[Sauer's binaural number test in noise. Significance in expertise]. / Beidohriger Zahlentest im Störgeräusch nach Sauer. Stellenwert in der Begutachtung.

OBJECTIVE: For the determination of speech intelligibility in the expertise of hearing loss, the Freiburg speech test (number test and monosyllable test) is recommended in the Federal Republic of Germany. In the former German Democratic Republic, Sauer's binaural number test with 70 dB background noise ("beidohriger Zahlentest", BZT) was a standard element in expert opinions and was used in the calculation of bodily injury ("Körperschaden"). In the current practice, a hearing test in noise is still lacking. The present study analyzes whether and to what degree the impairment ("Grad der Schädigungsfolgen", GdS) changes when also considering Sauer's test. MATERIAL AND METHODS: In a collective of 78 patients with hearing loss (66 patients with high-frequency hearing loss and 12 patients with pancochlear hearing loss) and 22 normal hearing controls, the following audiometric measurements were conducted: pure tone audiometry, speech audiometry (Freiburg speech test), free field audiometry with and without noise, and Sauer's test. Subsequently, the hearing loss for both sides was calculated taking into consideration the values obtained with and without Sauer's test, and the respective GdS was determined. RESULTS: Patients with high-frequency hearing loss and pancochlear hearing loss had a trend for higher GdS (approximately 2 and 5%, respectively), compared to the established algorithm without the use of hearing tests in noise. However, neither the Mann-Whitney U-test nor the Bland-Altman analysis yielded relevant differences between the two methods to calculate the GdS. CONCLUSION: The routine implementation of Sauer's test in the expertise of hearing loss cannot be recommended, since no relevant change in the GdS can be expected. This is especially true for high-frequency hearing loss. In pancochlear hearing loss, use of Sauer's test can be considered if problems concerning hearing in situations with background noise are present-at least until more advanced hearing tests optimized for use in noise have been integrated into the tables for GdS calculation.

[Correlation of pure tone thresholds and hearing loss for numbers. Comparison of three calculation variations for plausibility checking in expertise]. / Korrelation von Tonschwellenaudiogramm und Hörverlust für Zahlen. Vergleich dreier Rechenvarianten zur gutachterlichen Plausibilitätsprüfung.

BACKGROUND: The present study analyzes the best combination of frequencies for the calculation of mean hearing loss in pure tone threshold audiometry for correlation with hearing loss for numbers in speech audiometry, since the literature describes different calculation variations for plausibility checking in expertise. Three calculation variations, A (250, 500 and 1000 Hz), B (500 and 1000 Hz) and C (500, 1000 and 2000 Hz), were compared. METHODS: Audiograms in 80 patients with normal hearing, 106 patients with hearing loss and 135 expertise patients were analyzed in a retrospective manner. Differences between mean pure tone audiometry thresholds and hearing loss for numbers were calculated and statistically compared separately for the right and the left ear in the three patient collectives. RESULTS: We found the calculation variation A to be the best combination of frequencies, since it yielded the smallest standard deviations while being statistically different to calculation variations B and C. The 1- and 2.58-fold standard deviation (representing 68.3% and 99.0% of all values) was ±4.6 and ±11.8 dB for calculation variation A in patients with hearing loss, respectively. CONCLUSIONS: For plausibility checking in expertise, the mean threshold from the frequencies 250, 500 and 1000 Hz should be compared to the hearing loss for numbers. The common recommendation reported by the literature to doubt plausibility when the difference of these values exceeds ±5 dB is too strict as shown by this study.

[The tasks of the ENT specialist by hearing aid fitting. Part 2: checking the fit, subjective satisfaction, ear mold and hearing aid]. / Die Aufgaben des Hals-Nasen-Ohren-Arztes bei der Hörgeräteversorgung. Teil 2: Uberprüfung von Anpassbericht, subjektiver Zufriedenheit, Ohrpassstück und Hörgerät.

The second part of this series deals with the tasks of the ENT-specialist, who must not endorse the prescription before making sure that the hearing aid recommended by the acoustician will bring sufficient hearing improvement, and that the suggested hearing aid is suitable. The report and audiograms of the acoustician must be compared to his own results, and a check of whether at least three hearing aids from different companies have been compared must be made. The primary aim of patient satisfaction can be checked by means of the "Oldenburger Inventar" (Oldenburg questionnaire), which determines the improvement of hearing ability in quiet and noise, and of auditory localization. Since the otoplastic substantially effects the amplification of the hearing aid, the ENT specialist should make sure that it does not produce feedback, that it has a second boring, and, in case of need, a Libby horn. He should also consider whether an open fitting would be more appropriate. A free-field measurement--with and without noise--shows whether the dB(opt) has been reached. The in situ measurement and the loudness rating by the Würzburger Hörfeld (Wuerzburg auditory field) are of great help in detecting fitting errors. Additional procedures, such as auditory speech training, lip reading, or technical devices, for instance FM-communication or a light alarm clock, are often employed in elderly patients.

[The task of the HNO specialist by Hearing Aid fitting. Part 1: indications, special diagnostic tests, prescription]. / Die Aufgaben des HNO-Arztes bei der Hörgeräteversorgung. Teil 1: Indikation, gezielte Diagnostik und Verordnung.

The first part of the article deals with the indication of fitting, which mainly is given when the communication is impaired, not only in dialogue with one person, but also in conversation with several persons and in noisy surrounding. Yet, the healthy insurances cover only the expenses if the guidelines on relief-aid are considered, which are exactly listed in this article. Bevor starting the fitting of an Hearing Aid, special diagnostic tests are necessary, such as pure tone audiogram, speech audiogram including dB(opt), freefield measurement in noise, and several retrocochlear tests, as well as tinnitus determination and masking with narrow-band and broad-band noise. Most important is the correct filling in the form "Ohrenärztliche Verordnung einer Hörhilfe", including the necessity of renewal. In addition, it is necessary to accentuate the need of trying out several Hearing Aids and to let the patient know that digital Hearing Aids will not be covered by the health insurance.

[Niikawa-Kuroki syndrome. Which characteristics must the HNO doctor consider in its diagnosis]. / Niikawa-Kuroki-Syndrom. An welche Besonderheiten muss der HNO-Arzt bei der Diagnose denken?

Niikawa-Kuroki syndrome (Kabuki make-up syndrome) is a congenital disorder with characteristic facial features and possibly anomalies of the skeletal system and internal organs. There is an increasing number of reports of patients with combined hearing impairment, inner ear deformities or sensorineural hearing impairment. In addition, the patients often suffer from therapy-resistant chronic otitis media. In addition to multiple cardiac and renal deformities, our 3 year old patient has a hearing impairment due to chronic otitis media with chronic otorrhea, and requires a hearing aid. A high-definition CT scan of the petrosal bone revealed, for the first time in a patient with Niikawa-Kuroki syndrome, a large vestibular aqueduct syndrome and deformities of the vestibular system. We examine the problems involved with treating chronic otorrhea in chronic otitis media and providing patients with BTE hearing aids.

[Check of hearing aid fitting]. / Hörgeräteüberprüfung in der Praxis.

A qualified hearing aid fitting is only possible if the ENT doctor not only prescribes the device, but also conscientiously checks the comparative adjustments made by the hearing aid acoustician. In deciding, which of the tested hearing aids achieves the best and most appropriate improvement of hearing, the physician should first thoroughly study the acoustician's fitting protocol, which contains comparative results of all devices tested. The subjective satisfaction of the patient with his hearing aid can be determined in a detailed conversation or with a special questionnaire. The examination of the otoplastic is as necessary as the improvement of speech discrimination under free field conditions, especially with additional noise. With in situ measurement, the individual transmission characteristics of the hearing aid and the otoplastic are tested in a few minutes. Conscientious control of the fitted hearing aid is only possible with loudness scaling. The scaling function shows clearly whether the fitted aid has adequate amplification, is not too loudly adjusted, and whether the field of pleasant hearing has been considered.

Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: a feasibility study for chronic tinnitus.

Low-level-laser-therapy (LLLT) targeting the inner ear has been discussed as a therapeutic procedure for cochlear dysfunction such as chronic cochlear tinnitus or sensorineural hearing loss. Former studies demonstrate dose-dependent biological and physiological effects of LLLT such as enhanced recovery of peripheral nerve injuries, which could be of therapeutic interest in cochlear dysfunction. To date, in patients with chronic tinnitus mastoidal and transmeatal irradiation has been performed without systematic dosimetric assessment. However, light-dosimetric studies on human temporal bones demonstrated that controlled application of laserlight to the human cochlea depends on defined radiator position within the external auditory meatus. This feasibility study first presents a laser application system enabling dose-controlled transmeatal cochlear laser-irradiation (TCL), as well as preliminary clinical results in patients with chronic cochlear tinnitus. The novel laser TCL-system, consisting of four diode lasers (lambda=635 nm-830 nm) and a new specific head-set applicator, was developed on the basis of dosimetric data from a former light-dosimetric study. In a preliminary clinical study, the TCL-system was applied to 35 patients with chronic tinnitus and sensorineural hearing loss. The chronic symptoms persisted after standard therapeutic procedures for at least six months, while retrocochlear or middle-ear pathologies have been ruled out. The patients were randomised and received five single diode laser treatments (lambda=635 nm, 7.8 mW cw, n=17 and lambda=830 nm, 20 mW cw, n=18) with a space irradiation of 4 J/cm2 site of maximal cochlear injury. For evaluation of laser-induced effects complete otolaryngologic examinations with audiometry, tinnitus masking and matching, and a tinnitus-self-assessment were performed before, during and after the laser-irradiation. The first clinical use of the TCL-system has been well tolerated without side-effects and produced no observable damage to the external, middle or inner ear. Changes of tinnitus loudness and tinnitus matching have been described. After a follow-up period of six months tinnitus loudness was attenuated in 13 of 35 irradiated patients, while two of 35 patients reported their tinnitus as totally absent. Hearing threshold levels and middle ear function remained unchanged. Further investigations by large double-blind placebo-controlled studies are mandatory for clinical evaluation of the presented TCL-system and its therapeutic effectiveness in acute and chronic cochlear dysfunction.

Effect of adjuvant imiquimod 5% cream on sustained clearance of anogenital warts following laser treatment.

OBJECTIVES: Imiquimod is an immune response modifier that has demonstrated a good efficacy and relatively low recurrence rates in comparison to other genital wart treatment modalities. The primary objective of this open-label study was to evaluate the effect on sustained clearance of treated lesions and the safety of patient-applied topical imiquimod after laser therapy of external anogenital warts. METHODS: After laser treatment of visible external anogenital warts the ablated region(s) were treated with imiquimod 5% cream three times/week over 12 weeks beginning when the wound healing process was completed, followed by a six-month treatment-free observation period for the assessment of sustained clearance of treated lesions. RESULTS: A total of 211 male and female patients was enrolled in the study. After 12 weeks of treatment, 65.4% of all patients showed sustained clearance. During the treatment period, 15 patients (7.1% of 211 patients) presented with recurrent warts in the treated areas, and 58 (27.5%) patients were excluded for other reasons. During the six-month follow-up period, ten additional patients (7.3% of 138 patients) developed wart recurrences. The application of imiquimod 5% cream was well tolerated. The number of patients with adverse events related to study medication declined from the first month of treatment until the end of the third month. Most frequently, mild to moderate itching, burning, pain and erythema were reported. CONCLUSIONS: After laser therapy and sufficient wound healing, administration of imiquimod 5% cream three times/week appears to be safe and to reduce the incidence of wart recurrences.

[Detection of humoral immune response to inner ear proteins in patients with sensorineural hearing loss]. / Nachweis einer humoralen Immunreaktivität gegen Innenohrproteine bei Patienten mit einer sensorineuralen Schwerhörigkeit.

BACKGROUND: The precise mechanism of inner ear disease is still unknown. An autoimmune reaction could be one of several possible pathogenic factors involved in progressive sensorineural hearing loss. Heat shock protein 70 is suggested to play an important role in the development of autoimmune diseases. The aim of this study is the investigation of humoral immune reactivity to inner ear components in patients with sensorineural hearing loss. METHODS: The presence of antibodies to inner ear components was determined by immuno-blotting extracted bovine or human inner ear proteins. Study groups consisted of patients with idiopathic progressive sensorineural hearing loss (group A), patients with Menière's disease (group B), patients with sudden hearing loss (group C), patients with otosclerosis (group D), patients with Cogan's disease (group E), and individuals without hearing problems (group F). RESULTS: 40% of the patients with progressive sensorineural hearing loss showed reactivity against a 68-kDa protein extracted from bovine inner ear. In contrast to this, only 5% of healthy individuals and 10% with Menière's disease showed reactivity against the 68-kDa protein from bovine inner ear or against bovine heat shock protein 70. Some of the patients who showed reactivity against bovine inner ear proteins were tested with human inner ear and human heat shock protein 70; all of these showed reactivity. Approximately 6% of the patients with sudden hearing loss (group C), otosclerosis (group D), and Cogan's disease (group E) showed reactivity to inner ear proteins. A non-specific humoral immune reaction against inner ear proteins with molecular weights of 30, 40, 50, 60, and 220 kDa was observed in all patients. DISCUSSION: These results indicate a humoral immune reactivity against heat shock protein 70, which might be responsible for the pathogenesis of progressive sensorineural hearing loss.

Lightdosimetric quantitative analysis of the human petrous bone: experimental study for laser irradiation of the cochlea.

BACKGROUND AND OBJECTIVE: Application of laser irradiation targeting the inner ear has to be investigated for therapeutic effectiveness in cochlear injury and dysfunction. In vitro data demonstrate low-level laser-induced photochemical and photobiologic cell response, depending on cell type and irradiation parameters such as light dose. The aim of the presented study was to determine the light dose received by the cochlear hair cells by using different irradiation modalities for the human petrous bone. STUDY DESIGN/MATERIALS AND METHODS: Lightdosimetric assessment was performed in human cadaver temporal bones (n = 13) after removing the cochlear membranous labyrinth. The external auditory meatus, the tympanic membrane (quadrants), and the mastoid bone were illuminated by a helium-neon laser (lambda = 593 nm) and diode lasers of different wavelengths (lambda = 635, 690, 780, and 830 nm). The spatial distribution of transmitted light in the cochlear windings was measured by means of a retrocochlearly positioned endoscopic CCD camera for image processing and was assigned to acoustic frequencies according to the tonotopic organization of the cochlea. For an estimation of the corresponding space irradiance in an intact cochlea, correction factors have been calculated by a Monte Carlo procedure on the basis of experimentally determined optical properties of skull bone. RESULTS: The transmission of light across the tympanic cavity and the promontory depends strongly on wave-length of the laser and the position of the radiator. Transtympanal irradiation results in spatial intensity variations of a factor 4 to 10 within the cochlear windings. The space irradiance in an intact cochlea is 10 to 20 times the measured irradiance. For an irradiation of the mastoid, the light transmission within the cochlea is 10(3) to 10(5) times smaller compared with an irradiation of the tympanic membrane and is extremely variable for different specimens. CONCLUSION: The strong dependence of the cochlear light distribution on various irradiation parameters demonstrates the impact of preclinical lightdosimetric investigations for effective individual laser irradiation of the human cochlea. Because of the observed spatial intensity variations, the optimal external light dose has to be chosen with regard to the tonotopy of the human cochlea. The obtained results are enabling us to apply defined laser light doses to different cochlear winding areas. Mastoidal irradiation leads to therapeutically insufficient light doses within reasonable treatment times, whereas transmeatal irradiation is recommendable. Further studies are mandatory for development of clinical devices for transmeatal irradiation of the cochlea.

[Early detection of pediatric hearing loss. Visual and automated procedures compared]. / Früherkennung kindlicher Hörschäden. Visuelle und automatische Verfahren im Vergleich.

The recording of otoacoustic emissions is suitable for the detection of hearing loss in small children. The test meets the following requirements for hearing screening: it is carried out in a few minutes, specialized personnel is not necessary, the results do not depend on the vigilance of the child, and total costs are comparably low. However, the choice of a suitable device is quite essential. A test of the ILO88, ILO92, Echosensor (Otodynamics Ltd.), and Echoscreen (Madsen) devices was performed with 102 children (aged < 1 year). Additionally, a software package (Otoclass) for offline analysis of ILO88 data files was tested. The results indicate that all devices applying OAE as a screening measure was able to detect every ear (n = 25) with a hearing loss indicated by the outcome of a control BERA (stimulus level 35 dB nHL), thus reaching a sensitivity equal to 100%. The specificity of the different OAE devices depends on the underlying detection strategy. The best results were achieved with the automated Echoscreen device (95.9%) followed by the Otoclass analysis software (94.2%). The Echosensor device failed in our study to provide good specificity (77.3%). Reflex audiometry, which is favored by pediatricians in Germany, when used alone is completely inadequate as a screening method, even if conducted by a well-trained investigator. In our study, only 61.5% of the children with hearing loss were detected with reflex audiometry, and 42.7% of the children with normal hearing were misclassified. These results deviated from the results presented in ref. 13 to a large extent, as the Hanover group attested sensitivity and specificity of 100% for reflex audiometry (HNO 43, Reuter et al.). The deviating results are discussed in detail.

Comparison of the TEMPO+ ear-level speech processor and the cis pro+ body-worn processor in adult MED-EL cochlear implant users.

A study was conducted to compare the new MED-EL TEMPO+ ear-level speech processor with the CIS PRO+ body-worn processor in the COMBI 40/COMBI 40+ implant system. Speech tests were performed in 46 experienced subjects in two test sessions approximately 4 weeks apart. Subjects were switched over from the CIS PRO+ to the TEMPO+ in the first session and used only the TEMPO+ in the time between the two sessions. Speech tests included monosyllabic word tests and sentence tests via the telephone. An adaptive noise method was used to adjust each subject's scores to approximately 50%. Additionally, subjects had to complete a questionnaire based on their 4 weeks of experience with the TEMPO+. The speech test results showed a statistically significant improvement in the monosyllabic word scores with the TEMPO+. In addition, in the second session, subjects showed a significant improvement when using the telephone with the TEMPO+, indicating some learning in this task. In the questionnaire, the vast majority of subjects found that the TEMPO+ allows equal or better speech understanding and rated the sound quality of the TEMPO+ higher. All these objective and subjective results indicate the superiority of the TEMPO+ and are mainly attributed to a new coding strategy called CIS+ and its implementation in the TEMPO+. In other words, based on the results of this study, it appears that after switching over from the CIS PRO+ to the TEMPO+, subjects are able to maintain or even improve their own speech understanding capability.

Heparin-induced extracorporal low-density-lipoprotein precipitation (H.E.L.P.) to improve the recovery of hearing in patients with sudden idiopathic hearing loss.

The pathogenesis of sudden hearing loss (SHL) is still not well understood. Possible causes include increased blood viscosity, microthrombosis or altered blood flow. Hypercholesterolemia, hyperfibrinogenemia and increased platelet aggregation are frequently observed in patients with SHL. The aim of this study was to investigate whether drastic lowering of plasma cholesterol and fibrinogen by selective extracorporal apheresis could have a beneficial effect on hearing recovery in these patients. Seven patients with SHL were treated with an extracorporal procedure removing fibrinogen and cholesterol from plasma. Six of the seven patients showed an immediate improvement in auditory thresholds following a single treatment of heparin-induced low-density lipoprotein precipitation. These findings indicate for the first time that acute and drastic removal of plasma fibrinogen and low-density lipoproteins may be an effective clinical method for the treatment of patients with SHL.

[Use of auditory field measurement in patients with otosclerosis]. / Einsatz der Hörfeldmessung bei Patienten mit Otosklerose.

BACKGROUND: Middle ear surgery sometimes leads to unpleasant auditory impressions such as distortion or hyperacusis that cannot be detected by conventional audiometric testing. METHOD: Sixty-one patients with conductive hearing loss caused by otosclerosis underwent audiological evaluation, which included a questionnaire followed by testing of the audiometric threshold, speech audiometry, and assessment and quantification of loudness perception with a commercial system (WESTRA). This investigation includes the postoperative measurement of hearing improvement and the patients' subjective impressions regarding hearing increase, distortion of speech, and hyperacusis. RESULTS: Hearing improved in 88% of the patients. A quantification of this hearing increase was possible with pure tone audiometry and the Freiburg speech discrimination test. Reduced hearing threshold and lack of improvement in speech discrimination was confirmed by conventional hearing measurements. However, the presence of hyperacusis and distortion of speech could be determined by conventional audiometry in only 50% of cases. It was interesting to note that the subjects who reported speech distortion and hyperacusis in the questionnaire were identified by their increased loudness perception using the categorical loudness scaling. CONCLUSION: Category loudness scaling appears to be a valuable additional clinical test to characterize postoperative phenomena as distortion of speech and hyperacusis in patients undergoing stapes surgery.

Changes in serum osmolarity influence the function of outer hair cells.

Fast motility of outer hair cells (OHC) is thought to be based on a hydromechanic principle. In vitro, the function of OHCs can be disturbed by a change in the osmolarity of the culture medium. Whether changes in the serum osmolarity in vivo can also interfere with OHC motility has not been investigated as yet. Serum osmolarity of New Zealand White rabbits (n = 18) was elevated by a continuous infusion of glucose 40%, decreased by an infusion of aqua dest, or kept constant by an infusion of saline. OHC function was monitored using distortion products of otoacoustic emissions (DPOAE). Input output curves were established between 2 and 5 kHz (geometric mean of f2) with primaries of levels between 35 and 55 dB SPL. Cochlear perfusion was measured using a fluorescence microsphere method. Elevation of the serum osmolarity from 306 +/- 17 mosm/l to 365 +/- 23 induced a decrease of DPOAE between 3 and 12 dB SPL. Cochlear blood flow increased from 0.11 +/- 0.09 to 0.15 +/- 0.10 ml/min/g. When decreasing the serum osmolarity from 303 +/- 9 to 281 +/- 8 mosm/l, only slight changes of the DPOAE could be verified. As in the control group, cochlear perfusion was almost unchanged. In the control group, neither serum osmolarity nor DPOAE changed. Comparable to findings in vitro, increasing the serum osmolarity can lead to a disturbance of OHC function. In patients suffering from sudden hearing loss. dehydration due to physical or mental stress is often observed. This new and promising pathophysiological concept needs further clinical evaluation.

Bacterial meningitis in adults: demonstration of inner ear involvement using high-resolution MRI.

OBJECTIVE: To visualize the sites involved in audiovestibular dysfunction during bacterial meningitis in adults and to relate these findings to the extent of hearing impairment and vestibular dysfunction. BACKGROUND: Hearing impairment is among the most frequent complications of bacterial meningitis. METHODS: High-resolution MRI (HR-MRI) of the inner ear was performed in seven adult patients with hearing loss as a complication of bacterial meningitis. RESULTS: Five patients had unilateral (n = 1) or bilateral (n = 4) contrast enhancement of vestibulocochlear structures. The structures most frequently involved were the cochlear nerve (n = 9), the first cochlear turn (n = 9), the vestibulum (n = 9), and the semicircular canals (n = 7). There was a significant correlation between clinical and MRI findings: all nine ears with cochlear enhancement were deaf (hearing loss >90 dB), whereas none of the five ears with normal MRI findings had hearing losses of more than 90 dB (range, 30 to 70 dB; p = 0.0005). Vestibular dysfunction as revealed clinically and by quantitative vestibular function testing was found in six of seven patients (11 of 14 ears). Five of these patients (nine ears) also demonstrated enhancement of the vestibular organ on high-resolution MRI of the inner ear. CONCLUSIONS: High-resolution MRI can visualize the involvement of vestibulocochlear structures in bacterial meningitis in both cooperative and consciously impaired patients. These findings suggest a correlation between abnormalities on MRI and the extent of cochlear dysfunction.

[Improvement of hearing aid fitting with digital aids and new fitting strategies]. / Die Verbesserung der Hörgeräteanpassung mit digitalen Geräten und neuen Anpassmethoden.

Hearing aids with digital signal processing demonstrate a large dynamic range with negligible distortion and no significant inherent noise. Furthermore, many acoustic parameters allow the compensation of even severe hearing loss, and the adjustment is extremely accurate. However, the new hearing aid generation not only requires computerized fitting, but also an experienced examination with new integrated fitting procedures. In addition to in situ measurement, the hearing aid fitting should include not only the Freiburg speech test, but also the Göttingen sentence test and the monosyllable rhyme test with different noises, for example the Fastl noise or the Döring babble noise. Loudness scaling with different methods is particularly important.

Clinical utility of LDL-apheresis in the treatment of sudden hearing loss: a prospective, randomized study.

Although the pathogenesis of sudden hearing loss (SHL) is not as yet known, the clinical picture and the frequent association with vascular risk factors make an ischaemic event likely. This study aimed to assess the effect of an extracorporeal procedure (H.E.L.P.) in removing LDL-cholesterol, fibrinogen and lipoprotein (a) from the plasma, on the recovery of hearing SHL. This procedure using the HELP-system was compared with the usual standard treatment with prednisolone, dextranes and pentoxifyllin. We undertook a single centre, prospective, randomized study in which 18 patients were assigned to H.E.L.P.-apheresis and 9 patients were assigned to standard treatment (2:1 randomization). Audiometric and laboratory testing was performed at baseline, 24 h and 6 weeks after start of treatment. Primary endpoint was the improvement of the average pure-tone threshold between 0.125 and 8 kHz after 24 h. Twenty-four hours after H.E.L.P. treatment average pure-tone threshold recovered by 10.4 dB and by 26.4 dB after 6 weeks. The recovery of hearing of the standard treated patients was 5.8 dB and 16.8 dB after 24 h and 6 weeks respectively. LDL-cholesterol, fibrinogen and lipoprotein (a) were significantly reduced in the HELP treated patients compared with standard therapy, resulting in a significant improve in plasma viscosity, erythrocyte aggregation and resistance to oxidative stress of LDL particles. Our results suggest that the clinical outcome of SHL after a single extracorporeal LDL-apheresis is superior or at least equal to the more expensive standard treatment with prednisolone, dextranes and pentoxifyllin. Re-establishment of vascular endothelial function and improved blood rheology may be the underlying cause. These results must be confirmed in larger-scale trials.

[All sudden hearing losses are not alike. Away from infusion therapy?]. / Hörsturz ist nicht gleich Hörsturz. Weg von der Infusionstherapie?

The number of patients requiring treatment for acute functional disorders of the inner ear has increased over the last decades. The diagnosis sudden loss of hearing is made when the cause of a precipitous hearing impairment cannot be determined with clinical diagnostic means. In the large majority of such cases, the pathogenesis is unclear, with vascular, viral and autoimmune processes most commonly being considered. Against this background, numerous polypragmatic therapeutic measures are employed. In general treatment of sudden loss of hearing employs a combination of several drugs with perfusion-promoting or anti-inflammatory effects. However, the efficacy of such an approach has not been established. The present article discusses a number of known ideas on the pathogenesis of this condition, together with the associated therapeutic strategies, and reports on the importance of nitrogen oxide (NO), which as recent studies appear to show, plays an important role in the physiology of the cochlea.