Predictive factors of speech understanding in adults with cochlear implants

OBJECTIVE

The aim of this study was to analyse the factors that influenced speech recognition scores in quiet conditions and speech reception threshold levels (SRT) in fixed noise conditions, after cochlear implant (CI) surgery in adults with postlinguistic deafness.

STUDY DESIGN

Combined retrospective and prospective study in a tertiary referral centre.

METHODS

We included 66 patients that received implants between 2002 and 2013. We retrospectively collected speech recognition scores and 14 demographic, audiological, and technical factors, including gender, age at implantation, aetiology, hearing loss progression, preoperative Pure Tone Average (PTA), hearing loss onset age and duration, duration and use of hearing aids (HAs); implantation in the best or worst ear; implantation on the right or left side; use of HA after implantation; and the duration and type of CI. We prospectively tested a subgroup of 21 patients for SRT in fixed noise.

RESULTS

The hearing loss duration significantly affected speech recognition scores in quiet conditions (H (4) = 10.567, p =0.032) and SRTs in fixed noise conditions (rs = 0.466, p = 0.033). The PTA of the better ear significantly affected only the SRT in fixed noise conditions (rs = 0.57 1, p = 0.007).

CONCLUSION

The duration of hearing loss and the PTA of the best ear had significant effects on the outcomes of speech recognition and SRT in quiet and fixed noise conditions, respectively. These findings are important for counselling CI candidates. Further studies in larger study populations are warranted.

Speech-in-noise testing as a marker for noise-induced hearing loss and tinnitus

Speech-in-noise testing as a marker for noise-induced hearing loss and tinnitus. Noise-induced hearing loss and tinnitus are auditory complaints that often co-occur. Often, there is no immediate indication of changes in the pure tone audiogram. Patients can still have clinically normal hearing thresholds while clearly experiencing reduced speech comprehension. This might be explained by the process of neurodegeneration of the innervated dendrites of the auditory nerve fibres and secondary degeneration of spiral ganglion neurons. Subsequent maladaptive neuronal plasticity of the central auditory system can induce tinnitus. Standard hearing testing is no longer sufficient in these patients. Therefore more complex tasks, such as speech-in-noise tests, might be valuable extensions to the standard hearing tests. We carried out a prospective investigation of the influence of tinnitus upon speech comprehension in noise and the effectiveness of speech-in-noise testing, using the Flemish version of the digit triplet test (DTT). Thirty-seven patients with mild noise-induced hearing loss, tinnitus complaints and clinically normal pure tone thresholds completed the DTT and filled in two tinnitus enquiries. A statistically significant (p=0.026) correlation between the averaged high PTA, 2,z and the averaged SRT across ears on the DTT was found. There also seems to be a slight influence of tinnitus onset on the SRT score.

Auditory neuropathy/dyssynchrony revisited

Auditory neuropathy/dyssynchrony (AN/AD) is a relatively, recently described diagnostic term. It describes a disorder characterised by detectable otoacoustic emissions and/or cochlear microphonics, combined with abnormal or absent auditory brainstem responses and deficient speech understanding. Consequently, the patient's cognitive responses are inconsistent with a behavioural tone audiogram. This review describes the epidemiology, pathogenesis, diagnosis, and treatment of AN/AD. We have focused on the diagnostic pathway, because diagnosis is sometimes difficult, and recent research has provided important insights into the aetiopathology of the disease. The diagnostic tools for AN/AD currently used in our department will be demonstrated in a clinical case. It is very important to recognise AN/AD and provide patient counselling and support as early as possible, due to the potentially major influence of this disorder on a patient's social life and language acquisition.

Aetiology of congenital hearing loss: a cohort review of 569 subjects

OBJECTIVE

Newborn hearing screening was implemented in Flanders about fifteen years ago. The aim of this study was to determine the aetiology of hearing loss detected by the Flemish screening programme.

METHODS

From 1997 to 2011, 569 neonates were referred to our tertiary referral centre after failed neonatal screening with Auditory Brainstem Responses. In case hearing loss (HL) was confirmed, further diagnostic testing was launched. A retrospective chart review was performed analysing the degree of HL, risk factor and aetiology.

RESULTS

Metabolic disorders (0.5%), infectious diseases (35.8%), congenital malformations (6.1%) and genetic abnormalities (19.8%), whether or not syndromic, were retained. In 35% of the subjects no obvious aetiology could be determined in the current study.

CONCLUSION

In contrast to the literature findings, this series shows a genetic syndromic cause in 80% of the genetic bilateral HL cases. On the other hand connexin positive diagnoses were mostly underrepresented in this study, showing the need for better screening.

Noise exposure of care providers during otosurgical procedures

OBJECTIVE

To monitor the noise exposure of care providers during otological surgery due to drilling and suction in the operating room.

METHODS

A clinical study monitoring different standard otosurgical procedures was conducted; cochlear implantation (CI), mastotympanoplasty, and mastoidectomy alone. Noise exposure to the surgeon and assistant were monitored with wireless personal noise dosimetry and stationary sound monitoring. Both maximum peak level in dBC (Lpeak) and time-average sound pressure level in dBA (equivalent level or Leq) were measured during drilling episodes. Frequency analysis in one third octaves covering the frequency bands 6.3 Hz to 20 k Hz was performed using a sound analyzing program.

RESULTS

When averaged over the entire procedure, the sound pressure level was highest for the surgeon and the assistant with values of 76.0 dBA and 72.5 dBA, respectively, during CI. Lpeak was 135.9 dBC. Leq for the stationary sound measurement was 74.2 dBA. During cortical bone work using a cutting burr, 84.6 dBA was measured. Mean values of L95% (estimation of the background noise) were between 55.8 dBA and 61.2 dBA. Frequency analysis showed the highest sound pressure level for all procedures was between 2.5 kHz and 3.15 kHz.

CONCLUSION

This is the first study to use personal sound dosimetry to monitor noise exposure during otosurgical drilling. In accordance with other studies, the results presented show sound levels below international occupational noise level regulations. However, the measured noise exposure during drilling could have negative effects on care providers based on unfavorable acoustical comfort.

Fifteen years of early hearing screening in Flanders: impact on language and education

OBJECTIVES

To assess the impact of fifteen years of universal neonatal hearing screening in Flanders on language development and the educational setting.

METHODOLOGY

An analysis of the database of Kind en Gezin from 1997 to 2012 and a long-term evaluation of the children referred to our centre after failed neonatal hearing screening. The CELF and PPVT language tests were performed.

RESULTS

Between 1997 and August 2012, bilateral hearing loss was confirmed in 2393 children in Flanders, of whom 11.4% were referred to our tertiary centre. The educational setting and language development of 84 children older than 5 years was evaluated and 54% of them had additional disabilities. Of the children without additional disabilities, 84% attended mainstream schools; 42% of children with additional disabilities entered mainstream education with additional support. There was a significant correlation between the number of additional disabilities and the education level (p < 0.001) and between the degree of hearing loss and educational placement (p < 0.001). Data on language development were available for 76% of the children and a significant correlation could be demonstrated only between the results of the PPVT language and the number of additional handicaps (p < 0.008).

CONCLUSIONS

The majority of children receiving early treatment after neonatal hearing screening enter mainstream education. The number of additional disabilities has a significant effect on education level and language development.

Long-term audiological follow-up of children with congenital cytomegalovirus

OBJECTIVE

To evaluate the audiological outcome of children with congenital cytomegalovirus infection.

METHODOLOGY

In a prospective study, the hearing of 98 congenitally cytomegalovirus-infected children born between January 2003 and July 2009 was systematically evaluated until the age of six using the Flemish CMV protocol. Symptomatic children with hearing loss at birth were treated with ganciclovir, if parents consented.

RESULTS

Seventy children passed initial screening, 28 had unilateral or bilateral hearing loss. In the normal hearing group, one asymptomatic and two symptomatic children developed late-onset hearing loss. Eight children in the group with hearing loss at birth received ganciclovir. Nine symptomatic and 11 asymptomatic children did not receive ganciclovir. In the treated group, 37.5% of the children had stable hearing loss, and 37.5% had progressive and/or fluctuating hearing loss. First progression or fluctuation always occurred after the age of one year. The hearing threshold improved in 25.0%. The improvement took place during or shortly after treatment. Hearing loss remained stable in 33.3% of the untreated symptomatic children, while progression or fluctuation occurred in 55.5%. In the asymptomatic group, hearing loss was most commonly stable (63.6%). The first change in the hearing threshold was almost always detected before the age of one year in both untreated groups.

CONCLUSIONS

Hearing loss caused by congenital cytomegalovirus infection cannot be defined unequivocally either with respect to the level of hearing loss or its evolution over time. Treating symptomatic children with ganciclovir leads to a better prognosis during the first year of life, after which progression or fluctuation again becomes more likely. However, overall, progression is more common in the untreated symptomatic group. Asymptomatic children with SNHL are more likely to have a stable hearing status.

Syndromic disorders in congenital hearing loss

OBJECTIVES

To investigate the aetiology of congenital hearing loss detected by the universal neonatal hearing screening programme (Algo) that was introduced in Flanders 15 years ago, and, more specifically, to investigate genetic causes.

METHODOLOGY

Diagnostic work-up of all children with confirmed hearing loss after referral by the Algo screening programme and screening at the neonatal intensive care unit (NICU) of our university hospital.

RESULTS

A hearing loss was confirmed in 505 of the 569 neonates (18% from NICU) referred between 1997 and 2011. After further examination, a genetic origin was identified in 84 (17%) of 100 children with a syndromic hearing loss. The most frequent syndromes are discussed.

CONCLUSION

A higher percentage of syndromic hearing loss was found than in the literature. This could be explained by the good cooperation with the human genetics department and the proportion of children retrieved from the neonatal intensive care unit.

Prevalence of risk factors for sensorineural hearing loss in NICU newborns

OBJECTIVES

The aim of this study was to determine the prevalence and significance of traditional risk factors associated with sensorineural hearing loss (SNHL) in a population of 615 neonates who attended the neonatal intensive care unit (NICU) of the University Hospital in Leuven, Belgium between January 2005 and December 2007.

METHODOLOGY

Auditory brainstem response (ABR) audiometry using 40 dB stimuli was performed in all 615 neonates. A retrospective medical database analysis was performed to evaluate the influence of 14 predetermined risk factors. The evaluated risk factors were ototoxic medication, hyperbilirubinemia, in utero infections (including CMV, rubella, syphilis, herpes, and toxoplasmosis), craniofacial anomalies, syndromes associated with SNHL, low birth weight (< 1,500 g), low Apgar score, mechanical ventilation lasting for 5 days or longer, bacterial meningitis, family history of hereditary childhood SNHL, endocranial hemorrhage, hypoxic ischemic encephalopathy, convulsions, and sepsis

RESULTS

Uni- or bilateral hearing impairment was diagnosed in 25 out of 615 neonates (4.1%). In utero infections (especially CMV), craniofacial anomalies, and syndromes known to include SNHL were significant risk factors. For the remaining risk factors, no significant correlation with SNHL was found.

CONCLUSIONS

In this study, only in utero infections (especially CMV), craniofacial anomalies, and syndromes known to include SNHL were significant risk factors associated with SNHL. Adequate management of hyperbilirubinemia and ototoxic drug administration may eliminate some of the major historical risk factors associated with SNHL in NICU neonates.

Intratympanic lidocaine instillation for Menière's disease

OBJECTIVES

We studied the role of intratympanic lidocaine instillation as part of the treatment for vertigo in Menière's disease.

METHODOLOGY

We retrospectively analyzed 40 patients who underwent 74 labyrinth anaesthesias in our center between 1996 and 2006. We studied the attack-free period after instillation, the effect of repetitive procedures and the efficacy according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) (1995) criteria.

RESULTS

Labyrinth anaesthesia was effective in 70% of the studied procedures. If effective, the mean duration of the attack-free period was 12.6 months. Repetition was effective in 80.7% of the procedures if the previous procedure was effective as well. Two years after treatment 21 patients had AAO-HNS functional levels of 1 or 2 and 23 patients were class A or B.

CONCLUSION

Labyrinth anaesthesia is an effective treatment for Menière's disease and a useful tool for the control of symptoms. Repetitive instillation is effective especially when the previous instillation was also effective.

Hyperbaric oxygen therapy for tinnitus

OBJECTIVE

To assess the effect of hyperbaric oxygenation on tinnitus.

METHODOLOGY

A Medline search from 1960-2007 yielding 22 studies.

RESULTS

No significant effect could be demonstrated in four prospective studies. Retrospective studies indicate greater improvement in tinnitus in acute cases (49-85%) compared with tinnitus episodes exceeding three months (34-38%). One study, however, showed significantly more improvement in patients with positive expectations before therapy (60.3%) compared with those with negative expectations (19%).

CONCLUSIONS

There are no significant data about the effect of hyperbaric oxygenation for tinnitus, but there are indications of a better effect in acute cases. However, a major psychological component and a low risk of enhancement of the tinnitus should be considered.

2′,5′-Oligoadenylate synthetase activity analysis and human papilloma virus typing as prognostic factors in patients with recurrent respiratory papillomatosis

Objective: Determination of early prognostic factors in patients with recurrent respiratory papillomatosis is extremely important, so the major goal of our prospective, multicentre study was to evaluate (1) the feasibility of various factors to determine prognosis of the clinical course,as well as (2) the response to interferon-alpha therapy in recurrent respiratory papillomatosis.

Methods: Forty-two patients with recurrent respiratory papillomatosis were treated with interferon-alpha (3 MU/m2 three times per week; mean therapy duration was 2.7 ± 1.8 years)in 1983–1994 and followed-up until 2003. Human papilloma virus (HPV) type, recurrent respiratory papillomatosis severity and 2′,5′-oligoadenylate synthetase activity were determined by standard methods and analysed for correlation with the results of long-term clinical outcome.

Results and conclusion: Patients with HPV type 11, a severity score >4, a high number of surgical procedures prior to interferon-alpha therapy and a high basal 2′,5′-oligoadenylate synthetase activity should be considered at high risk of an aggressive clinical course, often with spread to lower airway passages, malignant transformation and death. Human papilloma virus type, score for recurrent respiratory papillomatosis severity, number of surgical procedures and 2′,5′-oligoadenylate synthetase activity showed significant association with response to interferon-alpha therapy and the long-term clinical course, so these factors have value in predicting prognosis in recurrent respiratory papillomatosis.

Hyperbaric oxygen therapy after failure of conventional therapy for sudden deafness

PROBLEMS/OBJECTIVES

We investigated the effect of secondary hyperbaric oxygen therapy (HBO) for patients with idiopathic sudden sensorineural hearing loss after unsuccessful conventional treatment.

METHODOLOGY

We retrospectively evaluated 3 groups: 100 patients without further treatment (group 1), 160 patients with secondary HBO at 1.5 ATA (group 2), and 56 patients with secondary HBO at 2.5 ATA (group 3).

RESULTS

In group 1, a mean hearing gain (MHG) of 2.6 +/- 15 dB was found at the end of the follow-up period. After HBO, a MHG of 3.1 +/- 9 dB in group 2 and 19.7 +/- 23 dB in group 3 was achieved. The results in group 3 were statistically significant in comparison to group 1 (p < 0.007) and to group 2 (p < 0.009). With HBO after initial therapy failure, there is a significant correlation of MHG with time delay before HBO (p < 0.03).

CONCLUSIONS

HBO at 2.5 ATA in patients with idiopathic sudden sensorineural hearing loss after unsuccessful conventional treatment yields significant improvement of hearing. MHG is higher when time delay before HBO is shorter.

The middle ear of cleft palate patients in their early teens: a literature study and preliminary file study

OBJECTIVES

Middle ear disease is a frequent problem in young children with cleft palate (CP). Less is known about otological status in the adolescent CP population. The aim of this study is to provide an overview of current knowledge in the literature concerning the aetiology of middle ear disease in CP patients and the middle ear status of older children with CP, and to compare the situation in our centre to this background through an assessment of the otological status of patients in our CP population.

MATERIAL AND METHODS

A literature review was conducted to summarise current knowledge about middle ear status in CP patients. A retrospective analysis was performed of the medical records of 20 CP patients between the ages of 10 and 15 who were treated and followed at the University Hospitals Leuven. The available otological data, otoscopic findings, information about hearing and surgery performed was collected for each patient when aged three and above ten years.

RESULTS

Current knowledge indicates that middle ear function improves as CP patients get older. In our study, otoscopic appearance was acceptable in 63% of ears of children aged over ten years of age. Otitis media with effusion (OME) was far less frequent above this age than around the age of 3, with a decrease from 50% to 13% of all ears. Above the age of 10, tympanic perforations were present in 13% of ears and retraction of the tympanic membrane in 23%.

CONCLUSIONS

Despite a very high incidence of OME in young CP patients, the long-term otological prognosis is not necessarily sinister. A favourable natural evolution, diligent otological follow-up, early diagnosis and treatment of middle ear disease with the use of tympanostomy tubes are the likely contributors to the acceptable otological result in older CP patients.

Management of otitis media with effusion in children

Otitis media with effusion in children: B-ENT Guidelines. OME is highly prevalent among young children, with peak prevalences at around two and five years of age. Although serious complications are rare, the burden of OM is large with impaired quality of life and high direct and indirect socio-economic costs. To date, medical treatment of OME is not recommended because of the limited scientific evidence that this treatment is effective in the long term. Surgical candidacy for OME depends largely on hearing status, associated symptoms, the child's developmental risk and the anticipated chance of spontaneous resolution of the effusion. Ultimately, the recommendation for surgery must be individualized.

Jugular foramen schwannoma: surgical experience in six cases

PURPOSE

Schwannomas of the lower cranial nerves are rare tumours. We have surgical experience in six patients.

MATERIAL AND METHODS

We have retrospectively reviewed the files of the six patients with jugular foramen schwannomas that were treated in multidisciplinary collaboration in the departments of neurosurgery and ENT.

RESULTS

From a clinical point of view, the most important finding was that these tumours usually mimic a vestibular schwannoma. The imaging findings however always allowed the differentiation. The surgical technique included in all cases a suboccipital approach for the intracranial part. When large, the extracranial extension had to be removed through a lateral cervical or transfacial approach. There was no mortality and minor morbidity, with good functional outcome. In subtotally removed tumours, recurrence occurred.

CONCLUSION

A combined neurosurgical and ENT approach allows for safe removal of these often large skull base tumours.

[Halitosis--foetor ex ore]

BACKGROUND

An overview is presented on the etiology, diagnosis, and therapy of halitosis.

METHODS

Results are given of our multidisciplinary halitosis outpatient department started in 1994. The team consists of ENT specialists and paradontologists, occasionally assisted by a psychiatrist. The oral odor is confirmed with a halitometer (Interscan Corporation, Model RH-17E USA). 491 Patients, nearly the same number of males as females, mostly between 20 and 50 years of age were seen.

RESULTS

Oral causes (87%) were due to tongue coating (51%), gingivitis (17%), paradontitis (15%), or combinations of factors (17%). The other 13% involved causes related to ENT problems (4%), both ENT and oral (3%), digestive tract (1%), and presumed psychiatric pathology (5%).

CONCLUSIONS

Many patients underwent diagnostic and therapeutic aimed interventions to no avail prior to their arrival in our halitosis clinic. Usually advising the patient to maintain better oral hygiene is sufficient.

Cochlear implantation: past and present

Experimental stimulation of the ear started at the end of the 18th century with Volta. The first electrode implantation was performed by Djouno and Eyries in 1957. This was followed by intensive cochlear implant research at first in California, then all over the world. During the past 2 decades there has been an evolution from single to high performance multichannel implants with the development of more sophisticated speech coding strategies.

Treatment of severe laryngeal papillomatosis with intralesional injections of cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine]

Respiratory papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted.

Labyrinthine fistulae: a retrospective analysis

A retrospective analysis has been conducted of 57 labyrinthine fistulae found in 375 cholesteatoma cases, primarily treated by removal of the matrix of the cholesteatoma and covering the fistula with a mixture of bone paste and fibrin glue. CT-scan with slices of 1 mm demonstrated the fistula in almost 90% of the cases. Eighteen percent of the ears were pre-operatively totally deaf. Large fistulae are riskier than smaller ones for post-operative perceptive losses, but even in very large and multiple fistulae the hearing may be preserved in most cases.

A follow-up study of long-term results after cochlear implantation in children and adolescents

The time course of speech development in children after cochlear implantation may extend over many years, thus making long-term studies necessary to evaluate any outcome. We report our long-term results after cochlear implantation in children and adolescents. Mean follow-up was 28 months, ranging from 1 to 5 years. After at least 1 year of experience all children were found to benefit from their cochlear implants. The majority of children scored above chance in speech identification tasks requiring closed set word and sentence understanding). At the 4-year interval, all children tested including prelingually deaf children had developed open set sentence understanding. The most relevant factor accounting for differences in the results was the duration of implant use in all groups. Even beyond 3 years the results continued to improve. Peri- or postlingually deafened children tended to have favorable results. For prelingually deaf children, duration of deafness and age at implantation were correlated negatively with the results.

[Infusion therapy in sudden deafness. Reducing the risk of pruritus after hydroxyethyl starch and maintaining therapeutic success--a prospective randomized study]

A Prospective Randomized Study: The aim of the study was to demonstrate the effectiveness of two different treatment schemes with hydroxyethyl starch (HES) and the incidence of pruritus as a side effect in a population of patients with sudden sensorineural hearing loss and hematocrit values above 44% and/or hemoglobin values above 14 g/dl. Under these circumstances we found a significant hearing improvement with infusions of 500 ml 10% HES 200/0.5 compared to saline infusions in a previous double-blind placebo-controlled study. Two groups are compared in a prospective randomized study. Group 1 was treated with infusions of 250 ml 10% HES 200/0.5 and group 2 with 500 ml of the same substance (n = 200). No difference in hearing improvement was detected between the two groups. The results were significantly better than with saline infusions. Eleven percent of the patients in group 1 developed pruritus and 38% in group 2. The incidence of pruritus correlated with the cumulative dosage of HES given. A correlation between allergic disposition and pruritus could not be found. Therefore, we suggest infusions with 250 ml 10% HES 200/0.5 per day for patients with sudden sensorineural hearing loss and hematocrit values above 44% and/or hemoglobin values above 14 g/dl. Indications for a long lasting HES-therapy should be restrictive. The effectiveness of HES has not been yet demonstrated in patients with lower hemoglobin and hematocrit values.

[Clavicular fractures after radical neck dissection]

Fracture of the medial end of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4%-0.5%. Radical neck dissection alters the mechanics of the shoulder girdle, and distorts normal muscle forces acting on the clavicle. We present two patients to illustrate the problems of differential diagnosis and mechanism of fracture. Once the diagnosis has been made the fracture should be managed conservatively, although clinical and radiological differentiation from avascular necrosis or bony metastasis may be difficult. Biopsy is essential in doubtful cases.

[Preoperative chemotherapy in head-neck tumors. Chances and risks of this therapeutic procedure]

We submit our present work dealing with stage III and IV squamous cell carcinomas of the head and neck referred for preoperative chemotherapy. Our results are based on a histological serial section investigation of the tumour tissues. In at least 50% inadequate tumour resection was observed with a tendency to increase if preoperative chemotherapy was conducted.

[Mini-plate osteosynthesis in zygomatic fractures--restoration or alternative?]

At the University ENT Clinic Frankfurt 105 patients with zygomatic fractures were treated from 1980 until 1986: 45 were treated with a maxillary sinus stent, part of them in combination with wire osteosynthesis, miniplate osteosynthesis was performed in 30 patients, some fractures seemed stable after reposition without fixation. The zygomatic fractures are classified into 3 types requiring different surgical treatments. Comparing the long term results of these methods with the pre- and postoperative radiological and functional data, patients with type 2 and 3 fractures do better with miniplate osteosynthesis than with the other treatments. In combination with an orbital floor fracture, the degree of enophthalmus is more severe in those patients where fractures were only repositioned without fixation.

[Randomized double-blind study of therapy of sudden deafness: initial results]

Three treatment groups (hydroxyethyl starch-pentoxifylline (HAES-steril/Trental), hydroxyethyl starch-pentoxifylline-naftidrofuryl (HAES-steril/Trental/Dusodril) and dextran-pentoxifylline (Rheomacrodex/Trental] and a placebo therapy control group (normal saline) were compared in a prospective randomised study (102 patients) and a retrospective study (292 patients). The trial therapy results were the same in all groups. However all treatments on patients with a haemoglobin greater than 14 g/l result in a significant hearing improvement compared with the placebo. The patient group with systolic blood pressure greater than 130 mm Hg treated with hydroxyethyl starch-pentoxifylline had a significant hearing improvement compared with the placebo, hydroxyethyl starch-pentoxifylline-naftidrofuryl and dextran-pentoxifylline. With increasing systolic blood pressure, patients in the placebo, hydroxyethyl starch-pentoxifylline-naftidrofuryl and dextran-pentoxifylline groups had a statistically significant worse result.