Background Cochlea Implantation represents a standard and has progressed through innovations. Reviewing guidelines in light of these developments is crucial. According to the guidelines of the German Society of Oto-Rhino-Laryngology (DGHNO), postlingually deafened patients should strive for a postoperative improvement in the audiogram of at least 20 dB and an increase in monosyllabic discrimination of more than 20% by the completion of follow-up therapy. It should be investigated how many patients do not achieve this goal and what factors contribute to it.
Introduction Musculoskeletal complaints and fatigue are commonly described symptoms in work of ENT doctors using a microscope. Long-lasting ear surgery procedures are associated with prolonged microscope use, which can lead to unconsciously tense and uncomfortable body posture. The digital microscope RoboticScope (BHS®) allows visualization of the surgical site through a Head-Mounted Display (HMD), independent of the camera head and thus providing independent head and neck movement. The aim of the prospective study is to investigate to what extent the use of an HMD changes the tension of neck and shoulder muscles of the surgeon in comparison to a conventional tripod microscope.
Einleitung Muskuläre Verspannungen und Ermüdung im Rückenbereich sind ein oft beschriebenes Symptom während der Arbeit von HNO-ÄrztInnen mit dem Mikroskop. Insbesondere ohrchirurgische Eingriffe sind mit verlängerter Mikroskopnutzung und mit einer unbewusst angespannten, unkomfortablen Körperhaltung verbunden. Das digitale Mikroskop RoboticScope (BHS®) ermöglicht die Visualisierung des Situs mittels Head-Mounted Displays (HMD) unabhängig vom Kamerakopf. Ziel der prospektiven Studie ist es zu untersuchen, inwieweit die Nutzung des HMD im Vergleich zum konventionellen Stativ-Mikroskop eine Veränderung der Anspannung der Nacken- und Schultermuskulatur der OperateurInnen mit sich bringt.
Previous studies demonstrated cognitive deficits in patients with peripheral vestibulopathy (PVP) with dysfunction of spatial navigation and orientation, but also documented cognitive decline in nonspatial abilities. This study evaluates cognitive deficits in patients with unilateral vestibulopathy (UVP) as well as bilateral vestibulopathy (BVP) in multiple cognitive domains using common screening tests to reliably detect these deficits in clinical practice.This prospective study compared patients with UVP and BVP to age- and sex-matched healthy controls (HC). Tests included the Alzheimer's Disease Assessment Scale (ADAS), Mini-Mental Status Examination (MMSE), Trail Making Test Part A and B, Clock Drawing Task, Executive Interview-25 (EXIT25), Dementia Detection (DemTect), and the Judgment of Line Orientation (JLO). The Montgomery-Åsberg Depression Rating Scale was used to control for depression. Videonystagmography objectively reconfirmed PVP. The Vertigo Symptoms Scale and the Dizziness Handicap Inventory were used to assess for symptom severity and restrictions of activities of daily living.Eighty-one patients (65 UVP, 16 BVP) were compared to 55 HC. Patients showed impairment in ADAS, MMSE, DemTect, EXIT25, and JLO. No differences between UVP and BVP were detected. The relative risk (RR) estimates of developing cognitive deficits following PVP were increased. The RR for the ADAS was higher in BVP (RR = 4.91, 95% confidence interval [CI] = 1.87-12.9, p = 0.001) than in UVP (RR = 3.75, 95% CI = 1.65-8.51, p = 0.002), but was similar for the MMSE and DemTect between groups.Patients with PVP showed deficits in multiple cognitive domains including nonspatial cognitive abilities. Vestibulopathy could be a risk factor for the development of cognitive impairment.
Abstract Introduction Real-time visualization of intraoperative electrocochleography (ECochG) potentials via a digital microscope during cochlear implantation can provide direct feedback during electrode insertion. The aim of this prospective, randomized study of 50 patients was to obtain long-term data with a focus on residual hearing preservation and speech understanding. Material and methods Cochlear implantations were performed in 50 patients (26 female, 24 male) with residual hearing using a digital microscope. Patients were randomized into two groups. Intraoperative ECochG potentials were either displayed directly in the surgeon’s field of view (picture-in-picture display, PiP) or not directly in the field of view (without picture-in-picture display, without PiP). Residual hearing preservation and speech comprehension were recorded within a 1-year follow-up period, compared between groups (PiP versus without PiP) and to a control group of 26 patients implanted without ECochG. Results Mean insertion time was significantly longer in the picture-in-picture group ( p = 0.025). Residual hearing preservation after 6 weeks at 250 Hz was significantly better in the picture-in-picture group ( p = 0.017). After one year, 76% of patients showed residual hearing in the picture-in-picture group (62% without picture-in-picture technique, p = n.s.). Use of the picture-in-picture technique resulted in better long-term pure tone residual hearing preservation at 250, 500, and 1000 Hz. Speech intelligibility improved by 46% in the picture-in-picture group (38% without picture-in-picture). Discussion This study is the first to describe long-term results in a large cohort of cochlear implant patients in whom digital visualization of intraoperative ECochG was used. Our results show that visualization of intraoperative ECochG has a positive effect on residual hearing preservation.
Introduction Real-time visualization of intraoperative electrocochleography (ECochG) potentials via a digital microscope during cochlear implantation can provide direct feedback during electrode insertion. The aim of this prospective, randomized study of 50 patients was to obtain long-term data related to residual hearing preservation and speech understanding.
The capability of Pseudomonas aeruginosa and Staphylococcus aureus to form biofilm on varying CI component materials differs in the presence and absence of bioactive glass (BAG). The application of BAG induces significant changes in biofilm morphology which can be visualized via scanning electron microscopy (SEM). Bacterial biofilm formation on medical devices, such as cochlear implants (CI), can lead to chronic infections. Interestingly, BAG of type S53P4 seems to be a promising tool for use in the reduction of biofilm development. Primarily, four bacterial species known to cause implant-related infections, P.aeruginosa (ATCC9027), S. aureus (ATCC6538), Staphylococcus epidermidis (ATCC12228) and Streptococcus pyogenes (ATCC19615) were analyzed regarding their capacity to form biofilm on CI components manufactured from three kinds of material: silicone, platinum and titanium. Subsequently, P. aeruginosa and S. aureus biofilms were visualized using scanning electron microscopy, comparing BAG-treated biofilm with non-treated biofilm. The four bacterial species presented biofilm-forming capabilities in a species and surface dependent manner. Metal CI components allowed for the greatest proliferation of biofilm. S. aureus and P. aeruginosa showed the highest rate of biofilm formation on polystyrene surfaces. For both species, SEM revealed altered biofilm morphology after treatment of S53P4 BAG. This study indicates that bacterial biofilm formation and structure on CI components is dependent on the surface composition, altering between metal and silicone surfaces. After application of BAG, changes in biofilm morphology on CI components were observed. These data highlight the impact of BAG on bacterial biofilm morphology.
Einführung Da die Anzahl an Patienten mit Cochlear-Implantaten stetig steigt, erhöht sich auch das Aufkommen an Implantat versorgten Patienten, die im Laufe ihres Lebens MRT-Untersuchungen benötigen. Hierdurch wiederum wird es wahrscheinlicher, dass Komplikationen im Zusammenhang mit der radiologischen Diagnostik auftreten. FallEs handelt sich um einen siebenjährigen Patienten, der unmittelbar nach einer MRT-Untersuchung in Narkose eine oberflächliche Verbrennung im Bereich beider Cochlea–Implantate aufwies. Der Patient leidet an einem MNGIE-Syndrom und wurde bereits vor 2 Jahren alio loco beidseits mit "MED-EL Synchrony®“-Implantaten versorgt. Im Rahmen der Abklärung einer aufsteigenden Lähmung mit Ateminsuffizienz wurde ein MRT des Schädels und der Wirbelsäule indiziert. Die Untersuchung wurde in Narkose durchgeführt. Die Untersuchungszeit lag bei etwas über einer Stunde.
Patients with unilateral deafness and residual hearing on the contralateral ear can benefit from a cochlear implant on one side and a hearing aid on the other. However, hearing improvements among these patients are heterogenous. Interindividual differences in bimodal benefit may be caused by a mismatch of cochlear implant and hearing aid as well as discrepant signal processing. Creating a balanced sound processing and a matching automatic gain control may help to improve hearing and speech perception.
