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1.
HNO ; 71(6): 356-364, 2023 Jun.
Article in German | MEDLINE | ID: mdl-33599810

ABSTRACT

BACKGROUND: Congenital aural atresia, which is usually unilateral, causes hearing loss and aesthetic impairment. Besides tympanoplasty with/without canalplasty and bone conduction devices, active middle ear implants are also available for functional rehabilitation. OBJECTIVE: This article aims to present a contemporary review on the treatment possibilities for middle ear malformations, with a focus on audiological rehabilitation with the Vibrant Soundbridge. MATERIALS AND METHODS: A selective literature search for treatment possibilities was performed in PubMed up to October 2020, and personal clinical experiences are reported. RESULTS: The Vibrant Soundbridge, which is approved for children ≥ 5 years, is suitable for treatment of middle ear malformations with a Jahrsdoerfer score ≥ 5. Although implantation of a Vibrant Soundbridge is surgically more demanding than implantation of a bone conduction device, the method is safe, delivers good auditory results (superior to bone conduction devices in terms of speech understanding and spatial hearing), does not involve intensive postsurgical care, and rarely requires revision surgery. The Vibrant Soundbridge can be coupled to (remnants of) the ossicular chain or the round window. CONCLUSION: The Vibrant Soundbridge is an appropriate treatment method in patients with middle ear malformations who have suitable anatomical preconditions.


Subject(s)
Ear , Ossicular Prosthesis , Child , Humans , Treatment Outcome , Ear/surgery , Hearing , Ear, Middle/surgery , Ear, Middle/abnormalities
2.
Int J Audiol ; 62(12): 1176-1186, 2023 Dec.
Article in English | MEDLINE | ID: mdl-36036176

ABSTRACT

OBJECTIVE: Subjective promontory stimulation is used to evaluate cochlear implant (CI) candidacy, but the test reliability is low. Electrically evoked auditory brainstem response (EABR) can verify the function of the auditory system objectively. This study's procedure uses a trans-tympanic rounded bent-tip electrode to perform pre-operative EABR under local anaesthesia (LA-TT-EABR) using MED-EL Software and Hardware. This study aimed to determine usability and effectiveness for CI candidates. DESIGN: We hypothesised that LA-TT-EABR waveforms of good quality would be related to successful hearing outcomes. We assumed that the duration of hearing loss/deafness was a confounding factor to study outcomes. STUDY SAMPLE: 19 borderline CI candidates. RESULTS: Positive LA-TT-EABR results were confirmed in 14 patients. LA-TT-EABR's mean latency was 2.05 ± 0.31 ms (eII/eIII) and 4.24 ± 0.39 ms (eIV/eV). Latencies weren't statistically different from intra-operative EABR elicited by basal CI contacts. All positive LA-TT-EABR patients benefitted from CI and speech performance improved one year after implantation. One patient with negative LA-TT-EABR was cochlear-implanted and had no hearing sensation. CONCLUSIONS: LA-TT-EABR is a tool in the frame of pre-operative objective testing the auditory pathway. It seems useful for clinical testing CI candidacy. Based on this study's outcomes, LA-TT-EABR should be recommended for uncertain CI candidates.


Subject(s)
Cochlear Implantation , Cochlear Implants , Humans , Evoked Potentials, Auditory, Brain Stem/physiology , Anesthesia, Local , Auditory Pathways , Reproducibility of Results , Auditory Threshold/physiology
4.
Neurosurg Rev ; 44(6): 3387-3397, 2021 Dec.
Article in English | MEDLINE | ID: mdl-33629235

ABSTRACT

Choroid plexus papillomas (CPPs) are primary neuroectodermal neoplasms that usually arise in the fourth ventricle in adults. In this study, we present 12 patients with CPP arising from the cerebellopontine angle (CPP-CPA) and/or of the cerebellomedullary angle (CPP-CMA) that were treated in our department. Patients who underwent surgery for the treatment for CPP-CPA/CMA from January 2004 to March 2020 were identified by a computer search of their files from the Department of Neurosurgery, Tübingen. CPPs were classified according to their location into type 1 (tumor portion only in the CPA,), type 2 (tumor portions only in the CMA), and type 3 (tumor portions both in the CPA and CMA). Patients were evaluated for initial symptoms, previous therapies in other hospitals, extent of tumor resection, recurrence rate, and complications by reviewing patient documents. Of approximately 1500 CPA lesions, which were surgically treated in our department in the last 16 years, 12 patients (mean age 42 ± 19 years) were found to have CPP-CPA/CMA. Five were male, and seven were female patients. Gross total resection was achieved in nine cases, and a subtotal resection was attained in three cases. Tumor recurrence in the same location after the first surgery in our hospital was observed in 2 patients after 15 and 40 months of follow-up, and in another patient, distant metastases (C3/4 and L3 levels) were observed. Surgical removal of CPP is the treatment of choice, but additional therapeutic options may be necessary in case of remnant tumor portions, recurrence, or malignant transformation.


Subject(s)
Choroid Plexus Neoplasms , Neurosurgery , Papilloma, Choroid Plexus , Adult , Cerebellopontine Angle/surgery , Choroid Plexus Neoplasms/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasm Recurrence, Local , Neurosurgical Procedures , Papilloma, Choroid Plexus/surgery , Young Adult
6.
J Neuroradiol ; 45(1): 32-40, 2018 Feb.
Article in English | MEDLINE | ID: mdl-28865921

ABSTRACT

PURPOSE: To assess the diagnostic performance of normalized and non-normalized diffusion kurtosis imaging (DKI) metrics extracted from different tumor volume data for grading glioma according to the integrated approach of the revised 2016 WHO classification. MATERIALS AND METHODS: Sixty patients with histopathologically confirmed glioma, who provided written informed consent, were retrospectively assessed between 01/2013 and 08/2016 from a prospective trial approved by the local institutional review board. Mean kurtosis (MK) and mean diffusivity (MD) metrics from DKI were assessed by two blinded physicians from four different volumes of interest (VOI): whole solid tumor including (VOItu-ed) and excluding perifocal edema (VOItu), infiltrative zone (VOIed), and single slice of solid tumor core (VOIslice). Intra-class correlation coefficient (ICC) was calculated to assess inter-rater agreement. One-way ANOVA was used to compare MK between 2016 CNS WHO tumor grades. Friedman's test compared MK and MD of each VOI. Spearman's correlation coefficient was used to correlate MK with 2016 CNS WHO tumor grades. ROC analysis was performed on MK for significant results. RESULTS: The MK assessment showed excellent inter-rater agreement for each VOI (ICC, 0.906-0.955). MK was significantly lower in IDHmutant astrocytoma (0.40±0.07), than in 1p/19q-confirmed oligodendroglioma (0.54±0.10, P=0.001) or IDHwild-type glioblastoma (0.68±0.13, P<0.001). MK and 2016 WHO tumor grades were strongly and positively correlated (VOItu-ed, r=0.684; VOItu, r=0.734; VOIed, r=0.625; VOIslice, r=0.698; P<0.001). CONCLUSIONS: Non-normalized MK values obtained from VOItu and VOIslice showed the best reproducibility and highest diagnostic performance for stratifying glioma according to the integrated approach of the recent 2016 WHO classification.


Subject(s)
Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Diffusion Magnetic Resonance Imaging/methods , Echo-Planar Imaging/methods , Glioma/diagnostic imaging , Glioma/pathology , Biopsy , Brain Neoplasms/genetics , Contrast Media , Feasibility Studies , Female , Humans , Image Interpretation, Computer-Assisted , Imaging, Three-Dimensional , Immunohistochemistry , Male , Middle Aged , Neoplasm Grading , Organometallic Compounds , Retrospective Studies , World Health Organization
7.
Laryngorhinootologie ; 95(5): 332-5, 2016 May.
Article in German | MEDLINE | ID: mdl-26509472

ABSTRACT

Patients with single sided vestibular schwannoma may report about a taste dysfunction apart from the well known cardinal symptoms. Very few data are published so far on that topic. The aim of this study was to investigate the influence of microsurgery for vestibular schwannomas on taste perception prospectively using a well validated taste test. 25 patients could be included in the study. No ageusia was claimed by the patients. In average a decrease of the taste score postoperatively could be detected on the tumor as well as on the non treated side. The differences were not statistically significant. But a subgroup of » of the subjects revealed a new onset of side difference in the taste score that was not present before surgery. In all those cases the treated side showed a clinically significant reduced taste score of 6,2 in average. Within this subgroup the temporal access was overpresented in contrast to the whole group. This may indicate an influence of the choosen approach and that for the position of the tumor to the change of the taste score. The observations should be verified on a greater collective.


Subject(s)
Ageusia/etiology , Microsurgery , Neuroma, Acoustic/surgery , Postoperative Complications/etiology , Humans , Prospective Studies , Taste Threshold
8.
Arthritis Rheumatol ; 66(11): 3122-8, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25223407

ABSTRACT

OBJECTIVE: Patients with autoimmune diseases such as systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (Wegener's) (GPA) have a 3-20-fold increased risk of herpes zoster compared to the general population. The aim of this study was to evaluate if susceptibility is due to decreased levels of cellular and/or humoral immunity to the varicella-zoster virus (VZV). METHODS: A cross-sectional study of VZV-specific immunity was performed in 38 SLE patients, 33 GPA patients, and 51 healthy controls. Levels of IgG and IgM antibodies to VZV were measured using an in-house glycoprotein enzyme-linked immunosorbent assay (ELISA). Cellular responses to VZV were determined by interferon-γ (IFNγ) enzyme-linked immunospot (ELISpot) assay and carboxyfluorescein succinimidyl ester (CFSE) dye dilution proliferation assay. RESULTS: Levels of IgG antibodies to VZV were increased in SLE patients as compared to healthy controls, but levels of IgM antibodies to VZV were not. Antibody levels in GPA patients did not differ significantly from levels in healthy controls. In response to stimulation with VZV, decreased numbers of IFNγ spot-forming cells were found among SLE patients (although not GPA patients) as compared to healthy controls. Proliferation of CD4+ T cells in response to stimulation with VZV was decreased in SLE patients but not GPA patients. CONCLUSION: SLE patients have increased levels of IgG antibodies against VZV, while cellular immunity is decreased. In GPA patients, antibody levels as well as cellular responses to VZV were comparable to those in healthy controls. These data suggest that increased prevalence of herpes zoster in SLE patients is due to a poor cellular response. Vaccination strategies should aim to boost cellular immunity against VZV.


Subject(s)
Autoimmune Diseases/immunology , Herpes Zoster/epidemiology , Herpes Zoster/immunology , Herpesvirus 3, Human/immunology , Immunity, Cellular/physiology , Immunity, Humoral/physiology , Adult , Autoimmune Diseases/pathology , Autoimmune Diseases/physiopathology , CD4-Positive T-Lymphocytes/pathology , CD4-Positive T-Lymphocytes/virology , Case-Control Studies , Cell Proliferation/physiology , Cross-Sectional Studies , Disease Susceptibility/immunology , Disease Susceptibility/pathology , Disease Susceptibility/physiopathology , Female , Granulomatosis with Polyangiitis/immunology , Granulomatosis with Polyangiitis/pathology , Granulomatosis with Polyangiitis/physiopathology , Herpes Zoster/physiopathology , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Immunoglobulin M/blood , Immunoglobulin M/immunology , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/pathology , Lupus Erythematosus, Systemic/physiopathology , Male , Middle Aged , Risk Factors
9.
Radiologe ; 54(7): 696-9, 2014 Jul.
Article in German | MEDLINE | ID: mdl-24989877

ABSTRACT

The written radiological report is the most important means of communication between the radiologist and the referring medical doctor. There is no universal definition of a radiological report concerning its structure and content. The majority of clinicians and radiologists prefer structured reporting rather than free text reports of findings. Structured reporting does not increase the quality of a radiological report but has many advantages in research, teaching and quality management. Using standard RadLex terms facilitates translation and ontological assignment of a report. The Reporting Initiative of the Radiological Society of North America (RSNA) offers free and freely available extensively validated best practices radiology report templates in the new management of radiology report templates (MRRT) format according to the guidelines of the Integrating the Healthcare Enterprise (IHE).


Subject(s)
Diagnostic Imaging/standards , Documentation/standards , Medical Records Systems, Computerized/standards , Practice Guidelines as Topic , Radiology/standards , Writing/standards , Forms and Records Control/standards , Germany , Health Records, Personal
11.
Radiologe ; 54(5): 487-90, 2014 May.
Article in German | MEDLINE | ID: mdl-24733696

ABSTRACT

Due to economic considerations and thanks to technological advances there is a growing interest in the integration of teleradiological applications into the regular radiological workflow. The legal and technical hurdles which are still to be overcome are being discussed in politics as well as by national and international radiological societies. The European Commission as well as the German Federal Ministry of Health placed a focus on telemedicine with their recent eHealth initiatives. The European Society of Radiology (ESR) recently published a white paper on teleradiology. In Germany §3 section 4 of the Röntgenverordnung (RöV, X-ray regulations) and DIN 6868-159 set a framework in which teleradiology can also be used for primary reads. These possibilities are already being used by various networks and some commercial providers across Germany. With regards to cross-border teleradiology, which currently stands in contrast to the RöV, many issues remain unsolved.


Subject(s)
Practice Guidelines as Topic , Radiology/legislation & jurisprudence , Radiology/standards , Teleradiology/legislation & jurisprudence , Teleradiology/standards , Germany , Internationality
12.
HNO ; 62(8): 564-9, 2014 Aug.
Article in German | MEDLINE | ID: mdl-24633383

ABSTRACT

BACKGROUND: Microtia is associated with increased psychosocial morbidity. The literature contains three purely retrospective studies using validated tools. These studies show that auricular reconstruction leads to a significant improvement in health-related quality of life in affected children and adults. METHODS: In a prospective approach, the authors assessed 21 consecutive microtia patients (return rate 81 %; 7 children and 10 adults) before and after auricular reconstruction with porous polyethylene using the following validated questionnaires: Glasgow Health Status Inventory (GHSI), Short Form 36 Health Survey Questionnaire (SF-36), Childhood Experiences Questionnaire (CEQ) and Kidscreen-52. RESULTS: An improved health-related quality of life was detected with all applied instruments. CONCLUSION: A subjective benefit of auricular reconstruction with porous polyethylene can be shown using prospective, as well retrospective tools.


Subject(s)
Congenital Microtia/psychology , Congenital Microtia/surgery , Ear Auricle/abnormalities , Ear Auricle/surgery , Plastic Surgery Procedures/methods , Polyethylene , Quality of Life/psychology , Adolescent , Adult , Child , Child, Preschool , Congenital Microtia/diagnosis , Female , Humans , Male , Middle Aged , Patient Satisfaction , Porosity , Prospective Studies , Prostheses and Implants , Plastic Surgery Procedures/instrumentation , Treatment Outcome , Young Adult
13.
Radiologe ; 54(1): 40-4, 2014 Jan.
Article in German | MEDLINE | ID: mdl-24366353

ABSTRACT

Radiology plays an important role in introduction and use of information technology (IT) systems in the daily clinical routine. The radiology information system (RIS) and picture archiving and communication system (PACS) are the main systems used in a digital radiology department. In this article the basic principles and functions of these systems and trends in development are described.


Subject(s)
Delivery of Health Care/organization & administration , Medical Informatics/methods , Models, Organizational , Radiology Information Systems/organization & administration , Technology, Radiologic/organization & administration , User-Computer Interface , Germany
14.
HNO ; 61(8): 655-61, 2013 Aug.
Article in German | MEDLINE | ID: mdl-23907205

ABSTRACT

BACKGROUND: Microtia leads to a severe functional and aesthetic handicap. Traditionally, the auricle is often reconstructed with cartilage transplants, which is, however, associated with some partially substantial disadvantages. The authors have instead used implants of porous polyethylene for successful ear reconstruction for years, thus, avoiding some of these disadvantages. A significant benefit for the patient is achieved by simultaneous hearing rehabilitation by the implantation of active middle ear prostheses. METHODS: The authors present their surgical concept which allows functional and aesthetic rehabilitation of microtia in children and adolescents in a single operation. In the respective patient collective, audiometric measurements in quiet and noisy environments were conducted pre- and postoperatively, and health-related quality of life was determined using a validated questionnaire. RESULTS: All patients experienced a substantial hearing gain both in quiet and noisy environments. The evaluation of health-related quality of life showed a significant benefit from the intervention. CONCLUSION: Functional and aesthetic rehabilitation of microtia with active middle ear implants and ear reconstruction using porous polyethylene leads to good and reliable long-term results and can increase the health-related quality of life of affected children and adolescents. The main advantage of this concept is the possibility of a single procedure.


Subject(s)
Congenital Abnormalities/rehabilitation , Congenital Abnormalities/surgery , Ear/abnormalities , Hearing Loss/rehabilitation , Plastic Surgery Procedures/instrumentation , Prostheses and Implants , Adolescent , Child , Child, Preschool , Congenital Microtia , Ear/surgery , Esthetics , Female , Hearing Loss/etiology , Humans , Male , Patient Satisfaction , Plastic Surgery Procedures/methods , Recovery of Function , Treatment Outcome
15.
Radiologe ; 53(6): 535-8, 2013 Jun.
Article in German | MEDLINE | ID: mdl-23519445

ABSTRACT

Strategies for reducing radiation exposure are an important part of optimizing medical imaging and therefore a relevant quality factor in radiology. Regarding the medical radiation exposure, computed tomography has a special relevance. The use of the integrating the healthcare enterprise (IHE) radiation exposure monitoring (REM) profile is the upcoming standard for organizing and collecting exposure data in radiology. Currently most installed base devices do not support this profile generating the required digital imaging and communication in medicine (DICOM) dose structured reporting (SR). For this reason different solutions had been developed to register dose exposure measurements without having the dose SR object.Registration and analysis of dose-related parameters is required for constantly optimizing examination protocols, especially computed tomography (CT) examinations based on the latest research results in order to minimize the individual radiation dose exposure from medical imaging according to the principle as low as reasonably achievable (ALARA).


Subject(s)
Body Burden , Documentation/methods , Radiation Dosage , Radiation Protection/methods , Radiometry/methods , Tomography, X-Ray Computed/methods , Humans
17.
HNO ; 60(9): 814-6, 2012 Sep.
Article in German | MEDLINE | ID: mdl-22944894

ABSTRACT

BACKGROUND: In Germany assessment of hearing loss for numbers is used to calculate the percentage hearing loss from speech audiometry and for plausibility checking with pure tone thresholds. It is common practice to take a graphical reading from the speech audiogram to determine the hearing loss for numbers. This study searches for a mathematical formula for the exact calculation of the hearing loss for numbers from the intelligibility values measured. METHODS: With analytical methods on the basis of the standard curve following DIN 45626-1, two simple formulas for the calculation of the hearing loss for numbers were developed. RESULTS: The hearing loss for numbers a(1) is calculated as a(1)=p(1)+(50-v(1)) (p(2)-p(1))/(v(2)-v(1))-18,4 for two available measured values and as a(1)=p(1)-0,13 v(1)-11,9 if only one measured value is used, with v(i )being number intelligibility in percent at the level p(i) in decibels (dB) of measurement number i. Number intelligibility of all inserted pairs of values must be between 30% and 70% because the standard curve of DIN 45626-1 runs approximately linearly only in this range. The calculated value for the hearing loss for numbers is subsequently mathematically rounded up to 5 dB as well as for the conventional graphically determined value. CONCLUSIONS: With the presented formulas the hearing loss for numbers can be calculated exactly from the measured values of the Freiburg number test especially in matters of expertise if the conventional graphical determination of this value does not seem to be unambiguous.


Subject(s)
Algorithms , Audiometry/methods , Diagnosis, Computer-Assisted/methods , Hearing Loss/diagnosis , Humans , Reproducibility of Results , Sensitivity and Specificity
18.
HNO ; 60(10): 886-91, 2012 Oct.
Article in German | MEDLINE | ID: mdl-22767194

ABSTRACT

OBJECTIVE: For the determination of speech intelligibility in the expertise of hearing loss, the Freiburg speech test (number test and monosyllable test) is recommended in the Federal Republic of Germany. In the former German Democratic Republic, Sauer's binaural number test with 70 dB background noise ("beidohriger Zahlentest", BZT) was a standard element in expert opinions and was used in the calculation of bodily injury ("Körperschaden"). In the current practice, a hearing test in noise is still lacking. The present study analyzes whether and to what degree the impairment ("Grad der Schädigungsfolgen", GdS) changes when also considering Sauer's test. MATERIAL AND METHODS: In a collective of 78 patients with hearing loss (66 patients with high-frequency hearing loss and 12 patients with pancochlear hearing loss) and 22 normal hearing controls, the following audiometric measurements were conducted: pure tone audiometry, speech audiometry (Freiburg speech test), free field audiometry with and without noise, and Sauer's test. Subsequently, the hearing loss for both sides was calculated taking into consideration the values obtained with and without Sauer's test, and the respective GdS was determined. RESULTS: Patients with high-frequency hearing loss and pancochlear hearing loss had a trend for higher GdS (approximately 2 and 5%, respectively), compared to the established algorithm without the use of hearing tests in noise. However, neither the Mann-Whitney U-test nor the Bland-Altman analysis yielded relevant differences between the two methods to calculate the GdS. CONCLUSION: The routine implementation of Sauer's test in the expertise of hearing loss cannot be recommended, since no relevant change in the GdS can be expected. This is especially true for high-frequency hearing loss. In pancochlear hearing loss, use of Sauer's test can be considered if problems concerning hearing in situations with background noise are present-at least until more advanced hearing tests optimized for use in noise have been integrated into the tables for GdS calculation.


Subject(s)
Audiometry, Pure-Tone/methods , Audiometry, Speech/methods , Hearing Loss/diagnosis , Perceptual Masking , Female , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Signal-To-Noise Ratio
19.
HNO ; 59(9): 908-14, 2011 Sep.
Article in German | MEDLINE | ID: mdl-21732149

ABSTRACT

BACKGROUND: The present study analyzes the best combination of frequencies for the calculation of mean hearing loss in pure tone threshold audiometry for correlation with hearing loss for numbers in speech audiometry, since the literature describes different calculation variations for plausibility checking in expertise. Three calculation variations, A (250, 500 and 1000 Hz), B (500 and 1000 Hz) and C (500, 1000 and 2000 Hz), were compared. METHODS: Audiograms in 80 patients with normal hearing, 106 patients with hearing loss and 135 expertise patients were analyzed in a retrospective manner. Differences between mean pure tone audiometry thresholds and hearing loss for numbers were calculated and statistically compared separately for the right and the left ear in the three patient collectives. RESULTS: We found the calculation variation A to be the best combination of frequencies, since it yielded the smallest standard deviations while being statistically different to calculation variations B and C. The 1- and 2.58-fold standard deviation (representing 68.3% and 99.0% of all values) was ±4.6 and ±11.8 dB for calculation variation A in patients with hearing loss, respectively. CONCLUSIONS: For plausibility checking in expertise, the mean threshold from the frequencies 250, 500 and 1000 Hz should be compared to the hearing loss for numbers. The common recommendation reported by the literature to doubt plausibility when the difference of these values exceeds ±5 dB is too strict as shown by this study.


Subject(s)
Audiometry, Pure-Tone/methods , Audiometry, Pure-Tone/statistics & numerical data , Audiometry, Speech/methods , Audiometry, Speech/statistics & numerical data , Auditory Threshold , Expert Testimony/legislation & jurisprudence , Hearing Loss, High-Frequency/diagnosis , Hearing Loss, Sensorineural/diagnosis , Adolescent , Adult , Aged , Audiometry, Pure-Tone/instrumentation , Audiometry, Speech/instrumentation , Child , Female , Hearing Loss, Sensorineural/classification , Humans , Male , Middle Aged , Reference Values , Reproducibility of Results , Retrospective Studies , Statistics as Topic , Young Adult
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