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ABSTRACT: Middle ear surgery sometimes leads to unpleasant auditory impressions such as distortion or hyperacusis that cannot be detected by conventional audiometric testing.
Sixty-one patients with conductive hearing loss caused by otosclerosis underwent audiological evaluation, which included a questionnaire followed by testing of the audiometric threshold, speech audiometry, and assessment and quantification of loudness perception with a commercial system (WESTRA). This investigation includes the postoperative measurement of hearing improvement and the patients' subjective impressions regarding hearing increase, distortion of speech, and hyperacusis.
Hearing improved in 88% of the patients. A quantification of this hearing increase was possible with pure tone audiometry and the Freiburg speech discrimination test. Reduced hearing threshold and lack of improvement in speech discrimination was confirmed by conventional hearing measurements. However, the presence of hyperacusis and distortion of speech could be determined by conventional audiometry in only 50% of cases. It was interesting to note that the subjects who reported speech distortion and hyperacusis in the questionnaire were identified by their increased loudness perception using the categorical loudness scaling.
Category loudness scaling appears to be a valuable additional clinical test to characterize postoperative phenomena as distortion of speech and hyperacusis in patients undergoing stapes surgery.
Laryngo-Rhino-Otologie 02/2000; 79(1):14-20. · 0.97 Impact Factor
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ABSTRACT: A commercially available system for the purpose of categorial loudness rating (WHF, WESTRA ELECTRONIC GmbH, Wertingen) was applied with 57 subjects with normal hearing to evaluate reference loudness level functions for 1/3-octave bandpass filtered noise and octave bandpass filtered environmental sounds.
The procedure can be carried out with high reproducibility without effects of training due to repetition and only slight influence of subject sex, whereas the labeling of input device and temporal structure of the environmental sounds influence results, as does the center frequency.
Our results showed deviations compared with the reference functions displayed in the WHF system.
Laryngo-Rhino-Otologie 09/1997; 76(8):458-65. · 0.97 Impact Factor
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ABSTRACT: High-resolution computed tomography (CT) has long been the method of choice in the visualization of the petrous bone, the internal auditory canal, and the cerebellopontine angle. The introduction of magnetic resonance imaging (MRI), especially of the three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS), has proved to be superior in the detection of soft-tissue lesions in the inner ear. The aim of this study was to visualize small anatomic structures of the inner ear and cerebellopontine angle. The examinations were performed with a standard head coil on a 1.5-T Magnetom ("Vision"; Siemens, Erlangen, Germany). The three-dimensional reconstruction of the cochlea, semicircular canals, and vestibulum allowed detailed visualization, as well as the imaging of cranial nerves VII and VIII. Our results indicate that 3DFT-CISS MRI is a valuable diagnostic tool in the evaluation of inner ear anatomy and pathology; in most cases, however, it must be supplemented by HR-CT.
The American journal of otology 06/1996; 17(3):480-5.
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ABSTRACT: Benign adenomas of the middle ear are rare tumors. To date, approximately 100 cases of adenomatous neoplasms of the middle ear space have been collected in the United States Armed Forces Institute of Pathology, Washington D.C. This report describes two cases of primary adenomatous neoplasms confined to the middle ear cleft seen at the Department of Otorhinolaryngology at Ludwig Maximilians University Hospital, Munich. Although tumors are derived from lining epithelium of the middle ear mucosa, the unique feature of our first case was based on its origin in the epitympanic part of the tympanic membrane. Histopathology was characterized by an adenomatous morphology without atypia or mitoses, proving its benign behavior. No evidence was found for invasion of adjacent tissue. Simple surgical removal afforded excellent prognosis. Clinical behavior, histological appearance, origin of tumors and differential diagnosis are discussed.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 02/1996; 253(1-2):65-8. · 1.29 Impact Factor
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ABSTRACT: Early identification of hearing impairment in children poses a major problem for clinical research and development. In the last two years we determined the hearing sensitivity of 1202 newborns, small infants and children. 52.4% of the children exhibited risk factors for hearing impairment in their medical history. The majority of children was referred to our department by pediatricians (52%), who first suspected hearing impairment, 40% by parents, 3.5% by otolaryngologists, 3% by educators, and 1.5% by general practitioners. The following examinations were performed: transiently evoked otoacoustic emissions (TEOAE), impedance audiometry, auropalpebralreflex, behavioral observation audiometry, and, if necessary, auditory brain stem response (ABR) with air and bone-conducted clicks as well as frequency-following responses at 500 Hz tone burst. In 378 children TEOAE were recorded on both sides, in 151 at least on one side. These results were confirmed by the other techniques. Only three children presented false negative results of TEOAE on one side. Two of these children had a middle ear effusion and a threshold of 35 dB, one had retrocochlear hearing loss. The absence of TEOAE in both ears in 155 children as well as in one ear in 16 children was detected by ABR. Seventy-seven patients showed no response on both sides, 25 on one side, although a hearing impairment more than 25 dB could not be verified by ABR. This high number of false positive results is explained in 77 cases (76%) by a middle ear dysfunction during the recording of TEOAE, when ABR was performed following adenotomy and paracentesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Laryngo-Rhino-Otologie 04/1995; 74(3):172-8. · 0.97 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the diagnostic value of modern imaging tools in pulsatile tinnitus, which might be apparent in a variety of different diseases. While computed tomography (CT) and digital subtraction angiography (DSA) have been the methods of choice in the diagnostic management of this symptom and its related diseases, the technical progress in the development of MRI and MRA highly recommends these techniques as additional yet sufficient imaging tools. The authors demonstrate 2 representative cases of pulsatile tinnitus (one patient with glomus tumour, one patient with jugular bulb deformity) and the adequate diagnostic procedure in terms of imaging tools. It is concluded that a routine MRI-examination might allow a diagnosis with high sensitivity and specificity. Still, digital subtraction angiography and computed tomography remain indispensable in the diagnostic management of pulsatile tinnitus.
Laryngo-Rhino-Otologie 04/1995; 74(3):179-82. · 0.97 Impact Factor
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ABSTRACT: Advances in high resolution magnetic resonance imaging (MRI) allow the evaluation of the cerebellopontine angle and temporal bone. The purpose of our study was to demonstrate pathological and anatomical aberrations of cerebral arteries in relation to clinical symptoms. The study was carried out on a 1T MR whole body scanner (Impact, Siemens, Erlangen, Germany), using a head coil, a pre- and postcontrast ("Magnevist", Schering, Berlin, Germany) T1-weighted 2D-FLASH sequence and a T2-weighted turbo-spin echo sequence. We examined 22 patients suffering from asymmetric hearing loss, pulse-synchronous tinnitus, hemifacial spasm or facial palsy. The problem of a clear differentiation of meningiomas and acoustic neurinomas by means of MRI is discussed. We identified aberrant AICAs at the cerebellopontine angle in close contact with the V., VII. and VIII. cranial nerve. Inflammatory lesions of the facial and vestibulocochlear nerve were visualised successfully. The potential of the pre- and postcontrast 2D-FLASH sequence for the detection of a wide range of different lesions in the cerebellopontine angle and the temporal bone in MRI of the head was demonstrated.
Laryngo-Rhino-Otologie 02/1995; 74(1):57-61. · 0.97 Impact Factor
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ABSTRACT: Adenomas of the middle ear are quite rare tumours of the ear and of recent recognition. Two cases of adenomatous neoplasms confined to the middle ear are presented. Usually these tumours are located on the promontorium or in the hypotympanon. The unique feature of the first described case is based on its origin in the epitympanic pouch of the tympanic membrane. The second case originated from the mucosa in the hypotympanon. The third case is a tumour-like lesion which was not distinguishable on clinical grounds from a jugulo-tympanic paraganglioma or a middle ear adenoma. The adenomas of the middle ear are histopathologically characterised by differentiated glandular structures within fibrous tissue and recurrences are rarely observed. Surgical removal by the endaural route gives an excellent prognosis as shown by the literature and our own clinical cases.
Laryngo-Rhino-Otologie 08/1994; 73(7):358-62. · 0.97 Impact Factor
