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1.
HNO ; 72(1): 44-50, 2024 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-37615685

RESUMO

A 41-year-old female patient presented due to acute onset of unilateral hearing loss 3 months previously and persistent since then. Systemic therapy with oral glucocorticoids in decreasing doses had been performed beforehand, but did not lead to any improvement. In the course of audiological diagnostics, based on subjective and objective methods, a retrocochlear hearing disorder was suspected. A meningioma was diagnosed by diagnostic imaging. Subsequent surgical removal achieved a significant hearing improvement.


Assuntos
Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Perda Auditiva Unilateral , Feminino , Humanos , Adulto , Transtornos da Audição , Audição , Testes Auditivos , Perda Auditiva Neurossensorial/diagnóstico , Audiometria
2.
HNO ; 72(7): 504-514, 2024 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-38536465

RESUMO

BACKGROUND: Binaural hearing enables better speech comprehension in noisy environments and is necessary for acoustic spatial orientation. This study investigates speech discrimination in noise with separated signal sources and measures sound localization. The aim was to study characteristics and reproducibility of two selected measurement techniques which seem to be suitable for description of the aforementioned aspects of binaural hearing. MATERIALS AND METHODS: Speech reception thresholds (SRT) in noise and test-retest reliability were collected from 55 normal-hearing adults for a spatial setup of loudspeakers with angles of ±â€¯45° and ±â€¯90° using the Oldenburg sentence test. The investigations of sound localization were conducted in a semicircle and fullcircle setup (7 and 12 equidistant loudspeakers). RESULTS: SRT (S-45N45: -14.1 dB SNR; S45N-45: -16.4 dB SNR; S0N90: -13.1 dB SNR; S0N-90: -13.4 dB SNR) and test-retest reliability (4 to 6 dB SNR) were collected for speech intelligibility in noise with separated signals. The procedural learning effect for this setup could only be mitigated with 120 training sentences. Significantly smaller SRT values, resulting in better speech discrimination, were found for the test situation of the right compared to the left ear. RMS values could be gathered for sound localization in the semicircle (1,9°) as well as in the fullcircle setup (11,1°). Better results were obtained in the retest of the fullcircle setup. CONCLUSION: When using the Oldenburg sentence test in noise with spatially separated signals, it is mandatory to perform a training session of 120 sentences in order to minimize the procedural learning effect. Ear-specific SRT values for speech discrimination in noise with separated signal sources are required, which is probably due to the right-ear advantage. A training is recommended for sound localization in the fullcircle setup.


Assuntos
Ruído , Localização de Som , Percepção da Fala , Humanos , Localização de Som/fisiologia , Reprodutibilidade dos Testes , Feminino , Adulto , Masculino , Percepção da Fala/fisiologia , Adulto Jovem , Sensibilidade e Especificidade , Teste do Limiar de Recepção da Fala/métodos , Estimulação Acústica/métodos , Testes de Discriminação da Fala/métodos
3.
BMC Med Imaging ; 23(1): 143, 2023 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-37773060

RESUMO

BACKGROUND: A manual evaluation of the CI electrode position from CT and DVT scans may be affected by diagnostic errors due to cognitive biases. The aim of this study was to compare the CI electrode localization using an automated method (image-guided cochlear implant programming, IGCIP) with the clinically established manual method. METHODS: This prospective experimental study was conducted on a dataset comprising N=50 subjects undergoing cochlear implantation with a Nucleus® CI532 or CI632 Slim Modiolar electrode. Scalar localization, electrode-to-modiolar axis distances (EMD) and angular insertion depth (aDOI) were compared between the automated IGCIP tool and the manual method. Two raters made the manual measurements, and the interrater reliability (±1.96·SD) was determined as the reference for the method comparison. The method comparison was performed using a correlation analysis and a Bland-Altman analysis. RESULTS: Concerning the scalar localization, all electrodes were localized both manually and automatically in the scala tympani. The interrater differences ranged between ±0.2 mm (EMD) and ±10° (aDOI). There was a bias between the automatic and manual method in measuring both localization parameters, which on the one hand was smaller than the interrater variations. On the other hand, this bias depended on the magnitude of the EMD respectively aDOI. A post-hoc analysis revealed that the deviations between the methods were likely due to a different selection of mid-modiolar axis. CONCLUSIONS: The IGCIP is a promising tool for automated processing of CT and DVT scans and has useful functionality such as being able to segment the cochlear using post-operative scans. When measuring EMD, the IGCIP tool is superior to the manual method because the smallest possible distance to the axis is determined depending on the cochlear turn, whereas the manual method selects the helicotrema as the reference point rigidly. Functionality to deal with motion artifacts and measurements of aDOI according to the consensus approach are necessary, otherwise the IGCIP is not unrestrictedly ready for clinical use.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Cóclea/cirurgia , Implante Coclear/métodos
4.
Int J Audiol ; 62(2): 118-128, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-34964676

RESUMO

OBJECTIVE: This study compared two different versions of an electrophysiology-based software-guided cochlear implant fitting method with a procedure employing standard clinical software. The two versions used electrically evoked compound action potential (ECAP) thresholds for either five or all twenty-two electrodes to determine sound processor stimulation level profiles. Objective and subjective performance results were compared between software-guided and clinical fittings. DESIGN: Prospective, double-blind, single-subject repeated-measures with permuted ABCA sequences. STUDY SAMPLE: 48 post linguistically deafened adults with ≤15 years of severe-to-profound deafness who were newly unilaterally implanted with a Nucleus device. RESULTS: Speech recognition in noise and quiet was not significantly different between software- guided and standard methods, but there was a visit/learning-effect. However, the 5-electrode method gave scores on the SSQ speech subscale 0.5 points lower than the standard method. Clinicians judged usability for all methods as acceptable, as did subjects for comfort. Analysis of stimulation levels and ECAP thresholds suggested that the 5-electrode method could be refined. CONCLUSIONS: Speech recognition was not inferior using either version of the electrophysiology-based software-guided fitting method compared with the standard method. Subject-reported speech perception was slightly inferior with the five-electrode method. Software-guided methods saved about 10 min of clinician's time versus standard fittings.


Assuntos
Implante Coclear , Implantes Cocleares , Surdez , Percepção da Fala , Adulto , Humanos , Estudos Prospectivos , Implante Coclear/métodos , Percepção da Fala/fisiologia , Ruído , Surdez/reabilitação
5.
HNO ; 71(Suppl 1): 26-34, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36480047

RESUMO

BACKGROUND: Nowadays, cochlear implant (CI) patients mostly show good to very good speech comprehension in quiet, but there are known problems with communication in everyday noisy situations. There is thus a need for ecologically valid measurements of speech comprehension in real-life listening situations for hearing-impaired patients. The additional methodological effort must be balanced with clinical human and spatial resources. This study investigates possible simplifications of a complex measurement setup. METHODS: The study included 20 adults from long-term follow-up after CI fitting with postlingual onset of hearing impairment. The complexity of the investigated listening situations was influenced by changing the spatiality of the noise sources and the temporal characteristics of the noise. To compare different measurement setups, speech reception thresholds (SRT) were measured unilaterally with different CI processors and settings. Ten normal-hearing subjects served as reference. RESULTS: In a complex listening situation with four loudspeakers, differences in SRT from CI subjects to the control group of up to 8 dB were found. For CI subjects, this SRT correlated with the situation with frontal speech signal and fluctuating interference signal from the side with R2 = 0.69. For conditions with stationary interfering signals, R2 values <0.2 were found. CONCLUSION: There is no universal solution for all audiometric questions with respect to the spatiality and temporal characteristics of noise sources. In the investigated context, simplification of the complex spatial audiometric setting while using fluctuating competing signals was possible.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva , Percepção da Fala , Adulto , Humanos , Compreensão , Fala , Implante Coclear/métodos , Perda Auditiva/diagnóstico , Perda Auditiva/cirurgia
6.
HNO ; 71(12): 779-786, 2023 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-37581621

RESUMO

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.


Assuntos
Implante Coclear , Implantes Cocleares , Auxiliares de Audição , Percepção da Fala , Estudos Retrospectivos , Fala , Implante Coclear/métodos
7.
Audiol Neurootol ; 27(5): 347-355, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35306487

RESUMO

INTRODUCTION: Transimpedance measurements from cochlear implant electrodes have the potential to identify anomalous electrode array placement, such as tip fold-over (TFO) or fold-back, basal electrode kinking, or buckling. Analysing transimpedance may thus replace intraoperative or post-operative radiological imaging to detect any potential misplacements. A transimpedance algorithm was previously developed to detect deviations from a normal electrode position with the aim of intraoperatively detecting TFO. The algorithm had been calibrated on 35 forced, tip folded electrode arrays in six temporal bones to determine the threshold criterion required to achieve a sensitivity of 100%. Our primary objective here was to estimate the specificity of this TFO algorithm in patients, in a prospective study, for a series of electrode arrays shown to be normally inserted by post-operative imaging. METHODS: Intracochlear voltages were intraoperatively recorded for 157 ears, using Cochlear's Custom Sound™ EP 5 electrophysiological software (Cochlear Ltd., Sydney, NSW, Australia), for both Nucleus® CI512 and CI532 electrode arrays. The algorithm analysed the recorded 22 × 22 transimpedance matrix (TIM) and results were displayed as a heatmap intraoperatively, only visible to the technician in the operating theatre. After all clinical data were collected, the algorithm was evaluated on the bench. The algorithm measures the transimpedance gradients and corresponding phase angles (θ) throughout the TIM and calculates the gradient phase range. If this was greater than the predetermined threshold, the algorithm classified the electrode array insertion as having a TFO. RESULTS: Five ears had no intraoperative TIM and four anomalous matrices were identified from heatmaps and removed from the specificity analysis. Using the 148 remaining data sets (n = 103 CI532 and n = 45 CI512), the algorithm had an average specificity of 98.6% (95.80%-99.75%). CONCLUSION: The algorithm was found to be an effective screening tool for the identification of TFOs. Its specificity was within acceptable levels and resulted in a positive predictive value of 76%, with an estimated incidence of fold-over of 4% in perimodiolar arrays. This would mean 3 out of 4 cases flagged as a fold-over would be correctly identified by the algorithm, with the other being a false positive. The measurements were applied easily in theatre allowing it to be used as a routine clinical tool for confirming correct electrode placement.


Assuntos
Implante Coclear , Implantes Cocleares , Algoritmos , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Implante Coclear/métodos , Eletrodos Implantados , Humanos , Estudos Prospectivos
8.
BMC Med Educ ; 22(1): 386, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35596162

RESUMO

BACKGROUND: The objective of this study was to demonstrate the utility of an approach in training predoctoral medical students, to enable them to measure electrode-to-modiolus distances (EMDs) and insertion-depth angles (aDOIs) in cochlear implant (CI) imaging at the performance level of a single senior rater. METHODS: This prospective experimental study was conducted on a clinical training dataset comprising patients undergoing cochlear implantation with a Nucleus® CI532 Slim Modiolar electrode (N = 20) or a CI512 Contour Advance electrode (N = 10). To assess the learning curves of a single medical student in measuring EMD and aDOI, interrater differences (senior-student) were compared with the intrarater differences of a single senior rater (test-retest). The interrater and intrarater range were both calculated as the distance between the 0.1th and 99.9th percentiles. A "deliberate practice" training approach was used to teach knowledge and skills, while correctives were applied to minimize faulty data-gathering and data synthesis. RESULTS: Intrarater differences of the senior rater ranged from - 0.5 to 0.5 mm for EMD and - 14° to 16° for aDOI (respective medians: 0 mm and 0°). Use of the training approach led to interrater differences that matched this after the 4th (EMD) and 3rd (aDOI) feedback/measurement series had been provided to the student. CONCLUSIONS: The training approach enabled the student to evaluate the CI electrode position at the performance level of a senior rater. This finding may offer a basis for ongoing clinical quality assurance for the assessment of CI electrode position.


Assuntos
Implante Coclear , Implantes Cocleares , Cóclea/cirurgia , Implante Coclear/métodos , Eletrodos Implantados , Humanos , Estudos Prospectivos
9.
HNO ; 70(12): 861-869, 2022 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-36301326

RESUMO

BACKGROUND: Nowadays, cochlear implant (CI) patients mostly show good to very good speech comprehension in quiet, but there are known problems with communication in everyday noisy situations. There is thus a need for ecologically valid measurements of speech comprehension in real-life listening situations for hearing-impaired patients. The additional methodological effort must be balanced with clinical human and spatial resources. This study investigates possible simplifications of a complex measurement setup. METHODS: The study included 20 adults from long-term follow-up after CI fitting with postlingual onset of hearing impairment. The complexity of the investigated listening situations was influenced by changing the spatiality of the noise sources and the temporal characteristics of the noise. To compare different measurement setups, speech reception thresholds (SRT) were measured unilaterally with different CI processors and settings. Ten normal-hearing subjects served as reference. RESULTS: In a complex listening situation with four loudspeakers, differences in SRT from CI subjects to the control group of up to 8 dB were found. For CI subjects, this SRT correlated with the situation with frontal speech signal and fluctuating interference signal from the side with R2 = 0.69. For conditions with stationary interfering signals, R2 values <0.2 were found. CONCLUSION: There is no universal solution for all audiometric questions with respect to the spatiality and temporal characteristics of noise sources. In the investigated context, simplification of the complex spatial audiometric setting while using fluctuating competing signals was possible.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva , Percepção da Fala , Adulto , Humanos , Fala , Compreensão , Implante Coclear/métodos , Perda Auditiva/diagnóstico , Perda Auditiva/cirurgia
10.
Eur Arch Otorhinolaryngol ; 277(6): 1625-1635, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32140773

RESUMO

PURPOSE: Hearing performance data was collected from a large heterogeneous group of subjects implanted with the Cochlear™ Nucleus® CI532 with Slim Modiolar Electrode, for the purposes of postmarket clinical follow-up. Data was analysed for factors which may predict postoperative speech recognition scores. METHODS: Data was collected retrospectively from five German clinics for 159 subjects from March 2017 to August 2018. Hearing thresholds and recognition scores for monosyllabic words in quiet and sentences in noise were measured preoperatively and at 3 and 6 months postoperatively. RESULTS: There was a mean gain of 44% points (95% CI 39-49%) at 6 months in monosyllable scores in quiet for implanted ears. Preoperative hearing thresholds in implant ears increased systematically with decreasing age; however, younger subjects had better baseline monosyllable scores with hearing aids compared with older subjects. Baseline performance alone explained 14% of the variation in postoperative scores. Residual hearing was preserved on average to within 22 dB at 250 Hz and 30 dB at 500 Hz of preoperative levels. CONCLUSIONS: In a large and varied cohort of routinely treated hearing-impaired adults, speech recognition with the CI532 for German monosyllabic words in quiet at 6 months was equivalent to performance reported at one year or more in other published studies. Although younger subjects had poorer preoperative pure-tone thresholds, they had better preoperative word recognition scores compared with older subjects, and also had higher post implant scores. Further research is required to identify if this phenomenon is just applicable to German health system assessment and referral practices.


Assuntos
Implante Coclear , Implantes Cocleares , Percepção da Fala , Adulto , Audição , Humanos , Estudos Retrospectivos
11.
Int J Audiol ; 58(12): 869-878, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31464542

RESUMO

Objective: To clinically evaluate ForwardFocus in noise with experienced Nucleus® cochlear implant (CI) recipients.Design: Listening performance with ForwardFocus was compared against the best in class directional microphone program (BEAM®). Speech comprehension was tested with the Oldenburg sentence test with competing signals (stationary, three, six and 18-talker babble) in both co-located and spatially-separated listening environments. Additionally, normal hearing participants were tested monaurally in the same listening environments as a reference and to promote cross-study comparisons between CI clinical study outcomes.Study sample: Post-lingually deaf adult CI recipients (n = 20) who were experienced users of the Nucleus sound processor (Cochlear Limited).Results: Improved speech comprehension was found with the ForwardFocus program compared to the BEAM program in a co-located frontal listening environment for both stationary and fluctuating competing signals. In spatially-separated environments ForwardFocus provided significant speech reception threshold (SRT) improvements of 5.8 dB for three-talker competing signals, respectively.Conclusions: ForwardFocus was shown to significantly improve speech comprehension in a wide range of listening environments. This technology is likely to provide significant improvements in real-world listening for CI recipients, given the clinically relevant performance outcomes in challenging dynamic noise environments, bringing their performance closer to their normal hearing peers.


Assuntos
Implantes Cocleares , Percepção da Fala , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruído , Padrões de Referência
12.
Clin Exp Rheumatol ; 36 Suppl 111(2): 78-84, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29799391

RESUMO

OBJECTIVES: Granulomatosis with polyangiitis is a rare autoimmune disease of the group of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Involvement of the ear, nose and throat (ENT)-region is only described in a few case series and case reports. The objective of this study is to systematically characterise the ENT-involvement in a large series of GPA patients. METHODS: GPA patients examined in the Department of Otorhinolayngology of the Christian-Albrechts-University of Kiel between 1990 and 2012 were included. Diagnosis was based on histological, serological and clinical parameters. GPA patients were examined in a standardised way based on the Ear Nose and Throat Activity Score (ENTAS) or its precursor. Medical history, ENT examination, diagnostic findings (ear, nose) and cranial radiology were documented cumulatively. RESULTS: A total of 230 GPA patients were included in this study. Over 95% of them showed ENT-involvement. 59% of the patients showed nasal obstructions, 57% a loss of smell. A hearing loss was diagnosed in 23% of the patients, 50% involvement in MR or CT scans and 15% showed laryngeal involvement. CONCLUSIONS: The data of the largest monocentric study presented here demonstrate a frequent ENT-involvement in GPA patients. Rhinological and ontological manifestations are most common.


Assuntos
Granulomatose com Poliangiite/fisiopatologia , Otorrinolaringopatias/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Tontura/etiologia , Tontura/fisiopatologia , Disfonia/etiologia , Disfonia/fisiopatologia , Dor de Orelha/etiologia , Dor de Orelha/fisiopatologia , Epistaxe/epidemiologia , Epistaxe/fisiopatologia , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico por imagem , Perda Auditiva/etiologia , Perda Auditiva/fisiopatologia , Testes Auditivos , Humanos , Laringoscopia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Otorrinolaringopatias/diagnóstico por imagem , Otorrinolaringopatias/etiologia , Otoscopia , Rinite/etiologia , Rinite/fisiopatologia , Rinomanometria , Zumbido/etiologia , Zumbido/fisiopatologia , Adulto Jovem
13.
Laryngorhinootologie ; 97(5): 313-320, 2018 05.
Artigo em Alemão | MEDLINE | ID: mdl-29534261

RESUMO

INTRODUCTION: Novel cochlear implant speech processors are capable of storing data logs. With the help of this information a more individualized patient care can be provided. However, standard data are missing to a greater extent to the individual usage behavior. MATERIALS AND METHODS: In a retrospective study, the use data of 2687 patients were evaluated. All patients had the Nucleus 6 system from Cochlear Ltd. RESULTS: The data allow a normal range to be defined for the duration of use of cochlear implant speech processors. Likewise, the identification of conspicuous usage behavior is possible.


Assuntos
Implante Coclear , Implantes Cocleares , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Percepção da Fala/fisiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Implante Coclear/reabilitação , Implante Coclear/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Eur Arch Otorhinolaryngol ; 273(11): 4011-4020, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27276990

RESUMO

Individual speech intelligibility was measured in quiet and noise for cochlear Implant recipients upgrading from the Freedom to the CP900 series sound processor. The postlingually deafened participants (n = 23) used either Nucleus CI24RE or CI512 cochlear implant, and currently wore a Freedom sound processor. A significant group mean improvement in speech intelligibility was found in quiet (Freiburg monosyllabic words at 50 dBSPL) and in noise (adaptive Oldenburger sentences in noise) for the two CP900 series SmartSound programs compared to the Freedom program. Further analysis was carried out on individual's speech intelligibility outcomes in quiet and in noise. Results showed a significant improvement or decrement for some recipients when upgrading to the new programs. To further increase speech intelligibility outcomes when upgrading, an enhanced upgrade procedure is proposed that includes additional testing with different signal-processing schemes. Implications of this research are that future automated scene analysis and switching technologies could provide additional performance improvements by introducing individualized scene-dependent settings.


Assuntos
Implantes Cocleares , Processamento de Sinais Assistido por Computador , Inteligibilidade da Fala , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Criança , Implante Coclear/métodos , Meio Ambiente , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Ruído , Razão Sinal-Ruído , Percepção da Fala
15.
Rhinology ; 53(3): 277-85, 2015 09.
Artigo em Inglês | MEDLINE | ID: mdl-26363169

RESUMO

INTRODUCTION: Besides an obvious clinical involvement of the ear, nose and throat (ENT)-region in Eosinophilic Granulomatosis with Polyangiitis (EGPA), systematic data is sparse. Only a few case series and case reports are available that particularly describe rhinological, otological or other manifestations of EGPA in the ENT-region. Therefore, the objective of this study is to systematically describe data on ENT-region involvement in a large series of EGPA patients. METHOD: EGPA patients examined in the Department of Otorhinolaryngology of the Christian-Albrechts-University of Kiel between 1990 and 2010 were included in the study. Criteria for ENT-manifestation were assigned to five subgroups (history, ENT examination, audiological and rhinological diagnostic findings and cranial MRI) and documented cumulatively. EGPA patients were examined in a standardized way based on the validated Ear Nose and Throat Activity Score (ENTAS) or its precursor, including audiological and rhinological diagnostic findings. MRI scans were analysed to further evaluate ENT involvement. RESULTS: A total of 95 EGPA patients were included in the study. In approximately 80% of them, ENT-involvement was documented and the assumption of a frequent rhinological manifestation in patients with EGPA was confirmed. Moreover, the data reveals remarkable evidence for an otological manifestation. A missing correlation between the rhinological and the otological manifestation indicates an independent autoimmune-inflammatory process for this manifestation. CONCLUSION: The data of the largest monocentric study presented here confirms the hypothesis of a frequent ENT involvement in EGPA patients, in whom rhinological and otological manifestations are most common. Therefore, treatment should include long term follow-up and should be managed interdisciplinary.


Assuntos
Eosinofilia/complicações , Eosinofilia/diagnóstico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/etiologia , Adolescente , Adulto , Idoso , Eosinofilia/terapia , Feminino , Granulomatose com Poliangiite/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Otorrinolaringopatias/terapia , Estudos Retrospectivos , Rinomanometria , Adulto Jovem
16.
Int J Audiol ; 53(12): 895-902, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25140602

RESUMO

OBJECTIVE: The aim of this study was to describe common properties (reproducibility, discrimination function, and its steepness) of matrix tests used for cochlear implant (CI) users and to obtain data for the German-language version matrix test, the Oldenburg sentence test (OLSA), presented in noise. DESIGN: The speech reception thresholds (SRT) in noise were measured by means of an adaptive test procedure, and by measurement at various signal-to-noise ratios to determine the course of the entire discrimination function per subject. STUDY SAMPLE: The measurements were performed on 38 CI users fitted with a Cochlear(™) Freedom(®) or a Cochlear(™) Nucleus(®) 5 CI system. RESULTS: The test-retest reproducibility showed a significant dependence on the SRT in noise. For the better performers, the test-retest difference was found to be smaller, while for the poorer performers the difference increased. For the better performers, the slope of the discrimination function at SRT (s50) was comparable to that for individuals with normal hearing, while for the poorer performers the s50 tended to be significantly reduced. CONCLUSIONS: As the CI users differed significantly in their SRT and their s50, a unified discrimination function for CI users must not be used. Further tailoring of the procedure may be required, especially for poorer CI performers.


Assuntos
Implantes Cocleares , Testes de Discriminação da Fala/métodos , Teste do Limiar de Recepção da Fala/métodos , Idoso , Feminino , Alemanha , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Ruído , Pacientes , Reprodutibilidade dos Testes , Razão Sinal-Ruído , Inteligibilidade da Fala , Percepção da Fala
17.
IEEE Trans Biomed Eng ; 71(2): 650-659, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37682654

RESUMO

OBJECTIVE: The current study investigates whether, during a Cochlear Implant (CI) surgery, conditioning (i.e. applying short bursts of electrical stimulation) within a saline solution can have positive effects on subsequent intra-operative measurements. We hypothesize that, based on previous research, the impedance values will be reduced, and that the reproducibility of Electrically Evoked Compound Action Potentials (ECAPs) is improved as a result of conditioning. METHODS: We conditioned half of the electrode contacts, within a saline solution, before CI insertion, using 23 MED-EL implants. Impedance was measured for both the conditioned and non-conditioned groups at five time points. Repeated ECAP recordings were measured and compared between the conditioned and non-conditioned groups. RESULTS: Impedance of the electrode contacts were reduced by 31% after conditioning in saline solution; however, there were no clinically relevant differences after the implantation of the electrode array. The hypothesis that measurement reproducibility would be increased after conditioning could not be confirmed with our data. Within the saline solution, we observed that 44% of the electrode contacts were covered with air bubbles, which most disappeared after implantation. However, these air bubbles limited the effectiveness of the conditioning within the saline solution. Lastly, the effect of conditioning on the reference electrode stimulation was approximately 16% of the total reduction in impedance. CONCLUSION: Our data does not suggest that intraoperative conditioning is clinically required for cochlear implantation with MED-EL implants. Additionally, an in-vivo ECAP recording can be considered as a method of conditioning the electrode contacts. SIGNIFICANCE: We confirm that the common clinical practice does not need to be changed.


Assuntos
Implante Coclear , Implantes Cocleares , Potenciais de Ação/fisiologia , Impedância Elétrica , Reprodutibilidade dos Testes , Solução Salina , Potenciais Evocados Auditivos/fisiologia , Potenciais Evocados , Implante Coclear/métodos , Estimulação Elétrica/métodos
18.
Hear Res ; 438: 108858, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37556897

RESUMO

Spiral ganglion neurons (SGNs) facilitation properties can be recorded utilizing electrically evoked compound action potential (ECAP). While intracochlear variation of the ECAP threshold in relation to its electrode channel is reported, no study investigated its impact on facilitation. In this study, we quantified intracochlear variation of the facilitation properties in cochlear implants (CI) using ECAPs. We hypothesized that the facilitation effect is dependent on the electrode channel and its ECAP threshold. Therefore, ECAPs were recorded in 23 CI subjects. For each subject, five default (channel-derived) and up to two additional (threshold-derived) stimulation sites were defined. Facilitation was quantified by the paradigm introduced by (Hey et al., 2017) with optimized parameter settings. For each channel the maximum facilitated amplitude was determined by a series of ECAP measurements. A linear mixed-effects model was used to investigate the impact of the electrode channel and ECAP threshold on the maximum facilitated amplitude. The maximum facilitated amplitude was found to be dependent on the ECAP threshold and independent on the electrode channel. We conclude that the facilitation paradigm is a useful and feasible tool to gain local information on the SGNs temporal processing patterns.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Potenciais de Ação/fisiologia , Potenciais Evocados , Gânglio Espiral da Cóclea , Potenciais Evocados Auditivos/fisiologia , Estimulação Elétrica , Nervo Coclear/fisiologia
19.
J Clin Med ; 12(9)2023 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-37176702

RESUMO

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.

20.
Acta Otolaryngol ; 143(11-12): 971-978, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38189322

RESUMO

BACKGROUND: Thresholds of electrically evoked compound action potentials (TECAP) may serve as starting points for electrophysiologically based fitting of cochlear implants. Absent TECAP data at single electrodes reduces the number of data points available for fitting and can be substituted by interpolation of measured data points. AIM: To compare complete TECAP profiles with interpolated TECAP profiles of 5/22 (∼22.7%) and 11/22 (50%) electrode contacts. MATERIAL AND METHODS: Single-centre, retrospective, observational study of data from 624 ears implanted with a Slim Modiolar (CI ×32) or Contour Advance (CI ×12, CI24RE(CA)) electrode array (Cochlear Ltd). The deviation of the complete measured TECAP profile from the same profile with missing and therefore interpolated TECAP values was quantified. RESULTS: Interpolated TECAP profiles significantly differ from complete measured profiles especially at the basal and apical electrodes. Reference data for Slim Modiolar and Contour Advance electrodes mean profiles are provided. CONCLUSIONS AND SIGNIFICANCE: Reducing the number of measured TECAP electrodes has to be weighted against losses in the TECAP accuracy of interpolated values. A clinically acceptable compromise may be a reduction from 22 to 11 even non-equidistant data points. While reducing ECAP measurement time, it is accompanied by a minimal loss of accuracy of the TECAP threshold profile.


Assuntos
Implante Coclear , Implantes Cocleares , Potenciais Evocados Auditivos/fisiologia , Estudos Retrospectivos , Cóclea , Potenciais de Ação/fisiologia , Estimulação Elétrica
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