One factor for the lacking integration of the middle ear stapes footplate prosthesis or the missing healing of stapes footplate fractures could be the known osteogenic inactivity. In contrast, it was ...recently demonstrated that titanium prostheses with an applied collagen matrix and immobilised growth factors stimulate osteoblastic activation and differentiation on the stapes footplate. Regarding those findings, the aim of this study was to evaluate the potential of bone regeneration including bone remodeling in the middle ear. Ten one-year-old female merino sheep underwent a middle ear surgery without implantation of middle ear prostheses or any other component for activating bone formation. Post-operatively, four fluorochromes (tetracycline, alizarin complexion, calcein green and xylenol orange) were administered by subcutaneous injection at different time points after surgery (1 day: tetracycline, 7 days: alizarin, 14 days: calcein, 28 days: xylenol). After 12 weeks, the temporal bones including the lateral skull base were extracted and histologically analyzed. Fluorescence microscopy analysis of the entire stapes with the oval niche, but in particular stapes footplate and the Crura stapedis revealed evidence of new bone formation. Calcein was detected in all and xylenol in 60% of the animals. In contrast, tetracycline and alizarin could only be verified in two animals. The authors were able to demonstrate the osseoregenerative potential of the middle ear, in particular of the stapes footplate, using fluorescence sequence labelling.
Background
Currently, there are different competing techniques for the treatment of Zenker’s diverticulum (ZD). To improve patient selection, we compared endoscopic laser-assisted diverticulotomy ...(ELAD) with transcervical myotomy (TCM) with regard to possible risk factors for treatment failure.
Methods
Data of ZD patients (
n
= 104) treated between 2004 and 2016 with either TCM (38%) or ELAD (62%) were analyzed retrospectively. Univariate and multivariate analyses were performed.
Results
TCM is associated with a higher morbidity (27.8% vs. 10.2%;
p
= 0.095) but lower recurrence rate (7.3% vs. 19.3%;
p
= 0.095). Preoperative reflux disease (OR 8.755;
p
= 0.021) was identified as an independent risk factor for complications.
Conclusions
Although short-term outcome and symptom relief are similar, TCM tends to have a higher complication rate but better long-term results. Preoperative reflux disease is an independent risk factor for postoperative complications.
The objective of this study was to assess hearing outcome after sequential cholesteatoma surgery stratified for exclusively transcanal technique (ETC), combined transcanal and transmastoidal ...technique (TCM) and canal wall down surgery (CWD) and to analyze the impact of ossicular reconstruction technique (partial ossicular replacement prostheses/PORP and total ossicular replacement prostheses/TORP) on hearing outcome. This study is a retrospective case review and clinical case study conducted in a tertiary referral center. Patients who underwent 376 cholesteatoma surgeries (2007–2009) and 92 ears in clinical re-examination at least 12 months postoperatively were included. Sequential cholesteatoma surgery with ETC, TCM, or CWD; ossiculoplasty with PORP or TORP were the interventions administered. Pre- and postoperative air–bone gap (ABG) and air conduction threshold (AC) for 0.5–3 kHz were the main outcome measures. Overall, the mean preoperative ABG decreased from 25.3 ± 1.3 to 19.8 ± 0.9 dB with a mean ABG closure of 5.4 ± 1.3 dB (
p
≤ 0.001). According to surgical technique, the postoperative ABG after CWD 23.5 ± 2.1 was significantly worse compared to ETC (17.3 ± 1.0 dB,
p
< 0.05) and TCM (19.4 ± 1.3 dB). A significant ABG closure was observed after ETC (6.8 ± 2.0 dB,
p
< 0.01) and TCM (6.5 ± 2.0 dB,
p
< 0.01) contrary to CWD (2.1 ± 2.9 dB,
p
> 0.05). Patients receiving PORP showed a significantly less ABG postoperatively (19.0 ± 0.9 dB,
p
≤ 0.05) compared to the TORP group (24.1 ± 2.5 dB). However, a significant hearing gain was assessed after PORP- (4.7 ± 1.6 dB,
p
≤ 0.01) and TORP- implantation (10.4 ± 3.7 dB,
p
≤ 0.01). Sequential cholesteatoma surgery allowed for an excellent hearing outcome postoperatively. An intact posterior canal wall and a present stapes suprastructure were identified to predict a significantly superior hearing result. In addition to the technical and prosthetic considerations, the audiological outcome was confounded by the attending middle ear pathology.
the word recognition score (WRS) achieved with cochlear implants (CIs) varies widely. To account for this, a predictive model was developed based on patients' age and their pre-operative WRS. This ...retrospective study aimed to find out whether the insertion depth of the nucleus lateral-wall electrode arrays contributes to the deviation of the CI-achieved WRS from the predicted WRS.
patients with a pre-operative maximum WRS > 0 or a pure-tone audiogram ≥80 dB were included. The insertion depth was determined via digital volume tomography.
fifty-three patients met the inclusion criteria. The median WRS achieved with the CI was 70%. The comparison of pre- and post-operative scores achieved with a hearing aid and a CI respectively in the aided condition showed a median improvement of 65 percentage points (pp). A total of 90% of the patients improved by at least 20 pp. The majority of patients reached or exceeded the prediction, with a median absolute error of 11 pp. No significant correlation was found between the deviation from the predicted WRS and the insertion depth.
our data support a previously published model for the prediction of the WRS after cochlear implantation. For the lateral-wall electrode arrays evaluated, the insertion depth did not influence the WRS with a CI.
Objectives: Inserting an electrode array into the cochlea may cause inner ear trauma, which has to be minimized, particularly in cochlear implant patients with substantial residual hearing. Another ...potential inner ear trauma has, to a large extent, been neglected so far: the acoustic trauma that can occur during cochleostomy using different techniques. In this study, the noise exposure of the inner ear during the drilling procedure was re‐evaluated. In experiments on temporal bones, quantitative measurements of sound pressure level (SPL) were carried out while a cochleostomy for cochlear implantation was drilled.
Study Design: Experimental study.
Materials and Methods: Acoustic measurements during different drilling procedures were carried out on four human temporal bone preparations equipped with microphones attached to the round window. Special calibrations were carried out, which allowed determination of SPLs affecting the cochlea during the drilling procedure.
Results: The highest SPLs measured on the cochlea were recorded when a still‐intact endosteal membrane was touched by the burr. The SPL exceeded 130 dB and reached a level almost comparable with the situation when the ossicular chain is touched by a running burr.
Conclusions: In the drilling procedure for a cochleostomy, the inner ear may be affected by very high SPLs, particularly if the endosteal membrane is left intact and comes into contact with the running burr. Of course, the resulting SPLs depend on the drilling speed and the size and characteristics of the burr (larger burrs cause higher SPLs); however, we are of the opinion that the cochlear function is at risk, anyway, if special precaution is not exercised. Even when working with reduced drilling speed, the surgeon should be aware of the high risk in the form of an acoustic trauma, which may endanger residual hearing. Recommendations in terms of “soft surgery” are given in the paper (e.g., the use of microhooks instead of a drill to remove the very last shell of bone covering the cochlea).
To summarize new application methods of an active middle ear implant (Vibrant Soundbridge) in patients with conductive or mixed hearing loss.
Publications listed in the Medline/PubMed database.
All ...publications published in English language; search term Vibrant Soundbridge AND floating mass transducer in all fields.
Structured analysis of all publications.
Extraction of significant findings and conclusions and audiometric data.
Modern application methods of an active middle ear implant (VSB) open new therapeutic options for patients with various outer and middle ear diseases resulting in conductive or mixed hearing loss. Titanium couplers can help to couple the active middle ear implant in a standardized way to remnants of the ossicular chain or to the round window. Thus, the active middle ear implant has been established as an alternative treatment option for patients with mixed and conductive hearing. However, the heterogeneity of the studies published so far complicates the analysis of the audiometric results, and thus, the functional hearing gain after VSB implantation varies a lot.
Sound transfer of active middle ear implants Beleites, Thomas; Neudert, Marcus; Bornitz, Matthias ...
Otolaryngologic clinics of North America,
12/2014, Letnik:
47, Številka:
6
Journal Article
Recenzirano
Implantable hearing aids are gaining importance for the treatment of sensorineural hearing loss and also for mixed hearing loss. The various hearing aid systems, combined with different middle ear ...situations, give rise to a wide range of different reconstructions. This article attempts to summarize the current knowledge concerning the mechanical interaction between active middle ear implants (AMEIs) and the normal or reconstructed middle ear. Some basic characteristics of the different AMEIs are provided in conjunction with the middle ear mechanics. The interaction of AMEIs and middle ear and the influence of various boundary conditions are discussed in more detail.
The present study aimed at investigating the question whether olfactory function changes in relation to barometric pressure and humidity. Using climate chambers, odor threshold and discrimination for ...butanol were tested in 75 healthy volunteers under hypobaric and hyperbaric, and different humidity conditions. Among other effects, olfactory sensitivity at threshold level, but not suprathreshold odor discrimination, was impaired in a hypobaric compared to a hyperbaric milieu, and thresholds were lower in humid, compared to relatively dry conditions. In conclusion, environmental conditions modulate the sense of smell, and may, consecutively, influence results from olfactory tests.
The development of a procedure for the measurement of insertion depth angles of cochlear implant electrode arrays based on flat-panel computed tomography (FPCT) and the application of this technique ...to in vivo postoperative images.
The knowledge of the insertion depth angle of electrode arrays is relevant for the preservation of low-frequency residual hearing and for optimizing speech coding strategies. Until now, the angular position of electrodes was derived from 2-dimensional radiographs.
In the present study, 3-dimensional (3D) radiographs provided by FPCT were used to determine the insertion depth according to angular electrode positions with higher accuracy. For this purpose, a new evaluation procedure was designed and applied to radiographs of 15 cochlear implant patients.
In contrast to 2-dimensional radiographs, the obtained 3D images show all 3 semicircular channels and therefore allow the determination of a clear reference, which is required for precise insertion angle measurements. Furthermore, the presented FPCT radiographs visualize distinct electrodes. Despite the constant length of the implanted electrode arrays, we have found a considerable variation of measured insertion depth angles, which is consistent with published observations on the variability and the gender dependence of the size of human cochleae.
FPCT provides 3D high-resolution radiographic data that enable the determination of the insertion depth angle with high accuracy and, potentially, an angle determination of individual electrodes. Therefore, this low-dose technique is especially appropriate for postoperative investigations after cochlea implantation.
