ARTIS Pheno®: a potential tool for cochlear implant surgery.

PURPOSE: Cochlear implantation is a standard approach to hearing rehabilitation and encompasses three main stages: appropriate patient selection, a challenging surgical procedure, which should be as atraumatic as possible and preserve cochlear structures, and lifelong postoperative follow-up. Computed tomography (CT) is performed to assess postoperative implant position. The Siemens Advanced Radar Target Identification System (ARTIS) Pheno provides fluoroscopic imaging during surgery and has so far been mainly used by cardiologists, neurosurgeons and trauma surgeons. METHODS: Six patients with difficult anatomy or a challenging medical history were selected for a surgical procedure, during which we planned to use the ARTIS Pheno to accurately position and assess implant position under fluoroscopy during and immediately after surgery. In all six cases, the ARTIS Pheno was used directly in the surgical setting. The procedures were performed in cooperation with the neuroradiology department in an interdisciplinary manner. RESULTS: In all six patients, fluoroscopy was used to visualise the procedure at different stages of surgery. In five patients, the procedure was successfully completed. This approach allowed us to finally assess implant position and confirm the correct and complete insertion of the electrode while the patient was still under anaesthesia. CONCLUSION: These cases showed positive surgical outcomes. Although the procedure is more complex than a standard approach, patients can be managed in a safe, effective and appropriate manner. The assessment of implant position in real time during surgery leads to greater patient and surgeon satisfaction. The approach presented here ensures a high quality of cochlear implant surgery even in difficult surgical situations and meets the requirements of modern surgery.

[Interdisciplinary defect reconstruction of upper aerodigestive fistulas-case series and treatment algorithm]. / Interdisziplinäre Defektrekonstruktion bei Fisteln des oberen Aerodigestivtrakts ­ Fallserie und Behandlungsalgorithmus.

BACKGROUND: Persistent complex defects and dysfunctions of the upper aerodigestive tract after tumor surgery represent a major challenge. The aim of this study was to evaluate the effectiveness of an interdisciplinary approach using the free anterolateral thigh flap (ALT) as a reconstruction option in the upper aerodigestive tract. MATERIALS AND METHODS: The retrospective study identified 5 patients with complex defects after laryngectomy/pharyngolaryngectomy (LE/PLE) and multiple revision surgeries between 2017 and 2023. The operations were performed by an interdisciplinary team from otolaryngology, plastic surgery, and visceral/thoracic surgery. The results of the microsurgical reconstruction were analyzed. RESULTS: There was an average of six previous operations. The defects included tracheoesophageal fistulas, pharyngocutaneous fistulas, neopharyngeal stenosis, and combinations thereof. Successful reconstruction was achieved in 100% of patients using the ALT flap. In 2 patients, ALT flow-through flaps were used with an additional free jejunal interposition (JI) and in 3 patients split-ALT flaps were used. The major complication rate was 40% and the minor complication rate was 20%. CONCLUSION: Complex defects of the upper aerodigestive tract with multiple previous operations can be successfully reconstructed. Because of its versatility, the ALT flap seems to be a very good option. Prerequisite for this is an interdisciplinary treatment approach with a critical assessment of patient- and disease-specific factors.

Adenoid hypertrophy-​diagnosis and treatment: the new S2k guideline.

Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.

[Adenoids-diagnosis and treatment: the new German S2k guideline]. / Adenoide Vegetationen ­ Diagnostik und Therapie ­ die neue S2k-Leitlinie.

Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.

[Study protocol of the monocentric prospective randomized placebo-controlled double-blind phase II study to explore the protective effects of the ginkgo biloba extract EGb 761® from temporary noise-induced hearing loss]. / Prüfplan für die monozentrische prospektive randomisierte placebokontrollierte doppelblinde Phase-II-Studie zur Exploration protektiver Effekte des Ginkgo-biloba-Spezialextrakts EGb 761® vor einer vorübergehenden Hörschädigung durch Lärm.

BACKGROUND: Hearing loss is frequently induced by occupational noise exposure and leads to rising hearing thresholds as well as reduced otoacoustic emissions (OAE), mostly caused by metabolic hair cell decompensation. OBJECTIVE: Primary endpoint is the increase in average pure tone thresholds after noise exposure, secondary endpoints are loss of distortion product and click-evoked OAE as well as reduction of their contralateral suppression. PARTICIPANTS AND METHODS: The present study design describes the verification of the anti-oxidant and neuroprotective properties of EGb 761® by evaluation of cochlear protection from noise impact as well as its safety and tolerance in 202 healthy male participants distributed equally to verum and placebo groups in a double-blind manner. Participants were assessed, medicated, exposed to noise, and then examined at timepoints up to 10 min and 4 weeks thereafter. CONCLUSION: This summary of the verification study protocol highlights the complexity of diligent and precise planning according to the European Medicines Agency criteria for controlled trials (EudraCT). Key points are the intervention rationale, definitions of in- and exclusion criteria, estimation of subject numbers, and examination method setting in terms of optimum endpoint description.

Balloon dilation of the Eustachian tube: clinical experience in the management of 126 children.

Balloon dilation of the Eustachian tube has been recently introduced as a novel and minimally invasive method for treating chronic obstructive Eustachian tube dysfunction. For the first time worldwide, we assessed the role of this technique in the treatment of children with Eustachian tube dysfunction who did not respond to other treatments. We retrospectively analysed the medical records of 60 children (mean age: 6.3 years, range: 28 months to 12 years) who underwent balloon dilation of the Eustachian tube using the Bielefeld balloon catheter. In addition, the parents of a further 66 children who underwent balloon dilation (mean age: 8 years, range: 4 to 13 years) were asked to complete a standardised written questionnaire and were interviewed by telephone about the postoperative course of their children. There were no complications during surgery. Clinical symptoms improved in more than 80% of patients. No patient reported a deterioration of symptoms. Of the participating parents, 81.3% were very satisfied or satisfied with the outcome of treatment. Balloon dilation is a rapid, simple and safe method for the treatment of both adults and children with Eustachian tube dysfunction that does not respond to other treatments. Further studies, ideally multicentre studies, are required in order to optimise the definition of existing and potential new indications for this treatment approach and to establish this treatment in the management of children with refractory chronic Eustachian tube dysfunction.

Reduction of permanent hearing loss by local glucocorticoid application : Guinea pigs with acute acoustic trauma.

BACKGROUND: High-intensity noise exposure from impulse and blast noise events often leads to acute hearing loss and may cause irreversible permanent hearing loss as a long-term consequence. Here, a treatment regime was developed to limit permanent damage based on a preclinical animal model of acute noise trauma. AIM: To develop clinical trials for the treatment of acute noise traumas using approved drugs. The otoprotective potential of glucocorticoids applied locally to the inner ear was examined. MATERIALS AND METHODS: A series of experiments with different impulse noise exposures were performed. Permanent hearing loss and hair cell density were assessed 14 days after exposure. Hearing and hair cell preservation were investigated as a function of the glucocorticoid dose. RESULTS: After impulse noise exposure, local application to the round window of the cochlea of high-dose prednisolone (25 mg/ml) or methylprednisolone (12.5 mg/ml) resulted in a statistically significant reduction in hearing loss compared with the control group. CONCLUSION: The local application of high doses of the drugs to the round window of the cochlea appears to be an effective treatment for acute noise trauma.

[Reduction of permanent hearing loss by local glucocorticoid application : Guinea pigs with acute acoustic trauma. German version]. / Begrenzung chronischer Hörverluste durch lokale Glukokortikoidgabe : Meerschweinchen mit akutem Lärmtrauma.

BACKGROUND: High-intensity noise exposure from impulse and blast noise events often leads to acute hearing loss and may cause irreversible permanent hearing loss as a long-term consequence. Here, a treatment regime was developed to limit permanent damage based on a preclinical animal model of acute noise trauma. AIM: To develop clinical trials for the treatment of acute noise traumas using approved drugs. The otoprotective potential of glucocorticoids applied locally to the inner ear was examined. MATERIALS AND METHODS: A series of experiments with different impulse noise exposures was performed. Permanent hearing loss and hair cell density were assessed 14 days after exposure. Hearing and hair cell preservation were investigated as a function of glucocorticoid dose. RESULTS: After impulse noise exposure, local application of high-dose prednisolone (25 mg/ml) or methylprednisolone (12.5 mg/ml) to the round window of the cochlea resulted in a statistically significant reduction in hearing loss compared to the control group. CONCLUSION: Local application of high doses of the drugs to the round window of the cochlea appears to be an effective treatment for acute noise trauma.

[Balloon dilation of the Eustachian tube in pediatric chronic obstructive Eustachian tube dysfunction patients]. / Einsatz der Ballondilatation der Eustachischen Röhre bei chronisch obstruktiven Tubenventilationsstörungen im Kindesalter.

OBJECTIVE: Balloon dilation of the Eustachian tube has recently been introduced as a novel and minimally invasive method for treating chronic obstructive Eustachian tube dysfunction. For the first time worldwide, we assessed the role of this technique in a large cohort of children with Eustachian tube dysfunction that did not respond to other treatments and in whom a tumor could be ruled out as the cause. STUDY DESIGN: This study is a retrospective analysis. METHODS: We retrospectively analyzed the medical records of 66 children (mean age 8.12 years, range 4-14 years) who underwent balloon dilation of the Eustachian tube using the Bielefeld balloon catheter. RESULTS: There were no complications during surgery. Clinical symptoms improved in more than 80% of the patients. No patient reported a deterioration of symptoms. Of the participating parents, over 80% were very satisfied or satisfied with the treatment outcome. CONCLUSION: Balloon dilation is a rapid, simple, and safe method for treatment of both adults and children with Eustachian tube dysfunction that does not respond to other treatments. Further studies, ideally multicenter studies, are required in order to optimize the definition of existing and potential new indications for this treatment approach, as well as to establish this treatment in the management of children with refractory chronic Eustachian tube dysfunction.

[Human papillomavirus in squamous cell cancer of the head and neck. A study at the Ulm Military Hospital, Germany]. / Humane Papillomavirusinfektionen bei Plattenepithelkarzinomen des Kopf- und Halsbereichs. Eine Untersuchung am Krankengut des Bundeswehrkrankenhauses Ulm.

There is increasing evidence worldwide that human papillomavirus is a major risk factor for head and neck cancer. Only few studies on this association have been performed in Germany to date. For the purposes of the present study, tumor specimens from 223 patients with squamous cell cancer of the oral cavity, oropharynx, hypopharynx and larynx were analyzed for HPV DNA and p16INK4a expression. The prevalence of HPV genotype 16 (HPV16) DNA in the study population was 17.5%. Further high-risk HPV types were not detected. All HPV16-positive tumors showed intense p16INK4a expression. HPV16 prevalence was highest in tonsillar carcinoma (37.5%) and lowest in laryngeal cancer (2.8%). We observed a significantly higher incidence of cervical lymph node metastases in patients with HPV16-positive tonsillar carcinoma in comparison to HPV-negative tumors (p < 0.016). Tobacco and/or alcohol consumption was significantly lower in patients with HPV-positive tumors (p < 0.0001).

[Eustachian tube dilation using the Bielefeld balloon catheter: clinical experience with 320 interventions]. / Die Tubendilatation mit dem Bielefelder Dilatationssystem: Klinische Erfahrungen an 320 Interventionen.

Balloon dilation has become established as a novel method for managing chronic ventilatory dysfunction of the Eustachian tube. In the present study the role of this method was assessed in a population of adult patients with ventilatory dysfunction of the Eustachian tube which did not respond to other treatment. The presence of a space-occupying lesion was ruled out. Clinical symptoms improved in 70 % of the patients after balloon dilation and none of the patients reported deterioration of symptoms. Balloon dilation is a rapid, simple and safe method and is currently used in particular for treating patients with ventilatory dysfunction of the Eustachian tube which does not respond to other treatment. Further studies, ideally multicentre studies are required in order to optimize the definition of existing and potential new indications for this treatment approach.

[Role of imaging before Eustachian tube dilation using the Bielefeld balloon catheter]. / Zum Stellenwert der Bildgebung vor Tubendilation mit dem Bielefelder Tubenkatheter.

Balloon dilation is a novel method in the management of chronic Eustachian tube dysfunction. Routine preoperative CT has been recommended in order to rule out possible bone dehiscence in the region of the carotid canal or aneurysms of the internal carotid artery which can lead to vascular injuries and life-threatening bleeding or brain damage during the dilation procedure.We evaluated head CT scans of 1000 patients to assess the occurrence of carotid canal dehiscence, aneurysms or other vascular malformations and to measure the osseous part of the carotid canal.No dehiscence was noted in a total of 2000 boney carotid canals. The mean thickness of the carotid canal wall was 1.02 ± 0.29 mm. No aneurysms or vascular malformations were detected.The necessity of routine CT scans before balloon dilation should be critically discussed with a view to protecting patients from unnecessary radiation exposure and saving costs in the health care system.

[Bilateral Eustachian tube dilation in infants: an alternative treatment for persistent middle ear functional dysfunction]. / Beidseitige Tubendilatation beim Kleinkind: Eine Therapiealternative bei persistierender Mittelohrfunktionsstörung.

Balloon dilation has become established as a novel method for managing chronic ventilatory dysfunction of the Eustachian tube. This treatment has so far not been used in children. This article presents the first case of a pediatric patient who required antibiotics for recurrent middle ear infections and was successfully treated with Eustachian tube dilation. After a single dilation the patient was almost free of symptoms. Further studies are required in order to establish this treatment in the management of children with recurrent ventilatory dysfunction of the Eustachian tube which does not respond to conventional therapy and to define existing and potential new indications for this treatment approach.

[Penetrating injuries in the face and neck region. Diagnosis and treatment]. / Penetrierende Gesichts- und Halsverletzungen. Diagnostik und Therapie.

Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

[Update: blast and explosion trauma]. / Update: Knall- und Explosionstraumata.

In recent decades, acoustic shock and explosion traumas have increased in frequency in the general population. Beside the use of fireworks and firearms, airbag ignitions and explosions caused by terror or suicidal acts are also relevant. Depending on duration and strength of the sound pressure affecting the human ear, isolated inner ear damage or additional ear drum perforation and interruption of the middle ear ossicle chain can result. By means of otoscopy, pure tone audiometry, measurement of otoacoustic emissions, and other neurootological examinations, the severity of the trauma can be determined. With prompt and adequate therapy, permanent hearing loss can be minimized. In particular, the measurement of otoacoustic emissions allows conclusions to be made on the functionality of the outer hair cells which are damaged first in most cases. Histological investigations on noise-exposed cochleas show extensive damage to the outer hair cells in the frequency range between 1.0 and 4.0 kHz, which correlates well with audiometric measurements.

[Laryngeal and pharyngeal actinomycosis]. / Aktinomykose im Bereich von Pharynx und Larynx.

Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed.

[Bacterial sialadenitis]. / Bakterielle Infektionen der grossen Kopfspeicheldrüsen.

The parotid gland is most commonly involved in bacterial sialadenitis. Predisposing factors for the ductally ascending infection, are dehydration, xerogenic drugs and salivary gland diseases associated with ductal obstructions or reduced saliva secretion. In the majority of cases the infection is caused by Staphylococcus aureus. However, a variety of other aerobic and anaerobic pathogens may be involved. Besides hydration, elimination of ductal obstruction and stimulation of saliva flow antibiotic treatment according to antibiogram is essential. In selected cases, for instance if a salivary gland abscess develops, surgical treatment may become necessary. Actinomycosis, tuberculosis and atypical mycobacteriosis are rare variations of bacterial sialadenitis which clinically may resemble a salivary gland tumor.

[Penetrating gunshot wound in the neck. Case report and review of the literature]. / Penetrierende Schussverletzung im Halsbereich. Fallbericht und Literaturübersicht.

Penetrating gunshot neck injuries present a serious challenge for the primary attending surgeon. By means of a case treated in the German Field Hospital in Mazar-e-Sharif (northern Afghanistan) and a review of the literature, the principles of diagnosis and treatment of penetrating zone II neck injuries due to gunshots or shrapnel are presented.