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Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The aim of this study was to develop a shortened German version of the Singing Voice Handicap Index (SVHI). The SVHI is a one-dimensional instrument for self-assessment of a voice disorder in singers. The questionnaire developed in the USA comprises 36 items and has been available in a validated German version since 2013., Methods: Bicentric data from a total of 200 patients formed the basis for item analysis and selection. Using corrected item-total correlations, 12 items were selected for the abridged version. The internal consistency was calculated. The SVHI-12 was subsequently validated in 97 vocal patients and 105 vocally healthy singers (control group) using the test-retest procedure., Results: The SVHI-12 achieved a good internal consistency (Cronbach's alpha = 0.93) and a good test-retest reliability (intra-class correlation r = 0.88 ; p < 0.001). The patients had significantly higher overall scores (18 ± 13 vs. 7 ± 6) compared to the healthy control group. The SVHI-12 overall score correlated significantly positively with the severity of the voice disorder as reported by the patient (r = 0.68; p < 0.001). As a threshold value above which a voice can be described as disturbed, a total score > 7 points was calculated using receiver operating curve analysis. As an indication of a voice disorder, a sensitivity of 81% and a specificity of 71% is thus achieved (Youden index 0.523, area under the curve 0.827, 95% confidence interval 0.769-0.885)., Conclusion: The shortened SVHI has similarly good psychometric characteristics to the original SVHI. With the SVHI-12, a valid and effective instrument for the detection of singing voice disorders is available for German-speaking countries., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Hearing-impairment can lead to a reduced quality of life and thus represents a vulnerability factor for mental disorders., Objective: This study represents the first psychiatric analysis of subjective quality of life and depression in people with hearing-impairment in Germany., Materials and Methods: The patient group included 30 hearing-impaired participants (27 women, 3 men) with a current or previous mental disorder and/or psychiatric/psychotherapeutic treatment (age: mean, M = 49.67 years; standard deviation, SD = 13.54 years). The control group consisted of 22 hearing-impaired participants (16 women, 6 men) without mental disorders or treatment (age: M = 52.41 years, SD = 17.30 years). Besides sociodemographic variables, we registered onset/extent of the various hearing-impairments and hearing aid provision. Both groups underwent extensive diagnostic assessment comprising subjective functional impairment (Sheehan Disability Scale, SDS), health-related quality of life (SF-36 Health Survey), and depressive symptoms (Beck Depression Inventory, BDI-II)., Results: Groups did not differ significantly in terms of sociodemographic variables such as age, gender, or intelligence. Participants of the patient group had a significantly greater subjective impairment, a lower quality of life, and more pronounced symptoms of depression. The invasiveness of the hearing aid (i. e., cochlear implant) as well as the timepoint of hearing-impairment onset (postlingually) appear to serve as vulnerability factors for mental health problems in this group., Conclusion: Our results indicate that besides delivering high-quality acoustic care, practitioners should continuously check patients' requirements for psychosocial treatment due to a loss of quality of life. The development of a specific psychotherapeutic treatment for hearing-impaired clients requires additional research focused on protective and vulnerability factors which may influence the emergence of mental disorders in these patients.

The Singing Voice Handicap Index (SVHI) was developed in the United States for the self-assessment of patients with singing problems. It has been translated into German and its reliability and validity have been assessed. In total, 54 (35 female, 19 male) dysphonic singers and 130 (74 female, 56 male) non-dysphonic professional singers were included in the study. Reliability rested on high test-retest reliability (r = 0.960, p ≤ 0.001, Pearson correlation) and a Cronbach's α of 0.975. A principal component analysis using the Varimax method and the results of the screeplot suggest the SVHI scored as a single scale. Validity rested on a highly significant correlation between the severity of the self-rated voice impairment by the patient and the total SVHI score. Dysphonic singers have significantly higher SVHI scores than healthy singers. The SVHI is thus suited to implementation as a diagnostic tool in German-speaking countries.

This article presents the current data and discussion on multimodal laryngeal preservation strategies in advanced laryngeal/hypopharyngeal carcinoma. Principally a distinction is made between simultaneous and induction chemoradiation protocols. In terms of late toxicity and related functional limitations, induction protocols are far superior to simultaneous platinum-based chemoradiation. Currently, the individual response to the first cycle of (short) induction chemotherapy appears to be the most reliable clinical marker for making treatment decisions, and this is under clinical investigation. No standard multimodal therapeutic alternative to laryngectomy exists; therefore, at this time multimodal strategies should only be carried out within the framework of clinical trials.

Hematopoietic neoplasms represent about 1% of all laryngeal neoplasms. MALT lymphoma arises from mucosa-associated lymphoid tissue and is associated with chronic inflammatory disease. Patients with Sjögren syndrome have a higher risk for development of non-Hodgkin lymphoma (MALT lymphoma). To date, only cases of MALT lymphoma of the salivary glands, thymus and stomach associated with Sjögren syndrome have been published. We present the case of a MALT lymphoma of the larynx associated with Sjögren syndrome. Radiation and chemotherapy are the first line of therapy as published in the literature.

Hoarseness is the leading symptom of dysphonia among children and adolescents. The incidence is evaluated internationally to be 6-25%. In an overview the hereditary and acquired organic and functional causes including secondary organic lesions of the vocal folds, the pathomechanisms and the symptoms typical for this age group are presented. In clinical routine, symptoms of dysphonia in children and adolescents should be consciously looked for and any long-term hoarseness should be examined by specialized physicians, even in this age group, using methods suitable to the age group and the developmental stage. When the appropriate indications are present all therapeutic options currently available should be taken into consideration. Furthermore, this paper provides information for the parents concerning the imminent phoniatric examination.

Objective: Large endolymphatic duct and sac (LEDS) syndrome is the most common radiologically detectable form of inner ear malformation (IEM) associated with sensorineural hearing loss (SNHL). Nevertheless, it is relatively unknown in the German-speaking countries., Methods: Among all patients referred from ear, nose, and throat specialists to the radiology department with clinically suspected IEM between 1994 and 2003, we identified the cases of LEDS. The retrospective study included clinical records, high-resolution computed tomography, and magnetic resonance imaging., Results: Of 169 patients, 17 (median age 12 years; 12 females) showed LEDS. A total of 28 ears were affected. Ten patients (6%; 15 ears) had isolated LEDS, while seven patients showed additional IEM (4%; 13 ears). The most frequent of these was dysplastic vestibule (13/13 ears), followed by Mondini deformity (10/13 ears) and dilated semicircular canals (7/13 ears). Three of 13 ears revealed severe IEM of the cochlea, vestibule, and semicircular canals. No correlation could be demonstrated between the severity of morphological changes and the degree of SNHL., Conclusion: LEDS may be an underestimated cause of SNHL. Imaging is necessary for a confident diagnosis.

Objective: The aim of this study was to clarify the clinical course of large endolymphatic duct and sac syndrome (LEDS). Although LEDS is the most common form of radiologically detectable inner ear malformation associated with sensorineural hearing loss (SNHL), it is relatively unknown in the German-speaking countries. We hoped to derive useful pointers for clinical care., Methods: We evaluated the clinical audiometric records and imaging findings of 169 patients with clinically suspected inner ear malformation seen between 1994 and 2003. Following identification of all LEDS cases, we serially investigated the anamnestic and functional data with regard to severity and course., Results: Among 169 patients, 17 (median age 12 years; 12 females) showed LEDS. A total of 28 ears were affected. Clinically, most cases were of prelingual or perilingual onset and displayed steady or fluctuatingly progressive severe SNHL with emphasis on the high frequencies or deafness. Episodes of sudden hearing loss were relatively frequent. No correlation could be demonstrated between the severity of morphological changes and the degree of SNHL., Conclusion: Progression of SNHL and episodes of sudden hearing loss were seen mainly in late childhood or adolescence. This should be taken into account when informing and advising patients and planning therapy.

Sialadenoma papilliferum is a rare tumour of the salivary glands that usually occurs in the oral cavity. Following the course of the salivary glands of the oral mucosa, the hard and soft palate are the most common locations of this tumor. In the international literature, only a few case reports about this entity can be found. We present a 63-year-old patient with a sialadenoma papilliferum accidentally found during diagnostic procedures for progredient dysphagia. Suffering from infrabifurcal cancer of the oesophagus, the patient had undergone partial oesophagectomy 1 year before. Histological verification was performed with a tumor biopsy at the border of hard and soft palate, on the right side. This case is compared with 39 further cases reported in the literature. The therapy of choice is resection of the tumor. Because of the high frequency of recurrence, in sano resection should be planned.

The influence of physical development and singing activity on vocal efficiency in children and adolescents is well known from clinical experience. There is, however, no comparative study between singing and non-singing children which also considers the influence of age and gender. Therefore, standard values for evaluation in clinical practice are missing. We examined the following parameters in 164 healthy children and adolescents (90 boys, 74 girls; 11-16 years), 86 without singing activity (group A) and 78 members of children's and youth choirs (group B): frequency and dynamic range of voice and its borders with a voice range profile, mean fundamental frequency (normal and loud phonation), maximum voice intensity, and maximum duration of intonation. The statistical analysis was performed using three-way ANOVA. We found significantly higher ranges of frequency and intensity in singing children and adolescents (p<0.0001). The borders of the dynamic range and the upper border of the frequency range were significantly higher in group B (p<0.0001). The boys in group B used a higher mean fundamental frequency during loud phonation. There were no significant differences between groups in maximum voice intensity (p=0.051) but a tendency towards higher values in singing children. As an unexpected result, we found significantly higher values in maximum duration of intonation in group A (p<0.0001) independent of age and gender, which seems to be related to the methods used. Regular training of the singing voice results in positive effects on several voice parameters in children as well as adolescents. Our results can be used for estimating standard values in professional clinical and educational care of young singing voices and non-singing children. For this purpose, voice range profile is particularly suitable.

We report the case of a 42 year old patient who developed chronic hyperplastic laryngitis during treatment with the angiotensin converting enzyme-inhibitor Cibacen 10. A severe cough and vocal restrictions with hoarseness were only incompletely cured after changing this anti-hypertensive medication to a adrenergic blocker, combined with a vocal rest and anti-inflammatory inhalation. Therefore we performed a laryngoscopy under general anesthesia and excised the swelling of the vocal cords. Additionally, voice therapy was prescribed and complete restitution achieved. Although hoarseness is documented as a potential side effect of angiotensin converting enzyme-inhibitors, morphological alterations in the vocal cords have not been linked to this type of drug. In our case, prolonged medication with Cibacen 10 led to chronic hyperplastic laryngitis. Initial coughing might have induced the trauma of the epithelium of the vocal cords. Due to the morphological alterations to the vocal cords the patient developed additional functional dysphonia.

Searching the medical literature is mainly characterized by the use of databases. The time for reviewing and printing a paper causes a delay between the first presentation of scientific results in a lecture and the appearance of the appropriate journal publication. Moreover, the possibilities for the integration of multimedia data are limited. Because of the development of new compression algorithms for audiovisual digitization software, the near simultaneous transmission of scientific presentations, both visually and aurally, has been possible since 1999. The section telemedicine of the interdisciplinary study group on image guided surgical navigation from the University of Leipzig has developed "medicstream" as a unique, audiovisual, scientific internetdatabase. It allows the documentation of presentations at congresses and courses, including the discussion,over a freely accessible, widely available homepage, using a home developed streaming technology. All presentations are examined by an authorized editorial committee consisting of representatives with different medical specializations for content before the admission to the data base. A total of 392 presentations from seven scientific meetings can be selected by an integrated search machine and viewed with Windows Media Player or Real Player using a conventional or faster internet connection to the homepage www.medicstream.de. The quality of the audiovisual transmission depends on the receiver-lateral data transmission rate,whereby the minimum variant of 56 kB/s is characterized by good detectability of the contents. In an analysis period of 242 days,we registered 44,199 accesses and 4,488 attendances. The telemedicine data base "medicstream" can optimize quality and extend medical education by live-streaming as well as by archiving scientific presentations as audiovisual data.

The transmission of scientific seminars into the Internet represents a new application of modern technologies for teleteaching.We digitally recorded 74 seminars and discussions during the 8th annual meeting of the German Society of Skull Base Surgery with five cameras and eight microphones, and transformed the data live with the real-Producer using a video card.This transferred data stream was sent via ISDN (128 kbit/s) to a real-server at the university, which was used for distribution in the net.The seminars could be called up in the display format of 320×240 pixels with a delay of 3 min (minimum: 30 s, as a function of the connection of the user) at each computer with Internet entrance. Altogether,we registered 3,284 accesses to the presentations following the congress until June 2002. The quality of picture transmission (24-36 kbit/s) and the quality of tone (audio stream: 5 kbit/s) were sufficient to understand the contents of the slide, video or computer presentation.The transmission of scientific meetings into the Internet can increase, with a justifiable technical expenditure, their efficiency by the ubiquitous availability of the information and the extension of the audience.

"Telemedicine" is a major new development with great potential for improving health care delivery. It therefore affects each department in medicine. There is a great deal of telemedicine activity around the world. However, the term telemedicine is not clear. It describes all forms of medical information, transferred from a relevant distance by an electronic transfer media. An essential condition for communication is the intelligibility between transmitter and receiver. Because of different transmitting technologies and networks in distinct countries, towns, or even academic institutions, satisfactory contact is not possible. In the last decade, the demand for worldwide audiovisual data transmission has led to the standardization of telecommunication media. Therefore it is no longer necessary to transport medical data (or even patients) by conventional manners, e.g., post, car, or aircraft. Telemedicine for diagnosis and management can be bidirectional in real-time, long-distance videoconferencing, in which the patient consults a specialist located at the remote site, or it can be the transmission of either real-time or pre-recorded images and data to a remote expert, as in teleradiology or telepathology. Another application is the use of videoconference systems in the course of meetings. The remote specialist has the opportunity to take part in the session, e.g., with a lecture. Furthermore, the remote specialist can demonstrate special operative techniques for teleteaching purposes, some of which may be specialities of the particular medical unit, e.g., operation in open NMR, telemanipulation, or telerobotic procedures. In this paper, we describe the use and benefit of a videoconference between the departments of otolaryngology and head and neck surgery of the Universities of Tübingen and Leipzig by means of an "ISDN-based videoconference system". During the meeting, the "operating course for reconstructive surgery in the head and neck", the practicability, reliability, costs and quality were determined and compared with other technologies for audiovisual data transfer.

Auditory similarities in voices of monozygotic twins have already been described in the literature. However, is there a clinical relevance? Thus, the present study was designed to identify parameters of vocal performance and acoustic features which are significantly more similar in monozygotic twins than in non-related persons. In our hypothesis, comparable prerequisites for an increased vocal load in a profession or in an artistic education of the voice could be due to these similarities. We compared intra-pair differences with data from a control group. Moreover, we examined the correlation of intra-pair differences with the age of the monozygotic twins. A greater difference in older twin pairs than in younger pairs could show the effect of an exogene influence. In addition to the few phoniatric studies in twins in the literature, we used current methods for acoustic analysis. We examined seven parameters of vocal performance and three acoustic features in 31 monozygotic twin pairs (median age 36 years, range 18-75 years) and compared them with 30 control group pairs, which consisted of non-related persons of the same age and sex, newly combined from the group of monozygotic twins ("statistical twins"). We found significant differences in seven of ten parameters (vocal range, highest and lowest vocal fundamental frequency, fundamental speaking frequency, maximum voice intensity, number of partials, vibrato of intensity; U-test by Mann-Whitney). No correlation of the differences of the identical twins with age was found in the examined parameters. The voices of identical twins are significantly more similar than those of non-related persons regarding the above mentioned features. Thus, the suitability of the voices of monozygotic twins for professions with a high demand on voice is comparable. Results of the group comparison correlate largely with the literature. The missing correlation with age could be due to the fact that the environmental effects were not measurable, and/or the development of the voice is more influenced by genetic effects.

Nasal steroid drops can produce iatrogenic Cushing's syndrome if the recommended dose is exceeded. We now report a 19-year-old male patient for whom dexamethasone nasal drops were prescribed because of nasal obstruction. He had been using these drops for more than 5 years, with a daily dexamethasone dose of 0.7-1.0 mg. It is likely that significant amounts of dexamethasone were swallowed and absorbed by the patient's gastrointestinal tract. As a consequence, the patient developed Cushing's syndrome with panhypopituitarism, growth retardation, osteoporosis and hypertension. A boyish size of the larynx resulted in a fundamental speaking frequency of a child. After discontinuing the intranasal use of the of dexamethasone and adjusting doses of hydrocortisone over 3.5 months a normalization of endocrine function occurred with the beginning of puberty and normal sexual changes. These findings show that the use of nasal steroid drops particularly in children should be limited to a short period and drugs with a low absorption dose employed.