[Incision-suture times in endoscopic ear surgery]. / Schnitt-Naht-Zeiten bei der endoskopischen Ohrchirurgie.

BACKGROUND: Endoscopic ear surgery (EES) is increasingly used internationally instead of microscopic ear surgery (MES), but has not yet become established as a routine procedure everywhere in Germany. OBJECTIVE: The incision-suture time and practicability of EES in the setting of a German clinic were investigated. MATERIALS AND METHODS: In a retrospective study, 60 consecutive MES patients from 2015 were compared with 60 consecutive EES patients from 2018. Hearing results, tympanic membrane findings after 3 weeks, and incision-suture times were compared. RESULTS: In EES, access was mostly transmeatal and bone of the anterior auditory canal wall had to be removed less often than in MES. There was no statistically significant difference in surgery times between the two groups. Perforation closure was achieved in 57/60 and 59/60 ears in the MES and EES groups, respectively. Hearing was improved in both groups. There was no statistical difference in hearing improvement between the two groups. CONCLUSION: EES is a time efficient and minimally invasive method which represents a viable alternative to MES with comparable results.

Induction chemotherapy (IC) followed by radiotherapy (RT) versus cetuximab plus IC and RT in advanced laryngeal/hypopharyngeal cancer resectable only by total laryngectomy-final results of the larynx organ preservation trial DeLOS-II.

Background: The German multicenter randomized phase II larynx organ preservation (LOP) trial DeLOS-II was carried out to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC). Patients and methods: Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF [docetaxel (T) and cisplatin (P) 75 mg/m2/day 1, 5-FU (F) 750 mg/m2/day days 1-5] followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24 months LFS above 35% in arm B. Results: Of 180 patients randomized (July 2007 to September 2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24 months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). One hundred and twenty-three early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A versus 80%/86.0% in B. The 24 months overall survival (OS) rates were 68.2% and 69.3%. Conclusions: Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24 months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS. Clinical trial information: NCT00508664.

Endoscopic ear surgery - a complement to microscopic ear surgery.

Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high-definition, 4K, and 3­dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragm can be visualized far better using an endoscope than with a microscope. Going through the external meatus, surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handedly, which is awkward. In cases of extensive bone removal or excessive bleeding, the view through the endoscope lens is obscured; therefore; the endoscope cannot fully substitute the microscope. It is, however, an interesting adjunct to microscopic ear surgery.

[Endoscopic ear surgery - complement to microscopic ear surgery]. / Endoskopische Ohrchirurgie ­ eine Weiterentwicklung der modernen Ohrchirurgie.

Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high definition, 4­k, and 3­dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragma can be visualized far better by using an endoscope rather than a microscope. Going through the external meatus surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handed, which is awkward. In case of extensive bone removal or excessive bleeding the view through the endoscope lense is obscured, the endoscope therefore cannot fully substitute the use of the microscope. It is however an interesting adjunct to microscopic ear surgery.

[Fulminant process of an orbital Mucoracea infection]. / Fulminanter Verlauf einer orbitalen Mucoracea-Infektion.

Rhinoorbitocerebral mucormycosis is a rare invasive fungal infection that is fatal when untreated. We describe an immunosuppressed patient with chronic lymphatic leukaemia who developed a severe rhinoorbitocerebral mucormycosis after allogeneic bone marrow transplantation. Due to the potentially fulminant course and fatal outcome, radical excision of the necrotic area in combination with antifungal therapy is necessary in the presence of suspicious clinical signs of mucormycosis despite a lack of histopathologic confirmation.

[Acetylsalicylic acid does not alter the mechanoelectrical transduction of mammalian outer hair cells in vitro]. / Die mechanoelektrische Transduktion der äusseren Haarzelle wird durch Azetylsalizylsäure in vitro nicht beeinflusst.

BACKGROUND: High doses of acetylsalicylic acid (ASS) induce tinnitus and hearing loss. This ototoxic side effect of ASS is characterized by a decrease in spontaneous and evoked otoacoustic emissions. A decrease in otoacoustic emissions is found not only in mammals, but also in non-mammalian ears without electromotile outer hair cells. The molecular mechanism underlying ASS ototoxicity seems to be competitive binding to and a block of the motor molecule prestin. In non-mammalian species, ASS ototoxicity is possibly explained by an effect on the hair bundle. RESULTS: The present data from the outer hair cells of the adult guinea pig cochlea show a reduction in the membrane capacitance by maximally 42%, probably as a result of ASS binding competitively to the motor molecule. However, spontaneous and evoked receptor currents were not modulated by ASS. CONCLUSION: The results suggest an influence of ASS on outer hair cell somatic electromotility, without a concomitant effect on hair-bundle function.

[Routine otorhinolaryngological examination in patients with cystic fibrosis]. / Standardisierte HNO-Untersuchung bei Patienten mit Mukoviszidose.

OBJECTIVES: Data on the prevalence of otorhinolaryngological (ORL) symptoms in patients with cystic fibrosis (CF) are limited. A standard annual examination would be useful for definition of risk factors and/or management alternatives for these symptoms. STUDY DESIGN: Prospective observational study of an unselected group of CF patients. PATIENTS AND METHODS: Between 1997 and 2004, 123 CF patients were routinely examined. The examinations included nasal endoscopy and audiological evaluation. RESULTS: All patients who were approached to take part in the study gave their consent and were extremely cooperative. In 40% of the patients nasal polyps were found endoscopically. In 22% rhinological surgery had already been performed. Of the 123 patients, 13 (12%) showed different grades of sensorineural hearing loss, and all of these patients had received aminoglycoside antibiotics. CONCLUSIONS: CF patients demonstrate a high prevalence of ORL symptoms. Therefore, an annual standard examination would provide data for identifying potential risk factors and for optimizing the management of these symptoms in CF patients.

[Electronic surveillance of nosocomial infections in head and neck surgery and stapes surgery]. / Elektronische Erfassung nosokomialer Infektionen bei Halsweichteileingriffen und Stapesplastiken (CISS).

BACKGROUND: Nosocomial infection is generally regarded as the most important postoperative complication. Therefore, on 28 December 2002 a German law was implemented requiring the surveillance of postoperative infections in all hospitals. METHODS: The authors propose using stapes and thyroid surgery to monitor the infection rate in a typical Head and Neck Department. A versatile software (CISS) based on MS Word and MS Excel was developed for this purpose. RESULTS: Postoperative infections were retrospectively analyzed for three subsequent years. The present data confirm the results of previous studies that surveillance itself is a powerful tool in reducing the postoperative infection rate. CONCLUSION: The newly developed software provided an easy tool for the collection of infection data. The reported infection rates in stapes and thyroid surgery are representative of ENT clinics in Germany.

[Potentially fatal orbital disorder]. / Potenziell letaler Orbitaprozess.

Fulminant processes of the orbit can cause considerable diagnostic difficulties with regards to the clinical, radiological and microbiological appearance. Rhino-orbito-cerebral mucormycosis is a rare but, when untreated, fatal orbital disease capable of destructive infiltration of soft tissue and bone. It occurs preferably in the ill adjusted diabetic or in the course of an immunodeficiency. The following case report describes a leukaemia patient developing a severe rhino-orbito-cerebral mucormycosis which was initially not recognised. Since untreated mucormycosis is fatal, an aggressive surgical approach with excision of the whole necrotic area is necessary even if the diagnosis cannot be confirmed with certainty.

Acoustomechanical properties of open TTP titanium middle ear prostheses.

OBJECTIVE: The purpose of the study was to identify acoustcomechanical properties of various biostable and biocompatible materials to create a middle ear prosthesis with the following properties: (i) improved handling including a good view of the head of the stapes or footplate and adjustable length, (ii) improved acoustical characteristics that are adequate for ossiculoplastic. The identified material should serve to build CE and FDA approved prostheses for clinical use in patients. METHODS: Test models made of Teflon, polyetheretherketone, polyethylenterephtalate, polysulfone, gold, Al2O3 ceramics, carbon and titanium were investigated for their potential to fulfill the requirements. Acoustical properties were investigated by laser Doppler velocimetry (LDV) in mechanical middle ear models (MMM). Measured data were fed in to a recently created computer model of the middle ear (multibody systems approach, MBS). Using computer-aided design (CAD) measured and computed data allowed creation and fine precision of titanium prostheses (Tübingen Titanium Protheses, TTP). Their handling was tested in temporal bones. Acoustomechanical properties were investigated using the MBS and mechanical middle ear models. MAIN OUTCOME MEASURES: Input impedance, mass, stiffness, and geometry of test models and prostheses were determined. Furthermore, their influence on the intraprosthetic transfer functions and on coupling to either tympanic membrane or stapes was investigated. RESULTS: Final results were FDA- and CE-approved filigreed titanium prostheses with an open head that fulfilled the four requirements detailed above. The prostheses (TTP) were developed in defined lengths of between 1.75 and 3.5 mm (partial) and 3.0 and 6.5 mm (total) as well as in adjustable lengths (TTP-Vario). CONCLUSIONS: The results suggest acoustomechanical advantages of TTPs because they combine a significantly low mass with high stiffness. In contrast to closed prostheses, the open head and filigreed design allow an excellent view of the prosthesis foot during coupling to the head or footplate of stapes, contributing to an improved intraoperative reliability of prosthesis coupling.

Distortion product otoacoustic emissions in human hypercholesterolemia.

Epidemiological and experimental studies suggest that hypercholesterolemia promotes the development of sensorineural hearing loss; however, the underlying cellular pathomechanism remains obscure. In the present study, 20 healthy subjects and 20 patients with familial hypercholesterolemia were compared with respect to their hearing function. None of the 40 persons reported any history of hearing disorder. In accordance with this subjective impression, mean hearing thresholds were within the normal, age-dependent ranges in both groups. In contrast, the single-generator distortion product otoacoustic emissions (sgDPOAE) were reduced at and above 4 kHz. Input-output functions of DPOAE could be subdivided into three groups: (i) normal, with unity slope at low intensities and slope less than unity (0.24+/-0.07 dB/dB at higher intensities; (ii) pathologic, described by a single straight line; (iii) ill-defined, with data usually indistinguishable from the background noise level. The ill-defined DPOAE behavior was only found in patients with hypercholesterolemia; namely, for 25% of patients at f(2)=1.5 kHz and for 50% at f(2)=4 kHz. Patients belonging to the pathologic and ill-defined DPOAE groups had significantly (P<0.05) higher total serum cholesterol and LDL-cholesterol levels compared with subjects from the normal DPOAE group. While hearing thresholds of patients with ill-defined growth functions were not statistically different from those of normal subjects, speech scores were significantly reduced in these cases. The data imply that nonlinear mechanical processes in the cochlea are compromised in hypercholesterolemic patients.

Glial lesion of the infratemporal fossa presenting as a soft tissue middle ear mass - rudimentary encephalocele or neural crest remnant?

We report about ectopic glial tissue of the skull base and the parapharyngeal space presenting as a soft tissue mass in the middle ear. An 11-year-old boy presented with bilateral conductive hearing loss since early childhood. The history included previously removed lesions consistent with ectopic neuroglial tissue of the tongue and the parapharyngeal space soon after birth, as well as surgery for cleft palate. High resolution computed tomography of the petrous bone and magnetic resonance imaging were useful in identifying the skull base defect and in characterizing the lesion's relation to the brain. There was no clinical, radiological or surgical evidence of any associated dural defect. The lesion was removed via a modified infratemporal approach. Histology revealed neuroglial tissue with calcifications without any signs of mesodermal or entodermal origin. On the basis of this case the pathogenesis and diagnosis of ectopic brain tissue and its relation to the more commonly encountered meningoencephalic herniations are reviewed. Furthermore therapeutical implications are discussed.

[In vivo cochleoscopy through the round window]. / In-vivo-Cochleoskopie durch das runde Fenster.

The overall aim of the present investigation was to develop a technique for endoscopic investigation of the cochlea. In the experiments reported here, the possible effect of the endoscope-called the "cochleoscope"-on the electrophysiology of the cochlea was investigated by recording the cochlear action potential (CAP) threshold tuning curve from (0.1-34 kHz). The dorsolateral bulla of anesthesized guinea pigs (with ketamine 60 mg/kg and Rompun 12 mg/kg) was opened, after which the cochleoscope was introduced under micromanipulator control through the round window membrane. Three cochleoscopes were used and had diameters of 0.29 mm, 0.7 mm and 0.89 mm, respectively, containing 2000, 3000 and 3000 fibers each. Experiments in 7 animals showed that the cochleoscope did not influence CAP thresholds. Although the present resolution of the endoscopes is limited, the basilar membrane can be clearly distinguished from the osseous spiral lamina. It is anticipated that improved resolution will allow the cochleoscope to be used for diagnostic purposes in cases of sensorineural hearing loss.

[Effect of weather on the incidence of sudden deafness]. / Der Einfluss des Wetters auf die Hörsturzinzidenz.

BACKGROUND: The etiology of sudden idiopathic hearing loss is not known. Among other causes, vascular disease is discussed as a possible pathomechanism in sudden hearing loss. Since other vascular diseases such as myocardial infarction, migraine, and open-angle glaucoma show a clear meteorotropy, it was the aim of the present prospective study to investigate the dependence of sudden hearing loss on weather parameters. PATIENTS AND METHODS: The incidence, the extent, and the remission of sudden idiopathic hearing loss in 128 patients were correlated with atmospheric pressure and temperature during a period of 12 months. RESULTS: The group of patients with a complete recovery of hearing thresholds was characterized by the smallest changes of atmospheric pressure and temperature, whereas patients with no recovery of hearing had the highest values for atmospheric pressure and temperature changes. However, a statistically significant correlation of sudden hearing loss with absolute values or relative changes of atmospheric air pressure or temperature was not found. Likewise, there was no seasonal dependence. CONCLUSION: The results indicate that sudden idiopathic hearing loss occurs independently of weather parameters.