Background
Attendance teaching is the predominant teaching method at universities but needs to be questioned in the context of digital transformation. This study establishes and evaluates a method to ...accomplish electronic learning to supplement traditional attendance courses.
Materials and methods
Surgery was transmitted in real-time conditions via an online live stream from the surgical theater. Visualization was transferred from a fully digital surgical microscope, an endoscope or an environmental camera in high definition quality. Students were able to participate at home from their personal computer. After following the surgery, they participated in an online-evaluation.
Results
A total of 65 students participated in the live stream. The majority of students (61.54%) indicated a significant subjective increase in knowledge after participation. The majority of students (53.85%) indicated that live surgeries should be offered as a permanent component in addition to classroom teaching. Likewise, a broader offer was desired by many students (63.08%).
Conclusions
Live streaming of surgery is a promising approach as an alternative or supplement to traditional attendance teaching. An expansion of digital teaching can be explicitly supported on the basis of this study.
Objective
We hypothesize that visualizing inner‐ear systematically in both cochlear view (oblique coronal plane) and in mid‐modiolar section (axial plane) and following three sequential steps ...simplifies, identification of inner‐ear malformation types.
Methods
Pre‐operative computer‐tomography (CT) scans of temporal bones of 112 ears with various inner ear malformation (IEM) types were taken for analysis. Images were analyzed using DICOM viewers, 3D slicer, and OTOPLAN®. The inner‐ear was captured in the oblique‐coronal plane for the measurement of length and width of cochlear basal turn which is also called as A‐, and B‐values respectively (Step 1). In the same plane, the angular‐turns of lateral‐wall (LW) of cochlear basal turn were measured (Step 2). As Step 3, the mid‐modiolar section of inner ear was captured in the axial plane by following the A‐value and perpendicular to cochlear view. From the mid‐modiolar section, the outer‐contour of inner ear was captured manually by following contrasting gray area between fluid filled and bony promontory and was compared to known resembling objects to identify IEM types (Step 3).
Results
Following reference values have emerged from our analysis: A‐, and B‐values (Step 1) on average are >8 mm and >5.5 mm respectively, in normal cochleae (NA), enlarged vestibular aqueduct syndrome (EVAS), incomplete partition (IP) type‐I and ‐II, whereas it is <8 mm and <5.5 mm respectively, in IP type‐III and cochlear hypoplasia (CH). Angular‐turn of LW is consistently observed in cochlear basal turn (Step 2), is 540° in NA and EVAS, 450° in IP‐II, and 360° in IP types I & III. In subjects with CH type, angular‐turn of LW is either 360° or 450° or 540°. In true mid‐modiolar section, outer‐contour of inner‐ear (Step‐3), other than in CH and cystic inner‐ear malformations, resembles recognizable shapes of known objects. Absence of EVA is an additional characteristic that confirms diagnosis of CH when the A‐, B‐values, and angular‐turn of LW can be similar to other anatomical types. Drawing a straight line along posterior edge of internal auditory canal (IAC) in axial view can differentiate a true common cavity (CC) from cochlear aplasia‐vestibular cavity (VC).
Conclusion
Three‐step process proposed in this study captures inner‐ear in cochlear view as well in mid‐modiolar sections visualizing key features of inner‐ear in identification of IEM types.
Level of Evidence
Level 1.
Three‐step process proposed in this study captures inner‐ear in cochlear view as well in true mid‐modiolar sections visualizing key features of inner‐ear in identification of inner ear malformation types.
Aim
To determine the minimal clinically important difference (MCID) of the Zurich Chronic Middle Ear Inventory (ZCMEI-21), a questionnaire assessing health-related quality of life (HRQoL) in chronic ...otitis media (COM).
Methods
In this longitudinal study, 103 patients completed the ZCMEI-21 before and after surgery for chronic otitis media. An anchor-based method including a global rating of change (GRC) was used to assess the MCID of the ZCMEI-21.
Results
A total of 103 patients were included. The mean preoperative and postoperative ZCMEI-21 scores were 28.6 (SD 13.6), and 21.8 (SD 12.8), respectively. The mean change was 6.8 (SD 0.8;
p
< 0.0001). A significant correlation between the ZCMEI-21 scores and the GRC was found (
r
= − 0.5;
p
< 0.001). Using the anchor-based method, the MCID of the ZCMEI-21 was estimated at 5.3 (SD 12.0).
Conclusions
Knowledge of values indicating a clinically relevant change in patient-reported outcome measures is important when interpreting effects of different treatment modalities. This is the first study assessing the MCID of a questionnaire measuring HRQoL in COM, i.e. the ZCMEI-21. We recommend a MCID of 5 in COM patients undergoing surgical treatment. This information substantially increases the usefulness of the ZCMEI-21 as an outcome measure in COM as changes can be assessed with regard to their clinical meaningfulness.
Purpose
A narrow bony internal auditory canal (IAC) may be associated with a hypoplastic cochlear nerve and poorer hearing performances after cochlear implantation. However, definitions for a narrow ...IAC vary widely and commonly, qualitative grading or two-dimensional measures are used to characterize a narrow IAC. We aimed to refine the definition of a narrow IAC by determining IAC volume in both control patients and patients with inner ear malformations (IEMs).
Methods
In this multicentric study, we included high-resolution CT (HRCT) scans of 128 temporal bones (85 with IEMs: cochlear aplasia,
n
= 11; common cavity,
n
= 2; cochlear hypoplasia type,
n
= 19; incomplete partition type I/III,
n
= 8/8; Mondini malformation,
n
= 16; enlarged vestibular aqueduct syndrome,
n
= 19; 45 controls). The IAC diameter was measured in the axial plane and the IAC volume was measured by semi-automatic segmentation and three-dimensional reconstruction.
Results
In controls, the mean IAC diameter was 5.5 mm (SD 1.1 mm) and the mean IAC volume was 175.3 mm
3
(SD 52.6 mm
3
). Statistically significant differences in IAC volumes were found in cochlear aplasia (68.3 mm
3
,
p
< 0.0001), IPI (107.4 mm
3
,
p
= 0.04), and IPIII (277.5 mm
3
,
p
= 0.0004 mm
3
). Inter-rater reliability was higher in IAC volume than in IAC diameter (intraclass correlation coefficient 0.92 vs. 0.77).
Conclusions
Volumetric measurement of IAC in cases of IEMs reduces measurement variability and may add to classifying IEMs. Since a hypoplastic IAC can be associated with a hypoplastic cochlear nerve and sensorineural hearing loss, radiologic assessment of the IAC is crucial in patients with severe sensorineural hearing loss undergoing cochlear implantation.
Purpose
Evaluating the current health state in chronic otitis media (COM), audiologic results are complemented by subjective outcomes, such as health-related quality of life (HRQoL). Two ...disease-specific instruments assessing HRQoL in COM in German-speaking patients exist, i.e., the chronic otitis media outcome test (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). Since the psychometric properties of these questionnaires in a concurrent application are unknown, the aim of this study was to compare the COMOT-15 and the ZCMEI-21.
Methods
HRQoL was assessed in adult COM patients using the COMOT-15 and the ZCMEI-21. Psychometric properties were determined, including response distribution, concurrent validity, internal consistency, correlation to hearing and gender differences.
Results
In 173 patients (mean age 51.5 years), both questionnaires showed normally distributed scores without strong floor and ceiling effects. The total scores and subscores of both questionnaires exhibited satisfactory internal consistency (Cronbach’s α 0.7–0.9) with the exception of the COMOT-15 hearing subscore (α = 0.94) and the ZCMEI-21 medical resource subscore (α = 0.66). Fair correlations between the air conduction pure-tone average and the total scores were found (COMOT-15:
r
= 0.36,
p
< 0.0001; ZCMEI-21:
r
= 0.34,
p
< 0.0001).
Conclusion
In the first study comparing the COMOT-15 and the ZCMEI-21, both questionnaires exhibited satisfactory psychometric properties with several subtle differences. The COMOT-15 has a strong focus on hearing with a probably redundant content of the hearing subscore and may be suited for hearing-focused research questions. The ZCMEI-21 provides a comprehensive assessment of the COM symptom complex and may therefore also be used in research settings, where ear discharge, vertigo or pain should be covered.
Objective measurements to predict the position of a cochlear electrode during cochlear implantation surgery may serve to improve the surgical technique and postoperative speech outcome. There is ...evidence that electrically evoked compound action potentials (ECAP) are a suitable approach to provide information about the site of stimulation. This study aims to contribute to the knowledge about the association between the intraoperative intracochlear ECAP characteristics and the site of stimulation.
In a retrospective cohort study, patients undergoing cochlear implant surgery with flexible lateral wall electrode arrays (12 stimulating channels) between 2020 and 2022 were analyzed. The CDL was measured using a CT-based clinical planning software. ECAP were measured for all electrode contacts and associated to the CDL as well as to the site of stimulation in degree.
Significant differences among the amplitudes and slopes for the individual stimulated electrode contacts at the stimulation sites of 90°, 180°, 270°, 360°, 450° and 540° were found. The values showed a trend for linearity among the single electrodes.
ECAP characteristics correlate with the electrode's position inside the cochlea. In the future, ECAP may be applied to assess the intracochlear position inside the cochlea and support anatomy-based fitting.
Objectives
Knowledge about cochlear duct length (CDL) may assist electrode choice in cochlear implantation (CI). However, no gold standard for clinical applicable estimation of CDL exists. The aim of ...this study is (1) to determine the most reliable radiological imaging method and imaging processing software for measuring CDL from clinical routine imaging and (2) to accurately predict the insertion depth of the CI electrode.
Methods
Twenty human temporal bones were examined using different sectional imaging techniques (high-resolution computed tomography HRCT and cone beam computed tomography CBCT). CDL was measured using three methods: length estimation using (1) a dedicated preclinical 3D reconstruction software, (2) the established A-value method, and (3) a clinically approved otosurgical planning software. Temporal bones were implanted with a 31.5-mm CI electrode and measurements were compared to a reference based on the CI electrode insertion angle measured by radiographs in Stenvers projection (CDL
reference
).
Results
A mean cochlear coverage of 74% (SD 7.4%) was found. The CDL
reference
showed significant differences to each other method (
p
< 0.001). The strongest correlation to the CDL
reference
was found for the otosurgical planning software-based method obtained from HRCT (CDL
SW-HRCT
;
r
= 0.87,
p
< 0.001) and from CBCT (CDL
SW-CBCT
;
r
= 0.76,
p
< 0.001). Overall, CDL was underestimated by each applied method. The inter-rater reliability was fair for the CDL estimation based on 3D reconstruction from CBCT (CDL
3D-CBCT
; intra-class correlation coefficient ICC = 0.43), good for CDL estimation based on 3D reconstruction from HRCT (CDL
3D-HRCT
; ICC = 0.71), poor for CDL estimation based on the A-value method from HRCT (CDL
A-HRCT
; ICC = 0.29), and excellent for CDL estimation based on the A-value method from CBCT (CDL
A-CBCT
; ICC = 0.87) as well as for the CDL
SW-HRCT
(ICC = 0.94), CDL
SW-CBCT
(ICC = 0.94) and CDL
reference
(ICC = 0.87).
Conclusions
All approaches would have led to an electrode choice of rather too short electrodes. Concerning treatment decisions based on CDL measurements, the otosurgical planning software-based method has to be recommended. The best inter-rater reliability was found for CDL
A-CBCT
, for CDL
SW-HRCT
, for CDL
SW-CBCT
, and for CDL
reference
.
Key Points
•
Clinically applicable calculations using high-resolution CT and cone beam CT underestimate the cochlear size
.
•
Ten percent of cochlear duct length need to be added to current calculations in order to predict the postoperative CI electrode position
.
•
The clinically approved otosurgical planning software-based method software is the most suitable to estimate the cochlear duct length and shows an excellent inter-rater reliability
.
To assess long-term results and present experience with a high-porosity hydroxyapatite ceramic for obliterating large open mastoid cavities.
Cross-sectional cohort study.
Tertiary academic referral ...center.
All patients who underwent tympanomastoid surgery for chronic middle ear disease or revision surgery with reduction of an open mastoid cavity using a highly porous hydroxyapatite matrix material (HMM) between May 2005 and June 2013 were assessed for eligibility. Twenty three patients (56.9 ± 18.3 yr) were included.
Primary middle ear surgery or revision surgery using a HMM.
Pure-tone average, computed tomography (CT), and magnetic resonance imaging (MRI) to investigate osseoinduction, osseointegration and presence of cholesteatoma, current quality of life assessed by Zurich Chronic Middle Ear Inventory and change in quality of life post-intervention assessed by the Glasgow Benefit Inventory.
Patients were reexamined after a mean follow-up period of 88.3 months (SD 21.4 mo) after obliteration of the open mastoid cavity with HMM. Compared with visit 1, patients showed a significantly reduced ABG at visit 2 (29.22 dB ± 2.71 dB versus 12.77 dB ± 3.46 dB).CT scan was carried out in 21 patients (91%) patients and 17 patients (74%) underwent MRI.Revision surgery was required in a total of 17 cases (74%). In four patients recurrent cholesteatoma was found at follow up.
Poor cavity obliteration, a high rate of revision surgery and difficult differentiation between recurrent cholesteatoma and granulation tissue in CT scan was observed.
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