Is Sigstad's score really capable of detecting post-surgical late dumping syndrome?

BACKGROUND: This clinical trial explores the Sigstad score for late dumping syndrome in postoperative patients who have undergone sleeve gastrectomy (SG) or One Anastomosis Gastric Bypass (OAGB). The aims of this study are to investigate the correlations with late dumping syndrome, to evaluate the reliability and validity of the Sigstad score and to discuss a modified scoring system. METHODS: The study was conducted at the Obesity Center of the Westküstenklinikum Heide and included 271 patients. Data collection involved conducting interviews, diet diaries and measuring blood glucose levels. Non-parametric tests, logistic regression and McDonald's Omega were the selected statistical approaches. RESULTS: Body Mass Index (BMI) decreased over time (-9.67 kg/m2 at 4 months, -15.58 kg/m2 at 12 months). Preoperatively, the Sigstad score exhibited the highest value, and no occurrences of late dumping syndrome were observed. No significant differences were found in BMI concerning late dumping syndrome or Sigstad score among postoperative patients. Postoperative patients experienced an increase in gastrointestinal symptoms. The reliability test showed a McDonald's omega value of 0.509. The analysis conducted through binary logistic regression indicated dizziness as a significant predictor of late dumping syndrome; however, this finding did not hold up after performing Bonferroni correction. CONCLUSION: The Sigstad score is not a reliable or valid method for detecting late dumping syndrome after surgery for obesity and metabolic disorders. It is necessary to have alternatives that use objective measures and assess the quality of life, and that these alternatives be validated in large patient cohorts.

[Extended preoperative speech audiometric diagnostics for cochlear implant treatment]. / Erweiterte präoperative sprachaudiometrische Diagnostik im Rahmen der Cochleaimplantatversorgung.

BACKGROUND: For severe hearing loss and even profound deafness, cochlear implants (CIs) have become the treatment of choice. For establishment of the CI indication, the preoperative Freiburger monosyllabic word recognition (EV) at 65 dB SPL in free field with a hearing aid (EVHG65) and the maximal understanding (mEV) without a hearing aid with headphones results are important. The goal of this retrospective study was to analyse the correlation of word recognition with a hearing aid at 80 dB SPL (EVHG80) and mEV. This represents an extension to measuring EVHG65 compared to mEV and to pure-tone audiometry (4FPTA). METHODS: In this study, word recognition with and without a hearing aid was retrospectively analysed for 661 ears. Inclusion criterium was CI implantation at a later date. RESULTS: During preoperative CI diagnostics, an mEV of 0% was found in 334 ears. The EVHG65 for 485 ears and the EVHG80 for 335 ears were also 0%. The EV with hearing aid was found to worsen with increasing 4FPTA at both sound pressure levels, although this effect was smaller at 80 dB SPL than at 65 dB SPL. Including only ears with mEV > 0 % (N = 260 ears), a stronger correlation between EVHG80 and mEV with a difference of (-4.0 ± 16.4%) in comparison to EVHG65 and mEV with a difference of (-18.3 ± 16.7%) is seen. This shows a significant difference between mEV and EVHG80 compared to mEV and EVHG65. CONCLUSION: At a sound pressure level of 65 dB SPL, EV with hearing aid often does not show the accordance with mEV specified by hearing aid and CI guidelines. The EVHG80 correlates better with mEV than EVHG65. For clinical diagnosis it is rational to measure speech discrimination with hearing aid at levels higher than 65 dB SPL.

Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants.

BACKGROUND: The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. Despite numerous studies examining the cochlear implant (CI) outcome, variations in speech comprehension with CI remains incompletely explained. The aim of this study was therefore to examine preoperative pure-tone audiogram and speech comprehension as well as aetiology, to investigate their relationship with postoperative speech comprehension in CI recipients. METHODS: A retrospective study with 664 ears of 530 adult patients was conducted. Correlations between the target variable postoperative word comprehension with the preoperative speech and sound comprehension as well as aetiology were investigated. Significant correlations were inserted into multivariate models. Speech comprehension measured as word recognition score at 70 dB with CI was analyzed as (i) a continuous and (ii) a dichotomous variable. RESULTS: All variables that tested preoperative hearing were significantly correlated with the dichotomous target; with the continuous target, all except word comprehension at 65 dB with hearing aid. The strongest correlation with postoperative speech comprehension was seen for monosyllabic words with hearing aid at 80 dB. The preoperative maximum word comprehension was reached or surpassed by 97.3% of CI patients. Meningitis and congenital diseases were strongly negatively associated with postoperative word comprehension. The multivariate model was able to explain 40% of postoperative variability. CONCLUSION: Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. Combining audiological and aetiological variables provides more insights into the variability of the CI outcome, allowing for better patient counselling.