[Prevalence, Risk Factors and Diagnostics of Hearing Impairment in Preterm Infants]. / Prävalenz, Risikofaktoren und Diagnostik von Hörstörungen bei Frühgeborenen.

Introduction: The preterm birth is clearly associated with increased risk of developing congenital hearing impairment. Therefore, special attention must be paid to the postnatal control of auditory function in all preterm infants. The present work investigates if the latest scientific findings regarding prevalence, clinical diagnostics, therapy and risk factors of hearing impairment in premature infants are regularly implemented in daily practice. Methods: At the department of phoniatrics and pediatric audiology of the University Hospital of Magdeburg, the treatment data of 126 preterm children born between 2006 and 2011 were evaluated retrospectively. The additional analysis of all records available at the screening center (n=67 640) covering this period enables drawing conclusions on the total number and prevalence of hearing impairment in preterm infants in Saxony-Anhalt. Results: Almost all premature babies, like mature newborns, underwent postnatal hearing screening of both ears. The data analysis shows that the practical implementation often does not comply with the guideline of the G-BA (Gemeinsamer Bundesausschuss) in all details. For example, the recommended screening method for preterm infants (AABR) or the screening and treatment timing are not always applied in accordance with the guidelines of the G-BA. Discussion: Assessment of the practical implementation of universal newborn hearing screening was planned at the time of the introduction of the hearing screening program by the G-BA. As a part of this investigation, the practical care of vulnerable groups such as preterm infants must be given special attention. Based on the collected data, the diagnostics and therapy should be unified. Regardless of the maternity clinic where the infants were born, there should be the same opportunity for early diagnosis and thus for prognostically better treatment of congenital hearing impairment. Rapid postnatal fitting with hearing aid can stimulate the maturation of the central auditory system and potentially help to avoid problems of hearing and speech development.

[What should the (abdominal) surgeon know about ORL/ENT aspects in general (abdominal) surgery]. / Was sollte der (Viszeral-)Chirurg von der HNO wissen - HNO-ärztliche Aspekte in der (Viszeral-)Chirurgie.

The separation of laryngology and rhinology from the medical field and of otology from the surgical field in the 1850s led to the development of an independent field: the ear, nose and throat diseases, head and neck surgery. Therefore, oto-rhino-laryngology (ORL) has its roots in surgery. Concerning this and considering common anatomic circumstances, ORL medical aspects should be relevant to the surgeon. This concerns traumatological cases, the problem of difficult intubation and the common treatment of a series of illnesses of the upper aerodigestive tract, in particular problems of the major tumour surgery.

[Otitis media with effusion : frequency, diagnosis, and therapy in early childhood]. / Seromukotympanon : Häufigkeit, Diagnose und Therapie im frühen Kindesalter.

BACKGROUND: Otitis media with effusion (OME) as the most common cause of hearing loss in childhood plays an important role in the follow-up after failed newborn hearing screening (NHS). The introduction of the NHS allows OME to be diagnosed and treated in the first months of life. MATERIAL AND METHODS: In 715 children referred to the Department of Phoniatrics and Pedaudiology of the Ear, Nose, Throat University Hospital of Magdeburg during the period 2006-2010, the prevalence and therapy process of OME during follow-up could be determined. RESULTS: OME was diagnosed in 16 % of the patients. Spontaneous resolution was observed in 37 % of the cases, while 46 % of the children were treated surgically. A substantially increased risk for persistent OME was observed in children with craniofacial dysmorphia or cleft palate. CONCLUSION: Using NHS, OME can be diagnosed and treated early, thus, preventing potential problems in the linguistic, social and intellectual development of children.

[Advances in endoscopic diagnosis of dysplasia and carcinoma of the larynx]. / Fortschritte der endoskopischen Diagnostik von Dysplasien und Karzinomen des Larynx.

To improve the preoperative and intraoperative diagnosis of laryngeal cancer and its precursors, various endoscopic imaging techniques have been developed in recent years. These techniques differ markedly in their specific applications and goals. Precisely distinguishing among normal mucosa, dysplasia and invasive carcinoma with these procedures is necessary. Furthermore, the exact identification of tumor margins should be possible. The long-term goal is the development of optical biopsy. Since so far there have only been small studies regarding the evaluation of the presented methods, it is necessary to establish multi-center trials with large sample sizes to accurately estimate the value of these endoscopic imaging techniques.

[Recurrent, severe epistaxis in COVID-19 patients]. / Rezidivierende, schwere Epistaxis bei COVID-19-Patienten.

A 12-year-old female patient presented in the emergency room due to spontaneous, recurrent, fulminant epistaxis. As an additional finding a COVID-19-infection was noticed. Persisting hemorrhage led to increasing symptoms of shock. The current literature indicates a clear correlation of a SARS-CoV­2-infection to spontaneous fulminant epistaxis, most likely due to a mucosal inflammation; however, other typical causes must be ruled out.

[Fusobacterium necrophorum--cause of a mastoiditis with skull- and mandibular joint osteomyelitis]. / Fusobacterium necrophorum--Verursacher einer Mastoiditis mit Schädel- und Kiefergelenksosteomyelitis.

BACKGROUND: The typical clinical manifestation of an infection with the obligate anaerobic, gram-negative, rod-shaped bacteria Fusobacterium necrophorum is the Lemierre syndrome. As the cause of osteomyelitis and mastoiditis factors of the normal bacteria flora are more likely to be found than Fusobacterium necrophorum. Nevertheless, Necrobacillosis is an important differential diagnosis of complicated courses of mastoiditis. MATERIAL AND METHODS: Because the clinical courses of mastoiditis with osteomyelitis may differ a lot, making the appropriate diagnosis more difficult, consistently and flawless detection of the pathogens is important. Therefore a correct specimen collection, transportation and the subsequent cultivation of the pathogens is essential. RESULTS: The genus Fusobacterium is an obligate anaerobic, gram-negative rod-shaped bacteria. Infections involving the genus Fusobacterium are usually formed endogenously. They are characterized by subacute to chronic, purulent gangrenous necrotizing inflammations. CONCLUSION: As a differential diagnosis, infections with Streptococcus spp., Haemophilus influenzae, Branhamella catarrhalis and Staphylococcus aureus are more likely to cause mastoiditis and osteomyelitis than an infection with Fusobacterium necrophorum. However, the infection with this fusiform bacillus is possible under pathological circumstances e.g. deficiency syndroms, so that when observing a prolonged disease course of mastoiditis an infection with Fusobacterium necrophorum should be considered .

[An anatomic facsimile model with origin inner ear structures for temporal bone preparations]. / Die Realisierung von anatomischen Felsenbeinfaksimilemodellen mit cochleären Hohlraumstrukturen.

BACKGROUND: Microsurgical dissection exercises are essential in otosurgery training. Human temporal bone specimens are rarely available for necessary extensive preparation steps up to the cochlea. This requires the development of new Anatomical Facsimile Models (AFM) of the temporal bone with its diffizil internal structures. MATERIAL AND METHODS: The construction of AFM was realized by rapid prototyping technologies. Data for processing come from high resolution CT-scans. RESULTS: With the production of AFM true to the original structures of the temporal bone by rapid prototyping methods it was possible to reproduce the very small cavity structures of the inner ear (cochlea, semicircular canals). All cavity structures of the temporal bone, including the middle ear, are constructed without solid support material. This allows the introduction of Cochlea-Implant electrodes into the cochlea. CONCLUSION: The use of modern rapid prototyping technologies enables us to produce any number of identical models of an original specimen. The preparation steps and the material properties correspond to those of the original temporal bone. Therefore AFM are excellent preparation models.

[Differential diagnosis of unilateral necrotic tonsillitis]. / Differenzialdiagnostik der nekrotisierenden Tonsillitis.

BACKGROUND: The best known clinical picture of a one-sided necrotisising, infectious tonsillitis is the by Plaut and Vincent (1894) described angina Plaut-Vincent. In addition to this fusospirochetosis it is in case of necrotisising inflammations in the oropharynx differential-diagnostically important to consider also the anaerobic type Prevotella, especially Prevotella disiens as a potential trigger . MATERIAL AND METHODS: Because the clinical course forms of a necrotisising oropharyngeal inflammations can be very different and complicate so a suitable diagnosis, it is very important to get a complete and perfect cause proof. For getting this proof a correct test production, transport and cultivation are of extreme importance . RESULTS: The type Prevotella consists of different species gram-negative, obligate anaerobic strains. They are regarded as a cause of suppurating inflammations and abscesses of the genital tract and are components of the aerobic anaerobic mixed flora in case of gingival infections. The sole proof in the microbiological culture as a smear test result of a one-sided necrotisising tonsillitis has to be seen as a first description by reason of missing literature . IMPLICATION: As triggers for one-sided necrotisising tonsillitis are considered different causes. Next a carcinoma of the tonsil, Lues, Angina Plaut-Vincent have to be excluded. An infection with Prevotella disiens is an extremely rare variation in contrast. However, the transmission is possible by insufficient hygiene, lack phenomena and sexual intercourse and to consider therefore as an exclusion diagnosis.

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.

[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.

[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.

[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.

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.

[Evaluation of deprivation manifestations of the auditory system in patients with unilateral middle ear deafness before and after surgical therapy]. / Zur Bewertung von Inaktivitätserscheinungen des auditorischen Systems bei Patienten mit einseitiger Mittelohrschwerhörigkeit vor und nach operativer Therapie.

BACKGROUND: This paper will discuss whether long term conductive hearing loss leads to late onset auditory deprivation as described in the literature in patients suffering from bilateral sensorineural hearing loss and fitted with monaural hearing aids. METHOD: The patients were examined using the Freiburg speech test in the undistorted and distorted forms (according to Dieroff 1985), and the pure tone threshold was ascertained for each patient. Thirty-six preoperative und postoperative results after tympanoplasty and stapes surgery were evaluated. Follow-up was performed six weeks and six months postoperatively. Twenty-one test persons with normal hearing were investigated. RESULTS: Comparison showed that the quotient obtained from undistorted and distorted tests is significantly higher in the affected patients. We even observed a highly significant improvement of this quotient, the speech recognition score (according to Bönninghaus/Röser), and the pure tone threshold after surgery. Seventy-eight percent of our patients showed an improved quotient, and 73% attained a normal value. But in only 29% of all cases did we see a symmetrical quotient in both ears in this period of time. In the statistical evaluation, we were unable to demonstrate a correlation between the patient's age at that moment, the age at the beginning of hearing loss, and this echo quotient. There is also no correlation between the absolute and relative change of the echo quotient and the duration of hearing loss. CONCLUSION: It was evident that the distorted Freiburg speech test is a good method to demonstrate the deprivation of the auditory system. We observed the improvement of the distorted Freiburger speech test at postoperative intervals of six weeks and six months. Hearing training should be applied after surgery in an effort to improve the hearing results.

[Postmortem changes in ear canal resonance and tympanic membrane impedance in the human ear]. / Zur Untersuchung postmortaler Veränderungen von Gehörgangsresonanz und Trommelfellimpedanz am menschlichen Ohr.

BACKGROUND: The human temporal bone preparation is a common model for research of physical processes of the ear canal and middle ear. In the past decade only a few reports were published discussing changes of the vibration behaviour of the tympanic membrane, as well as the ear canal resonance, during the time between death and preparation of the temporal bone. The aim of our study is to verify whether measurements at the temporal bone of dead humans can be really applied to the in vivo situation. METHODS: We investigated whether changes of the ear canal resonance and the vibration of the tympanic membrane depend on temperature and time after death. In a female human body we defined the resonance of the outer ear and the impedance of the tympanic membrane using a tympanometer and a real ear measurement system during nine hours post mortem. RESULTS: We were able to prove that before the preparation of the temporal bone none of the parameters changed significantly. CONCLUSIONS: In conclusion, the method of preserving the bone after its preparation is decisive for the validity of measurements at the isolated (post mortem) human temporal bone.

High-speed digital videoimaging of fast eardrum motions during Valsalva maneuver.

Digital high-speed camera systems are used to record high-frequency video-clips. After adapting this technology to the analysis of eardrum motions, fast motions of the eardrum can be recorded using an endoscope. Under specific static pressure conditions during the Valsalva maneuver, recordings of eardrum motions were made. The use of a Kodak Image Ektapro 1000 Motion Analyzer allowed only conventional videosignal processing and storage. A new type of data interface made it possible to save and process the complete video-clip digitally. Using an image-processing workstation and special mathematical algorithms, three-dimensional computer animations of fast eardrum motions under static pressure can be generated. In the present study, several animations of fast eardrum movements are described. High-speed digital videoimaging is an adequate method to describe fast eardrum displacements under static pressure (Valsalva maneuver). It is possible to create visible timeshift images of separate eardrum parts during the fast Valsalva maneuver.

[Methodological aspects of observations of rapid tympanic membrane movements due to changes in static pressure (Valsalva maneuver) using digital high speech video recordings]. / Methodische Aspekte von Beobachtungen schneller Trommelfellbewegungen bei Anderung des statischen Druckes (Valsalva-Manöver) mittels digitaler Hochgeschwindigkeitsvideoaufnahmen.

BACKGROUND: CCD-high speed camera systems are used to record high frequency videoclips. Introducing this technology in the analysis of eardrum motions, fast motions of the eardrum can be taped using an endoscope. METHODS: Records of the eardrum were made under specific static pressure conditions during the Valsalva maneuver. Initial experience with the help of a Kodak image (I 3) Ektapro 1000 Motion Analyzer allowed only conventional video signal processing and storage. A new data interface makes it possible to save and process the complete videoclip digitally. RESULTS: Using an image processing workstation and special mathematical algorithms, three-dimensional computer animations of rapid eardrum motions on static pressure can be performed. The present study describes different animations of fast motion eardrum movements. CONCLUSIONS: Digital high-speed video imaging is a suitable method to describe rapid eardrum motions on static pressure (Valsalva maneuver). It is possible to visualize the motion of the eardrum over time on the fast Valsalva movement at high resolution.

[Correlation between ear canal resonance and tympanic membrane impedance in relation to age and body mass and postmortem changes]. / Untersuchung über Korrelation von Gehörgangsresonanz und Trommelfellimpedanz bezüglich Alter und Körpermassen sowie Veränderungen nach Todeseintritt.

The human temporal bone preparation is an acknowledged model for research of the physical processes affecting the outer ear canal and eardrum. Changes affecting the oscillation and resonance behavior of the tympanic membrane and ear canal between death and temporal bone preparation presently exist in only a few studies. Since the influence of age and physique, as well as the width of ear canal on the ear canal resonance may be important, we prepared two separate studies to analyze these questions. The goal of our first test series involved children and was devised to determine if changes in the outer auditory canal resonances differed according to age. In so doing, canal resonance was recorded with a real ear measurement system. Further, we recorded middle ear pressure, impedance of the tympanic membrane, ear canal volume, height, weight and surface of the body, head and ear size. We found a significant decrease in the resonance frequency of the outer ear which was age-dependent and was 2.75 kHz in the 7-year-old child. In a separate study we wanted to know if results found in the postmortem temporal bone reflected in vivo relationships. A tympanometer and real ear measurement system was used to test the resonance behavior of the auditory canal as well as the vibration of the eardrum in dependence on temperature and the time after death for 9 h. We then proved the absence of significant changes in the auditory canal and eardrum oscillation in this time period before possible postmortem changes occurred. Our findings show that the method of bone preservation after its preparation is decisive for the validity of measurements in the isolated human temporal bone.

[Histological studies of tympanic membrane rim defects in chronic otitis media mesotympanalis]. / Histologische Untersuchungen des Trommelfelldefektrandes bei der chronischen Otitis media mesotympanalis.

In the present study we investigated resected tympanic membranes taken during tympanoplasty. Tissue from 111 patients with chronic otitis media was analyzed after being embedded in paraffin and stained with hematoxylin and eosin. In 67 patients (60%) the tympanic membrane epidermis did not extend beyond the margin of the perforation rim, so that no epithelial migration was observed on the inner side of the tympanic membrane. In 27 specimens (24%) we found an epithelial migration on the inner side of the tympanic membrane, but this did not extend to the margins of the excised tissue. In 17 tissue specimens (16%) epithelial migration extended to the margins of the resected tissue. Clinically, these patients were found to have non-functioning Eustachian tubes. The size of the tympanic membrane perforation was not found to impact on epithelial migration. However, there was a correlation between the extent of the epithelial migration seen in the specimens and the occurrence of a permanent tympanic membrane perforation after tympanoplasty. Of 17 patients with these findings, 4 (23%) had consistent reperforations. The tympanic membrane rims of these patients were completely covered with squamous epithelium. Patients with no or only little epithelial migration to the inner side of the tympanic membrane were found to have a significantly lower postoperative rate of recurrent infection and drum reperforation.

Resonant frequency pattern in multifrequency tympanograms: results in normally-hearing subjects.

This paper presents experimental data on the evaluation of middle ear resonances by multifrequency tympanometry. Multifrequency tympanograms (MFTs) of 18 normally-hearing subjects were recorded with a frequency resolution of 15 Hz. The fine structure found in the MFT patterns was compared with findings in literature. A first approach for the evaluation of this fine structure was made explaining the great variability of the main ossicular resonance frequencies described in previous publications. The consequence of the present investigation is that the concept of the main ossicular resonance has to be revised critically.