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HNO 12/2012; · 0.40 Impact Factor
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ABSTRACT: Implantierbare Hörgeräte im engeren Sinne sind technische Systeme, die ein akustisches Signal nach entsprechender Verarbeitung
durch direkte mechanische Stimulation der Ossikelkette oder der Cochlea bereitstellen. Gegenüber konventionellen Hörgeräten
weisen sie Vorteile bezüglich des Tragekomforts und der generellen Akzeptanz auf. Da bis heute allerdings keine überzeugenden
audiologischen Vorteile vorliegen, sind die Indikationen zur Verwendung implantierbarer Hörsysteme momentan vorrangig medizinischer
Natur. In Deutschland sind heutzutage die Systeme Vibrant Soundbridge®, Carina® und Esteem® verfügbar. Die Leistung der verschiedenen
implantierbaren und nichtimplantierbaren Hörsysteme in Verbindung mit verschiedenen Operationsverfahren unterliegt aktuell
großen Veränderungen, sodass zukünftig auch rein audiologische Indikationen möglich sein könnten.
Strictly speaking, implantable hearing aids are technical systems that process audiological signals and convey these by direct
mechanical stimulation of the ossicular chain or cochlea. They have certain benefits over conventional hearing aids in terms
of wearing comfort and general acceptance. As current studies lack convincing audiological results, the indications for implantable
hearing aids are primarily of medical or cosmetic nature. To date, three systems are available in Germany: Vibrant Soundbridge®,
Carina®, and Esteem®. Because the performance of the different implantable and nonimplantable hearing systems together with
various surgical procedures are currently undergoing major changes, audiological indications may also develop in the future.
SchlüsselwörterHörgeräte–Mittelohrimplantat–Mittelohr–Innenohr–Schwerhörigkeit
KeywordsHearing aids–Middle ear implant–Middle ear–Inner ear–Hearing loss
HNO 04/2012; 59(10):980-987. · 0.40 Impact Factor
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ABSTRACT: Eine 15-jährige Patientin klagte über rezidivierende Infekte, protrahierte Heiserkeit sowie zunehmende Belastungsdyspnoe und
Nasenatmungsbehinderung. In der Anamnese fanden sich weder ein Trauma noch eine vorangegangene Intubation. Unmittelbar subglottisch
war das Tracheallumen durch ein weiches Gewebepolster zirkulär eingeengt. Der c-ANCA-Titer war negativ. Der Röntgenthoraxbefund
war ebenso wie Nierenfunktionstests unauffällig. Die Patientin wurde tracheostomiert, der histologische Befund ergab lediglich
eine diffuse Plasmazellinfiltration. Ein Jahr später entwickelte die Patientin ein akutes Nierenversagen. Die Diagnose M.Wegener
wurde anschließend durch eine Nierenbiopsie bestätigt. Unter der eingeleiteten immunsuppressiven Therapie mit Cyclophosphamid
bildete sich die Stenose im Verlauf vollständig zurück. Im Vergleich zum adulten M.Wegener sollen beim juvenilen Typ subglottische
Stenosen bis zu 5-mal häufiger auftreten. Ein positiver c-ANCA-Titer kann lediglich helfen, die Verdachtsdiagnose M.Wegener
zu erhärten, ein negativer Titer schließt die Erkrankung keinesfalls aus. Eine chirurgische Therapie kommt im Bereich von
Larynx und Trachea nur bei erfolgloser medikamentöser Therapie in Frage.
A 15-year-old female, having developed recurrent infections of the upper airway, hoarseness, dyspnea, and nasal congestion,
was referred to our department. There was no history of trauma or intubation. The subglottic space was circularly narrowed.
The test for c-ANCA was negative. Chest X-ray and renal function were normal. A tracheotomy was performed; the histology showed
infiltrating plasma cells, but no signs of vasculitis or granulomatous inflammation. One year later the patient developed
acute renal failure. Biopsy of the kidney confirmed Wegener’s disease. The laryngeal stenosis completely resolved after therapy
with cyclophosphamide. Juvenile Wegener’s granulomatosis is extremely rare; the larynx and trachea seem to be involved more
frequently in children than in adults. The positive testing of c-ANCA can support the diagnosis; however, even when c-ANCA
do not test positive, the disease can never be excluded. Surgical interventions within the larynx or trachea might only be
considered after ineffective therapy with immunosuppressive drugs.
HNO 04/2012; 55(10):807-811. · 0.40 Impact Factor
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ABSTRACT: Der Geruchssinn trägt nicht nur entscheidend zu dem bei, was gemeinhin als „Lebensqualität“ bezeichnet wird, sondern er lässt
uns z.B. einen Brand frühzeitig erkennen oder schützt uns vor dem Genuss verdorbener Nahrungsmittel. In der Regel wird der
Wert dieses Sinneswerkzeugs aber erst dann erkannt, wenn es verloren gegangen ist. Riechstörungen werden in 5 große Gruppen
eingeteilt, die postinfektiösen, sinunasalen, posttraumatischen, neurodegenerativen und idiopathischen Ursachen entsprechen.
Derzeit gibt es praktisch keine Aussagen hinsichtlich zuverlässiger prognostischer Faktoren, um die Remissionswahrscheinlichkeit
auf individueller Ebene voraussagen zu können. Bei sinunasal bedingten Riechstörungen haben sich medikamentöse und operative
Verfahren als effizient erwiesen. Dabei werden v.a. Kortikoide topisch und systemisch eingesetzt. Bei schweren mechanischen
Behinderungen der Riechfunktion sowie bei fortgeschritteneren Stadien der nasalen Polypose hat sich die funktionelle endoskopische
Nasennebenhöhlenchirurgie bewährt.
Olfaction not only contributes to our quality of life but, among other functions, it is also necessary for identifying potential
dangers, e.g., fire or spoilt food. In general the value of olfaction is only recognized when the sense of smell is impaired
or lost. Olfactory dysfunction is diagnosed according to its cause (e.g., sinonasal, post-traumatic, post-upper respiratory
tract infection, neurodegenerative, and idiopathic). At present little is known about prognostic factors for predicting resolution
of olfactory loss on an individual basis. In cases of impaired olfaction due to sinonasal disease, both conservative and operative
treatments have been established. Corticoids are used both topically and systemically. In cases of severe mechanical obstructions
or advanced stages of nasal polyposis, FESS (functional endoscopic sinus surgery) seems to be the state of the art.
SchlüsselwörterRiechen-Entzündung-Hyposmie-Anosmie-Riechstörung
KeywordsSmell-Inflammation-Hyposmia-Anosmia-Olfactory dysfunction
HNO 04/2012; 53:S26-S32. · 0.40 Impact Factor
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ABSTRACT: We present our results on the prognosis of parotid gland cancer with the help of a group of patients who were treated in a standardised manner and received a long term follow-up.We retrospectively analysed the clinicopathological data of 231 patients with a surgically treated primary parotid gland cancer and calculated survival parameters. The mean follow-up time was 52 months.The 5- and 10-year overall survival rate was 74.2% and 66.9%. 70 patients got a locoregional recurrence, 18.6% of those even after more than 5 years. Initial facial nerve palsy was a significant negative prognostic indicator for the disease-free survival. The most frequent histological subtypes could be divided into 3 prognostic groups with significant differences in the survival. The pathological tumour stage was a prognostic indicator for a worse overall and disease-free survival. The pT-stage, the pN-stage and the existence of distant metastases were independent prognostic factors.The group of patients is mainly characterised by the large size, the standardised therapy and the long follow-up time. We could show that the facial nerve palsy is a severe negative prognostic factor. For practical purpose, the classification into 3 histological subgroups seemed to be of great help. This should be considered in patient follow-up. Due to the amount of late recurrences, we propose a follow-up time longer than 5 years. We propose standardized surgery including total parotidectomy in combination with neck dissection.
Laryngo-Rhino-Otologie 11/2011; 90(11):664-71. · 0.97 Impact Factor
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ABSTRACT: Strictly speaking, implantable hearing aids are technical systems that process audiological signals and convey these by direct mechanical stimulation of the ossicular chain or cochlea. They have certain benefits over conventional hearing aids in terms of wearing comfort and general acceptance. As current studies lack convincing audiological results, the indications for implantable hearing aids are primarily of medical or cosmetic nature. To date, three systems are available in Germany: Vibrant Soundbridge®, Carina®, and Esteem®. Because the performance of the different implantable and nonimplantable hearing systems together with various surgical procedures are currently undergoing major changes, audiological indications may also develop in the future.
HNO 10/2011; 59(10):980-7. · 0.40 Impact Factor
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ABSTRACT: Dysfunction of the senses of taste and smell may strongly affect our lives. During the last years reliable techniques for the standardized investigation of the 2 senses have been introduced to clinical routine. These techniques are highly standardized and can be easily used, for example, for quality control before and after surgery. Although there are proven therapeutic approaches to taste or smell loss, by far not all patients can be helped. New ideas need to tested within rigorous double-blind studies. The regenerative capacity within the chemical senses provides a major basis for hopes on therapeutic success.
Laryngo-Rhino-Otologie 03/2011; 90 Suppl 1:S44-55. · 0.97 Impact Factor
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ABSTRACT: Besides eradication of chronic middle ear disease, the reconstruction of the sound conduction apparatus is a major goal of ear microsurgery. If available, the autogenous ossicle represents the gold standard as material for the partial ossicular reconstruction. In the event of a more extensive destruction of the ossicular chain diverse alloplastic materials are used for total reconstruction. Such prostheses must fulfil high demands in terms of biocompatibility and their acoustic-mechanic properties. In recent years, filigree titanium middle ear implants, allowing individual adaptation to anatomical variations, have been widely used for this procedure. However, despite the development of modern prostheses, the postoperative hearing result is significantly influenced by a number of prosthesis-unrelated factors, such as the status of the middle ear mucosa and the aeration of the middle-ear. This article reviews the up-to-date standard for reconstruction of the ossicular chain.
Laryngo-Rhino-Otologie 03/2010; 89(3):172-81; quiz 182-3. · 0.97 Impact Factor
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ABSTRACT: Although the function of active middle ear implants in cases of intact ossicular chains and ventilated middle ears is well known, information about sound transfer function to the inner ear in cases of chronic middle ear effusion and defective middle ear structures is needed. A temporal bone model was developed to measure (1) the coupling of the active middle ear implant Vibrant Soundbridge in cases of nonventilated radical cavities, and (2) the effect of effusion and cartilage shielding.
Three fresh human temporal bone specimens were studied. After preparation of a radical cavity, the floating mass transducer was coupled to the stapes footplate. The transducer was stimulated with 50 mV multisinus signals and inner ear fluid vibration was measured using a microphone in the round window niche. Several coupling conditions were simulated with mass and stiffness variations and cartilage shielding.
Coupling modality and prestress have the most influence on the sound transfer function to the inner ear. Cartilage shielding may ensure better coupling of the FMT to the footplate. The effect of middle ear effusion is negligible.
The Vibrant Soundbridge provides good sound transfer to the inner ear not only in cases of coupling onto an intact ossicular chain in a ventilated middle ear but also in cases of coupling to the stapes footplate in non-ventilated radical cavities.
Advances in oto-rhino-laryngology 01/2010; 69:32-7.
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ABSTRACT: Some patients with chronic middle ear disease and multiple failed revisions, who also need a hearing aid, may benefit from an active middle ear implant. An advantage of an active middle ear implant is that the ear canal is unoccluded.
Following extensive experimental development in temporal bones and investigations of various locations and attachments of a Vibrant Soundbridge transducer, a new titanium clip holder for the vibrant floating mass transducer was developed. This assembly is a total ossicular replacement prosthesis (TORP) that is placed on the stapes footplate. Six patients were implanted with this device.
Acoustic results demonstrate significantly improved gain, especially in the high frequencies, which is typically unobtainable by conventional hearing aids.
The simple procedure of placing an active TORP assembly on the stapes footplate, similar to the implantation of a passive TORP prosthesis during tympanoplasty, offers promising treatment for cases of incurable middle ear disease.
Advances in oto-rhino-laryngology 01/2010; 69:27-31.
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ABSTRACT: Besides eradication of chronic middle ear disease, the reconstruction of the sound conduction apparatus is a major goal of modern ear microsurgery. The material of choice in cases of partial ossicular replacement prosthesis is the autogenous ossicle. In the event of more extensive destruction of the ossicular chain diverse alloplastic materials, e. g. metals, ceramics, plastics or composits are used for total reconstruction. Their specialised role in conducting sound energy within a half-open implant bed sets high demands on the biocompatibility as well as the acoustic-mechanic properties of the prosthesis. Recently, sophisticated titanium middle ear implants allowing individual adaptation to anatomical variations are widely used for this procedure. However, despite modern developments, hearing restoration with passive implants often faces its limitations due to tubal-middle-ear dysfunction. Here, implantable hearing aids, successfully used in cases of sensorineural hearing loss, offer a promising alternative. This article reviews the actual state of affairs of passive and active middle ear implants.
Laryngo-Rhino-Otologie 05/2009; 88 Suppl 1:S32-47. · 0.97 Impact Factor
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Laryngo-Rhino-Otologie 04/2009; 88(3):158-61. · 0.97 Impact Factor
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ABSTRACT: The use of steroids either systemically or topically is known as a common therapy in patients with anosmia. Nevertheless, investigations giving proof for the benefit of a topical therapy are very rare, and no prognostic factors are known. In our study, we for the first time evaluated the additional effect of a topical therapy not only with steroids but also with antibiotics after conventional pretreatment with oral steroids and propose the steroid-responsiveness of an anosmia as a prognostic factor.
Retrospective design.
We analyzed the data of 299 patients with olfactory dysfunction. Eighty-nine underwent initial pretreatment with systemic steroids and presented data over a sufficient follow-up time. In a second step all these patients were given a topical treatment in a head down forward position, namely either budesonid alone or in combination with neomycin. Primary outcome parameter was the threshold, discrimination and identification (TDI) score.
Initial therapy with oral steroids changed the TDI from 15.5 to 18.7 in the means (P < .001). In general, leaving away systemic steroids while applying local therapy did not led to a reduction of the TDI (P < .001). Dividing up the patients into those suffering from a steroid-responsive anosmia (SRA) and those without benefit from initial systemic steroids (non-SRA), the topical treatment led to a significant difference between the two groups with benefit toward the non-SRA group (P < .001). Regarding only the nonchronic rhinosinusitis anosmics, these findings became even more apparent. Furthermore, in non-SRA patients we found even better results with steroids in combination with neomycin as a topical therapy. In this group, the combined topical therapy elevated the TDI for +2.1 points whereas topical steroids alone raised it only for +1.0 point.
The steroid-responsiveness of anosmia seems to be a relevant prognostic indicator for a significant benefit of a topical therapy in general. Within all patients, the effect of an initial systemic therapy could be maintained by the adjacent topical treatment whereas in non-SRA patients a topical therapy has a significant greater impact. Furthermore, antibiotics even seem to have an additional effect in this group. Different reasons, first of all an overwhelmed steroid resistance by additional antiinflammatory effects of antibiotics, e.g., the inhibition of apoptosis might play a role and are discussed.
The Laryngoscope 09/2008; 118(9):1681-6. · 1.75 Impact Factor
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ABSTRACT: There are numerous causes for chronic cheek swelling, including masseteric hypertrophy, lymphadenopathy, diffuse inflammatory changes and neoplasia. We report an unusual case of a recurrent swelling as the result of sialolithiasis of an accessory parotid gland, which lay isolated from the main parotid gland along the Stensen's duct. The calculi developed in the accessory salivary tissue whereas all major salivary glands presented without sialolithiasis. Clinical findings as well as imaging results are shown and surgical management and histopathology are discussed. Hereby, for the first time we report a case with multiple calculi in an accessory parotid gland removed via a standard parotid incision. Further to this, we give a comprehensive review of literature on accessory parotid gland lesions.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 02/2008; 265(9):1135-8. · 1.29 Impact Factor
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ABSTRACT: The primary goal in chronic otitis media is the creation of a dry, safe ear with hearing preservation and reconstruction. This study was designed to evaluate the authors' experience using autologous bone pate and conchal cartilage for mastoid obliteration in canal wall down tympanomastoidectomy.
A retrospective long-term review in 2003 of thirty-nine ears was performed, which underwent mastoid obliteration in canal wall down tympanomastoidectomy between 1993 and 2002 performed by the senior author. Data included questionnaire results, clinical observation as well as pre- and postoperative audiometry.
Long-term follow-up shows, that 38 out of 39 ears maintained a small, dry, healthy mastoid cavity. Recurrent cholesteatoma occurred in a single patient. A self-cleaning mastoid bowl was achieved in 90 %, resulting in reduced follow-up visits. Postoperative vertigo in canal wall down revision surgery is clearly diminished due to the mastoid obliteration. Overall, 92 % of patients are satisfied with the surgical result.
Obliteration of a canal wall down mastoid cavity by autologous bone pate and conchal cartilage is a reliable and effective technique that results in a dry, trouble free mastoid cavity in 90 % of the patients with chronic otitis media.
Laryngo-Rhino-Otologie 01/2008; 86(12):861-6. · 0.97 Impact Factor
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HNO 12/2007; 55(11):848-9; author reply 849-50. · 0.40 Impact Factor
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ABSTRACT: A 15-year-old female, having developed recurrent infections of the upper airway, hoarseness, dyspnea, and nasal congestion, was referred to our department. There was no history of trauma or intubation. The subglottic space was circularly narrowed. The test for c-ANCA was negative. Chest X-ray and renal function were normal. A tracheotomy was performed; the histology showed infiltrating plasma cells, but no signs of vasculitis or granulomatous inflammation. One year later the patient developed acute renal failure. Biopsy of the kidney confirmed Wegener's disease. The laryngeal stenosis completely resolved after therapy with cyclophosphamide. Juvenile Wegener's granulomatosis is extremely rare; the larynx and trachea seem to be involved more frequently in children than in adults. The positive testing of c-ANCA can support the diagnosis; however, even when c-ANCA do not test positive, the disease can never be excluded. Surgical interventions within the larynx or trachea might only be considered after ineffective therapy with immunosuppressive drugs.
HNO 11/2007; 55(10):807-11. · 0.40 Impact Factor
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ABSTRACT: Quasi static pressure changes as they occur in altitude changes or Valsalva's manoeuvre are causing great tympanic membrane displacements. These can produce a prosthesis dislocation from the stapes footplate, in case of using a TORP for reconstruction. Additionally, prostheses extrusions can occur in the chronically poor ventilated middle ear. Anatomical studies on the ostrich demonstrate that the flexible columella in the avian middle ear provides a good sound transmission and features an effective inner ear protection in pressure changes.
Focusing on this bionic attempt, we designed a new micro joint TORP by interposing a silicone ball joint in the prosthesis shaft. This prototype was used for frequency response measurements with the laser Doppler vibrometer in the ventilated middle ear and under conditions of increased pressure in the external auditory canal.
Frequency response measurements showed comparable results to those using a conventional TORP. Investigations on pressure changes in the external auditory canal demonstrated a significant decrease in footplate excursion after reconstruction with the new micro-joint prosthesis then compared to a common TORP.
The insertion of the new silicone bordered micro joint into a TORP shaft provides an effective method to decrease the potentially damaging stapes footplate excursions after complete ossicular reconstruction. Limited deflections of the prosthesis shaft reduce the occurring forces on the stapes footplate as they partly bore the quasi static pressure changes. Thus, the micro joint can reduce the risk of prostheses dislocation and annular ligament damage and is additionally providing a proper sound transmission through the reconstructed middle ear. Moreover, the bionic modification of a TORP reflects the remaining possibilities for further improvements in prosthetic reconstruction.
Laryngo-Rhino-Otologie 10/2007; 86(9):649-54. · 0.97 Impact Factor
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ABSTRACT: In earlier studies optical transmission spectroscopy showed that continuous monitoring of changes in the swelling of the nasal mucosa is possible. However, independent measurement in both sides of the nose cannot be achieved by this method. With the aim of achieving real-time monitoring of endonasal swelling separately for both nostrils we developed the new method of bilateral nasal remission spectroscopy for this pilot study.
In nasal remission spectroscopy, light at a wavelength of 790 nm (close to the isobestic point of hemoglobin) is beamed into each side of the nose, and the light that is backscattered by the internal nasal tissue is measured continuously on the same nasal side. To evaluate the principle of this new method a pilot study was conducted in five healthy probands subjected to a one-sided (unilateral) nasal histamine provocation test (0.14 ml, 2 mg/ml).
In each proband single-sided nasal histamine provocation led to an increase in light extinction on the provoked side by an average of 0.18 optical densities (OD). In four of the five probands a slight increase (0.04 OD) in light extinction was observed on the other side of the nose.
Nasal remission spectroscopy seems to allow single-side, continuous monitoring on both sides of the nose. Therefore, the method could also be suitable for use in studies of the nasal cycle, as well as for objectivisation of nasal allergen provocation tests.
HNO 05/2007; 55(4):254-7. · 0.40 Impact Factor
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ABSTRACT: EinleitungMittels der optischen Transmissionsspektroskopie konnte in frheren Studien gezeigt werden, dass ein kontinuierliches Monitoring von Schwellungsvernderungen der Nasenschleimhaut mglich ist. Mit diesem Verfahren gelingt jedoch keine kontinuierliche, seitengetrennte Messung von Schwellungsnderungen beider Nasenseiten. Mit dem Ziel eines seitengetrennten kontinuierlichen Monitorings von endonasalen Schwellungsvernderungen wurde fr diese Pilotstudie die nasale Remissionsspektroskopie entwickelt.Material und MethodenBei der nasalen Remissionsspektroskopie wird in jede Nasenseite Licht der Wellenlnge 790nm (isobestischer Punkt des Hmoglobins) eingestrahlt und an der gleichen Nasenseite das von den Nasenbinnenstrukturen rckgestreute Licht kontinuierlich gemessen. Zur Evaluierung des Messprinzips wurden an 5 gesunden Probanden einseitige nasale Histaminprovokationen (0,14ml; 2mg/ml) durchgefhrt.ErgebnisseBei allen Probanden kam es zu einem Anstieg der Lichtextinktion der provozierten Nasenseite um durchschnittlich 0,18 optische Dichten (OD). Bei 4 der 5 getesteten Probanden kam es ebenfalls zu einem geringen Anstieg der Lichtextinktion der nicht provozierten Seite um durchschnittlich 0,04 OD.SchlussfolgerungenMittels der nasalen Remissionsspektroskopie scheint ein seitengetrenntes kontinuierliches Schwellungsmonitoring beider Nasenseiten mglich zu sein. Das Verfahren knnte damit auer zur Objektivierung nasaler Allergenprovokationstests auch fr Untersuchungen zum nasalen Zyklus geeignet sein.IntroductionIn earlier studies optical transmission spectroscopy showed that continuous monitoring of changes in the swelling of the nasal mucosa is possible. However, independent measurement in both sides of the nose cannot be achieved by this method. With the aim of achieving real-time monitoring of endonasal swelling separately for both nostrils we developed the new method of bilateral nasal remission spectroscopy for this pilot study.Materials and methodsIn nasal remission spectroscopy, light at a wavelength of 790nm (close to the isobestic point of hemoglobin) is beamed into each side of the nose, and the light that is backscattered by the internal nasal tissue is measured continuously on the same nasal side. To evaluate the principle of this new method a pilot study was conducted in five healthy probands subjected to a one-sided (unilateral) nasal histamine provocation test (0.14ml, 2mg/ml).ResultsIn each proband single-sided nasal histamine provocation led to an increase in light extinction on the provoked side by an average of 0.18 optical densities (OD). In four of the five probands a slight increase (0.04 OD) in light extinction was observed on the other side of the nose.Conclusion Nasal remission spectroscopy seems to allow single-side, continuous monitoring on both sides of the nose. Therefore, the method could also be suitable for use in studies of the nasal cycle, as well as for objectivisation of nasal allergen provocation tests.
HNO 03/2007; 55(4):254-257. · 0.40 Impact Factor
