[Active hearing implants in chronic otitis media]. / Aktive Hörimplantate bei chronischer Otitis media.

In patients with inadequate hearing improvement after tympanoplasty and failure of conventional hearing aid fitting, active hearing implants provide an alternative treatment option. Active middle ear implants function as a vibromechanical bypass of the stiffness and damping effect of a poorly oscillating tympanic membrane and the (reconstructed) ossicular chain. The selection of the hearing system depends on the maximum output levels of the hearing system and the anatomical conditions in mostly multiply operated ears. The development of variable coupling elements for active middle ear implants led to an extension of the indications to include not only purely sensorineural hearing loss but also mixed and conductive hearing loss in patients, as the transducer can now be coupled to the (mobile) stapes or the round window membrane. The article provides an overview of current clinical study results and recommendations on the indications for active hearing implants in patients with chronic otitis media.

[Listening effort with cochlear implants: Unilateral versus bilateral use]. / Höranstrengung bei Cochlea-Implantaten: Einseitige versus beidseitige Versorgung.

AIM: The influence of bilateral cochlear implants (CI) and unilateral CI on the self-reported listening effort in standardized situations is being assessed. SAMPLE AND METHODS: The sample consisted of 34 bilateral and 38 unilateral adult CI users. Unilateral CI users had at least severe hearing loss in the non-implanted ear and had been fitted with a hearing aid. The listening effort has been defined as a subjectively perceived effort in understanding a speaker. Patients were administered a customized questionnaire containing nine examples of listening situations with different demands. The listening effort expended in each situation had to be rated on a six-step scale. Answers were analyzed using repeated measures ANOVA, including the factors "level of background noise," "listening duration," and the covariates "patient age" and "time since CI implantation." RESULTS: Only the factors "level of background noise" and "listening duration" were significant (p = 0.024 and p = 0.001 respectively). Unilateral versus bilateral CI was not significant (p = 0.17). Nevertheless, bilateral CI users reported a lower degree of listening effort than unilateral users in all of the nine situations asked about in the questionnaire (binomial test: p = 0.002). DISCUSSION: We conclude that bilateral CI use has some effect on reducing listening effort, but compared with unilateral use the effect is possibly not very great.

[On the interdisciplinary S3 guidelines for the treatment of chronic idiopathic tinnitus]. / Zur interdisziplinären S3-Leitlinie für die Therapie des chronisch-idiopathischen Tinnitus.

INTRODUCTION: Tinnitus is a frequent symptom, which, particularly in combination with comorbidities, can result in a severe disease-related burden. Chronic idiopathic tinnitus (CIT) is the most frequent type of tinnitus. A considerable number of treatment strategies are used to treat CIT-for many of which there is no evidence of efficacy. In order to enable scientific evidence-based treatment of CIT, German interdisciplinary S3 guidelines have recently been constructed for the first time. Here we present a short form of these S3 guidelines. MATERIALS AND METHODS: The guidelines were constructed based on a meta-analysis of the treatment of chronic tinnitus performed by the authors. Additionally, a systematic literature search was performed in the PubMed and Cochrane Library databases. Furthermore, a systematic search for international guidelines was performed in Google, as well as in the Guidelines International Network and National Guideline Clearinghouse (USA) database. Evidence was classified according to the Oxford Centre for Evidence-Based Medicine system. RESULTS: According to the guidelines, alongside counselling, manualized structured tinnitus-specific cognitive behavioral therapy (tCBT) with a validated treatment manual is available as evidence-based therapy. In addition, the guidelines recommend concurrent treatment of comorbidities, including drug-based treatment, where appropriate. Particularly important is treatment of anxiety and depression. Where a psychic or psychiatric comorbidity is suspected, further diagnosis and treatment should be performed by an appropriately qualified specialist (psychiatrist, neurologist, psychosomatic medicine consultant) or psychological psychotherapist. In cases accompanied by deafness or hearing loss bordering on deafness, cochlear implants may be indicated. CONCLUSION: No recommendations can be made for drug-based treatment of CIT, audiotherapy, transcranial magnetic or electrical stimulation, specific forms of acoustic stimulation or music therapy; or such recommendations must remain open due to the lack of available evidence. Polypragmatic tinnitus treatment with therapeutic strategies for which there is no evidence of efficacy from controlled studies is to be refused.

Some anthropological aspects of the prehistoric Tyrolean ice man.

The corpse of a Late Neolithic individual found in a glacier in Oetztal is unusual because of the intact nature of all body parts that resulted from the characteristics of its mummification process and its protected geographical position with regard to glacier flow. Anthropological data indicate that the man was 25 to 40 years old, was between 156 and 160 centimeters in stature, had a cranial capacity of between 1500 and 1560 cubic centimeters, and likely died of exhaustion.

Endocranial capacity in an early hominid cranium from Sterkfontein, South Africa.

Two- and three-dimensional computer imaging shows that endocranial capacity in an approximately 2.8- to 2.6-million-year-old early hominid cranium (Stw 505) from Sterkfontein, South Africa, tentatively assigned to Australopithecus africanus, is approximately 515 cubic centimeters. Although this is the largest endocranial capacity recorded for this species, it is still markedly less than anecdotal reports of endocranial capacity exceeding 600 cubic centimeters. No australopithecine has an endocranial capacity approaching, let alone exceeding, 600 cubic centimeters. Some currently accepted estimates of early hominid endocranial capacity may be inflated, suggesting that the tempo and mode of early hominid brain evolution may need reevaluation.

Glutamatergic control of food intake in pigeons: effects of central injections of glutamate, NMDA, and AMPA receptor agonists and antagonists.

The possible involvement of glutamatergic mechanisms in the control of food intake was studied in free-feeding and in 24-h food-deprived (FD24) pigeons for 1 h after intracerebroventricular (i.c.v.) treatment with glutamate (Glu, 0, 50, 150, 300, and 600 nmol). Glu injections dose dependently induced decreases (30-65%) in food intake (FI) and feeding duration (FD), and increases in latency to start feeding (LSF) in FD24 animals, but not in free-feeding ones. None of these treatments affected noningestive behaviors (locomotion, sleep, and preening). In FD24 pigeons, i.c.v. treatments with N-methyl-D-aspartic acid (NMDA, 0.1, 1, 4, 8, or 16 nmol) or D,L-alpha-amino-3-hydroxy-isoxazole proprionic acid (AMPA, 0.1, 1, 4, or 8 nmol) decreased FI and FD, but left LSF unchanged compared to vehicle-treated FD24 controls. Kainic acid (0.1, 0.5, and 1 nmol), or [trans-(1S,3R)-ACPD-(5NH4OH)] (ACPD, 0.1, 1, 4, 8, and 16 nmol) left unchanged the ingestive profile of FD24 pigeons. Pretreatment with the NMDA receptor antagonist MK-801 (15 nmol) and the AMPA-kainate receptor antagonist CNQX (390 nmol), 20 min before an i.c.v. injection of Glu (300 nmol) induced a partial blockade of the Glu-induced decreases in FI and FD and completely inhibited the Glu-induced increase in LSF in FD24 pigeons. I.c.v. injections of MK-801 (30 nmol) and of CNQX (780 nmol) increased FI and FD and reduced LSF in free-feeding pigeons. A lower dose of MK-801 (15 nmol) increased FI and FD, but not LSF. Conversely, a lower dose of CNQX (390 nmol) reduced LSF without changing FI or FD. These findings indicate the involvement of Glu as a chemical mediator in the regulation of food intake in the pigeon, possibly acting on multiple central mechanisms in this species through NMDA- and AMPA-sensitive Glu receptors.

Virtual reality and anthropology.

Since the discovery of the Tyrolean Iceman in 1991 advanced imaging and post processing techniques were successfully applied in anthropology. Specific techniques include spiral computed tomography and 3-dimensional reconstructions including stereolithographic and fused deposition modeling of volume data sets. The Iceman's skull was the first to be reproduced using stereolithography, before this method was successfully applied in preoperative planning. With the advent of high-end graphics workstations and biomedical image processing software packages, 3-dimensional reconstructions were established as a routine tool for analyzing volume data sets. These techniques opened totally new insights in the field of physical anthropology. Computed tomography became the ideal research tool to access the internal structures of various precious fossils without damaging or even touching them. Many of the most precious specimens from the species Autralopithecus (1.8-3.5 Myears), Homo heidelbergensis (200-600 kyears) or Homo neanderthalensis (40-100 kyears) were scanned during the last 5 years. Often the fossils are filled with a stone matrix or other materials. During the postprocessing routines highly advanced algorithms were used to remove virtually these incrustations. Thus it was possible to visualize the morphological structures that lie beneath the matrix. Some specimen were partially destroyed, so the missing parts were reconstructed on computer screen in order to get estimations of the brain volume and endocranial morphology, both major fields of interest in physical anthropology. Moreover the computerized form of the data allows new descriptions of morphologic structures by the means of 'geometric morphometrics'. Some of the results may change aspects and interpretations in human evolution. The introduction of new imaging and post processing techniques created a new field of research: Virtual Anthropology.

Virtual anthropology (VA): methodological aspects of linear and volume measurements--first results.

Virtual Anthropology (VA) is the three-dimensional analysis of anthropological objects within a computer environment. For the investigation of fossil hominid material the VA approach is a very powerful and essential technique to obtain quantitative and qualitative data. The permanent accessibility of the virtual objects and the possibility to study inner structures are striking advantages. The present study is an attempt to evaluate the usefulness and problems of VA and to provide data on accuracy and reproducibility. 10 Homo sapiens skulls were CT-scanned and were measured on the computer and with established methods (calipers and mustard seeds/water displacement). Different co-variables like sex, age, observer, and class and dimension of measurement were included. The results are very promising: The mean of absolute difference for linear measurements is 0.71 mm +/- 0.55 (0.58% +/- 0.49), and 31.59 ccm +/- 13.37 (2.26% +/- 0.86) for volume measurements. Reproducibility is 0.11 mm +/- 0.15 for located landmarks and 0.37 mm +/- 0.41 for relocating landmarks. Age and class of measurement are significant factors.

The iceman under pressure (Part I): A description of skull deformations due to 5100 years of glacial action.

Due to its long deposition in the glacier, the 'Iceman' (an ice-mummy from the Hauslabjoch) has been deformed, notably its skull. We introduce various comparative methods that describe these deformations, assuming they can be ascribed--to a large extent--to glacial action. While pressure is a scalar, the deformations must be described via a 2-tensor strain field (which can be represented by a matrix function value at every point throughout the skull). In this paper, we present the assumed deformations in numerous graphical forms and, furthermore, the limitations in interpretation--including an estimate of statistical variability--that can be revealed by this analysis. These methods, although describing the results of glacial action and implying a 2-tensor strain field (which will be presented in a subsequent paper), do not permit a straightforward reconstruction of the original, underformed skull. These methods have wider applications to the general problem of deformation.

New methods and techniques in anthropology.

Since the discovery of the Tyrolean Iceman in 1991, advanced imaging and post-processing techniques have been successfully applied to anthropological research. Among the specific techniques are spiral computed tomography and 3-dimensional reconstructions, which include stereolithographic and fused deposition modeling of volume data sets. The Iceman's skull was the first to be produced using stereolithography; subsequently, it has been successfully applied in preoperative planning. With the advent of high-end performance graphics workstations and biomedical image processing software packages, 3-dimensional reconstructions have become established as routine tools for analyzing volume data sets. These techniques enabled dramatically new insights to be gained in the field of physical anthropology. Computed tomography became the ideal research tool to access the internal structures of various precious fossils without even touching--let alone damaging--them. Among the most precious are specimens from the genus Australopithecus (1.8 Myr-3.5 Myr), as well as representatives of Homo heidelbergensis (200 kyr-600 kyr) and Homo neanderthalensis (40 kyr-100 kyr); such fossils have been CT-scanned during the last five years. The fossils often are filled with a stone matrix or other encrustations. During the post-processing routines, highly advanced algorithms were used to remove these encrustations virtually (the concrete fossils remain untouched). Thus it has been possible to visualize the morphological structures that are hidden by the matrix layer. Some specimens have been partially destroyed, but it has been possible for the missing parts were reconstructed on the computer screen in order to get estimations of brain volume and endocranial morphology, both major fields of interest in physical anthropology. Moreover, the data in computerized form allows new descriptions of morphological structures using geometric morphometrics. Some of the results may change aspects and interpretations in human evolution and approaches to long-standing questions in this field. We subsume the introduction of these new imaging and post-processing techniques into a new field of research: Virtual Anthropology.

Re-evaluation of the endocranial volume of the Guattari 1 Neandertal specimen (Monte Circeo).

The endocranial capacity of Guattari 1 originally was estimated by Sergi as approximately 1.550 cm3. Using three different approaches, a physical endocast, a stereolithographic model, and a virtual endocast, we have estimated the endocranial capacity of Guattari 1 as approximately 1.350 cm3. This paper explains our revision of the estimated endocranial volume of Guattari 1, provides a cautionary case concerning other estimates of endocranial volume, and demonstrates and encourages the use of recent advances in imaging, modeling, and analysis of endocranial volume.

[A new model for training in tympanoplasty]. / Entwicklung eines Tympanoplastik-Trainingsmodells.

BACKGROUND: Functional simulation of middle ear reconstruction is a valuable tools for training in otosurgery. We introduce a new experimental model which provides a direct acoustic feedback of the functional quality of ossicular chain reconstruction. METHOD: In this model the tympanic membrane and the ossicular chain have to be reconstructed for proper sound transmission to an artificial inner ear receptor. The received signal is converted into acoustic information and consecutively provided via headphone. RESULTS: Any changes in the reconstruction (e. g. tilting the prosthesis) can be experienced online and immediately optimized by the surgeon or a trainee. CONCLUSION: The experimental model can be used for demonstration and training in otosurgery. This model is also suitable for comparing measurements of transfer functions in a calibrated version and can be applied to development and critical evaluation of middle ear prostheses.

[Variations in body height in 18-year-old males in Austria]. / Zur Variation der Körperhöhe bei 18jährigen Männern in Ostösterreich.

By means of the conscription data of the Austrian Army the variability of the height of 18 years old men from the age-classes 1962 and 1964, who come from three different Austrian provinces (Vienna, Niederösterreich and Burgenland) was analysed. In spite of the extensive data material it was nearly impossible to establish a causal interpretation beyond a pure description, because too many external additional informations are lacking. In all the three provinces a definite trend of acceleration was ascertained. Known social-anthropological facts could as well be confirmed, like the dependency of the height from school education in all the three provinces.

[Approaches to the determination of social anthropologic status in Austria]. / Ansätze zu einer sozialanthropologischen Bestandsaufnahme in Ostösterreich.

The variation of height and psychological test results based on the data of 22,872 Austrian conscripts (year of birth: 1964) was analysed, considering urban-rural and differences in occupation. The observed results are in accordance with the hitherto reported observations. It is seen that the social differences in body height are decreasing, whereas the social differences in intellectual capacities seem to increase.

[Effects of DDT and lindane on thyroid function in the rat]. / Zur Wirkung von DDT und Lindan auf die Schilddrüsenfunktion der Ratte

Using the previously described test method, the authors studied with the aid of iodine-131 labelled NaI the effects of daily doses of 30 and 75 mg DDT/kg of body weight, and of 12 and 36 mg of lindane/kg of body weight on the iodine and hormone metabolism in the rat. With DDT, the authors observed a marked increase of the thyroid mass and of the thyroid tri-iodothyronine and thyroxin levels and a simultaneous decrease of the thyroid iodine level. The values for serum iodine and protein-bound iodine were reduced. Serum thyroxin was slightly increased. Serum tri-iodothyronine was markedly increased, which was also true of the iodine fractions in the liver. Lindane was considerably less effective. Only the decrease of thyroid tri-iodothyronine and the simultaneous increase of thyroid thyroxin were striking. In the serum, both hormones remained unchanged. The values for the urine fractions of both the active principles were indicative of a hypofunction. The causes of the changes observed were discussed with regard to the findings of other authors. The present results permit the conclusion that the effects of the pesticides tested are obviously complex by nature.

[In vitro behavior of 14C-lindane in blood]. / Zum in-vitro-Verhalten von 14-C-markiertem Lindan im Blut

Almost 55% of lindane (gamma-HCH) which had been applied in vitro are removed by simple hexane extraction of the blood; if blood fractions are extracted, a total rate of 95% results. The partition of gamma-HCH between the plasma and the erythrocytes is approximately I:I; when HCH erythrocytes are incubated in fresh plasma, almost 60% of erythrocyte HCH pass into the plasma. The erythrocytes absorb nearly 90% of the HCH contained in an aqueous medium. Haemolysis showed that HCH is most probably transferred through the membrane. The partition of HCH between the cytoplasm and the membrane fraction ranges from 3:7 to 7:3. TCA precipitates almost 90% of erythrocyte HCH together with the protein. The absorbing capacity of the erythrocytes could be followed up to nearly 0.4-10(-6)M/ml of blood. Cadmium increases, lead decreases the binding of HCH to the erythrocytes; mercury and ethanol exert but small effects.

[Method for the control of (rat) liver functions by means of 14C-acetate for the toxicological analysis of foreign substances]. / Methode zur Kontrolle von (Ratten-)Leberfunktionen mit Hilfe von 14-C-Acetat für die toxikologische Untersuchung von Fremdstoffen.

The authors present a test procedure which permits to obtain, by means of a single carbon-14-labelled compound as structural element in a series of essential substances, a survey of important fields of liver function. Special attention was paid to cholesterol. Methodical studies resulted in an optimization of the application under in vivo and in vitro conditions, and of the isolation of carbon-14-labelled cholesterol, ester cholesterol and glucose as well as of carbon-14-labelled phospholipids, triglycerides, bile acids, proteins and nucleic acids as groups. A comparison of the experimental techniques demonstrated the advantages of in vivo application. The method and its validity are illustrated by an example (DDT). Its use in studies on various active principles will be dealt with in future communications.

Numerical description of selected endo- and ectocranial dimensions in Homo sapiens and the three Homo heidelbergensis: Kabwe, Atapuerca and Petralona.

Investigation of hominid cranial morphology is of particular importance for those dealing with questions concerning both ontogenetic and phylogenetic aspects in the genus Homo. The present study provides a numerical description of several regions of extant human crania and, in addition, mid-Pleistocene crania, given in distances and angles. This study is seen as a basic preparatory work that is most useful for further investigation on cranial development in hominids. The sample used consisted of 60 recent adult human crania as well as stereolithographic models of three H. heidelbergensis crania: Kabwe, Atapuerca and Petralona. 12 ecto- and 20 endocranial landmarks were selected and 3D-coordinates taken on each cranium using a 3D Polhemus 3Space FASTRAK tracking system. From the resulting data set, 21 ectocranial and 17 endocranial distances were calculated, in addition to 41 angles of the ectocranium and 21 angles of the endocranium; the measurements are presented in tables, serving as a reference database.

Iron status and iron supplementation in children with classical phenylketonuria.

Iron (Fe) status and Fe supplementation were assessed in 20 children with phenylketonuria (PKU) through dietary intake and through measurements of ferritin, hematocrit, hemoglobin, mean cellular hemoglobin, mean cellular volume, serum Fe, total iron binding capacity, unbounded iron binding capacity, transferrin saturation and transferrin. Findings were compared to reference values and to data from age-matched controls. The prescribed phenylalanine-restricted diet supplied all the recommended nutrients. Dietary Fe was present in the diets, but its bioavailability is questionable as several laboratory results were not within accepted reference values. A ferrous sulphate supplement (5 mg elemental Fe/kg daily) was given for 120 days to a group of PKU children with lower Fe parameters, thus changing some of the parameters studied. Serum ferritin (p < 0.1), transferrin saturation and serum Fe (p < 0.05) increased after the treatment. The need for improved diagnosis of Fe status and determination of whether PKU children can benefit from therapeutic Fe is discussed.