Klinik und Poliklinik für Hals-, Nasen-, Ohrenkrankheiten, Kopf- und Halschirurgie
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A close anatomical and physiological relationship is known between the senses of hearing and balance, while an additional pathophysiological interaction is supposed. The mechanisms underlying this association are not yet fully understood, especially in individuals without a known specific otologic disorder. In particular, only scarce information on the combined occurrence of audiovestibular sensory impairment is available so far. Therefore, this study aims to provide further insight into the prevalence and co-prevalence of the audiovestibular symptoms hearing loss, tinnitus and dizziness. Additionally, the influence of potential risk factors from lifestyle habits as well as cardiovascular and metabolic conditions on the development of those symptoms is studied. Data was analyzed from 8134 individuals from the population-based Study of Health in Pomerania (SHIP). SHIP pursues a broad and comprehensive examination program in chronologically separated cohorts with longitudinal follow-up. Cohorts are sampled from Western Pomerania, a rural region of north-eastern Germany. The study population represents a cross-sectional analysis from the cohorts SHIP-START (recruited 1997–2001) and SHIP-TREND (recruited 2008–2012), sampled for baseline investigations (SHIP-START-0 and SHIP-TREND-0) at the age of 20–79 years. Audiovestibular symptoms as outcome variables were assessed by structured questionnaires. Additionally, individuals were comprehensively characterized regarding modifiable lifestyle factors as well as cardiovascular and metabolic disorders, allowing the assessment of their role as exposure variables. We calculated a weighted prevalence of 14.2% for hearing loss, 9.7% for tinnitus, and 13.5% for dizziness in the population. Prevalence increased with age and differed among the sexes. A considerable share of 28.0% of the investigated individuals reported more than one symptom at once. The prevalence of hearing loss as well as tinnitus increased between the two cohorts. A moderate positive correlation was found between the occurrence of hearing loss and tinnitus (phi-coefficient 0.318). In multivariable regression analyses, education was identified as a significant protective factor while only smoking was significantly associated with all three symptoms. Furthermore, several cardiovascular risk factors contributed to both hearing loss and dizziness. In conclusion, audiovestibular symptoms are highly prevalent in the investigated population. A considerable but complex influence of risk factors points towards a relation with neuronal as well as cardiovascular disease processes. To clarify the underlying mechanisms, the interaction between the senses of hearing and balance as well as the mode of action of the risk factors should be evaluated in more detail in the future.
Hintergrund: Patienten, die auf eine HNO-Operation warten, erleben häufig erheblichen physischen und psychischen Stress. Obwohl es Hinweise darauf gibt, dass präoperative Aufklärungsmaßnahmen zu positiven perioperativen Ergebnissen bei chirurgischen Patienten führen können, ist die Evidenzlage zur Wirksamkeit dieser Maßnahmen speziell bei HNO-Patienten begrenzt.
Zielsetzung: Diese Studie untersuchte, ob eine speziell für HNO-Patienten entwickelte präoperative Aufklärung als zeit- und kosteneffiziente Maßnahme dazu beitragen kann, den Stress und die Angst der Patienten zu reduzieren.
Background: By using outcome prediction scores, it is possible to distinguish between good and poor performers with cochlear implants (CI) after CI implantation. The reasons for poor performance, despite good basic conditions, can be manifold. On the one hand, the postoperative fitting may be inadequate; on the other, neurophysiological disease processes may impair speech understanding with a CI. These disease processes are not yet fully understood. In acoustics, it is known that the auditory brainstem responses (ABR) and their latencies and amplitudes allow differential diagnosis based on reference values for normal-hearing individuals. The aim of this study was to provide reference values for electrically evoked brainstem responses (EABRs) in terms of rate-dependent latencies and amplitudes. Methods: 20 ears of 18 experienced adult CI recipients with a predicted and measured good postoperative word recognition score were recruited from the clinic’s patient pool. In the same stimulation mode and intensity we measured latencies and interpeak-latencies of EABRs and electrically evoked compound action potentials (ECAPs). With a defined supra-threshold stimulation intensity above the individual ECAP threshold, we applied stimulation at several rates between 11 and 91 stimuli per second. Results: We found rate dependences for EABR latency t3 and t5 in the order of 0.19 ms and 0.37 ms, respectively, while ECAP was not affected by rate. Correspondingly, the interpeak intervals’ rate dependences for t5−t1, t5−t3 and t3−t1 were of the order of 0.37 ms, 0.18 ms and 0.19 ms. Comparing the EABR amplitudes between the stimulation rates 11/s and 81/s, we found that at 81/s the amplitudes were significantly reduced down: to 73% for A3 and 81% for A5. These rate dependences of latency and amplitude in EABR have characteristics comparable to those of acoustic ABR. Conclusions: These data may serve to provide reference values for EABR and ECAP latencies, interpeak intervals and amplitudes with respect to stimulation rate. Altered response patterns of ECAPs and EABRs to normalised stimulation modes could be used in the future to describe and classify neuropathological processes in a better-differentiated way.
Background and Objectives: Obstructive sleep apnea (OSA) is common not only in the general population but even more so in patients with tumors of the head and neck region. Untreated, it leads to reduced quality of life, increased daytime sleepiness, and other comorbidities. The aim of this study was to determine the difference in the occurrence of OSA in the patient population with head and neck tumors compared with the general population as represented by the Trend cohort of the Study of Health in Pomerania (SHIP), and to assess the influence of tumor treatment. Materials and Methods: Between July 2018 and December 2021, preoperative polysomnography was conducted in 47 patients with histologically confirmed squamous cell carcinoma in the oropharynx, hypopharynx, or larynx. A follow-up polysomnography was performed in 23 patients 2–11 months after completing treatment. The collected data were correlated with tumor treatment and tumor size. Results: Of the included patients, 43 were male and 4 were female. Age ranged from 54 to 90 years. The pretherapeutic measurement found no significant difference in the prevalence of a pathologically elevated apnea–hypopnea index (AHI) in our patients compared with the SHIP Trend cohort. In the follow-up measurement after completion of treartment, a significant deterioration in AHI was observed. Initially, 70% of patients had an AHI > 5; after therapy, this increased to 87% (p = 0.008). The effect was particularly pronounced in the group of patients with advanced tumor stages who had received primary chemoradiation. Conclusions: OSA is a relevant condition in patients with head and neck cancer. Tumor treatment can lead to an increased occurrence of sleep-related breathing disorders, especially in patients with advanced tumor stages undergoing primary chemoradiation. Additional studies are necessary to better understand the exact mechanism involved.
Morbus Menière ist durch periodisch auftretende Schwindelanfälle, fluktuierende Schallempfindungsschwerhörigkeit, Ohrdruck und Tinnitus gekennzeichnet. Zur Erfassung der durch diese Krankheit verursachten Belastungen können patientenberichtete Ergebnismaße (Patient-Reported Outcome Measures) hilfreich sein. Diese Arbeit analysiert die Beziehung zwischen audiometrischen Ergebnissen und der Hörbeeinträchtigung bei Patienten mit Morbus Menière.
In der vorliegenden Arbeit wurden monozentrische Daten aus der prospektiven, multizentrischen Registerstudie SEMM (Systematische Erfassung von Morbus Menière) analysiert. Die Ergebnisse der "Speech, Spatial and Qualities of Hearing Scale" wurden dabei in Beziehung zu Daten aus der Reintonaudiometrie und der Sprachaudiometrie gesetzt.
Untersucht wurden 26 Patienten mit einem Durchschnittsalter von 60,3 Jahren (±8,4 Jahre), von denen 17 (65,4 %) weiblich waren. Bei 15 der Fälle (57,7 %) war die linke Seite betroffen. Es zeigte sich ein signifikanter Zusammenhang zwischen dem 4PTA und dem Alter auf dem kontralateralen Ohr, jedoch nicht auf dem betroffenen Ohr. Zudem war ein schlechteres Sprachverstehen auf dem betroffenen Ohr signifikant mit einer subjektiv empfundenen Einschränkung des räumlichen Hörvermögens verbunden.
Patienten mit Morbus Menière erleben im Alltag subjektive Beeinträchtigungen aufgrund der meist einseitigen Schwerhörigkeit. Dieser Aspekt sollte in der Patientenberatung berücksichtigt werden und ist wichtig zur Beurteilung der Schwere und des Verlaufs der Krankheit. Eine umfassende Bewertung und Validierung dieses Ansatzes erfordert jedoch weitere Untersuchungen.
Representative epidemiologic data on the average volume of the parotid gland in a large population-based MRI survey is non-existent. Within the Study of Health in Pomerania (SHIP), we examined the parotid gland in 1725 non-contrast MRI-scans in T1 weighted sequence of axial layers. Thus, a reliable standard operating procedure (Intraclass Correlation Coefficient > 0.8) could be established. In this study, we found an average, single sided parotid gland volume of 27.82 cm3 (95% confidence interval (CI) 27.15 to 28.50) in male and 21.60 cm3 (95% CI 21.16 to 22.05) in female subjects. We observed positive associations for age, body mass index (BMI), as well as male sex with parotid gland size in a multivariate model. The prevalence of incidental tumors within the parotid gland regardless of dignity was 3.94% in the Northeast German population, slightly higher than assumed. Further epidemiologic investigations regarding primary salivary gland diseases are necessary.
Background
One of the main treatment goals in cochlear implant (CI) patients is to improve speech perception. One of the target parameters is speech intelligibility in quiet. However, treatment results show a high variability, which has not been sufficiently explained so far. The aim of this noninterventional retrospective study was to elucidate this variability using a selected population of patients in whom etiology was not expected to have a negative impact on postoperative speech intelligibility.
Materials and methods
Audiometric findings of the CI follow-up of 28 adult patients after 6 months of CI experience were evaluated. These were related to the preoperative audiometric examination and evaluated with respect to a recently published predictive model for the postoperative monosyllabic score.
Results
Inclusion of postoperative categorical loudness scaling and hearing loss for Freiburg numbers in the model explained 55% of the variability in fitting outcomes with respect to monosyllabic word recognition.
Conclusion
The results of this study suggest that much of the cause of variability in fitting outcomes can be captured by systematic postoperative audiometric checks. Immediate conclusions for CI system fitting adjustments may be drawn from these results. However, the extent to which these are accepted by individual patients and thus lead to an improvement in outcome must be subject of further studies, preferably prospective.
Hintergrund
Ein Hauptziel der Versorgung von Patient*innen mit Cochlea-Implantat (CI) ist die Verbesserung des Sprachverstehens. Einer der Zielparameter ist die Sprachverständlichkeit in Ruhe. Die Versorgungsergebnisse lassen jedoch eine sehr große Variabilität erkennen, welche bislang nur unzureichend erklärt werden konnte. Ziel dieser nichtinterventionellen retrospektiven Studie war die Aufklärung dieser Variabilität. Dies erfolgte anhand einer ausgewählten Population von Patient*innen, bei der die Ätiologie keinen negativen Einfluss auf die postoperative Sprachverständlichkeit erwarten ließ.
Material und Methoden
Es wurden die audiometrischen Befunde der CI-Folgetherapie von 28 erwachsenen Patient*innen nach 6 Monaten CI-Erfahrung ausgewertet. Diese wurden in Relation zur präoperativen audiometrischen Untersuchung gesetzt und hinsichtlich eines unlängst publizierten Prädiktionsmodells für das postoperative Einsilberverstehen ausgewertet.
Ergebnisse
Durch Einschluss der postoperativen Hörfeldskalierung und des Hörverlusts für Zahlen in das Modell lassen sich 55 % der Variabilität in den Versorgungsergebnissen bzgl. des Einsilberverstehens erklären.
Schlussfolgerung
Die Ergebnisse dieser Studie legen nahe, dass ein Großteil der Ursachen für die Variabilität der Versorgungsergebnisse durch systematische postoperative audiometrische Kontrollen erfasst werden kann. Aus diesen Ergebnissen können sich unmittelbare Schlussfolgerungen für die Anpassungen der CI-Systeme ziehen lassen. Inwieweit diese jedoch von den einzelnen Patient*innen akzeptiert werden und somit zu einer Verbesserung der Befundlage führen, muss Gegenstand weiterer, möglichst prospektiver Studien sein.
Hintergrund: Sprachaudiometrische Messungen unter Störschalleinflüssen sind grundlegender Bestandteil bei der Evaluation des Versorgungsergebnisses apparativer Hörversorgungen. Für die adaptive sprachaudiometrische Messung im Störschall bei Cochlea-Implantat(CI)-Trägern:innen existieren bisher noch keine Empfehlungen zur Wahl der Pegelsteuerungsmethode, d. h. entweder die adaptive Pegeländerung des Sprachsignals (S) bei konstantem Störgeräusch (N) oder die adaptive Pegeländerung von N bei konstantem S.
Fragestellung: Hat die verwendete Pegelsteuerung beim Oldenburger Satztest (OLSA) einen Einfluss auf die Ergebnisse der monaural gemessenen Sprachverständlichkeitsschwelle (SVS) im Störschall?
Material und Methoden: Insgesamt wurden von 50 CI-Trägern:innen die im Rahmen der klinischen Routine erzeugten OLSA-Messreihen im Störgeräusch mit unterschiedlicher Pegelsteuerung sowie sprachaudiometrischen Messungen in Ruhe mittels Freiburger Sprachtest ausgewertet und verglichen.
Ergebnisse: In Abhängigkeit von der Pegelsteuerung im OLSA zeigen sich keine signifikanten Unterschiede zwischen den ermittelten Sprachverständlichkeitsschwellen, die kleiner als 5 dB(S/N) sind. Unter 55 % Einsilberverständlichkeit im FBE wird die SVS im OLSA größer als 5 dB(S/N)
Schlussfolgerungen: Damit bei den Messungen mit positivem S/N der Summenpegel möglichst konstant gehalten wird bzw. nur wenig ansteigt, empfiehlt sich aus klinisch audiologischer und methodischer Sicht die Durchführung der adaptiven monauralen Sprachverständlichkeitsmessung mit konstantem Sprachsignal bei 65 dB(SPL). Zudem ist die Prüfung der monauralen Sprachverständlichkeit im Störschall erst ab einer Einsilberverständlichkeit von mindestens 55 % (65 dB(SPL)) sinnvoll.
Purpose
Investigating whether the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) are valid and comparable to previous unmasked measurements if the speaker wears a surgical mask or a FFP-2 mask to reduce the risk of transmitting air-borne viruses such as SARS-CoV-2.
Methods
A convenience sample of 31 subjectively healthy participants was subjected to AVQI and ABI voice examination four times: Twice wearing no mask, once with a surgical mask and once with a FFP-2 mask as used regularly in our hospital. The order of the four mask conditions was randomized. The difference in the results between the two recordings without a mask was then compared to the differences between the recordings with each mask and one recording without a mask.
Results
Sixty-two percent of the AVQI readings without a mask represented perfectly healthy voices, the largest AVQI without a mask value was 4.0. The mean absolute difference in AVQI was 0.45 between the measurements without masks, 0.48 between no mask and surgical mask and 0.51 between no mask and FFP-2 mask. The results were neither clinically nor statistically significant. For the ABI the resulting absolute differences (in the same order) were 0.48, 0.69 and 0.56, again neither clinically nor statistically different.
Conclusion
Based on a convenience sample of healthy or only mildly impaired voices wearing CoViD-19 protective masks does not substantially impair the results of either AVQI or ABI results.