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PURPOSE: This multicentric, retrospective study aimed to analyze the short-term safety and effectiveness of the mCLIP Partial Prosthesis. METHODS: Patients underwent tympanoplasty with implantation of a mCLIP Partial Prosthesis. Follow-up examination included ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3 kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. Thus, the follow-up times of each study center were different, which resulted in different follow-up times for the audiological analysis and for adverse events (AE). RESULTS: 72 (66 adults, 6 children) patients were implanted with the mCLIP Partial Prosthesis. 68 (62 adults, 6 children) patients underwent audiological examination; all 72 patients were examined for adverse events. All patients (N = 68): 72.1% of the patients showed a PTA4 ABG of ≤ 20 dB. Individual post-operative bone conduction (BC) PTA4 thresholds were stable in 67 patients. The mean post-operative follow-up time was 78 ± 46 days. Children (N = 6): 5 out of 6 children showed a PTA4 ABG of ≤ 20 dB. None of the children reported a BC PTA4 deterioration of > 10 dB HL after the implantation. The mean post-operative follow-up time was 101 ± 45 days. Adverse events (all patients, N = 72): 15 (14 adults, 1 child) patients had AEs (27 AEs and 2 Follow-Ups). The mean post-operative follow-up time was 375 days. CONCLUSION: Clinical data show satisfactory audiological parameters after implantation of the mCLIP Partial Prosthesis. The prosthesis is safe and effective for implantation in children and adults. TRIAL REGISTRATION NUMBER: NCT05565339, 09 September 2022, retrospectively registered.
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Prótese Ossicular , Adulto , Criança , Humanos , Resultado do Tratamento , Estudos Retrospectivos , Seguimentos , Implantação de Prótese , Condução Óssea , Audiometria de Tons PurosRESUMO
PURPOSE: This multicentric, retrospective study provides safety and performance data of the MED-EL total ossicular replacement prostheses (TORP). METHODS: Patients underwent tympanoplasty with mXACT Total Prosthesis Center, mXACT Total Prosthesis Offcenter or mXACT PRO Total Prosthesis. The clinical data were retrospectively analyzed. Follow-up examination included access to the medical record (for adverse events) of the patients, ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3 kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. RESULTS: 103 patients were implanted with a TORP. 102 (88 adults, 14 children; 37 CHL, 64 MHL, 1 not specified) patients were analyzed for safety and 92 (79 adults, 13 children) patients for performance of the prostheses. ADVERSE EVENTS RESULTS (N = 102): In 1 patient (child, mXACT Total Prosthesis Offcenter) a prosthesis dislocation was reported, which lead to a revision surgery. No prosthesis extrusion or migration was reported. AUDIOLOGICAL RESULTS (N = 92): 49 (53.3%) of the 92 patients had a PTA4 ABG of ≤ 20 dB and therefore a successful rehabilitation. The mean post-operative PTA4 ABG of all 92 patients was 21.0 ± 9.7 dB. The first endpoint, improvement in post-operative PTA4 ABG of ≤ 20 dB by ≥ 25% of the patients was achieved. The individual Δ BC PTA4 (post-operative minus pre-operative BC PTA4) thresholds were stable (within ± 5 dB HL) in 91 (98.9%) patients. 1 patient had a BC PTA4 deterioration of 11.3 dB HL. CONCLUSION: The MED-EL TORPs are safe and effective for middle ear reconstruction. Trial registration number NCT05565339, September 09, 2022, retrospectively registered.
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PURPOSE: The aims of this study were to compare speech recognition at different postoperative times for both ears in bilaterally implanted patients and to assess the influence of the time of deafness, frequency-to-place mismatch, angular insertion depth (AID) and angular separation between neighbouring electrode contacts on audiometric outcomes. METHODS: This study was performed at an academic tertiary referral centre. A total of 19 adult patients (6 men, 13 women), who received sequential bilateral implantation with lateral wall electrode arrays, were analysed in retrospective. Statistical analysis was performed using two-sided t test, Wilcoxon test, median test, and Spearman's correlation. RESULTS: Postlingually deafened patients (deafness after the age of 10) had a significantly better speech perception (WRS65[CI]) than the perilingually deafened subjects (deafness at the age of 1-10 years) (p < 0.001). Comparison of cochlear duct length between peri- and postlingually deafened subjects showed a slightly significantly smaller cochleae in perilingual patients (p = 0.045). No association between frequency-to-place mismatch as well as angular separation and speech perception could be detected. There was even no significant difference between the both ears in the intraindividual comparison, even if insertion parameters differed. CONCLUSION: The exact electrode position seems to have less influence on the speech comprehension of CI patients than already established parameters as preoperative speech recognition or duration of deafness.
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Implante Coclear , Implantes Cocleares , Surdez , Percepção da Fala , Adulto , Masculino , Humanos , Feminino , Lactente , Pré-Escolar , Criança , Surdez/cirurgia , Estudos Retrospectivos , Eletrodos ImplantadosRESUMO
PURPOSE: Flat-detector computed tomography (FD-CT) is the standard for cochlear implant (CI) imaging. FD-CT systems differ in technical characteristics. Our aim was an evaluation of two different FD-CT generations with different protocols and hardware regarding image quality, radiation dose, and scan time. METHODS: Two temporal bone specimens (- / + CI = TB0/TB1) were scanned using three different scanners: two FD-CT systems with different scanning protocols (standard FD-CT: 20 s 70 kV, 20 s 109 kV; high-speed FD-CT [HS-FD-CT]: 7 s 109 kV, 9 s 109 kV, 14 s 72 kV) and MS-CT (5 s 120 kV). Acquired datasets were evaluated in consensus reading regarding qualitative and quantitative parameters: addressing CI- and cochlea-specific parameters, cochlea delineation, lamina spiralis ossea visibility, distinction of single CI electrodes, determination of intracochlear implant position, stapes delineation, and mastoidal septation were assessed. Addressing protocol-specific parameters, radiation dose (dose-length-product/DLP), and scan time were assessed. RESULTS: Two HS-FD-CT protocols (14 s/9 s) provide higher or equivalent diagnostic information regarding CI- and cochlea-specific parameters compared to both standard FD-CT protocols. The fastest HS-FD-CT protocol (7 s)-providing inferior diagnostic information compared to all other FD-CT protocols-still exceeds MS-CT. The highest DLP was recorded for the 14 s HS-FD-CT protocol (TB1 = 956 mGycm); the lowest DLPs were recorded for the 7 s HS-FD-CT protocol (TB0 = 188 mGycm) and for MS-CT (TB0 = 138 mGycm), respectively. HS-FD-CT allows a significant reduction of scan time compared to standard FD-CT. CONCLUSION: High-speed FD-CT improves visualization of temporal bone anatomy and postoperative assessment of CIs by combining excellent image quality, fast scan time, and reasonable radiation exposure.
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Implantes Cocleares , Humanos , Doses de Radiação , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
INTRODUCTION: The aim of this study was to present our concept in the management of extracranial temporal bone paragangliomas and demonstrate the outcome after primary surgical management of the middle ear component, with an individualized indication for adjuvant radiotherapy. MATERIALS AND METHODS: The records of all patients treated for extracranial jugulotympanic paragangliomas by means of primary surgical management between 2010 and 2021 were studied retrospectively. RESULTS: Twenty-nine patients made up our study sample (mean age 58.8 years). 15 cases were managed solely by means of surgery. Out of the remaining 14 cases with reduction of the middle ear component, adjuvant irradiation was performed in 11 cases, whereas a wait-and-scan strategy was adopted at the patient's request in three cases. No further growth was detected in our study cases. CONCLUSION: Our protocol seems to be associated with an acceptable quality of life and a satisfactory oncologic outcome.
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Orelha Média/cirurgia , Tratamentos com Preservação do Órgão/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Paraganglioma/cirurgia , Radioterapia Adjuvante , Neoplasias Cranianas/cirurgia , Osso Temporal/cirurgia , Timpanoplastia/métodos , Adulto , Terapia Combinada , Feminino , Perda Auditiva/etiologia , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/complicações , Paraganglioma/radioterapia , Qualidade de Vida , Estudos Retrospectivos , Neoplasias Cranianas/complicações , Neoplasias Cranianas/radioterapia , Zumbido/etiologia , Zumbido/cirurgia , Resultado do TratamentoRESUMO
A 64-year-old female patient presented with otalgia and hearing loss in the right ear. On otoscopy, the right tympanic membrane was highly vascularized and bulged into the anteroinferior quadrant. High-resolution computed tomography revealed an osteolytic lesion with occupation of the hypotympanum extending into the petrous apex and right parapharyngeal space as well as infiltration of the wall of the right internal carotid artery. MRI strengthened the suspicion of a jugulotympanic paraganglioma. The biopsy material obtained through exploratory tympanotomy was assessed as a low-grade polymorphic adenocarcinoma. The tumor was treated with definitive chemoradiotherapy. Posttherapeutic imaging after 4 months did not show any evidence of tumor progression.
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Adenocarcinoma , Tumor do Glomo Jugular , Adenocarcinoma/patologia , Orelha Média/diagnóstico por imagem , Orelha Média/patologia , Feminino , Tumor do Glomo Jugular/diagnóstico , Tumor do Glomo Jugular/cirurgia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osso PetrosoRESUMO
OBJECTIVES: The aim of our study was to perform a comparative analysis in our cases with titanium partial clip ossiculoplasty in terms of audiometric outcome and extrusion rates as well as to review the literature for relevant information on this surgical issue. MATERIALS AND METHODS: The records of all patients who had undergone primary partial ossiculoplasty with the implantation of a CliP® Partial Prosthesis Dresden Type (CPPDT, group A) or a CliP Partial FlexiBAL® (CPF, Group B, both Heinz Kurz GmbH, Dusslingen, Germany) between 2012 and 2020 were studied retrospectively. RESULTS: 274 patients made up our study sample (148 men, 126 women, male to female ratio: 1.17). Their mean age at the time of first surgery was 39.6 years (range: 4-79 years). The mean preoperative air-bone gap (ABG) was 22.7dΒ ± 10.5 dB. Mean follow-up was approximately 4 months (1-12 months). The mean postoperative ABG was 15.7 ± 8.1 dB. In total, the postoperative ABG was significantly improved compared to preoperative values (P < 0.001). Surgical success, defined as an ABG ≤ 20 dB, was achieved in the majority of our study patients (210/274, 76.6%). Extrusion of the prosthesis was detected in 3/216 CPF and 5/58 CPPDT cases (p = 0.012). Comparison of both prosthesis groups revealed a significantly better audiological outcome for the patients with ossicular reconstruction using CPF. A significantly better audiological outcome was detected in the cases with a normal aeration of the middle ear. DISCUSSION: Titanium clip partial ossiculoplasty is a reliable component of modern tympanoplasty, allowing a satisfying audiologic outcome. The higher adaptability of the CPF to the changing postoperative circumstances and the frequently defective aeration of the middle ear is reflected in the better audiologic outcome for this prosthesis.
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Orelha Média/cirurgia , Prótese Ossicular , Substituição Ossicular/métodos , Titânio , Timpanoplastia/métodos , Adolescente , Adulto , Idoso , Audiometria , Condução Óssea , Criança , Pré-Escolar , Orelha Média/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: Erosion of the long process of the incus is the most common ossicular chain pathology occurring in the course of chronic middle ear disease. The aim of this study was to evaluate our experience in the reconstruction of short-length defects of the long process of the incus using hydroxyapatite bone cement over a period of 15 years. METHODS: The medical records of all patients treated with hydroxyapatite bone cement for an isolated short-length erosion of the long process of the incus or the lenticular process at an academic tertiary referral center between 2005 and 2019 were studied retrospectively. RESULTS: 48 patients made up our study sample (19 men, 29 women). The mean age at the time of surgery was 38.1 years. The mean preoperative air-bone gap (ABG) was 21.36 dB. The mean postoperative ABG was 15.89 dB within 8 weeks of surgery and 11.81 dB at least 6 months after surgery. The postoperative ABG had significantly improved compared to preoperative ABG values at both the short- and middle-term follow-up (p < 0.001 for both). An ABG ≤ 20 dB was achieved in 68% in the short term and 83% in the middle term. The mean ABG in the long term (< 12 months) was 11.1 dB. CONCLUSION: Restoration of the anatomic and functional continuity of the ossicular chain using hydroxyapatite cement in defects of the long process of the incus seems to warrant a satisfactory audiologic outcome in the majority of cases.
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Cimentos Ósseos , Otopatias/cirurgia , Orelha Média/cirurgia , Hidroxiapatitas , Bigorna/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Idoso , Criança , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
A 64-year-old female patient presented with otalgia and hearing loss in the right ear. On otoscopy, the right tympanic membrane was highly vascularized and bulged into the anteroinferior quadrant. High-resolution computed tomography revealed an osteolytic lesion with occupation of the hypotympanum extending into the petrous apex and right parapharyngeal space as well as infiltration of the wall of the right internal carotid artery. MRI strengthened the suspicion of a jugulotympanic paraganglioma. The biopsy material obtained through exploratory tympanotomy was assessed as a low-grade polymorphic adenocarcinoma. The tumor was treated with definitive chemoradiotherapy. Posttherapeutic imaging after 4 months did not show any evidence of tumor progression.
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Adenocarcinoma , Tumor do Glomo Jugular , Paraganglioma , Orelha Média/diagnóstico por imagem , Feminino , Tumor do Glomo Jugular/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osso PetrosoRESUMO
Smoking is the leading preventable cause of premature death in Germany. The network "Education Against Tobacco" (EAT) is an initiative that was founded in Germany in 2012, in which more than 3500 medical students and physicians engage in volunteer work in about 80 medical faculties in 14 countries. In this article, the concept, activities, objectives and associated research studies oft he EAT initiative are introduced.On the school level, the initiative addresses 10- to 15-year-old secondary school students. In addition to a multimodal approach, school visits use modern media such as facemorphing apps, which are not only used by students (45,000 per year in 14 countries), but by a total of over 500,000 other people as well. The effectiveness of the school-based intervention is currently being investigated in randomised long-term studies with 20,000 adolescents in Germany. A first long-term study demonstrated evidence of a protective effect regarding the onset of smoking, especially among female students, students having a low level of education and students with a migratory background.The programme educates several hundred prospective physicians at 13 (of 28 participating) German medical faculties each year in science-based elective courses for the well-established smoking cessation counselling of patients and sensitises them to the tobacco epidemic. The approved members engage in dialogue with local members of the German house of representatives as "Ärzteverband Tabakprävention".EAT motivates the prospective generation of physicians, initially through prevention in school settings, to face the challenge of national tobacco control at the university and federal level.
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Nicotiana , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Adolescente , Criança , Feminino , Alemanha , Humanos , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , EstudantesRESUMO
BACKGROUND A mass in the parotid gland usually indicates parotid gland neoplasia. Warthin tumors or pleomorphic adenomas are common differential diagnoses. Less frequently, other differential diagnoses and sites of origin are considered. Schwannomas are rare, benign tumors in the head and neck region. Even more rarely, these tumors occur in the intraparotid course of the facial nerve. In the following, we report about 2 patients in whom a mass in the right parotid gland was found incidentally during magnetic resonance imaging (MRI). CASE REPORT We reviewed data from the literature on intraparotid facial nerve schwannomas (IPFNS) and compared them with those from our cases. The focus was on data such as clinical history, clinical symptoms, electroneurography, and various imaging modalities, such as ultrasonography and MRI combined with diffusion-weighted imaging. CONCLUSIONS It is challenging to distinguish facial nerve schwannomas from other neoplasms. Patient's history, clinical symptoms, MRI examination with diffusion-weighted imaging, and high-resolution ultrasound imaging are decisive factors for diagnosis and should be performed when IPFNS is suspected. Diagnosis and therapy for IPFNS remain challenging. A wait-and-scan approach could be an option for patients with small tumors and good facial nerve function. On the other hand, patients with advanced tumors associated with limited facial nerve function can benefit from surgical approaches or stereotactic radiosurgery.
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Neoplasias dos Nervos Cranianos , Neurilemoma , Neoplasias Parotídeas , Humanos , Nervo Facial/diagnóstico por imagem , Nervo Facial/patologia , Nervo Facial/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/cirurgia , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/inervação , Glândula Parótida/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgiaRESUMO
BACKGROUND: To reduce smoking uptake in adolescents, the medical students' network Education Against Tobacco (EAT) has developed a school-based intervention involving a face-aging mobile app (Smokerface). METHODS: A two-arm cluster-randomized controlled trial was conducted, evaluating the 2016 EAT intervention, which employed the mobile app Smokerface and which was delivered by medical students. Schools were randomized to intervention or control group. Surveys were conducted at baseline (pre-intervention) and at 9, 16, and 24 months post-intervention via paper & pencil questionnaires. The primary outcome was the difference in within-group changes in smoking prevalence between intervention and control group at 24 months. RESULTS: Overall, 144 German secondary schools comprising 11,286 pupils participated in the baseline survey, of which 100 schools participated in the baseline and at least one of the follow-up surveys, yielding 7437 pupils in the analysis sample. After 24 months, smoking prevalence was numerically lower in the intervention group compared to control group (12.9 % vs. 14.3 %); however, between-group differences in change in smoking prevalence between baseline and 24-months follow-up (OR=0.83, 95 %-CI: 0.64-1.09) were not statistically significant (p = 0.176). Intention to start smoking among baseline non-smokers declined non-significantly in the intervention group (p = 0.064), and remained essentially unchanged in the control group, but between-group differences in changes at the 24-months follow-up (OR=0.88, 0.64-1.21) were not statistically significant (p = 0.417). CONCLUSION: While a trend towards beneficial effects of the intervention regarding smoking prevalence as well as intention to start smoking among baseline non-smokers was observed, our smoking prevention trial demonstrated no significant effect of the intervention.
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INTRODUCTION AND IMPORTANCE: Reports about laryngeal trauma and fractures of the hyoid bone are rare in the literature. Most cases are forensic cases and the results of postmortem analysis. Traumatic larynx and hyoid bone fractures represent a rare but important differential diagnosis of the common symptom hoarseness. CASE PRESENTATION: A 60-year-old female patient presented with unclear dysphonia and globus sensation following intubation for a surgical treatment for a lower leg fracture after a bicycle accident two months ago. Endoscopy and the computed tomography (CT) of the neck revealed a fixed and immobile fractured piece of the larynx, a hyoid bone fracture and a pseudarthrosis between the greater horn of the hyoid bone and the upper edge of the thyroid cartilage. The hyoid bone fracture led to a distortion of the supraglottis. After surgical removal of the fractured part of the hyoid bone and the pseudarthrosis separation, the supraglottis appeared symmetrical again. Four weeks after surgery the patient was symptom-free. CLINICAL DISCUSSION: Though combined hyoid bone and larynx fractures after traumatic injuries are rare, they represent an important differential diagnosis in trauma patients with dysphagia or dysphonia. The clinical symptoms can vary and occur immediately or within a latent period taking weeks or months until the proper diagnosis. Depending on the symptoms, surgical management can be effective. CONCLUSION: An isolated partial resection of the hyoid bone with separation of the pseudarthrosis is a reasonable therapeutic option and can lead to completely resolving symptom. Preoperatively, a CT provides further valuable information.
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AIM: Microanatomical evaluation of cochlear implant (CI) patients to identify anatomical risk factors for a scalar translocation. METHODS: CI patients with both a regular scala tympani spiralization (group A) and a scalar translocation (group B) were identified via postoperative flat-detector computed tomography (FD-CT). Then, the corresponding preoperative multislice computed tomography (MS-CT) and postoperative FD-CT datasets were assessed: First, the cochleae were separated in 6 segments of 45° each. Next, quantitative (cochlea height, length, depth, cochlear duct diameter [CD] per segment; percentual tapering of the CD per segment named cochlear geometry index [CGI]) and qualitative (identifiability of the CI model; CI-integrity; intracochlear array position) parameters were evaluated and compared for both groups. Receiver-operating-characteristics (ROC) analysis was performed for the CGI. RESULTS: In total, 40 preoperative MS-CT and postoperative FD-CT datasets (nA=20; nB=20) were analysed. Model "CI 512" was successfully identified and CI-integrity has been confirmed in all cases. Quantitative analysis showed a significant difference of both the CD at 0° (CDA0°= 2.06± 0.23mm; CDB0°= 2.19±0.18mm; p0°= 0.04) and the CGI of the first segment (CGIA0°-45°= 18.87±6.04%; CGIB0°-45°= 28.89±8.58%; p0°-45°= 0.0001). For all other 5 cochlear segments there was no significant difference of CD and CGI; there was no significant difference of external cochlea diameters. The area under the curve (AUC) of the CGI0-45° was 0.864 with 24.50° as the optimal cut-off value to discriminate patients with a scala tympani spiralization and a scalar translocation. CGI0-45° of> 24.50° allowed the correct identification of 85% of patients with a scalar translocation. CONCLUSION: CI insertion trauma is associated with a significantly higher narrowing of the proximal basal cochlea turn (BCT). The CGI as percentual tapering of the BCT turned out as reliable, clinically applicable parameter for identification of patients with an increased risk for a scalar translocation.
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Implante Coclear , Implantes Cocleares , Cóclea/cirurgia , Humanos , Fatores de Risco , Rampa do Tímpano/cirurgiaRESUMO
Postlaryngectomy sinonasal squamous cell carcinoma, being theoretically associated with exposure to the same risk factors or development of precancerous lesions due to altered nasal physiology, should warrant a thorough head and neck examination.
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PURPOSE: Evaluation of a new postprocessing method for postoperative control of cochlear implants (CI) based on a single flat detector computed tomography (FD-CT) run and volume rendering of 3D models of the inner ear. METHODS: The FD-CT datasets of CIs were selected and postprocessed to generate both standard multiplanar reconstructions (MPR) and merged volume-rendered 3D datasets (MRD) of the CIs. The MRDs consisted of two different reconstructions (bone/implant) that are automatically layered to avoid manual coregistration inaccuracy. Corresponding datasets were evaluated in consensus reading in terms of qualitative (integrity, position, configuration) and quantitative (insertion depth angle) CI parameters. RESULTS: In total 20 FD-CTs with 20 CIs were successfully postprocessed. Qualitative evaluation of MPR and MRD demonstrated complete congruency (integrity: narray integrityâ¯= 20; position: nscala tympaniâ¯= 13, nscalar translocationâ¯= 7; configuration: nharmonic spiralizationâ¯= 16, ntip fold overâ¯= 3, nlooped implantâ¯= 1). Adverse intracochlear implant spiralization was identified in all 10 cases with MRD and MPR. Measurement of the insertion depth angle in MRD was equivalent to that in MPR (râ¯= 0.99; Pâ¯= <0.0001). CONCLUSION: The use of MRD is a helpful method for precise postoperative CI assessment and provides easy detection of incorrect intracochlear spiralization.
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Implante Coclear , Implantes Cocleares , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Humanos , Cuidados Pós-Operatórios , Osso Temporal , Tomografia Computadorizada por Raios XRESUMO
AIM: This study was carried out to evaluate the diagnostic value of merging preoperative magnetic resonance imaging (MRI) with postoperative flat-panel computed tomography (FD-CT) and compare it to standard postoperative FD-CT for assessment of cochlear implant (CI) insertion. METHODS: The T2-weighted (T2w) constructive interference in steady state (CISS) data sets of preoperative 1.5â¯T and 3â¯T MRI scans of CI patients with both regular and adverse implant spiralization were co-registered with the corresponding postoperative FD-CT data sets using defined anatomic landmarks. These merged FD-CT/MRI volumes (CMV) were compared to the corresponding postoperative FD-CT MPRs in consensus reading with respect to qualitative, i.e. scala tympani spiralization, scala vestibuli spiralization, scalar translocation and quantitative, i.e. distance of the last electrode to the lateral cochlea wall (D1) distance of the 2nd/5th electrode to the basal cochlear wall (D2) and the transition point (TP) of the scalar translocation, parameters. RESULTS: In total 30 patients (n 1.5T MRIâ¯= 18 patients; n 3T MRIâ¯= 12 patients) were included in the analysis. In all cases both CMVs and FD-CT MPRs were generated. Qualitative analysis of intracochlear CI position with CMVs (both 1.5â¯T and 3â¯T) and FD-CT was equivalent: In 20 patients the CI showed a regular implant spiralization, in 10 cases a scalar translocation was identified with both CMVs and FD-CT. Quantitative analysis showed a high level of congruency between CMVs (both 1.5â¯T and 3T) and FD-CT for fusion accuracy (D1: mean FD-CT D1â¯= 1.30⯱ 0.7â¯mm; mean CMV D1â¯= 1.27⯱ 0.77â¯mm, correlation râ¯= 0.94, pâ¯< 0.0001; D2: mean FD-CT D2â¯= 1.17⯱ 0.34â¯mm; mean CMV D2â¯= 1.10⯱ 0.31â¯mm, correlation râ¯= 0.89, pâ¯< 0.0001) and TP of the scalar translocation (mean FD-CTâ¯= 126.0⯱ 59.25°, mean CMVâ¯= 117.0⯱ 52.82°, correlation râ¯= 0.95, pâ¯< 0.0001). CONCLUSION: The co-registration of preoperative 1.5 and 3â¯T MRI with postoperative FD-CT enables a direct evaluation of the position of a CI equivalent to the current standard FD-CT. Despite the fact that CMV provided no additional diagnostic value in this series, regardless whether preoperative 1.5 or 3â¯T MRI was used for co-registration, it might help to simplify postoperative CI diagnostics.
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Implante Coclear , Implantes Cocleares , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Rampa do TímpanoRESUMO
BACKGROUND: Most smokers start smoking during their early adolescence under the impression that smoking entails positive attributes. Given the addictive nature of cigarettes, however, many of them might end up as long-term smokers and suffering from tobacco-related diseases. To prevent tobacco use among adolescents, the large international medical students' network Education Against Tobacco (EAT) educates more than 40,000 secondary school students per year in the classroom setting, using evidence-based self-developed apps and strategies. OBJECTIVE: This study aimed to evaluate the long-term effectiveness of the school-based EAT intervention in reducing smoking prevalence among seventh-grade students in Germany. Additionally, we aimed to improve the intervention by drawing conclusions from our process evaluation. METHODS: We conduct a cluster-randomized controlled trial with measurements at baseline and 9, 16, and 24 months postintervention via paper-and-pencil questionnaires administered by teachers. The study groups consist of randomized schools receiving the 2016 EAT curriculum and control schools with comparable baseline data (no intervention). The primary outcome is the difference of change in smoking prevalence between the intervention and control groups at the 24-month follow-up. Secondary outcomes are between-group differences of changes in smoking-related attitudes and the number of new smokers, quitters, and never-smokers. RESULTS: A total of 11,268 students of both sexes, with an average age of 12.32 years, in seventh grade of 144 secondary schools in Germany were included at baseline. The prevalence of cigarette smoking in our sample was 2.6%. The process evaluation surveys were filled out by 324 medical student volunteers, 63 medical student supervisors, 4896 students, and 141 teachers. CONCLUSIONS: The EAT cluster randomized trial is the largest school-based tobacco-prevention study in Germany conducted to date. Its results will provide important insights with regards to the effectiveness of medical student-delivered smoking prevention programs at school. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13508.