[Laser Doppler vibrometric measurements on human temporal bones]. / Laser-Doppler-vibrometrische Messungen an humanen Felsenbeinen.

Laser Doppler vibrometric (LDV) measurements on human temporal bones represent the standard method for predicting the performance of active middle ear implants (AMEI) and are used as preclinical tests in the development, approval process, and indication expansion of AMEI. The quality of the coupling of the floating mass transducer to the mobile structures of the middle ear is decisive for the performance of the implant and patients' hearing perception. The cochlea can be stimulated via the oval window (forward stimulation) or the round window (reverse stimulation). For forward stimulation, the ASTM standard F2504-05 defines a method to ensure physiologically normal properties of the temporal bones used in the experiments. For reverse stimulation, which depends even more critically on the quality of the temporal bone, a comparable standard method is lacking. Appropriate preparation and storage of the human petrous bone as well as suitable LDV test setups with respect to calibration and reproducibility of measuring positions and angles provide results that allow a comparison of different types of coupling and also correlate well with clinical data.

Screening for irradiation vasculopathy by intima-media thickness sonography in head and neck cancer patients.

PURPOSE: Post-irradiation vasculopathy is a severe form of atherosclerosis and affects the prognosis of head and neck cancer survivors. Sonographic intima-media thickness (IMT) precedes stenosis, plaque formation, and cerebrovascular events. Therefore, IMT may be a valuable screening marker for post-irradiation toxicity. However, the critical irradiation dose and the onset of IMT increase remain unclear. METHODS: The cross-sectional study analysed the carotid artery IMT in 96 irradiated patients and 41 controls regarding irradiation dose, post-irradiation-interval, and cardiovascular risk factors. Distinct irradiation doses to the tumour side and the contralateral hemineck enabled detection of dose depended effects within one patient and control of risk factors. RESULTS: Radiotherapy caused a dose-dependent increase in IMT. The toxicity did not have saturation effects for > 60 Gy. The IMT increase occurred in short-term following radiotherapy and the risk for a pathological value (> 0.9 mm) rose significantly. The correlation between IMT and radiotherapy was comparable to established cardiovascular risk factors. CONCLUSION: Radiotherapists should consider the additional toxicity of high doses for non-metastatic head and neck cancer. If neck metastases require radiotherapy with boost, IMT measurement is suitable for early detection of carotid artery damage.

[Functional rehabilitation of severe laryngopharyngeal injuries after near-lethal suicide attempt by hanging]. / Funktionelle Rehabilitation schwerer laryngopharyngealer Verletzungen nach Suizidversuch durch Erhängen.

BACKGROUND: Hanging is a common method of suicide with an estimated mortality rate of about 70%. Survival of patients with severe laryngopharyngeal injuries after strangulation is not common. However, clinical findings of patients reaching the hospital alive may be minimal. A rapid onset of multidisciplinary diagnostic and therapeutic management is mandatory, followed by psychiatric treatment and functional rehabilitation. CASE PRESENTATION AND RESULTS: Two uncommon cases after severe laryngopharyngeal injury due to near-lethal suicide attempt by hanging demonstrate the emergency management and reconstructive surgery. Subsequent tracheal cannula management and swallowing therapy to full recovery are described. In addition, a proposal for an interdisciplinary treatment algorithm for those patients is presented. CONCLUSION: Minimal external clinical findings after near-lethal suicide attempts by hanging do not exclude severe internal injuries of the upper aerodigestive tract structures. After reconstructive surgery an appropriate tracheal cannula management and an early and intensive swallowing therapy parallel to the psychiatric treatment is mandatory to restore voice, airway and deglutition.

[20 Years of Bilateral Cochlear Implantation - an Analysis of the Implanted Patients]. / 20 Jahre bilaterale Cochleaimplantation ­ eine Analyse seither implantierter erwachsener Patienten.

Binaural hearing is essential for localization abilities and improves the speech perception in noise. Since 20 years, bilateral cochlear implantation is routinely performed to restore binaural hearing. In this cross-sectional study, we evaluated speech perception in quiet (Freiburger monosyllables, Hochmair-Schulz-Moser (HSM) sentence test, each at 70 dB) and in noise (HSM test, signal-to-noise ratio 10 dB) in 103 out of 165 adult patients who were bilaterally implanted in Würzburg between 1995 and June 2014. In almost half the patients, the second implanted side showed the better speech perception. Compared to the first implanted side, the average monosyllable scores with bilateral implants were improved from 54 to 63% and the HSM scores from 86 to 96%. In noise the speech perception improved from 47 to 65%. The speech perception of the second implanted side was independent of the time interval between the implantation of both sides in this cohort of postlingually deafened patients. This cross-sectional data underline the importance of bilateral cochlear implantation for speech understanding in quiet and even more in noise and thus, for the everyday life. For this, bilateral cochlear implantation should be the generally accepted standard in the treatment of deaf patients.

[Direct Drive Simulation - Sound-Simulation of the Vibrant Soundbridge®]. / Direct Drive Simulation - Klangsimulation des Vibrant Soundbridge®-Hörens.

BACKGROUND: The Direct-Drive-Simulation (DDS) tends to simulate the sound quality of hearing with the active middle ear implant Vibrant Soundbridge(®) (VSB). Up to now a scientific evaluation of the validity is missing. Furthermore, the test procedure has not been described yet. Aim of this study was to evaluate the test validity and to describe the test realization in detail. MATERIAL AND METHODS: 10 patients evaluated their sound impression on scales from 1 to 10 concerning sound quality during DDS, postoperative free field testing at least 3 month after the first fitting of the VSB and in the everyday life situation. 3 patients were implanted bilaterally. Together, 36 data sets could be analyzed. RESULTS: Coupling of the Floating Mass Transducer (FMT), which was placed inside of a silicone probe during DDS was successful in all cases. In 11 out of 13 cases the coupling quality was judged as "good" an only in 2 cases as "medium". None of the patients needed local anesthesia. Comparing the evaluation of the sound impression during DDS preoperatively, and with the implanted VSB in free field testing and in everyday life no significant differences were found. CONCLUSION: The DDS offers the possibility of a realistic preoperative sound simulation of the "VSB-hearing" in case of sensorineural hearing loss. Thus, the test is supposed to facilitate the patient's decision towards possible treatment options. The specialist gets additional information regarding the indication especially when audiologic indication criteria are critical. The DDS should be a basic part of the preoperative diagnostic prior to VSB-implantation.

Synchronous spontaneous cerebrospinal fluid leaks in the nose and ear.

OBJECTIVE: The majority of spontaneous cerebrospinal fluid leaks occur at the anterior skull base; few cases at the temporal bone have been described. There have been no previous reports of synchronous leaks at the anterior skull base and temporal bone in the same patient. METHODS: Case report and brief review of management of spontaneous cerebrospinal fluid leaks in the nose and ear. CASE REPORT: A 34-year-old, pregnant woman presented with watery nasal discharge and unilateral middle-ear effusion. The nasal and ear secretions both proved to be cerebrospinal fluid. Radiological imaging showed defects in both the ethmoid roof and the mastoid roof (middle cranial fossa). These defects were surgically closed using duraplasties. CONCLUSION: A literature review indicated that this is the first reported case of synchronous spontaneous cerebrospinal fluid leaks via the anterior skull base and temporal bone.

Treatment of chronic tinnitus with θ burst stimulation: a randomized controlled trial.

OBJECTIVE: To test whether 4 weeks of bilateral repetitive transcranial magnetic stimulation (rTMS) to the temporal or temporoparietal cortex is effective and safe in the treatment of chronic tinnitus. METHODS: In this controlled 3-armed trial, 48 patients with chronic tinnitus were treated with 4 weeks (20 sessions) of bilateral continuous theta burst stimulation (cTBS) at the Tübingen University Hospital. They were randomized to stimulation above the temporal cortex, the temporoparietal cortex, or as sham condition behind the mastoid. Patients were masked for the stimulation condition. Tinnitus severity was assessed after 2 and primarily 4 weeks of treatment and at 3 months follow-up with the tinnitus questionnaire and by a tinnitus change score. Audiologic safety was monitored by pure-tone and speech audiometry after 2 and 4 weeks of cTBS. RESULTS: Tinnitus severity was slightly reduced from baseline by a mean (SD) 2.6 (8.2) after sham, 2.4 (8.0) after temporoparietal, 2.2 (8.3) after temporal treatment of 16 patients each, but there was no significant difference between sham treatments and temporal (confidence interval [CI] -5.4 to +6.7) or temporoparietal cTBS (CI -5.9 to +6.3) or real cTBS (CI -7 to +5.1). Patients' global evaluation of tinnitus change after treatment did not indicate any effects. Audiologic measures were unaffected by treatment. CONCLUSIONS: Treating chronic tinnitus for 4 weeks by applying cTBS to the temporal or temporoparietal cortex of both hemispheres appears to be safe but not more effective than sham stimulation. However, these results are not to be generalized to all forms of rTMS treatments for tinnitus.

[Spreader grafts in septorhinoplasty]. / Spreader grafts in der Septorhinoplastik1.

BACKGROUND: Spreader grafts are strut-shaped cartilage grafts, which are placed bilaterally between anterior septal edge and upper lateral cartilages. Spreader grafts are harvested from autologeous cartilage (septum, auricle, rib). A typical dimension is 24×8×2 mm, however the size can vary considerably. Depending on the pathology to be corrected, spreader grafts can have the following effects: straightening of the anterior edge of the septum (often called septal roof), straightening of the cartilageneous dorsum, prevention of collapse of the middle vault, prevention of stenosis of the inner nasal valve, straightening of the caudal septum, correction of asymmetries in the cartilageneous dorsum, connection between septum and columella. METHODS: Retrospective analysis of the indications for SG in 100 consecutive septorhinoplasties at the Dept. of Otolaryngology, University of Tübingen, in the year 2009. Review of anatomical background, indication and operation technique of SG, illustrated by clinical examples. RESULTS AND CONCLUSION: SG were used in 70 of 100 consecutive septorhinoplasties in 2009. The indications comprised nasal humps, nasal overprojection, nasal deviations, saddle noses, steps and irregularities in the dorsum, and extracorporal septoplasties. 47 times the SG were made of septal cartilage, 6 times from rib cartilage and 17 times from conchal cartilage. SG play an important role in the achievement of satisfactory long-term results in the correction of many nasal deformities, among those the deviated nose and the hump nose, which are the most commonly corrected conditions in rhinoplasty.