Publications by authors named "Patrick Dubach"

26 Publications

  • Page 1 of 1

Sinus floor elevation or referral for further diagnosis and therapy: A comparison of maxillary sinus assessment by ENT specialists and dentists using cone beam computed tomography.

Clin Oral Implants Res 2020 May 12;31(5):463-475. Epub 2020 Feb 12.

Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.

Objectives: To compare ear, nose, and throat (ENT) specialists and dentists assessing health or pathology of maxillary sinuses using cone beam computed tomography (CBCT).

Material And Methods: Two ENT specialists and two oral surgeons assessed 100 CBCT datasets of healthy patients referred for dental implant placement in the posterior maxilla and decided on the possibility of sinus floor elevation or the necessity for further diagnostic examinations based solely on radiographic findings. Inter-rater agreements within the same specialty were calculated with Cohen's kappa and overall agreements with Fleiss kappa, and factors influencing the decisions taken were evaluated using regression analyses.

Results: The correlation between all four raters was generally fair to moderate. The intra-specialty comparison showed a lower correlation between dentists than between ENT specialists. Absence of membrane thickening and total or subtotal sinus opacification showed the highest predictive value for a consensus in favor of sinus floor elevation and ENT referral, respectively. Flat membrane thickening with an irregular surface morphology was associated with disagreement between the examiners. Dome-shaped membrane thickenings were often considered as to be referred by dentists but not by ENTs.

Conclusion: The assessment of maxillary sinuses using CBCT imaging exhibited unsatisfactory agreement between ENT specialists and oral surgeons. Referral guidelines based on accidental CBCT findings that aim to diagnose relevant sinus pathologies early and avoid unnecessary diagnostics and/or therapies are needed, and an initial proposal for such recommendations is provided. Further research on correct interpretation of sinus findings and a validation of the present recommendations are required.
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http://dx.doi.org/10.1111/clr.13582DOI Listing
May 2020

Blunt nasal trauma in children: a frequent diagnostic challenge.

Eur Arch Otorhinolaryngol 2019 Jan 31;276(1):85-91. Epub 2018 Oct 31.

Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.

Objective: The clinical challenge in blunt nasal trauma in children, is to identify cases requiring specialized care among frequently encountered banalities, whilst trying to minimize the exposure to diagnostic procedures. We aim to evaluate the related diagnostic and therapeutic pathways and its outcome during follow-up.

Methods: This retrospective cohort study includes children up to 16 years presenting at the emergency department with blunt nasal trauma of our tertiary reference center.

Results: The incidence of blunt nasal injuries was estimated 1750 cases in 7 years. A total of 459 consecutive cases with suspected complications were enrolled. Univariate comparison between age groups revealed a statistically significant diminution of downfall related injuries with growing up, whereas blows (including violence) significantly increased with age (p < 0.001 each). The logistic regression model identified male sex as an independent risk factor for soft tissue lesions (OR 1.699, p = 0.017) and for frontobasal fractures (OR 2.415, p = 0.050). Age was not identified to play a significant role regarding localization of injuries. Delayed septorhinoplasties became necessary in 2 cases only (0.4%). The logistic regression model identified nasal bone fracture (OR 17.038, p < 0.001) and mandibular fracture (OR 4.753, p = 0.004) as independent risk factor for a surgical intervention.

Conclusions: Blunt trauma to the nose is frequent in children. Trauma mechanisms differ significantly between age groups, whereas localization and concomitant injuries do not. Male sex was identified as an independent risk factor for soft tissue lesions and frontobasal fractures. In our experience, initial triage by the pediatric department with consecutive involvement of the ENT specialists in case of suspected complications is safe and effective and may help to reduce unnecessary diagnostic procedures/irradiation to the young patients.
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http://dx.doi.org/10.1007/s00405-018-5183-1DOI Listing
January 2019

A RARE CASE OF CROHN DISEASE COMPLICATED WITH STEROID MONOTHERAPY-RELATED RETROPHARYNGEAL ABSCESS AND INITIALLY MISINTERPRETED PYODERMA GANGRENOSUM DEVELOPMENT.

Gastroenterol Nurs 2018 Jul/Aug;41(4):347-351

Michael Doulberis, PhD, MD, DVM, Department of Internal Medicine, Bürgerspital Hospital of Solothurn, Solothurn, Switzerland; and Division of Gastroenterology, Second Department of Internal Medicine, Ippokration Hospital, Medical School of Aristotle University, Thessaloniki, Macedonia, Greece. Jörg Dähn, MD, Department of Otorhinolaryngology, Bürgerspital Hospital of Solothurn, Solothurn, Switzerland. Jannis Kountouras, PhD, MD, is Professor, Division of Gastroenterology, Second Department of Internal Medicine, Ippokration Hospital, Medical School of Aristotle University, Thessaloniki, Macedonia, Greece. Volker Maier, MD, Department of Internal Medicine, Bürgerspital Hospital of Solothurn, Solothurn, Switzerland. Arthur Helbling, MD, is Professor, Division of Allergology, University Clinic of Rheumatology, Immunology & Allergology, Inselspital/University Hospital Bern, Switzerland. Patrick Dubach, MD, is Head, Department of Otorhinolaryngology, Bürgerspital Hospital of Solothurn, Solothurn, Switzerland.

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http://dx.doi.org/10.1097/SGA.0000000000000401DOI Listing
August 2019

Binaural Tympanic-Membrane Perforations after Blast Injury.

N Engl J Med 2017 May;376(19):e41

Burgerspital Solothurn, Solothurn, Switzerland

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http://dx.doi.org/10.1056/NEJMicm1612629DOI Listing
May 2017

Endoscopic Ear Surgery for External Auditory Canal Cholesteatoma.

Otol Neurotol 2017 06;38(5):e34-e40

*Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital, and University of Bern †Department of Otorhinolaryngology, Head and Neck Surgery, Bürgerspital Solothurn, Solothurn, Switzerland ‡Department of Otorhinolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Osaka, Japan §Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.

Background: Treatment of external auditory canal cholesteatoma (EACC) has been a question of debate. To our knowledge and according to a systematic review of endoscopic ear surgery (EES) in 2015, this study describes for the first time the technique and outcome by solely transcanal EES for EACC.

Study Method: Retrospective case series, level of evidence IV.

Methods: Between October 2014 and December 2016, nine patients with unilateral EACC have been treated by EES. Using a bimanual technique, canaloplasty has been performed using tragal perichondrium, cartilage, or artificial bone. Symptoms, signs, and reconstruction technique have been assessed and the primary endpoint: healing time was compared with benchmark values in the literature.

Results: During the 26 months study period all of our nine Naim stage III EACCs were successfully treated by EES with median healing time of 23.8 days. EACC limited to the external auditory canal (Naim stage III) represented an ideal target for EES minimizing tissue damage and thus median healing time compared with retroauricular (42-56 d) or endaural (59 d) surgical techniques.

Discussion: Shorter healing time helped to reduce skepticism toward a surgical treatment of EACC from the patient's perspective. Moreover, EES relied on reduced bulky equipment, dressing time, and complex maintenance compared with microscopic techniques.

Conclusion: Transcanal endoscopic surgery is a valid treatment option for EACC up to Naim stage III. Moreover, the described procedure fosters in our eyes the teaching of our residence to get familiar with the basic steps of EES.
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http://dx.doi.org/10.1097/MAO.0000000000001386DOI Listing
June 2017

Design and evaluation of an interactive training system for scrub nurses.

Int J Comput Assist Radiol Surg 2016 Aug 12;11(8):1527-36. Epub 2016 Feb 12.

Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University of Leipzig, Semmelweisstr. 14, 04103, Leipzig, Germany.

Objective: The current trend toward increasingly integrated technological support systems and the rise of streamlined processes in the OR have led to a growing demand for personnel with higher levels of training. Although simulation systems are widely used and accepted in surgical training, they are practically non-existent for perioperative nursing, especially scrub nursing. This paper describes and evaluates an interactive OR environment simulation to help train scrub nurses.

Methods: A system comprising multiple computers and monitors, including an interactive table and a touchscreen combined with a client-server software solution, was designed to simulate a scrub nurse's workplace. The resulting demonstrator was evaluated under laboratory conditions with a multicenter interview study involving three participating ear, nose, and throat (ENT) departments in Germany and Switzerland.

Results: The participant group of 15 scrub nurses had an average of 12.8 years hands-on experience in the OR. A series of 22 questions was used to evaluate various aspects of the demonstrator system and its suitability for training novices.

Discussion: The system received very positive feedback. The participants stated that familiarization with instrument names and learning the instrument table setup were the two most important technical topics for beginners. They found the system useful for acquiring these skills as well as certain non-technical aspects.

Conclusions: Interactive training through simulation is a new approach for preparing novice scrub nurses for the challenges at the instrument table in the OR. It can also improve the lifelong training of perioperative personnel. The proposed system is currently unique in its kind. It can be used to train both technical and non-technical skills and, therefore, contributes to patient safety. Moreover, it is not dependent on a specific type of surgical intervention or medical discipline.
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http://dx.doi.org/10.1007/s11548-016-1356-9DOI Listing
August 2016

Severe Cutaneous Leishmaniasis in a Human Immunodeficiency Virus Patient Coinfected with Leishmania braziliensis and Its Endosymbiotic Virus.

Am J Trop Med Hyg 2016 Apr 1;94(4):840-843. Epub 2016 Feb 1.

Leishmania parasites cause a broad range of disease, with cutaneous afflictions being, by far, the most prevalent. Variations in disease severity and symptomatic spectrum are mostly associated to parasite species. One risk factor for the severity and emergence of leishmaniasis is immunosuppression, usually arising by coinfection of the patient with human immunodeficiency virus (HIV). Interestingly, several species of Leishmania have been shown to bear an endogenous cytoplasmic dsRNA virus (LRV) of the Totiviridae family, and recently we correlated the presence of LRV1 within Leishmania parasites to an exacerbation murine leishmaniasis and with an elevated frequency of drug treatment failures in humans. This raises the possibility of further exacerbation of leishmaniasis in the presence of both viruses, and here we report a case of cutaneous leishmaniasis caused by Leishmania braziliensis bearing LRV1 with aggressive pathogenesis in an HIV patient. LRV1 was isolated and partially sequenced from skin and nasal lesions. Genetic identity of both sequences reinforced the assumption that nasal parasites originate from primary skin lesions. Surprisingly, combined antiretroviral therapy did not impact the devolution of Leishmania infection. The Leishmania infection was successfully treated through administration of liposomal amphotericin B.
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http://dx.doi.org/10.4269/ajtmh.15-0803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824227PMC
April 2016

Mucosal Erosion of the Cricoid Cartilage After the Use of an i-Gel Supraglottic Airway Device in a Patient with Diffuse Idiopathic Skeletal Hyperostosis.

A A Case Rep 2014 Aug;3(4):45-7

From the Departments of *Anesthesiology and Pain Therapy, †Orthopedic and Trauma Surgery, and ‡Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital and University of Bern, Bern, Switzerland.

After standard hip arthroplasty, an 82-year-old patient with previously undiagnosed diffuse idiopathic skeletal hyperostosis of the cervical spine experienced life-threatening side effects after use of a supraglottic airway device (i-gel). Extensive mucosal erosion and denudation of the cricoid cartilage caused postoperative supraglottic swelling and prolonged respiratory failure requiring tracheostomy. In this case report, we highlight the importance of evaluating risk factors for failure of supraglottic airway devices.
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http://dx.doi.org/10.1213/XAA.0000000000000049DOI Listing
August 2014

FDG-PET/CT computer-assisted biopsies for suspected persistent or recurrent malignant skull base disease.

Head Neck 2014 May 12. Epub 2014 May 12.

Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, 3010, Bern, Switzerland; BMBF-Innovation Center Computer Assisted Surgery ICCAS, University of Leipzig, 04103, Leipzig, Germany.

Background: FDG-PET/CT is increasingly used for the evaluation of regional or distant metastasis in head and neck oncology. However, positive PET findings lack specificity, which is especially challenging for localized disease at the skull base. Methods: An optically tracked navigation system for multimodal image-guided biopsies was tested to evaluate PET-positive skull base lesions between 2009 and 2013. Results: FDG-PET/CT navigated biopsies of patients with suspected persistence or recurrence of carcinoma (sinonasal, n=3; nasopharyngeal, n=1; adenocarcinoma, n=2; and carcinoma of unknown primary origin, n=1) have been safely performed. Histology confirmed local persistent or recurrent malignant disease (n=5), radio-osteonecrosis (n=1) and super-infection (n=1). Conclusions: In the follow-up of tumor patients, FDG-PET/CT-navigated biopsies are a valid tool to evaluate PET-positive skull base lesions. This is an especially useful technique if functional anomalous areas in FDG-PET/CT do not cause structural alterations in MRI/CT, and if endoscopic visualization is impossible because of post-treatment alterations. Head Neck, 2014.
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http://dx.doi.org/10.1002/hed.23756DOI Listing
May 2014

Topographic bone thickness maps for Bonebridge implantations.

Eur Arch Otorhinolaryngol 2015 Jul 14;272(7):1651-8. Epub 2014 Mar 14.

ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3010, Bern, Switzerland.

Bonebridge™ (BB) implantation relies on optimal anchoring of the bone-conduction implant in the temporal bone. Preoperative position planning has to account for the available bone thickness minimizing unwanted interference with underlying anatomical structures. This study describes the first clinical experience with a planning method based on topographic bone thickness maps (TBTM) for presigmoid BB implantations. The temporal bone was segmented enabling three-dimensional surface generation. Distances between the external and internal surface were color encoded and mapped to a TBTM. Suitable implant positions were planned with reference to the TBTM. Surgery was performed according to the standard procedure (n = 7). Computation of the TBTM and consecutive implant position planning took 70 min on average for a trained technician. Surgical time for implantations under passive TBTM image guidance was 60 min, on average. The sigmoid sinus (n = 5) and dura mater (n = 1) were exposed, as predicted with the TBTM. Feasibility of the TBTM method was shown for standard presigmoid BB implantations. The projection of three-dimensional bone thickness information into a single topographic map provides the surgeon with an intuitive display of the anatomical situation prior to implantation. Nevertheless, TBTM generation time has to be significantly reduced to simplify integration in clinical routine.
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http://dx.doi.org/10.1007/s00405-014-2976-8DOI Listing
July 2015

Internet video telephony allows speech reading by deaf individuals and improves speech perception by cochlear implant users.

PLoS One 2013 24;8(1):e54770. Epub 2013 Jan 24.

University Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern, Switzerland.

Objective: To analyze speech reading through Internet video calls by profoundly hearing-impaired individuals and cochlear implant (CI) users.

Methods: Speech reading skills of 14 deaf adults and 21 CI users were assessed using the Hochmair Schulz Moser (HSM) sentence test. We presented video simulations using different video resolutions (1280 × 720, 640 × 480, 320 × 240, 160 × 120 px), frame rates (30, 20, 10, 7, 5 frames per second (fps)), speech velocities (three different speakers), webcameras (Logitech Pro9000, C600 and C500) and image/sound delays (0-500 ms). All video simulations were presented with and without sound and in two screen sizes. Additionally, scores for live Skype™ video connection and live face-to-face communication were assessed.

Results: Higher frame rate (>7 fps), higher camera resolution (>640 × 480 px) and shorter picture/sound delay (<100 ms) were associated with increased speech perception scores. Scores were strongly dependent on the speaker but were not influenced by physical properties of the camera optics or the full screen mode. There is a significant median gain of +8.5%pts (p = 0.009) in speech perception for all 21 CI-users if visual cues are additionally shown. CI users with poor open set speech perception scores (n = 11) showed the greatest benefit under combined audio-visual presentation (median speech perception +11.8%pts, p = 0.032).

Conclusion: Webcameras have the potential to improve telecommunication of hearing-impaired individuals.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054770PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554620PMC
September 2013

Diagnostic value of biopsies in identifying cytoplasmic antineutrophil cytoplasmic antibody-negative localized Wegener's granulomatosis presenting primarily with sinonasal disease.

Am J Rhinol Allergy 2012 Nov-Dec;26(6):475-80

Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital, University of Bern, Switzerland.

Background: A substantial proportion of Wegener's disease (WG) patients present with localized disease of the upper airways, i.e., sinonasal and other ear/nose/throat (ENT) symptoms. Because of the oligosymptomatic presentation a timely diagnosis of this potentially fatal disease is challenging. This study evaluates diagnostic peculiarities between WG in its localized and generalized form of the disease.

Methods: Retrospective analysis was performed of 82 patients with suspected WG manifesting in the ENT region between 1989 and 2009. Comparison was performed of the clinical and laboratory results between patients with localized (n = 15) and generalized stage (n = 16) as well as non-WG patients (n = 50).

Results: ENT signs and symptoms were subtle, especially in the population presenting with localized disease. Therapy refractory rhinosinusitis or serous otitis media were the most frequent presentations of WG. In testing for localized WG, mucosal biopsy had the highest sensitivity (53%) compared with cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCAs) with a lower sensitivity (47%) but highest specificity (96%) and highest positive predictive value (PPV; 78% versus 73%). Patients with generalized WG typically revealed a pathological urine sediment, hemoptysis, or rheumatological symptoms. In the generalized stage, c-ANCA had the highest sensitivity (81%), specificity (96% versus 95%), and highest PPV (87%).

Conclusion: Timely diagnosis and treatment of localized WG limited to the ENT region remains problematic. Even with adequate therapy, nearly one-half of patients with sinonasal localization suffer from relapse, at least 1 in 10 will progress to generalized disease, and up to two-thirds may develop permanent tissue damage. Unfortunately, the diagnostic usefulness of c-ANCA is significantly reduced at this early stage compared with cases with generalized disease (p = 0.04). Hence, the relative diagnostic value of mucosal biopsy increases especially for the significant proportion of c-ANCA(-) localized WG patients (47%). Sinonasal tissue sampling represents a cornerstone for diagnosis, which unlike c-ANCA testing can be repeated in short intervals and is associated with low morbidity.
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http://dx.doi.org/10.2500/ajra.2012.26.3825DOI Listing
July 2013

Temporal bone histopathology case of the month: Idiopathic external ear canal cholesteatoma.

Otol Neurotol 2013 Jul;34(5):e40-1

Department of Otorhinolaryngology, Head and Neck Surgery, University of Bern, Inselspital, Bern, Switzerland.

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http://dx.doi.org/10.1097/MAO.0b013e318278bcf9DOI Listing
July 2013

How reliable and safe is full-body low-dose radiography (LODOX Statscan) in detecting foreign bodies ingested by adults?

Emerg Med J 2013 Jul 25;30(7):559-64. Epub 2012 Jul 25.

University Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital Bern, Bern, Switzerland.

Objective: Foreign body ingestion is common and potentially lethal. This study evaluates the use of low-dose Statscans (LODOX) in emergency departments.

Design: This comparative cross-sectional study retrospectively assessed 28289 digital chest x-rays and 2301 LODOX scans performed between 2006 and 2010 at a tertiary emergency centre. The radiographic appearance, image quality and location of ingested foreign bodies were evaluated in standard digital chest and LODOX radiography. The mean irradiation (μSv) and cumulative mean radiation dose per patient with the ingested foreign body were calculated according to literature-based data, together with the sensitivity and specificity for each modality.

Results: A total of 62 foreign bodies were detected in 39 patients, of whom 19 were investigated with LODOX and 20 with conventional digital chest radiography. Thirty-three foreign bodies were located in the two upper abdominal quadrants, 21 in the lower quadrants-which are not visible on conventional digital chest radiography-seven in the oesophagus and one in the bronchial system. The sensitivity and specificity of digital chest radiography were 44.4% and 94.1%, respectively, and for the LODOX Statscan 90% and 100%, respectively. The calculated mean radiation dose for LODOX investigations was 184 μS, compared with 524 μS for digital chest radiography.

Conclusions: LODOX Statscan is superior to digital chest radiography in the diagnostic work-up of ingested foreign bodies because it makes it possible to enlarge the field of view to the entire body, has higher sensitivity and specificity, and reduces the radiation dose by 65%.
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http://dx.doi.org/10.1136/emermed-2011-200911DOI Listing
July 2013

Speech perception benefits of internet versus conventional telephony for hearing-impaired individuals.

J Med Internet Res 2012 Jul 16;14(4):e102. Epub 2012 Jul 16.

Cochlear Implant Division, Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University of Bern, Bern, Switzerland.

Background: Telephone communication is a challenge for many hearing-impaired individuals. One important technical reason for this difficulty is the restricted frequency range (0.3-3.4 kHz) of conventional landline telephones. Internet telephony (voice over Internet protocol [VoIP]) is transmitted with a larger frequency range (0.1-8 kHz) and therefore includes more frequencies relevant to speech perception. According to a recently published, laboratory-based study, the theoretical advantage of ideal VoIP conditions over conventional telephone quality has translated into improved speech perception by hearing-impaired individuals. However, the speech perception benefits of nonideal VoIP network conditions, which may occur in daily life, have not been explored. VoIP use cannot be recommended to hearing-impaired individuals before its potential under more realistic conditions has been examined.

Objective: To compare realistic VoIP network conditions, under which digital data packets may be lost, with ideal conventional telephone quality with respect to their impact on speech perception by hearing-impaired individuals.

Methods: We assessed speech perception using standardized test material presented under simulated VoIP conditions with increasing digital data packet loss (from 0% to 20%) and compared with simulated ideal conventional telephone quality. We monaurally tested 10 adult users of cochlear implants, 10 adult users of hearing aids, and 10 normal-hearing adults in the free sound field, both in quiet and with background noise.

Results: Across all participant groups, mean speech perception scores using VoIP with 0%, 5%, and 10% packet loss were 15.2% (range 0%-53%), 10.6% (4%-46%), and 8.8% (7%-33%) higher, respectively, than with ideal conventional telephone quality. Speech perception did not differ between VoIP with 20% packet loss and conventional telephone quality. The maximum benefits were observed under ideal VoIP conditions without packet loss and were 36% (P = .001) for cochlear implant users, 18% (P = .002) for hearing aid users, and 53% (P = .001) for normal-hearing adults. With a packet loss of 10%, the maximum benefits were 30% (P = .002) for cochlear implant users, 6% (P = .38) for hearing aid users, and 33% (P = .002) for normal-hearing adults.

Conclusions: VoIP offers a speech perception benefit over conventional telephone quality, even when mild or moderate packet loss scenarios are created in the laboratory. VoIP, therefore, has the potential to significantly improve telecommunication abilities for the large community of hearing-impaired individuals.
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http://dx.doi.org/10.2196/jmir.1818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409568PMC
July 2012

Anosmia and sarcoidosis.

Am J Med 2011 Sep 19;124(9):e25; author reply e27. Epub 2011 Apr 19.

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http://dx.doi.org/10.1016/j.amjmed.2010.10.015DOI Listing
September 2011

Images in clinical medicine. Amalgam tattoo.

N Engl J Med 2011 Apr;364(15):e29

Department of Otorhinolaryngology, Head and Neck Surgery, University of Bern Inselspital, Bern, Switzerland.

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http://dx.doi.org/10.1056/NEJMicm1011669DOI Listing
April 2011

Characteristics and dimensions of the Schneiderian membrane: a radiographic analysis using cone beam computed tomography in patients referred for dental implant surgery in the posterior maxilla.

Clin Oral Implants Res 2011 Dec 23;22(12):1446-53. Epub 2011 Mar 23.

Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Objectives: To determine the dimensions of the Schneiderian membrane using limited cone beam computed tomography (CBCT) in individuals referred for dental implant surgery, and to determine factors influencing the mucosal thickness.

Material And Methods: The study included 143 consecutive patients referred for dental implant placement in the posterior maxilla. A total of 168 CBCT images were taken using a limited field of view of 4 × 4 cm, 6 × 6 cm, or 8 × 8 cm. Reformatted coronal CBCT slices were analyzed with regard to the thickness and characteristics of the Schneiderian membrane in nine standardized points of reference. Factors such as age, gender, or status of the remaining dentition that could influence the dimensions of the Schneiderian membrane were evaluated using univariate and multivariate linear regression models.

Results: The thickness of the Schneiderian membrane exhibited a wide range, with a minimum value of 0.16 mm and a maximum value of 34.61 mm. The highest mean values, ranging from 2.16 to 3.11 mm, were found for the mucosa located in the mid-sagittal regions of the maxillary sinus. The most frequent mucosal findings diagnosed were flat thickenings of the Schneiderian membrane (62 positive findings, 37%). For the multivariate linear regression model, only gender had a statistically significant influence on the mean overall and mid-sagittal thickness of the sinus mucosa.

Conclusion: There is great interindividual variability in the thickness of the Schneiderian membrane. Gender seems to be the most important parameter influencing mucosal thickness in asymptomatic patients. Future studies are needed to assess the therapeutic and prognostic consequences of mucosal alterations in the maxillary sinus.
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http://dx.doi.org/10.1111/j.1600-0501.2010.02140.xDOI Listing
December 2011

Diffuse swelling of the buccal mucosa and palate as first and only manifestation of an extranodal non-Hodgkin 'double-hit' lymphoma: report of a case.

Oral Maxillofac Surg 2012 Mar 28;16(1):69-74. Epub 2010 Oct 28.

Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland.

Background: Most of the lymphomas arising in the oral cavity are of B-cell origin. Among these, diffuse large B-cell lymphomas are the most common. Diffuse large B-cell lymphomas may exhibit more than one chromosomal rearrangement and are then referred to as 'double-hit' or 'triple-hit' lymphomas.

Case Report: We present a case of an intraoral 'double-hit' lymphoma in a 76-year-old male who had been referred by an oral surgeon in private practice. Intraoral examination exhibited a firm, exophytic lesion in the region of the right hard palate and buccal mucosa with extension to the soft palate. Radiographic examination exhibited a massive thickening of the right sinus membrane, and arrosion of the lateral and basal cortical sinus walls in the right maxilla. After diagnosis of the lesion, the patient was treated with six cycles of chemotherapy.

Discussion: Lymphomas arising within the oral cavity account for less than 5% of all oral malignancies and typically affect the palatine tonsils and the palate. 'Double-hit' lymphomas are associated with older age, usually present with an advanced stage of disease, and show an aggressive clinical behaviour. They normally have a poor prognosis, even when treated with intensive chemotherapy regimens. Nevertheless, in the case presented, the patient was free of symptoms 1 year after initial diagnosis.
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http://dx.doi.org/10.1007/s10006-010-0254-5DOI Listing
March 2012

Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment.

Curr Opin Otolaryngol Head Neck Surg 2010 Oct;18(5):369-76

Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Purpose Of Review: We present an update on clinical evaluation, staging, classification and treatment of canal cholesteatoma, including a meta-analysis of clinical data of the last 30 years.

Recent Findings: Ear canal cholesteatoma is frequently associated secondarily to other canal pathologies. The cause for the rare idiopathic form of the disease remains enigmatic. Epidemiologic and experimental studies of its pathogenesis have increased; however, the main explanatory theory of a deficient migratory capacity of the canal epithelium affected has been falsified only recently. Therefore, the debate on the pathogenesis has gained additional impetus and more data is needed.

Summary: Canal cholesteatoma is a rarity in otologic pathology, often leading to misdiagnosis as external otitis or otomycosis by physicians unfamiliar with the disease. It presents typically with otorrhea, focal erosion and keratin accumulation in the osseous ear canal and has to be distinguished from keratosis obturans, which leads to otalgia and bilateral conductive hearing loss by ceruminal plugs, with circumferential distention of the ear canal. Treatment by canaloplasty is curative and highly successful. Alternative conservative treatment is feasible, however, requiring long-term follow up, with often painful cleaning of the lesion.
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http://dx.doi.org/10.1097/MOO.0b013e32833da84eDOI Listing
October 2010

How internet telephony could improve communication for hearing-impaired individuals.

Otol Neurotol 2010 Sep;31(7):1014-21

University Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern, Switzerland.

Objective: To test, whether modern Internet telephony with a broadband transmission (0.1-8 kHz) of speech improves speech perception in comparison to conventional telephony (0.3-3.5 kHz) in hearing-impaired and normal-hearing adults.

Study Design: Experimental clinical study.

Setting: Audiologic laboratory in a tertiary referral center in Bern, Switzerland.

Patients: Twenty-one adult hearing-impaired patients consisting of 11 users of cochlear implants and 10 users of hearing aids were selected from the institution's database based on pure tone audiograms, speech perception scores, and device settings. Ten normal-hearing adults served as controls.

Intervention: Superiority trial of speech perception assessed with Internet versus conventional telephone quality and noninferiority trial of Internet telephone versus frequency restricted, uncompressed audio CD quality. A modern broadband codec was chosen to simulate Internet telephone quality, and ideal network conditions without packet loss were assumed.

Main Outcome Measures: Speech perception scores of a monosyllabic word test in quiet and a sentence test in background noise assessed in different audio qualities.

Results: : Test scores were, on average, 15% (4-33) higher in the monosyllabic word and 25% (8-51) higher in the sentence test using Internet versus conventional telephone quality across all subject groups. Speech perception was not significantly different when Internet telephone quality was compared with high-cut CD quality.

Conclusion: Internet telephony offers significantly improved speech perception to hearing-impaired and normal-hearing adults under ideal laboratory conditions through doubling the frequency range and through conserving audio quality during digital sound processing.
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http://dx.doi.org/10.1097/MAO.0b013e3181ec1d46DOI Listing
September 2010

Intensity-modulated radiotherapy for a rendu-osler-weber disease patient with recurrent severe epistaxis: a case report.

Case Rep Med 2010 28;2010:321835. Epub 2010 Mar 28.

Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany.

We present a case of a Rendu-Osler-Weber disease patient with recurrent life threatening epistaxis demanding multiple blood transfusions despite of repetitive endoscopic laser and electrocoagulations, endovascular embolisation, septodermoplasty, and long-term intranasal dressings. As alternative treatment modalities repeatedly failed and the patient became almost permanently dependent on nasal dressing, we performed a highly conformal intensity-modulated radiotherapy of the nasal cavity; a total dose of 50 Gy in 2 Gy single fractions was applied. The therapy was very well tolerated, no acute toxicities occurred. Two weeks after the last radiation dose had been applied, the nasal dressing could be removed without problems. Endoscopical control revealed an almost avascular white mucosa without any trace of bleeding spots; previously existing hemangiomas and crusts had disappeared. After a 1-year-follow up, the patient had no significant recurrent epistaxis.
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http://dx.doi.org/10.1155/2010/321835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846684PMC
July 2011

Rumpel-Leede sign in thrombocytopenia due to Epstein-Barr virus-induced mononucleosis.

Br J Haematol 2010 Jan 26;148(1). Epub 2009 May 26.

Department of ENT, Head and Neck Surgery, Inselspital, University of Bern.

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http://dx.doi.org/10.1111/j.1365-2141.2009.07736.xDOI Listing
January 2010

Late-onset posttraumatic septal hematoma and abscess formation in a six-year-old Tamil girl--case report and literature review.

Rhinology 2008 Dec;46(4):342-4

Department of ENT, Head and Neck Surgery, Inselspital, University of Berne, Berne, Switzerland.

Nasal septal hematoma with abscess (NSHA) is an uncommon complication of trauma and studies on children are especially rare. We discuss the case of a 6-year-old girl, who was initially evaluated independently by three doctors for minor nasal trauma but had to be re-hospitalized 6 days later with NSHA. Although septal hematoma had initially been excluded (5, 7 and 24 hours after trauma), a secondary accumulation of blood seems to have occured. Delayed hematoma formation has been described in the orbit as a result of possible venous injuries after endoscopic sinus surgery. However, such an observation is new for septal hematoma in children. Thus, we recommend re-evaluation for septal hematoma 48h to 72h after paediatric nasal trauma. Such a scheduled re-examination offers a chance to treat delayed subperichondral hematoma on time before almost inevitable superinfection leads to abscess formation and destruction of the nasal infrastructure. We suggest that parents should be vigilant for delayed nasal obstruction as possible herald of hematoma accumulation within the first week.
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December 2008

External auditory canal cholesteatoma: reassessment of and amendments to its categorization, pathogenesis, and treatment in 34 patients.

Otol Neurotol 2008 Oct;29(7):941-8

Department of Otolaryngology, Head and Neck Surgery, University of Bern, Inselspital, Bern, Switzerland.

Objective: External auditory canal cholesteatoma (EACC) is a rarity. Although there have been numerous case reports, there are only few systematic analyses of case series, and the pathogenesis of idiopathic EACC remains enigmatic.

Study Design: In a tertiary referral center for a population of 1.5 million inhabitants, 34 patients with 35 EACC (13 idiopathic [1 bilateral] and 22 secondary) who were treated between 1994 and 2006 were included in the study.

Results: EACC cardinal symptoms were longstanding otorrhea (65%) and dull otalgia (12%). Focal bone destruction in the external auditory canal with retained squamous debris and an intact tympanic membrane were characteristic. Only 27% of the patients showed conductive hearing loss exceeding 20 dB. Patients with idiopathic EACC had lesions typically located on the floor of the external auditory canal and were older, and the mean smoking intensity was also greater (p < 0.05) compared with patients with secondary EACC. The secondary lesions were assigned to categories (poststenotic [n = 6], postoperative [n = 6], and posttraumatic EACC [n = 4]) and rare categories (radiogenic [n = 2], postinflammatory [n = 1], and postobstructive EACC [n = 1]). In addition, we describe 2 patients with EACC secondary to the complete remission of a Langerhans cell histiocytosis of the external auditory canal. Thirty of 34 patients were treated surgically and became all free of recurrence, even after extensive disease.

Discussion: For the development of idiopathic EACC, repeated microtrauma (e.g., microtrauma resulting from cotton-tipped applicator abuse or from hearing aids) and diminished microcirculation (e.g., from smoking) might be risk factors. A location other than in the inferior portion of the external auditory canal indicates a secondary form of the disease, as in the case of 2 patients with atypically located EACC after years of complete remission of Langerhans cell histiocytosis, which we consider as a new posttumorous category and specific late complication of this rare disease.
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http://dx.doi.org/10.1097/MAo.0b013e318185fb20DOI Listing
October 2008

Significance of coil orientation for motor evoked potentials from nasalis muscle elicited by transcranial magnetic stimulation.

Clin Neurophysiol 2004 Apr;115(4):862-70

Department of Neurology, University Hospital, Inselspital, 3010 Berne, Switzerland.

Objective: In transcranial magnetic stimulation (TMS) of the motor cortex, the optimal orientation of the coil on the scalp is dependent on the muscle under investigation, but not yet known for facial muscles.

Methods: Using a figure-of-eight coil, we compared TMS induced motor evoked potentials (MEPs) from eight different coil orientations when recording from ipsi- and contralateral nasalis muscle.

Results: The MEPs from nasalis muscle revealed three components: The major ipsi- and contra-lateral middle latency responses of approximately 10 ms onset latency proved entirely dependent on voluntary pre-innervation. They were most easily obtained from a coil orientation with posterior inducing current direction, and in this respect resembled the intrinsic hand rather than the masseter muscles. Early short duration responses of around 6 ms onset latency were best elicited with an antero-lateral current direction and not pre-innervation dependent, and therefore most probably due to stimulation of the nerve roots. Late responses (>18 ms) could inconsistently be elicited with posterior coil orientations in pre-innervated condition.

Conclusions: By using the appropriate coil orientation and both conditions relaxed and pre-innervated, cortically evoked MEP responses from nasalis muscle can reliably be separated from peripheral and reflex components and also from cross talk of masseter muscle activation.
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http://dx.doi.org/10.1016/j.clinph.2003.11.033DOI Listing
April 2004