Structured reports of videofluoroscopic swallowing studies have the potential to improve overall report quality compared to free text reports.

PURPOSE: To compare free text (FTR) and structured reports (SR) of videofluoroscopic swallowing studies (VFSS) and evaluate satisfaction of referring otolaryngologists and speech therapists. MATERIALS AND METHODS: Both standard FTR and SR of 26 patients with VFSS were acquired. A dedicated template focusing on oropharyngeal phases was created for SR using online software with clickable decision-trees and concomitant generation of semantically structured reports. All reports were evaluated regarding overall quality and content, information extraction and clinical decision support (10-point Likert scale (0 = I completely disagree, 10 = I completely agree)). RESULTS: Two otorhinolaryngologists and two speech therapists evaluated FTR and SR. SR received better ratings than FTR in all items. SR were perceived to contain more details on the swallowing phases (median rating: 10 vs. 5; P < 0.001), penetration and aspiration (10 vs. 5; P < 0.001) and facilitated information extraction compared to FTR (10 vs. 4; P < 0.001). Overall quality was rated significantly higher in SR than FTR (P < 0.001). CONCLUSION: SR of VFSS provide more detailed information and facilitate information extraction. SR better assist in clinical decision-making, might enhance the quality of the report and, thus, are recommended for the evaluation of VFSS. KEY POINTS: • Structured reports on videofluoroscopic exams of deglutition lead to improved report quality. • Information extraction is facilitated when using structured reports based on decision trees. • Template-based reports add more value to clinical decision-making than free text reports. • Structured reports receive better ratings by speech therapists and otolaryngologists. • Structured reports on videofluoroscopic exams may improve the comparability between exams.

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.

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.

Prevalence and characteristics of preoperative balance disorders in cochlear implant candidates.

OBJECTIVES: The aim of this study was to elucidate the frequency and characteristics of preoperative vertigo symptoms in patients who undergo cochlear implantation (CI), in order to differentiate them from CI-related symptoms. METHODS: In a prospective observational study, 47 adult CI candidates were asked about vertigo problems on a questionnaire. A subdivision into 3 groups was done: group A (probable otogenic vertigo), group B (possible otogenic vertigo), and group C (not otogenic vertigo). Horizontal semicircular canal function was measured. Patients with vertigo complaints were compared to patients without vertigo with regard to the presence of abnormal vestibular function findings. RESULTS: Twenty-five patients (53%) reported preoperative vertigo problems. In 21 (84%), the patient's history suggested a probable (group A) or possible (group B) otogenic origin. Patients with vertigo more often had abnormal findings on vestibular function testing than did patients without vertigo. This difference, however, was not statistically significant. CONCLUSIONS: A considerable number of CI candidates have preoperative vertigo symptoms. These cannot be explained by horizontal semicircular canal function alone. In order to understand why CI patients develop postoperative vertigo, analysis of prospective preoperative vestibular function test findings and vertigo symptoms is necessary.

Spectrum of novel mutations found in Waardenburg syndrome types 1 and 2: implications for molecular genetic diagnostics.

OBJECTIVES: Till date, mutations in the genes PAX3 and MITF have been described in Waardenburg syndrome (WS), which is clinically characterised by congenital hearing loss and pigmentation anomalies. Our study intended to determine the frequency of mutations and deletions in these genes, to assess the clinical phenotype in detail and to identify rational priorities for molecular genetic diagnostics procedures. DESIGN: Prospective analysis. PATIENTS: 19 Caucasian patients with typical features of WS underwent stepwise investigation of PAX3 and MITF. When point mutations and small insertions/deletions were excluded by direct sequencing, copy number analysis by multiplex ligation-dependent probe amplification was performed to detect larger deletions and duplications. Clinical data and photographs were collected to facilitate genotype-phenotype analyses. SETTING: All analyses were performed in a large German laboratory specialised in genetic diagnostics. RESULTS: 15 novel and 4 previously published heterozygous mutations in PAX3 and MITF were identified. Of these, six were large deletions or duplications that were only detectable by copy number analysis. All patients with PAX3 mutations had typical phenotype of WS with dystopia canthorum (WS1), whereas patients with MITF gene mutations presented without dystopia canthorum (WS2). In addition, one patient with bilateral hearing loss and blue eyes with iris stroma dysplasia had a de novo missense mutation (p.Arg217Ile) in MITF. MITF 3-bp deletions at amino acid position 217 have previously been described in patients with Tietz syndrome (TS), a clinical entity with hearing loss and generalised hypopigmentation. CONCLUSIONS: On the basis of these findings, we conclude that sequencing and copy number analysis of both PAX3 and MITF have to be recommended in the routine molecular diagnostic setting for patients, WS1 and WS2. Furthermore, our genotype-phenotype analyses indicate that WS2 and TS correspond to a clinical spectrum that is influenced by MITF mutation type and position.

Influence of cochlear implantation on peripheral vestibular receptor function.

OBJECTIVE: The objectives of this study were 1) to assess the influence of a cochlear implantation on peripheral vestibular receptor function in the inner ear in the implant and in the nonimplant side, and 2) to analyze a possible correlation with resulting vertigo symptoms. STUDY DESIGN: Prospective clinical study. SETTING: Cochlear implant center at tertiary referral hospital. SUBJECTS AND METHODS: A total of 32 patients, aged 15 to 83 years, undergoing cochlear implantation were assessed pre- and postoperatively for caloric horizontal semicircular canal response and vestibular-evoked myogenic potentials of the sacculus, and postoperatively for subjective vertigo symptoms. Patients with vertigo were compared with patients without symptoms with regard to the findings of the vestibular function tests. RESULTS: Cochlear implantation represents a significant risk factor for horizontal semicircular canal impairment (P < 0.001) and sacculus impairment (P = 0.047) in the implanted ear. In eight of 16 patients with preoperatively preserved caloric response, this response was decreased postoperatively. Before surgery, 14 of 30 patients had regular vestibular-evoked myogenic responses. Two months after implantation, six patients had a new loss and another six showed depression of sacculus function on vestibular-evoked myogenic potentials testing. The impaired vestibular function did not correlate with vertigo symptoms. Function on the contralateral side remains unaffected (P > 0.05). CONCLUSION: Cochlear implantation is a relevant risk factor for damage of peripheral vestibular receptor function. Therefore, preservation not only of residual hearing function but also of vestibular function should be aimed for, by using minimally invasive surgical techniques.