Publications by authors named "Stefan K Plontke"

124 Publications

[Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia. German version].

HNO 2022 Aug 3. Epub 2022 Aug 3.

Universitätsklinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.

Background: The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), a semi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area.

Material And Methods: A preoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome.

Results: Between 2014 and 2021 a 3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3 males, 2 females; age range 17-56 years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed a clear benefit for hearing 3 months and > 11 months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery.

Conclusion: Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.
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http://dx.doi.org/10.1007/s00106-022-01189-3DOI Listing
August 2022

Influence of the spread of electric field on neural excitation in cochlear implant users: Transimpedance and spread of excitation measurements.

Hear Res 2022 Jul 23;424:108591. Epub 2022 Jul 23.

Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany. Electronic address:

Channel interactions caused by spread of the intracochlear electric field and, thus, the spread of neural excitation constrain frequency selectivity and speech recognition in cochlear implant (CI) users. Studying the influence of the spread of electric field (SEF) on the spread of excitation (SOE) can help us better understand the electrical-neural interface. The primary aim of this study was to examine the influence of the SEF on the SOE. In 38 Nucleus (Cochlear Ltd. Sydney, Australia) CI recipients, we assessed the spatial SEF by measuring the voltage drop (transimpedance) and the SOE through neural responses (electrically evoked compound action potentials [eCAPs]) along the electrode array. Transimpedance was recorded using the monopolar (MP2) mode as the stimulation and recording mode. Biphasic square-wave pulses with an amplitude of 110 CL and duration of 37 µs were used for stimulation. SOE was measured at the probe active electrodes E5, E13, and E18. The stimulation amplitudes were set individually to the thresholds of the neural response telemetry (T-NRT), which were measured by the AutoNRT protocol. The transimpedance half-widths were between 0.00 electrodes and 8.55 electrodes. The SOE half-widths reached values between 0.54 electrodes and 5.70 electrodes. Considering individual transimpedance and SOE half-widths, the SEF and SOE showed a significant positive correlation only at electrode E13. Furthermore, this study shows a significant negative correlation of the SEF and SOE in consideration of mean half-widths.
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http://dx.doi.org/10.1016/j.heares.2022.108591DOI Listing
July 2022

Intratympanic corticosteroids for sudden sensorineural hearing loss.

Cochrane Database Syst Rev 2022 07 22;7:CD008080. Epub 2022 Jul 22.

Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is common, and defined as a sudden decrease in sensorineural hearing sensitivity of unknown aetiology. Systemic corticosteroids are widely used, however their value remains unclear. Intratympanic injections of corticosteroids have become increasingly common in the treatment of ISSNHL.

Objectives: To assess the effects of intratympanic corticosteroids in people with ISSNHL.

Search Methods: The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL (2021, Issue 9); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials (search date 23 September 2021).

Selection Criteria: We included randomised controlled trials (RCTs) involving people with ISSNHL and follow-up of over a week. Intratympanic corticosteroids were given as primary or secondary treatment (after failure of systemic therapy).

Data Collection And Analysis: We used standard Cochrane methods, including GRADE to assess the certainty of the evidence. Our primary outcome was change in hearing threshold with pure tone audiometry. Secondary outcomes included the proportion of people whose hearing improved, final hearing threshold, speech audiometry, frequency-specific hearing changes and adverse effects.

Main Results: We included 30 studies, comprising 2133 analysed participants. Some studies had more than two treatment arms and were therefore relevant to several comparisons. Studies investigated intratympanic corticosteroids as either primary (initial) therapy or secondary (rescue) therapy after failure of initial treatment. 1. Intratympanic corticosteroids versus systemic corticosteroids as primary therapy We identified 16 studies (1108 participants). Intratympanic therapy may result in little to no improvement in the change in hearing threshold (mean difference (MD) -5.93 dB better, 95% confidence interval (CI) -7.61 to -4.26; 10 studies; 701 participants; low-certainty). We found little to no difference in the proportion of participants whose hearing was improved (risk ratio (RR) 1.04, 95% CI 0.97 to 1.12; 14 studies; 972 participants; moderate-certainty). Intratympanic therapy may result in little to no difference in the final hearing threshold (MD -3.31 dB, 95% CI -6.16 to -0.47; 7 studies; 516 participants; low-certainty). Intratympanic therapy may increase the number of people who experience vertigo or dizziness (RR 2.53, 95% CI 1.41 to 4.54; 1 study; 250 participants; low-certainty) and probably increases the number of people with ear pain (RR 15.68, 95% CI 6.22 to 39.49; 2 studies; 289 participants; moderate-certainty). It also resulted in persistent tympanic membrane perforation (range 0% to 3.9%; 3 studies; 359 participants; very low-certainty), vertigo/dizziness at the time of injection (1% to 21%, 3 studies; 197 participants; very low-certainty) and ear pain at the time of injection (10.5% to 27.1%; 2 studies; 289 participants; low-certainty). 2. Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as primary therapy We identified 10 studies (788 participants). Combined therapy may have a small effect on the change in hearing threshold (MD -8.55 dB better, 95% CI -12.48 to -4.61; 6 studies; 435 participants; low-certainty). The evidence is very uncertain as to whether combined therapy changes the proportion of participants whose hearing is improved (RR 1.27, 95% CI 1.15 to 1.41; 10 studies; 788 participants; very low-certainty). Combined therapy may result in slightly lower (more favourable) final hearing thresholds but the evidence is very uncertain, and it is not clear whether the change would be important to patients (MD -9.11 dB, 95% CI -16.56 to -1.67; 3 studies; 194 participants; very low-certainty). Some adverse effects only occurred in those who received combined therapy. These included persistent tympanic membrane perforation (range 0% to 5.5%; 5 studies; 474 participants; very low-certainty), vertigo or dizziness at the time of injection (range 0% to 8.1%; 4 studies; 341 participants; very low-certainty) and ear pain at the time of injection (13.5%; 1 study; 73 participants; very low-certainty).  3. Intratympanic corticosteroids versus no treatment or placebo as secondary therapy We identified seven studies (279 participants). Intratympanic therapy may have a small effect on the change in hearing threshold (MD -9.07 dB better, 95% CI -11.47 to -6.66; 7 studies; 280 participants; low-certainty). Intratympanic therapy may result in a much higher proportion of participants whose hearing is improved (RR 5.55, 95% CI 2.89 to 10.68; 6 studies; 232 participants; low-certainty). Intratympanic therapy may result in lower (more favourable) final hearing thresholds (MD -11.09 dB, 95% CI -17.46 to -4.72; 5 studies; 203 participants; low-certainty). Some adverse effects only occurred in those who received intratympanic injection. These included persistent tympanic membrane perforation (range 0% to 4.2%; 5 studies; 185 participants; very low-certainty), vertigo or dizziness at the time of injection (range 6.7% to 33%; 3 studies; 128 participants; very low-certainty) and ear pain at the time of injection (0%; 1 study; 44 participants; very low-certainty).  4. Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as secondary therapy We identified one study with 76 participants. Change in hearing threshold was not reported. Combined therapy may result in a higher proportion with hearing improvement, but the evidence is very uncertain (RR 2.24, 95% CI 1.10 to 4.55; very low-certainty). Adverse effects were poorly reported with only data for persistent tympanic membrane perforation (rate 8.1%, very low-certainty).

Authors' Conclusions: Most of the evidence in this review is low- or very low-certainty, therefore it is likely that further studies may change our conclusions.   For primary therapy, intratympanic corticosteroids may have little or no effect compared with systemic corticosteroids. There may be a slight benefit from combined treatment when compared with systemic treatment alone, but the evidence is uncertain. For secondary therapy, there is low-certainty evidence that intratympanic corticosteroids, when compared to no treatment or placebo, may result in a much higher proportion of participants whose hearing is improved, but may only have a small effect on the change in hearing threshold. It is very uncertain whether there is additional benefit from combined treatment over systemic steroids alone. Although adverse effects were poorly reported, the different risk profiles of intratympanic treatment (including tympanic membrane perforation, pain and dizziness/vertigo) and systemic treatment (for example, blood glucose problems) should be considered when selecting appropriate treatment.
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http://dx.doi.org/10.1002/14651858.CD008080.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307133PMC
July 2022

Insights into Inner Ear Function and Disease Through Novel Visualization of the Ductus Reuniens, a Seminal Communication Between Hearing and Balance Mechanisms.

J Assoc Res Otolaryngol 2022 Jul 8. Epub 2022 Jul 8.

Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, Annenberg Building Room 12-90, 1468 Madison Ave, New York, NY, 10029, USA.

The sensory end-organs responsible for hearing and balance in the mammalian inner ear are connected via a small membranous duct known as the ductus reuniens (also known as the reuniting duct (DR)). The DR serves as a vital nexus linking the hearing and balance systems by providing the only endolymphatic connection between the cochlea and vestibular labyrinth. Recent studies have hypothesized new roles of the DR in inner ear function and disease, but a lack of knowledge regarding its 3D morphology and spatial configuration precludes testing of such hypotheses. We reconstructed the 3D morphology of the DR and surrounding anatomy using osmium tetroxide micro-computed tomography and digital visualizations of three human inner ear specimens. This provides a detailed, quantitative description of the DR's morphology, spatial relationships to surrounding structures, and an estimation of its orientation relative to head position. Univariate measurements of the DR, inner ear, and cranial planes were taken using the software packages 3D Slicer and Zbrush. The DR forms a narrow, curved, flattened tube varying in lumen size, shape, and wall thickness, with its middle third being the narrowest. The DR runs in a shallow bony sulcus superior to the osseus spiral lamina and adjacent to a ridge of bone that we term the "crista reuniens" oriented posteromedially within the cranium. The DR's morphology and structural configuration relative to surrounding anatomy has important implications for understanding aspects of inner ear function and disease, particularly after surgical alteration of the labyrinth and potential causative factors for Ménière's disease.
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http://dx.doi.org/10.1007/s10162-022-00858-yDOI Listing
July 2022

Efficacy and safety of systemic, high-dose glucocorticoid therapy for idiopathic sudden sensorineural hearing loss : Study protocol for a three-armed, randomized, triple-blind, multicenter trial (HODOKORT).

HNO 2022 Jul 20;70(Suppl 2):30-44. Epub 2022 Jun 20.

Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.

Background: Systemic glucocorticosteroids ("steroids") are widely used worldwide as a standard of care for primary therapy of idiopathic sudden sensorineural hearing loss (ISSHL). The German ISSHL guideline recommends high-dose steroids without evidence from randomized controlled trials (RCTs) and refers solely to retrospective cohort studies. This RCT aims to assess the efficacy (improvement in hearing) and safety (especially systemic side effects) of high-dose steroids versus standard of care (standard dose systemic steroids) for the treatment of unilateral ISSHL, when given as a primary therapy.

Methods: The study is designed as a multicenter (approximately 40 centers), randomized, triple-blind, three-armed, parallel group, clinical trial with 312 adult patients. The interventions consist of 5 days of 250 mg/day intravenous prednisolone (intervention 1) + oral placebo, or 5 days of 40 mg/day oral dexamethasone (intervention 2) + intravenous placebo. The control intervention consists of 60 mg oral prednisolone for 5 days followed by five tapering doses + intravenous placebo. The primary efficacy endpoint is the change in hearing threshold in the three most affected contiguous frequencies between 0.25 and 8 kHz 1 month after ISSHL. Secondary endpoints include further measures of hearing improvement including speech audiometry, tinnitus, quality of life, blood pressure, and altered glucose tolerance.

Discussion: There is an unmet medical need for an effective medical therapy of ISSHL. Although sensorineural hearing impairment can be partially compensated by hearing aids or cochlear implants (CI), generic hearing is better than using hearing aids or CIs. Since adverse effects of a short course of high-dose systemic corticosteroids have not been documented with good evidence, the trial will improve knowledge on possible side effects in the different treatment arms with a focus on hyperglycemia and hypertension.

Trial Registration: EudraCT (European Union Drug Regulating Authorities Clinical Trials Database) Nr. 2015-002602-36; Sponsor code: KKSH-127.
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http://dx.doi.org/10.1007/s00106-022-01184-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208545PMC
July 2022

Where do we come from? Where are we? Where are we going? : President's speech at the 92nd Annual Meeting of the German Society of Otorhinolaryngology, Head and Neck Surgery on the occasion of its centennial.

Authors:
Stefan K Plontke

HNO 2022 07 1;70(Suppl 2):18-29. Epub 2022 Jun 1.

Dept. of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.

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http://dx.doi.org/10.1007/s00106-021-01137-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9157482PMC
July 2022

The vestibular labyrinth is more robust than previously thought-Lessons from surgical removal of intracochlear schwannoma.

HNO 2022 07 1;70(Suppl 2):15-17. Epub 2022 Jun 1.

Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.

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http://dx.doi.org/10.1007/s00106-022-01175-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256573PMC
July 2022

Influence of Hearing Rehabilitation With Active Middle Ear and Bone Conduction Implants on Postural Control.

Front Neurol 2022 11;13:846999. Epub 2022 May 11.

Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.

Background: As audition also seems to contribute to balance control, additionally to visual, proprioceptive, and vestibular information, we hypothesize that hearing rehabilitation with active middle ear and bone conduction implants can influence postural control.

Methods: In a prospective explorative study, the impact of hearing rehabilitation with active middle ear [Vibrant Soundbrige (VSB), MED-EL, Innsbruck, Austria] and bone conduction implants [Bonebridge (BB), MED-EL, Innsbruck, Austria] on postural control in adults was examined in three experiments. Vestibulospinal control was measured by cranio-corpography (CCG), trunk sway velocity (°/s) by the Standard Balance Deficit Test (SBDT), and postural stability with a force plate system, each time in best aided (BA) and unaided (UA) condition with frontal-noise presentation (Fastl noise, 65 dB SPL), followed by subjective evaluation, respectively.

Results: In 26 subjects [age 55.0 ± 12.8 years; unilateral VSB/BB: = 15; bilateral VSB/BB: = 3, bimodal (VSB/BB + hearing aid): = 8], CCG-analysis showed no difference between BA and UA conditions for the means of distance, angle of displacement, and angle of rotation, respectively. Trunk sway measurements revealed a relevant increase of sway in standing on foam ( = 0.01, = 0.51) and a relevant sway reduction in walking ( = 0.026, = 0.44, roll plane) in BA condition. Selective postural subsystem analysis revealed a relevant increase of the vestibular component in BA condition ( = 0.017, = 0.47). As measured with the Interactive Balance System (IBS), 42% of the subjects improved stability (ST) in BA condition, 31% showed no difference, and 27% deteriorated, while no difference was seen in comparison of means. Subjectively, 4-7% of participants felt that noise improved their balance, 73-85% felt no difference, and 7-23% reported deterioration by noise. Furthermore, 46-50% reported a better task performance in BA condition; 35-46% felt no difference and 4-15% found the UA situation more helpful.

Conclusions: Subjectively, approximately half of the participants reported a benefit in task performance in BA condition. Objectively, this could only be shown in one mobile SBDT-task. Subsystem analysis of trunk sway provided insights in multisensory reweighting mechanisms.
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http://dx.doi.org/10.3389/fneur.2022.846999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9130604PMC
May 2022

A case series shows independent vestibular labyrinthine function after major surgical trauma to the human cochlea.

Commun Med (Lond) 2021 6;1:37. Epub 2021 Oct 6.

Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany.

Background: The receptors for hearing and balance are housed together in the labyrinth of the inner ear and share the same fluids. Surgical damage to either receptor system was widely believed to cause certain permanent loss of the receptor function of the other. That principle, however, has been called into question because there have been anecdotal reports in individual patients of at least partial preservation of cochlear function after major surgical damage to the vestibular division and vice versa.

Methods: We performed specific objective vestibular function tests before and after surgical trauma (partial or subtotal cochlear removal) for treatment of intracochlear tumors in 27 consecutive patients in a tertiary referral center. Vestibular function was assessed by calorics (low-frequency response of the lateral semicircular canal), vestibulo-ocular reflex by video head impulse test (vHIT) of the three semicircular canals, cervical and ocular vestibular evoked myogenic potentials (cVEMP, saccule and oVEMP, utricle). Preoperative and postoperative distributions were compared with paired -tests.

Results: Here we show that there was no significant difference between pre- and post-operative measures for all tests of the five vestibular organs, and that after major surgical cochlear trauma, the vestibular receptors continue to function independently.

Conclusions: These surprising observations have important implications for our understanding of the function and the surgery of the peripheral auditory and vestibular system in general and open up new possibilities for the development, construction and evaluation of neural interfaces for electrical or optical stimulation of the peripheral auditory and vestibular nervous system.
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http://dx.doi.org/10.1038/s43856-021-00036-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053204PMC
October 2021

[The vestibular labyrinth is more robust than previously thought-lessons from surgical removal of intracochlear schwannoma. German version].

HNO 2022 06 28;70(6):415-417. Epub 2022 Apr 28.

Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.

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http://dx.doi.org/10.1007/s00106-022-01174-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160155PMC
June 2022

[Case report on traumatic complete laryngotracheal separation with a positive outcome].

HNO 2022 Apr 1. Epub 2022 Apr 1.

Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.

History: A 21-year-old female was injured by accidental strangulation. Dyspnea and stridor occurred with delay, and led to emergency intubation.

Findings: Physical examination showed strangulation marks and neck emphysema. Computed tomography confirmed laryngotracheal separation and revealed misplacement of the ventilation tube.

Diagnosis: Further surgical exploration revealed complete laryngotracheal (cricotracheal) separation.

Treatment: After initial emergency tracheotomy, cricotracheal reanastomosis was achieved by a two-stage surgical approach.

Conclusion: Laryngotracheal separation is associated with high mortality. In the case presented herein, the patient survived and was discharged from hospital without a tracheostomy tube despite bilateral recurrent laryngeal nerve palsy.
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http://dx.doi.org/10.1007/s00106-022-01159-9DOI Listing
April 2022

[Objective Audiological Test Procedures: Indications and Differential Diagnostics].

Laryngorhinootologie 2022 Apr 23;101(4):335-362. Epub 2022 Mar 23.

Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals- Chirurgie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Halle (Saale), Germany.

Diagnostics of hearing loss comprises subjective and objective methods and is successfully applied since many decades. This article introduces into the methods of impedance audiometry, otoacoustic emissions, auditory evoked potentials and electrically evoked potentials and describes the respective methodologies. Using an exemplary case, in this article we guide through all stages of objective audiological diagnostics and introduce the scientific and technical background, the application and evaluation of the findings of the objective test procedures. An application pathway for objective audiometric diagnostic tools is also described, including newborn hearing screening, differential diagnostics of hearing loss, auditory neuropathy, sudden sensorineural hearing loss, vestibular schwannoma and pediatrics patients. Finally, the application to patients with active middle-ear implants and cochlear implants is described.
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http://dx.doi.org/10.1055/a-1673-2986DOI Listing
April 2022

[Where do we come from? Where are we? Where are we going? : President's speech at the 92nd Annual Meeting of the German Society of Otorhinolaryngology, Head and Neck Surgery on the occasion of its centennial. German version].

Authors:
Stefan K Plontke

HNO 2022 07 22;70(7):508-519. Epub 2022 Mar 22.

Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin‑Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.

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http://dx.doi.org/10.1007/s00106-021-01136-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8939494PMC
July 2022

Active Middle Ear Implant Evoked Auditory Brainstem Response Intensity-Latency Characteristics.

Front Neurol 2021 20;12:739906. Epub 2022 Jan 20.

Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.

Objective: To analyze intensity-latency functions of intraoperative auditory evoked brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant with respect to coupling efficiency, VSB evoked ABR thresholds, and coupling modality [oval window (OW) placement vs. Incus placement and vs. round window (RW) placement].

Study Design: Exploratory study.

Setting: Bi-centric study at tertiary referral centers.

Patients: Twenty-four patients (10 female, 14 male, mean age: 58 years) who received a VSB.

Outcome Measures: Wave-V intensity-latency functions of intraoperative VSB evoked ABRs using a modified audio processor programmed to preoperative bone conduction thresholds for stimulation. Threshold level correction to coupling efficiency and ABR thresholds. Individual plots and exponential function fits.

Results: After ABR threshold level correction, the latency functions could be aligned. A large variance of latencies was observed at individual threshold level. Wave-V latency was longest in the Incus placement subgroup (9.73 ms, SD: 1.04) as compared to OW placement subgroup (9.47 ms, SD: 1.05), with the shortest latency in the RW placement subgroup (8.99 ms, SD: 0.68). For increasing stimulation levels, the variance decreased with intensity-latency function slopes converging toward a steady-state (saturation) latency caused by saturation of audio processor (stimulation) gain. Latency saturation was reached at a stimulation level of 50 dB nHL for the OW placement subgroup, 35 dB nHL for the Incus placement subgroup, and 30 dB nHL for the RW placement subgroup. The latency and saturation results indicated decreased dynamic range for RW placement, i.e., reverse stimulation.

Conclusions: VSB evoked ABR wave-V intensity-latency function slopes were similar to acoustic stimulation at high stimulation levels with a shift toward longer latencies caused by audio processor signal delay. Saturation of latencies occurred for higher stimulation levels due to saturation of audio processor gain. Thus, the analysis of VSB evoked intensity-latency functions appears to allow for the objective assessment of a patient's individual dynamic range. This can further improve diagnostics as well as intraoperative and postoperative quality control.
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http://dx.doi.org/10.3389/fneur.2021.739906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8810535PMC
January 2022

Systematic and audiological indication criteria for bone conduction devices and active middle ear implants.

Hear Res 2022 Aug 25;421:108424. Epub 2021 Dec 25.

Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Halle (Saale), Germany.

Certain patients with conductive or mixed hearing loss can benefit from bone-conduction hearing devices or active middle ear implants. Available devices differ in coupling site, energy transfer from the sound processor to the implant, and the active or passive actuator technology. The audiological benefit of those devices depends on the maximum stable power output and the noise floor of the device, the degree and expected stability of the sensorineural hearing loss and the coupling efficiency with the aim on achieving a minumum of 30-35 dB effective dynamic range. The choice of the device is often a trade-off between the optimal audiological solution with respect to the hearing loss, technical device-related parameters and the expected coupling efficiency, the optimal surgical solution with respect to patho-anatomical aspects, device dimensions and the coupling site, invasiveness or surgical risks, and other patient factors with respect to the patients' wish and expectations, social aspects, device usability and connectivity. This review article lists all currently available implantable and conventional bone-conduction hearing devices and active middle ear implants with respect to technical features like maximum power output, market availability, and the expected effective output dynamic range.
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http://dx.doi.org/10.1016/j.heares.2021.108424DOI Listing
August 2022

Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs.

Sci Rep 2021 11 9;11(1):21955. Epub 2021 Nov 9.

Department of Geriatrics and Geriatric Day Clinic, Diakonie Hospital, Diakoniewerk Halle (Saale), Halle (Saale), Germany.

Risk factors for oropharyngeal dysphagia (OD) in elderly patients are mainly central nervous system (CNS) and structural organic diseases or presbyphagia. We analysed the OD prevalence and association of OD with multimorbidity and polypharmacy using real-life data to complete this spectrum, with a focus on further and iatrogenic risk. This was a cross-sectional retrospective study based on a random sample of 200 patients admitted to a geriatric hospital. Data analysis included diagnoses, the detailed list of drugs, and an intense clinical investigation of swallowing according to Stanschus to screen for OD in each patient. The mean patient age was 84 ± 6.5 years. The prevalence of OD was 29.0%, without an effect of age, but a higher rate was found in men and in nursing home residents and an elevated risk of pneumonia. OD risk was slight in diabetes mellitus and COPD, and pronounced in CNS diseases. A relevant OD association was found, even after adjusting for CNS diseases, with antipsychotics, benzodiazepines, anti-Parkinson drugs, antidepressants, and antiepileptics. Further risk of OD was found with beta-blockers, alpha-blockers, opioids, antiemetics, antivertiginosa or antihistamines, metoclopramide, domperidone, anticholinergics, loop diuretics, urologics, and ophthalmics. From real-life data in patients with and without CNS diseases, we identified drug groups associated with a risk of aggravating/inducing OD. Restrictive indications for these drugs may be a preventative contribution, requiring implementation in dysphagia guidelines and an integrative dysphagia risk scale that considers all associated and cumulative medication risks in addition to diseases.
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http://dx.doi.org/10.1038/s41598-021-99858-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8578645PMC
November 2021

Pure tone discrimination with cochlear implants and filter-band spread.

Sci Rep 2021 10 12;11(1):20236. Epub 2021 Oct 12.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.

For many cochlear implant (CI) users, frequency discrimination is still challenging. We studied the effect of frequency differences relative to the electrode frequency bands on pure tone discrimination. A single-center, prospective, controlled, psychoacoustic exploratory study was conducted in a tertiary university referral center. Thirty-four patients with Cochlear Ltd. and MED-EL CIs and 19 age-matched normal-hearing control subjects were included. Two sinusoidal tones were presented with varying frequency differences. The reference tone frequency was chosen according to the center frequency of basal or apical electrodes. Discrimination abilities were psychophysically measured in a three-interval, two-alternative, forced-choice procedure (3I-2AFC) for various CI electrodes. Hit rates were measured, particularly with respect to discrimination abilities at the corner frequency of the electrode frequency-bands. The mean rate of correct decision concerning pitch difference was about 60% for CI users and about 90% for the normal-hearing control group. In CI users, the difference limen was two semitones, while normal-hearing participants detected the difference of one semitone. No influence of the corner frequency of the CI electrodes was found. In CI users, pure tone discrimination seems to be independent of tone positions relative to the corner frequency of the electrode frequency-band. Differences of 2 semitones can be distinguished within one electrode.
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http://dx.doi.org/10.1038/s41598-021-99799-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511217PMC
October 2021

Course of social support and associations with distress after partial laryngectomy.

J Psychosoc Oncol 2022 14;40(3):366-379. Epub 2021 Aug 14.

Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University Mainz, Mainz, Germany.

Purpose: Social support has been shown to be positively associated with quality of life and adjustment after a cancer diagnosis. The present study investigates the course of social support up to one year after partial laryngectomy and its association with distress.

Design: Longitudinal questionnaire study.

Sample: A total of 428 patients after partial laryngectomy (mean age: 64, SD = 11, 91% male).

Methods: Patients completed questionnaires before treatment (t1), one week after a partial laryngectomy (t2), 3 months (t3), and one year (t4) thereafter. Social support was evaluated at t2, t3, and t4 using a brief version of the Social Support Questionnaire. Distress was measured at t2, t3, and t4 using the HADS. Descriptive statistics for social support were computed across the three measurement points. Changes were analyzed by Wilcoxon signed-rank tests. Associations with distress were identified using linear regression analyses.

Findings: Social support increased between t2 and t3 and decreased to baseline level between t3 and t4. Distress at t2 was associated with social support at t2 (B = -0.15, p < 0.01) and distress at t3 with social support at t3 (B = -0.19, p < 0.01). Distress at t4 was related to social support at t2 (B = -0.10, p = 0.05).

Conclusions: Although perceived social support increases after partial laryngectomy, it decreases again during the course of aftercare.

Implications For Psychosocial Providers Or Policy: Social support resources should be assessed to identify patients at risk for worse psychological well-being.
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http://dx.doi.org/10.1080/07347332.2021.1958122DOI Listing
August 2021

Rare Diseases and Otorhinolaryngology, Head and Neck Surgery.

Authors:
Stefan K Plontke

Laryngorhinootologie 2021 04 30;100(S 01):S1-S11. Epub 2021 Apr 30.

Rare diseases pose multiple challenges for patients, relatives, physicians, nursing staff, and therapists. Their rarity impedes research and treatments due to medical and economical reasons. Many diseases in the field otorhinolaryngology, head and neck surgery are rare diseases due to their low prevalence. The initiation of the right management processes requires knowledge about diagnostics, resources like centers, networks and registries, about specifics of the physician-patient relationship, follow-up care including communication with family doctors and the role of self-help groups. Of special interest for university hospitals and our scientific society are the specific aspects of research including European networks and research funding, information management, public relations, education, training, financing, and regulations like orphan drugs and clinical trials in small populations.
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http://dx.doi.org/10.1055/a-1397-0842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354574PMC
April 2021

Editorial.

Authors:
Stefan K Plontke

Laryngorhinootologie 2021 04 30;100(S 01):S1. Epub 2021 Apr 30.

Rare diseases represent a major challenge for affected patients, their relatives, physicians, nursing staff, and therapists. For medical and economic reasons, disease rarity complicates the research and medical care of affected patients. The Hollywood movie, "Lorenzo's Oil", touchingly illustrates the complex problems associated with orphan disease diagnostics, research, and therapy. Directed by George Miller, this film shows the true story of a boy named Lorenzo Michael Murphy Odone, who was diagnosed in 1984 at the age of 6 with the rare neural disease adrenoleukodystrophy (ALD). The movie highlights the manifold problems associated with rare diseases - a large number of which still exist today. However, especially in recent years, orphan diseases have been placed in the focus of public attention.
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http://dx.doi.org/10.1055/s-1397-0832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354573PMC
April 2021

[The COVID-19 pandemic and its effects on otorhinolaryngology, head and neck surgery].

Authors:
Stefan K Plontke

HNO 2021 Aug 27;69(8):609-610. Epub 2021 Jul 27.

Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.

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http://dx.doi.org/10.1007/s00106-021-01091-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314262PMC
August 2021

[Implantable hearing aids: the details matter for the outcome].

HNO 2021 Jun 1;69(6):445-446. Epub 2021 Jun 1.

Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.

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http://dx.doi.org/10.1007/s00106-021-01058-5DOI Listing
June 2021

[100 years of the German Society of Otorhinolaryngology, Head and Neck Surgery : Where do we come from? Where are we? Where are we going?]

Authors:
Stefan K Plontke

HNO 2021 05 26;69(5):335-337. Epub 2021 Apr 26.

Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.

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http://dx.doi.org/10.1007/s00106-021-01048-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072301PMC
May 2021

Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma.

Sci Rep 2021 04 21;11(1):8608. Epub 2021 Apr 21.

Department of Neurosurgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.

In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and counselling modalities. A novel scoring system based on functional tests was designed to predict the nerve of origin for VS and was applied to a large number of consecutive patients. A prospective, double blind, cohort study including 93 patients with suspected unilateral VS was conducted at a tertiary referral centre. Preoperatively before tumor resection a functional test battery [video head-impulse test (vHIT) of all semicircular canals (SCC)], air-conducted cervical/ocular vestibular evoked myogenic potential tests (cVEMP, oVEMP), pure-tone audiometry, and speech discrimination was applied. Sensitivity and specificity of prediction of intraoperative finding by a preoperative score based on vHIT gain, cVEMP and oVEMP amplitudes and asymmetry ratios was calculated. For the prediction of inferior vestibular nerve origin, sensitivity was 73% and specificity was 80%. For the prediction of superior vestibular nerve origin, sensitivity was 60% and specificity was 90%. Based on the trade-off between sensitivity and specificity, optimized cut-off values of - 0.32 for cVEMP and - 0.11 for oVEMP asymmetry ratios and vHIT gain thresholds of 0.77 (anterior SCC), 0.84 (lateral SCC) and 0.80 (posterior SCC) were identified by receiver operator characteristic curves. The scoring system based on preoperative functional tests improves prediction of nerve of origin and can be applied in clinical routine.
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http://dx.doi.org/10.1038/s41598-021-87515-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060325PMC
April 2021

Influence of bone conduction transducer type and placement on ocular and cervical vestibular evoked myogenic potentials.

Sci Rep 2021 04 19;11(1):8500. Epub 2021 Apr 19.

Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.

Evaluating the effectiveness of different bone conduction (BC) transducers with controlled coupling force to elicit cervical and ocular vestibular evoked myogenic potentials (cVEMPs, oVEMPs) in healthy subjects by comparing response rates, amplitudes, latencies, thresholds and asymmetry ratios. Prospective experimental study including healthy participants. VEMPs were measured to different stimulation modes; the BC transducer coupling force was controlled to 5.4 (± 0.5) Newton. cVEMPs: to bone conducted vibration (BCV) with the B81 transducer on the mastoid; oVEMPs: to BCV with the B81 on the mastoid, BCV with the B81 on the forehead, and BCV with the Mini-Shaker 4810 on the forehead. Air conducted sound (ACS) with insert earphones was used as reference. Data of 24 normal subjects (mean age 25.3 (± 3.0) years) were analyzed. ACS and BCV with the B81on the mastoid evoked cVEMPs in 100% of ears. The highest oVEMP response rates were obtained with the B81 on the mastoid (83-92%), the lowest with the B81 on the forehead (17-22%). The Mini-Shaker elicited lower response rates (65%) compared to results from the literature without coupling force control and compared to ACS (78-87%). Amplitudes were higher for BCV than ACS. ACS and BCV on the mastoid caused higher asymmetry compared to BCV forehead stimulation. The B81 was feasible to elicit VEMPs with mastoid placement and can be used as an approved medical device to measure BCV VEMPs in a clinical set-up. Normative asymmetry values have to be established due to higher variability for mastoid stimulation.
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http://dx.doi.org/10.1038/s41598-021-87682-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055867PMC
April 2021

[Outpatient Surgery in German ENT].

Laryngorhinootologie 2021 Apr 1. Epub 2021 Apr 1.

Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Germany.

Currently there is an intense discussion ongoing to enhance and expand outpatient surgery in the ENT in Germany, which is the intention by several politicians. The goal is to achieve a frequency of outpatient surgery comparable to an international level.To achieve this goal, acceptance of outpatient interventions by both, surgeons and patients is required, particularly in regard of equal quality standards and patient safety requirements.In the following review the organization, outcome, quality management and strategies for different ENT outpatient surgery worldwide is analyzed. Basically, outpatient surgery is organized in different ways: office-based-procedures in local anesthesia, procedures in ambulatory surgery center settings as standalone facilities or in connection with and adjacent to a hospital with possible inpatient treatment. Contact and resident times of the patients in the outpatient surgery centers differ between some hours through 23 hours. A deliberated and careful selection of patients which are suitable for outpatient procedures is required and should address comorbidities, medications, social circumstances, health literacy of the patient and its relatives, and distance from home to the hospital. A careful and strict quality management is mandatory which comprises the entire process from patient selection through patient entry, surgery, discharge and postoperative care in a multidisciplinary setting.Zur besseren Lesbarkeit des Textes wird bei geschlechterbezogenen Bezeichnungen die männliche Form benutzt. Es sind jedoch in gleicher Rangfolge auch das jeweilige weibliche Geschlecht oder andere Geschlechtsausprägungen gemeint.
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http://dx.doi.org/10.1055/a-1418-9745DOI Listing
April 2021

Clinical and functional results after implantation of the bonebridge, a semi-implantable, active transcutaneous bone conduction device, in children and adults.

Eur Arch Otorhinolaryngol 2022 Jan 6;279(1):101-113. Epub 2021 Mar 6.

Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Germany.

Purpose: Aim of the study was to evaluate the surgical, clinical and audiological outcome of 32 implantations of the Bonebridge, a semi-implantable transcutaneous active bone conduction implant.

Methods: In a retrospective cohort study, we analyzed data for 32 implantations in 31 patients (one bilateral case; seven age < 16 years) with conductive or mixed hearing loss, malformations, after multiple ear surgery, or with single-sided deafness as contralateral routing of signal (CROS).

Results: Four implantations were done as CROS. Five cases were simultaneously planned with ear prosthesis anchors, and 23 implantations (72%) were planned through three-dimensional (3D) "virtual surgery." In all 3D-planned cases, the implant could be placed as expected. For implant-related complications, rates were 12.5% for minor and 3.1% for major complications. Implantation significantly improved mean sound field thresholds from a preoperative 60 dB HL (SD 12) to 33 dB HL (SD 6) at 3 postoperative months and 34 dB HL (SD 6) at > 11 postoperative months (p < 0.0001). Word recognition score in quiet at 65 dB SPL improved from 11% (SD 20) preoperatively to 74% (SD 19) at 3 months and 83% (SD 15) at > 11 months (p < 0.0001). The speech reception threshold in noise improved from - 1.01 dB unaided to - 2.69 dB best-aided (p = 0.0018).

Conclusion: We found a clinically relevant audiological benefit with Bonebridge. To overcome anatomical challenges, we recommend preoperative 3D planning in small and hypoplastic mastoids, children, ear malformation, and simultaneous implantation of ear prosthesis anchors and after multiple ear surgery.
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http://dx.doi.org/10.1007/s00405-021-06626-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738362PMC
January 2022

Microimaging of a novel intracochlear drug delivery device in combination with cochlear implants in the human inner ear.

Drug Deliv Transl Res 2022 01 4;12(1):257-266. Epub 2021 Feb 4.

Department of Otorhinolaryngology-Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.

The effective delivery of drugs to the inner ear is still an unmet medical need. Local controlled drug delivery to this sensory organ is challenging due to its location in the petrous bone, small volume, tight barriers, and high vulnerability. Local intracochlear delivery of drugs would overcome the limitations of intratympanic (extracochlear) and systemic drug application. The requirements for such a delivery system include small size, appropriate flexibility, and biodegradability. We have developed biodegradable PLGA-based implants for controlled intracochlear drug release that can also be used in combination with cochlear implants (CIs), which are implantable neurosensory prosthesis for hearing rehabilitation. The drug carrier system was tested for implantation in the human inner ear in 11 human temporal bones. In five of the temporal bones, CI arrays from different manufacturers were implanted before insertion of the biodegradable PLGA implants. The drug carrier system and CI arrays were implanted into the scala tympani through the round window. Implanted temporal bones were evaluated by ultra-high-resolution computed tomography (µ-CT) to illustrate the position of implanted electrode carriers and the drug carrier system. The µ-CT measurements revealed the feasibility of implanting the PLGA implants into the scala tympani of the human inner ear and co-administration of the biodegradable PLGA implant with a CI array.
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http://dx.doi.org/10.1007/s13346-021-00914-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677643PMC
January 2022

Reduced Spread of Electric Field After Surgical Removal of Intracochlear Schwannoma and Cochlear Implantation.

Otol Neurotol 2020 12;41(10):e1297-e1303

Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany.

Objective: The primary aim of the study was to explore whether reduced spread of electrical field is observed after partial or subtotal cochleoectomy and cochlear implantation compared with standard cochlear implantation. Secondarily, the influence on speech perception was explored comparing both groups.

Study Design: Nonconcurrent cohort study.

Setting: Monocentric study at a tertiary referral center.

Patients: Twenty adult cochlear implant (CI) users after tumor resection with cochleoectomy of varying extent and 20 electrode-matched CI users with standard electrode insertion.

Interventions: Partial and subtotal cochleoectomy for tumor removal and CI.

Outcome Measures: Trans-impedance, electrically evoked compound action potentials, and word recognition were measured. Relative impedance was computed as a function of distance between the stimulation and recording electrode.

Results: Trans-impedance was smaller and more homogeneous in patients with partial or subtotal cochleoectomy than in the control group. In the tumor group, the mean relative impedance decreased to 0.20 (standard deviation [SD] = 0.03) at a distance of 1 electrode and to 0.25 (SD = 0.04) in the control group. After excluding seven patients with a second tumor in the internal auditory canal or cerebellopontine angle, with transmodiolar tumors, after near total cochleoectomy, or only extended cochleostomy, word recognition was 61% (SD = 19%) at 3 months and 75% (SD = 19%) at 12 months after activation of the audio processor in the tumor group. At 12 months, it was significantly (p < 0.05) better than in the control group (3 mo: 45%, SD = 25%; 12 mo: 53%, SD = 26%). A smaller trans-impedance is associated with a better word recognition.

Conclusion: We conclude that the surgical technique used for CI surgery after subtotal cochleoectomy reduces the spread of the electric field and overcomes the potential drawbacks in structure preservation associated with that technique.
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http://dx.doi.org/10.1097/MAO.0000000000002884DOI Listing
December 2020

[Diseases and Surgery of the Orbit].

Laryngorhinootologie 2020 12 11;99(12):896-917. Epub 2020 Dec 11.

Most orbital diseases are rarely diagnosed in the clinic. Because the consequences for the eye can be severe, it is important to recognize the signs of orbital disease early in order to initiate the correct diagnostic and therapeutic steps in good time. This article presents the basics of the systematics, diagnostics and therapy of orbital diseases in preparation for the specialist examination for ENT medicine. Some orbital diseases are typical manifestations of systemic diseases (e. g. Graves' disease) or typical complications of diseases in the vicinity of the orbit (e. g. orbital complications from inflammatory or tumorous sinus diseases). The diseases of the lacrimal system and the eyelids as well as their therapy are closely related to the diseases of the orbit. Basically, it can be said that the diagnosis and therapy of orbital diseases should always be carried out on an interdisciplinary basis, whereby the involvement of the ophthalmologist is of particular importance.
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http://dx.doi.org/10.1055/a-1263-6285DOI Listing
December 2020
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