Laryngo-rhino-otologie最新文献

Background: Tinnitus is one of the most common otologic comorbidities, particularly in older patients with severe hearing loss or deafness. Cochlear implants (CI) have been used for hearing rehabilitation more and more successfully in elderly patients and CI treatment is performed in Germany without an age limit. The aim of this follow-up study was to assess the tinnitus burden in the long-term follow-up of elderly patients with hearing rehabilitation using CI.

Material and methods: This prospective longitudinal study included 15 patients between 72 and 92 years of age with preoperative tinnitus who had been treated unilaterally with a CI for the first time about six years ago. Monosyllabic speech understanding and tinnitus burden were assessed using the Mini-Tinnitus Questionnaire. The results were compared with our previous study 24, focusing on the first six months.

Results: Six years postoperatively, there was a nonsignificant increase in monosyllabic understanding to 61.7 ± 26.3%, compared with the results six months postoperatively (p = 0.069). The burden of tinnitus showed a stable low mean of 3.9 ± 3.6 points six years postoperatively, compared with the six-month control (p = 0.689) and significantly reduced compared to the preoperative status with 6.9 ± 6.5 points (p = 0.016).

Conclusion: Hearing rehabilitation by using CI leads to a stable improvement of monosyllabic discrimination in elderly people as well as to a stable reduction of tinnitus burden over years.

Objective: Upper airway obstructions are usually acute emergencies. Coniotomy is the last option to secure the airway and can be supported by sonography. The aim of this study was to establish a training program to teach these skills.

Material and methods: The training consisted of theoretical training with an additional video presentation (10 minutes each) and practical training (45 minutes). Evaluations were completed before (T1) and after (T2) the training to measure prior experience and satisfaction with the training as well as subjective and objective competence levels. At T2, a practical test was also completed by n=113 participants. A standardized evaluation form was used to document the results of the practical test.

Results: A large proportion of the participants had neither seen a coniotomy (64.6%) nor performed one independently (79.6%). Significant improvement (T1 to T2) was measured with regard to the subjective assessment of competence (p<0.001). The training received positive ratings for all items tested (scale ranges 1-2). During practical tests, the participants achieved an average of 89.2% of the possible points and needed a mean of 101 ±23 seconds to identify the conic ligament.

Conclusion: Structured training for sonographic identification of the conic ligament leads to significant improvement in the subjective assessment of competence and a high objective competence level in a short period of time. This type of training should be standardized in head and neck ultrasound training in the future.

Nowadays, it is only relatively rare and in selected situations that colonic interposition is chosen rather than the stomach as a reconstructive organ for replacing the oesophagus. The colon is a reliable organ for tubular replacement of the oesophagus when the stomach is not available for reconstruction. Colon interposition is a complex and complicated operation. It requires a specific indication and thorough preoperative preparation. From a technical point of view, colon interposition places high demands on the selection and surgical dissection of the vascular supply to the reconstructed organ. The reconstruction route and elevation of the interposition graft to the proximal oesophagus and the need to create 3 or 4 gastrointestinal anastomoses also place significantly higher demands than reconstruction using a gastric tube. Overall, despite the significant surgery-related morbidity, good functional results and a good quality of life can usually be achieved. The surgical technique applied in our own practice is described in detail. An overview from literature on the results of colonic interposition is given, particularly with regard to surgical complications and quality of life after colon interposition.