[Overview of Alternative Methods of Cochleostomy with Focus on Laser Ablative Techniques]. / Überblick der Cochleostomieverfahren mit Fokussierung auf neue Laserablationstechniken.

BACKGROUND: Bone removal during mastoidectomy and cochleostomy or round window enlargement prior to electrode insertion is typically performed with a drill. The present work is a review of alternate methods of mastoidectomy and cochleostomy/round window enlargement that may reduce the risk of acoustic inner ear trauma associated with use of surgical drills during cochlear implant surgery. MATERIALS AND METHODS: MEDLINE database search was conducted using PubMed and Google Scholar search engines. Inclusion criteria for this study was the use of a laser to ablate the bone respectively the opening of Cochlear in terms of Cochleostomy. RESULTS: For the experimental studies, a total number of 4 papers were found, which deal with the application of the widely used CO2 laser. A comparison of the works could only partially under the above criteria, since no single study protocol was used and not always the sound pressure levels were determined occurring or evidence of damage to the inner ear missing. But for all that, a comparison of the work has been attempted because it is the authors' opinion about a promising approach to the atraumatic opening of the inner ear. CONCLUSION: There are promising approaches, using a laser to realize the erosion of bone and perform the opening of the inner ear. Nevertheless, there is a significant need for further investigations and in particular, the acoustic injury is not well enough understood here.

Radiographic examination of patients with dehiscence of semicircular canals with digital volume tomography.

Digital volume tomography (DVT) is an extension of panoramic tomography. With this diagnostic technique, characterized by high resolution, a narrow section width (0.125 mm), and three-dimensional display, small pathological processes can be well visualized. We examined 434 patients with DVT (Accu-I-tomo, Morita, Japan). Eleven patients with a history of peripheral vertigo presented a fistula of the labyrinth. The results were compared with intraoperative findings to evaluate the diagnostic value of DVT in cases of erosion of the semicircular canals. With high resolution and artifact-free demonstration of the labyrinth and inner ear structures, it was possible to determine the presence of a fistula of the semicircular canals in all 11 patients. An erosion of the lateral semicircular canal was found in nine patients with additional fistulae of the superior and posterior semicircular canals in one patient, a dehiscence of bone of the superior semicircular canal in one patient, and a dehiscence of the posterior semicircular canal in another patient. The predicted erosion of semicircular canals was verified in all patients during surgery where a closure of the fistulae was performed. DVT is an excellent technique to examine the semicircular canal structures in patients with peripheral vertigo, and expand the application of diagnostic possibilities in the lateral skull base. With this method, the preoperative diagnosis is improved allowing more accurate planning of the surgical procedure. DVT delivers a small radiation dose with a high resolution and a low purchase price for the equipment.

Measurement and comparison of labyrinthine structures with the digital volume tomography: ancient Egyptian mummies' versus today's temporal bones.

The objective of this study was to investigate whether the labyrinthine structures of ancient Egyptian mummies differ significantly from modern labyrinths. The new technique of digital volume tomography (DVT) was used to visualize the temporal bones. To obtain standardized images and measurements, precise instructions regarding volume rotation, slicing and measurements' positioning were determined. Twenty-five dimensions were obtained. The groups were compared statistically. No significant differences could be found except one cochlear diameter which proved to be significantly larger in the control group. DVT is applicable for imaging of temporal bones. Measurements might help to increase understanding of the temporal bone's structure, to aid the diagnostics of pathologies as well as to supplement the planning of surgical procedures.

[Hereditary sensorineural hearing impairment and macrothrombocytopenia: a rare MYH9 gene mutation]. / Hereditäre sensorineurale Schwerhörigkeit und Makrothrombozytopenie: Eine seltene Mutation des MYH9-Gens.

We report on a rare case of an exon 16 mutation of the MYH9 gene in a 23-year-old woman. This gene encodes for non-muscular myosin IIA, which acts as a cytoskeletal contractile protein in diverse cell types. This disorder led to sensorineural hearing loss, macrothrombocytopenia, and proteinuria. MYH9 gene mutation can lead to diverse organ manifestation like pre-senile cataract or renal failure which are progressive in course. Due to the current lack of causal treatment, diagnostic steps, advice for follow-up examinations and symptomatic therapy approaches are presented.

Imaging of ancient Egyptian mummies' temporal bones with digital volume tomography.

The radiographic imaging of ancient Egyptian mummies has always been of great interest. Computed tomography is the method of choice to demonstrate bony pathologies with high quality. As digital volume tomography (DVT) is an extension of panoramic tomography with a very high resolution, its qualities were evaluated by examination of temporal bones of Egyptian mummy skulls. Ten Egyptian mummy skulls from the Zoological Collection Marburg, estimated 1,700-5,000 years of age, from Abydos, Philae, Theben-West and Sakkarah, were examined by DVT (3D Accuitomo, Morita, Japan). Through a rotation 360° of the X-ray source around the region of interest, a cylinder of 3 × 4 cm was captured as a three-dimensional volume. The gained data were analyzed with the help of special software on a PC. The angles of the axial, coronal and sagittal sections were arbitrarily changed to represent single structures with high resolution of 0.125 mm to analyze specific anatomical structures. In all skulls, conditions of the temporal bone and its anatomical structures were evaluated and normal as well as pathological findings evaluated in detail. The analysis of special landmarks such as the ossicular chain, cochlea, external, and internal auditory canal, facial nerve canal, and semicircular canals showed an intact ossicular chain in six temporal bones, while only isolated and dislocated ossicles were found in eight temporal bones. Besides one dehiscence of the superior semicircular canal in one temporal bone which might have led to vertigo and deafness at lifetime, all other findings were normal. Fragments of foreign bodies additionally found in the labyrinth, external ear canal and intracranially were attributed to postmortem damage. Digital volume tomography extends the imaging possibilities of CT for paleoradiological evaluation of temporal bones. With its high resolution, geometric accuracy, reconstruction capabilities, rapidness, and comparably low costs, even small bony pathologies are precisely demonstrated in a limited area. Investigations of larger numbers of specimen might reveal further details of ancient history for further interdisciplinary investigation of anthropologists, Egyptiologists, otolaryngologists, and radiologists.

Malleostapedotomy: the Marburg experience.

BACKGROUND: The surgical procedure for patients with otosclerosis routinely is incus stapedotomy. In case of otosclerosis with incus necrosis or a bony fixation of the malleus and incus, malleostapedotomy is performed. PATIENTS AND METHODS: Between May 2002 and September 2003, malleostapedotomy was performed in 6 out of 34 patients with otosclerosis. In 2 primary cases, a middle ear dysplasia was found. The malleus was fixed in 2 further primary cases. Two revision surgeries were performed with incus necrosis present. A titanium piston was used, which was fixed at the malleus handle and introduced into an opening of the footplate. RESULTS: The preoperative air-bone gap was reduced from 36 dB(A) to 13 dB(A) after surgery for an average checkup time of 3 months. The length of the prostheses varied from 6.3 to 7.5 mm. No patient showed a hearing loss or vertigo after surgery. CONCLUSION: Malleostapedotomy is the technique of choice in case of an additional pathology of the ossicular chain in patients with otosclerosis. Larger numbers of patients and long-term investigations need to compare the results of malleostapedotomy with those of a conventional incus stapedotomy.

Early supraglottic cancer: how extensive must surgical resection be, if used alone?

OBJECTIVES: Two centre based evaluations of oncologic results of endoscopic resection of supraglottic cancer without post-operative irradiation. PATIENTS AND METHODS: Twenty-six patients with clinical T1 (n=5) or T2 (n=21) primary squamous cell carcinomas of the supraglottic larynx and with N0 (n=24) or N1 (n=2) neck disease were treated by endoscopic supraglottic laryngectomy coupled with neck dissection(s). Endoscopic resection was standardized whereas neck dissections (NDs) varied from classical modified radical ND to selective ND of levels I to IV. RESULTS: Pathologically, three T2 patients were upstaged to T3, four N0 patients to N1 and one N2 patient down-staged to N1. Within an average of 42 months, there were no local failures and only one regional failure. CONCLUSIONS: Endoscopic resection of T1 and T2 supraglottic cancer without post-operative irradiation achieved good oncological results. No patients with lateralized primary cancers were found to have contralateral cancer on pathological evaluation from bilateral dissections.

Value of digital volume tomography in patients with conductive hearing loss.

Digital volume tomography (DVT) is an extension of panoramic tomography. With this diagnostic technique, characterized by high resolution, a narrow section width (0.125 mm) and three-dimensional display, small pathological processes can be well visualized. Twenty-five patients with the history of a progressive hearing loss were examined with DVT (Accu-I-tomo, Morita, Japan). The results were compared with pre- and intraoperative findings to evaluate the diagnostic value of DVT in cases of erosion of the ossicular chain. With high resolution and artifact-free demonstration of the middle ear and the ossicular chain, it was possible to define its continuity preoperatively by DVT in all 25 cases. An intact ossicular chain was found by DVT in 13 cases and was later confirmed by surgery. The predicted erosion of the ossicles was verified in 12 patients, and a tympanoplasty type III was performed. Digital volume tomography is an excellent technique to examine the middle ear cleft and inner ear, and expands the application of diagnostic possibilities in the lateral skull base. Therefore, improvement in preoperative diagnosis is achieved along with more accurate planning of the surgical procedure. Digital volume tomography delivers a small radiation dose with a high resolution and a low purchase price for the equipment.

Bipolar radiofrequency induced thermotherapeutic volumetric reduction of VX2 metastases in an animal model.

BACKGROUND: Radiofrequency-induced thermotherapy has shown promising results in the palliative treatment of various tumor entities. The purpose of this study was to investigate the effectiveness of bipolar radiofrequency volumetric tissue reduction (VTR) on lymph node (LN) metastases in the VX2 SCC model. MATERIALS AND METHODS: Six male New Zealand white rabbits, with palpable metastatic disease within the parotid lymph nodes, were treated using the Celon-ProSurge probe, needle length 10 mm, diameter of 2.3 mm. The animals were sacrificed on the 4th, 8th, 11th, 14th, 18th and 22nd postoperative days respectively. RESULTS AND CONCLUSION: Bipolar radiofrequency VTR could prevent progression of local metastatic disease in one-third of the animals compared to the control group of untreated VX2 carcinoma rabbits. These results encourage further studies, directed at whether this treatment modality could play a role in the palliative therapy of metastatic LN. Future studies should concentrate on the refinement of the treatment parameters and optimization of the treatment duration.

RT-PCR expression profiling of matrix metalloproteinases and their specific inhibitors in cell lines and fresh biopsies of squamous cell carcinomas of the head and neck.

The expressions of MMP2, -7, -9, -13 and TIMP1, -2, -3 were examined in biopsies and cell lines of head and neck squamous cell carcinomas (HNSCC) to determine the association between the expression profile and TNM-staging of the primary. The expressions of MMP2, -7, -9, -13 and TIMP1, -2, -3 were analyzed in 30 HNSCC biopsies, 7 HNSCC cell lines and 1 keratinocyte cell line using RT-PCR. Negative correlation was determined between N-status and MMP13-RNA expression [Kendall-tau-b -0.404 (p = 0.016), Spearman-rho -0.448 (p = 0.014)], histological grading [Kendall-tau-b -0.291 (p = 0.049), Spearman-rho -0,333 (p = 0.048)], and MMP7 and TIMP2 expression [Kendall-tau-b -0.318 (p = 0.045); Spearman-rho -0.353 (p = 0.045)]. Positive correlation was determined between M-status and MMP9-RNA expression [Kendall-tau-b 0.341 (p = 0.025), Spearman-rho 0.377 (p = 0.024)] and MMP13 and TIMP2 expression [Kendall-tau-b 0.727 (p = 0.037), Spearman-rho 0.850 (p = 0.016)]. The results point to a role of the tested MMPs and TIMPs in the metastatic spread of HNSCC.

Reconstruction of the ossicular chain with titanium implants.

OBJECTIVES: Since 1994 more than 1300 titanium implants have been used to reconstruct the ossicular chain of the middle ear for chronic otitis media. Two different types of implants were used. First, a total and a partial implant of fixed length, available in numerous different lengths. And second, a total and partial implant that has an adjustable length. The implants are commercially available from 2 different companies. Patients were followed for a postoperative term from 6 to 72 months. METHODS: A wide variety of patients aged 5 to 82 years received a tympanoplasty type III. Those patients whose ossicular chain had been reconstructed with titanium implants since 1994 were evaluated. As implants from one company are fixed in length; implants of a second company are trimmable in length. All prostheses are lightweight and made of pure titanium, fitting most anatomical situations. RESULTS: Earlier results already showed a very low complication rate. Extrusions occurred only in cases of middle ear atalectasis with resorption of interposed cartilage (<1%). No adverse reaction to the prostheses could be seen, even in histologic reviews. An average air-bone gap less than 20 dB(A) for all calculated frequencies of 0.5, 1, 2, and 4 kHz was achieved for 76% of cases; 43% of cases showed a calculated air-bone gap of less than 10 dB(A), only 10% higher than 30 dB(A). CONCLUSION: All implants used offer the proven benefits of titanium, namely high biocompatibility and high stability at a very low complication rate with excellent hearing results for the patients. Titanium implants can highly be recommended to reconstruct the ossicular chain of the middle ear.