Publications by authors named "Jan Löhler"

21 Publications

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[Possibilities to predict the success of an individual hearing aid fitting using the APHAB].

Laryngorhinootologie 2021 Jan 11. Epub 2021 Jan 11.

Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Germany.

Background:  Since 2012, the APHAB is part of the quality agreement for statutory insured patients in hearing aid fitting (HAF). So far, individual results could be interpreted by using percentile curves only, but not for the improvement quotient and the cumulated benefit. The presented study should close this gap. Moreover, it should be clarified if an individual constancy within percentile exists.

Methods:  Using the data of 6861 hearing aid fitted patients from a database, we calculated the benefit by improvement quotient and cumulated benefit for different age-classes and percentile-groups and presented by a heatmap. Individual constancy of percentile would be calculated using Spearman's rank correlation.

Results:  The average benefit was 21.41. The average of the improvement quotient was 41.01. It was significantly higher (44.36 %) in subjects younger than the average (27.26 years ± 11.86) than in the elderly (37.66 %). It decreased in cases of lower APHAB-scores before HAF concerning the percentile-group, ranging from 23.22 % to 52.07 %. Spearman's rank coefficient for the APHAB benefit was 0.285, Cohen's effect size was small. The correlation between the APHAB-score before HAF and the cumulated benefit was 0.582 and the improvement quotient was 0.270.

Conclusions:  An individual constancy within percentile before and after HAF was not detectable. Nevertheless, some relationships of the improvement quotient and the age resp. percentile-groups could be demonstrated. The benefit of HAF was less in older subjects with lower APHAB-scores and best in young subjects with higher APHAB-scores before HAF.
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http://dx.doi.org/10.1055/a-1337-3325DOI Listing
January 2021

Die Stimulation des Nervus hypoglossus in der Behandlung der obstruktiven Schlafapnoe – Aktualisiertes Positionspapier der Arbeitsgemeinschaft Schlafmedizin der DGHNO-KHC.

Laryngorhinootologie 2021 Jan 14;100(1):15-20. Epub 2020 Dec 14.

Für die Arbeitsgruppe Apnoe der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin e. V. (DGSM), Schwalmstadt-Treysa.

Hypoglossal nerve stimulation for obstructive sleep apnea - Updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Since the first statement of the German Society of Oto-Rhino-Laryngology, hypoglossal nerve stimulation (HNS) is meanwhile an established treatment option for obstructive sleep apnea (OSA). There are three HNS systems available in Germany which differ in their technical details of the underlying comparable basic principle. For the unilateral HNS with respiratory sensing, several comparative studies, high-volume register analysis and long-term reports exist. The continuous HNS without respiratory sensing does not require a sleep endoscopy for indication. For the bilateral continuous HNS as the single partially implantable device, a feasibility study exists. For indication, the assessment of positive airway pressure failure by sleep medicine is crucial, and the decision for HNS should be made in discussion of other treatment options for at least moderate OSA. The implantation center holds primarily responsibility among the interdisciplinary sleep team and is primary contact for the patient in problems. This depicts why structural processes are required to secure outcome quality and minimize complications. The aftercare of HNS patients can be provided interdisciplinary and by different medical institutions whereat minimal reporting standards to document outcome and usage are recommended.
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http://dx.doi.org/10.1055/a-1327-1343DOI Listing
January 2021

[Screening on hearing loss with the Mini-Audio-Test - A pilot study].

Laryngorhinootologie 2020 10 13;99(10):713-719. Epub 2020 Jul 13.

Institut für Medizinische Statistik, Informatik und Dokumentation, Jena, Universitätskrankenhaus, Jena, Germany.

Background: In the second half of life, an untreated hearing impairment seems to be associated to increase the risk of dementia, depression, fall, cognitive decline, or general helpless. Most of the affected persons are not treated adequately, e. g. with hearing aids. The Mini-Audio-Test (MAT) is an evaluated inventory for detecting an unknown hearing loss. This study should investigate whether the MAT could be used in a representative sample of adults.

Methods: In spring 2019, in total 123 subjects have been investigated on hearing loss using the MAT. Subjects with positive results were ask to consult an ENT-physician for further diagnostics. All data have been collected anonymously and analyzed by descriptive statistics.

Results: In general, 79 of all questioned subjects, aged from 18 to 93 years, agreed to be investigated. At all, 63 of them answered the MAT, 22 of them intended to consult an ENT-physician; only on subject really did.

Conclusion: Today, an unspecific use of the MAT for screening on hearing loss seems not to be successful. Thus, a structured approach, e. g. during a regular consultation of a physician at the age of 50 years and more, seems to be more sensible. Moreover, the public should be better informed in the risks of untreated hearing loss.
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http://dx.doi.org/10.1055/a-1209-3185DOI Listing
October 2020

[Comparison of different measurements of the benefit in hearing aid fitting using the APHAB].

Laryngorhinootologie 2020 08 14;99(8):536-544. Epub 2020 Apr 14.

HNO-Praxis, Bad Bramstedt, Germany.

Background: Questionnaires measuring the subjective outcome of hearing aid benefit are used in diagnostics of hearing loss additionally. Since 2012, the APHAB is part of the quality agreement for statutory insured patients in hearing aid fitting. Actually, calculating the benefit by the given formula (improvement quotient A) causes distortion by patients with negative results. In general, these dues to misinterpretation of the results. In this study, we proposed two alternative ways of calculation and compared the results together.

Methods: Using the data of 6861 hearing aid fitted patients from a database, we calculated the benefit by A and two new formulas (improvement quotient B and cumulated benefit) and compared the results together.

Results: The average for A was -29.02 % (SD ± 47.94) and a minimum of -637.93 %. The average for B was -13.42 % (SD ± 13.14) and a minimum of -78,63. No relevant differences by calculating the improvement quotients between A and B occurred. The average APHAB-score (EC-, BN-, and RV-subscale) was 50.70 before and 29.29 after hearing aid fitting, the average of the cumulated benefit was 21.41.

Conclusions: Quotient B avoids the intrinsic potential of distortion of A in favor of patients with negative results in hearing aid benefit. It would be useful for the further developing of the quality agreement if B in exchange for A and, in addition, the cumulated benefit should be used.
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http://dx.doi.org/10.1055/a-1144-3574DOI Listing
August 2020

[The sensitivity and specificity of the Mini-Audio-Test (MAT) for different levels of hearing loss].

Laryngorhinootologie 2020 06 6;99(6):400-406. Epub 2020 Apr 6.

HNO, Ruhr-Universität Bochum, Germany.

Background: An untreated hearing impairment could have a severe influence on the morbidity. The Mini-Audio-Test (MAT) has been developed for early detecting of a relevant hearing loss. This follow-up investigation should determine the sensitivity, specificity, and the predictive values for a minimum-level of detected hearing loss of 25, 30, 35, and 40 dB, both, in one octave-frequency between 0.5 and 4 kHz and the average of hearing loss for these four frequencies.

Methods: This survey uses data which were collected in 2016 and 2017. 943 patients parted into two groups (aged 50 to 59 years and aged 60 years and more), were investigated using the MAT. Statistical analysis on the sensitivity, specificity, and predictive values in respect were done as proportions together with the 95 %-confidence interval by a logistic regression.

Results: The sensitivity of the MAT was increasing in both groups of age by increasing the minimum of to be detected hearing loss. The specificity was decreasing as well, but less. The positive predictive values were higher for the older age-group and are decreasing by increasing of the minimum of to be detected hearing loss. In general, the values using the averaged hearing loss are noticeably lower than for the single frequency detecting. The values for the negative predictive values were contrary.

Conclusion: The results for persons aged 60 years and more are worse than for the younger. Therefore, a first screening on hearing loss starting at the age of 50 years seems to be recommended urgently. Only by this, a sufficient rehabilitation of the hearing loss could be done in time so that the negative consequences of an untreated hearing impairment could be influenced positively.
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http://dx.doi.org/10.1055/a-1144-3544DOI Listing
June 2020

[Training Curriculum for the Certificate "Diagnostics and Therapy of Oropharyngeal Dysphagia, including FEES", of the German Society for Phoniatrics and Pedaudiology and the German Society for Otolaryngology, Head and Neck Surgery].

Laryngorhinootologie 2019 Oct 14;98(10):695-700. Epub 2019 Oct 14.

Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Universitätsklinikum Eppendorf, Hamburg.

Background: In Germany, about 5 million people of all ages suffer from dysphagia. Due to demographic change and improved medical care, the incidence of swallowing disorders is expected to increase. Dysphagia is associated with an increased morbidity and mortality and leads to a considerable financial burden on the health systems. The two most common causes of dysphagia are neurological disorders and head and neck cancer. Diagnostics and therapy have developed continuously over the past decades. In particular, the flexible endoscopic evaluation of swallowing (FEES) has become an established part of dysphagia diagnostics.

Results: The certificate "Diagnostics and Therapy of Oropharyngeal Dysphagia, incl. FEES" was developed by the German Society for Phoniatrics and Pedaudiology (DGPP) and the German Society for Otolaryngology, Head and Neck Surgery (DGHNO KHC) in cooperation with the German Professional Association for Phoniatrics and Pedaudiology and the German Professional Association of Otolaryngologists.It consists of three parts: the modules (A, B and C), the indirect supervision and a practical examination. Structure, detailed contents and requirements for obtaining the certificate are described in the following article. The qualification of the lecturers and auditors are also defined.

Conclusion: The systematic training serves the quality assurance and establishment of standards in the diagnostics and therapy of oropharyngeal dysphagia in the area of phoniatrics and ear, nose and throat medicine.
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http://dx.doi.org/10.1055/a-0987-0517DOI Listing
October 2019

[Tinnitracks - First results of a user survey].

Laryngorhinootologie 2019 Nov 26;98(11):789-796. Epub 2019 Sep 26.

Universitätsklinikum Jena, Klinik für Hals-Nasen-Ohrenheilkunde, Jena.

Background:  The treatment of chronic tinnitus poses still a challenge for clinicians and researchers alike. Since a couple of years, the tailor-made notched music training (TMNMT) has been proposed as a new method in which the frequency of tonal tinnitus is been filtered from the spectrum of individually chosen music. Today, some smartphone-based apps are available for the patients, i. e. Tinnitracks.

Methods:  During spring 2018, in total 457 ENT-physicians have been consulted by e-mail in respect of effectiveness and compatibility by using Tinnitracks. The data were collected centrally, were arcsin transformed and analysed by single factor ANOVA, t-tests were used for further analyses of effects.

Results:  In total, 117 (25.6 %) of all consulted ENT-physicians participated in the survey. On average, TMNMT has been used for 1.26 years in the offices. With respect to loudness, frequency, and comfort of the tinnitus significant effects were found, which came forth by less reporting of negative in comparison of equal or better effects. Significant differences between "equal" and "better" as a positive effect of the therapy were not found.

Discussion:  The effectiveness of Tinnitracks has not been investigated. Our survey demonstrated that Tinnitracks did not influence negatively the loudness or discomfort of the tinnitus, its frequency was not influenced significantly. Negative effects were statistically not significant. Thus, a therapy with Tinnitracks could not be recommended yet.
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http://dx.doi.org/10.1055/a-1007-1858DOI Listing
November 2019

What Does Head Impulse Testing Really Test?-Reply.

JAMA Otolaryngol Head Neck Surg 2019 Sep 26. Epub 2019 Sep 26.

Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.

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http://dx.doi.org/10.1001/jamaoto.2019.2779DOI Listing
September 2019

[The influence of the daily-life relevance of APHAB-questions on answering the APHAB-questions itself].

Laryngorhinootologie 2019 Sep 24;98(9):617-624. Epub 2019 Jul 24.

Praxis HNO.

Objective: The APHAB questionnaire measures the subjective hearing impairment in different daily-life situations. Recently, a survey investigated the daily life relevance of APHAB-questions. This study should evaluate the influence of the daily-life relevance of each APHAB question on the answers of the APHAB questions itself.

Methods: Between July 2016 and November 2017, the amount of 517 hearing impaired out-clinic patients from 11 different ENT-offices in the state of Schleswig-Holstein, Germany, have been investigated by using the APHAB. Additionally, every APHAB question ought to be evaluated with respect to its daily life relevance using a four-step scale (often - sometimes - rarely - never) as well. The answers have been listed in a cross-table and statistically analyzed using the χ-test and Cramérs V.

Results: The average age of all subjects was 67.4 years (± 14.0 years); the gender of 45.3 % of all participants was female and 54.7 % was male. Using the χ-test and Cramérs V, 4 questions of the EC-, 3 of the BN-, and 2 of the RV-subscale had a middle-grade level of coherence. Regarding a weak level of coherence, the results were exactly the opposite. However, most of the inverted APHAB-questions demonstrated such a weak coherence using Cramérs V (p < 0.001).

Conclusions: Indeed, a correlation between daily-life relevance and ranking of APHAB-questions could be demonstrated. This coherence is in a half of the APHAB-questions weak and in a half middle-grade. The reasons are unclear and need further investigation.
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http://dx.doi.org/10.1055/a-0970-9205DOI Listing
September 2019

Hearing Impairment in Old Age.

Dtsch Arztebl Int 2019 Apr;116(17):301-310

Department of Ear, Nose and Throat Medicine, Universitätsklinikum Schleswig-Holstein, Campus Lübeck; German Center of Oto-Rhino-Laryngology, Head and Neck Surgery (DSZ HNO), Bonn; Otolaryngological practice, Bad Bramstedt; Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Division of Pedaudiology, Phoniatrics and Electrophysiology, University Hospital of Würzburg, CHC, Würzburg; St. Elisabeth- Hospital, Clinics of the Ruhr University of Bochum, Ear, Nose and Throat Clinic, Head and Throat Surgery, Ruhr University of Bochum; Otolaryngological group practice, Sulzbach (Taunus); Department of Otorhinolaryngology, Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheimm.

Background: Hearing impairment associated with old age (presbycusis) is becoming more common because the population is aging.

Methods: This review is based on publications retrieved by a selective search in Medline and Google Scholar, including individual studies, meta-analyses, guidelines, Cochrane reviews, and other reviews.

Results: The cardinal symptom of presbycusis is impaired communication due to bilateral hearing impairment. Patients may be unaware of the problem for a long time because of its insidious progression. Evidence suggests that untreated hearing impair- ment in old age can have extensive adverse effects on the patient's mental, physical, and social well-being. Early detection is possible with the aid of simple diagnostic tests or suitable questionnaires. In most cases, bilateral hearing aids are an effective treatment. Surgery is rarely indicated. For patients with uni- or bilateral deafness, a cochlear implant is the treatment of choice. These treatments can improve many patients' quality of life.

Conclusion: The small amount of evidence that is currently available suggests that presbycusis is underdiagnosed and under- treated in Germany. Early detection by physicians of all specialties, followed in each case by a specialized differential diagnostic evaluation, is a desirable goal.
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http://dx.doi.org/10.3238/arztebl.2019.0301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584833PMC
April 2019

[Hypersalivation - Update of the S2k guideline (AWMF) in short form].

Laryngorhinootologie 2019 Jun 5;98(6):388-397. Epub 2019 Jun 5.

Medizinische Hochschule Hannover, Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie.

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This update presents recent changes and innovation in the treatment of hypersalivation.Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, saliva aspiration, and oro-motor deficiencies. Clinical screening tools and diagnostics such as fiberoptic endoscopic evaluation of swallowing generate important data on therapy selection and control. Many cases profit from swallowing therapy programmes in order to activate compensation mechanisms as long compliances is given. In children with hypotonic oral muscles, oral stimulation plates can induce a relevant symptom release because of the improved lip closure. The pharmacologic treatment improved for pediatric cases as glycopyrrolate fluid solution (Sialanar) is now indicated for hypersalivation within the E. U. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Here, a phase III trial is completed for Incobotulinum toxin A and, in the U. S., is indicated for the treatment of adult patients with chronic hypersalivation. Surgical treatment should be reserved for isolated cases. External radiation is judged as a safe and effective therapy when using modern 3 D techniques to minimize tissue damage. Therapy effects and symptom severity has to be followed, especially in cases with underlying neurodegenerative disease.
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http://dx.doi.org/10.1055/a-0874-2406DOI Listing
June 2019

Evaluating the Diagnostic Accuracy of the Head-Impulse Test: A Scoping Review.

JAMA Otolaryngol Head Neck Surg 2019 06;145(6):550-560

Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Germany.

Importance: Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies comparing various head-impulse test (HIT) methods with other diagnostic procedures have been published but not systematically reviewed.

Objective: To conduct a scoping review and describe key characteristics of the growing number of diagnostic studies in patients presenting with vestibular symptoms.

Evidence Review: In April 2017, published studies were identified through searches of 4 bibliographic databases: Medline, Science Citation Index Expanded, the Cochrane Library, and ScienceDirect. Studies were included if they provided diagnostic accuracy data (sensitivity and specificity) for any HIT method with reference to any other vestibular test or clinical diagnosis in patients with vestibular symptoms. Study key characteristics were extracted, and the current literature was described narratively. All analysis took place between June 2017 and July 2018.

Findings: We identified a total of 27 diagnostic studies (including 3821 participants). There were disagreements between diagnostic test accuracy data both within and between studies when different HIT methods were compared with other diagnostic procedures. The proportion of correctly identified people having the disease (sensitivity) ranged between 0% and 100% (median, 41%), whereas the proportion of correctly identified people without the disease (specificity) was higher and ranged between 56% and 100% (median, 94%).

Conclusions And Relevance: Based on the studies included in this review, sensitivity, specificity, and, more importantly, the risk of misdiagnosis and associated undertreatment or overtreatment cannot be reliably estimated by HIT methods for patients with vestibular symptoms. We recommend that further diagnostic studies consider (1) multiple possible underlying causes of vestibular symptoms and multiple test thresholds, (2) a representative sample of patients with and without the disease, and (3) reporting guidelines for diagnostic test accuracy studies.
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http://dx.doi.org/10.1001/jamaoto.2019.0243DOI Listing
June 2019

Hypersalivation: update of the German S2k guideline (AWMF) in short form.

J Neural Transm (Vienna) 2019 07 10;126(7):853-862. Epub 2019 Apr 10.

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

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This update presents recent changes and innovation in the treatment of hypersalivation. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, saliva aspiration, and oro-motor deficiencies. Clinical screening tools and diagnostics such as fiberoptic endoscopic evaluation of swallowing generate important data on therapy selection and control. Many cases profit from swallowing therapy programmes to activate compensation mechanisms as long compliances are given. In children with hypotonic oral muscles, oral stimulation plates can induce a relevant symptom release because of the improved lip closure. The pharmacologic treatment improved for pediatric cases as glycopyrrolate fluid solution (Sialanar) is now indicated for hypersalivation within the EU. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long-lasting saliva reduction. Here, a phase III trial is completed for incobotulinum toxin A and, in the US, is indicated for the treatment of adult patients with chronic hypersalivation. Surgical treatment should be reserved for isolated cases. External radiation is judged as a safe and effective therapy when using modern 3D techniques to minimize tissue damage. Therapy effects and symptom severity have to be followed, especially in cases with underlying neurodegenerative disease.
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http://dx.doi.org/10.1007/s00702-019-02000-4DOI Listing
July 2019

The prevalence of hearing loss and use of hearing aids among adults in Germany: a systematic review.

Eur Arch Otorhinolaryngol 2019 Apr 9;276(4):945-956. Epub 2019 Feb 9.

Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine, University Teaching Hospital, Albert Ludwig University of Freiburg, Freiburg, Germany.

Background: Worldwide approximately 360 million people suffer from hearing impairment, 328 million of whom are adults. Up to now there has been no systematic evaluation of any representative epidemiological data on the prevalence of hearing loss among adults in Germany. The present paper is intended to investigate this within the framework of a systematic review.

Methods: A systematic literature search was carried out in electronic databases as well as by means of hand-searching. Studies published after 1975 and indicating the prevalence or incidence of hearing impairment among German adults were included. Study selection, data extraction and additional quality assessments were made by two independent reviewers.

Results: By means of a systematic literature search it was possible to identify 6 sources, which provided solely cross-sectional data, whereby the reported data are based on a study population of between some hundred and 10 million people living in Germany. The prevalences ascertained showed a broad range of between 16% and 25% and varied according to age, study setting, definition of hearing loss and method of data capture. At present there are no utilizable data on the extent of the use of hearing aids.

Discussion: The present review demonstrates clearly that evidence-based information relating to Germany can only be made on the basis of a clear definition of hearing loss within the framework of an up-to-date and representative epidemiological study carried out with appropriate methodology. In view of the high prevalence of illnesses causing hearing impairment and of the risks to health associated with untreated hearing impairment as well as of socio-economic costs, such an epidemiological study is of great social significance.
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http://dx.doi.org/10.1007/s00405-019-05312-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426811PMC
April 2019

[The Mini-Audio-Test (MAT) - a screening method on hearing impairment to be used by general practitioners and specialized physicians].

Laryngorhinootologie 2019 Jan 5;98(1):27-34. Epub 2018 Dec 5.

Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie der Ruhr-Universität Bochum.

Background: In Germany, about 15 million people are suffering from hearing loss (HL), whereas only 16 % are using hearing aids. Untreated hearing loss may lead to severe complications (e. g. social isolation, depression, progress of dementia). An early and widespread screening, beginning at the age of 50, is meant to improve this shortage in medical care. By this study, the Mini-Audio-Test (MAT), a six-question and three-step answers containing questionnaire on subjective HL, should be verified on a normal collective of subjects (sensitivity (Se), specificity (Sp), positive predictive value (Ppv)).

Methods: 943 subjects (older 50 years) without any history of ear disease answered the MAT and received pure-tone audiometry. The Se, Sp, and Pv to detect a relevant HL with the MAT for the age-group < 60 years (AG1) and ≥ 60 years (AG2) were determined.

Results: The Se for AG1 was 0.66, the Sp 0.61, the Ppv 0.60, for AG2 the Se was 0.47, the Sp 0.80, the Ppv 0,89.

Conclusion: Following our results, the MAT is recommended as a general screening-tool for HL in patients over 50 years of age for general practitioners. Hereby, severe secondary diseases (loss of cognitive power, risk of fall, depression, dementia) could be influenced positively.
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http://dx.doi.org/10.1055/a-0805-5741DOI Listing
January 2019

Are electronic cigarettes a healthier alternative to conventional tobacco smoking?

Eur Arch Otorhinolaryngol 2019 Jan 3;276(1):17-25. Epub 2018 Nov 3.

Schleswig-Holstein University Hospital, Lübeck Campus, ENT Clinic, Lübeck, Germany.

Electronic cigarettes (EC) with and without nicotine are used by more and more consumers within the last decade. The long-term risks of vapor inhalation are unknown. This study should describe the state of the art of knowledge with respect to the following four items: (1) ingredients of the vapor and their potential risks, the influence of EC on smoking of combustible tobacco to (2) adults and (3) the youth, and (4) the side effects of passive vaping. The vapor of EC contains, in comparison to tobacco smoke, less harmful substances, qualitatively and quantitatively. But, due to failing standardization of EC, this comparison is difficult. Adults are often using both, EC and combustible cigarettes dually. In addition, EC were used for supporting smoke-quitting. Unfortunately, consuming EC with and without nicotine due later to a higher risk of conventional tobacco smoking for the user. In general, the effects of passive vaporing are unknown. Although the vapor of EC is less harmful than tobacco smoke, EC are not hazard-free lifestyle products. Technical standardization should be desirable. Adult smoker's benefit using EC is given by completely change to EC only. The rates of success using EC for smoke quitting are not well evaluated. Children and their parents should be informed on the risks of EC use as a precursor of combustible smoking mandatorily. Internet selling EC to any non-adult should be forbidden by law. EC ought not to be allowed to weaken non-smoker's rights, and third persons should be protected by the potential hazards of EC vaporing.
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http://dx.doi.org/10.1007/s00405-018-5185-zDOI Listing
January 2019

Sensitivity and specificity of the abbreviated profile of hearing aid benefit (APHAB).

Eur Arch Otorhinolaryngol 2017 Oct 29;274(10):3593-3598. Epub 2017 Jul 29.

Section of Phoniatrics and Pedaudiology in the Department of ENT-Surgery, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.

Subjective hearing loss in hearing-impaired patients can be assessed by inventory questionnaires. The abbreviated profile of hearing aid benefit (APHAB) measures subjective hearing loss in four typical hearing situations (subscales). It is used to fit hearing aids in patients with statutory insurance in Germany. In addition, the unaided APHAB (APHAB) can be used as a primary diagnostic instrument in audiology. There are no published data regarding the sensitivity and specificity of the unaided APHAB. Therefore, we investigated these parameters for detecting hearing loss of at least 25 dB at any frequency between 0.5 and 8.0 kHz. We used the APHAB to determine hearing loss in 245 subjects aged 50 years and older without any reported disease of the ears. Due to incomplete answering of the APHAB form, 55 subjects have been excluded. We also measured the pure-tone thresholds by air conduction for all octave frequencies between 0.5 and 8 kHz. Receiver operating characteristic (ROC) curves and the Youden Index were used to determine the diagnostic value of the APHAB, particularly sensitivity and specificity, in three different ways: (1) separately for ease of communication (EC), background noise (BN), and hearing with reverberation (RV) subscales; (2) with the mean value of EC, BN, and RV; and (3) with a logistic regression model. The area under the ROC curve was lower for BN only (0.83) and nearly equal for all other methods (0.87-0.89). Depending on how we performed the analyses, the sensitivity of the APHAB was 0.70-0.84 (single subscales), 0.76 (mean value of EC, BN, and RV), or 0.85 (logistic regression model). The specificity was 0.79-0.95. The use of single APHAB subscales for determining the sensitivity and specificity of the APHAB due to confusing results. In comparison, the use of the mean value of EC, BN, and RV and the use of the logistic regression model due to equal values in the ROC curves but a higher sensitivity in the logistic regression model. Therefore, we would recommend the last method for determining the sensitivity and specificity of the APHAB.
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http://dx.doi.org/10.1007/s00405-017-4680-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591815PMC
October 2017

Evidence and evidence gaps - an introduction.

GMS Curr Top Otorhinolaryngol Head Neck Surg 2016 15;15:Doc11. Epub 2016 Dec 15.

German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; Scientific Institute for Applied Oto-Rhino-Laryngology, Bad Bramstedt, Germany.

Medical treatment requires the implementation of existing evidence in the decision making process in order to be able to find the best possible diagnostic, therapeutic or prognostic measure for the individual patient based on the physician's own expertise. Clinical trials form the evidence base and ideally, their results are assembled, analyzed, summarized, and made available in systematic review articles. Beside planning, conducting, and evaluating clinical trials in conformity with GCP (good clinical practice), it is essential that all results of conducted studies are publicly available in order to avoid publication bias. This includes also the public registration of planned and cancelled trials. During the last 25 years, evidence-based medicine became increasingly important in medical care and research. It is closely associated with the names of Archibald Cochrane and David Sackett. About 15 years ago, the Deutsche Cochrane Zentrum (Cochrane Germany) and the Deutsche Netzwerk Evidenzbasierte Medizin e.V. (German Network for Evidence-based Medicine, DNEbM) were founded in Germany. In the International Cochrane Collaboration, clinicians and methodologists come together on an interdisciplinary level to further develop methods of evidence-based medicine and to discuss the topics of evidence generation and processing as well as knowledge transfer. Evidence is particularly important for physicians in the process of decision making, however, at the same time it is the base of a scientific proof of benefit for the patient and finally for the payers in health care. The closure of evidence gaps requires enormously high staff and financial resources, significant organizational efforts, and it is only successful when clinical and methodical expertise as well as specific knowledge in the field of clinical research are included. On the other hand, the knowledge has to be transferred into practice. For this purpose, practice guidelines, meetings, databases, information portals with processed evidence as well as specific journals and finally teaching are appropriate vehicles. One problem is the multitude of information so that knowledge gaps may affect the clinical routine despite actually existing evidence. Generally, it still takes several years until new knowledge is implemented in daily routine. The German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsche Gesellschaft für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., DGHNOKHC) and the Professional Association of Otolaryngologists (Deutscher Berufsverband der HNO-Ärzte e.V., BVHNO) have fundamental interest in supporting their members in generating, processing, and providing evidence as well as accompanying knowledge transfer. It encompasses the fields of diagnostics, therapy, and prognosis in the same way as prevention and applies to medicinal products as well as to medical devices or surgical procedures. The base for this is the regular assessment of evidence gaps, also in the area of established procedures, that has to be followed by a prioritization of research questions and the subsequent initiation of clinical research. In addition, large trials verifying therapies and diagnostics, for example in the context of daily conditions after approval, can only be conducted combining all resources in the ENT community. Together, the executive committees of the DGHNOKHC and the BVHNO founded the German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsches Studienzentrum für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie, DSZ-HNO). First projects have been initiated, among those a clinical trial on the therapy of sudden hearing loss supported by the BMBF and a survey on evidence gaps in oto-rhino-laryngology. It seems to be both reasonable and feasible to make available methodological expertise via such an infrastructure of a study center for physicians in hospitals and private practices in order to support clinical research and to implement the principles of evidence-based medicine in daily routine.
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http://dx.doi.org/10.3205/cto000138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5169084PMC
December 2016

Evidence gaps in ENT surgery - a qualitative survey.

GMS Curr Top Otorhinolaryngol Head Neck Surg 2016 15;15:Doc10. Epub 2016 Dec 15.

German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; University Department of Otolaryngology, Philipps University of Marburg, Germany.

As in other disciplines, the burgeoning knowledge in ENT medicine long ago surpassed our ability to adequately absorb it and maintain a proper overview. This can give rise to actual or assumed evidence gaps that can impede the progress of the discipline and evidence-based treatment of patients. Clinics and medical practices also hold to traditional doctrines that shape day-to-day medicine, without these schools being challenged based on evidence. Between February and June 2015, 160 ENT clinics, including 34 university hospitals, and 2,670 ENT practices took part in a two-arm online survey on existing or perceived evidentiary gaps in ENT medicine using a previously developed questionnaire. The survey used for half of the participants was open in form; the other half were given a closed survey with systematics of the field for orientation. The survey was augmented with additional data such as the number of publications and focus areas in the clinics and the age and type of practice of the established physicians. The return rate from the clinics was 39.7%; the return rate of the closed surveys was 29.3%. Of the physicians in medical practice, 14.6% responded to the closed and 18.6% to the open survey. There were no major differences between the two forms of survey. Otological and oncological issues comprised approximately 30% of the list of answers from clinics. Corresponding questions were formulated regarding the current diagnostic and therapeutic problems, such as with stage-related tumor treatment or implantable hearing aids. Diagnostic procedures, e.g., special new procedures in audiology and vestibulogy, dominated the surveys from the practices. However clinics and practices alike cited marginal areas of the discipline that are of daily relevance. The cited evidence gaps then needed to be verified or refuted and clarified based on research of the literature as to whether the existing evidence actually reached healthcare providers in the form of guidelines, publications, conferences, or continuing training for application in daily practice. Other steps would include prioritizing future research, evidence mapping, deciding on further systematic reviews, and targeted studies in conjunction with procuring third-party funding and in cooperation with patient associations. The knowledge thus gained should ultimately be transferred in improved form for application in daily clinical practice. Ten questions of key importance each needed to be formulated for the hospitals and practices.
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http://dx.doi.org/10.3205/cto000137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5169083PMC
December 2016

[Hearing loss--what to do if the patient does not understand you].

MMW Fortschr Med 2012 Jun;154(11):68-71

HNO-Praxis, Bad Bramstedt.

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http://dx.doi.org/10.1007/s15006-012-0756-1DOI Listing
June 2012