57 research outputs found
Ausbildungskonzepte der Audiologie in der Schweiz
No full textDie Kommission für Audiologie und Expertenwesen der Schweizerischen Gesellschaft für Otorhinolaryngologie hat sich in letzter Zeit intensiv mit der Frage der Qualität der Ausbildung in Audiologie sowohl für HNO-Ärzte als auch medizinische Praxisassistentinnen beschäftigt. Insbesondere für Audiometristinnen, welche in den Arztpraxen die Hörtests durchführen, existierten bisher keine Grundlagen für die Ausbildung. Die Kommission hat deshalb ein verbindliches Ausbildungskonzept für die Schweiz erarbeitet. Die Ausbildung für medizinische Praxisassistentinnen ist in drei Modulen aufgebaut. Im ersten Teil ist das Ziel des Kurs die Erstellung eines Tonaudiogramms mit korrekter Maskierung. Das zweite Modul widmet sich der Sprachaudiometrie und den Messungen für die Hörgeräteexpertise. Neben Referaten zu den theoretischen Grundlagen wird in beiden Modulen ein grosses Gewicht auf praktisches Üben an Patienten und mit Unterstützung von Computer-Simulations-Programmen gelegt. Das dritte Modul umfasst das selbstständige Erstellen von Audiogrammen in der Praxis unter Supervision des HNO-Arztes. Voraussetzung für das flächendeckende Kursangebot in allen Landesteilen war, dass die Kommission für alle Kurse gemeinsame und verbindliche Richtlinien zur Durchführung der Audiometrie erstellt hat. Dazu war insbesondere eine Einigung auf eine einheitliche Methode zum Maskieren eines Tonaudiogramms nötig. Die gewählte Audiometrie-Methode muss nun auch allen HNO-Ärzten in der Praxis vermittelt werden und wird zukünftig auch in der Audiologie-Ausbildung an den Kliniken gelehrt. Die gemeinsam erarbeiteten Richtlinien werden in der Weiterbildungsverordnung für HNO-Ärzte verankert. In Zukunft wird für die Abrechnung der audiologischen Leistungen zu Handen der Sozialversicherungen Voraussetzung sein, dass die Untersuchung von Praxisassistentinnen mit entsprechendem Zertifikat in Audiologie ausgeführt wird
Der „Professional Ear User“ – Implikationen für die Prävention, Diagnostik und Therapie von Ohrerkrankungen
No full textBACKGROUND
Perfect hearing is crucial to the practice of various professions, such as instrument makers, musicians, sound engineers, and other professions not related to music, such as sonar technicians. For people of these occupational groups, we propose the term "professional ear user" (PEU) in analogy to "professional voice user". PEUs have special requirements for their hearing health, as they have well-known above-average auditory perceptual abilities on which they are professionally dependent.
OBJECTIVE
The purpose of this narrative review is to summarize selected aspects of the prevention, diagnosis, and treatment of ear disorders in PEUs.
RESULTS AND CONCLUSION
Prevention of hearing disorders and other ear diseases includes protection from excessive sound levels, avoidance of ototoxins and nicotine, and a safe manner of cleaning the outer auditory canal. Diagnosing hearing disorders in PEUs can be challenging, since subclinical but relevant changes in hearing cannot be reliably objectified by conventional audiometric methods. Moreover, the fact that a PEU is affected by an ear disease may influence treatment decisions. Further, physicians must be vigilant for non-organic ear diseases in PEUs. Lastly, measures to promote comprehensive ear health in PEUs as part of an educational program and to maintain ear health by means of a specialized otolaryngology service are discussed. In contrast to existing concepts, we lay the attention on the entirety of occupational groups that are specifically dependent on their ear health in a professional setting. In this context, we suggest avoiding a sole focus on hearing disorders and their prevention, but rather encourage the maintenance of a comprehensive ear health.Hintergrund
Ein vollständig intaktes Hörvermögen ist zentral für die Ausübung verschiedener Berufe wie Instrumentenbaumeister, Musiker, Tonmeister sowie für weitere Berufsgruppen ohne Bezug zu Musik wie beispielsweise Sonar-Techniker. Für Personen all dieser Berufsgruppen schlagen wir in Analogie zum „Professional Voice User“ den Begriff „Professional Ear User“ (PEU) vor. PEU haben spezielle Anforderungen an ihre Ohrgesundheit, da sie über eine überdurchschnittliche auditive Wahrnehmungsfähigkeit verfügen, von der sie beruflich abhängig sind.
Fragestellung
Die vorliegende narrative Übersichtsarbeit hat zum Ziel, die sich daraus ergebenden speziellen Aspekte der Prävention, Diagnostik und Therapie von Ohrerkrankungen bei PEU zusammenzufassen.
Ergebnisse und Schlussfolgerung
Die Prävention von Hörstörungen und weiteren Ohrerkrankungen umfasst den Schutz vor zu hohen Schallpegeln, die Vermeidung von Ototoxinen oder Nikotin sowie die korrekte Durchführung einer Gehörgangsreinigung. Die Abklärung von Hörstörungen kann sich bei PEU herausfordernd gestalten, da subklinische, jedoch einschränkende Veränderungen des Hörvermögens mit konventionellen audiometrischen Methoden nicht zuverlässig objektiviert werden können. Schließlich kann das Vorliegen einer Ohrerkrankung bei einem PEU Therapieentscheidungen beeinflussen. Weiter muss bei PEU auch eine hohe Wachsamkeit bezüglich nichtorganischer Ohrerkrankungen bestehen. Abschließend werden Möglichkeiten diskutiert, um bei PEU eine umfassende Ohrgesundheit im Rahmen eines edukativen Programms zu fördern und mittels einer spezialisierten ohrenärztlichen Sprechstunde zu erhalten. Im Gegensatz zu bestehenden Konzepten ist der Fokus dabei auf die Gesamtheit der Berufsgruppen gerichtet, welche in professionellem Rahmen speziell von der Ohrgesundheit abhängig sind. Außerdem soll der Schwerpunkt hierbei nicht nur auf Hörstörungen und deren Prävention, sondern auch auf der Erhaltung einer ganzheitlichen Ohrgesundheit liegen
Assessment of Surgical Complications With Respect to the Surgical Indication: Proposal for a Novel Index.
No full textIntroduction: The Clavien-Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them. A drawback of the method is that it does not consider why the patient was operated on primarily. Methods: We designed a novel index based on Clavien-Dindo but with respect to the surgical indication. We surveyed an international panel of otolaryngologists who filled out a questionnaire with 32 real case-inspired scenarios. Each case was graded for the surgical complication, surgical indication, and a subjective rating whether the complication was acceptable or not. Results: Seventy-seven otolaryngologists responded to the survey. Mean subjective rating and surgical complication grading for each scenario showed an inverse correlation (r2 = 0.147, p = 0.044). When grading the surgical complication with respect to the surgical indication, the correlation with the subjective rating increased dramatically (r2 = 0.307, p = 0.0022). Conclusion: We describe a novel index grading surgical complications with respect to the surgical indication. In our survey, most respondents judged a complication as acceptable or not according to its grade but kept in mind the surgical indication. This subjective judgment could be quantified with our novel index
Evaluation of universal newborn hearing screening in Switzerland 2012 and follow-up data for Zurich
No full textBACKGROUND: The European Consensus Statement of Neonatal Hearing recommended universal newborn hearing screening (UNHS) in 1998. UNHS was introduced in Switzerland in 1999 under the auspices of a "Swiss Working Group Hearing Screening in Newborns". The aim of this study was to evaluate the number of newborns being screened and consequently followed-up in Switzerland for the year 2012.
METHODS: Postal questionnaires were sent to all registered maternity clinics and birth-centres in Switzerland. To evaluate follow-up of newborns failing the screening process, a retrospective consecutive cohort analysis of newborns failing screening at the University Hospital Zurich between 2005 and 2010 was performed.
RESULTS: A total of 102/110 (92.7%) maternity clinics and 1/14 (7.1%) birth-centres routinely performed UNHS. When weighted according to the number of births in the varying locations, 97.9% of all newborn received hearing screening. At the University Hospital of Zurich, 253/12,080 (2.1%) newborns failed the screening test and in 15/253 (6%) a relevant bilateral hearing impairment was found. This makes an overall incidence of congenitally relevant hearing loss of 0.12%. Unfortunately, 33/253 (13%) of newborns with failed screening were lost to follow-up.
CONCLUSION: UNHS is well-established in Switzerland and the vast majority of newborns are screened. However, follow-up of failed screens is disappointing. Further measures need to be taken to improve follow up
Chudley-McCullough syndrome: case report and review of the neuroimaging spectrum
No full textWe report on a child with Chudley-McCullough syndrome and re-evaluate the spectrum of imaging findings (in 15 previously reported patients) which appear to be variable and, to some extent, ambiguous in the literature. Magnetic resonance imaging of the brain revealed asymmetric colpocephaly with agenesis of the splenium corporis callosi, ribbon-like subcortical gray matter heterotopia along the cingulate gyri, malrotation of both hippocampi, and dysplasia of the cerebellum. Macrocrania together with sensorineural hearing loss, colpocephaly, and posterior or complete agenesis of the corpus callosum can be considered the hallmarks of the autosomal recessive Chudley-McCullough syndrome. These may be variably associated with interhemispheric arachnoid cyst, cortical dysplasia, gray matter heterotopia, and cerebellar dysplasia. While early support with hearing aids may lead to improved language and cognitive outcome, shunting of ventricular dilatation is not indicated in the Chudley-McCullough syndrome
Hearing Loss in Cancer Patients with Skull Base Tumors Undergoing Pencil Beam Scanning Proton Therapy: A Retrospective Cohort Study
No full textSIMPLE SUMMARY: Most patients with skull base tumors require radiation therapy as part of their overall treatment, preferably with protons. However, vital and healthy organs, such as the cochlea, are often located in the immediate anatomical vicinity of the tumor. Despite the high precision of the proton beam, irradiating the cochlea is often unavoidable, resulting in an increased risk of hearing loss. To assess the frequency and severity of changes in hearing after proton therapy, we performed a retrospective study in a cohort of 51 patients undergoing proton therapy for skull base tumors. We observed that a hearing threshold shift correlates to the applied radiation dose intensity to the cochlea. In addition, advancing age, hearing sensitivity before proton therapy, and the time elapsed after the end of proton therapy are independently associated with the deterioration of the hearing threshold after proton therapy. These results are essential to adequately inform patients about the treatment’s impact and side effects. ABSTRACT: To assess the incidence and severity of changes in hearing threshold in patients undergoing high-dose pencil-beam-scanning proton therapy (PBS-PT). This retrospective cohort study included fifty-one patients (median 50 years (range, 13–68)) treated with PBS-PT for skull base tumors. No chemotherapy was delivered. Pure tone averages (PTAs)were determined before (baseline) and after PBS-PT as the average hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Hearing changes were calculated as PTA differences between pre-and post-PBS-PT. A linear mixed-effects model was used to assess the relationship between the PTA at the follow-up and the baseline, the cochlea radiation dose intensity, the increased age, and the years after PBS-PT. Included patients were treated for chordoma (n = 24), chondrosarcoma (n = 9), head and neck tumors (n = 9), or meningioma (n = 3), with a mean tumor dose of 71.1 Gy (RBE) (range, 52.0–77.8), and a mean dose of 37 Gy (RBE) (range, 0.0–72.7) was delivered to the cochleas. The median time to the first follow-up was 11 months (IQR, 5.5–33.7). The PTA increased from a median of 15 dB (IQR 10.0–25) at the baseline to 23.8 (IQR 11.3–46.3) at the first follow-up. In the linear mixed-effect model, the baseline PTA (estimate 0.80, 95%CI 0.64 to 0.96, p ≤ 0.001), patient’s age (0.30, 0.03 to 0.57, p = 0.029), follow-up time (2.07, 0.92 to 3.23, p ≤ 0.001), and mean cochlear dose in Gy (RBE) (0.34, 0.21 to 0.46, p ≤ 0.001) were all significantly associated with an increase in PTA at follow-up. The applied cochlear dose and baseline PTA, age, and time after treatment were significantly associated with hearing loss after proton therapy
Cochlea-Implantation
No full textDie Cochlea-Implantation ist eine erstaunliche medizinische Erfolgsgeschichte. Sie erlaubt hochgradig schwerhörigen oder tauben Patientinnen und Patienten, ein Hörvermögen zu erlangen und an der Welt der Hörenden teilzuhaben. Dieser Artikel soll einen kurzen Überblick über den bisherigen Weg und den jetzigen Stand geben
Correlation Between Electrocochleographic Changes During Surgery and Hearing Outcome in Cochlear Implant Recipients
No full textObjective:
To determine the correlation between intraoperative changes of electrocochleography (ECochG) responses and traumatic cochlear implant insertions as well as postoperative hearing loss.
Methods:
ECochG, radiological, and audiological data were collected prospectively in a cochlear implant recipient with otosclerosis and assumed cochlear trauma during electrode insertion. A systematic review was conducted within PubMed-NCBI, EMBASE, and the Cochrane Library using the terms “Cochlear implant” and “Electrocochleography.” Original studies that evaluated intraoperative ECochG responses and postoperative hearing loss were selected and analyzed.
Results:
The case report revealed a drop of intra- and extracochlear ECochG signals during electrode insertion. The postoperative computed tomography scan suggested a scalar dislocation. There was no measurable hearing 4 weeks after surgery. Within the database search, nine articles met the inclusion criteria. All were case series reports (range from 2 to 36 subjects) with a total of 173 subjects. Due to the heterogeneous data, a meta-analysis was unfeasible.
Conclusions:
In concordance with some findings in the literature, the presented case report suggests that a drop of intra- and extracochlear ECochG signals during the insertion of the electrode array is associated with cochlear trauma and postoperative hearing loss in some cases. However, the literature is inconclusive regarding the correlation between intraoperative changes of the ECochG signals and postoperative hearing preservation. More studies investigating the correlation are needed to provide sufficient data
Cost Effectiveness of Cochlear Implantation in Single-Sided Deafness
No full textObjective: To analyze the cost effectiveness of cochlear implantation (CI) for the treatment of single-sided deafness (SSD).
Study design: Cost-utility analysis in an adapted Markov model.
Setting: Adults with single-sided deafness in a high-income country.
Intervention: Unilateral CI was compared with no intervention.
Main outcome measure: Incremental cost-effectiveness ratios were compared with different cost-effectiveness thresholds (150,000) for different age, sex, and cost combinations. The calculations were based on the quality-adjusted life year (QALY), national life expectancy tables, and different cost settings. The health utility values for the QALY were either directly collected from published data, or, derived from published data using a regression model of multiple utility indices (regression estimate).
Results: The regression estimate showed an increase of the health utility value from 0.62 to 0.74 for SSD patients who underwent CI. CI for SSD was cost effective for women up to 64 years (100,000 per-QALY threshold), and 86 years ($150,000 per-QALY threshold). For men, these values were 58, 77, and 84, respectively. Changing the discount rate by up to 5% further increased the cutoff ages up to 5 years. A detailed cost and age sensitivity analysis is presented and allows testing for cost effectiveness in local settings worldwide.
Conclusions: CI is a cost-effective option to treat patients with SSD
Hearing preservation after cochlear implantation may improve long-term word perception in the electric-only condition
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