H?rverlustbestimmung und MdE-Absch?tzung unter Einbezug von Sprachverst?ndlichkeitsmessungen im St?rger?usch

BACKGROUND: In Germany the guideline for the hearing loss quantification and the resulting assessment of the reduction in earning capacity is the K?nigsteiner Merkblatt (KM). The quantification depends on the results of the tone and speech audiogram in silence. However, speech discrimination tests in noise may provide additional information about the impairment of the ENT patients. Especially, the impairment of persons with a slight hearing loss, characterized by high-frequency hearing loss, in noisy environment can not be indicated by the measurement in silence, which is proposed in the KM. METHODS UND PATIENTS: The G?ttingen sentence test in noise was applied as a supplement to the routine ENT procedures of the medical estimate in 135 test persons. Based on these measurement results a table for the percentage hearing loss in noise is defined. Furthermore, an integration of the hearing loss in noise in the assessment of the reduction in earning capacity is proposed in addition to the hearing loss in silence. RESULTS: Using the newly introduced hearing loss for speech in noise, a suitable assessment for persons with a slight hearing loss is achieved. By integrating it into the assessment procedure additionally to the hearing loss in silence, the hearing impairment of all patients can be rated depending on their speech test results in silence and in noise. In comparison to the results obtained by the KM, the new procedure does not lead to higher values for the proposed reduction in earning capacity in general, but instead seems to be equally suitable for all groups of patients.     

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Interdisziplin?re Sch?delbasischirurgie

Total endoscopic or endoscopy-assisted surgical procedures are becoming more and more important for skull base surgery. In particular at the frontal skull base endoscopic procedures with planned opening of the subarachnoidal space have mostly replaced the microscope because of the good experiences in functional endoscopic sinus surgery (FESS). The advantages for the patients of endoscopic procedures with planned opening of the subarachnoidal space measured by criteria, such as mortality, morbidity or recurrence rate are unclear due to a lack of valid study data according to the criteria of evidence-based medicine.     

Implantierbare H?rger?te

Strictly speaking, implantable hearing aids are technical systems that process audiological signals and convey these by direct mechanical stimulation of the ossicular chain or cochlea. They have certain benefits over conventional hearing aids in terms of wearing comfort and general acceptance. As current studies lack convincing audiological results, the indications for implantable hearing aids are primarily of medical or cosmetic nature. To date, three systems are available in Germany: Vibrant Soundbridge?, Carina?, and Esteem?. Because the performance of the different implantable and nonimplantable hearing systems together with various surgical procedures are currently undergoing major changes, audiological indications may also develop in the future.     

Ultra-Hochaufl?sungsmanometrie des oberen ?sophagussphinkters

Background

High-resolution manometry (HRM) represents a valuable tool for the evaluation of peristalsis in the oesophagus. Due to the wide spacing of the pressure transducers, however, examination of the upper oesophageal sphincter’s relaxation period has not proved satisfactory as yet.

Design

A feasibility study was carried out to clarify whether evaluation of the upper oesophageal sphincter’s behaviour during swallows is possible using a catheter with very closely spaced pressure transducers. Setting: University hospital. Procedure: Healthy subjects were analysed using a specially developed catheter as well as a modified software to evaluate whether swallow-associated behaviour could be verified.

Results

Interpreting pressure profiles in terms of resting pressure, residual pressure, relaxation time and maximum peristaltic pressure proved to be feasible. The present analysis supports the existence of distinct dynamic swallow-associated phases, which conform to the phases that had previously been postulated. An additional initial phase, however, should be added.

Conclusion

This newly created catheter design in combination with the modified software enable a very detailed evaluation of the sphincter’s swallow-associated behaviour and represent a valuable, minimally invasive tool with no exposure to radiation for dysphagia diagnosis as well as treatment planning.     

H?rtraining, H?rtherapie und nichtapparative H?rrehabilitation bei Schwerh?rigen im Wandel der Zeiten

Background

The remarkable quality of modern hearing aids enables most hearing impaired individuals to take part in verbal communication without great effort. As a result, auditory training seems to have fallen into oblivion, even though its use is certainly still justified today. This article aims to review the development of these diverse therapy methods.

Methods

For this systematic review, a selective literature research in PubMed using the keywords “auditory training” = 211 hits and “auditory rehabilitation” = 166 hits has been carried out. In addition, handbooks and monographs were taken into consideration.

Results

For around 2,000 years, people have tried to restore hearing by acoustic stimulation. Initially it was believed that hearing could be “woken up” by means of acoustic stimulation. From the 19th?Century onwards, auditory training was meant to support residual hearing and help understanding in verbal communication. Towards the end of the 20th?Century, systematic approaches that were intended to enhance cognitive skills, such as concentration and attentiveness by acoustic stimulation, were developed.

Discussion

The wish to integrate deaf individuals into the auditory verbal oriented society, the tremendous number of soldiers suffering from noise-induced hearing loss after World War?II, modern hearing aids and cochlear implants, and finally availability of personal computers has fostered the development of auditory training methods. Further research has to investigate whether auditory training combined with drug therapy or other stimulation methods are beneficial.     

Defizite der ?rztlichen Beratung bei Riechst?rungen

Olfactory dysfunctions are common with a prevalence of up to 20% in the population. An impaired sense of smell can lead to specific dangers, therefore, counseling and warning of hazardous situations to raise patient awareness is an important medical function. In this study 105 patients presenting to the University of Mainz Medical Centre with dysosmia were evaluated using a questionnaire. For quantification of the olfactory dysfunction a standardized olfactory test (Sniffin' Sticks) was used. Of the patients 46% were hyposmic and 40% were functionally anosmic. The median duration of the olfactory impairment was 10 months and the main causes of dysosmia were upper respiratory tract infections and idiopathic disorders. More than 90% of the patients consulted an otorhinolaryngologist and 60% a general practitioner before presenting to the University of Mainz Medical Center. More than two thirds of the patients conducted a professional activity, 95% of patients reported that they had not received any medical counseling and 6% of the subjects were forced to discontinue their profession because of olfactory dysfunction. In patients with olfactory dysfunctions appropriate diagnostics, including olfactometry should be performed. Furthermore, correct medical counseling concerning necessary additional arrangements (e.g. installation of smoke or gas detectors, precautions while cooking or for hygiene) has to be performed. For patients in a profession an analysis of the hazards at work is crucial.     

Wenn Kinder v?llig unverst?ndlich sprechen

Background

Some children referred to ENT physicians suffer from severe and seemingly therapy-resistant impairment of the articulation of speech. Apart from classical symptoms of specific language impairment (SLI), such as a delay in the acquisition of syntax or poor lexical competence, these children’s speech is sometimes practically incomprehensible. Describing the disorder as SLI although not correct would nevertheless be inappropriate. The term childhood apraxia of speech (CAS) has been coined for such impairment. In this article the background, symptoms, diagnostics and therapy of CAS are reviewed.

Method

For this systematic review a selective literature search in PubMed was conducted.

Results

The etiology of CAS is not well known and genetic factors, neurological diseases and metabolic imbalances are assumed. Symptoms differ significantly among individuals as well as intraindividually. CAS is defined as impairment in planning and controlling articulatory movements, which has a severe impact on the sound production.

Discussion

For ENT specialists it is important to be aware that CAS symptoms may lead to a severe impediment of verbal communication and subsequently also interfere with the normal socio-emotional development of an affected child. Thus, an intensive therapy regimen is mandatory. Studies with a high level of evidence concerning the sensitivity and specificity of diagnostic tools, as well as studies regarding the effectiveness and efficiency of therapeutic approaches are needed.     

Werden mit dem SETK?3–5 klinisch diagnostizierte Sprachentwicklungsst?rungen erfasst?

Background

The German language development test for 3- to 5-year-olds (SETK?3?C5) as well as its short form, the language screening for pre-school children (SSV), are widely used tests for language impairment in German mother-tongue children. However, data published on validation are sparse. We investigated to what extent those children who demonstrated language impairment in clinical assessment were also detected by the SETK?3?C5 and SSV tests.

Material and Methods

A group of 201?children aged 4?C5?years was tested using the SETK?3?C5, in addition to which assessments in phonology, active vocabulary, grammar, receptive language abilities, and the recall of nonsense syllables and sentences were conducted. Correlation analyses were performed and the clinical assessment based on the aforementioned tests was compared to the results of the SETK?3?C5 and the SSV.

Results

Raw values of the test results were significantly correlated on different levels of correlation. Those of comparable subtests were high. The SETK?3?C5 had good specificity but sensitivity of only 71.9%.

Conclusion

Children with language impairment are not always detected using the SETK?3?C5 test. Standardization with a sufficient number of children should be carried out.     

Welche phonologische Arbeitsged?chtnisleistung trennt Kinder mit AVWS von unauff?lligen Kindern?

Aim

The aim of this study was to compare performance in phonological working memory across children with auditory processing disorders (APD), partly associated with different developmental disorders, and to examine which memory measure distinguishes children with from children without APD.

Method

Data from a health care research database were retrospectively analyzed. All children completed three measures of phonological serial recall: one-syllable digits, one-syllable words, and multi-syllabic nonwords of increasing length (2?C6 syllables).

Participants

The study included 48 subjects with APD only (mean age: 87.9 months; SD 12.9 months); 35 with co-occurring APD and developmental language disorder (DLD) (mean age: 82.2; SD 13.4); 16 with co-occurring APD and dyslexia (mean age: 109.2; 18.7); 10 with co-occurring slight intelligence reduction and APD (mean age: 102.4; SD 12.5), while 13 were non-affected, typically forming controls (non-APD; mean age: 86.0; SD 16.1). The mean intelligence (T-score) of the first three mentioned APD groups and the controls were significantly different (p<0.0001) from the children with lowered intelligence and APD (35.4; SD 3.1).

Results

Mean performance in all three verbal memory measures was significantly different from the controls in children with DLD+APD (digit span: p=0.0009; word span: p=0.0012; nonwords: p=0.05) and children with APD only (digit span: p=0.0037; word span: p=0.0006; non words: p=0.05). The set of memory measures (excluding the small and older group with lowered intelligence) went into a stepwise discriminate analysis. A significant group separation APD vs. non-APD was made by the subvocal rehearsal component of the phonological loop, as indicated by word span (F=14.40; p=0.0002) and digit span (F=2.87; p=0.0932). The rate of misclassification was 23%.

Conclusion

The present results raise the question of the validity of APD diagnostics which includes the phonological working memory on principle. It remains controversial whether the assessment of the cognitive function ??phonological memory?? should remain part of (C)APD diagnosis. Further research should aim to replicate the study with subjects of the same age and supplementary studies of the ??central executive?? and processing precision of the phonological store.     

H?chstaufl?sende optische Mikroskopie am Corti-Organ

Background

Inner hair cells encode sound into action potentials in the auditory nerve. Spiral ganglion neurons form the afferent innervation of inner hair cells via the hair cell synapse. The structure and function of this ribbon-type synapse is considered to have a major impact on the sound encoding process itself. In this study we have used conventional confocal microscopy as well as super-resolution techniques to investigate the synaptic organization in the inner hair cells of mice.

Material and methods

Functionally relevant proteins of the afferent inner hair cell synapse were selectively marked using immunohistochemical methods and investigated with conventional confocal and super-resolution 4Pi- and stimulated emission depletion (STED) techniques.

Results

Synapse and innervation density was mapped over the entire tonotopic axis. We found inner hair cells in the region of best hearing to have about twice the number of afferent fibres compared to the apex or base of the cochlea. For the first time 4Pi and STED microscopic techniques were employed to resolve the fine structure of these synapses beyond the resolution of conventional light microscopy. With 4Pi a resolution of approximately 100?nm in the z-axis direction is feasible. In practice STED delivers an effective resolution between 150 and 30?nm, depending on the power of the lasers employed. Synapses at different tonotopic positions of the cochlea exhibit no relevant structural differences at this level of resolution.

Summary

The 4Pi and STED microscopic techniques are capable of showing the structure of afferent synapses in the organ of Corti with unsurpassed resolution. These images contribute to our understanding of sound-encoding mechanisms in the inner ear.     

Insertionsergebnisse von Contour?- und Contour-Advance?-Elektroden

The aim of our study was to evaluate results of insertion following cochlear implantation with Contour? and Contour Advance? electrode arrays in adult patients and to analyze individual insertion results for three experienced surgeons. We performed a retrospective analysis of postoperative 3D volume tomography results in 223 adult patients. The intracochlear electrode position was evaluated to be in scala tympani, scala vestibuli or with a dislocation from one scala to the other. Surgical methods were analyzed and assigned to the different surgeons. We observed a significant increase for scala tympani insertions from initially 33% to 84% and a reduction in dislocations from scala tympani to scala vestibuli from 71% with the Contour? electrode to 22% with the Contour Advance? electrode. Results for the different surgeons varied individually with regard to scala tympani insertion rates and dislocation rates over time. 3D Volume tomography offers an important method for postoperative quality control following cochlear implant surgery. The intracochlear electrode position could be determined in all cases. We were able to identify individual learning curves for insertion results. Controlling the insertion quality serves as a feedback of surgical results and may be helpful for improving surgical quality and thus rehabilitation results.     

Computergraphische Simulationsm?glichkeiten in der orthop?dischen Chirurgie

BACKGROUND: In addition to standard X-rays, photographic documentation, cephalometric and model analysis, a computer-aided, three-dimensional (3D) simulation system has been developed in close cooperation with the Institute of Communications of the Friedrich-Alexander-Universit?t Erlangen-Nürnberg. With this simulation system a photorealistic prediction of the expected soft tissue changes can be made. Prerequisites are a 3D reconstruction of the facial skeleton and a 3D laser scan of the face. After data reduction, the two data sets can be matched. Cutting planes enable the transposition of bony segments. The laser scan of the facial surface is combined with the underlying bone via a five-layered soft tissue model to convert bone movements on the soft tissue cover realistically. CONCLUSION: Further research is necessary to replace the virtual subcutaneous soft tissue model by correct, topographic tissue anatomy.     

Stimm?rztliche Betreuung und Behandlung von S?ngern

ENT/phoniatrics specialists are frequently the primary reference persons for patients who have problems with the professional use of their voice. Singers show the highest risk factors for voice disorders among all professional voice users. The treatment and care of singers requires specific knowledge and competence of the physician, as well as a treatment setting adapted to the needs of this special group of patients, whose existence depends on the use of their voice. To some extent, evidence based concepts can be taken into account when treating professional singers. In cases for which no concepts have yet been developed and evaluated, recourse to clinical experience is necessary. In the present paper, current concepts for the treatment of singers are discussed on the basis of scientific publications and on long-standing experience of consultations in musician's medicine and ENT, under the aspects of diagnosis, therapy as well as prevention, taking into account the most frequent voice problems in professional singers.