John Martin Hempel

Technische Universität München, München, Bavaria, Germany

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Publications (42)39.25 Total impact

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    ABSTRACT: Conclusion: The length of the cochlea can be determined with good precision using a 3D-curved multiplanar reconstruction analysis technique and linear reconstruction of the cochlea. The method is not time-consuming and can be applied during clinical routine. Objective: A preoperative prediction of the best cochlear implant electrode length can help reduce the risk of intraoperative cochlear trauma in patients who need to retain residual acoustic hearing for electric-acoustic stimulation or in patients with anatomical anomalies or malformations. The goal of this study was to evaluate the accuracy and reliability of length measurement of the cochlea after linear reconstruction using 3D-curved multiplanar reconstrucion analysis of high resolution computed tomography (CT) scans. Methods: Human cadaveric temporal bone specimens underwent cochlear implantation using custom-made electrodes with two radiopaque markers of a defined length before CTscans were made. Length measurement was performed by four readers and the results were compared to the true value. Inter-reader reliability was calculated. The time needed for analysis was recorded. Results: The mean time needed for analysis of one specimen's radiologic data was 6.1 (± 3.4) min. The mean deviation of the length measurement from the true value was 0.8 (± 0.7) mm. Inter-reader reliability was excellent (0.76, p = 0.006).
    No preview · Article · Sep 2014 · Acta Oto-Laryngologica
  • F Braun · T Braun · J Martin Hempel · E Krause · J Müller · A Berghaus · M Reiser · B Ertl-Wagner

    No preview · Article · Apr 2014 · RöFo - Fortschritte auf dem Gebiet der R
  • J M Hempel · D Knöbl · A Berghaus · T Braun
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    ABSTRACT: Microtia is associated with increased psychosocial morbidity. The literature contains three purely retrospective studies using validated tools. These studies show that auricular reconstruction leads to a significant improvement in health-related quality of life in affected children and adults. In a prospective approach, the authors assessed 21 consecutive microtia patients (return rate 81 %; 7 children and 10 adults) before and after auricular reconstruction with porous polyethylene using the following validated questionnaires: Glasgow Health Status Inventory (GHSI), Short Form 36 Health Survey Questionnaire (SF-36), Childhood Experiences Questionnaire (CEQ) and Kidscreen-52. An improved health-related quality of life was detected with all applied instruments. A subjective benefit of auricular reconstruction with porous polyethylene can be shown using prospective, as well retrospective tools.
    No preview · Article · Mar 2014 · HNO
  • Thomas Braun · John Martin Hempel · Alexander Berghaus
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    ABSTRACT: Developmental disorders of the ear can impair hearing and cause cosmetic deformities. In recent years, new surgical treatments have become established, above all in audiological rehabilitation. We selectively searched the PubMed database up to May 2013 for publications in English and Germanabout the therapeutic options. No randomized trials have been performed, for both ethical and practical reasons (inadmissibility of placebo surgery, specialization of surgeons for individual techniques). To correct prominent ears, cartilage-sparing suture techniques are preferred, as they lead less often than scoring and incisional techniques to the formation of persistent, incompletely correctable ridges and scaffolding defects. The successful esthetic rehabilitation of severe deformities of the external ear is achievable through pinna reconstruction with costal cartilage (main risks: tissue defect at donor site, scaffolding resorption) or porous polyethylene (main risk: implant extrusion). The functional rehabilitation of conductive or mixed hearing impairment due to ear-canal atresia and major middle-ear deformities is preferably achieved with active middle-ear implants or bone-conduction hearing aids. Functional rehabilitation should be provided even when the hearing impairment is unilateral, in order to improve directional hearing and hearing with ambient noise. In cases of purely cochlear, unilateral, severe hearing impairment or deafness, a boneconduction hearing aid can be tried, and the individual indication for a cochlear implant can be considered. The treatment options described here enable the affected children to benefit from complete functional and esthetic rehabilitation before they start school.
    No preview · Article · Feb 2014 · Deutsches Ärzteblatt International
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    ABSTRACT: To analyze the value of a routine x-ray position check after cochlear implantation and to assess if an increased resistance during electrode insertion is a sufficient predictor of electrode misplacement. Retrospective data collection. University hospital. Plain x-rays (Stenvers' projection) and the respective surgery reports of 218 patients having received cochlear implantation (243 ears) were analyzed for possible electrode misplacements and intraoperative conspicuities during electrode insertion. Electrode misplacement (tip-over, loop, kinking, scalar transition, and incomplete insertion) was observed in 8% of the entire study cohort, but only in 5% if cases with inner ear dysplasia or labyrinthine ossification (n = 28) were excluded from analysis. Intraoperatively, an increased resistance during electrode insertion was found in 16% but only in 8% when cases with inner ear dysplasia or labyrinthine ossification were excluded. The intraoperative finding of an increased resistance during electrode insertion had a sensitivity of 55% and a specificity of 88% for predicting radiographically confirmed electrode misplacements (positive predictive value, 29%; negative predicting value, 96%). Nearly half of the cases of electrode misplacement would have been overlooked if radiographic position checks would have been done only in patients with intraoperative conspicuities during electrode insertion. This finding advocates routine radiographic position checks, although electrode misplacements are relatively rare in patients with regular inner ear anatomy.
    No preview · Article · Oct 2013 · Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
  • J.M. Hempel · T Braun · A Berghaus
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    ABSTRACT: Microtia leads to a severe functional and aesthetic handicap. Traditionally, the auricle is often reconstructed with cartilage transplants, which is, however, associated with some partially substantial disadvantages. The authors have instead used implants of porous polyethylene for successful ear reconstruction for years, thus, avoiding some of these disadvantages. A significant benefit for the patient is achieved by simultaneous hearing rehabilitation by the implantation of active middle ear prostheses. The authors present their surgical concept which allows functional and aesthetic rehabilitation of microtia in children and adolescents in a single operation. In the respective patient collective, audiometric measurements in quiet and noisy environments were conducted pre- and postoperatively, and health-related quality of life was determined using a validated questionnaire. All patients experienced a substantial hearing gain both in quiet and noisy environments. The evaluation of health-related quality of life showed a significant benefit from the intervention. Functional and aesthetic rehabilitation of microtia with active middle ear implants and ear reconstruction using porous polyethylene leads to good and reliable long-term results and can increase the health-related quality of life of affected children and adolescents. The main advantage of this concept is the possibility of a single procedure.
    No preview · Article · Aug 2013 · HNO
  • Thomas Braun · Martin Patscheider · Alexander Berghaus · John Martin Hempel
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    ABSTRACT: Background Total ear reconstruction with porous polyethylene implants leads to three typical skin scars: a scalp scar from harvesting the temporoparietal fascia flap as well as a groin scar and a contralateral postauricular scar from harvesting full-thickness skin grafts. This study evaluates the annoyance of these scars from the patients’ perspective. Methods Fifteen patients received structured questionnaires covering the aesthetical outcome and daily impairment by the three scar types, as well as validated questionnaires measuring health-related quality of life. Results The ear reconstruction had raised the health-related quality of life in 14 patients. The scalp and groin scars were rated “satisfactory,” and the postauricular scar was “good” on an average. In contrast to the postauricular scar, the annoyance by scalp and groin scars was substantial: Half of the patients had sensation disorders on the scalp or groin. The scalp scar impaired a third of the patients wearing a desired hairstyle and the groin scar a third of the patients wearing swimsuits. A fifth of the patients experienced feelings of shame in the public due to the scalp and groin scars. Conclusions While not preventing the beneficial effect of ear reconstruction on patients’ health-related quality of life, scalp and groin scars are annoying for a relevant percentage of the patients. Therefore, the temporoparietal fascia flap should be harvested with the smallest incision possible, full-thickness skin grafts from the groin should be harvested as small as possible, and harvesting areas for full-thickness skin grafts other than the groin should be evaluated. Level of Evidence: III.
    No preview · Article · Jul 2013 · European Journal of Plastic Surgery
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    ABSTRACT: Objective: To evaluate the prevalence of labyrinthine ossification, and especially cochlear ossification, in a cohort of patients with unilateral sudden deafness or severe sensorineural hearing loss. Design: Retrospective data collection. Study sample: Sixty-four consecutive patients with unilateral sudden deafness or severe sensorineural hearing loss and either high-resolution CT (HRCT) of the temporal bone (isotropic spatial resolution ≤ 0.8 mm; n = 18) or high resolution CISS MRI (isotropic spatial resolution ≤ 1 mm; n = 55) were included. Nine patients underwent both imaging modalities. A standardized reading regarding labyrinthine ossifications was performed by an experienced head and neck radiologist blinded to clinical symptoms. Results: Radiologic signs of cochlear ossification were present in 14 patients (12 CT and 2 MRI). Eight patients showed unilateral and six patients bilateral signs of cochlear ossification. In all except one of the unilateral cases, the deafened ear was affected. Conclusions: Signs of cochlear ossification were found in an unexpectedly high rate (14/64, 22%) of patients with acute deafness. The data suggest HRCT of the temporal bone to be more sensitive to detect labyrinthine ossification than MRI. HRCT of the temporal bone should therefore be considered in patients with impaired recovery of acute deafness to exclude cochlear ossification; if present, and, in cases of early signs, the patient should be evaluated further to facilitate early cochlear implantation before progression impedes electrode insertion, reflecting latest developments considering cochlea implants for single-sided deafness to be effective.
    No preview · Article · May 2013 · International journal of audiology
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    ABSTRACT: Introduction: The goal of this clinical study was to determine whether physiotherapy (PMR: physical medicine and rehabilitation) can be an effective treating modality for patients with subjective tinnitus. Materials and Methods: Prospective clinical trial using questionnaires before and after PMR therapy. 34 patients with acute tinnitus or acute exacerbation of chronic tinnitus complaining about disorders of the cervical spine were included. Patients underwent individually adapted PMR therapy according to PMR specialists' recommendations. The main outcome measure was the participants' assessment of how loud and how troublesome their tinnitus was before and after treatment. For statistical analysis Fisher's exact test was used. Results: About 35 % of all participants experienced a long-term benefit from PMR therapy. The long-term benefit rate was higher for female participants. Conclusion: PMR therapy can significantly reduce the annoyance of tinnitus and the associated comorbidity in patients with cervical spine disorders.
    No preview · Article · Jan 2013 · Journal of International Advanced Otology
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    ABSTRACT: PURPOSE To investigate the feasibility and accuracy of length measurements of the cochlear implant (CI) electrode by high-resolution computed tomography (HR-CT) using CI electrodes of a predefined length in human temporal bone specimens. METHOD AND MATERIALS Eight human temporal bone specimens were surgically prepared analogous to a regular CI surgery for the study. The round window was opened and the cochleae were then injected with a physiologic saline solution to avoid air bubbles, which could interfere with CT scanning. Dummy-electrodes by MED-EL with two markers in a predefined distance of 20 mm were inserted and fixated in the round window. Two temporal bones at a time were inserted into both sides of a plastic head phantom and HR-CT imaging was performed with a dual source CT (Somatom FLASH, Siemens). The data were reconstructed with a slice thickness of 0.4 mm, an increment of 0.1 mm in a maximum-intensity-projection technique (MIP). For data analysis OsiriX (version 4.1, 64-bit) was applied using a 3D-curved MPR technique. Readings were performed by 4 M.D.s of differing experience (Reader 1: otolaryngology resident, Reader 2: junior radiology resident, Reader 3: senior radiology resident, Reader 4: head and neck staff radiologist). Mean values and standard deviation for time and measured length were calculated.For statistical analysis we performed a linear mixed effects model for modeling the deviations from the true value (20 mm) where the raters are treated as random effects. Intraclass correlation 0.133) RESULTS The mean measurement error from 20 mm over all specimens and readers was 0.9 mm ±0. 9 (reader 1 to 4: 1.2mm ±1.2 ; 0.8mm ±0.8; 1.0mm ±0.8; 0.7 mm ± 2.3, respectively). The time needed to measure one electrode was similar for all readers with an average of 6.06 min ±3.40min. Electrode markers were reliably identified by all readers in all specimen. The average bias was 0.032cm and statistically not significant (p = 0.71)) CONCLUSION Our results show that CT based measurement of cochlear implant length is highly accurate and can be done in a limited time. This may aid in the post-operative assessment of electrode positioning. CLINICAL RELEVANCE/APPLICATION As CI electrode length measurements by HRCT were highly accurate in this experimental setting, post-operative assessments of inserted electrode length with curved MPR-techniques appear feasible.
    No preview · Conference Paper · Nov 2012
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    ABSTRACT: OBJECTIVE: To evaluate patient benefit and health-related quality of life after lid loading with platinum chains in adult patients with facial palsy. STUDY DESIGN: Retrospective data collection. SETTING: Germany's largest university clinic for otorhinolaryngology, head and neck surgery. SUBJECTS AND METHODS: Thirty-five patients received validated questionnaires determining the effects of the operation on the patients' health-related quality of life (Glasgow Benefit Inventory). Scores can range from -100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). Furthermore, satisfaction, complaints, and complications regarding the platinum chain implant were inquired. RESULTS: Twenty-two patients (63 %) returned a valid questionnaire. The mean follow-up time was 31.5 months. A complete coverage of the cornea was achieved in 95% of the patients after the first operation and in the remaining patients after a revision with implantation of a heavier weight. Complete symmetry to the nonaffected eye was perceived by 64%. Recurrent conjunctivitis was complained preoperatively by 18% and postoperatively only by a single patient. In 2 patients, a mild pseudoptosis was found postoperatively, and a single patient complained about blurred vision. The median total Glasgow Benefit Inventory score was 27.8 (p < 0.001). The health-related quality of life was raised in 91% of the patients; 87% were fully satisfied with the functional result, and 91% with the aesthetical result. 100% would again decide in favor of platinum chain lid loading. CONCLUSION: Platinum chain lid loading in facial palsy patients can significantly increase patients' health-related quality of life and leads to a high rate of patient satisfaction.
    No preview · Article · Oct 2012 · Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
  • Dr. T. Braun · B. Leisering · E. Krause · K. Schorn · J.M. Hempel
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    ABSTRACT: Hintergrund Für die Begutachtung bei Schwerhörigkeit werden zur Ermittlung der Sprachverständlichkeit Zahlen- und Einsilbertest des Freiburger Sprachtests empfohlen. In der ehemaligen DDR war zusätzlich der sog. Sauer-Test, ein beidohriger Zahlentest (BZT) bei 70 dB Störgeräusch, Standard und floss in die Ermittlung des Körperschadens mit ein. In der heutigen Begutachtungspraxis fehlt eine solche Messung im Störgeräusch. In der vorliegenden Studie wurde untersucht, ob und inwieweit sich der Grad der Schädigungsfolgen (GdS) unter Einbeziehung des BZT ändert. Material und Methoden Bei 78 schwerhörigen Patienten (66 Hochton- und 12 pankochleäre Schwerhörigkeiten) und 22 normalhörenden Kontrollpersonen erfolgten Hörschwellenmessung, Sprachaudiometrie (Freiburger Sprachtest), Freifeldmessung mit und ohne Störgeräusch sowie BZT. Dann wurde der Hörverlust seitengetrennt jeweils mit und ohne Berücksichtigung des BZT errechnet und die jeweiligen GdS-Werte festgestellt. Ergebnisse Patienten mit Hochton- bzw. mit pankochleärer Schwerhörigkeit hatten unter Berücksichtigung des BZT einen tendenziell (etwa 2% bzw. 5%) höheren GdS verglichen mit dem gängigen Verfahren ohne Störgeräusch. Jedoch lag weder im Mann-Whitney-U-Test noch in der Bland-Altman-Analyse ein statistisch signifikanter Unterschied der beiden Methoden zur GdS-Berechnung vor. Fazit Die routinehafte Anwendung des BZT zur Begutachtung kann nicht empfohlen werden, da keine wesentliche Änderung des GdS zu erwarten ist. Dies betrifft besonders die Hochtonschwerhörigkeiten. Bei pankochleären Schwerhörigkeiten kann der BZT bei Vorliegen von Kommunikationsstörungen im Störgeräusch berücksichtigt werden, zumindest bis modernere Sprachtests im Störgeräusch in die Begutachtung integriert sind.
    No preview · Article · Oct 2012 · HNO
  • Dr. T. Braun · M. Wimmer · J. M. Hempel
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    ABSTRACT: Hintergrund Der Hörverlust für Zahlen wird zur Berechnung des prozentualen Hörverlusts aus dem Sprachaudiogramm und zur gutachterlichen Plausibilitätsprüfung verwendet. Gängige Praxis ist es, den Hörverlust für Zahlen aus dem Sprachaudiogramm graphisch abzulesen. Ziel dieser Arbeit war es, den Hörverlust für Zahlen mittels mathematischer Formeln exakt aus den gemessenen Verständlichkeitswerten zu berechnen. Methoden Mittels analytischer Methoden wurden auf Basis der Normkurve nach DIN 45626-1 zwei einfache Formeln zur Berechnung des Hörverlusts für Zahlen erarbeitet. Ergebnisse Der Hörverlust für Zahlen a1 berechnet sich bei Vorliegen zweier Messwerte als a1= p 1 +(50–v 1 ) (p 2 –p 1 )/(v 2 –v 1 )–18,4 oder bei Verwendung nur eines Messwerts als a1=p 1 –0,13 v 1 –11,9, wobei v i die Zahlenverständlichkeit (in Prozent) beim Pegel p i (in dB) der i-ten Messung darstellt. Die Zahlenverständlichkeit aller eingesetzten Wertepaare muss hierbei zwischen 30% und 70% liegen, da nur in diesem Bereich die Normkurve nach DIN 45626-1 als linear angenommen werden darf. Der errechnete Wert für den Hörverlust für Zahlen wird anschließend wie auch bei der graphischen Bestimmung üblich mathematisch auf 5 dB gerundet. Schlussfolgerung Mithilfe der vorgestellten Formeln kann der Hörverlust für Zahlen insbesondere bei gutachterlichen Fragestellungen aus den Messwerten des Freiburger Zahlentests exakt berechnet werden, falls die konventionelle graphische Bestimmung dieser Größe nicht eindeutig erscheint.
    No preview · Article · Sep 2012 · HNO
  • T Braun · M Wimmer · J M Hempel
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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.
    No preview · Article · Sep 2012 · HNO
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    ABSTRACT: To obtain clinical and audiometric findings in traumatic tympanic membrane perforations from a typical patient collective in a Western industrial nation because the appropriate data have an important relevance in medicolegal questions. Retrospective data collection. Germany's largest university clinic for otorhinolaryngology, head and neck surgery. From the medical records of 198 patients with traumatic tympanic membrane perforations, the following data were collected: demographic data, date and mechanism of the trauma, otoscopic findings and collateral injuries, kind of therapy and its results, pure tone audiometry, and statement of tinnitus or vertigo in the course. Most patients were young (mean age, 29.2 yr) and male (62%). Men and women are equally represented in perforations resulting from a physical blow to the ear (44.7% vs 46.7%); a collision was more often the cause in men (23.6% vs 14.7%), whereas an accidental perforation by insertion of a cotton bud was approximately 2 times more common on women (13.8% vs 25.3%). The left ear was more often affected than the right ear (58.5% vs 41.5%). Collateral damage was found in only 1% of the cases. In blows, collisions, barotraumas, and the insertion of sharp objects, the inferior parts of the tympanic membrane were most often affected; the most severe (subtotal) perforations were caused by explosions, weld beads, and insertion of cotton buds. For therapy, myringoplasty had an overall success rate of 88.9%; splinting with silicon foils, 51.6%; and "no therapy," 53.3%. Bone conduction thresholds for the affected ear were higher in low, middle, and high frequencies compared with the contralateral ear by trend, but a statistical difference was only found in the high frequencies. In follow-up examinations, the hearing thresholds in the high frequencies were no longer significantly different. A "c dip" or "fis dip" was found in 18.0% and 9.2%. Tinnitus and vertigo were reported in 30.8 and 8.1%, respectively, but only in 2.0% and 0% during follow-up. High-frequency hearing loss, tinnitus, and vertigo in traumatic tympanic membrane perforations have a good prognosis.
    No preview · Article · Aug 2012 · Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
  • T Braun · B Leisering · E Krause · K Schorn · J M Hempel
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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.
    No preview · Article · Jul 2012 · HNO
  • Alexander Berghaus · Thomas Braun · John Martin Hempel
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    ABSTRACT: To describe how severe ear deformities after otoplasty can be corrected. The correction of creases is possible through readaptation of the cartilage edges followed by revision otoplasty using suture techniques in the reconstructed cartilage. In the case of defect formation or extreme thinning of the cartilage, an appealing auricular shape is achieved by the use of porous polyethylene implants. We have treated 12 severe ear deformities in the past 2 years with the procedures described herein. In 11 cases, there were no complications, nor was it necessary to make further corrections for cosmetic reasons. Reconstructing the cartilaginous skeleton and redoing otoplasty is a recommendable procedure with a longer lasting effect than just covering creases with fascia or preserved materials. In the case of a missing ear cartilage skeleton, the use of porous polyethylene implants instead of autogenous cartilage should be considered for reconstruction.
    No preview · Article · May 2012 · Archives of facial plastic surgery: official publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies
  • John Martin Hempel · Sonja Gratza · Alexander Berghaus · Thomas Braun
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    ABSTRACT: Background Ear reconstructions in patients with severe hemifacial microsomia belong to the most challenging cases. When deciding about the best position for the reconstructed ear, the surgeon has to make a compromise out of different given factors, it being impossible to achieve symmetry to the contralateral side. The present study was initiated to analyze if this difficult patient collective with naturally imperfect esthetical results benefits from the operation by an increase in health-related quality of life. Methods For ear reconstruction, the authors used frameworks of porous polyethylene (PPE) covered by a temporoparietal fascia flap. Six patients with microtia and hemifacial microsomia type 3 (three adults and three children) received validated questionnaires determining the effects of the ear reconstruction on the patients’ health-related quality of life (Glasgow Benefit Inventory, GBI, or Glasgow Children’s Benefit Inventory, GCBI, respectively). Scores can range from −100 (maximal negative effect of the intervention) through 0 (no effect) to +100 (maximal positive effect). Results All patients achieved positive GBI or GCBI scores suggesting a benefit from the ear reconstruction. For the adults, the mean GBI total score was 27.8. For the children, the mean GCBI total score was 40.3. Scores were higher compared to a control group of microtia patients without additional facial asymmetries. Conclusions In severe cases of hemifacial microsomia, ear reconstruction with PPE can significantly increase patients’ health-related quality of life. Furthermore, PPE frameworks offer different surgical advantages compared to autologous cartilage especially in severe hemifacial microsomia. Level of Evidence: Level III, therapeutic study.
    No preview · Article · Apr 2012 · European Journal of Plastic Surgery
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    ABSTRACT: For successful cochlear implantation in difficult ears, image guided navigation systems can help identify surgical landmarks or confirm the surgeon's anatomical knowledge. In this pilot case study, exact navigation based on intraoperative CT scanning was investigated and helped confirm important and necessary landmarks, such as the facial nerve, cochlea and intracochlear structures, and at least adequate placement of a straight electrode array. Intraoperative imaging was performed on a 40-slice sliding-gantry CT scanner (Siemens SOMATOM Sensation 40 Open) with an expanded gantry bore (82 cm). Raw image data were reconstructed with a slice thickness and increment of 0.6 mm and were imported to a frameless infrared-based navigation station (BrainLAB VectorVision Sky). In a preoperative accuracy and feasibility study, a phantom skull was scanned and registered five times by the navigation system. Based on the encouraging results, the system was then applied to a male patient with post-traumatic sensorineural hearing loss. The intraoperative target positioning error was measured by a "blinded" colleague who defined the distance of the pointer from different sections of the facial nerve without seeing the intraoperative field. The average deviation in the phantom skull was 0.91 mm (SD 0.27 mm) on the mastoid, 1.01 mm (SD 0.21 mm) on the round window, and 0.9 mm (SD 0.18 mm) on the inner ear canal. Surgery could be performed without major complications. The distance of the pointer from the facial nerve could be defined exactly using navigation in ten measurements. The cochleostomy and electrode insertion were performed with the aid of navigation. After insertion, direct intraoperative control of the electrode position was achieved by means of a low-dose CT scan. Two months postoperatively, the patient had a satisfactory open-set speech understanding of 85%. With the use of intraoperative acquisition of CT images (or digital volume tomography devices) and automatic volumetric registration for navigation, surgical precision can be improved, thereby allowing successful cochlear implant surgery in patients with complex malformations or who have undergone multiple previous ear surgeries and consequently lack anatomical landmarks. Our study clearly shows that this high-technology combination is superior to other registration methods in terms of accuracy and precision. Further investigations should aim at developing automatic segmentation and applications for minimally invasive surgery of the lateral skull base.
    No preview · Article · Mar 2012 · Computer Aided Surgery
  • John Martin Hempel · Sabine Forell · Eike Krause · Joachim Müller · Thomas Braun
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    ABSTRACT: To analyze the impact of surgery for ear canal exostoses and osteomata on patients' health-related quality of life because the literature suggests that surgery cannot achieve excellent symptom control in all cases and has a considerable complication rate. Retrospective data collection. Germany's largest university clinic for otorhinolaryngology and head and neck surgery. Thirty-nine patients having received surgery for ear canal exostoses and osteomata. Glasgow Benefit Inventory (GBI), a retrospective questionnaire well validated for measuring the effect of otorhinolaryngologic interventions on the health-related quality of life. None. GBI total scores and subscores. Thirty of the 39 patients returned a valid questionnaire (return rate, 76.9%). The mean total GBI score was 14.6 (p < 0.001), suggesting a benefit from the operation. In contrast to the general subscale score (mean, 21.0; p < 0.001), the mean physical health score and the mean social support score were not significantly increased. Of all patients, 83.3% had a total GBI score higher than 0, indicating a benefit from the operation. In 90% of the cases, patients were satisfied with the result of the operation, and 86.7% would again decide in favor of the operation. Most patients preoperatively experienced hearing loss, wax retention and recurrent otitis externa. Postoperatively, 70% of the patients were free of any complaints. The patients not satisfied were the only patients with negative GBI scores in the whole patient collective, and all had had complications from surgery. Surgery for ear canal exostoses and osteomata can significantly improve patients' health-related quality of life and leads to a high rate of patient satisfaction. Postoperative complications are the most important factor for a negative impact on the patient's health-related quality of life. Therefore, in the authors' opinion, only patients with symptoms should have surgery.
    No preview · Article · Jan 2012 · Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

Publication Stats

195 Citations
39.25 Total Impact Points


  • 2010-2014
    • Technische Universität München
      München, Bavaria, Germany
  • 2005-2014
    • Ludwig-Maximilians-University of Munich
      • Department of Ear, Nose and Throat Medicine
      München, Bavaria, Germany