry was performed with a German standardized test during simulated flight conditions with helicopter pilots. Results demonstrate the helpful effect on speech understanding especially for pilots with noise-induced hearing losses. This may help to avoid pre-retirement professional disability.

[Immunology and deafness. Manifestations of relapsing polychondritis in the ENT area. A case report]. / Immunologie und Ertaubung. Manifestation der rezidivierenden Polychondritis im HNO-Bereich. Ein Fallbericht.

Relapsing polychondritis is a rare episodic systemic disorder characterised by recurrent, widespread, and potentially destructive inflammatory lesions involving cartilaginous structures, the cardiovascular system, and organs of special sense, such as the eyes and ears. Although the aetiology is unknown and its pathogenesis is incompletely understood, experimental evidence strongly suggests that immunological mediated mechanisms are operative. The following case report adds some considerations to the discussion about the immunopathology of the inner ear.

[Allergic reaction in therapy with naftidrofuryl (Dusodril). A case report]. / Allergische Reaktion bei Therapie mit Naftidrofuryl (Dusodril). Ein Fallbericht.

There are many drugs marketed for the purpose of altering vascular blood flow in various regions, especially of the central nervous system and in peripheral arterial insufficiency. More than 50 different methods are described for the treatment of sudden deafness. Considerations of the therapy of sudden deafness are influenced by the fact that the cause of the disease is unknown. The dysfunction of the hair-cells of the organ of CORTI is thought to be caused by a deficit of oxygen due to disorders of micro-circulation in the inner ear. The infusion of vaso-active drugs in the early state of disease can lead to a remarkable improvement of hearing whereas the prospect of improvement without treatment remains uncertain. Nevertheless it may be difficult to distinguish the beneficial effects of vasodilator agents from spontaneous improvement. Naftidrofuryl oxalate (dusodril) has been in use for many years and proved its therapeutic value in many studies. It is regarded as non-toxic and is used extensively in Europe. Side effects are only reported rarely, and include decrease of cerebral blood flow, abdominal distension, diarrhoea, oesophageal ulceration, epileptic seizures, aphasia, disturbances of consciousness, hypotension, hypertensive crisis, vertigo and dizziness, depression of cardiac conduction, thrombophlebitis, and allergy. This case report of allergic reaction in a young female patient demonstrates that the intravenous application of this drug may lead to severe complications.

[Risk of noise-induced hearing loss caused by radio communication? Audiologic findings in helicopter crews and pilots of propeller airplanes]. / Lärmschwerhörigkeitsrisiko durch Sprechfunkverkehr? Audiologische Befunde bei Hubschrauberbesatzungen und Piloten von Propellerflugzeugen.

The affects of noise on the human inner ear have been well known for a long time, and measures to prevent occupational noise-induced hearing loss show a clear reduction in the statistics of morbidity. Nevertheless, there are working environments in which the use of ear protection seems to be inapplicable, because communication by speech is indispensable, for example in the cockpit of aircraft. Noise exposure measurements were performed on pilots of helicopters and propeller-machines of the German Federal Navy during realistic flight situations. The ambient noise levels during regular flight service were maintained at levels between 89 dB and 120 dB. Sound protection by flight-helmets and headphones is not only neutralised while using radio and intercom, but the noise during radio-communication is even louder than the noise of the engines. The use of ear protection to avoid excessive noise exposure is only of limited effectiveness. While pilots with normal hearing show only little impairment of speech intelligibility, those with noise-induced hearing loss show substantial impairment that varies in proportion to their hearing loss. Communication abilities may be drastically reduced which may compromise the reliability of radio-communication. The problem may be possibly solved in future by an electronic compensation system for noise.

Frequency selectivity and psychoacoustic tuning curves in old age.

Frequency selectivity represents an important contributory factor in the understanding of human speech. It refers to the ability of the ear to discriminate between two simultaneously occurring sounds of different spectral composition. The capabilities of frequency selection, time pattern analysis, and information processing can be determined generally only by speech audiometry. Schorn and co-workers (1977) published a simplified method for audiological investigations whereby results obtained at two different frequency values are sufficient. The test tone frequencies of 0.5 and 4 kHz were selected because they are representative of the frequency range of normal speech. To determine the influence of ageing on frequency selectivity we investigated three groups of patients between the ages of 20-30, 40-50 and 60-70 years. All of the subjects had normal hearing according to ISO 7029 standards. The measurements of pure-tone audiometry, speech audiometry, and the psychoacoustic tuning curves were performed sequentially on the same day. The influence of ageing on frequency selectivity mainly concerns frequencies above 2 kHz. This is related to the progressive loss of outer hair cells in the basal parts of the cochlea in old age. Our investigations show that particular attention must be paid to a loss of frequency selectivity in old age. This becomes evident mainly after the 60th year. Frequency selectivity is not significantly disturbed before that age, although pure tone audiograms show high frequency inner ear hearing loss earlier in life.

Smoking habits in patients with sudden hearing loss. Preliminary results.

Tobacco, especially its content of nicotine, is a drug that has a powerful seductive effect and a dangerous risk of dependence. It is well known that smoking of cigarettes in the industrialized countries of Europe neutralizes an essential part of medical success in that tobacco-induced shortening of life is estimated to equal the possible medical extension of life. Nicotine is the best explored component of tobacco and its effects on heart circulation have been investigated by many research groups. Cigarette smoking raises the body's need for oxygen, because the carbon monoxide that is always inhaled with the smoke partially blocks the haemoglobin. Though acute and combined effects of nicotine and carbon monoxide have been established chronic diseases of the smoker cannot fully be declared. An attempt was made to define some correlation between smoking habits and the risk of a sudden hearing loss. All the patients who were treated in our clinic because of sudden hearing loss were asked to complete a questionnaire anonymously in order to get more reliable answers. However, the outcome was not very encouraging. Only three quarters of our patients responded to the questions, of these only 29% were smokers. However, half of the non-smokers were former smokers. The data are discussed in relation to other investigations.

[Implantable bone conduction hearing aids]. / Implantierbare Knochenleitungshörgeräte.

Conventional extern bone conduction hearing aids often cause retroauricular pain by compression of the skin, distortion is enhanced by the vibrational pattern and feedback can be a problem and, last but not least, do not fit into cosmetic schemes. We report about experiences with 2 different systems of partly implantable bone conduction hearing aids which were designed to overcome the technical, audiological and cosmetical problems of conventional bone conduction hearing aids. There is a transcutaneous and a percutaneous system discussed. Clinical experiences demonstrate that the percutaneous system is superior in both objective hearing gain and patient acceptance.

[Differential diagnosis of medial neck tumors. 2 cases of thyroid malignancy]. / Zur Differentialdiagnose der medialen Halstumoren. Zwei Fälle von Schilddrüsenmalignomen.

Mobile swellings in the neck are a frequent finding in Ear Nose and Throat practice. Any such swelling demands a thorough investigation since there are many possible causes. In doubtful cases, histological examination is necessary. Two cases are presented in which small mobile nodes in the mid-line of the neck, anterior to the larynx, were the presenting symptom of a thyroid carcinoma. The laboratory findings and thyroid scan were normal in these two patients.

[Evaluation of sonography in diseases of the paranasal sinuses]. / Die Bewertung der Sonografie bei Erkrankungen der Nebenhöhlen.

The diagnosis of disorders of the paranasal sinuses by ultrasound has grown in importance during the last few years and has become easier due to developments in ultrasonic equipment. Nevertheless it seemed to be necessary to evaluate the advertising claims that the method is as reliable as radiography in the diagnosis of pathological conditions of the paranasal sinuses. We investigated 188 maxillary sinuses of adults by sinuscopy and compared the findings to those of radiography and ultrasound. The results are given and discussed.

[A case of olfactory neuroblastoma and Marcumar therapy (author's transl)]. / Uber ein Olfaktorius-Neuroblastom und Marcumar-Therapie.

Although nasal polypectomy is a frequently performed procedure in ENT Clinics, tissues taken may only seldom be histologically examined. We have recently uncovered an esthesioneuroblastoma during a routine polypectomy, and believe that even slightly changed "polyps" or fleshy or pinkish-gray appearing "polyps" seen with dicumarol therapy may mask tissue malignancy.

[Experience with surgical therapy in snoring and sleep apnea]. / Erfahrungen mit einer operativen Therapie bei Schnarchen und Schlafapnoe.

Knowledge of the connection between habitual snoring diseases and obstructive sleep apnoea has stimulated research into sleep disturbance in patients at high risk of cardiovascular disease. Any disturbance of nasal ventilation leads to a higher resistance to breathing and may cause cardiovascular complications in the long run. Anatomical and functional conditions that lead to intermittent incomplete blockage or complete occlusion of the upper respiratory tract must be detected and surgically eliminated, if possible. Surgical procedures for treating snoring and obstructive sleep apnoea may be successful and fill the gap between conservative treatment and continuous nasal positive airway pressure therapy. Our experience in 24 patients in presented.

[Cochlear implant for children? Possibilities--risks--prerequisites]. / Kochleaimplantat für Kinder? Möglichkeiten--Risiken--Voraussetzungen.

The development of scientific, technical, medical and psychological knowledge of human hearing and communication has reached a point where it seems possible to liberate totally deaf patients from their acoustic isolation. For some of them there is now reasonable hope that, to a certain degree, hearing and speech may be restored by the use of a cochlear implant. The cochlear implant is a device which directly stimulates the auditory nerve via electrical stimuli and in doing so mimics the function of the auditory system transmitting sound information to the central hearing pathways. It is expected that the human brain is able to "read" this message and, for example, to understand speech. But there are very special risks regarding implantation in children which are reviewed and discussed. Preconditions that have to be met to ethically, justify this experiment are stated, aiming at achieving maximum benefit for the child.

[Early detection of hearing disorders. A simple method of mass screening in newborn infants]. / Zur Früherkennung von Hörstörungen. Eine einfache Methode der Reihenuntersuchung bei Neugeborenen.

The necessity of early detection and rehabilitation of hearing impaired children is accepted worldwide, but there are still different opinions about the earliest possible time and the kind of examinations in the Federal Republic of Germany. We report our method of examination of neonates, our results and our conclusions. We think that our method is very simple, easy, quick and can be done by well trained personnel. It is reliable enough to filter out suspicious cases, allowing audiological investigation and treatment, if necessary.

[Septum deviation and concomitant sinusitis]. / Septumdeviation und Begleitsinusitis.

It is generally assumed that there is a relation between nasal obstruction due to deformities of the nasal septum and disease of the paranasal sinuses. We investigated patients with septal deviation and rhinomanometrically determined nasal obstruction and checked the sinuses before septal surgery by radiography, ultrasonography, and endoscopy. The results of our investigation on 150 unselected patients during 1983 support the hypothesis. We found that non-invasive diagnostic methods, i.e. radiography and ultrasound were sufficiently reliable. Furthermore we found that more men are afflicted with deformities of the nasal septum than women. Nearly half of the number of patients needed therapy for the paranasal sinuses. Therefore preoperative diagnosis of sinusitis is essential before nasal septum surgery.

[Early detection of hearing disorders. 10 years experience with screening more than 8,000 infants]. / Früherkennung von Hörstörungen. 10jährige Erfahrung mit einem Screening bei mehr als 8000 Säuglingen.

Prevention and early detection of deficits of the developing human being demand more and more complex solutions. Screening programmes have been developed to detect deficits and diseases before they cause symptoms. A well-organised and accurately performed screening programme can detect preliminary signs of diseases and may prevent irreversible damage. Early detection of deficits only makes sense if it is followed by consequences. Not only early detection of impairment or of children which are threatened by impairment is a very important medical task, but also the interdisciplinary cooperation in therapy. The most serious impact of hearing deficits in newborn is on the lack of speech-acquisition. It is an indisputable fact that the early detection of hearing impairment in newborn markedly improves the prognosis for further language development if early medical and/or rehabilitative therapy takes place. The following description of 10 years of experience with a newborn hearing screening programme that is effected in cooperation with the maternity ward and the ENT-clinic since 1981, can supply further arguments in favour of the need for early detection, the discussion on reflex audiometry, and to emphasise the need for cooperation of all relevant specialists.

[Duration and complications following grommet insertion in childhood]. / Verweildauer und Komplikationen nach Paukenröhrcheneinlage im Kindesalter.

We report 1000 insertions of ventilation tubes in 534 children for secretory otitis media (SOM) within a period of 6 years. In 77.5% of the cases, the air-bone gap was greater than 20 dB. The grommets are allowed to undergo spontaneous expulsion which happened in 319 ears, about 7 months after insertion. SOM recurred in 32.6% of the cases once, in 5.0% of the cases twice, and in 1.9% three times, requiring re-insertion of grommets. Recurrence appeared between 4 and 65 months after the first insertion. In three cases perforations of the tympanic membrane persisted and required tympanoplasty. Tympanometric examination and pure tone audiometry are necessary, in addition to pure tone audiometry to follow up successfully ventilated middle ears and to show recurrence as early as possible. Pre-existing but unsuspected sensorineural hearing loss was discovered in 10 cases. The deprivation of neural auditory pathways in early childhood and the possible retardation of speech development caused by SOM are mentioned. Normal hearing is the most important goal of therapy in children suffering from SOM, and insertion of ventilation tubes is the preferred method of achieving that goal safely. Adenoidectomy and treatment of upper airway infections are indispensable parts of the therapy of SOM. Regular follow up after insertion of grommets and even after their expulsion is necessary because of the high rate of late recurrence of SOM. Induction of cholesteatoma by grommets was not observed.

[Clinical, histologic and bacteriologic findings in peritonsillar abscess]. / Klinische, histologische und bakteriologische Befunde beim Peritonsillarabszess.

Peritonsillar abscesses are the main complication of chronic inflammation of the tonsils. They should be considered as emergency cases and require quick and adequate treatment. Although abscess tonsillectomy has been reported since 1932, there is still a vivid discussion about this method of choice. We report on our experiences and findings in 284 cases of peritonsillar abscess. Our experiences show that theoretical considerations against this method of surgical treatment are smaller than the advantages for the patient. The authors recommend abscess tonsillectomy at one time and on both tonsils as treatment of choice in peritonsillar abscess without restriction.

[Is there a correlation between sudden deafness and smoking?]. / Besteht ein Zusammenhang zwischen Hörsturz und Tabakrauchen?

BACKGROUND: The etiology of sudden hearing loss is not yet known. The most common mechanism of sudden hearing loss would appear to be impaired cochlear blood circulation. Tobacco smoking causes changes in hemostasis and raises the body's need for oxygen because of carbon monoxide, one component of the smoke which blocks a part of the hemoglobin. PATIENTS AND METHODS: 297 patients (76 smokers, 99 former smokers, and 122 non smokers) who were treated because of sudden hearing loss in the hospital in the last 5 years were queried about their smoking habits. We asked the patients to complete a questionnaire in order to get more reliable answers. We explored the kind of tobacco, the number of cigarettes or cigars per day, the age at onset of smoking, the number and rate of recurrence of sudden hearing loss, the result of the treatment of a former sudden hearing loss (if there was one), the characteristics of tinnitus, the possibility of stopping smoking, and the significance of tobacco smoking as reflected in health policy. RESULTS: Tobacco smoking does not increase the overall risk of sudden hearing loss. The incidence of smokers in the population of the region and the incidence of smokers among patients with sudden hearing loss is equal. But the average age of the smoking patients is significantly lower than the average age of non smokers and former smokers. Smokers have a higher rate of recurrence of a sudden hearing loss. The result of treatment of former sudden hearing loss is worse in smoking patients. CONCLUSIONS: There is no obvious relation between the risk of sudden hearing loss and tobacco smoking.

[The place of rhinomanometry in septum surgery]. / Zur Stellung der Rhinomanometrie in der Septumchirurgie.

On 141 patients the nasal ventilation was measured by anterior rhinomanometry the day before septal surgery according to Cottle. 71 patients could be controlled in mean 54 days after surgery. 59 rhinomanometric measurements could be compared concerning nasal ventilation before and after surgery. There was statistically significance for improvement of nasal ventilation as well as symmetry. The method of anterior rhinomanometry is well suited to document and compare the nasal function in septal surgery for clinical interests.

[Subjective assessment of acute tinnitus and proposal of a tinnitus score]. / Subjektive Einschätzung akuter Ohrgeräusche und Vorschlag für einen Tinnitus-Score.

BACKGROUND: Frequency, loudness and the level for masking of tinnitus of many patients can be measured. The measured parameters and the subjective feelings of the patients often do not correlate. METHODS: In a prospective study the subjective experiences of symptoms of 34 in-patients with acute tinnitus without hearing loss were analysed. The patients were asked before, during, immediately after and 3 years after therapy to fill in a form each. 4 questions allowed to assume the complaints to categories, 4 times the patients were asked to mark the intensity of their complaints on horizontal visual analogue scales. Each question scored from 0 to 5 points, a total score from 0 to 40 is possible. RESULTS: The therapy improved all parameters, the score improved from 23.0 to 14.7. The introduced questionnaire and the score allow a detailed documentation of the success of the treatment and with it the possibility to compare various approaches of therapy.