Stephan Wolpert’s research while affiliated with University of Tübingen and other places

Background Vestibular vertigo is one of the leading causes of disability. The clinical standard of care for vestibular vertigo includes physical activity producing central vestibular compensation (CVC). Home exercises are considered an integral part of physical therapy. However, a reliable solution is still needed to support the regular and correct execution of home exercises. For this purpose, VH-90-D DiGA was developed, which is a digital therapeutic (DTx) for multimodular in-home therapeutic training. Objective The purpose of this study is to assess the clinical efficacy and safety of a vestibular health app for patients with vestibular vertigo. Methods A randomized group-controlled single-blinded clinical trial (RCT) has been designed. Patients will be randomly assigned to one of two treatment groups and the endpoints examined in a pre-determined order. The experimental group receives the DTx (around 15 min/daily for 90 days), and the control receives physiotherapy according to the German statutory health care plan (usually 6 × 20 min of live physiotherapy). The primary outcome will be vertigo intensity measured using the German version of the validated Vertigo Symptom Scale-short form VSS-sf-VER (0–32 score points). Evaluation is performed after 2, 6, and 12 weeks. Primary outcomes are determined by measuring the group differences of the VSS-sf-score point changes from baseline to week twelve. Including dropouts, the sample size has been determined to be 2 × 100. Expected results It is expected that therapy with the DTx will be statistically superior to physiotherapy in terms of effect size. Discussion This trial protocol marks a confirmatory RCT (GEVE II) to investigate the efficacy and safety of a digital vertigo treatment. The planned RCT is based on a series of primary and secondary efficacy variables. Examination of the endpoints in a pre-determined order ensures the rigor of confirmatory statistics and addresses the challenge of multiplicity. This sequential testing continues until significance is achieved. However, if a specific variable fails to reach significance, subsequent variables will be explored solely on a descriptive basis. Trial registration German National Registry of Clinical Studies (DRKS00028026), a WHO ICRTP registry. Registered on December 12, 2023.

Phonation is important for our daily communication and requires the activation of internal and external laryngeal muscles, which can be recorded by electromyography (EMG) using surface or needle electrodes. Here we present a new noncontact method, laryngeal magnetomyography. As a proof-of-concept, we investigated the feasibility of differentiating various vocalization conditions using laryngeal MMG in two healthy subjects using optically pumped magnetometers (OPM). We recorded magnetic muscle activity of the larynx and neighboring cervical muscles using a 3 × 5 array of OPMs. Subjects vocalized an /a/ in three different conditions: loud high pitch, loud low pitch, and soft high pitch, in 90 s blocks. After removing cardiac artifacts, MMG signals were in the range of 1.5 pT with significant amplitude differences between conditions. In both subjects, Linear Discriminant Analysis (LDA) was able to significantly classify vocalization conditions based on the spatial pattern of MMG activities. In sum, we show that laryngeal MMG allows contactless differentiation of phonations based on myomagnetic signals. Our results set the stage for future studies to explore this method for clinical diagnostics and therapy. Functional, contactless muscle recordings during vocalization enable new applications for miniaturized quantum sensors, e.g. in linguistic studies and speech rehabilitation.

Zusammenfassung Die Durchführung der flexiblen Rhinolaryngoskopie ist eine häufig angewendete HNO-ärztliche Untersuchungsmethode. Sie erfolgt regelhaft mit wiederverwendbaren Endoskopiesystemen. Seit 2019 stehen alternativ flexible Einweg-Rhinolaryngoskope verschiedener Hersteller mit und ohne Arbeitskanal auf dem deutschen Markt zur Verfügung. In den letzten Jahren gelten deutlich gestiegene hygienische Anforderungen und Vorgaben für die Aufarbeitung wiederverwendbarer Endoskope. Diese Arbeit evaluiert anhand von Fragebögen die Benutzerzufriedenheit des Einweg-Endoskopiesystems mit Arbeitskanal der Firma Ambu innerhalb einer bizentrisch durchgeführten Beobachtungsstudie. Der Gesamteindruck des Endoskopie-Einwegsystems mit Arbeitskanal wurde in der Hälfte der Fälle mit „sehr gut“ bewertet. Bildqualität und Handhabung wurden vorwiegend mit „gut“ bis „sehr gut“ beurteilt. Die parallele Bedienung von Instrumenten durch den Arbeitskanal stellt eine Herausforderung dar. Einweg-Rhinolaryngoskopiesysteme bieten eine hervorragende Handhabung, Bildqualität und Anwenderzufriedenheit. Im Hinblick auf Kontaminationsrisiken und Komplikationsraten bieten sie eine hohe Sicherheit. Die Einhaltung aktueller Hygienerichtlinien kann zu steigenden Kosten in der Wiederaufbereitung von Endoskopie-Mehrwegsystemen führen und Einweg-Endoskope zukünftig attraktiver machen. In Kombination mit einem integrierten Arbeitskanal können Endoskopie-Einwegsysteme aus hygienischen Betrachtungen einen echten Mehrwert gegenüber den Mehrwegsystemen bieten.

Full-text on ScienceDirect until July 06, 2025: https://www.sciencedirect.com/science/article/pii/S0378595525001236?dgcid=author

Objective Measuring facial muscle activity is crucial in the diagnosis of facial palsy. This study investigated whether contactless Magnetomyography (MMG) using optically pumped magnetometers (OPM) is feasible for visualizing facial muscle activity. Methods An anatomically shaped mask featuring eleven OPM was arranged on one side of the face of five healthy subjects. MMG was recorded while they performed different facial expressions. The root mean square of each OPM signal was calculated for each expression and subject and allocated to the individual face. Moreover, the maximum average muscle activity and the signal-to-noise ratio (SNR) were determined. Results The subjects’ facial muscle activity could be measured individually per facial expression. Mean RMS was 0.6pT (SD 0.4pT), resulting in a mean SNR of 2.2 (SD 1.2). Conclusions Imaging facial activity via MMG using OPM is possible, although the sensor positioning (sensor geometry and distance to the muscle) is decisive. However, the signal amplitude of the facial muscles is low and the interindividual anatomical variability renders the measurement setup challenging. Significance As the imaging of facial MMG is feasible, this study paves the way for future studies using OPM for the diagnosis, monitoring, and rehabilitation of facial muscle and facial nerve disorders.

This study was designed to examine the changes in emergency room visits in otolaryngology, head and neck surgery, during the COVID-19 pandemic. The study included 11,277 patients who presented to a tertiary care hospital (ER) and an emergency practice (EP) during on-call hours in the first half of 2018, 2019, and 2020. The epidemiologic parameters, diagnoses, and level of urgency were recorded using a four-step scale. A comparison was made between the pre-pandemic years and 2020. The findings revealed a significant decrease in the frequency of ER visits in the second quarter of 2020 compared to 2019 (ER: 30.8%, EP: 37.8%), mainly due to the fact that there were significantly fewer patients, with low levels of urgency. Certain diagnoses, such as epistaxis (−3.0%) and globus sensation (−3.2%), were made at similar frequencies to 2019, while inflammatory diseases like skin infections (−51.2%), tonsillitis (−55.6%), sinusitis (−59%), and otitis media (−70.4%) showed a significant reduction. The study concludes that patients with a low triage level were less likely to visit the ER during the early stages of the pandemic, but some diagnoses were still observed at comparable rates. This suggests a disparity in perception between patients and ER staff regarding urgency. Many of the issues discussed were also emphasized in the 2024 proposal by the German Ministry of Health to reform emergency care in Germany.

Background: It is assumed that speech comprehension deficits in background noise are caused by age-related or acquired hearing loss. Methods: We examined young, middle-aged, and older individuals with and without hearing threshold loss using pure-tone (PT) audiometry, short-pulsed distortion-product otoacoustic emissions (pDPOAEs), auditory brainstem responses (ABRs), auditory steady-state responses (ASSRs), speech comprehension (OLSA), and syllable discrimination in quiet and noise. Results: A noticeable decline of hearing sensitivity in extended high-frequency regions and its influence on low-frequency-induced ABRs was striking. When testing for differences in OLSA thresholds normalized for PT thresholds (PTTs), marked differences in speech comprehension ability exist not only in noise, but also in quiet, and they exist throughout the whole age range investigated. Listeners with poor speech comprehension in quiet exhibited a relatively lower pDPOAE and, thus, cochlear amplifier performance independent of PTT, smaller and delayed ABRs, and lower performance in vowel-phoneme discrimination below phase-locking limits (/o/-/u/). When OLSA was tested in noise, listeners with poor speech comprehension independent of PTT had larger pDPOAEs and, thus, cochlear amplifier performance, larger ASSR amplitudes, and higher uncomfortable loudness levels, all linked with lower performance of vowel-phoneme discrimination above the phase-locking limit (/i/-/y/). Conslusions: This study indicates that listening in noise in humans has a sizable disadvantage in envelope coding when basilar-membrane compression is compromised. Clearly, and in contrast to previous assumptions, both good and poor speech comprehension can exist independently of differences in PTTs and age, a phenomenon that urgently requires improved techniques to diagnose sound processing at stimulus onset in the clinical routine.