Christoph Arnoldner

Medical University of Vienna | MedUni Vienna · Department of Otolaryngology, Head&Neck Surgery

Background Within otologic surgery, a paucity of well-controlled studies assessing the use of systemic antibiotic to reduce surgical site infections exists. Moreover, discrepancies in wound classification of procedures challenge consensus in antimicrobial prescribing patterns. We sought to compare surgeons from two different health systems to exami...

Purpose Cochlear implantation in patients with vestibular schwannomas is of increasing importance and interest. Two remaining challenges are the assessment of conduction of the cochlear nerve and the possibility of postoperative surveillance with magnetic resonance imaging. The aim of the current study was to assess follow-up imaging and determine...

Background: Cisplatin is among the most effective antineoplastic agents and has revolutionized the treatment of many cancer diseases. However, one of its serious side effects is a progressive and irreversible hearing loss, occurring in both adults and children. For the development of otoprotective therapies that prevent this side effect, cisplatin...

To shed some light on glycotargeting as a potential strategy for nasal drug delivery, a reliable preparation method for human nasal mucosa samples and a tool to investigate the carbohydrate building blocks of the glycocalyx of the respiratory epithelium are required. Applying a simple experimental setup in a 96-well plate format together with a pan...

Hearing impairment is the most common sensory disorder in humans, and yet hardly any medications are licensed for the treatment of inner ear pathologies. Intricate pharmacokinetic examinations to better understand drug distribution within this complex organ could facilitate the development of novel therapeutics. For such translational research proj...

Objectives: Numerous preclinical experiments over the past years have shown the potential of novel therapeutic approaches for sensorineural hearing loss (SNHL) that are now awaiting clinical translation. In this pilot study, we aimed to evaluate the patient acceptance of these future innovative therapies in individuals with SNHL. Study design: C...

Objective: Electrically evoked auditory brainstem response audiometry has emerged as a suitable option to intraoperatively assess cochlear nerve function during vestibular schwannoma resection. This study aimed to analyze the functional outcome and implant usage of patients with preserved auditory nerve responses after simultaneous translabyrinthi...

Objective: In the treatment of inner ear conditions, intratympanic injection emerges as an important drug delivery method. Novel compounds designed for intratympanic injection are routinely loaded in viscous drug carriers. To date, it is unclear if they can freely distribute in the middle ear. The aims of this study were to investigate the middle...

Objectives Various animal models have been established and applied in hearing research. In the exploration of novel cochlear implant developments, mainly rodents have been used. Despite their important contribution to the understanding of auditory function, translation of experimental observations from rodents to humans is limited due to the size d...

Purpose of Review Cochlear implantation gives us a unique opportunity to expand the pharmacological treatment of hearing loss. Delivery of pharmacological agents, cells, and gene therapy vectors to the inner ear are challenging due to anatomic and physiologic factors. Since cochlear implantation opens the inner ear, there is an opportunity to deliv...

Background: Stimulation with triphasic pulses has been shown to reduce the occurrence of unwanted facial nerve stimulation (FNS) with cochlear implants (CIs). However, there is little data available on how different pulse shapes affect the hearing outcome with electrical hearing in general. The aim of the study was to evaluate the effects of diffe...

The functional hearing outcome with hearing implants does not always properly reflect the subjective benefit in everyday listening situations. In this study, the functional hearing gain and the impact on the subjective hearing ability and quality of life were assessed in patients with a Bonebridge. A chart review was performed on 45 patients with a...

Traumatic iatrogenic perforation of the anterior skull base is a rare complication following endonasal intubation in preterm infants. Subsequent meningoencephaloceles with concomitant cerebrospinal fluid (CSF) fistulas bear the risk of severe complications, therefore early diagnosis and closure of the skull defect are crucial. However, there is no...

Purpose Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate pat...

Robotic cochlear implant surgery is a new and safe technique. A system for robotic cochlear implant surgery has become available in Europe. Robotic cochlear implant surgery can be successfully performed in partially‐ossified basal cochlear turns. Adaption of the planning procedure by increasing the milling depth enables robotic cochlear implant sur...

Purpose The disease activity of skull base osteomyelitis can be challenging to assess by means of conventional imaging methods and renders monitoring of the disease difficult, especially in areas with restricted access to nuclear medicine imaging. Here, we provide clinically relevant data on the management of skull base osteomyelitis including asse...

Background: The opioid epidemic is a significant public health crisis challenging the lives of North Americans. Interestingly, this problem does not exist to the same extent in Europe. Surgeons play a significant role in prescribing opioids, especially in the context of post-operative pain management. The aim of this study was to compare the post-...

Intratympanically applied treatments are of increasing interest to the otologic community to treat sudden sensorineural hearing loss or vestibular disorders but also to deliver gene therapy agents, or biologics to the inner ear. Further diversion from the middle ear and perilymph to blood circulation and cerebrospinal fluid via the cochlear aqueduc...

Introduction: Temporal bone paragangliomas are rare tumors with high vascularization and usually benign entity. A variety of modalities, including gross total resection, subtotal resection, conventional or stereotactic radiotherapy including gamma-knife, embolization, and wait-and-scan strategy can be considered. The aim of this study was to compa...

Importance The use of intratympanically applied steroids is of increasing interest. Consequently, research has focused on finding an ideal drug that diffuses through the round window membrane and can be retained in the perilymph. Objective To compare levels of triamcinolone acetonide (TAC) in perilymph and plasma after intratympanic injection. De...

Background: Robotic surgery has been proposed in various surgical fields to reduce recovery time, scarring, and to improve patients' outcomes. Such innovations are ever-growing and have now reached the field of cochlear implantation. To implement robotic ear surgery in routine, it is of interest if preoperative planning of a safe trajectory to the...

Purpose of review: Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this disease. Yet, there is no consensus on the optimal diagnostic and follow-up management. This review should aid clinicians in decision-making for their patients....

• Simultaneous translabyrinthine tumor resection and cochlear implantation is a promising treatment method with hearing rehabilitation for sporadic vestibular schwannomas. • Size of vestibular schwanomma, distance to modiolus, residual hearing and promontory stimulation electrical brainstem response audiometry are important preoperative predictive...

Objective: The aim of this study was to evaluate whether stapes prostheses can be visualized with less metal artifacts and therefore more accurately on cone beam computed tomography in comparison to computed tomography imaging. Recent studies have shown that cone beam computed tomography has advantages when imaging metal artifacts. Patients with he...

Objectives Here we present the audiometric outcomes of patients undergoing vestibular schwannoma resection and cochlear implantation. We additionally reviewed preoperative audiometric and radiological data, with the aim of developing a new scoring system to identify suitable patients for this treatment course. Methods After translabyrinthine vestib...

Zusammenfassung Vestibularisschwannome können die Lebensqualität von Patienten stark beeinträchtigen. Neben einer eingeschränkten Hörfunktion wird die Gesichtslähmung hierbei als besonders störend empfunden. Unterschiedliche Wachstumsraten dieser gutartigen Tumore erschweren die zeitliche Vorhersage einer funktionellen Beeinträchtigung von Hirnnerv...

Objectives: The aim of this study was to evaluate the performance and limits of an adhesive bone conduction hearing aid in patients implanted with an active transcutaneous bone conduction implant. Therefore, hearing performance and subjective benefit of patients with mixed and conductive hearing loss were assessed with both bone conduction devices...

Background Implant lifts were recently introduced in order to facilitate implantation of the Bonebridge and to reduce the risk of uncovering the sigmoid sinus and/or dura. Purpose The current study analyzed medical, technical and audiological outcomes of implantation with the Bonebridge implant using lifts. Research Design This was a retrospectiv...

Objectives: Temporal fine structure information such as low-frequency sounds including the fundamental frequency (F0) is important to separate different talkers in noisy environments. Speech perception in noise is negatively affected by reduced temporal fine structure resolution in cochlear hearing loss. It has been shown that normal-hearing (NH)...

Objectives To evaluate the performance of radiomic features extracted from high-resolution computed tomography (HRCT) for the differentiation between cholesteatoma and middle ear inflammation (MEI), and to investigate the impact of post-reconstruction harmonization and data resampling. Methods One hundred patients were included in this retrospecti...

OBJECTIVE: The aim of the study was to evaluate the predictive value regarding postoperative hearing benefit of electrically evoked auditory brainstem response audiometry in sporadic vestibular schwannoma patients undergoing simultaneous tumor resection and cochlear implantation. DESIGN: Patients were included in a prospective study conducted betwe...

Background: Prolonged hospitalization after tonsillectomy up to three nights was implemented to decrease mortality due to post-tonsillectomy hemorrhage. Aims: To assess if extension of postoperative inpatient observation time from one to three nights results in potential benefits following tonsillectomy. Subjects and methods: Patients who stayed on...

Recent sound coding strategies for cochlear implants (CI) have focused on the transmission of temporal fine structure to the CI recipient. To date, knowledge about the effects of fine structure coding in electrical hearing is poorly charactarized. The aim of this study was to examine whether the presence of temporal fine structure coding affects ho...

N-acetylcysteine is a thiol-containing antioxidant, which has shown otoprotective effects in in-vitro as well as in-vivo models of cisplatin induced hearing loss. Systemic administration of antioxidants, however, is associated with the major potential drawback of interference with the tumoricidal effect of cisplatin. This therapeutic limitation can...

Interaural time differences (ITDs) at low frequencies are important for sound localization and spatial speech unmasking. These ITD cues are not encoded in commonly used envelope-based stimulation strategies for cochlear implants (CIs) using high pulse rates. However, ITD sensitivity can be improved by adding extra pulses with short inter-pulse inte...

Background Menière’s disease (MD) is a symptom complex which is characterized by episodes of vertigo, tinnitus and fluctuating sensorineural hearing loss, which worsens during the course of the disease. Objective Vertigo attacks (MD functional level scale) before compared to after cochlear implantation in patients with end-stage MD. Design and pa...

Bone-conduction implants are a standard therapeutic option for patients with conductive, unilateral, or mixed hearing loss who either do not tolerate conventional hearing aids or can benefit from surgery. The aim of this study was to evaluate long-term medical and technical outcomes, and audiological results with the Bonebridge transcutaneous bone-...

Introduction: In recent years, the preservation of residual hearing has become a major factor in patients undergoing cochlear implantation (CI). In studies attempting to pharmaceutically improve hearing preservation rates, glucocorticoids (GCs) applied perioperatively in many institutions have emerged as a promising treatment regimen. Although dex...

Cochlear implantation has become the most effective hearing restoration method and is one of the great advances in modern medicine. Early implants have been continuously developed into more efficient devices, and electro-acoustic stimulation is increasingly expanding the indication criteria for cochlear implants to patients with more residual heari...

Introduction: Corticosteroids represent the most commonly used treatment option for patients with idiopathic sudden sensorineural hearing loss. In the past, these compounds were mainly formulated and tested for intravenous or oral administration. Intratympanic application is increasingly being used, often as salvage treatment. The most suitable co...

Objectives: The main aim of this study was to compare the average daily wearing time of a conventional bone conduction device with a pressure-free, adhesive bone conduction device. Further, audiologic and quality-of-life outcome parameters were evaluated. Methods: An academic, prospective, randomized cross-over trial was performed at a single ce...

Objective: To assess the audiological and long-term medical and technical follow-up outcomes of an active middle ear implant. Methods: This was a retrospective medical chart analysis of all patients provided with an active middle ear implant in a tertiary academic medical referral center between September 1, 1998, and July 31, 2015. Main outcome m...

Objectives: Patients with single-sided deafness (SSD) have great difficulties in listening situations which rely on binaural auditory processing. The purpose of this study was to examine to which extent a cochlear implant (CI) can improve speech perception outcomes in various noisy listening environments. Additionally, the ability to use interaura...

The otoprotective effects of thermoreversible poloxamer 407 hydrogels containing dexamethasone or triamcinolone acetonide were evaluated in an animal model of noise-induced hearing loss. Seven days after noise exposure, hearing threshold shifts at 16 kHz were significantly reduced in the 6% dexamethasone group (p < 0.05). Even though no significant...

Objectives The aim of this study was to evaluate the hearing benefit, advantages, and disadvantages in a series of patients using a new, nonimplantable, pressure-free, adhesive bone conduction hearing aid. Methods Twelve patients were included in the study at the ear, nose, and throat department of the Medical University of Vienna. All patients su...

Cochlear implants are highly efficient devices that can restore hearing in subjects with profound hearing loss. Due to improved speech perception outcomes, candidacy criteria have been expanded over the last few decades. This includes patients with substantial residual hearing that benefit from electrical and acoustical stimulation of the same ear,...

OBJECTIVE The authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma. METHODS Six hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patient...

Objectives: To determine whether preoperative steroids can improve hearing outcomes in cochlear implantation (CI). Methods: This is a randomized controlled trial involving 30 postlingual deaf CI patients. Subjects had preoperative thresholds of better than or equal to 80 dB at 125 and 250 Hz, and better than or equal to 90 dB at 500 and 1,000 Hz...

Objective To determine the impact of the fixed and adaptive beamforming technology of the new MED-EL SONNET cochlear implant audio processor on speech perception in noise. Methods The study cohort comprises 18 postlingually deafened adult cochlear implant recipients with at least six months of experience. Speech reception thresholds were measured...

It has been shown that patients with electric acoustic stimulation (EAS) perform better in noisy environments than patients with a cochlear implant (CI). One reason for this could be the preserved access to acoustic low-frequency cues including the fundamental frequency (F0). Therefore, our primary aim was to investigate whether users of EAS experi...

In 2011 a bone conduction implant that utilizes electromagnetic signals transmitted through the skin instead of vibrations was introduced onto the market. The implantable portion (the bone conduction floating mass transducer, or BC-FMT) is an electromagnetic transducer that is fixed to the skull bone with screws and delivers mechanical vibrations t...

It has been shown that glucocorticoids reduce the hearing threshold shifts associated with cochlear implantation. Previous studies evaluated the administration of glucocorticoids immediately before surgery or the repeated pre- or perioperative systemic application of glucocorticoids. The aim of this study was to evaluate the effects of a sustained...

Objective: The aim of the present study was to evaluate the effect of stimulation rate on speech perception and sound quality for the fine structure strategy FS4 and the envelope-based strategy high definition continuous interleaved sampling (HDCIS). Study design: Randomized crossover trial with four conditions. Setting: Tertiary referral. Pa...

BACKGROUND: Selective glucocorticoid receptor modulators (SEGRMs) comprise a novel class of drugs promising both reduced side effects and similar pharmacological potency relative to glucocorticoids, which presently serve as the only clinical treatment for many otologic disorders. In the first otologic SEGRM experiment in an animal model of noise tr...

A diamond burr is used to skeletonize the facial nerve in its descending (mastoid) portion. As mentioned, the direction of preparation should always be parallel to the course of the nerve. The nerve should be skeletonized broadly using slow deliberate strokes of the drill. Excessive hand movement should be avoided to minimize inadvertent injury to...

Finding a patent cochlea may be very challenging in postmeningitic patients with labyrinthis ossificans. A myriad of cochlear drill out procedures including access to the scala vestibuli and mid/apical cochleostomies have been described.

In chronic otitis media, cholesteatoma formation classically starts in the space just medially to the pars flaccida portion of the tympanic membrane and the scutum (a sharp bony spur formed by the lateral wall of the tympanic cavity and the superior wall of the external auditory canal, usually the first bony structure to erode as a result of a chol...

Completely drilling out the semicircular canals and removing all the soft tissue of the canals and the vestibule is referred to as labyrinthectomy. The indication for this procedure is the eradication of labyrinthine vertigo which is a hallmark symptom of conditions such as Meniere’s disease. In addition, it is a common (non hearing preserving) sur...

It must be understood that the medial wall of the vestibule forms the lateral wall of the internal auditory canal. Therefore, a small amount of bone removal is sufficient to unroof the internal auditory canal at its anterior (lateral) end, the fundus. Posteriorly, the route to the porus acusticus (the medial end of the canal) is much deeper because...

The thorough knowledge of the complex anatomy of the temporal bone builds the firm basis for ear surgery. Even for experienced surgeons, reinforcement of their skills by training on the cadaver is of tremendous importance.

In the context of cochlear implantation, visualization of the round window is very important: first, if the electrode is inserted directly through the round window membrane, and second when a cochleostomy is performed, the round window serves as an important landmark.

Locating the mastoid antrum is one of the earliest steps in the dissection of a temporal bone:

The posterior canal wall is taken down mainly in cholesteatoma cases when a wide overview of the middle ear structures is necessary. Initially the canal wall is usually preserved to have a landmark for the mastoidectomy. When the canal wall is then taken down, drilling is performed parallel to the facial nerve. Once you are medial to the tympanic a...

The endolymphatic sac (ELS) can be found in a thickened portion of the posterior fossa dura medial to the sigmoid sinus and inferior to the posterior canal. A classic landmark that consistently defines the upper boundary of the ELS is known as “Donaldson’s line”. This line is drawn through the lateral semicircular canal (SCC), which bisects the pos...

The next part of the dissection aims at identifying the facial nerve in its mastoid (vertical segment). The facial nerve is normally located inferior and slightly medial to the horizontal semicircular canal.

CONCLUSION: The intraoperative application of glucocorticoid-loaded hydrogels seems to cause a reduction in neutrophil infiltration. No beneficial effect on hearing thresholds was detected. OBJECTIVES: To evaluate the application of dexamethasone- and triamcinolone acetonide-loaded hydrogels for effects on hearing preservation and foreign body reac...

In the present study the glycosylation pattern of the middle ear mucosa (MEM) of guinea pigs, an approved model for middle ear research, was characterized with the purpose to identify bioadhesive ligands which might prolong the contact time of drug delivery systems with the middle ear mucosa (MEM). To assess the utility of five fluorescein labeled...

The facial recess (posterior tympanotomy) is a triangular region delineated by the fossa incudis superiorly, the facial nerve posteriorly, and the chorda tympani anteriorly (Figs 4.1 and 4.2). Anterior to the chorda tympani lies the annulus fibrosus of the tympanic membrane.