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ABSTRACT: In Germany assessment of hearing loss for numbers is used to calculate the percentage hearing loss from speech audiometry and for plausibility checking with pure tone thresholds. It is common practice to take a graphical reading from the speech audiogram to determine the hearing loss for numbers. This study searches for a mathematical formula for the exact calculation of the hearing loss for numbers from the intelligibility values measured.
With analytical methods on the basis of the standard curve following DIN 45626-1, two simple formulas for the calculation of the hearing loss for numbers were developed.
The hearing loss for numbers a(1) is calculated as a(1)=p(1)+(50-v(1)) (p(2)-p(1))/(v(2)-v(1))-18,4 for two available measured values and as a(1)=p(1)-0,13 v(1)-11,9 if only one measured value is used, with v(i )being number intelligibility in percent at the level p(i) in decibels (dB) of measurement number i. Number intelligibility of all inserted pairs of values must be between 30% and 70% because the standard curve of DIN 45626-1 runs approximately linearly only in this range. The calculated value for the hearing loss for numbers is subsequently mathematically rounded up to 5 dB as well as for the conventional graphically determined value.
With the presented formulas the hearing loss for numbers can be calculated exactly from the measured values of the Freiburg number test especially in matters of expertise if the conventional graphical determination of this value does not seem to be unambiguous.
HNO 09/2012; 60(9):814-6. · 0.40 Impact Factor
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ABSTRACT: For the determination of speech intelligibility in the expertise of hearing loss, the Freiburg speech test (number test and monosyllable test) is recommended in the Federal Republic of Germany. In the former German Democratic Republic, Sauer's binaural number test with 70 dB background noise ("beidohriger Zahlentest", BZT) was a standard element in expert opinions and was used in the calculation of bodily injury ("Körperschaden"). In the current practice, a hearing test in noise is still lacking. The present study analyzes whether and to what degree the impairment ("Grad der Schädigungsfolgen", GdS) changes when also considering Sauer's test.
In a collective of 78 patients with hearing loss (66 patients with high-frequency hearing loss and 12 patients with pancochlear hearing loss) and 22 normal hearing controls, the following audiometric measurements were conducted: pure tone audiometry, speech audiometry (Freiburg speech test), free field audiometry with and without noise, and Sauer's test. Subsequently, the hearing loss for both sides was calculated taking into consideration the values obtained with and without Sauer's test, and the respective GdS was determined.
Patients with high-frequency hearing loss and pancochlear hearing loss had a trend for higher GdS (approximately 2 and 5%, respectively), compared to the established algorithm without the use of hearing tests in noise. However, neither the Mann-Whitney U-test nor the Bland-Altman analysis yielded relevant differences between the two methods to calculate the GdS.
The routine implementation of Sauer's test in the expertise of hearing loss cannot be recommended, since no relevant change in the GdS can be expected. This is especially true for high-frequency hearing loss. In pancochlear hearing loss, use of Sauer's test can be considered if problems concerning hearing in situations with background noise are present-at least until more advanced hearing tests optimized for use in noise have been integrated into the tables for GdS calculation.
HNO 07/2012; 60(10):886-91. · 0.40 Impact Factor
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ABSTRACT: The present study analyzes the best combination of frequencies for the calculation of mean hearing loss in pure tone threshold audiometry for correlation with hearing loss for numbers in speech audiometry, since the literature describes different calculation variations for plausibility checking in expertise. Three calculation variations, A (250, 500 and 1000 Hz), B (500 and 1000 Hz) and C (500, 1000 and 2000 Hz), were compared.
Audiograms in 80 patients with normal hearing, 106 patients with hearing loss and 135 expertise patients were analyzed in a retrospective manner. Differences between mean pure tone audiometry thresholds and hearing loss for numbers were calculated and statistically compared separately for the right and the left ear in the three patient collectives.
We found the calculation variation A to be the best combination of frequencies, since it yielded the smallest standard deviations while being statistically different to calculation variations B and C. The 1- and 2.58-fold standard deviation (representing 68.3% and 99.0% of all values) was ±4.6 and ±11.8 dB for calculation variation A in patients with hearing loss, respectively.
For plausibility checking in expertise, the mean threshold from the frequencies 250, 500 and 1000 Hz should be compared to the hearing loss for numbers. The common recommendation reported by the literature to doubt plausibility when the difference of these values exceeds ±5 dB is too strict as shown by this study.
HNO 07/2011; 59(9):908-14. · 0.40 Impact Factor
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J M Hempel
HNO 03/2011; 59(3):266-7. · 0.40 Impact Factor
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ABSTRACT: The human ability to localize odorants has been examined in a number of studies, but the findings are contradictory. In the present study we investigated the human sensitivity and ability to localize hydrogen sulphide (H(2)S), which in low concentrations stimulates the olfactory system selectively, the olfactory-trigeminal substance isoamyl acetate (IAA), and the trigeminal substance carbon dioxide (CO(2)). A general requirement for testing of localization was the conscious perception of the applied stimuli by the participants. Using Signal Detection Theory, we determined the human sensitivity in response to stimulation with these substances. Then the subjects' ability to localize the three different substances was tested. We found that humans can detect H(2)S in low concentration (2 ppm) with moderate sensitivity, and possess a high sensitivity in response to stimulation with 8 ppm H(2)S, 17.5% IAA, 50% v/v CO(2). In the localization experiment, subjects could localize neither the low nor the high concentration of H(2)S. In contrast, subjects possessed the ability to localize IAA and CO(2) stimuli. These results clearly demonstrate that humans, in spite of the aware perception, are not able to localize substances which only activate the olfactory system independent of their concentration, but they possess an ability to localize odorants that additionally excite the trigeminal system.
Physiology & Behavior 04/2009; 97(3-4):401-5. · 2.87 Impact Factor
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ABSTRACT: To assess the incidence of vestibular disturbance in patients after cochlear implantation, and to evaluate the quality of vertigo symptoms.
Prospective, observational study.
Cochlear implant centre at a tertiary referral university hospital, Munich, Germany.
Forty-seven adult patients undergoing unilateral cochlear implantation between 2003 and 2007.
Patients were interviewed post-operatively about vertigo symptoms, using a specifically designed questionnaire. Questionnaire data were used to define patient subgroups based on probable vertigo aetiology. Cochlear implantation was performed via a retroauricular, transmastoidal approach. Thirty-six implants were Cochlear Nucleus 24 devices and 11 were MedEl devices.
Twenty-one (45 per cent) patients reported vertigo symptoms following cochlear implantation. The time of onset was directly post-operatively in the majority of patients. In 90 per cent, the symptoms suggested an otogenic origin. The majority of patients reported paroxysmal vertigo with a duration of seconds to minutes. Typical concomitant symptoms were tinnitus, fluctuating hearing loss and vegetative reactions. Serious disablement by vertigo was rare.
Exposing patients to the risk of possible balance disorders associated with cochlear implantation is justified in view of the hearing rehabilitation achieved, even with today's broader indications for cochlear implantation. However, patients should in any case be informed about the possibility and quality of post-operative vertigo symptoms.
The Journal of Laryngology & Otology 07/2008; 123(3):278-82. · 0.60 Impact Factor
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ABSTRACT: When assessing hardness of hearing, the physician must in the first instance differentiate between an acute event--for example sudden loss of hearing--and chronic deafness. Otoscopy, tuning fork testing and measurement of hearing distance provide importance information for the differentiation of hardness of hearing. In the case of noise deafness, the general physician has a preventive task. With regard to the provision of a hearing aid he can play a supportive role as a mediator between the hearing aid wearer, the ENT specialist and the acoustician.
MMW Fortschritte der Medizin 02/2007; 149(4):39-41.
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ABSTRACT: Radiosurgery (RS) is a noninvasive, ambulatory special neurosurgical procedure for the treatment of vestibular schwannoma (VS). We treated 123 patients with unilateral schwannomas between 1994 and 2000 at the gamma knife (GK) center in Munich using a primary stereotactic procedure. These patients were followed up until June 2004 in respect to audiological, neurological, neurootological and radiological features before and after radiosurgical intervention. The actual tumor control rate of 8.2 years (mean) after GK surgery for all patients and a single treatment was calculated to be 96.7%. The impairment of hearing was on average 18% after GK, ranking from 0% gain of hearing loss up to 90%. Facial nerve function, graded according to the House-Brackmann scale, deteriorated in none of the patients; 5.8% reported a trigeminal neuralgia. Tinnitus developed in 4.1% of the patients after RS; 13.3% had vertigo for the first time after the treatment, age apparently being a predisposing factor. Radiosurgical treatment for VS is an alternative to microsurgery (MS). It is associated with a lower rate of facial and trigeminal neuropathy, postoperative complications and hospital stay. The hearing preservation rate is equivalent to MS.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 09/2006; 263(8):714-8. · 1.29 Impact Factor
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ABSTRACT: The prerequisite for normal speech development is the ability to hear normally. Our objective here is the detection of a hearing deficit with a relevant impact on the acquisition of speech before the child is three months old. Such a hearing impairment due to sensorineural deafness requires the provision of a hearing aid, which needs to be done before the child is six months old. If the provision of a hearing aid fails to provide the desired results, or if they may no longer be expected, a cochlear implant is indicated. In the event of tympanic effusion persistence, an adenotomy with paracentesis, and possibly the insertion of an ear tube, is indicated. This intervention can be done before the child is one year old. Permanent sound-conduction deafness may be due to auditory canal atresia or middle ear anomalies. In such cases, it is important to establish whether surgical reconstruction, for example of the sound conduction system, can restore good hearing over the long term. Prior to surgery at the age of about five, the child must be provided with a hearing aid.
MMW Fortschritte der Medizin 06/2006; 148(19):30-3.
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ABSTRACT: Niikawa-Kuroki syndrome (Kabuki make-up syndrome) is a congenital disorder with characteristic facial features and possibly anomalies of the skeletal system and internal organs. There is an increasing number of reports of patients with combined hearing impairment, inner ear deformities or sensorineural hearing impairment. In addition, the patients often suffer from therapy-resistant chronic otitis media. In addition to multiple cardiac and renal deformities, our 3 year old patient has a hearing impairment due to chronic otitis media with chronic otorrhea, and requires a hearing aid. A high-definition CT scan of the petrosal bone revealed, for the first time in a patient with Niikawa-Kuroki syndrome, a large vestibular aqueduct syndrome and deformities of the vestibular system. We examine the problems involved with treating chronic otorrhea in chronic otitis media and providing patients with BTE hearing aids.
HNO 04/2005; 53(3):253-6. · 0.40 Impact Factor
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ABSTRACT: Das Niikawa-Kuroki-Syndrom (Kabuki-Syndrom) ist eine angeborene Erkrankung mit charakteristischen Gesichtsmerkmalen und mglichen Anomalien des Skelettsystems und der inneren Organe. Kombinierte Schwerhrigkeiten, Innenohrfehlbildungen und sensorineurale Schwerhrigkeiten werden beschrieben, hufig auch therapieresistente Otitis media chronica. Neben multiplen Fehlbildungen von Herz und Niere weist der vorgestellte 3-jhrige Patient eine chronische Otorrhoe bei Otitis media chronica und eine hrgertepflichtige kombinierte Schwerhrigkeit auf. In der hochauflsenden Felsenbein-CT konnten wir erstmalig bei einem Patienten mit Niikawa-Kuroki-Syndrom ein Large-vestibular-aqueduct-Syndrom und Fehlbildungen des Gleichgewichtsorganes nachweisen. Wir errtern die Behandlung der chronischen Otorrhoe und die Versorgung mit HdO-Gerten.Niikawa-Kuroki syndrome (Kabuki make-up syndrome) is a congenital disorder with characteristic facial features and possibly anomalies of the skeletal system and internal organs. There is an increasing number of reports of patients with combined hearing impairment, inner ear deformities or sensorineural hearing impairment. In addition, the patients often suffer from therapy-resistant chronic otitis media. In addition to multiple cardiac and renal deformities, our 3year old patient has a hearing impairment due to chronic otitis media with chronic otorrhea, and requires a hearing aid. A high-definition CT scan of the petrosal bone revealed, for the first time in a patient with Niikawa-Kuroki syndrome, a large vestibular aqueduct syndrome and deformities of the vestibular system. We examine the problems involved with treating chronic otorrhea in chronic otitis media and providing patients with BTE hearing aids.
HNO 02/2005; 53(3):253-256. · 0.40 Impact Factor
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ABSTRACT: Contrary to the more frequent hematogenously spread cerebral aspergillosis, localized invasive intracranial aspergillosis is a fungal infection that can also occur in patients who are not severely immunosuppressed. This illness can be effectively treated in some of these patients by early and rigorous therapy. Localized invasion of the fungus, generally from one of the nasal sinuses, causes intracranial growth mainly along the base of the skull and larger vessels,where fibrous, granulomatous tissue develops. This generally leads to damage of the cranial nerves (primarily I-VI) as well as localized pain syndromes. We report on the clinical course documented by MRI of a patient with localized invasive intracranial aspergillosis who had multiple failure of cranial nerves following surgery for an aspergilloma of the maxillary sinus. Clinical course, imaging findings, and treatment of the illness are discussed with a review of the relevant literature.
Der Nervenarzt 01/2003; 73(12):1186-90. · 0.68 Impact Factor
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ABSTRACT: Die lokalinvasive intrakranielle Aspergillose ist im Gegensatz zur häufigeren hämatogenen zerebralen Aspergillose eine Erkrankung,
die auch bei nicht schwer immunsupprimierten Patienten auftritt und die bei früher und konsequenter Therapie bei einem Teil
der Patienten erfolgreich behandelt werden kann.Durch lokale Invasion des Pilzes, bevorzugt aus einer der Nasennebenhöhlen,
kommt es zum intrakraniellen Wachstum vor allem entlang der Schädelbasis und größerer Gefäße mit Bildung von fibrösem granulomatösem
Fremdgewebe. Dieses führt vorrangig zur Schädigung von Hirnnerven (bevorzugt I–VI) sowie lokalen Schmerzsyndromen. Wir berichten
über den klinischen und kernspintomographischen Verlauf einer Patientin mit lokalinvasiver intrakranieller Aspergillose, die
multiple Hirnnervenausfälle nach der Operation eines Aspergilloms der Kieferhöhle entwickelte. Die Klinik, Bildgebung und
Therapie der Erkrankung wird anhand einer Literaturübersicht diskutiert.
Contrary to the more frequent hematogenously spread cerebral aspergillosis, localized invasive intracranial aspergillosis
is a fungal infection that can also occur in patients who are not severely immunosuppressed. This illness can be effectively
treated in some of these patients by early and rigorous therapy. Localized invasion of the fungus, generally from one of the
nasal sinuses, causes intracranial growth mainly along the base of the skull and larger vessels,where fibrous, granulomatous
tissue develops. This generally leads to damage of the cranial nerves (primarily I–VI) as well as localized pain syndromes.
We report on the clinical course documented by MRI of a patient with localized invasive intracranial aspergillosis who had
multiple failure of cranial nerves following surgery for an aspergilloma of the maxillary sinus. Clinical course, imaging
findings, and treatment of the illness are discussed with a review of the relevant literature.
Der Nervenarzt 11/2002; 73(12):1186-1190. · 0.68 Impact Factor
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ABSTRACT: The precise mechanism of inner ear disease is still unknown. An autoimmune reaction could be one of several possible pathogenic factors involved in progressive sensorineural hearing loss. Heat shock protein 70 is suggested to play an important role in the development of autoimmune diseases. The aim of this study is the investigation of humoral immune reactivity to inner ear components in patients with sensorineural hearing loss.
The presence of antibodies to inner ear components was determined by immuno-blotting extracted bovine or human inner ear proteins. Study groups consisted of patients with idiopathic progressive sensorineural hearing loss (group A), patients with Menière's disease (group B), patients with sudden hearing loss (group C), patients with otosclerosis (group D), patients with Cogan's disease (group E), and individuals without hearing problems (group F).
40% of the patients with progressive sensorineural hearing loss showed reactivity against a 68-kDa protein extracted from bovine inner ear. In contrast to this, only 5% of healthy individuals and 10% with Menière's disease showed reactivity against the 68-kDa protein from bovine inner ear or against bovine heat shock protein 70. Some of the patients who showed reactivity against bovine inner ear proteins were tested with human inner ear and human heat shock protein 70; all of these showed reactivity. Approximately 6% of the patients with sudden hearing loss (group C), otosclerosis (group D), and Cogan's disease (group E) showed reactivity to inner ear proteins. A non-specific humoral immune reaction against inner ear proteins with molecular weights of 30, 40, 50, 60, and 220 kDa was observed in all patients.
These results indicate a humoral immune reactivity against heat shock protein 70, which might be responsible for the pathogenesis of progressive sensorineural hearing loss.
Laryngo-Rhino-Otologie 06/2001; 80(5):237-44. · 0.97 Impact Factor
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