Neues aus der Hörforschung

In the clinical setting, a patient’s hearing level is usually quantified by determining the hearing threshold in pure tone and speech audiometry. The measurement and analysis of auditory brainstem responses (ABRs) for quantification of hearing impairment go beyond the scope of routine ENT diagnostic practice. In basic scientific studies, ABRs are commonly used to determine hearing thresholds in animal models. In the last few years, analysis of suprathreshold ABRs, particularly ABR wave I suprathreshold amplitudes, have led to the discovery and understanding of previously undetected hearing impairments in noise-induced and age-related hearing loss models. Deafferentation of inner hair cells and auditory nerve fiber degeneration were identified as pathophysiological correlates to the observed reduction in ABR wave I amplitudes. Such reductions in ABR wave 1 amplitudes could also be identified in chronic tinnitus patients with apparently normal hearing. Recent functional magnetic resonance tomography studies in humans have shown that the limbic system can influence the perception of tinnitus by interacting with an endogenous noise-cancelling system. This highlights the importance of psychotherapeutic treatment approaches for chronic tinnitus.     

Kritisches und Neues über Stimmgabeluntersuchungen

Ohne ZusammenfassungIch bringe hier in etwas erweiterter Form den im Tageblatt der Naturforscherversammlung erschienenen Auszug, der vielfache Unrichtigkeiten enthält, da die Correctur nicht von mir selbst besorgt werden konnte.     

Kritisches und Neues zur Vibrationsmassage des Gehörorgans

Ohne Zusammenfassung     

The Vibrant Soundbridge® middle ear implant: A historical overview

Objective: To present a historical overview of the Vibrant Soundbridge^® (VSB) middle ear implant (MEI), since its beginning in the 1990s to date and to describe its course and contemplate what it might become in the future.

History: MEIs started to take form in researchers’ mind in the 1930s with the first experiment of Wilska. In the 1970s, several devices, such as the Goode and Perkins’, the Maniglia’s, or the Hough and Dormer’s were created but remained prototypes. It is only in the 1990s the devices that emerged remained on the market. In 1994, Symphonix, Inc. was created and aimed to manufacture and commercialize its semi-implantable MEI, the VSB. The principle of the VSB lies on a direct drive of the sound to a vibratory structure of the middle ear through an electromagnetic transducer, the floating mass transducer (FMT). The particularity of the system VSB is the simplicity of the transducer which is made of both the magnet and the coil; thus, the FMT, fixed on a vibrating middle ear structure, mimics the natural movement of the ossicular chain by moving in the same direction. The goal of the VSB was to give an alternative to patients with mild-to-severe sensorineural hearing loss who could not wear hearing aids (HAs) or who were unsatisfied conventional HA users. Subsequent to Tjellström’s experiment in 1997, implantations started to include etiologies such as otosclerosis, radical mastoidectomy, failed ossiculoplasty/tympanoplasty, and atresia.

Nowadays, the VSB, with more than 20 years of experience, is the oldest and most used middle ear implant worldwide. It is well acknowledged that the straightforward design and reliability of the transducer have certainly contributed to the success of the device.     

Result on speech perception after conversion from Spectra® to Freedom®

New technology in the Freedom® speech processor for cochlear implants was developed to improve how incoming acoustic sound is processed; this applies not only for new users, but also for previous generations of cochlear implants.AimTo identify the contribution of this technology – the Nucleus 22® – on speech perception tests in silence and in noise, and on audiometric thresholds.MethodsA cross-sectional cohort study was undertaken. Seventeen patients were selected. The last map based on the Spectra® was revised and optimized before starting the tests. Troubleshooting was used to identify malfunction. To identify the contribution of the Freedom® technology for the Nucleus22®, auditory thresholds and speech perception tests were performed in free field in soundproof booths. Recorded monosyllables and sentences in silence and in noise (SNR = 0dB) were presented at 60 dBSPL. The nonparametric Wilcoxon test for paired data was used to compare groups.ResultsFreedom® applied for the Nucleus22® showed a statistically significant difference in all speech perception tests and audiometric thresholds.ConclusionThe reedom® technology improved the performance of speech perception and audiometric thresholds of patients with Nucleus 22®.     

The Gelfoam® plug: an alternative treatment for small eardrum perforations

Aim:

To examine if a Gelfoam® plug in combination with surgical removal of the perforation edges could be an alternative to the widely accepted fat plug treatment for smaller ear drum perforations.

Materials and Methods:

A prospective study of 17 consecutive patients with persistent small ear drum perforations considered for myringoplasty. The perforations were central perforations 2 to 4 mm in diameter. Patient ages ranged from 6 to 83 years, and the operation was performed under general anesthesia with mask ventilation in children and under topical local anesthesia in adults. A Gelfoam® plug was inserted into the perforation after surgical removal of the perforation edges. The follow‐up time was more than 3 months.

Results:

The closure rate of the ear drum was 83% (15/18). Pure tone average (PTA) was 19 dB preoperatively and 16 dB postoperatively.

Conclusions:

We show for the first time in humans that a Gelfoam® plug in combination with surgical removal of the perforation edges seems to result in about the same closure rate as the fat plug technique in persistent small ear drum perforations. Moreover, the method using Gelfoam® is simpler and faster than the fat plug technique. We suggest that randomized studies comparing the Gelfoam® plug technique with the fat plug technique should be performed. Laryngoscope, 2011     

Prolene®: a novel,cheap, and effective material in dacryocystorhinostomy

Conclusion. Prolene® is cheap, effective, and readily available in almost all operating theaters. It might be used successfully in endoscopic dacryocystorhinostomy and is promising as an alternative to silicone stent intubations, especially in settings with limited resources. Objective. To evaluate the clinical efficacy and results of stenting with polypropylene (Prolene®; Ethicon, Inc.) suture material instead of silicone tube in endoscopic dacryocystorhinostomy. Patients and methods. Forty-two endoscopic dacryocystorhinostomy operations were performed in 36 patients (11 men and 25 women; mean age 34.7±9.5 years, range 16–60 years) between 2007 and 2008. After creating an aperture in the medial wall of the lacrimal sac, 2/0 Prolene was inserted through the canaliculi into the sac. The Prolene was left in the lacrimal sac for 3 months. The patients were followed up for between 6 and 18 months (mean 8.1±3.6 months). The improvement in the complaint of epiphora was grouped as very good, good, or no change. Results. The improvement in 34 eyes (81%) was reported as very good, whereas improvement was noted as good in 5 eyes (11.9%), and there was no change in 3 eyes (7.1%). We observed granulation tissue formation around the Prolene in two patients.     

AMTAS®: Automated method for testing auditory sensitivity: III. Sensorineural hearing loss and air-bone gaps

Abstract

Objective: The objectives were to measure the occlusion effect produced by three earphones—circumaural, supra-aural, and insert—and to compare air- and bone-conduction thresholds obtained with manual and automated methods for subjects with sensorineural hearing loss. Design: Acoustic and psychoacoustic occlusion effects were measured with each earphone. Manual and automated, air- and bone-conduction thresholds were compared. Study sample: Occlusion effects were measured for six adult subjects with normal external and middle ears. Pure-tone thresholds were measured for nineteen ears of thirteen subjects with sensorineural hearing loss. Results: The supra-aural earphone produced the largest occlusion effects, followed by the insert and circumaural earphones. Some systematic differences in air-conduction thresholds were found for the two procedures that may be attributable to earphone differences. A large air-bone gap at 4 kHz, reported in a previous study, was replicated. Conclusions: From 0.5 to 8.0 kHz, occlusion effects produced by the circumaural earphone are sufficiently small that covering the ear does not appreciably alter bone-conduction thresholds. Air-conduction threshold differences warrant further study to determine if reference equivalent threshold sound pressure levels for the two earphones produce equivalent thresholds. The large air-bone gap at 4 kHz suggests the possibility of an incorrect reference equivalent threshold force level at that frequency.

Sumario

Objetivo: Los objetivos fueron medir el efecto de oclusión producido por tres auriculares – circumaural, supra-aural y de inserción – y comparar umbrales de conducción aérea y ósea obtenidos con métodos manuales y automatizados para sujetos con hipoacusia sensorineural. Diseño: Se midieron los efectos de oclusión acústicos y psicoacústicos con cada auricular. Se compararon los umbrales de conducción aérea y ósea manuales y automatizados. Muestra del Estudio: Se midieron los efectos de oclusión para seis sujetos adultos con oídos externos y medios normales. Resultados: Los auriculares supra-aurales produjeron los mayores efectos de oclusión, seguidos de los auriculares de inserción y los circumaurales. Se encontraron algunas diferencias sistemáticas en los umbrales de conducción aérea para los dos procedimientos que pueden atribuirse a las diferencias en los auriculares. Una gran brecha aéreo-ósea en 4 kHz que se reportó en un estudio previo, fue replicada. Conclusiones: De 0.5 a 8 kHz, los efectos de oclusión producidos por los auriculares circumaurales son lo suficientemente pequeños por lo que cubrir el cubrir el oído no altera apreciablemente los umbrales de conducción ósea. Las diferencias en los umbrales de conducción aérea exigen estudios adicionales para determinar si los niveles umbrales equivalentes de referencia de presión sonora para los dos auriculares producen umbrales equivalentes. La mayor brecha aéreo-ósea en 4 kHz sugiere la posibilidad de un nivel de referencia equivalente de fuerza umbral en esa frecuencia.     

AMTAS®: Automated method for testing auditory sensitivity: II. Air conduction audiograms in children and adults

Abstract

Objective: This study was designed to evaluate an automated pure-tone audiometric procedure (AMTAS^®) for 4–8 year-old children, and a quality assessment method (QUALIND^®) that predicts the accuracy of the test. Design: Children were tested with AMTAS and conventional manual air-conduction audiometry. A group of adults was tested for comparison. Study sample: Eighty-one 4–8 year-old children and 15 adults. Most had normal hearing. Results: For most subjects (93% of adults and 91% of children) differences between AMTAS and manual thresholds were similar to differences that occur when two experienced audiologists test the same subjects. QUALIND detected the inaccurate audiograms with a sensitivity of 71% and a specificity of 91%. When inaccurate audiograms identified by QUALIND are excluded, the accuracy of AMTAS is similar to the accuracy of manual audiometry. Conclusions: AMTAS produces accurate air-conduction audiograms in a high proportion of 4–8 year-old children and adults. QUALIND successfully identified most inaccurate AMTAS audiograms. The method can decrease the cost and increase efficiency and accessibility of hearing testing.

Sumario

Objetivo: Este estudio fue diseñado para evaluar un procedimiento automatizado de evaluación audiométrica de tonos puros (AMTAS^®) para niños de 4-8 años y un método de evaluación de calidad (QUALIND?) que predice la exactitud de la prueba. Diseño: Los niños fueron evaluados con el AMTAS y con audiometría convencional manual de conducción aérea. Un grupo de adultos fue evaluado como comparación. Muestra de estudio: Ochenta y un niños de 4–8 años de edad y 15 adultos. La mayoría tenían audición normal. (“la mayoría”: COMO PUEDEN DECIR ESTO, ASI, EN UN ESTUDIO CIENTÍFICO?) Resultados: En la mayoría de los sujetos (93% de los adultos y 91% de los niños) la diferencia entre el AMTAS y los umbrales manuales fue similar a las diferencias que ocurren cuando dos audiólogos de experiencia evalúan al mismo sujeto. QUALIND detectó los audiogramas inexactos con una sensibilidad del 71% y una especificidad del 91%. Cuando se excluyen los audiogramas inexactos identificados por QUALIND, la exactitud de AMTAS es similar a la exactitud de la audiometría manual. Conclusiones: AMTAS produce audiogramas de conducción aérea exactos en una alta proporción de niños de 4–8 años de edad y en adultos. QUALIND identifica con éxito las mayor parte de los audiogramas inexactos obtenidos por AMTAS. El método puede disminuir el costo y aumentar la eficiencia y la accesibilidad para pruebas auditivas.     

Sniffin’Sticks®: Ein neues Instrument zur Geruchsprüfung im klinischen Alltag

INTRODUCTION: The Sniffin'Sticks test battery consists of a short screening test and tests for odor detection thresholds (using n-butanol), odor discrimination and odor identification. We evaluated the usefulness of this new test in clinical practice and propose normative values. MATERIAL AND METHODS: In the present study 30 normosmic and 15 anosmic volunteers as well as 35 patients with various olfactory dysfunctions were examined. RESULTS: All four Sniffin'Sticks tests were able to separate normosmics and anosmics in a highly significant manner. Even a small decrease in olfactory performance was detectable in elderly patients. For practical purposes the sensitivity of the test for screening test was found to be too low. The good correlation between the individual Sniffin'Sticks tests and the correlation between the Sniffin'Sticks test battery and the "University of Pennsylvania Smell Identification Test" (UPSIT) test battery and the "University of Pennsylvania Smell Identification Test" (UPSIT) document the reliability of these tests. CONCLUSIONS: Our findings show that the Sniffin'Sticks are well suited to assess olfactory performance in clinical practice.     

Complications associated with Dermabond® during head and neck surgery: MAUDE and literature review

IntroductionDermabond® is a liquid surgical sealant containing 2-octyl-cyanoacrylate that has been widely used during head and neck surgeries. This study aims to provide a summary of adverse events related to Dermabond® in head and neck procedures as reported in the MAUDE database, and to report a complete overview of all documented adverse events related to Dermabond® use in current literature.MethodsThe US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports of adverse events related to Dermabond® use from January 1, 2010, to February 1, 2020. Data were extracted from reports pertaining to head and neck procedures. In addition, literature review was performed from January 1970 to January 2021. Various adverse events related to Dermabond® were included in the study.ResultsWe identified 32 adverse events, from which 29 (90.6%) were patient-related events and 3 (9.4%) were operator-related events. Of the patient-related events, contact dermatitis (CD) (20 [69.0%]) was the most common, followed by wound dehiscence (4 [13.8%]). All of the operator-related events were from inadvertent cut injury (3 [100%]). Following the literature review, adverse events of Dermabond® were categorized into CD, wound dehiscence, infection, and cut injury.ConclusionDermabond® demonstrated utility in various surgical procedures including head and neck surgeries but are associated with risks. This study identified adverse events associated with Dermabond®. Further studies are needed to establish the causation of contact dermatitis in certain populations.     

Fingerfreies Sprechen mit dem Provox-HME-Freehands®-Tracheostomaventil

Introduction

The use of voice prostheses allows excellent rehabilitation of laryngectomized patients but it is considered a disadvantage that the tracheostoma must be closed manually for speech production. This limits their ability to simultaneously communicate by gestures or to work with both hands. An automatic tracheostoma valve helps patients to overcome this problem.

Patients, material and methods

A total of 17 laryngectomized patients were asked to join a long-term study 18 months after having been fitted with a Provox FreeHands HME Automatic Tracheostoma Valve® system. The patients completed a questionnaire in order to assess satisfaction, voice quality, wearing comfort, fixation, potential problems and the effectiveness of the HME cassette.

Results

Of the 17 patients 4 discontinued the study due to problems of securing the valve to the skin (n=2) or fistula leakage (n=2). Of the remaining patients 7 wore the valve daily for an average of 6 h. Of the patients 76% considered it a great advantage to be able to speak without using their hands. With the Provox FreeHands HME Automatic Tracheostoma Valve® system, maximum phonation time was 8.5 s (±6.8) and the dynamic range was 21.7 decibels (±5.6).

Conclusion

The results show that the Provox FreeHands HME Automatic Tracheostoma Valve® system not only allows hands-free speech but is also associated with excellent long-term compliance and good voice rehabilitation.     

Screening of Olfactory function Using the Biolfa® Olfactory Test: Investigations in Patients with Dysosmia

Objective —To present a statistical evaluation of a new olfactory test, Biolfa^®.

Material and Methods —The olfactory test was carried out in individuals with normal olfactory function (n=67; 31 males; mean age 27.4 years) and in patients with mild, moderate or severe hyposmia (n=155; 61 males; mean age 54.6 years). The main diagnoses of the hyposmic patients were upper respiratory tract infection (32%), nasal polyposis (24%), head trauma (8%), idiopathic (8%), old age (5%) and chronic rhinitis (5%). In the first part of the test, olfactory thresholds were measured for three different substances (eugenol, aldehyde C14 and phenyl ethyl alcohol). The second part comprised an odor identification test for determining olfactory function for a large panel of common odors of Southern European countries.

Results —Mean olfactory thresholds were determined for subjects with normal olfaction and hyposmic patients; there was a statistically significant relationship between olfactory thresholds and degree of olfaction (mild to moderate hyposmia versus severe hyposmia). For the odor identification test, a global score was determined to allow the differentiation of normosmic subjects from patients with mild, moderate or severe hyposmia. The principles of decision theory (i.e. analysis of the receiver operating characteristic curve) were applied to the problem of evaluating the ability of Biolfa to distinguish subnormal subjects from hyposmic subjects.

Conclusion —This study provides a basis for the routine clinical use of Biolfa.     

Piezosurgery® for removal of symptomatic ear osteoma

Piezosurgery^® is an ultrasound instrument (24.7–29.5 kHz) that is able to cut the bone without necrosis and nonmineralized tissue damage. The aim of this work has been to determine the applicability and efficiency of the piezoelectric device in the excision of symptomatic ear osteomas. 10 patients affected by osteoma of the external auditory canal (EAC) (6 right, 4 left) were enrolled. Patients underwent excision of the EAC osteoma through a transcanal approach, with the piezoelectric device. Before and 6 months after surgery, all the patients underwent pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording. The piezoelectric device provided excellent control without side effects on the adjacent structures of the external, middle and inner ear. The piezoelectric device is a new bony scalpel using the microvibrations at ultrasonic frequency so that soft tissue (nerve, vessel, dura mater, skin, etc.) will not be damaged even on accidental contact with the cutting tip. A feature of the piezoelectric device is its good manageability, which makes it easy for a well-trained otologic surgeon to create a straight osteotomy line: this renders the piezoelectric device suitable for bone surgery and for removal osteomas of the EAC.