[Sound levels in nursery schools]. / Lärm in Kindertagesstätten.

INTRODUCTION: Children and teenagers often suffer from hearing loss because of exposure to sound levels above 100 dB generated by toys, portable music players and stereo equipment in discotheques. Even in nursery schools and schools, considerable noise levels are produced by children's voices. METHODS: Sound levels were measured in a nursery school in Cologne in four different rooms, each with 22 children aged between 3 and 6 years and two teachers. Sound dosimeters detected sound levels in each room for 5 days of the week. These were positioned in the room above the playing children as well as near the teachers' ears. The same measurements were repeated after the children had been instructed about noise and possible noise damage. In addition, the children were now able watch the "noise lights", an instrument resembling traffic lights which translated the sound levels actually measured in their room into optical signals. A questionnaire containing 13 questions about noise and sensitivity to noise was distributed to 35 teachers at nursery schools in the Cologne municipal area. RESULTS: Mean sound levels of an 8-h/day measuring period (L(eq)) were 80.1 ± 2.3 dB(A) near the ear of the teacher and 70.87 ± 2.5 dB(A) measured in the room. The maximal sound level for 1 s, L(max) dB(A), was 112.55 ± 2.3 dB(A) near the ear and 103.77 ± 8.1 dB(A) in the room. After the children had learned about noise and were able to check the sound level they produced with the help of the "noise lights", a tendency towards a reduction of sound levels in the room and near the teachers' ears could be seen. An evaluation of the questionnaire revealed the high physical strain and emotional stress the teachers were subjected to due to noise. CONCLUSIONS: Children and teachers in nursery schools are subjected to high sound levels. Therefore, the education and early sensitization of children to noise in order to prevent prospective hearing damage, e.g. using the "noise light", should be set as a goal. Soundproofing measures are also possible. Further investigations to assess the effects of these measures are planned.

[Degeneration and osteoporosis of the spine. Is there a modified procedure?]. / Degeneration und Osteoporose der Wirbelsäule. Andert sich die Vorgehensweise?

Reduced bone quality due to osteoporosis poses a fundamental problem in spine surgery instrumentation. The consequences observed most often are insufficient implant anchoring and adjacent fractures. In cases of manifest osteoporosis, several modern anchoring possibilities are at our disposal that, to differing degrees, increase the stability of the instrumentation. Cement augmentation of a fractured vertebra by means of kyphoplasty or vertebroplasty verifiably leads to significantly better pain reduction than conservative treatment does, at least in the short-term postoperative course. A difference between these two techniques has not yet been substantiated. The rate of adjacent fractures occurring after cement augmentation is not higher than in conservatively treated patients.

[Anterior spondylosis of the cervical spine causing dyspnea and sleep disturbance]. / Spondylophytäre Atem- und Schlafstörungen.

BACKGROUND: Cervical osteochondrosis is a rare differential diagnosis leading to dysphagia, inspiratory stridor and obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: We report six cases of patients with episodes of neck pain (n=6), pain reflected to the arm (n=1), sleep apnea (n=5), inspiratory stridor (n=3) and/or unclear dysphagia (n=6), who presented between 2000 and 2003 at the Römerwallklinik Mainz and the university hospitals of Mainz and Cologne. None of these patients had symptoms of spinal or radicular compression. All underwent otorhinolaryngological and radiological examination followed by excision of anterior spondylophytes and intervertebral fusion. One patient required immediate tracheotomy due to perforation of the pharyngeal wall associated with severe supraglottic swelling. RESULTS: All patients were free of inspiratory stridor postoperatively. Symptoms of dysphagia disappeared in four patients and were reduced in two. Three of five patients were free of apnea. OSAS had improved in two. Neck pain was eliminated in four cases and markedly improved in two cases. CONCLUSIONS: In case of symptoms of pharyngeal compression and OSAS, a vertebragenic cause should be considered.

[Characterization of sleep disturbance in patients with tinnitus]. / Charakteristik der Schlafstörungen bei Patienten mit Tinnitus.

BACKGROUND: Approximately 60 % of patients with tinnitus experience disturbances of the normal sleep pattern. METHODS: Polysomnography was performed on 26 patients with tinnitus and sleep disturbances. RESULTS: In 17 of 26 patients polysomnography revealed a pathological sleep analysis: 10 patients were diagnosed with obstructive sleep apnea syndrome, 4 with insomnia and an increased index of arousals as well as a reduction of deep sleep- and REM-phases. Pathological movements of the legs were seen in 3 cases. Six of 9 patients with a normal sleep during the whole night displayed a prolonged latency period until falling asleep. CONCLUSIONS: Many studies show that sleep disturbances are a factor that strongly predicts decreased tolerance to tinnitus. This and the findings of this study implicate, that somnographic workup is helpful in patients with tinnitus in order to integrate adequate therapy of the sleep disturbance in the concept of tinnitus therapy and to avoid adaptive difficulties to tinnitus.

Retro-pharyngeal obstruction in association with osteophytes of the cervical spine.

We describe five patients with cervical spondylosis and large anterior osteophytes causing pharyngeal compression. All had dysphagia, two had obstructive sleep apnoea and another two had dyspnoea and stridor on inspiration. One, with perforation of the pharynx, required emergency tracheostomy. Only three had pain in the neck or arm. Compression of the retroglottic space was confirmed in all patients by pharyngoscopy and in all the symptoms were relieved by excision of the osteophytes. Three also underwent intervertebral fusion. One had some persistent sleep apnoea.

[Attention diversion in tinnitus therapy. Comparison of the effects of different treatment methods]. / Aufmerksamkeitslenkung in der Tinnitustherapie. Vergleich von Effekten unterschiedlicher Behandlungsmethoden.

BACKGROUND: Diversion or distraction of auditory attention is a core principle of tinnitus retraining therapy as introduced by P. Jastreboff and J. Hazell. The aim of this study was to evaluate the effectiveness of a different form of attention diversion in tinnitus therapy. METHODS AND PATIENTS: In a prospective and randomized study, 40 patients suffering from chronic tinnitus were assigned to two different groups, A or B. All patients received appropriate counselling and were instructed in relaxation training. Patients in group A learned to distract attention away from the tinnitus by using sound or music. White noise generators or hearing aids were applied in this group. Patients in group B were instructed to direct their attention away from the tinnitus using imagination that was facilitated by the use of light and warmth stimuli as distracters. Different standardized questionnaires were used for an evaluation of therapy effectiveness. RESULTS: In both groups, patients were significantly less annoyed and disabled by their tinnitus immediately after therapy and after 6 months. Tinnitus annoyance still proved to be reduced 1 year after the end of the therapy. There were no significant differences in the effects of each treatment. CONCLUSIONS: Attention diversion is an important method for decreasing tinnitus-related distress. Patients should be instructed to use not only auditory but also visual and thermal sensations in order to distract attention away from their tinnitus.