[The Freiburg monosyllable word test in postoperative cochlear implant diagnostics]. / Der Freiburger Einsilbertest in der postoperativen CI-Diagnostik.

BACKGROUND: The Freiburg monosyllable word test represents a central tool of postoperative cochlear implant (CI) diagnostics. OBJECTIVES: The objective of this study is to test the equivalence of different word lists by analysing word comprehension. For patients whose CI has been implanted for more than 5 years, the distribution of suprathreshold speech intelligibility outcomes will also be analysed. PATIENTS AND METHODS: In a retrospective data analysis, speech understanding for 626 CI users word correct scores were evaluated using a total of 5211 lists with 20 words each. RESULTS: The analysis of word comprehension within each list shows differences in mean and in the kind of distribution function. There are lists which show a significant difference of their mean word recognition to the overall mean. The Freiburg monosyllable word test is easy to administer at suprathreshold speech level for CI recipients, and typically has a saturation level above 80 %. CONCLUSION: The Freiburg monosyllable word test can be performed successfully by the majority of CI patients. The limited balance of the test lists elicits the conclusion that an adaptive test procedure with the Freiburg monosyllable test does not make sense. The Freiburg monosyllable test can be restructured by resorting all words across lists, or by omitting individual words of a test list to increase the reliability of the test. The results show that speech intelligibility in quiet should also be investigated in CI recipients al levels below 70 dB.

[Cochlear implant for non-deaf patients?]. / Cochlear-Implant-Versorgung bei nicht tauben Patienten?

BACKGROUND: Cochlear implants have proven to be the method of choice for postlingually deafened adults. The great success of this application requires discussion of the degree in which the indication for cochlear implantation should be expanded to include patients with residual hearing. METHOD AND PATIENTS: Following an initial discussion of the term deafness, we present the preoperative and postoperative results in five patients with residual hearing. These patients achieve a certain degree of speech recognition with their well fitted hearing aids. However, their aided speech intelligibility did not exceed 30% with the standardized Freiburg monosyllabic word test at 70 dB. In each case the worse hearing ear was treated with a cochlear implant. Speech discrimination in silence and noise are compared with the results of a group of postlingually deafened cochlear implant patients. RESULTS: The five patients are very satisfied with the cochlear implant and use the telephone to communicate with unknown partners. They score 100% in the standardized four-syllable number test above 55 dB and they document a loss of speech discrimination between 0 and 25% within the open-set monosyllabic word test. The mean increase of best monosyllable intelligibility by the cochlear implant over the hearing aids is 65%. Using the innsbruck sentence test the patients score 100% at 70 dB; with the Göttingen sentence test, the mean result is 75%. Their mean results in noise are also very good, 76% at 10 dBS/N and 57% at 5 dBS/N respectively. None of these patients use the hearing aid on the untreated, better hearing ear. CONCLUSION: A multichannel cochlear implant lead to a significant improvement of speech comprehension in these patients with residual hearing. We can successfully implant patients with minimal benefit of their well fitted hearing aids. Our group is too small to be able to define general selection criteria. For the time being we use as an audiological indication a open-set monosyllabic word intelligibility of not more than 30% at 70 dB with well fitted hearing aids.

[Paralysis of the superior laryngeal nerve after whiplash trauma]. / N.-laryngeus-superior-Parese nach Schleudertrauma.

BACKGROUND: The current literature rejects the possibility of strain of the superior laryngeal nerves by whiplash injury. However, due to the anatomic situation and the mechanism of the whiplash injury this damage does not seem unlikely. PATIENT: A 58-year-old male patient, who was a trained singer, complained of a loss of his head voice following a major whiplash injury. Indirect laryngoscopy revealed no unusual findings. The phoniatric examination showed a loss of the head voice in the vocal field indicating paresis of the superior laryngeal nerves. Three and one-half months after the whiplash injury, the paresis had completely receded and the patient had a voice well above average with an excellent frequency range. CONCLUSIONS: In the case presented the paresis of the superior laryngeal nerves could have been caused by a strain of the nerves during whiplash injury. A complete and exact phoniatric diagnosis can be recommended for elderly patients complaining of an altered voice following whiplash injury.

Cemento-ossifying fibroma of the petromastoid region: case report and review of the literature.

The cemento-ossifying fibroma (COF) is a mesodermal, non-odontogenic tumour of ectopic multipotential periodontal membrane blast cells. It is aggressive, locally destructive, and has a high recurrence rate. A case report of COF of the petromastoid region is presented. This location has not been described until now. Trauma may act as a trigger to sudden growth of the atopic periodontal tissue. Due to the aggressive behaviour of this tumour and its frequent recurrence radical surgery is needed.

Effect of fenfluramine on episodic ACTH and cortisol secretion.

OBJECTIVE: The central serotoninergic system is known to modulate the activity of the hypothalamic-pituitary-adrenal axis, but the effect of fenfluramine, a serotonin reuptake inhibitor, on ACTH and cortisol secretion is not well understood. We have therefore evaluated its effects on the hypothalamic-pituitary-adrenal axis in healthy controls. DESIGN: Episodic secretion of ACTH and cortisol was investigated in 6 healthy volunteers under basal conditions and again during treatment with 20 and 60 mg fenfluramine given orally every 8 hours. On all occasions blood samples were obtained at 10-minute intervals for 24 hours and the mode of hormone secretion was analysed by three different methods (PULSAR, CLUSTER, DESADE). In addition ACTH and cortisol responses to CRH were tested at the end of the sampling period. RESULTS: At the lower dose fenfluramine had no effect on ACTH and cortisol secretion. At the higher dose a significant increase of mean plasma ACTH (+85%) and cortisol (+129%) levels as well as of urinary free cortisol secretion (+44%) was observed. Fenfluramine did not modulate the frequency, but increased the amplitudes of ACTH and cortisol secretory episodes. ACTH and cortisol responses to CRH injection remained unchanged. Maximum plasma levels of d-fenfluramine and d-norfenfluramine were documented 2-4 hours after the ingestion of the drug. CONCLUSION: Fenfluramine stimulates the activity of the hypothalamic-pituitary-adrenal axis at a suprapituitary level by modulating the amplitude of ACTH and cortisol secretory bursts.

Effect of cyproheptadine on episodic ACTH and cortisol secretion.

To investigate the effect of cyproheptadine on ACTH and cortisol secretion, we obtained blood samples at 10-min intervals for 24 h in six healthy volunteers under basal conditions and under treatment with 16 mg day-1 cyproheptadine. Cyproheptadine caused significant decreases in mean plasma ACTH and cortisol levels in 30% and 19% of samples, respectively, mainly in the afternoon and evening. Analysis of episodic hormone secretion by three different methods demonstrated that the drug did not modulate the frequency but lowered the amplitudes of ACTH and cortisol secretory episodes. ACTH and cortisol responses following ovine CRH injection at 20.00 h were unchanged. We conclude that in the afternoon and evening central serotoninergic mechanisms influence the activity of the hypothalamic-pituitary-adrenal axis at the hypothalamic level by modulating the amplitude of the secretory hormonal bursts, but do not influence the increase in ACTH and cortisol secretion in the morning.

[Acute hearing loss caused by arterial hypotension]. / Akute Hörminderung durch arteriellen Hypotonus.

The aim of this study was to confirm the hypothesis based on clinical observations of a causal relationship between arterial hypotension and sudden hearing loss of lower frequencies. A noninvasive system was used that enables repeated blood pressure measurements at programmable time intervals. With this method 24-hour blood pressure monitoring was performed on 81 patients with sudden inner ear hearing loss proved by audiological tests (and in part defined by magnetic resonance imaging). The profiles of the circadian blood pressures recorded actually revealed a significant incidence of low-frequency hearing loss of up to 30 dB HL in the patient group suffering from arterial hypotension compared to those showing normal blood pressure or hypertension. In the patient group designated arterial hypotension may be the probable cause for sudden hearing impairments and should be regarded as a circulatory disorder with certain implications for management.