T Lenarz

Publications of T Lenarz

• [Current status of outpatient surgery in German ENT clinics : Exemplary analysis of a university hospital.]

  Authors: M Teschner, T Lenarz

  HNO. 02/2012;

  AIM: German ENT clinics currently do not attach great importance to outpatient surgical procedures. However, up-to-date data on the proportion of outpatient surgeries are not yet available. MATERIALSAIM: German ENT clinics currently do not attach great importance to outpatient surgical procedures. However, up-to-date data on the proportion of outpatient surgeries are not yet available. MATERIALS AND METHODS: In a retrospective study, outpatient surgical procedures using anesthesia or sedation at a German ENT clinic were analyzed as an illustrative case study. RESULTS: In 2010, the proportion of outpatient surgeries performed under anesthesia or sedation in relation to the total number of surgeries performed under anesthesia or sedation was no more than 3.1%. Although a broad range of surgeries was offered, mainly adenoidectomies were carried out. DISCUSSION: In view of the increasingly limited financial resources in the German health care system and considering the situation in international health care systems, the significance of outpatient surgical procedures in ENT clinics is expected to increase in the future. Future-oriented clinic organization should therefore include sufficient capacity for outpatient surgeries. The basic requirement is realistic cost reimbursement by the insurers.

• [Indications of Intraoperative Ultrasound in Head and Neck Surgery.]

  Authors: M Stieve, P R Issing, K F Mack, T Lenarz, N Prenzler

  Laryngo- rhino- otologie. 02/2012;

  A possible use of B-scan sonography arises from the difficulty in transferring information by means of imaging to the intraoperative situation, which is now possible with navigation systems inA possible use of B-scan sonography arises from the difficulty in transferring information by means of imaging to the intraoperative situation, which is now possible with navigation systems in complicated surgical procedures in the field of otolaryngology. A solution to this problem offers the intraoperative use of ultrasonography for orientation in soft tissue surgery.A prospective study involving 115 patients in total entailed scanning with a small part linear and fingertip probe with either 10 and 7.5 MHZ. An ultrasound endoscope featuring a 7.5 MHZ convex probe was used to image endolarygeal processes.Indications included panendoscopies, parotidectomies, submandibulectomies, lymph node exstirpations and abscess incisions. The colour doppler sonography was used in reconstructive surgery involving microvascular transplants. The display of soft tissue tumours provided information about tumour size as well as demarcation or infiltration of neighbouring structures. The fingertip probe and the ultrasound endoscopy served to evaluate areas that were morphologically difficult to access. After clamping the radial artery when harvesting the forearm flap, a sufficient perfusion of the thumb and later the sufficiency of the vascular anastomosis could be verified.The intraoperative use of sonography is an inexpensive non-invasive procedure that can be performed by the surgeon himself and allows quick and reliable orientation during difficult operations.

• [Wearing of motorcycle helmets and occurrence of auricular hematomas : A connection?]

  Authors: M Teschner, F Maser, T Lenarz

  HNO. 01/2012;

  INTRODUCTION: In addition to trauma, risk factors for the formation of auricular hematomas include the influence of tangential shearing forces upon the auricle. Thus far, no data are availableINTRODUCTION: In addition to trauma, risk factors for the formation of auricular hematomas include the influence of tangential shearing forces upon the auricle. Thus far, no data are available concerning the impact of these forces as caused by the putting on and removal of motorcycle helmets. MATERIAL AND METHODS: In a retrospective observational study, all patients presenting with auricular hematoma and auricular seroma at a German Department of Otolaryngology between January 2005 and March 2011 were analyzed as to a possible connection with the wearing of motorcycle helmets. RESULTS: The proportion of auricular hematoma and seroma patients who were helmet-wearing users of motorcycles, motor scooters or mopeds was 41%. However, none of these patients indicated having put on a protective helmet prior to the occurrence of the hematoma. DISCUSSION: According to our findings, the wearing of motorcycle helmets, with the possible associated influence of tangential shearing forces when putting on or removing the helmet is - despite isolated cases having been described - not a cause of the acute formation of auricular hematomas or seromas. However, the proportion of motorcycle/motor scooter/moped users among patients with these conditions appears to be higher than that for the population as a whole. It may be, therefore, that this does have chronic effects on the auricle.

• [Göttingen Sentence in Noise for Different Audiogram Classes.]

  Authors: C Thiele, H Sukowksi, T Lenarz, A Lesinski-Schiedat

  Laryngo- rhino- otologie. 01/2012;

  In addition to the standardized Freiburg sentence test in silence validated speech tests in noise are available. They are mainly used to test the benefit of hearing systems in everyday-lifeIn addition to the standardized Freiburg sentence test in silence validated speech tests in noise are available. They are mainly used to test the benefit of hearing systems in everyday-life situations. In diagnostics tests in noise can also give additional information of the patients' hearing impairment. The determined speech reception threshold (SRT) depends on the degree of hearing loss and the used speech and noise test material. Aim of this study was to analyze the results of the Göttingen sentence test in noise in relation to different audiogram classes.The Göttingen sentence test in stationary noise (65 dB) was performed for 135 patients with different degrees of hearing losses. Based on the air-conducted threshold all ears were categorized to an audiogram class by an automated procedure.For the mild hearing losses the results of the Göttingen sentence test increased with increasing pure-tone-average (PTA) and the values are smaller than 0 dB SNR with a small standard deviation (±1-2 dB SNR). For the moderate hearing losses values of 5 dB SNR with a standard deviation of 6 dB SNR were achieved on average. Patients with a high hearing loss achieved values higher than 20 dB SNR.For the mild hearing losses the results were located in a small range. However, they can give important information about the patient's hearing impairment mainly appears in a noisy environment. With increasing hearing loss also the reduced hearing in silence affects the results achieved with the Göttingen sentence test in noise. Therefore the hearing in silence has to be taken into account at the interpretation of the results.

• Validity of cochlear microphonics at high sound pressure levels as an important clinical aspect.

  Authors: M Teschner, T Lenarz, R-D Battmer

  ORL; journal for oto-rhino-laryngology and its related specialties. 01/2012; 74(1):38-41.

  Introduction: Cochlear microphonics are electrical stimulus responses of the inner ear, generated by mechanical displacement of the hair cells caused by acoustic stimulation. As cochlear microphonicsIntroduction: Cochlear microphonics are electrical stimulus responses of the inner ear, generated by mechanical displacement of the hair cells caused by acoustic stimulation. As cochlear microphonics are often used in the diagnosis of hearing impairment and deafness, in preliminary investigations it was seen that obliteration or ossification have no effect on the extent to which cochlear microphonics can be recorded at high sound pressure levels. As artifacts at high sound pressure levels suggested, measurements were subsequently conducted using temporal bone specimens. Methods: In a test setup equivalent to that for electrocochleography, a needle electrode was placed on the cochlear promontory and used to record potentials following application of an acoustic stimulus. Results: Curves comparable to cochlear microphonics were registrable down to a threshold of 80 dB HL. Additional measurements conducted on damp cloths yielded comparable findings. Conclusions: Registration of cochlear microphonics at high sound pressure levels does not serve as an indicator of hair cell function, but should instead be regarded as artifacts. The possible sources are discussed.

• [Hearing loss determination and assessment of the reduction in earning capacity taking speech discrimination tests in noise into account].

  Authors: C Thiele, H Sukowski, K Wagener, B Kollmeier, T Lenarz, A Lesinski-Schiedat

  HNO. 10/2011; 59(11):1111-7.

  BACKGROUND: In Germany the guideline for the hearing loss quantification and the resulting assessment of the reduction in earning capacity is the Königsteiner Merkblatt (KM). The quantificationBACKGROUND: In Germany the guideline for the hearing loss quantification and the resulting assessment of the reduction in earning capacity is the Königsteiner Merkblatt (KM). The quantification depends on the results of the tone and speech audiogram in silence. However, speech discrimination tests in noise may provide additional information about the impairment of the ENT patients. Especially, the impairment of persons with a slight hearing loss, characterized by high-frequency hearing loss, in noisy environment can not be indicated by the measurement in silence, which is proposed in the KM. METHODS UND PATIENTS: The Göttingen sentence test in noise was applied as a supplement to the routine ENT procedures of the medical estimate in 135 test persons. Based on these measurement results a table for the percentage hearing loss in noise is defined. Furthermore, an integration of the hearing loss in noise in the assessment of the reduction in earning capacity is proposed in addition to the hearing loss in silence. RESULTS: Using the newly introduced hearing loss for speech in noise, a suitable assessment for persons with a slight hearing loss is achieved. By integrating it into the assessment procedure additionally to the hearing loss in silence, the hearing impairment of all patients can be rated depending on their speech test results in silence and in noise. In comparison to the results obtained by the KM, the new procedure does not lead to higher values for the proposed reduction in earning capacity in general, but instead seems to be equally suitable for all groups of patients.

• Preliminary results of the new individual made magnet-based nasal septal button.

  Authors: M Teschner, K Willenborg, T Lenarz

  European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 09/2011; 269(3):861-5.

  The surgical care of large nasal septal defects is often not feasible. As an alternative method, these defects may be closed by nasal septal buttons. Although these buttons should be replaced on aThe surgical care of large nasal septal defects is often not feasible. As an alternative method, these defects may be closed by nasal septal buttons. Although these buttons should be replaced on a regular basis for cleaning purposes, this procedure is usually painful and causes discomfort to the patient. Moreover, it could cause the nasal septal defects to become enlarged. In a retrospective observational study we analyzed a new method, which combines the advantages of an individually made nasal septal button with a magnet-based technique. After casts of the nasal septal defects were taken under general anaesthesia and magnet-based nasal septal buttons were custom-made, patients were fitted with these devices. The results were evaluated using a questionnaire developed specifically for this purpose. All patients reported that the replacement procedure was being less uncomfortable. The insertion or removal of the magnet-based nasal septal button was not reported as causing particular discomfort in these patients. A precise, tight fit was documented in all cases. The general characteristics of nasal septal buttons are, however, also present in this procedure. Individually made magnet-based nasal septal buttons are practicable and a less uncomfortable alternative method in the treatment of large inoperable nasal septal defects.

• [Indication for and verification of hearing aid benefit using modern methods of speech audiometry in German].

  Authors: B Kollmeier, T Lenarz, A Winkler, M A Zokoll, H Sukowski, T Brand, K C Wagener

  HNO. 07/2011; 59(10):1012-21.

  The current guidelines for hearing aid supply in Germany employ the often criticised Freiburg monosyllabic speech test (FBE) in quiet. This test can be replaced with the monosyllabic rhyme test byThe current guidelines for hearing aid supply in Germany employ the often criticised Freiburg monosyllabic speech test (FBE) in quiet. This test can be replaced with the monosyllabic rhyme test by von Wallenberg and Kollmeier (WaKo) in quiet and by the measurement of a speech reception threshold in an interfering noise at a moderate level (45 dB SPL) using either the Göttingen or the Oldenburg sentence test (criterion: 2 dB improvement in SNR, "signal-to-noise ratio"). This procedure was investigated in a group of 38 participants with a sensorineural hearing impairment (mild, moderate or severe hearing loss) and 11 volunteers with normal hearing. On average, comparable indications were achieved. Participants with a mild hearing loss and a selective problem with listening in interfering noise were assessed more fairly.

• [The implementation of risk management in a department of otolaryngology].

  Authors: M Teschner, M I Cartes, T Lenarz

  Laryngo- rhino- otologie. 07/2011; 90(9):548-53.

  The reasons for introducing risk management in hospitals are manifold. Not only legal but also ethical and moral aspects are of great importance.The implementation of risk management in a GermanThe reasons for introducing risk management in hospitals are manifold. Not only legal but also ethical and moral aspects are of great importance.The implementation of risk management in a German department of otolaryngology is presented. Although various instruments were introduced, the main emphasis was placed on the establishment of a risk management team with the aim of prospectively and retrospectively addressing critical situations in hospital operation management and also with the goal of achieving a change of attitude towards mistakes, complications and damages in the clinic.Many aspects of the in-house processes were critically analyzed and optimization strategies were developed such as the introduction of checklists for preoperative patient identification. Furthermore the implemented CIRS has been well accepted.A meaningful objectivity of the results seems difficult. A main reason is that the index "reduction of damage and medical malpractice" is too small to make a conclusive statistical analysis. However, implementation of risk management is advisable for every ENT clinic.

• Effects of metal ions on fibroblasts and spiral ganglion cells.

  Authors: G Paasche, P Ceschi, M Löbler, C Rösl, P Gomes, A Hahn, H W Rohm, K Sternberg, T Lenarz, K-P Schmitz, S Barcikowski, T Stöver

  Journal of neuroscience research. 04/2011; 89(4):611-7.

  Degeneration of spiral ganglion cells (SGC) after deafness and fibrous tissue growth around the electrode carrier after cochlear implantation are two of the major challenges in current cochlearDegeneration of spiral ganglion cells (SGC) after deafness and fibrous tissue growth around the electrode carrier after cochlear implantation are two of the major challenges in current cochlear implant research. Metal ions are known to possess antimicrobial and antiproliferative potential. The use of metal ions could therefore provide a way to reduce tissue growth around the electrode array after cochlear implantation. Here, we report on in vitro experiments with different concentrations of metal salts with antiproliferative and toxic effects on fibroblasts, PC-12 cells, and freshly isolated spiral ganglion cells, the target cells for electrical stimulation by a cochlear implant. Standard cell lines (NIH/3T3 and L-929 fibroblasts and PC-12 cells) and freshly isolated SGC were incubated with concentrations of metal ions between 0.3 μmol/liter and 10 mmol/liter for 48 hr. Cell survival was investigated by neutral red uptake, CellQuantiBlue assay, or counting of stained surviving neurons. Silver ions exhibited distinct thresholds for proliferating and confluent cells. For zinc ions, the effective concentration was lower for fibroblasts than for PC-12 cells. SGC showed comparable thresholds for reduced cell survival not only for silver and zinc ions but also for copper(II) ions, indicating that these ions might be promising for reducing tissue growth on the surface of CI electrode arrays. These effects were also observed when combinations of two of these ions were investigated.

• [No Hearing Sensation after cochlear implantation despite successful objective measurement outcome].

  Authors: L Gärtner, A Büchner, G Joseph, J Neuburger, T Lenarz

  Laryngo- rhino- otologie. 12/2010; 90(4):224-5.

• [Traffic medicine expert opinions in otorhinolaryngology: current aspects].

  Authors: F Waldfahrer, H Iro, M von Brevern, M Fetter, K-F Hamann, I Holube, T Lenarz, A Lesinski-Schiedat, W Stoll, S von Stuckradt-Barre, M Westhofen

  HNO. 02/2010; 58(2):110-2, 114-6.

  According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the momentAccording to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (> or = 60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

• [Central auditory prosthesis]

  Authors: T Lenarz, H Lim, G Joseph, G Reuter, M Lenarz

  HNO. 07/2009; 57(6):551-62.

  Deaf patients with severe sensory hearing loss can benefit from a cochlear implant (CI), which stimulates the auditory nerve fibers. However, patients who do not have an intact auditory nerve cannotDeaf patients with severe sensory hearing loss can benefit from a cochlear implant (CI), which stimulates the auditory nerve fibers. However, patients who do not have an intact auditory nerve cannot benefit from a CI. The majority of these patients are neurofibromatosis type 2 (NF2) patients who developed neural deafness due to growth or surgical removal of a bilateral acoustic neuroma. The only current solution is the auditory brainstem implant (ABI), which stimulates the surface of the cochlear nucleus in the brainstem. Although the ABI provides improvement in environmental awareness and lip-reading capabilities, only a few NF2 patients have achieved some limited open set speech perception. In the search for alternative procedures our research group in collaboration with Cochlear Ltd. (Australia) developed a human prototype auditory midbrain implant (AMI), which is designed to electrically stimulate the inferior colliculus (IC). The IC has the potential as a new target for an auditory prosthesis as it provides access to neural projections necessary for speech perception as well as a systematic map of spectral information. In this paper the present status of research and development in the field of central auditory prostheses is presented with respect to technology, surgical technique and hearing results as well as the background concepts of ABI and AMI.

• TNRT profiles with the Nucleus Research Platform 8 system.

  Authors: W K Lai, N Dillier, B P Weber, T Lenarz, R Battmer, B Gantz, C Brown, N Cohen, S Waltzman, M Skinner, L Holden, R Cowan, P Busby, M Killian

  International journal of audiology. 07/2009;

  This study investigates the effect of the Nucleus CI24RE implant's neural response telemetry (NRT) system, which has less internal noise compared to its predecessor, the CI24M/R implant, on the NRTThis study investigates the effect of the Nucleus CI24RE implant's neural response telemetry (NRT) system, which has less internal noise compared to its predecessor, the CI24M/R implant, on the NRT threshold (TNRT) profile across the array. CI24M/R measurements were simulated by ignoring CI24RE measurements with response amplitudes below 50 uV. Comparisons of the estimated TNRTs from the CI24RE measurements and the CI24M/R simulations suggest that, apart from a constant level difference, the TNRT profiles from the newer implant generally would not have differed very much from those of its predecessor. This view was also reflected by principal component analysis (PCA) results which revealed a 'shift' component similar to that reported by Smoorenburg et al (2002). On the whole, there is no indication that current practices of using the TNRT profiles for assisting with speech processor programming need to be revised for the CI24RE implant.

• Temporal Bone Imaging: Comparison of Flat Panel Volume CT and Multisection CT.

  Authors: O Majdani, K Thews, S Bartling, M Leinung, C Dalchow, R Labadie, T Lenarz, G Heidrich

  AJNR. American journal of neuroradiology. 05/2009;

  BACKGROUND AND PURPOSE: A recent development in radiology is the use of flat panel detectors in CT to obtain higher-resolution images. This technique is known as flat panel volume CT (fpVCT). WeBACKGROUND AND PURPOSE: A recent development in radiology is the use of flat panel detectors in CT to obtain higher-resolution images. This technique is known as flat panel volume CT (fpVCT). We sought to compare the image quality and diagnostic value of 2 different flat panel detector-equipped scanners: one is a prototype fpVCT scanner, and the other is a so-called flat panel digital volume tomography (fpDVT) scanner, which is routinely used in clinical setup with current state-of-the-art multisection CT (MSCT) scanners. MATERIALS AND METHODS: Five explanted temporal bones and 2 whole-head cadaveric specimens were scanned with fpVCT, fpDVT, and MSCT scanners. The image series were blindly evaluated by 3 trained observers who rated 38 anatomic structures with regard to their delineation/appearance. RESULTS: Although the image quality obtained with fpVCT and fpDVT was rated significantly better compared with MSCT on isolated temporal bones, the differences were not significant when whole cadaveric heads were scanned. CONCLUSIONS: Theoretic and practical advantages exist for flat panel detector-equipped scanners, including improved image quality. However, when imaging whole cadaveric heads, no significant difference could be demonstrated between them and standard-of-care MSCT.

• [Biomaterials in cochlear implants].

  Authors: T Stöver, T Lenarz

  Laryngo- rhino- otologie. 05/2009; 88 Suppl 1:S12-31.

  Cochlear implants (CI) represent the "gold standard" for the treatment of congenitally deaf children and postlingually deafened adults. Thus, cochlear implantation is a success story of new bionicCochlear implants (CI) represent the "gold standard" for the treatment of congenitally deaf children and postlingually deafened adults. Thus, cochlear implantation is a success story of new bionic prosthesis development. Owing to routine application of cochlear implants in adults but also in very young children (below the age of one), high demands are placed on the implants. This is especially true for biocompatibility aspects of surface materials of implant parts which are in contact with the human body. In addition, there are various mechanical requirements which certain components of the implants must fulfil, such as flexibility of the electrode array and mechanical resistance of the implant housing. Due to the close contact of the implant to the middle ear mucosa and because the electrode array is positioned in the perilymphatic space via cochleostomy, there is a potential risk of bacterial transferral along the electrode array into the cochlea. Various requirements that have to be fulfilled by cochlear implants, such as biocompatibility, electrode micromechanics, and although a very high level of technical standards has been carried out there is still demand for the improvement of implants as well as of the materials used for manufacturing, ultimately leading to increased implant performance. General considerations of material aspects related to cochlear implants as well as potential future perspectives of implant development will be discussed.

• Spontaneous increases in impedance following cochlear implantation: suspected causes and management.

  Authors: J Neuburger, T Lenarz, A Lesinski-Schiedat, A Büchner

  International journal of audiology. 05/2009; 48(5):233-9.

  Modern cochlear implant systems deliver impulse transmission rates up to 50,000 pps. It emerged that the fast stimulation rates led to enhanced speech comprehension. Impedance measurement is anModern cochlear implant systems deliver impulse transmission rates up to 50,000 pps. It emerged that the fast stimulation rates led to enhanced speech comprehension. Impedance measurement is an important aspect in cochlear implant testing procedures. Impedance values are a measure of the electrical resistance between the individual implant electrodes. Increased impedances were attributed frequently to inflammatory/tissue-related processes. In recent years, however, we have repeatedly found cases of impedance increase for which the inflammatory model did not provide a satisfactory explanation. The aim of this study is to evaluate increases in impedance in our cochlear implant population, to attempt to find their cause, and to formulate therapeutic hypotheses. In our cochlear implant programme (> 3000 recipients) we screened our database for impedance increases over time during device fitting. We found 16 patients with 18 affected ears in whom impedance increases were clearly demonstrated. We found that especially in cases without any sign of prior inflammation, increasing the pulse width of the stimulation strategy seems to be an effective tool to return increased impedances to normal levels.

• [Newborn hearing impairment : Epidemiology and therapeutic relevance.]

  Authors: G Reuter, C Krauth, T Lenarz

  HNO. 02/2009;

  At last, newborn hearing screening has arrived. Hearing screening is now obligatory in Germany from 01.01.2009. Is this a reason for happiness only or will it become in those regions which do notAt last, newborn hearing screening has arrived. Hearing screening is now obligatory in Germany from 01.01.2009. Is this a reason for happiness only or will it become in those regions which do not have a setup achieved by their own initiatives for an optimal basic structure for screening and tracking, a patchwork of unorganized implementation of newborn hearing screening? By using programming models for the improvement of early detection of hearing impairment for children, the profits and debts have been identified. Multidisciplinary working groups have updated and augmented the relevant questions. At the initial start of the first screening activities it became clear that early recognition of hearing impairment in children will only be effective when this has been done in an integrated network of appropriate facilities for diagnostics and therapeutics for treatment of hearing malfunctions in children. At present tracking measures are supported in only a few federal states, while in most others both responsibilities and funding have not been organized. Some relevant cost analyses might help to avoid the coarser meanders.

• Impact of low-frequency hearing.

  Authors: A Büchner, M Schüssler, R D Battmer, T Stöver, A Lesinski-Schiedat, T Lenarz

  Audiology & neuro-otology. 02/2009; 14 Suppl 1:8-13.

  Today, cochlear implantation is the treatment of choice in the case of severe to profound hearing loss, but the speech perception abilities of many recipients in noisy conditions are still poor andToday, cochlear implantation is the treatment of choice in the case of severe to profound hearing loss, but the speech perception abilities of many recipients in noisy conditions are still poor and the overall sound quality and ease of listening still require improvement. Residual low-frequency hearing has been associated with improved hearing performance in cochlear implant patients, especially in difficult listening environments (i.e. cocktail party effect). It seems that low-frequency information can enhance the segregation of competing voices, which leads to better speech understanding in noise. We investigated the effect of low-frequency hearing on speech perception performance in a group of subjects being implanted with the Nucleus Hybrid-L device. The Hybrid-L device is a modified Nucleus Freedom implant, which instead of the standard electrode carries a very delicate electrode array that allows preservation of residual hearing to a great extent. Sentence test results from 22 subjects are presented here. Additionally, for 8 subjects, the acoustically presented frequency range was limited to 300, 500 and 700 Hz, and speech perception tests with a single competing talker were conducted. The Hybrid-L study group achieved a speech reception threshold of 15.9 dB in the hearing aid alone condition, 10.8 dB in the cochlear implant alone condition, and 3.9 dB when using the combination of cochlear implant and hearing aid. Differences between the 3 conditions are statistically significant. Results from the additional experiment on the acoustically presented frequency range suggest that very limited residual hearing below 500 Hz is already sufficient to produce a significant improvement in speech perception performance in conjunction with a cochlear implant.

• Diffusion-Weighted MRI in the Diagnosis of Cholesteatomas.

  Authors: M Teschner, K Hinz, T Stöver, T Lenarz, H Becker

  ORL; journal for oto-rhino-laryngology and its related specialties. 02/2009; 71(2):99-104.

  Objective: The diagnosis of a cholesteatoma can be difficult in cases with an intact tympanic membrane. The aim of our study was to examine whether diffusion-weighted MRI can confirm the diagnosis ofObjective: The diagnosis of a cholesteatoma can be difficult in cases with an intact tympanic membrane. The aim of our study was to examine whether diffusion-weighted MRI can confirm the diagnosis of a cholesteatoma. Study Design: A preoperative diffusion-weighted MRI (echo-planar imaging) scan of the temporal bone was performed in 31 patients with clinically suspected cholesteatoma. The diagnosis was confirmed by pathohistological examination in 18 cases, while the majority of the remaining patients showed chronic otitis media without cholesteatoma. Results: In 3 out of 18 patients with histologically confirmed cholesteatoma, diffusion-weighted imaging produced a hyperintense signal. Another 4 of the 18 cases had a questionable positive result. No increased signal was observed in 11 of these 18 patients. Of 12 patients without a cholesteatoma, 2 showed a positive signal while a questionable hyperintense signal was observed in 5 patients. Conclusions: According to our present findings, diffusion-weighted MRI (echo-planar imaging) can - with a low sensitivity and specificity - be helpful in individual cases in provisionally diagnosing a cholesteatoma in association with standard MRI and high-resolution CT, even though the lack of a hyperintense signal in diffusion-weighted MRI does not exclude a cholesteatoma.