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ZusaMmenfassung Hintergrund Eine nichtbehandelte Schwerhörigkeit hat einen erheblichen Einfluss auf die Morbidität. Zur Früherkennung wurde der Mini-Audio-Test (MAT) entwickelt. Im Rahmen einer Nachuntersuchung soll untersucht werden, welche Werte sich für die Sensitivität, Spezifität und prädiktiven Werte für einen minimal zu detektierenden Hörverlust von 25, 30, 35 und 40 dB sowohl in mindestens 1 der 4 Oktavfrequenzen zwischen 0,5 und 4 kHz als auch in den über diesen Frequenzen gemittelten Hörverlust ergeben. Methode Nachuntersucht wurden Daten, die 2016 und 2017 erhoben wurden. Bestimmt wurden die Sensitivität, Spezifität und die negativ und positiv prädiktiven Werte mittels einer logistischen Regression. Ergebnisse Die Sensitivität des MAT stieg in beiden Altersgruppen mit zunehmendem zu detektierendem Hörverlust an, die Spezifität sank analog. Die positiv prädiktiven Werte waren für die Älteren höher als für die Jüngeren und sanken mit steigendem, minimal zu detektierendem Hörverlust. Dabei lagen die Werte für die gemittelten Frequenzen deutlich unter denen, die den Hörverlust nur in 1 Frequenz berücksichtigen. Die negativ prädiktiven Werte verhielten sich genau entgegengesetzt. Schlussfolgerung Die Werte sind für Ältere ab dem 60. Lebensjahr deutlich schlechter als für Jüngere ab dem 50. Lebensjahr. Dies lässt es umso wichtiger erscheinen, dass bereits ein erstes Hörscreening ab dem 50. Lebensjahr durchgeführt wird, um einen individuellen Hörverlust realistisch einschätzen zu können. Nur durch eine rechtzeitige Hörrehabilitation können negative Folgen einer unbehandelten Schwerhörigkeit positiv beeinflusst werden.

It is important for the surgeon to determine the position of the CI electrode array during and after its placement within the cochlea. Most preferably, this should be within the scala tympani to obtain the best audiological outcome. Thus, misplacement into the scala vestibuli or tip fold-over should be prevented. Since there are different ways to ensure proper positioning of the electrode array within the scala tympani (e.g., intraoperative radiography, electrophysiological recordings), our study was aimed at detecting intraoperative electrophysiologic characteristics to better understand the mechanisms of those electrode tip fold-overs. In a multi-centric, retrospective case–control series, patients with a postoperatively by radiography detected tip fold-over in perimodiolar electrodes were included. The point of fold-over (i.e., the electrode position) was determined and the intraoperative Auto-NRT recordings were analysed and evaluated. Four patients were found to have an electrode tip fold-over (out of 85 implantees). Significant changes of the Auto-NRT recordings were not detected. All tip fold-overs occurred in the most apical part of the electrodes. Cochlear implantation for hearing impaired patients plays a decisive role in modern auditory rehabilitation. Perimodiolar electrode arrays may fold over during the insertion and, hence, could have a negative impact on audiological outcome. Characteristic electrophysiologic changes to possibly predict this were not found in our series.

Objectives: The benefit of using the electroacoustic functionality was tested compared to electric stimulation alone. Two different cut-off frequencies between acoustic and electric stimulation wer...

Objective: Atraumatic cochlear implantation (CI) and insertion of the electrode in particular are major goals of recent CI surgery. Perimodiolar electrode arrays need a stylet or exosheath for insertion. The sheath can influence the intracochlear pressure changes during insertion of the electrode. The aim of this study was to modify the insertion sheath to optimize intracochlear pressure changes. Methods: In an artifical cochlear model, 7 different modified insertion sheaths were used. The intracochlear pressure was measured with a micro-optical sensor in the apical part of the model cochlea. Results: Significant lower intracochlear pressure changes were observed when the apical part of the insertion sheath was either shortened or tapered. Modification of the stopper does influence the intracochlear pressure significantly. Conclusion: Modification of the insertion sheath leads to lower intracochlear pressure gain. The differences and impact on intracochlear pressure changes found in this study underline the importance of even subtle modifications of the electrode insertion technique.

To compare the standard T-Mic setting to UltraZoom and StereoZoom in 10 unilateral cochlear implant (CI) users, 10 bimodal device users and 10 bilateral CI users as well as a normal hearing (NH) reference group (n = 10).Speech reception thresholds were measured using the Oldenburg sentence test in noise. Speech was presented from the front at 0°, noise was presented from five loudspeakers spaced at ±60°, ±120°, 180° (setup A) or from four loudspeakers in the front hemisphere at ±30°, ±60° and one at 180° (setup B).There was a significant advantage for UltraZoom and StereoZoom for all groups in both setups. The largest advantage was for StereoZoom in the bilateral group (setup A, 5.2 dB, P 0.001 and B, 3.4 dB, P 0.001) There was a significant advantage for StereoZoom over UltraZoom in the bimodal group (setup A, P 0.01 and B, P 0.05) and in the bilateral group (P 0.01, setup B only). The bilateral group performed as well as the normally hearing group in both setups and the bimodal group performed as well in setup A. There was a significant benefit of 1.8 dB for ClearVoice over UltraZoom alone for the unilateral group.UltraZoom and StereoZoom provided a clinically and statistically significant benefit over the T-Mic condition. The largest gain was shown for StereoZoom in the bimodal and bilateral groups. The use of StereoZoom enabled the bilateral group to perform as well as the normally hearing group in both the challenging speaker setups. However, real life environments might provide an even greater challenge than the conditions tested here.

Zusammenfassung Hintergrund In Deutschland leiden etwa 15 Millionen Menschen an einer Schwerhörigkeit (SH), doch nur 16 % tragen Hörgeräte. Diese Unterversorgung kann für die Betroffenen zu schwerwiegenden Folgen (soziale Isolation, Depression, Förderung einer Demenz etc.) führen. Ein frühzeitiges und flächendeckendes Hörscreening ab dem 50. Lebensjahr kann dies verbessern. In dieser Studie wurde der Mini-Audio-Test (MAT), ein sechs Fragen zum subjektiven Hörverlust (HV) umfassender Test mit dreistufiger Antwortskala, an einem Normalkollektiv überprüft (Sensitivität (Se), Spezifität (Sp), positiver prädiktiver Wert (PPW)). Methode Es wurden 943 Patienten (älter als 50 Jahre) ohne bekannte Ohrenerkrankungen mittels MAT befragt, zum Vergleich die Hörschwellen tonaudiometrisch ermittelt und die Se, Sp und der PPW zur Detektion eines relevanten HV durch den MAT für die Altersklassen < 60 Jahre (AG1) und ≥ 60 Jahre (AG2) mittels binomialer Proportionen ermittelt. Ergebnisse Die Se lag für AG1 bei 0,66, die Sp bei 0,61, der PW bei 0,60, für die AG2 lag die Se bei 0,47, die Sp bei 0,80, der PPW bei 0,89. Schlussfolgerung Entsprechend der vorliegenden Ergebnisse wird der Einsatz des MAT als Screeningmethode für Nicht-HNO-Ärzte zur Detektion von schwerhörenden Patienten ab dem 50. Lebensjahr vorgeschlagen. Hierdurch ließen sich auch schwerwiegende Begleiterkrankungen wie Minderung der kognitiven Leistungsfähigkeit, Sturzrisiko, Depression und Demenz positiv beeinflussen.

Objectives Patients with single-sided deafness can nowadays receive a cochlear implant. A majority of these patients are well adapted and benefit from the implant. The aim of this study was to evaluate the reasons for poor performance in a group of patients with single-sided deafness, who received a cochlear implant. Design A total of 65 patients were enrolled into a retrospective case series. Seven poor performers were present in the group. Freiburger monosyllabics, localization testing, and radiologic images were evaluated. Results Localization testing showed the absence of lateralization ability in three patients, whereas the Freiburger monosyllabic word scores improved in three patients. One patient had no speech perception after 1 year of rehabilitation. Findings of magnetic resonance imaging (MRI) revealed cerebral involvement in five patients. Conclusion Various factors influence the outcome in unilateral cochlear implantation in patients with single-sided deafness. These reasons may be preoperative, operative, or postoperative. Nevertheless, the majority of patients benefit from these implants.

Objective: To evaluate the long-term safety and performance of four different vibroplasty couplers (round window, oval window, CliP and Bell coupler) in combination with an active middle ear implant. Methods: This was a multicentre, prospective, long-term study including 5 German hospitals. Thirty adult subjects suffering from conductive or mixed hearing loss were initially enrolled for the study, 24 of these were included in the final analysis with up to 36 months of postsurgical follow-up data. Bone conduction and air conduction were measured pre- and postoperatively to evalu ate safety. Postoperative aided sound field thresholds and Freiburger monosyllable word recognition scores were compared to unaided pre-implantation results to confirm performance. Additional speech tests compared postoperative unaided with aided results. To determine patient satisfaction, an established quality-of-life questionnaire developed for conventional hearing aid usage was administered to all subjects. Results: Mean postoperative bone conduction thresholds remained stable throughout the whole study period. Mean functional gain for all couplers investigated was 38.5 ± 11.4 dB HL (12 months) and 38.8 ± 12.5 dB HL (36 months). Mean word recognition scores at 65 dB SPL increased from 2.9% in the unaided by 64.2% to 67.1% in the aided situation. The mean postoperative speech reception in quiet (or 50% understanding of words in sentences) shows a speech intelligibility improvement at 36 months of 17.8 ± 12.4 dB SPL over the unaided condition. The signal-to-noise ratio (SNR) improved by 5.9 ± 7.2 dB SNR over the unaided condition. High subjective device satisfaction was reflected by the International Inventory for Hearing Aids scored very positively. Conclusion: A significant improvement was seen with all couplers, and audiological performance did not significantly differ between 12 and 36 months after surgery.

Hypothesis It was the aim of this study to establish normative data regarding intended changes in cochlear implants (CI) receiver positioning by one surgeon over time. Background With the increasing number of CI patients, the probability of needing magnetic resonance imaging (MRI) increases. The accessibility of cerebral structures is limited by MRI artifacts caused by CI. New studies show a dependence of the visibility of intracranial structures by the MRI sequences and the position of the CI receiver itself. Methods Retrospective and interindividual investigation of topograms with regard to the nasion-external auditory canal-internal magnet angle and the distance between the internal magnet and the external auditory canal. We evaluated scans of 150 CI recipients implanted from 2008 until 2015. Results The most common implant position in the years 2008 to 2015 was a nasion-external auditory canal-internal magnet angle between 121 and 140 degrees (mean, 127 degrees) and an internal magnet-external auditory canal distance between 61 and 80 mm (mean, 70 mm). Over time the nasion-external auditory canal-internal magnet angle increased and the internal magnet-external auditory canal distance decreased, both to a statistically significant degree. A difference between the manufacturers was not observed. Conclusion The CI receiver position is important for an artifact-free examination of the internal auditory canal and the cochlea. The realization of the position over a time course supports awareness of artifact-related visibility limitations.

Our present findings demonstrate that resealing to cover the electrode is an effective method to treat vertigo after CI. An insufficient cochleostomy sealing can be regarded as a cause of postoperatively newly occuring vertigo after CI. A transtympanic revision is a promising treatment option in cases of post-operative dizziness. Intoduction: A well-known and frequently reported complication after cochlear implantation is the appearance of postoperative vertigo symptoms. The aim of the present study was to observe if the postoperatively new occurrence of vertigo can be treated by resealing of the round window patch after cochlear implantation.A retrospective analysis revealed that 10 patients underwent revision surgery transtympanally. Vertigo was assessed preoperatively and directly postoperatively and after 6 month after revision surgery by using the Dizziness Handycap Inventory (DHI).The most common symptom was rotating vertigo. A spontanous nystagmus was seen in four cases. No nystagmus was found after the revision surgery. In three cases, the onset of dizziness was associated with an event (sneezing, otitis media, climbing a mountain). A preoperative CT showed insuspectible results in seven patients but revealed pathologies two patients. Vertigo was improved significantly in six patients, and three of them were symptom-free.

Objective To preserve residual hearing in cochlear implant surgery, the electrode design has been refined, and an atraumatic insertion has become one aspect of cochlear implant research. Previous studies have described the effect of insertion speed and opening of the round window membrane on intracochlear pressure changes. The aim of our current study was to observe intracochlear pressure changes due to different cochlear implant electrodes in an artificial cochlear model with stable surrounding factors. Study Design Prospective controlled study. Setting Tertiary referral center. Subjects and Methods The experiments were performed in an artificial cochlear model with a pressure sensor in the apical area. With straight and perimodiolar electrode arrays, 5 insertions with the same insertion speed and 5 insertions over the same time were performed. Results With the perimodiolar high-volume electrode, significantly greater intracochlear fluid pressure changes were observed than with the straight electrode. Compared with the straight electrode, the perimodiolar electrode induces significantly higher pressure peaks (1.12 ± 0.15 vs 0.86 ± 0.05 mm Hg, P = .006) and significantly higher amplitudes (0.38 ± 0.07 vs 0.09 ± 0.07 mm Hg, P.001). Conclusion The reliable preservation of residual hearing is an important multifactorial challenge in modern cochlear implant surgery. Insertion speed, handling, and electrode design are known to influence the preservation of residual hearing. In our artificial model experiments, we could prove objectively that the volume of the electrodes has a significant influence on the intracochlear pressure changes during cochlear implantation.

Objectives: An intraoperative neural response telemetry-ratio (NRT-ratio) was established, which can provide information about the intraoperative intracochlear electrode array position for perimodiolar electrodes. Methods: In a retrospective controlled study in 2 tertiary referral centers, the electrophysiological data sets of 50 patients with measured intraoperative auto-NRTs and postoperative radiological examinations were evaluated. All patients were implanted with Nucleus slim straight electrodes. The NRT-ratio was calculated by dividing the average auto-NRT data from electrodes 16 to 18 with the average from electrodes 5 to 7. Using a flat panel tomography system or a computed tomography, the position of the electrode array was certified radiological. Results: Radiologically, 2 out of 50 patients were identified with an electrode translocated from the scala tympani into the scala vestibuli. The radiologically estimated electrodes indicating a scalar change showed a regular NRT-ratio but nonspecific NRT-level changes at the localization of translocation.

BACKGROUND Dehiscence syndromes of the semicircular canals are a relatively new group of neurotological disorders. They have a variety of symptoms with hearing/balance involvement. Younger patients have clinically relevant symptoms in only about one third of cases. In addition to etiology and pathogenesis, the present paper describes diagnostic and therapeutic possibilities using a patient series of the authors. MATERIALS AND METHODS This nonrandomized prospective study included 52 patients with uni-/bilateral dehiscence syndromes of the superior and/or posterior canal (SCDS/PCDS), diagnosed with high-resolution computed tomography (HR-CT) of the petrous bone. Of 41 patients undergoing surgical therapy for severe symptoms-predominantly vertigo attacks (Meniere-like) and/or falls (Tumarkin crises)-31 received single-sided hearing implants. RESULTS Of the 41 patients with transmastoid superior and/or posterior canal occlusion, 30 showed a significant improvement of balance in the Dizziness Handicap Inventory (DHI); the dizzy spells ceased. A positive outcome was correlated with the severity of the preoperative disorder; a poor outcome (nonsignificant increase in DHI, recurrent vertigo of various qualities/frequencies) with the comorbidities vestibular migraine, Meniere's disease of the contralateral ear, and a dehiscence size exceeding 4 mm. CONCLUSION The more severe the vestibular symptoms, the better the outcome of surgical therapy. Auditory symptoms (nonspecific aural fullness, hyperacusis) do not generally respond well to surgical therapy. Cochlear implants have an additional beneficial effect; comorbidities should be considered as (relative) contraindications.

Based on this model experiment, a small tip and low volume electrode show lowest intra-cochlear pressure values. Insertional support by a tool minimizes fast pressure changes. Higher electrodes volumes affect slow and fast pressure changes as well.Insertion causing low intra-cochlear pressure is assumed to be important for atraumatic cochlear implant surgery to preserve residual hearing. Cochlear implant electrodes differ in terms of parameters like tip size, length, volume, and technique of insertion. The aim of this study was to observe the effect of different cochlear implant electrodes on insertional intra-cochlear pressure in a cochlear model.Cochlear implant electrode insertions were performed in an artificial cochlear model and intra-cochlear pressure changes were recorded in parallel with a micro-pressure sensor positioned in the apical region of the cochlear model to follow the maximum values, temporal changes, maximum amplitude, and frequency of changes in intra-cochlear pressure. Insertions were performed with four different electrodes (Advanced Bionics 1j, Helix, HFMS, and LW23).This study found statistically significant differences in the occurrence of initial maximum pressure values correlating with the electrode tip size. The different electrodes and the technique of insertion significantly affected the occurrence of maximum value, amplitude, and frequency of intra-cochlear pressure occurrence.

Conclusion: Over time, a homogenous increase in intracochlear pressure was seen in every experiment. Significant reductions in terms of amplitude variation and insertion depth were observed over time, using the one-point-supported insertion method. The frequency of peaks between the thirds was significantly lower when using the two-points-supported insertion method.Objectives: The preservation of residual hearing and minimization of intracochlear trauma are two of the major goals in modern cochlear implantation (CI) surgery. It is assumed that intracochlear pressure measurements yield information about the intracochlear behavior of the electrode itself in the cochlea. The aim of this study was to investigate temporal intracochlear fluid pressure changes using two different kinds of insertion conditions.Method: Cochlear implantations with the Advanced Bionics IJ® electrode were performed in an artificial cochlear model with a constant insertional speed of 0.5 mm/s provided by a linear actor. Amplit...

To preserve residual hearing in cochlear implant candidates, the atraumatic insertion of the cochlea electrode has become a focus of cochlea implant research. In a previous study, intracochlear pressure changes during the opening of the round window membrane were investigated. In the current study, intracochlear pressure changes during opening of the round window membrane under dry and transfluid conditions were investigated. Round window openings were performed in an artificial cochlear model. Intracochlear pressure changes were measured using a micro-optical pressure sensor, which was placed in the apex. Openings of the round window membrane were performed under dry and wet conditions using a cannula and a diode laser. Statistically significant differences in the intracochlear pressure changes were seen between the different methods used for opening of the round window membrane. Lower pressure changes were seen by opening the round window membrane with the diode laser than with the cannula. A significant difference was seen between the dry and wet conditions. The atraumatic approach to the cochlea is assumed to be essential for the preservation of residual hearing. Opening of the round window under wet conditions produce a significant advantage on intracochlear pressure changes in comparison to dry conditions by limiting negative outward pressure.

Objective Different aspects should be considered to achieve an atraumatic insertion of cochlear implant electrode arrays as an important surgical goal. Intracochlear pressure changes are known to influence the preservation of residual hearing. By using the intraoperative "pullback technique," an electrode position closer to the modiolus can be achieved than without the pullback. The aim of the present study was therefore to investigate to what extent the pullback technique can influence intracochlear pressure changes. Methods Insertions of cochlear implant electrodes were performed in an artificial cochlear model with two different perimodiolar arrays. Intracochlear pressure changes were recorded with a micro-optical pressure sensor positioned in the apical part of the cochlear. After complete insertion of the electrode array, a so-called pullback of the electrode was performed. Results Statistically significant pressure differences were measured if the electrode array was wet (ie, moisturized) during the pullback. Relative pressure changes in electrodes with smaller total volume are lower than pressure changes in larger electrodes. Conclusion The preservation of residual hearing and, thus, the resulting postoperative audiological outcome has a major impact on the quality of life of the patients and has become of utmost importance. Intracochlear pressure changes during the pullback manoeuver are small in absolute terms, but can even be still reduced statistically significantly by a moistening the electrode before insertion. Using the pullback technique in cases with residual hearing does not affect the probability of preservation of residual hearing but could lead to a better audiological outcome. Level of evidence NA.

Objective. Cerebral magnetic resonance imaging with the magnet of the cochlear implant receiver/stimulator in place causes artifacts and hinders evaluation of intracerebral structures. The aim of this study was to evaluate the internal auditory canal and the labyrinth in a 1.5T MRI with the magnet in place. Study Design. Observational study. Setting. Tertiary referral center. Subjects and Methods. The receiver/stimulator unit was placed and fixed onto the head of three volunteers at three different angles to the nasion–outer ear canal (90°–160°) and at three different distances from the outer ear canal (5–9 cm). T1 and T2 weighted sequences were conducted for each position. Results. Excellent visibility of the internal auditory canal and the labyrinth was seen in the T2 weighted sequences with 9 cm between the magnet and the outer ear canal at every nasion–outer ear canal angle. T1 sequences showed poorer visibility of the internal auditory canal and the labyrinth. Conclusion. Aftercare and visibility of intracerebral structures after cochlear implantation is becoming more important as cochlear implant indications are widened worldwide. With a distance of at least 9 cm from the outer ear canal the artifact induced by the magnet allows evaluation of the labyrinth and the internal auditory canal.