Hno最新文献

Background: Diagnostic testing prior to ear surgery is an important part of the work of ear specialists in hospitals. To date, there is no national or international diagnostic standard. Rather, the test batteries used are dependent on hospitals' own doctrinal opinions.

Objective: The aim of this study was to conduct a survey in German-speaking countries to determine the routine diagnostic methods used prior to various ear surgery procedures.

Methods: An online questionnaire with 18 general questions on the hospital's equipment and availability of tests and 6 questions on specific ear operations was sent to the departmental directors.

Results: Of the 180 hospitals contacted, 56 (31%) took part in the survey. For eight specific operations (rehabilitative ear surgery with and without cholesteatoma, hearing-improving surgery, stapes surgery, ear canal stenosis surgery, ear canal atresia surgery, implantation of active middle ear implants, and cochlear implant surgery), the test batteries most commonly used in German-speaking countries could be determined. It was found that the majority of clearly defined diagnostic batteries are implemented in the hospital's own diagnostic steps. In German-speaking countries, neuro-otological diagnostics are preferably carried out before treatment with hearing implants, but are of only minor importance for middle ear surgery in German-speaking hospitals.

Conclusion: There is inhomogeneity regarding diagnostic pathways in ear surgery in German-speaking countries. The results of this survey provide a further basis for discussion concerning the development of a diagnostic standard, which is to be developed in corresponding guidelines and consensus papers.

Background: Persons whose speech recognition with hearing aids at 65 dB_SPL, WRS₆₅(HA), is inadequate but whose maximum monosyllabic word recognition score (WRS_max) is still measurable may benefit from a cochlear implant (CI). Using a validated prediction model, one can estimate word recognition with a CI, WRS₆₅(CI), for these patients. The aim of this study was to investigate the relationship between electrically evoked compound action potentials (ECAP) and stimulation parameters of the CI system.

Patients and methods: In this prospective study, 37 patients were included. The WRS₆₅(CI) was determined after 6 and 12 months and compared with the predicted WRS₆₅(CI). The correlation of minimum and maximum electrical stimulation with the ECAP was investigated.

Results: All patients showed a significantly better WRS₆₅(CI) after 12 months compared with the preoperatively determined WRS₆₅(HA). The proportion of patients whose WRS₆₅(CI) fell short of the predicted value by more than 20 percentage points was 19% after 6 months and 5% after 12 months. In the patient population, there was a closer correlation of the ECAP thresholds with the maximum than with the minimum electrical stimulation.

Conclusion: For patients whose speech understanding with hearing aids is inadequate-even with a very high preoperative WRS_max in moderately severe hearing loss-CI fitting appears to be a promising treatment option. The predictive model enables individual treatment planning. Its application contributed to a quality of care that was higher than was found in an earlier retrospective study. The correlation found between stimulation intensity and ECAP in a cohort of patients with achieved predicted values supports the hypothesis that a fitting procedure based on ECAP and audiometry is a promising approach.

Background: This study investigates the inverse use of the Vibrant Soundbridge® Floating Mass Transducer (FMT; MED-EL, Innsbruck, Austria) as a microphone in a pilot test. Should this be applicable, it would open up interesting application possibilities, e.g., as a microphone for a fully implantable cochlear implant.

Materials and methods: Experimental measurements on an ear canal-eardrum model were used to analyze the acoustic properties of the FMT when used as a microphone, including frequency response and sensitivity. The FMT from the Direct Drive Simulation Set was coupled to the artificial eardrum for this purpose.

Results: The results show that the FMT has a usable signal-to-noise performance over the entire frequency range investigated, albeit with a non-linear frequency characteristic. The highest sensitivity was found between 1500 and 2000 Hz.

Conclusion: The study suggests that an FMT optimized for microphone properties could be used as a microphone in the middle ear, which would open up new possibilities for the development of fully implantable hearing systems. Further investigations, in particular measurements on the petrous bone, are required to determine the suitability of the FMT as a middle ear microphone more precisely.

Background: Individual cognitive abilities are increasingly discussed as a potential factor influencing the outcomes of cochlear implant (CI) treatment. In this context, the present study investigated a possible correlation between the secondary and post-secondary education of a large cohort of CI recipients and their speech comprehension. Other variables with a potential influence on the treatment outcome included age at implantation, the duration of hearing loss, and the treatment mode.

Methods: The study included data of n = 326 patients from the audiology database of the Frankfurt University ENT Clinic. Secondary and post-secondary education histories were collected as part of the anamnesis using a questionnaire. Speech comprehension was assessed using the Freiburg monosyllabic test (FBE) and the Oldenburg sentence test in noise (OLSA) at 6 and 12 months after implantation and correlated with various biographical and audiological factors.

Results: Patients with higher educational qualifications showed better outcomes in the FBE at 6 months (ANOVA_Welch; F (2, 104) = 5.60; p = 0.05) and at 12 months (F (2, 223) = 3.07; p = 0.05; η² = 0.03) compared to those with vocational qualifications. In the speech comprehension in noise (OLSA), a significant group difference was observed 12 months postoperatively. Patients without qualifications or with other qualifications scored lower than those with vocational or higher qualifications (F (2, 74) = 4.41; p = 0.02; η² = 0.11). Other significant factors influencing speech comprehension included the age at implantation and mode of care.

Conclusion: The correlation between secondary and post-secondary education and speech comprehension after CI treatment was not unequivocal. Only the choice of post-secondary education showed a significant correlation with speech comprehension. Further research is required to confirm a potential relationship.

Background: Due to the anatomical variety of the human cochlea and the many factors that may determine the choice of the cochlear array, there is no one-size-fits-all method for determining the right implant. The cochlear size, preoperative residual hearing, anatomical variants, operative technique, and cause of deafness must be taken into consideration when making this decision.

Objective: This work aims to spread awareness of precision surgery and provide an overview.

Materials and techniques: Factors that contribute to individualization are explained, and future advances are outlined.

Results: The optimum treatment, if possible, is electroacoustic stimulation. Cochlear coverage of approximately 80% should be the goal when using electrical stimulation alone.

Conclusion: In order to maximize rehabilitation results, recent developments in cochlear implantation mark a paradigm shift away from standardized treatments and toward individualized therapy.

Tumors of the parotid gland are rare and predominantly benign. The surgical management is challenging due to the close anatomical relationship to the facial nerve. Pleomorphic adenoma and cystadenolymphoma are among the most frequently occurring lesions. The surgical approach depends on the location, size and suspected diagnosis of the lesion. While radical surgical techniques were favored in the past, current practice emphasizes reducing surgical morbidity through less invasive resection methods. In this context, extracapsular dissection offers functional advantages over more extensive resections, with similarly low recurrence rates. Complications such as facial nerve palsy, salivary fistulas and Frey's syndrome occur less frequently with milder severity and are generally well-treatable, for example, with botulinum toxin. In selected cases, such as confirmed bilateral cystadenolymphoma, a conservative wait-and-scan approach may be considered as an alternative to surgery. The goal remains the complete resection of the lesion with maximum preservation of function.

Background: Due to their high prevalence the management of thyroid nodules requires a particularly systematic approach. If the diagnostics reveal a suspected or confirmed thyroid cancer, in most cases surgical treatment remains the primary treatment option.

Objective: The aim of this work is to provide an overview of the guideline-based approach to thyroid nodules and carcinomas with a focus on diagnostics and surgical treatment. The essential differences in content between the previous and current guidelines are identified.

Material and methods: Selection of the most practice-relevant recommendations of the guidelines on thyroid cancer published in 2025 and comparison of these with the recommendations of the guidelines on surgical treatment of malignant thyroid diseases published in 2012.

Results: The new guidelines are significantly more comprehensive and detailed. The recommended diagnostic procedure is more precise and supplemented by examination techniques such as elastography. The surgical procedure keeps its role as the primary treatment approach. In accordance with the current study situation new options, such as the observational behavior for papillary microcarcinomas under defined conditions, are included. The recommendations on the diagnostics and treatment of undifferentiated thyroid cancer have been substantially expanded.

Conclusion: The new guidelines provide a comprehensive overview of the diagnostics and treatment of thyroid cancer and expands on the previous guidelines with consideration of the current study situation.

Prehabilitation is gaining increasing importance in the care of patients with head and neck cancer. While the positive effects of exercise therapy interventions are well established in other oncological entities, the prehabilitative use of physical activity in head and neck cancer has so far been largely limited to prevention and reduction of swallowing disorders. Targeted exercise therapy interventions to enhance physical and mental performance have rarely been implemented in these patients. This article shows which aspects of the disease can be addressed through appropriate training measures. Based on the evidence, it derives how exercise control can be implemented in practice using the FITT criteria (frequency, intensity, time, type).

Background: Meniere's disease is frequently associated with psychogenic comorbidities such as anxiety, depression, and persistent dizziness in the sense of "persistent postural perceptual dizziness" (PPPD) or reactive psychogenic dizziness.

Materials and methods: The current meta-analyses on anxiety and depression and the consequences for otorhinolaryngology are presented and discussed.

Objective: The aim is to raise awareness of psychogenic comorbidity and to encourage helpful approaches in diagnosis and treatment.