[Increased report completeness and satisfaction with structured neurotological reporting in the interdisciplinary assessment of vertigo]. / Erhöhte Befundvollständigkeit und gesteigerte Zuweiserzufriedenheit bei strukturierter neurootologischer Befunderhebung in der interdisziplinären Schwindelabklärung.

BACKGROUND: Results of neurotological function diagnostics in the context of interdisciplinary vertigo assessment are usually formulated as free-text reports (FTR). These are often subject to high variability, which may lead to loss of information. The aim of the present study was to evaluate the completeness of structured reports (SR) and referrer satisfaction in the neurotological assessment of vertigo. MATERIALS AND METHODS: Neurotological function diagnostics performed as referrals (n = 88) were evaluated retrospectively. On the basis of the available raw data, SRs corresponding to FTRs from clinical routine were created by means of a specific SR template for neurotological function diagnostics. FTRs and SRs were evaluated for completeness and referring physician satisfaction (n = 8) using a visual analog scale (VAS) questionnaire. RESULTS: Compared to FTRs, SRs showed significantly increased overall completeness (73.7% vs. 51.7%, p < 0.001), especially in terms of patient history (92.5% vs. 66.7%, p < 0.001), description of previous findings (87.5% vs. 38%, p < 0.001), and neurotological (33.5% vs. 26.7%, p < 0.001) and audiometric function diagnostics (58% vs. 32.3%, p < 0.001). In addition, SR showed significantly increased referring physician satisfaction (VAS 8.8 vs. 4.9, p < 0.001). CONCLUSION: Neurotological SRs enable a significantly increased report completeness with higher referrer satisfaction in the context of interdisciplinary assessment of vertigo. Furthermore, SRs are particularly suitable for scientific data analysis, especially in the context of big data analyses.

Erratum to: Hearing preservation in children with electric-acoustic stimulation after cochlear implantation : Outcome after electrode insertion with minimal insertion trauma.

The article Hearing preservation in children with electric-acoustic stimulation after cochlear implantation-Outcome after electrode insertion with minimal insertion trauma, written by T. Rader, A. Bohnert, C. Matthias, D. Koutsimpelas, M­A. Kainz, S. Strieth was originally published electronically.

The new Mainz speech test for children 3-7 years old (MATCH) : Design, standardization, and validation.

OBJECTIVE: To develop a new, German, age-appropriate speech audiometry test for children, by using 26 nouns that are most likely part of the lexicon of 2-year-olds. The test is a picture-pointing task with a four-option non-forced choice method. MATERIALS AND METHODS: In total, 179 children aged 2;11 to 6;9 y were included for standardizing and validating the speech test. Of these, 51 had a hearing impairment in both ears ranging up to 90 dB hearing level (HL). The normal-hearing collective was divided into three groups according to age. For each group, the speech reception threshold (SRT) and the slope of the psychometric function of intelligibility were determined. For validation, the test-retest reliability was measured in 85 ears, and the correlation between the pure tone average (PTA) at 0.5, 1, 2, and 4 kHz and the SRT was measured in 86 ears. RESULTS: The sound spectrum of the 26 items was in good accordance with the international long-term speech spectrum, and the relative frequency of phonemes matched the distribution of the 50 more frequent German phonemes. The SRTs ranged from 24.6 ± 0.6 dB sound pressure level (SPL) for the oldest group (> 5.5 y) to 29.3 ± 1.3 dB SPL for the youngest group (< 4.25 y). The slopes of the psychometric function ranged from 4.3 ± 0.5%/dB for the oldest group to 2.6 ± 0.4%/dB for the youngest. The test and retest showed good correlation (r  = 0.89, p < 0.0001) as did the PTA and SRT (r = 0.84, p < 0.0001). CONCLUSION: The newly developed Mainz speech-test effectively measures age-related speech perception from the age of three years.

[The new Mainz speech test for children aged 3-7 years (MATCH) : Design, standardization, and validation. German version]. / Der neue Mainzer Sprachtest für Kinder 3­7 Jahre (MATCH) : Design, Normierung und Validierung.

OBJECTIVE: A new German speech audiometry test was developed using 26 nouns that are most likely part of the lexicon of 2­year-old children. The test was a picture-pointing task using a four-alternative non-forced choice method. MATERIALS AND METHODS: In total, 179 children aged 2 years 11 months to 6 years 9 months were included to standardize and validate the speech test. Of these children, 51 had a hearing impairment in both ears ranging up to 90 dB hearing level. The normal-hearing collective was divided into three groups according to age. For each group, the speech reception threshold (SRT) and the slope of the psychometric function of intelligibility were determined. For validation, the test-retest reliability was measured in 85 ears and the correlation between the pure-tone average (PTA) at 0.5, 1, 2, and 4 kHz and the SRT was determined in 86 ears. RESULTS: The sound spectrum of the 26 items was in good accordance with the international long-term speech spectrum and with the distribution of the 50 most frequent German phonemes. The SRT ranged from 24.6 ± 0.6 dB sound pressure level (SPL) for the oldest group (>5.5 years) to 29.3 ± 1.3 dB SPL for the youngest group (<4.25 years). The slopes of the psychometric function ranged from 4.3 ± 0.5%/dB for the oldest group to 2.6 ± 0.4%/dB for the youngest group. The test and retest showed good correlation (r = 0.89, p < 0.0001), as did the PTA and SRT (r = 0.84, p < 0.0001). CONCLUSION: The newly developed test effectively measures age-related speech perception from the age of 2 years 11 months.

Hearing preservation in children with electric-acoustic stimulation after cochlear implantation : Outcome after electrode insertion with minimal insertion trauma.

BACKGROUND: Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective. OBJECTIVES: Short- and mid-term hearing preservation outcome in pediatric patients is investigated. MATERIALS AND METHODS: A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values. RESULTS: In the whole group, the mean values of the preoperative PTAlow were 29.8 dB and the short-term postoperative PTAlow 42.6 dB. The mean value of the HL% was 73.6%, corresponding to an HL of 9.4 dB. In the subgroup, the mean PTAlow postoperatively was 46.0 dB in the mid-term and the HL% at 80.7% with a HL of 6.6 dB. CONCLUSIONS: The results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.

[Hearing preservation in children with electric-acoustic stimulation after cochlear implantation : Outcome after electrode insertion with minimal insertion trauma (German version)]. / Hörerhalt bei Kindern mit elektrisch-akustischer Stimulation nach Cochleaimplantation : Ergebnisse nach Elektrodeninsertion mit minimalem Insertionstrauma.

BACKGROUND: Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective. OBJECTIVES: Short- and mid-term hearing preservation outcome in pediatric patients is investigated. MATERIALS AND METHODS: A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values. RESULTS: In the whole group, the mean values of the preoperative PTAlow were 29.8 dB and the short-term postoperative PTAlow 42.6 dB. The mean value of the HL% was 73.6%, corresponding to an HL of 9.4 dB. In the subgroup, the mean PTAlow postoperatively was 46.0 dB in the mid-term and the HL% at 80.7% with a HL of 6.6 dB. CONCLUSIONS: The results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.

[Quality of life and vertigo after bilateral cochlear implantation : Questionnaires as tools for quality assurance]. / Lebensqualität und Schwindel bei bilateraler Cochleaimplantation : Fragebogeninstrumente zur Qualitätssicherung.

BACKGROUND: Persistent dizziness symptoms after cochlear implantation have an impact on quality of life. In this study, the effects of bilateral cochlear implants (CI) on quality of life as well as on subjective dizziness complaints are analyzed using questionnaires, some of which have never been applied before in these patient collectives. OBJECTIVE: In this article, questionnaires for the assessment of dizziness symptoms and quality of life are introduced in order to realize quality assurance. MATERIALS AND METHODS: A total of 32 patients with bilateral CI were questioned regarding dizziness symptoms and quality of life. The Nijmegen Cochlear Implant Questionnaire (NCIQ) was used. In the case of reported regular dizziness, the Vertigo Handicap Questionnaire (VHQ) and the Vertigo Symptom Scale (VSS) were also assessed. RESULTS: Persistent dizziness symptoms were shown in 8 of 32 patients. Quality of life was measured with the NCIQ and was improved significantly (p < 0.001) by 23.7% after the second CI. The dizziness symptoms changed slightly (VHQ -11.2%; VSS +16.4%) after the second implantation. CONCLUSION: The results show that the questionnaires are valid instruments for documenting quality of life and dizziness symptoms for quality assurance. These questionnaires may be applied as a complement or an alternative to device-based measurements of peripheral vestibular dysfunction.

Reporting of sex and gender in randomized controlled trials in Canada: a cross-sectional methods study.

BACKGROUND: Accurate reporting on sex and gender in health research is integral to ensuring that health interventions are safe and effective. In Canada and internationally, governments, research organizations, journal editors, and health agencies have called for more inclusive research, provision of sex-disaggregated data, and the integration of sex and gender analysis throughout the research process. Sex and gender analysis is generally defined as an approach for considering how and why different subpopulations (e.g., of diverse genders, ages, and social locations) may experience health conditions and interventions in different or similar ways.The objective of this study was to assess the extent and nature of reporting about sex and/or gender, including whether sex and gender analysis (SGA) was carried out in a sample of Canadian randomized controlled trials (RCTs) with human participants. METHODS: We searched MEDLINE from 01 January 2013 to 23 July 2014 using a validated filter for identification of RCTs, combined with terms related to Canada. Two reviewers screened the search results to identify the first 100 RCTs that were either identified in the trial publication as funded by a Canadian organization or which had a first or last author based in Canada. Data were independently extracted by two people from 10% of the RCTs during an initial training period; once agreement was reached on this sample, the remainder of the data extraction was completed by one person and verified by a second. RESULTS: The search yielded 1433 records. We screened 256 records to identify 100 RCTs which met our eligibility criteria. The median sample size of the RCTs was 107 participants (range 12-6085). While 98% of studies described the demographic composition of their participants by sex, only 6% conducted a subgroup analysis across sex and 4% reported sex-disaggregated data. No article defined "sex" and/or "gender." No publication carried out a comprehensive sex and gender analysis. CONCLUSIONS: Findings highlight poor uptake of sex and gender considerations in the Canadian RCT context and underscore the need for better articulated guidance on sex and gender analysis to improve reporting of evidence, inform policy development, and guide future research.

[Simulation of speech perception with cochlear implants : Influence of frequency and level of fundamental frequency components with electronic acoustic stimulation]. / Simulation von Sprachverstehen mit Cochleaimplantat : Einfluss von Frequenz und Pegel der Grundfrequenzkomponente bei elektrisch-akustischer Stimulation.

BACKGROUND: After implantation of cochlear implants with hearing preservation for combined electronic acoustic stimulation (EAS), the residual acoustic hearing ability relays fundamental speech frequency information in the low frequency range. With the help of acoustic simulation of EAS hearing perception the impact of frequency and level fine structure of speech signals can be systematically examined. OBJECTIVE: The aim of this study was to measure the speech reception threshold (SRT) under various noise conditions with acoustic EAS simulation by variation of the frequency and level information of the fundamental frequency f0 of speech. The study was carried out to determine to what extent the SRT is impaired by modification of the f0 fine structure. MATERIAL AND METHODS: Using partial tone time pattern analysis an acoustic EAS simulation of the speech material from the Oldenburg sentence test (OLSA) was generated. In addition, determination of the f0 curve of the speech material was conducted. Subsequently, either the parameter frequency or level of f0 was fixed in order to remove one of the two fine contour information of the speech signal. The processed OLSA sentences were used to determine the SRT in background noise under various test conditions. The conditions "f0 fixed frequency" and "f0 fixed level" were tested under two different situations, under "amplitude modulated background noise" and "continuous background noise" conditions. A total of 24 subjects with normal hearing participated in the study. RESULTS: The SRT in background noise for the condition "f0 fixed frequency" was more favorable in continuous noise with 2.7 dB and in modulated noise with 0.8 dB compared to the condition "f0 fixed level" with 3.7 dB and 2.9 dB, respectively. DISCUSSION: In the simulation of speech perception with cochlear implants and acoustic components, the level information of the fundamental frequency had a stronger impact on speech intelligibility than the frequency information. The method of simulation of transmission of cochlear implants allows investigation of how various parameters influence speech intelligibility in subjects with normal hearing.

Interactive social media interventions to promote health equity: an overview of reviews.

INTRODUCTION: Social media use has been increasing in public health and health promotion because it can remove geographic and physical access barriers. However, these interventions also have the potential to increase health inequities for people who do not have access to or do not use social media. In this paper, we aim to assess the effects of interactive social media interventions on health outcomes, behaviour change and health equity. METHODS: We conducted a rapid response overview of systematic reviews. We used a sensitive search strategy to identify systematic reviews and included those that focussed on interventions allowing two-way interaction such as discussion forums, social networks (e.g. Facebook and Twitter), blogging, applications linked to online communities and media sharing. RESULTS: Eleven systematic reviews met our inclusion criteria. Most interventions addressed by the reviews included online discussion boards or similar strategies, either as stand-alone interventions or in combination with other interventions. Seven reviews reported mixed effects on health outcomes and healthy behaviours. We did not find disaggregated analyses across characteristics associated with disadvantage, such as lower socioeconomic status or age. However, some targeted studies reported that social media interventions were effective in specific populations in terms of age, socioeconomic status, ethnicities and place of residence. Four reviews reported qualitative benefits such as satisfaction, finding information and improved social support. CONCLUSION: Social media interventions were effective in certain populations at risk for disadvantage (youth, older adults, low socioeconomic status, rural), which indicates that these interventions may be effective for promoting health equity. However, confirmation of effectiveness would require further study. Several reviews raised the issue of acceptability of social media interventions. Only four studies reported on the level of intervention use and all of these reported low use. More research on established social media platforms with existing social networks is needed, particularly in populations at risk for disadvantage, to assess effects on health outcomes and health equity.

TITRE: Interventions interactives dans les médias sociaux visant à promouvoir l'équité en matière de santé : vue d'ensemble des examens. INTRODUCTION: L'utilisation des médias sociaux en matière de santé publique et de promotion de la santé est en croissance, car ces outils permettent d'éliminer les barrières géographiques et physiques à l'accès aux services et aux soins de santé. Cependant, ils sont une source potentielle d'inégalité en matière de santé car une partie de la population n'y a pas accès ou ne les utilise pas. Cet article a comme objectif d'évaluer les effets des interventions interactives dans les médias sociaux sur les résultats sanitaires, les changements de comportement et l'équité en matière de santé. MÉTHODOLOGIE: Nous avons réalisé une synthèse rapide d'examens systématiques axés sur des interventions favorables aux interactions réciproques, que ce soit les forums de discussion, les réseaux sociaux (comme Facebook et Twitter), les blogues, les applications liées aux communautés électroniques ou le partage de contenu multimédia. Nous avons eu recours à une stratégie de recherche fine pour sélectionner les examens systématiques. RÉSULTATS: Onze examens systématiques ont répondu à nos critères d'inclusion. La plupart des interventions visées par ces examens visaient des groupes de discussion en ligne ou des outils similaires. Ces interventions étaient isolées ou conjointes à d'autres. Sept examens ont fait état d'effets mixtes sur les résultats sanitaires et les comportements sains. On n'a constaté aucune analyse détaillée des caractéristiques liées aux inconvénients, notamment un statut socioéconomique plus faible ou l'âge. Par contre, certaines études ciblées ont montré que les interventions dans les médias sociaux étaient efficaces pour certaines populations précises sur le plan de l'âge, du statut socioéconomique, de l'ethnicité et du lieu de résidence. Quatre examens ont fait état d'avantages qualitatifs, comme la satisfaction, le recueil d'information et l'amélioration du soutien social. CONCLUSION : Les interventions dans les médias sociaux se sont avérées efficaces pour certaines populations susceptibles d'être désavantagées (jeunes, aînés, personnes à faible statut socioéconomique et population rurale), ce qui prouve leur efficacité potentielle pour l'avancement de l'équité en matière de santé. La confirmation de cette efficacité nécessiterait toutefois une étude approfondie. Plusieurs examens ont soulevé la question de l'acceptabilité des interventions dans les médias sociaux. Seulement quatre études se sont penchées sur le niveau d'utilisation de l'intervention et elles ont toutes dévoilé un faible niveau d'utilisation. Il faudra réaliser d'autres travaux de recherche sur les plateformes des principaux médias sociaux actuels, particulièrement auprès des populations risquant d'être désavantagées, afin d'évaluer leurs effets sur les résultats sanitaires et l'équité en matière de santé.

Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials.

BACKGROUND: Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). METHODS/DESIGN: A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. DISCUSSION: This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.

[Speech perception with electric-acoustic stimulation : Comparison with bilateral cochlear implant users in different noise conditions]. / Sprachverstehen mit elektrisch-akustischer Stimulation : Vergleich mit bilateral versorgten Cochleaimplantatträgern in verschiedenen Störgeräuschumgebungen.

BACKGROUND: Cochlear implantation with the aim of hearing preservation for combined electric-acoustic stimulation (EAS) is the therapy of choice for patients with residual low-frequency hearing. Preserved residual acoustic hearing has a positive effect on speech intelligibility in difficult noise conditions. OBJECTIVES: The goal of this study was to assess speech reception thresholds in various complex noise conditions for patients with EAS in comparison with patients using bilateral cochlear implants (CI). MATERIALS AND METHODS: Speech perception in noise was measured for bilateral CI and EAS patient groups. A total of 22 listeners with normal hearing served as a control group. Speech reception thresholds (SRT) were measured using a closed-set sentence matrix test. Speech was presented with a single source in frontal position; noise was presented in frontal position or in a multisource noise field (MSNF) consisting of a four-loudspeaker array with independent noise sources. Modulated speech-simulating noise and pseudocontinuous noise served respectively as interference signal with different temporal characteristics. RESULTS: The average SRTs in the EAS group were significantly better in all test conditions than those of the group with bilateral CI. Both user groups showed significant improvement in the MSNF condition compared with the frontal noise condition as a result of bilateral interaction. The normal-hearing control group was able to use short temporal gaps in modulated noise to improve speech perception in noise (gap listening). This effect was absent in both implanted user groups. CONCLUSION: Patients with combined EAS in one ear and a hearing aid in the contralateral ear show significantly improved speech perception in complex noise conditions compared with bilateral CI recipients.

Low bone mineral density and fractures in stages 3-5 CKD: an updated systematic review and meta-analysis.

SUMMARY: The utility of bone mineral density (BMD) testing in chronic kidney disease (CKD) is not known. We performed a meta-analysis of studies reporting on BMD and fracture in CKD. All but one study was cross-sectional. BMD was lower in those with CKD and fractures compared to those without fractures. INTRODUCTION: CKD is associated with an increased risk of fracture. The utility of dual energy X-ray absorptiometry (DXA) to assess fracture risk in CKD is unknown. METHODS: We performed an updated meta-analysis and systematic review of published studies that reported on the association between DXA and fracture (morphometric spine or clinical nonspine) in predialysis and dialysis CKD. We identified 2,894 potential publications, retrieved 292 for detailed review, and included 13. All but one study was cross-sectional and three reported on the ability of DXA to discriminate fracture status in predialysis CKD. Results were pooled using a random effects model and statistical heterogeneity was assessed using the I2 statistic. RESULTS: BMD was statistically significantly lower at the femoral neck, lumbar spine, the 1/3 and ultradistal radius in subjects with fractures compared to those without regardless of dialysis status. For example, femoral neck BMD was 0.06 g/cm2 lower in dialysis subjects and 0.102 g/cm2 lower in predialysis subjects with fractures compared to those without. Lumbar spine BMD was 0.05 g/cm2 lower in dialysis subjects and 0.108 g/cm2 lower in predialysis subjects with fractures compared to those without. Our meta-analysis was limited to studies with small numbers of subjects and even smaller numbers of fractures. All of the studies were observational and only one was prospective. There was statistical heterogeneity at the lumbar spine, 1/3 and ultradistal radius. CONCLUSIONS: Our findings suggest that BMD can discriminate fracture status in predialysis and dialysis CKD. Larger, prospective studies are needed.

[Hearing preservation: Better hearing with advanced technology]. / Hörerhaltende Cochlea-Implantation: Besser Hören mit neuer Technik.

Preservation of residual hearing after cochlear implantation allows patients the synergetic use of electric and acoustic stimulation (EAS). The application of specific surgical and therapeutic techniques enables the reduction of inner ear trauma, which leads otherwise to complete hearing loss. Due to simultaneous electric and acoustic stimulation, speech understanding is improved especially in noise. EAS is a well-accepted therapeutic treatment for subjects with profound hearing loss in the higher frequencies and no or mild hearing loss in the low frequencies. Several Manufacturers offer individual soft electrodes specially designed for hearing preservation as well as combined electric-acoustic audio processors.

Effect of transtympanic low-pressure therapy in patients with unilateral Menière's disease unresponsive to betahistine: a randomised, placebo-controlled, double-blinded, clinical trial.

OBJECTIVE: To determine the effect of the Meniett low-pressure generator on the subjective symptoms and audiovestibular disease markers of patients with unilateral Menière's disease unresponsive to betahistine treatment. METHODS: Randomised, placebo-controlled, double-blinded, clinical trial at a tertiary referral centre. After ventilation tube placement, patients were randomised to the active treatment or placebo group. Monitoring comprised audiometry and air caloric testing and a vertigo diary (enabling calculation of vertigo and activity scores, and the number of vertigo days, vertigo-free days and sick days). RESULTS: Sixty-eight patients completed the study. For the active treatment versus placebo group, the following pre- and post-treatment values, and significances for treatment effect comparisons, were respectively seen: cumulative vertigo scores, 22.47 and 15.97 vs 20.42 and 19.23 (p = 0.048); vertigo days, 6.5 and 4.08 vs 5.94 and 5.52 (p = 0.102); sick days, 3.08 and 0.78 vs 2.87 and 3.45 (p = 0.041); vertigo-free days, 14.47 and 17.61 vs 15.48 and 17.58 (p = 0.362); activity score, 23.61 and 13.42 vs 24.68 and 20.23 (p = 0.078); low-tone hearing threshold, 49.15 and 53.18 dB nHL vs 41.66 and 46.10 dB nHL (p > 0.05); and slow phase velocity in response to caloric stimulation, 18.86 and 18.72 °/second vs 14.97 and 15.95 °/second, (p > 0.05). CONCLUSION: Use of the Meniett low-pressure generator improved patients' vertigo but not their hearing or vestibular function. This safe, minimally invasive treatment is recommended as second-line treatment for unilateral Menière's disease.

Impaired fixation suppression is a risk factor for vertigo after cochlear implantation.

OBJECTIVES: To analyse the correlation between visual fixation suppression test results and the occurrence of post-operative vertigo in patients receiving a cochlear implant, and to compare this with other possible risk factors. METHODS: In a prospective study setting, caloric vestibular responses, visual fixation suppression and subjective vertigo symptoms were assessed in 59 adult patients undergoing cochlear implantation. These parameters were compared in patients with post-operative vertigo versus vertigo-free patients. RESULTS: Vertigo symptoms were reported by 49 per cent of patients. Thirty-nine per cent of the patients had a decrease in caloric response on the implanted side. There was no statistically significant difference between the two patient groups regarding canal paresis, age, sex, implanted electrode type, implant side, surgeon, cause of deafness, petrous bone computed tomography findings and incidence of pre-operative vertigo. Patients with post-operative vertigo had a significantly greater prevalence of insufficient visual fixation suppression. All patients who suffered long-term post-operative vertigo had insufficient visual fixation suppression. CONCLUSIONS: Pre-operative impaired visual fixation suppression is a major risk factor for the occurrence of vertigo after cochlear implantation.

[Persistent pharyngeocutaneous fistula after transcervical resection of a diverticulum of the hypopharynx]. / Persistierende pharyngokutane Fistel nach Resektion eines Hypopharynxdivertikels.

CASE: A 26-year-old white male patient had undergone resection of a diverticulum of the hypopharynx and myotomy of the cricopharyngeal muscle elsewhere. A transcervical approach had been chosen owing to the presence of an arteria lusoria and the associated risk of vessel injury. The patient had subsequently had recurrent fistulas through the skin incision, which had not resolved despite four further operations. He presented in our department with significant weight loss and persistent retrosternal pain. Esophageal manometry revealed that resting muscle tone in the upper esophageal sphincter was still significantly elevated. Assuming that the earlier myotomy had not been completely successful, we decided to complete this operation as revision surgery. The pharynx was closed with a running suture using the Conley technique. The fistula healed, and there were no further recurrences. CONCLUSION: Complete and careful dissection of all muscle fibers back to the mucosa is essential, as well as complete removal of the diverticulum if this operation is to be successful when performed by the transcutaneous approach. Recurrent diverticula are not the only possible complication; persistent pharyngeocutaneous fistulas can also arise.

Incidence and quality of vertigo symptoms after cochlear implantation.

OBJECTIVES: To assess the incidence of vestibular disturbance in patients after cochlear implantation, and to evaluate the quality of vertigo symptoms. STUDY DESIGN: Prospective, observational study. SETTING: Cochlear implant centre at a tertiary referral university hospital, Munich, Germany. PATIENTS: Forty-seven adult patients undergoing unilateral cochlear implantation between 2003 and 2007. METHODS: Patients were interviewed post-operatively about vertigo symptoms, using a specifically designed questionnaire. Questionnaire data were used to define patient subgroups based on probable vertigo aetiology. Cochlear implantation was performed via a retroauricular, transmastoidal approach. Thirty-six implants were Cochlear Nucleus 24 devices and 11 were MedEl devices. RESULTS: Twenty-one (45 per cent) patients reported vertigo symptoms following cochlear implantation. The time of onset was directly post-operatively in the majority of patients. In 90 per cent, the symptoms suggested an otogenic origin. The majority of patients reported paroxysmal vertigo with a duration of seconds to minutes. Typical concomitant symptoms were tinnitus, fluctuating hearing loss and vegetative reactions. Serious disablement by vertigo was rare. CONCLUSION: Exposing patients to the risk of possible balance disorders associated with cochlear implantation is justified in view of the hearing rehabilitation achieved, even with today's broader indications for cochlear implantation. However, patients should in any case be informed about the possibility and quality of post-operative vertigo symptoms.

Expediting the transfer of evidence into practice: building clinical partnerships.

A librarian/clinician partnership was fostered in one hospital through the formation of the Evidence-based Practice Committee, with an ulterior goal of facilitating the transfer of evidence into practice. The paper will describe barriers to evidence-based practice and outline the committee's strategies for overcoming these barriers, including the development and promotion of a Web-based guide to evidence-based practice specifically designed for clinicians (health professionals). Educational strategies for use of the Web-based guide will also be addressed. Advantages of this partnership are that the skills of librarians in meeting the needs of clinicians are maximized. The evidence-based practice skills of clinicians are honed and librarians make a valuable contribution to the knowledge-base of the clinical staff. The knowledge acquired through the partnership by both clinicians and librarians will increase the sophistication of the dialogue between the two groups and in turn will expedite the transfer of evidence into practice.