Publications by authors named "Gerd Fabian Volk"

75 Publications

Continual rehabilitation motivation of patients with postparalytic facial nerve syndrome.

Eur Arch Otorhinolaryngol 2021 May 24. Epub 2021 May 24.

Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.

Purpose: To evaluate the continued rehabilitation motivation in patients with postparalytic facial synkinesis (PFS).

Methods: In this single-center cross-sectional survey, the multidimensional patient questionnaire for assessment of rehabilitation motivation (PAREMO-20) was used to assess the rehabilitation motivation. Associations Sunnybrook and Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, general quality of life (SF-36), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire (PHQ)-9, technology commitment and affinity, and interest in further therapy were analyzed.

Results: 69 adults with PFS (73% women; median age: 54 years) answered the survey. In comparison to prior treatment forms, there was a significant higher future interest in computer-based home facial training (p < 0.0001). For PAREMO Psychological burden subscore, SF36 Emotional role was the highest negative correlative factor (p < 0.0001). For PAREMO Physical burden subscore, SF-36 General health was the highest negative correlative factor (p = 0.018). Working (p = 0.033) and permanent relationship (p = 0.029) were the only independent factors correlated to PAREMO Social Support Subscore. Higher positive impacts of technology affinity was inversely correlated to PAREMO Knowledge subscore (p = 0.017). Lower SF-36 Role physical subscore p = 0.045) and a lower SF-36 General health (p = 0.013) were correlated to a higher PAREMO Skepticism subscore.

Conclusions: Patients with PFS seem to have a high facial motor and non-motor psychosocial impairment even after several facial therapies. Rehabilitation-related motivation increases with both, higher facial motor and non-motor dysfunction. Social and emotional dysfunction are drivers to be interested in innovative digital therapy forms.
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http://dx.doi.org/10.1007/s00405-021-06895-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141409PMC
May 2021

[Acute facial paresis as a possible complication of vaccination against SARS-CoV-2].

Laryngorhinootologie 2021 May 11. Epub 2021 May 11.

Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde und Fazialis-Nerv-Zentrum, Universitätsklinikum Jena.

Although acute facial nerve palsy (Bell's palsy) is explicitly mentioned in the information sheets for vaccines as a possible complication of vaccination against SARS-CoV-2, from our point of view the benefits of the vaccination clearly outweigh the possible risks. At most, if at all, a slightly increased risk can be derived from the previous case reports. In general, the risk of acute facial palsy is described in association with many vaccinations. The risk, if any, does not appear to be a specific risk of SARS-CoV-2 vaccines. On the other hand, cases of acute facial palsy as symptom of a COVID-19 disease have also been described, so that the theoretical question arises as to the extent to which the vaccination may prevent rather than promote the occurrence of facial palsy. Ultimately, if acted quickly, acute facial paralysis can be treated well and its severity and sequelae cannot be compared with the severity of a COVID-19 disease and its possible long-COVID sequelae.
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http://dx.doi.org/10.1055/a-1501-0470DOI Listing
May 2021

Jod-Stärke-Test nach Minor.

Laryngorhinootologie 2021 05 29;100(5):355-356. Epub 2021 Apr 29.

Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Deutschland.

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http://dx.doi.org/10.1055/a-1372-2845DOI Listing
May 2021

Role of Body Dysmorphic Disorder in Patients With Postparalytic Facial Synkinesis.

Laryngoscope 2021 Mar 17. Epub 2021 Mar 17.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.

Objectives/hypothesis: To evaluate the role of body dysmorphic disorder (BDD) in patients with postparalytic facial nerve syndrome with synkinesis (PFS).

Study Design: A single-center retrospective cohort study.

Methods: A total of 221 adults (74% women; median age: 44 years; median duration since onset of facial palsy: 1.6 years) were included. To diagnose BDD, the BDD Munich Module was used. Associations with House-Brackmann grading, Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, Facial Disability Index (FDI), general quality of life (SF-36), Beck Depression Inventory (BDI), and the Liebowitz Social Anxiety Scale (LSAS) was analyzed.

Results: A total of 59 patients (27%) were classified as patients with BDD. Significant associations were found between the diagnosis of BDD and female gender and lower FDI, FaCE, and SF-36 scores and higher BDI and LSAS scores. Multivariate analysis revealed BDI, FaCE total score, and FaCE social function subscore as independent factors associated with BDD.

Conclusion: BDD was a relevant diagnosis in patients with PFS. A higher BDD level was associated with general and facial-specific quality of life and more psychosocial disabilities. Optimal treatment of PFS has to include these nonmotor dysfunctions.

Level Of Evidence: 3 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29526DOI Listing
March 2021

Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle.

Diagnostics (Basel) 2021 Jan 28;11(2). Epub 2021 Jan 28.

Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany.

This article describes a first attempt to generate a standardized and safe selective surface electrostimulation (SES) protocol, including detailed instructions on electrode placement and stimulation parameter choice to obtain a selective stimulation of the denervated zygomaticus muscle (ZYG), without unwanted simultaneous activation of other ipsilateral or contralateral facial muscles.

Methods: Single pulse stimulation with biphasic triangular and rectangular waveforms and pulse widths (PW) of 1000, 500, 250, 100, 50, 25, 15, 10, 5, 2, 1 ms, at increasing amplitudes between 0.1 and 20 mA was performed. Stimulations delivered in trains were assessed at a PW of 50 ms only. The stimulation was considered successful exclusively if it drew the ipsilateral corner of the mouth upwards and outwards, without the simultaneous activation of other ipsilateral or contralateral facial muscles. I/t curves, accommodation quotient, rheobase, and chronaxie were regularly assessed over 1-year follow-up.

Results: 5 facial paralysis patients were assessed. Selective ZYG response in absence of discomfort and unselective contraction of other facial muscle was reproducibly obtained for all the assessed patients. The most effective results with single pulses were observed with PW ≥ 50 ms. The required amplitude was remarkably lower (≤5 mA vs. up to 15 mA) in freshly diagnosed (≤3 months) than in long-term facial paralysis patients (>5 years). Triangular was more effective than rectangular waveform, mostly because of the lower discomfort threshold of the latter. Delivery of trains of stimulation showed similar results to the single pulse setting, though lower amplitudes were necessary to achieve the selective ZYG response. Initial reinnervation signs could be detected effectively by needle-electromyography (n-EMG).

Conclusion: It is possible to define stimulation parameters able to elicit an effective selective stimulation of a specific facial muscle, in our case, of the ZYG, without causing discomfort to the patient and without causing unwanted unspecific reactions of other ipsilateral and/or contralateral facial muscles. We observed that the SES success is strongly conditioned by the correct electrode placement, which ideally should exclusively interest the area of the target muscles and its immediate proximity.
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http://dx.doi.org/10.3390/diagnostics11020188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912406PMC
January 2021

Ratings of Emotional Expressions in Static and Dynamic Facial Recordings Before and After Upper Face Botulinum Injections-An Observational Prospective Study.

Aesthet Surg J 2021 05;41(6):NP609-NP615

Department of Otorhinolaryngology, University Hospital Jena, Jena, Germany.

Background: Botulinum toxin A (BTX), a neurotoxin widely used for facial aesthetics, causes dose-dependent muscle paralysis. It was hypothesized that treatment of mimic muscles with BTX might have a positive impact on emotional expression in static images (photographs), but a negative impact in dynamic recordings (videos).

Objectives: The aim of this study was to compare of emotional expression recorded in photographs and videos before and after treatment with BTX.

Methods: Twenty healthy women (mean age, 45 years) received a dose of 19 mouse units of XEOMIN (Merz, Frankfurt am Main, Germany) into the procerus, occipitofrontalis, and orbicularis oculi muscles. Photographs and videos of the participants' faces with neutral and happy expressions were recorded before treatment and 2 weeks later. Recordings were rated by naive raters blind to the conditions and in balanced order.

Results: Videos were generally rated as more pleasant, arousing, attractive, and genuine than photographs (all Ps > 0.001). This was especially the case for videos with neutral expression (P = 0.003). Independent of presentation mode and facial expression, women were rated as more attractive after BTX treatment (P = 0.03).

Conclusions: In contrast to the hypothesis, the reduced mobility had no detectable negative impact on dynamic emotional expression, but videos received more positive ratings, particularly for neutral expressions. It is thus recommended to assess emotional expression with dynamic recordings to evaluate the effects of treatment with BTX. BTX seems to improve perceived attractiveness, although the cause of this effect remains unclear.
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http://dx.doi.org/10.1093/asj/sjaa393DOI Listing
May 2021

The use of a surgical planning tool for evaluating the optimal surgical accessibility to the stapedius muscle via a retrofacial approach during cochlear implant surgery: a feasibility study.

Int J Comput Assist Radiol Surg 2021 Feb 13;16(2):331-343. Epub 2020 Nov 13.

Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.

Purpose: During cochlear implant (CI) surgery, visual detection of the stapedius reflex as movements of the stapes tendon, electrically elicited via the CI, is a standard measure to confirm the system's functionality. Direction visualization of the stapedius muscle (SM) movements might be more reliable, but a safe access to the small SM is not defined. A new surgical planning tool for pre-operative evaluation of the accessibility to the stapedius muscle (SM) during a cochlear implantation (CI) via a retrofacial approach was now evaluated.

Methods: A surgical planning tool was developed in MATLAB using an image processing algorithm to evaluate drilling feasibility. A flat-panel computed tomography (CT) combining a rotational angiographic C-arm units with flat-panel detectors (Dyna-CT) was used. In total, 30 3D Dyna-CT-based temporal bone reconstructions were evaluated by automatized algorithms, generating a series of trajectories and comparing their feasibility and safety to reach the SM via a retrofacial approach. The predictability of the surgical planning tool results was tested in 5 patients.

Results: The surgical planning tool showed that a retrofacial access to the SM would be feasible in 25/30 cases. Moreover, the evaluation of the predictability of the results obtained with the surgical planning tool conducted during 5 CI surgeries confirmed the results. Both the surgical planning tool and the results on SM accessibility via retrofacial approach during CI showed that this is safe and feasible only when the SM-exposed area was > 25% of its total, the distance between the SM and the facial nerve was > 0.8 mm, and the surgical corridor diameter was > 3 mm.

Conclusion: The surgical planning tool seems to be useful for the pre-operative evaluation of the accessibility to the SM during a CI surgery via a retrofacial approach. Further prospective studies are needed to validate the results in larger cohorts.
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http://dx.doi.org/10.1007/s11548-020-02288-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880982PMC
February 2021

Laryngeal Electromyography.

Adv Otorhinolaryngol 2020 9;85:18-24. Epub 2020 Nov 9.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,

Laryngeal electromyography (LEMG) is an important diagnostic and prognostic tool in neurolaryngology. This chapter presents the advances in LEMG in the last 5 years based on clinical trials. LEMG is in most cases an office-based procedure for decision making in neurolaryngology. When performed in a standardized way, LEMG helps to differentiate abnormal function of the vocal folds from nonorganic disorders. It is mainly used to confirm the diagnosis of vocal fold paralysis (VFP) and is less frequently used for the diagnosis of myopathies and motor neuron disorders. Also, the value of LEMG for other diseases than VFP is presented. First consensus recommendations for standard performance of LEMG have been published. This will facilitate the comparison of results from different researchers in the future. For many years, LEMG focused on the thyroarytenoid muscle. Data are presented showing that now more and more studies are performed including other laryngeal muscles, most importantly the posterior cricoarytenoid muscle and cricothyroid muscle. Diagnostics and estimating the prognosis for patients with VFP remains the most important issue for LEMG. First meta-analyses are now available analyzing which LEMG parameters are the best prognosticators for recovery or persistent palsy. Due to the advances in multichannel LEMG, laryngeal nerve monitoring can now control the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve during thyroid surgery. Finally, also the advances of LEMG for laryngeal pacing, guided laryngeal injections, laryngeal electrostimulation, and other indications beyond otolaryngology are discussed.
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http://dx.doi.org/10.1159/000456680DOI Listing
November 2020

Classification of facial movements in chronic facial palsy based on intramuscular EMG signals recorded from the paretic side.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:662-665

Patients suffering from chronic facial palsy are frequently impaired by severe life-long dysfunctions. Thus, the loss of the ability to close eyes rapidly and completely bears the risk of corneal damages. Moreover, the loss of smile and an altered facial expression imply psychological stress and impede a healthy social life. Since surgical and conservative treatments frequently do not solve many problems sufficiently, closed-loop neural prosthesis are considered as feasible approach. For it, amongst others a reliable detection of the currently executed facial movement is necessary. In our proof of concept study, we propose a data-driven feature extraction for classifying eye closures and smile based on intramuscular EMGs from orbicularis oculi and zygomaticus muscles of the patient's palsy side. The data-adaptive nature of the approach enables a flexible applicability to different muscles and subjects without patient-or muscle-specific adaptations.
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http://dx.doi.org/10.1109/EMBC44109.2020.9175249DOI Listing
July 2020

Prognostic value of a three-dimensional dynamic quantitative analysis system to measure facial motion in acute facial paralysis patients.

Head Face Med 2020 Jul 18;16(1):15. Epub 2020 Jul 18.

Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China.

Background: To investigate the prognostic value of a three-dimensional dynamic quantitative analysis system to measure facial motion (3D ASFM) in acute facial palsy patients and compare it with subjective grading methods and electroneurography.

Methods: We continuously recruited 37 patients with acute (< 1 month) Bell's palsy. An integrated evaluation of facial palsy was performed for each patient. The integrated evaluation included the House-Brackmann grading system (H-BGS), Sunnybrook Facial Grading System (SFGS), electroneurography and three-dimensional objective measurements. Then, the entire set of evaluations were repeated for each patient 1 month later. The patients were followed up monthly until recovery or for up to more than 6 months. We adopted the SFGS and H-BGS as the representative subjective grading system and final criteria for recovery. Poor recovery was defined as an SFGS score less than 70 or H-BGS score higher than II.

Results: Multiple regression analysis was performed to find the best prognostic indicators. In less than 1 month from onset, ENoG had the highest prognostic value. However, in the second month from onset, the results of SFGS and 3D ASFM were identified as the best prognostic parameters, and a prediction formula with a determination coefficient of 0.673 was established. The receiver operating characteristic curves revealed that a gross score of the 3D ASFM less than 31 in the first evaluation and 49 in the second evaluation had higher sensitivity and specificity to predict poor recovery.

Conclusions: In different phases of Bell's palsy, the best predictor of prognosis is different. ENOG is the most effective predictor of the prognosis in the first month after onset. In the second month after onset, the combination of SFGS and 3D ADSM is considered to be the best prognostic predictor.
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http://dx.doi.org/10.1186/s13005-020-00230-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368680PMC
July 2020

Can MRI quantify the volume changes of denervated facial muscles?

Eur J Transl Myol 2020 Apr 1;30(1):8918. Epub 2020 Apr 1.

ENT-Department, Jena University Hospital, Jena, Germany.

Could manual segmentation of magnetic resonance images be used to quantify the effects of transcutaneous electrostimulation and reinnervation of denervated facial muscle? Five patients with unilateral facial paralysis were scanned during the study while receiving a daily surface electrostimulation of the paralytic cheek region, but also after reinnervation. Their facial muscles were identified in 3D (coronal, sagittal, and axial) and segmented in magnetic resonance imaging (MRI) data for in total 28 time points over the 12 months of study. A non-significant trend of increasing muscle volume were detected after reinnervation. MRI is a valuable technique in the facial paralysis research.
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http://dx.doi.org/10.4081/ejtm.2019.8918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254417PMC
April 2020

Prognostic factors for the outcome of Bells' palsy: A cohort register-based study.

Clin Otolaryngol 2020 09 27;45(5):754-761. Epub 2020 May 27.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.

Objectives: There is a lack of data on patients' and diagnostic factors for prognostication of complete recovery in patients with Bell's palsy.

Design And Setting: Cohort register-based study of 368 patients with Bell's palsy and uniform diagnostics and standardised treatment in a university hospital from 2007 to 2017 (49% female, median age: 51 years).

Main Outcome Measures: Clinical data, facial grading, electrodiagnostics, motor function tests, non-motor function tests and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics.

Results: Median onset of treatment was 1.5 days. 46% of patients had a House-Brackmann scale at baseline of ≥ III. The median recovery time was 2.6 months (95% confidence interval [CI] = 2.1-3.0). 54.9% achieved a complete recovery. If prednisolone therapy started later than 96 hours after onset, the recovery rate decreased significantly. Beyond less severe palsy, no abnormal electroneurography side difference, no pathological spontaneous activity in electromyography and normal stapedius reflex testing were the most powerful tool for prognostication of recovery after Bell's palsy.

Conclusion: Beyond severity of the palsy, facial electrodiagnostics and stapedius reflex testing are the most powerful tool for prognostication of recovery time after Bell's palsy. Prednisolone therapy should have started at best within a time window of 96 hours after onset to reach the highest probability of complete recovery.
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http://dx.doi.org/10.1111/coa.13571DOI Listing
September 2020

Facial nerve electrodiagnostics for patients with facial palsy: a clinical practice guideline.

Eur Arch Otorhinolaryngol 2020 Jul 8;277(7):1855-1874. Epub 2020 Apr 8.

International Head and Neck Scientific Group, Padua, Italy.

Purpose: Facial nerve electrodiagnostics is a well-established and important tool for decision making in patients with facial nerve diseases. Nevertheless, many otorhinolaryngologist-head and neck surgeons do not routinely use facial nerve electrodiagnostics. This may be due to a current lack of agreement on methodology, interpretation, validity, and clinical application. Electrophysiological analyses of the facial nerve and the mimic muscles can assist in diagnosis, assess the lesion severity, and aid in decision making. With acute facial palsy, it is a valuable tool for predicting recovery.

Methods: This paper presents a guideline prepared by members of the International Head and Neck Scientific Group and of the Multidisciplinary Salivary Gland Society for use in cases of peripheral facial nerve disorders based on a systematic literature search.

Results: Required equipment, practical implementation, and interpretation of the results of facial nerve electrodiagnostics are presented.

Conclusion: The aim of this guideline is to inform all involved parties (i.e. otorhinolaryngologist-head and neck surgeons and other medical specialists, therapeutic professionals and the affected persons) and to provide practical recommendations for the diagnostic use of facial nerve electrodiagnostics.
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http://dx.doi.org/10.1007/s00405-020-05949-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286870PMC
July 2020

Functional Outcome and Quality of Life After Hypoglossal-Facial Jump Nerve Suture.

Front Surg 2020 19;7:11. Epub 2020 Mar 19.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.

To evaluate the face-specific quality of life after hypoglossal-facial jump nerve suture for patients with long-term facial paralysis. A single-center retrospective cohort study was performed. Forty-one adults (46% women; median age: 55 years) received a hypoglossal-facial jump nerve suture. Sunnybrook and eFACE grading was performed before surgery and at a median time of 42 months after surgery. The Facial Clinimetric Evaluation (FaCE) survey and the Facial Disability Index (FDI) were used to quantify face-specific quality of life after surgery. Hypoglossal-facial jump nerve suture was successful in all cases without tongue dysfunction. After surgery, the median FaCE Total score was 60 and the median FDI Total score was 76.3. Most Sunnybrook and eFACE grading subscores improved significantly after surgery. Younger age was the only consistent independent predictor for better FaCE outcome. Additional upper eyelid weight loading further improved the FaCE Eye comfort subscore. Sunnybrook grading showed a better correlation to FaCE assessment than the eFACE. Neither Sunnybrook nor eFACE grading correlated to the FDI assessment. The hypoglossal-facial jump nerve suture is a good option for nerve transfer to reanimate the facial muscles to improve facial motor function and face-specific quality of life.
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http://dx.doi.org/10.3389/fsurg.2020.00011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096350PMC
March 2020

Abnormal Emotional Processing and Emotional Experience in Patients with Peripheral Facial Nerve Paralysis: An MEG Study.

Brain Sci 2020 Mar 4;10(3). Epub 2020 Mar 4.

Biomagnetic Center, Jena University Hospital, 07747 Jena, Germany.

Abnormal emotional reactions of the brain in patients with facial nerve paralysis have not yet been reported. This study aims to investigate this issue by applying a machine-learning algorithm that discriminates brain emotional activities that belong either to patients with facial nerve paralysis or to healthy controls. Beyond this, we assess an emotion rating task to determine whether there are differences in their experience of emotions. MEG signals of 17 healthy controls and 16 patients with facial nerve paralysis were recorded in response to picture stimuli in three different emotional categories (pleasant, unpleasant, and neutral). The selected machine learning technique in this study was the logistic regression with LASSO regularization. We demonstrated significant classification performances in all three emotional categories. The best classification performance was achieved considering features based on event-related fields in response to the pleasant category, with an accuracy of 0.79 (95% CI (0.70, 0.82)). We also found that patients with facial nerve paralysis rated pleasant stimuli significantly more positively than healthy controls. Our results indicate that the inability to express facial expressions due to peripheral motor paralysis of the face might cause abnormal brain emotional processing and experience of particular emotions.
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http://dx.doi.org/10.3390/brainsci10030147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139433PMC
March 2020

Objectivation of laryngeal electromyography (LEMG) data: turn number vs. qualitative analysis.

Eur Arch Otorhinolaryngol 2020 May 18;277(5):1409-1415. Epub 2020 Feb 18.

Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Purpose: This paper describes a first attempt to quantify LEMG data based on turn number calculation. The results obtained for both healthy and ailing thyroarytenoid (TA) muscles of patients with unilateral vocal fold immobility (UVFI) were compared with the respective qualitative evaluation concerning volitional activity to determine whether the two types of analyses deliver similar results.

Methods: LEMG data obtained from 44 adults with UVFI were considered for the study. Semiquantitative evaluation of TA volitional activity and turn number were assessed for the ailing and the healthy TA and the difference in percentage was calculated. Paired data were compared with the Wilcoxon signed-rank test. The volitional activity assessment and the turn number evaluation were compared with the Kruskal-Wallis test, and their relationship was tested with the Kendall rank correlation.

Results: Datasets of 27 patients were considered compatible with turns/s calculation. The results showed that complete paralysis correlated with no turns; single fiber volitional activity with 62-208 turns/s, strongly decreased volitional activity with 198-501 turns/s; and dense volitional activity with 441-1234 turns/s. On the ailing VF only, the Kruskal-Wallis test showed a statistically significant difference (p = 0.0001), and the Kendall rank correlation a positive relationship (r = 0.853,p ≤ 0.0001) between the volitional activity rating and the turn number assessment.

Conclusions: Our preliminary results showed that turn number evaluation is an effective tool to confirm LEMG qualitative analysis, and that, in combination with laryngostroboscopy and voice assessment, can help improving the accuracy of the diagnosis and prognosis and the effectiveness of the chosen therapy.
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http://dx.doi.org/10.1007/s00405-020-05846-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160217PMC
May 2020

Tolerability of facial electrostimulation in healthy adults and patients with facial synkinesis.

Eur Arch Otorhinolaryngol 2020 Apr 24;277(4):1247-1253. Epub 2020 Jan 24.

Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.

Purpose: To evaluate optimal stimulation parameters with regard to discomfort and tolerability for transcutaneous electrostimulation of facial muscles in healthy participants and patients with postparetic facial synkinesis.

Methods: Two prospective studies were performed. First, single pulse monophasic stimulation with rectangular pulses was compared to triangular pulses in 48 healthy controls. Second, 30 healthy controls were compared to 30 patients with postparetic facial synkinesis with rectangular pulse form. Motor twitch threshold, tolerability threshold, and discomfort were assessed using a numeric rating scale at both thresholds.

Results: Discomfort at motor threshold was significantly lower for rectangular than for triangular pulses. Average motor and tolerability thresholds were higher for patients than for healthy participants. Discomfort at motor threshold was significantly lower for healthy controls compared to patients. Major side effects were not seen.

Conclusions: Surface electrostimulation for selective functional and tolerable facial muscle contractions in patients with postparetic facial synkinesis is feasible.
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http://dx.doi.org/10.1007/s00405-020-05818-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072059PMC
April 2020

Exploring intrinsic triggers for functional facial electrostimulation based on intramuscular electromyography recordings.

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;2019:6599-6602

Based on univariate intramuscular electromyography (EMG) recordings of facial muscles of patients suffering from chronic idiopathic facial palsy we propose a data-driven feature selection process for the discrimination of different mimic maneuvers. Following fundamental ideas of automatic EMG decompositions based on templates defined by motor unit action potentials, the proposed approach relies on a multiple template matching. Yet, the novel methodology utilizes templates derived from the intramuscular EMG signal itself without any supervisor interaction or a priori information by identifying abundant short signal sections (motifs). Focusing on motifs as individual, characteristical graphoelements of an EMG recording implies a high level of flexibility. In connection with facial palsy such a flexibility is necessary, since unique individual, also pathological, EMG patterns can be expected due to the high spatial variability of intramuscular recordings combined with random patterns of aberrant reinnervation. The proposed methodology is applied to EMG data of frontalis, zygomaticus, and orbicularis oculi muscle without patient- or muscle-specific adaptations.
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http://dx.doi.org/10.1109/EMBC.2019.8856675DOI Listing
July 2019

Dyna-CT of the temporal bone for case-specific three-dimensional rendering of the stapedial muscle for planning of electrically evoked stapedius reflex threshold determination during cochlear implantation directly from the stapedius muscle via a retrofacial approach: a pilot study.

Eur Arch Otorhinolaryngol 2020 Apr 2;277(4):975-985. Epub 2020 Jan 2.

Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.

Purpose: Evaluation of 3D Dyna-CTs to improve cochlear implantation (CI) planning and intraoperative electrically elicited stapedius reflex threshold (ESRT) measurements.

Methods: A prospective observational cohort study was performed. Anonymized data collection of Dyna-CTs and CI surgeries in which a retrofacial approach was implemented to access the stapedius muscle. 3D Dyna-CTs of 30 patients and the intraoperative confirmation of the predication in 5/30 patients during CI surgery were evaluated. Inter-rater reliability was also analyzed along with the predictive value of this evaluation.

Results: 36 representative structures of the middle and inner ear and 3D renderings of the Dyna-CTs were evaluated by four otoneurological surgeons. Fleiss' kappa values for the evaluation of the visibility were high (> 0.7) for most of the anatomical structures. The stapedius muscle was visible in 90% of the cases. Using the 3D data, the retrofacial access to the stapedius muscles was estimated as feasible in 86.7%. Fleiss' kappa value of the evaluation of the accessibility was 0.942. The intraoperative exploration of the stapedius muscle confirmed the preoperative prediction in all five selected patients (four patients with predicted accessibility and one patient with predicted inaccessibility).

Conclusions: The use of Dyna-CT and 3D rendering is a helpful tool for preoperative planning of cochlear implantations and ESRT measurements from the stapedius muscle via the retrofacial approach.
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http://dx.doi.org/10.1007/s00405-019-05773-2DOI Listing
April 2020

Surface electrical stimulation for facial paralysis is not harmful.

Muscle Nerve 2020 03 9;61(3):347-353. Epub 2020 Jan 9.

ENT Department, Jena University Hospital, Jena, Germany.

Introduction: Does electrical stimulation (ES) of denervated muscles delay or prevent reinnervation, or increase synkinesis? In this retrospective study we evaluate the outcome, with and without ES, of patients with acutely denervated facial muscles.

Methods: The effect of ES was analyzed in two experiments. In the first experiment, 39 patients (6 with home-based ES, median 17.5 months) underwent facial nerve reconstruction surgery. Time to recovery of volitional movements was analyzed. The second experiment involved 13 patients (7 with ES, median 19 months) during spontaneous reinnervation. Sunnybrook and eFACE scores provided functional outcome measures.

Results: No difference in time of reinnervation after facial nerve reconstruction surgery was seen between the patients with and without ES (median [interquartile range]: 4.5 [3.0-5.25] vs 5.7 [3.5-9.5] months; P = .2). After spontaneous reinnervation, less synkinesis was noted (Sunnybrook synkinesis score: 3.0 [2.0-3.0] vs 5.5 [4.75-7.0]; P = .02) with ES.

Discussion: We find no evidence that ES prevents or delays reinnervation or increases synkinesis in facial paralysis.
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http://dx.doi.org/10.1002/mus.26784DOI Listing
March 2020

Automated objective and marker-free facial grading using photographs of patients with facial palsy.

Eur Arch Otorhinolaryngol 2019 Dec 18;276(12):3335-3343. Epub 2019 Sep 18.

Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.

Purpose: An automated, objective, fast and simple classification system for the grading of facial palsy (FP) is lacking.

Methods: An observational single center study was performed. 4572 photographs of 233 patients with unilateral peripheral FP were subjectively rated and automatically analyzed applying a machine learning approach including Supervised Descent Method. This allowed an automated grading of all photographs according to House-Brackmann grading scale (HB), Sunnybrook grading system (SB), and Stennert index (SI).

Results: Median time to first assessment was 6 days after onset. At first examination, the median objective HB, total SB, and total SI were grade 3, 45, and 5, respectively. The best correlation between subjective and objective grading was seen for SB and SI movement score (r = 0.746; r = 0.732, respectively). No agreement was found between subjective and objective HB grading [Test for symmetry 80.61, df = 15, p < 0.001, weighted kappa = - 0.0105; 95% confidence interval (CI) = - 0.0542 to 0.0331; p = 0.6541]. Also no agreement was found between subjective and objective total SI (test for symmetry 166.37, df = 55, p < 0.001) although there was a nonzero weighted kappa = 0.2670; CI 0.2154-0.3186; p < 0.0001). Based on a multinomial logistic regression the probability for higher scores was higher for subjective compared to objective SI (OR 1.608; CI 1.202-2.150; p = 0.0014). The best agreement was seen between subjective and objective SB (ICC = 0.34645).

Conclusions: Automated Sunnybrook grading delivered with fair agreement fast and objective global and regional data on facial motor function for use in clinical routine and clinical trials.
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http://dx.doi.org/10.1007/s00405-019-05647-7DOI Listing
December 2019

Pain on the first postoperative day after tonsillectomy in adults: A comparison of metamizole versus etoricoxib as baseline analgesic.

PLoS One 2019 14;14(8):e0221188. Epub 2019 Aug 14.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.

Objective: To compare the effect of metamizole versus etoricoxib as baseline analgesic for treating postoperative pain after tonsillectomy.

Design: Single centre prospective cohort study.

Setting: Two consecutive cohorts of tonsillectomy patients.

Participants: 124 patients (n = 55 treated with etoricoxib, n = 69 with metamizole); median age 30.5 years; 50% women.

Main Outcome Measures: Patients rated their pain on first postoperative day using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0-10) for pain determination. The influence of preoperative and postoperative parameters on patients' pain was estimated by univariate and multivariate statistical analysis.

Results: The demographic parameters showed no differences between the patients in the metamizole group and the etoricoxib group (all p>0.05) with one exception: Patients in the metamizole group had significantly more preoperative pain than patients in the etoricoxib group (p = 0.001). The metamizole group had a mean postoperative pain in activity of 4.4 ± 2.1 and the etoricoxib group of 4.5 ± 2.2. Maximal pain for the metamizole group and the etoricoxib group were 5.6 ± 2.2 and 6.1 ± 1.9, respectively. Pain in activity, maximal pain and minimal pain were not different between both groups (p = 0.652, p = 0.113, p = 0.276, respectively). Patients of the etoricoxib group received more frequently piritramide in recovery room as demand medication (p = 0.046). In the whole cohort, patients with peritonsillar abscess had more preoperative pain in comparison to chronic tonsillitis (p<0.001). Patients under 30.5 years reported higher maximal pain than older patients (p = 0.049). On the other hand, a significant influence of patients' age on the pain in activity and minimal pain could not be demonstrated (p = 0.368, p = 0.508, respectively). Men reported lower minimal pain than women (p = 0.041). Also, patients with ASA status I had lower minimal pain than patients with higher ASA status (p = 0.019). The multivariate analysis did not show an association between postoperative pain in activity and preoperative counseling on postoperative pain management (p = 0.588, p = 0.174, respectively). Special preoperative counseling on postoperative pain management resulted in lower levels of maximal pain (p = 0.024). Linear regression demonstrated an independent association of higher pain in activity with higher mobility impairment (p = 0.034) and respiratory impairment (p = 0.002). The linear regression of minimal pain identified female gender (p = 0.005) as an independent influencing factor with higher pain levels. In terms of satisfaction, no preoperative pain therapy (p = 0.016) could be found as an independently significant influencing factor with higher satisfaction.

Conclusion: Etoricoxib does not have an advantage as baseline analgesic for post tonsillectomy pain in comparison to metamizole.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221188PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693748PMC
March 2020

Inter-rater reliability of seven neurolaryngologists in laryngeal EMG signal interpretation.

Eur Arch Otorhinolaryngol 2019 Oct 16;276(10):2849-2856. Epub 2019 Jul 16.

Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Purpose: Laryngeal electromyography (LEMG) has been considered as gold standard in diagnostics of vocal fold movement impairment, but is still not commonly implemented in clinical routine. Since the signal interpretation of LEMG signals (LEMGs) is often a subjective and semi-quantitative matter, the goal of this study was to evaluate the inter-rater reliability of neurolaryngologists on LEMGs of volitional muscle activity.

Methods: For this study, 52 representative LEMGs of 371 LEMG datasets were selected from a multicenter registry for a blinded evaluation by 7 experienced members of the neurolaryngology working group of the European Laryngological Society (ELS). For the measurement of the observer agreement between two raters, Cohen's Kappa statistic was calculated. For the interpretation of agreements of diagnoses among the seven examiners, we used the Fleiss' Kappa statistic.

Result: When focusing on the categories "no activity", "single fiber pattern", and "strongly decreased recruitment pattern", the inter-rater agreement varied from Cohen's Kappa values between 0.48 and 0.84, indicating moderate to near-perfect agreement between the rater pairs. Calculating with Fleiss' Kappa, a value of 0.61 showed good agreement among the seven raters. For the rating categories, the Fleiss' Kappa value ranged from 0.52 to 0.74, which also showed a good agreement.

Conclusion: A good inter-rater agreement between the participating neurolaryngologists was achieved in the interpretation of LEMGs. More instructional courses should be offered to broadly implement LEMG as a reliable diagnostic tool in evaluating vocal fold movement disorders in clinical routine and to develop future algorithms for therapy and computer-assisted examination.
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http://dx.doi.org/10.1007/s00405-019-05553-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757022PMC
October 2019

Altered facial muscle innervation pattern in patients with postparetic facial synkinesis.

Laryngoscope 2020 05 25;130(5):E320-E326. Epub 2019 Jun 25.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.

Objectives/hypothesis: Using surface electrostimulation, we aimed to use facial nerve mapping (FNM) in healthy subjects and patients with postparetic facial synkinesis (PPFS) to define functional facial target regions that can be stimulated selectively.

Study Design: Single-center prospective cohort study.

Methods: FNM was performed bilaterally in 20 healthy subjects and 20 patients with PPFS. Single-pulse surface FNM started at the main trunk of the facial nerve and followed the peripheral branches in a distal direction. Stimulation started with 0.1 mA and increased in 0.1 mA increments. The procedure was simultaneously video recorded and evaluated offline.

Results: A total of 1,873 spots were stimulated, and 1,875 facial movements were evaluated. The stimulation threshold was higher on the PPFS side (average = 9.8 ± 1.0 mA) compared to the contralateral side (4.1 ± 0.8 mA) for all stimulation sites or compared to healthy subjects (4.1 ± 0.5 mA; all P < .01). In healthy subjects, selective electrostimulation ± one unintended coactivation was possible at all sites in >80% of cases, with the exception of pulling up the corner of the mouth (65%-75%). On the PPFS side, stimulation was possible for puckering lips movements in 60%/75% (selective stimulation ± one coactivation, respectively), blinking in 55%/80%, pulling up the corner of the mouth in 50%/85%, brow raising in 5%/85, and raising the chin in 0%/35% of patients, respectively.

Conclusions: FNM mapping for surgical planning and selective electrostimulation of functional facial regions is possible even in patients with PPFS. FNM may be a tool for patient-specific evaluation and placement of electrodes to stimulate the correct nerve branches in future bionic devices (e.g., for a bionic eye blink).

Level Of Evidence: 2b Laryngoscope, 130:E320-E326, 2020.
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http://dx.doi.org/10.1002/lary.28149DOI Listing
May 2020

Therapy of bilateral vocal fold paralysis: Real world data of an international multi-center registry.

PLoS One 2019 29;14(4):e0216096. Epub 2019 Apr 29.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.

Purpose: To collect data on diagnosis, treatment, patient's management, and quality of life in patient with bilateral vocal fold paralysis (BVFP).

Methods: A retrospective, observational, multicenter registry study was performed. Medical records of 326 adults with permanent BVFP (median age: 61 years; 70% female, 60% after thyroid surgery) generated between 2010 and 2017.

Results: Median time between BVFP onset and inclusion was 1.2 years. Median post-treatment follow-up was 2 months (range: 0-42). Surgery was treatment of choice in 61.7% of the cases, with a 2-year revision rate of 32.4%. Prior to inclusion, 40.2% of the patients underwent at least one surgery. For tracheotomized patients, decannulation rate was 33.8%. Non-surgical treatments included voice therapy and botulinum toxin injection. Corticosteroid application was the most frequent treatment for post-treatment complications (18%; 1-month after surgery). Older age was an independent predictor for dyspnea (Hazard ratio [HR] = 1.041; CI = 1.005 to 1.079; p = 0.026) and the need for oxygen treatment (HR = 1.098; CI = 1.009 to 1.196; p = 0.031). Current alcohol consumption (HR = 2.565; CI = 1.232 to 5.342; p = 0.012) and a cancer-related etiology (HR = 4.767; CI = 1.615 to 14.067; p = 0.005) were independent factors of higher revision risk.

Conclusions: Surgery for BVFP is currently not standardized but highly variable. Postoperative and BVFP-related complications and revision surgery are frequent. Complications are linked to patients' alcohol drinking habits and BVFP etiology. These results shall be confirmed by the upcoming evaluation of the prospective data of this registry.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216096PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488092PMC
January 2020

Reliability of grading of facial palsy using a video tutorial with synchronous video recording.

Laryngoscope 2019 10 20;129(10):2274-2279. Epub 2018 Dec 20.

Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.

Objective: To determine the intrarater, interrater, and retest reliability of facial nerve grading of patients with facial palsy (FP) using standardized videos recorded synchronously during a self-explanatory patient video tutorial.

Study Design: Prospective, observational study.

Methods: The automated videos from 10 patients with varying degrees of FP (5 acute, 5 chronic FP) and videos without tutorial from eight patients (all chronic FP) were rated by five novices and five experts according to the House-Brackmann grading system (HB), the Sunnybrook Grading System (SB), and the Facial Nerve Grading System 2.0 (FNGS 2.0).

Results: Intrarater reliability for the three grading systems was very high using the automated videos (intraclass correlation coefficient [ICC]; SB: ICC = 0.967; FNGS 2.0: ICC = 0.931; HB: ICC = 0.931). Interrater reliability was also high (SB: ICC = 0.921; FNGS 2.0: ICC = 0.837; HB: ICC = 0.736), but for HB Fleiss kappa (0.214) and Kendell W (0.231) was low. The interrater reliability was not different between novices and experts. Retest reliability was very high (SB: novices ICC = 0.979; experts ICC = 0.964; FNGS 2.0: novices ICC = 0.979; experts ICC = 0.969). The reliability of grading of chronic FP with SB was higher using automated videos with tutorial (ICC = 0.845) than without tutorial (ICC = 0.538).

Conclusion: The reliability of the grading using the automated videos is excellent, especially for the SB grading. We recommend using this automated video tool regularly in clinical routine and for clinical studies.

Level Of Evidence: 4 xsLaryngoscope, 129:2274-2279, 2019.
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http://dx.doi.org/10.1002/lary.27739DOI Listing
October 2019

Facial motor and non-motor disabilities in patients with central facial paresis: a prospective cohort study.

J Neurol 2019 Jan 26;266(1):46-56. Epub 2018 Oct 26.

Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.

Although central facial paresis (CFP) is a major symptom of stroke, there is a lack of studies on the motor and non-motor disabilities in stroke patients. A prospective cohort study was performed at admission for inpatient rehabilitation and discharge of post-stroke phase of 112 patients (44% female, median age: 64 years, median Barthel index: 70) with CFP. Motor function was evaluated using House-Brackmann grading, Sunnybrook grading and Stennert Index. Automated action unit (AU) analysis was performed to analyze mimic function in detail. Non-motor function was assessed using the Facial Disability Index (FDI) and the Facial Clinimetric Evaluation (FaCE). Median interval from stroke to rehabilitation was 21 days. Rehabilitation lasted 20 days. House-Brackmann grading was ≥ grade III for 79% at admission. AU activation in the lower face was significantly lower in patients with right hemispheric infarction compared to left hemispheric infarction (all p < 0.05). Median total FDI and FaCE score were 46.5 and 69, respectively. Facial grading and FDI/FaCE scores improved during inpatient rehabilitation (all p < 0.05). There was a significant increase of the activation of AU12 (Zygomaticus major muscle), AU13 (Levator anguli oris muscle), and AU24 (Orbicularis oris muscle) during inpatient rehabilitation (all p < 0.05). Multivariate analysis revealed that activation of AU10 (Levator labii superioris), AU12, AU17 (Depressor labii), and AU 38 (Nasalis) were independent predictors for better quality of life. These results demonstrate that CFP has a significant impact on patient's quality of life. Therapy of CFP with focus on specific AUs should be part of post-stroke rehabilitation.
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http://dx.doi.org/10.1007/s00415-018-9099-xDOI Listing
January 2019

Weather, Weather Changes and the Risk of Bell's Palsy: A Multicenter Case-Crossover Study.

Neuroepidemiology 2018 11;51(3-4):207-215. Epub 2018 Sep 11.

Hans Berger Department of Neurology, Jena, Germany.

Background: To evaluate if weather or changes in weather are risk factors for Bell's palsy (BP) as exposure to draught of cold air has been popularly associated with the occurrence of BP.

Methods: Using a multicenter hospital-based case-crossover study, we analyzed the association between ambient temperature, atmospheric pressure, relative air humidity or their 24 h changes and the risk for BP in 825 patients or subgroups.

Results: One day following a 24 h increase in atmospheric pressure of more than 6 hPa, the risk for BP increased by 35% (OR 1.35; 95% CI 1.03-1.78) in the overall population. The risk for BP more than doubled in patients with diabetes mellitus after rapid variations in ambient temperature, independent of the direction (temperature decrease > 2.25°C; OR 2.15; 95% CI 1.08-4.25; temperature increase between 0.75 and 2.25°C; OR 2.88; 95% CI 1.63-5.10).

Conclusions: Our findings support the hypothesis of an association between certain weather conditions and the risk for BP with acute changes in atmospheric pressure and ambient temperature as the main risk factors. Additionally, contrasting results for risk of BP after temperature changes in the diabetic and non-diabetic subgroups support the paradigm of a diabetic facial palsy as a distinct disease entity.
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http://dx.doi.org/10.1159/000492671DOI Listing
September 2019

Vocal fold paresis: Medical specialists' opinions on standard diagnostics and laryngeal findings.

Eur Arch Otorhinolaryngol 2018 Oct 23;275(10):2535-2540. Epub 2018 Aug 23.

Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.

Purpose: There is still no clear consensus on the diagnostic value of specific laryngeal findings in patients with suspected vocal fold paresis (VFP). The aim of the study was to establish expert opinion on criteria for the diagnosis of VFP in Europe.

Methods: A cross-sectional survey using the questionnaire introduced by Wu and Sulica for US American experts was addressed to laryngeal experts in Germany, Austria, and Switzerland and in a second survey wave to members of the European Laryngological Society.

Results: 100 respondents returned survey 1 (response rate 47.2%). 26% worked at a university department. 28% regularly used laryngeal electromyography (LEMG). A pathologic test results in LEMG was considered to have the strongest positive predictive value for VFP (79 ± 23%), followed by a decreased vocal fold abduction (70 ± 29%), decreased vocal fold adduction (61 ± 34%), and atrophy of the hemilarynx (61 ± 31%). The multivariate analysis showed the predictive value of LEMG was estimated lower by respondents from non-university hospital (β = - 16.33; confidence interval (CI) = - 25.63 to - 7.02; p = 0.001) and higher in hospitals with higher frequency of VFP patients per months (β = 1.57; CI = - 0.98 to 2.16; p < 0.0001). 30 ELS members returned survey 2 (response rate, 8.4%). Their answers were not significantly different to survey 1.

Conclusions: The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.
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http://dx.doi.org/10.1007/s00405-018-5102-5DOI Listing
October 2018

[Restricted sleep as a secondary psychosocial consequence of facial palsy].

Laryngorhinootologie 2018 06 1;97(6):398-404. Epub 2018 Mar 1.

Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena.

Background: Facial palsy (FP) is a paralysis of facial muscles and one of the most common motor failures. It is associated with intense impairment of health related quality of life and depressive symptoms. Sleep disorders as a result of FP are often attributed to illness-related impairments, although psychosocial problems might also be the cause. This study examined the direct and indirect effects of FP on sleep quality.

Methods: The sample of this cross-sectional study included N = 81 patients with FP. Symptoms of FP (FACE), sleep quality (PSQI), quality of life (SF36), depression (PHQ9) and social anxiety (LSAS) were measured. Mediation models were used to investigate the relationship between symptoms of FP, social anxiety, depression and sleep quality.

Results: Sleep quality was decreased in 33.3 % of patients. The subjective severity of the FP correlated significantly with sleep quality. Mediation analyses suggest a causal link between the severity of FP, symptoms of social anxiety, depressive symptoms and restricted sleep quality. However, including social anxiety and depression as mediators resulted in no direct effects of FP on sleep quality.

Conclusion: Sleep problems related to FP seem to be caused less by physical than by an indirect consequence of psychosocial impairment. The change in the face associated with FP causes psychological problems which in turn lead to reduced sleep quality. The medical care of FP patients should therefore also consider the psychosocial consequences in order to prevent the onset of mental disorders (such as depression) and sleep disorders.
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http://dx.doi.org/10.1055/a-0573-2119DOI Listing
June 2018