1,721,038 research outputs found
Long-term functional outcome and satisfaction of patients with an active middle ear implant for sensorineural hearing loss compared to a matched population with conventional hearing aids
No full textThe objectives of the study were to review the results of an active middle ear implant for sensorineural hearing loss in patients who were unable to wear or did not benefit from conventional hearing aids in comparison to patients with a matched degree of hearing loss successfully fitted with a conventional hearing aid. A retrospective chart review of 10 patients (10 ears) after implantation of an active middle ear implant and 12 patients (13 ears) with conventional hearing aids in one tertiary referral center was performed. Intervention for sensorineural hearing loss was the implantation of an active middle ear implant in one group or fitting of conventional hearing aids in the other group. Outcome measures were pure-tone audiometry (auditory thresholds, functional gain), speech audiometry (Freiburg Monosyllabic Test in quiet and in noise) and a quality-of-life questionnaire (Glasgow Benefit Inventory). Average functional gain was 25.2 +/- A 8.6 and 14.6 +/- A 10.8 dB, speech recognition score in noise was 36.6 +/- A 18.4 and 31.2 +/- A 19.2 % and in quiet was 66.0 +/- A 23.2 and 61.5 +/- A 23.8 %, Glasgow Benefit Inventory total score was 38.3 +/- A 32.3 and 24.8 +/- A 22.2 in patients with active middle ear implants and conventional hearing aids, respectively. In two patient groups matched for degree of sensorineural hearing loss, active middle ear implants provided comparable speech recognition and superior functional gain and quality of life compared to conventional hearing aids. Level of evidence: 4
TNF-alpha inhibition using etanercept prevents noise-induced hearing loss by improvement of cochlear blood flow in vivo
No full textObjective: Exposure to loud noise can impair cochlear microcirculation and cause noise-induced hearing loss (NIHL). TNF-alpha signaling has been shown to be activated in NIHL and to control spiral modiolar artery vasoconstriction that regulates cochlear microcirculation. It was the aim of this experimental study to analyse the effects of the TNF-alpha inhibitor etanercept on cochlear microcirculation and hearing threshold shift in NIHL in vivo. Design: After assessment of normacusis using ABR, loud noise (106 dB SPL, 30 minutes) was applied on both ears in guinea pigs. Etanercept was administered systemically after loud noise exposure while control animals received a saline solution. In vivo fluorescence microscopy of strial capillaries was performed after surgical exposure of the cochlea for microcirculatory analysis. ABR measurements were derived from the contralateral ear. Study sample: Guinea pigs (n=6, per group). Results: Compared to controls, cochlear blood flow in strial capillary segments was significantly increased in etanercept-treated animals. Additionally, hearing threshold was preserved in animals receiving the TNF-alpha inhibitor in contrast to a significant threshold raising in controls. Conclusions: TNF-alpha inhibition using etanercept improves cochlear microcirculation and protects hearing levels after loud noise exposure and appears as a promising treatment strategy for human NIHL
Preliminary Functional Results and Quality of Life After Implantation of a New Bone Conduction Hearing Device in Patients With Conductive and Mixed Hearing Loss
No full textObjective: To review functional results and quality of life of the first patients implanted with a newly introduced bone conduction implant system. Study Design: Retrospective chart analysis of 6 patients (6 ears) implanted for conductive hearing loss (CHL) and mixed hearing loss (MHL) in 1 tertiary referral center between July 2012 and February 2013. Methods: Implantation of a new bone conduction hearing device. Pure tone audiometry (air conduction and bone conduction thresholds, pure tone average, air-bone gap, and functional gain), speech audiometry (Freiburg Monosyllabic Test), intraoperative and postoperative complication rate, and patient satisfaction (Glasgow benefit inventory [GBI]) were assessed. Results: Air-conduction pure tone average (PTA) was 58.8 +/- 8.2 dB HL. Unaided average air-bone gap (ABG) was 33.3 +/- 6.2 dB. Aided air-conduction PTA in sound field was 25.2 +/- 5.1 dB HL. Aided average ABG was -0.3 +/- 7.3 dB. Average functional gain was 33.6 +/- 7.2 dB. Mean improvement of GBI was +36.1. No intraoperative complications occurred. During a follow-up period of 8.5 +/- 2.2 months, no device failure and no need for revision surgery occurred. Conclusion: Audiometric results of the new bone conduction hearing system are satisfying and comparable to the results of devices that have been applied previously for CHL and MHL. Intraoperatively and postoperatively, no complications were noted. Level of Evidence: 4 (Individual retrospective cohort study) Level of Evidence: 4 (Individual retrospective cohort study
Coated collagen patches for closure of pharyngo-cutaneous fistulas
No full textAfter laryngectomy or lateral pharyngotomy for treatment of laryngeal or hypopharyngeal cancer the occurrence of a pharyngo-cutaneous fistula is a challenging complication. Especially after previous radiotherapy and expanded surgical resections of mucosa the management is demanding. Besides the prolonged hospital stay, increased treatment costs and reduced quality of life, a delayed adjuvant treatment follows the development of a fistula. Treatment strategies range from conservative procedures comprising parenteral nutrition, antibiotics and local wound care to primary surgical closure or reconstructive tissue transfer. We report three cases of using the fibrin/thrombin-coated collagen patch TachoSil (R) as a solitary or adjuvant strategy in surgical treatment. In one patient primary closure of the fistula was achieved by transoral application of the collagen patch. In the other cases a not tension free primary suture was strengthened by the adjuvant use of TachoSil (R). The healing process was rapid and straightforward in all patients. The use of TachoSil (R) may be indicated in between conservative treatment strategies and reconstructive surgery. After occurrence of a fistula the healing process is intended to be accelerated by primary closure with TachoSil (R) or by sealing of a primary suture. (C) 2014 Elsevier Inc. All rights reserved
Free flap salvage with subcutaneous injection of tissue plasminogen activator in head and neck patients
No full textIn this report, we present our experience with subcutaneous rt-PA injection for salvage of free radial forearm flaps with vascular compromise. Three patients underwent reconstruction of defects of the soft palate or the lateral tongue with a free radial forearm flap. Patients underwent on average two attempted operative revisions with thrombectomy and intravenous heparin injections. After recurrent venous thrombosis 3-6 days after surgery, rt-PA (Alteplase 2 mg; 1,160,000 IE) was injected subcutaneously at multiple sites into the compromised flap as final attempt. In all three patients, successful thrombolysis with no or only partial soft tissue loss was achieved after subcutaneous injection of rt-PA. We therefore suggest subcutaneous rt-PA injection as an additional tool in managing difficult and recurrent cases of venous thrombosis in free flap head and neck reconstruction. (c) 2013 Wiley Periodicals, Inc
Application of a TNF-alpha-inhibitor into the scala tympany after cochlear electrode insertion trauma in guinea pigs: Preliminary audiologic results
No full textObjective: Cochlear implantation trauma causes both macroscopic and inflammatory trauma. The aim of the present study was to evaluate the effectiveness of the TNF-alpha inhibitor etanercept applied after cochlear implantation trauma on the preservation of acoustic hearing. Design: Guinea pigs were randomly assigned to three groups receiving cochlear implantation trauma by cochleostomy. In one group, the site was sealed by bone cement with no further treatment. A second group was additionally implanted with an osmotic minipump delivering artificial perilymph into the scala tympani for seven days. In the third group, etanercept 1 mg/ml was added to artificial perilymph. Hearing was assessed by auditory brainstem responses at 2, 4, 6, and 8 kHz prior to and after surgery and on days 3, 5, 7, 14, 28. Study sample: Fifteen healthy guinea pigs. Results: The trauma led to threshold shifts from 50.3 dB +/- 16.3 dB to 68.0 dB +/- 19.3 dB. Hearing thresholds were significantly lower in etanercept-treated animals compared to controls on day 28 at 8 kHz and from day 3 onwards at 4 and 2 kHz (p < 0.01; two-way RM ANOVA / Bonferroni t-test). Conclusion: The application of etanercept led to preservation of acoustic hearing after cochlear implantation trauma
Transoral laser microsurgery for T1a glottic cancer: Review of 404 cases
No full textBackgroundVarious therapeutic options exist for treatment of T1a glottic squamous cell cancer (SCC). Radiotherapy (RT) has been favored over surgical excision. This has been challenged by transoral laser microsurgery (TLM) showing low morbidity and good functional results. MethodsA retrospective chart review was carried out. Patients with untreated T1a glottic SCC were included in the study. Endpoints were locoregional control, overall survival, disease-specific survival, and absolute rate of larynx preservation. ResultsFour hundred four patients were included in this study. Five-year Kaplan-Meier estimates were: local control 86.8%, overall survival 87.8%, disease-specific survival 98.0%, recurrence-free survival 76.1%, and larynx preservation 97.3%. The complication rate was 1%; the majority of patients had either normal or mildly dysphonic voices. ConclusionLow complication rates, excellent functional outcome, and high rates of organ preservation favor TLM. In agreement with the literature, TLM should be the treatment of choice for patients presenting with T1a glottic SCC. (c) 2014 Wiley Periodicals, Inc. Head Neck 37: 889-895, 201
Two-Photon Microscopy Allows Imaging and Characterization of Cochlear Microvasculature In Vivo
Full text linkImpairment of cochlear blood flow has been discussed as factor in the pathophysiology of various inner ear disorders. However, the microscopic study of cochlear microcirculation is limited due to small scale and anatomical constraints. Here, two-photon fluorescence microscopy is applied to visualize cochlear microvessels. Guinea pigs were injected with Fluorescein isothiocyanateor Texas red-dextrane as plasma marker. Intravital microscopy was performed in four animals and explanted cochleae from four animals were studied. The vascular architecture of the cochlea was visualized up to a depth of 90.0 +/- 22.7 mu m. Imaging yielded a mean contrast-to-noise ratio (CNR) of 3.3 +/- 1.7. Mean diameter in vivo was 16.5 +/- 6.0 mu m for arterioles and 8.0 +/- 2.4 mu m for capillaries. In explanted cochleae, the diameter of radiating arterioles and capillaries was measured with 12.2 +/- 1.6 mu m and 6.6 +/- 1.0 mu m, respectively. The difference between capillaries and arterioles was statistically significant in both experimental setups (P < 0.001 and P = 0.022, two-way ANOVA). Measured vessel diameters in vivo and ex vivo were in agreement with published data. We conclude that two-photon fluorescence microscopy allows the investigation of cochlear microvessels and is potentially a valuable tool for inner ear research
Transoral laser microsurgery or total laryngectomy for recurrent squamous cell carcinoma of the larynx: Retrospective analysis of 199 cases
No full textBackground. Surgical treatment options for local recurrences of laryngeal cancer can be either organ-preserving surgery or total laryngectomy. The purpose of this study was to present our evaluation of the treatment with transoral laser microsurgery (TLM) in comparison to laryngectomy. Methods. We conducted a retrospective review of 199 consecutive patients with recurrent laryngeal cancer at 1 tertiary referral center. Results. The 5-year overall survival, disease-specific survival, and local control rates were 64.8%, 79.6%, and 57.5%, respectively, for 93 patients with early tumors treated by TLM, 28.9%, 41.7%, and 43.7%, respectively, for 52 patients with advanced tumors treated by TLM as well as 39.4%, 44.6%, and 68.8%, respectively, for 54 patients with advanced tumors treated by total laryngectomy. Five-year larynx-preservation rate was 77.7% for early as well as 68.4% for advanced tumors treated by TLM. Conclusion. TLM is an option in early and in selected cases of advanced locally recurrent laryngeal cancer. (C) 2017 Wiley Periodicals, Inc
Transoral laser microsurgery in treatment of pT2 and pT3 glottic laryngeal squamous cell carcinoma - results of 391 patients
No full textBackgroundThe purpose of this study was to evaluate oncological and functional results of transoral laser microsurgery (TLM) in patients with T2 and T3 glottic laryngeal squamous cell carcinoma (SCC). MethodsA retrospective chart analysis was carried out. Cases were classified into categories pT2a, pT2b, and pT3. Treatment was exclusively TLMselective neck dissection and adjuvant (chemo)radiotherapy. ResultsThree hundred ninety-one patients were treated by TLM; 142 cases were category pT2a, 127 were pT2b, and 122 were pT3. Median follow-up was 71 months. Five-year overall, recurrence-free, and disease specific survival rates were 72.2%, 76.4%, and 93.2% for pT2a tumors, 64.9%, 57.3%, and 83.9% for pT2b tumors, and 58.6%, 57.8%, and 84.1% for pT3 tumors, respectively. Larynx preservation was achieved in 93% (pT2a) and 83% (pT2b and pT3). ConclusionResults are comparable to open partial or total laryngectomy and superior to primary (chemo)radiotherapy. TLM results in a lower morbidity and superior function compared to standard treatment. (c) 2013 Wiley Periodicals, Inc. Head Neck 36: 859-866, 201
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