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ZusammenfassungDie Aktualisierung der Leitlinie war ein wichtiger Schritt, um mit zunehmender Verbreitung der Sialendoskopie und anderer minimalinvasiver Verfahren Behandlungsstandards zur Therapie der Sialolithiasis und der Speichelgangstenosen zu definieren. Im Rahmen der Aktualisierung wurden die diagnostischen und therapeutischen Algorithmen dem aktuellen Wissensstand angepasst. Sie werden in diesem Artikel in verkürzter Form mit Betonung der praxisrelevanten konservativen Therapieoptionen wiedergegeben.

The SARS-CoV‑2 pandemic has affected the health and practice of otorhinolaryngologists (ORLs) for over 1 year. Follow-up data of a national survey with German ORLs were evaluated regarding differences between the two waves of the pandemic.As in the initial survey, German ORLs were addressed via e‑mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association. All ORLs afflicted with SARS-CoV‑2 were invited to participate in a web-based survey. General data on infections and concomitant parameters were evaluated.Since the start of the pandemic, 129 ORLs reported testing positive for SARS-CoV‑2 in Germany. The ORLs infected during the first wave had a relative risk (RR) of 4.07 (95% CI: 3.20; 5.19) of contracting SARS-CoV‑2. During the second wave, the RR decreased to 0.35 (95% CI: 0.28; 0.45). The availability of personal protective equipment (PPE) increased from the first to the second wave along with an increased perception of protection in the professional environment. The source of infection shifted from infections via medical staff during the first wave to patients and household exposure during the second wave. Regular medical practice was resumed by clinicians and general practitioners in the second wave. Nevertheless, a proportionally lower infection rate was observed compared with the German population as a whole.The data reflect a unique long-term survey of ORLs during the pandemic. Differences in the source of infection were seen between the first and second wave, confirming the need for appropriate PPE for medical professionals working in high-risk environments. Further strategies to reduce the risk of infection include consistent testing for SARS-CoV‑2 in healthcare professionals, patients, and the general public as well as vaccination of high-risk medical groups.ZIEL: Die Pandemie mit SARS-CoV‑2 bedroht seit nunmehr über einem Jahr die eigene Gesundheit und beeinflusst das alltägliche Arbeiten von HNO-Ärzt*innen in Deutschland. Die Nachfolgedaten einer initialen Web-basierten Befragung werden im Hinblick auf Unterschiede zwischen der ersten und zweiten Infektionswelle mit SARS-CoV‑2 vorgestellt.Im Unterschied zur ersten Befragung (April bis Mai 2020), bei der alle HNO-Ärzt*innen – unabhängig vom Infektionsstatus – aufgerufen waren teilzunehmen, waren in der Nachfolgeerhebung (Juni 2020 bis Februar 2021) nur infizierte Kolleg*innen aufgerufen, daran teilzunehmen. Persönliche Daten zu Krankheitsverlauf, Symptomen, Arbeitsort, aber auch Informationen zu Infektionsursache, Verfügbarkeit von Schutzmaterialien und empfundener Sicherheit wurden via E‑Mail von der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO KHC) und dem Deutschen Berufsverband der Hals-Nasen-Ohrenärzte e.V. (BVHNO) erfragt.Seit Beginn der Pandemie infizierten sich 129 HNO-Ärzt*innen mit SARS-CoV‑2. Das relative Risiko für HNO-Ärzt*innen lag während der ersten Welle bei 4,07 (95%-Konfidenzintervall, 95%-KI: 3,20; 5,19) und sank während der zweiten Welle auf 0,35 (95%-KI: 0,28; 0,45). Persönliche Schutzmaterialien waren während der zweiten Welle in ausreichendem Maß verfügbar, wohingegen viele Teilnehmer einen Mangel daran während der ersten Welle empfanden. Die gesicherten Infektionsketten zwischen erster und zweiter Welle wiesen Unterschiede auf. Während der ersten Welle spielte die Übertragung durch infiziertes Personal eine große Rolle. In der zweiten Welle lag der Schwerpunkt der Infektionsübertragung bei dem Kontakt zu COVID-19-Patient*innen und infizierten Familienmitgliedern. Die reguläre medizinische Tätigkeit wurde von Klinikärzt*innen und niedergelassenen Ärzt*innen in der zweiten Welle wieder aufgenommen. Dennoch zeigte sich eine anteilig geringere Infektion mit SARS-CoV‑2 im Vergleich zur deutschen Gesamtbevölkerung.Die vorliegenden Daten der einzigen Langzeiterhebung unter HNO-Ärzt*innen während der Pandemie sprechen dafür, dass eine Rückkehr zu einer regulären HNO-ärztlichen Tätigkeit unter konsequenter Beachtung persönlicher Schutzmaßnahmen möglich ist. Zu den weiteren Strategien, um das Infektionsrisiko zu senken, gehören auch konsequentes Testen auf SARS-CoV‑2 bei im Gesundheitswesen Tätigen, Patient*innen und der allgemeinen Bevölkerung sowie die frühzeitige Impfung für medizinische Hochrisikogruppen.

Introduction: COVID-19 can be associated with a variety of longer-lasting impairments that can have a significant impact on patients’ quality of life (QoL). While this is well described in the literature for limitations in lung capacity or permanent headaches, there is little research on the impact of olfactory dysfunction in the context of COVID-19 on patients’ QoL. Methods: In 65 patients with a history of COVID-19, the present olfactory ability was assessed using the Sniffin’ Sticks test. In addition, olfactory QoL was assessed by the Questionnaire of Olfactory Disorders. Self-assessment was performed with visual analogue scales. The data were compared with the results obtained in healthy individuals and in patients with hyposmia due to other viral infections. Results: The QoL of COVID-19 patients was significantly lower compared to the healthy control group. Even recovered subjects whose olfaction had already returned to the normal range still had a reduced QoL. The severity of the olfactory impairment correlated with the reduction in QoL. However, the olfactory QoL of COVID-19 patients was not worse than that of patients’ olfactory loss due to other viral infections. Patients with parosmia had reduced QoL and rated their situation worse than patients without parosmia. Conclusion: QoL appears to be impaired in patients with long-lasting COVID-19 olfactory disorders several months after overcoming acute symptoms, even if olfaction has normalized. However, the impairment is not more pronounced than in patients with other postviral olfactory disorders of the same duration.

The update of this guideline was an important step to define standards for the use of sialendoscopy and other emerging minimally invasive techniques for the therapy of sialolithiasis and other obstructive salivary gland diseases. The current actualization was necessary to adapt the diagnostic and therapeutic algorithms to the current scientific knowledge. In this article they are presented in a shortened version with a focus on conservative therapeutic measures which are especially relevant for daily practice.Die Aktualisierung der Leitlinie war ein wichtiger Schritt, um mit zunehmender Verbreitung der Sialendoskopie und anderer minimalinvasiver Verfahren Behandlungsstandards zur Therapie der Sialolithiasis und der Speichelgangstenosen zu definieren. Im Rahmen der Aktualisierung wurden die diagnostischen und therapeutischen Algorithmen dem aktuellen Wissensstand angepasst. Sie werden in diesem Artikel in verkürzter Form mit Betonung der praxisrelevanten konservativen Therapieoptionen wiedergegeben.

Background While the leading symptoms during coronavirus disease 2019 (COVID-19) are acute and the majority of patients fully recover, a significant fraction of patients now increasingly experience long-term health consequences. However, most data available focus on health-related events after severe infection and hospitalisation. We present a longitudinal, prospective analysis of health consequences in patients who initially presented with no or minor symptoms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. Hence, we focus on mild COVID-19 in non-hospitalised patients. Methods 958 Patients with confirmed SARS-CoV-2 infection were observed from April 6th to December 2nd 2020 for long-term symptoms and SARS-CoV-2 antibodies. We identified anosmia, ageusia, fatigue or shortness of breath as most common, persisting symptoms at month 4 and 7 and summarised presence of such long-term health consequences as post-COVID syndrome (PCS). Predictors of long-term symptoms were assessed using an uni- and multivariable logistic regression model. Findings We observed 442 and 353 patients over four and seven months after symptom onset, respectively. Four months post SARS-CoV-2 infection, 8•6% (38/442) of patients presented with shortness of breath, 12•4% (55/442) with anosmia, 11•1% (49/442) with ageusia and 9•7% (43/442) with fatigue. At least one of these characteristic symptoms was present in 27•8% (123/442) and 34•8% (123/353) at month 4 and 7 post-infection, respectively. A lower baseline level of SARS-CoV-2 IgG, anosmia and diarrhoea during acute COVID-19 were associated with higher risk to develop long-term symptoms. Interpretation The on-going presence of either shortness of breath, anosmia, ageusia or fatigue as long-lasting symptoms even in non-hospitalised patients was observed at four and seven months post-infection and summarised as post-COVID syndrome (PCS). The continued assessment of patients with PCS will become a major task to define and mitigate the socioeconomic and medical long-term effects of COVID-19. Funding COVIM:„NaFoUniMedCovid19"(FKZ: 01KX2021)

Smell disorders persist in about half of the patients with other symptoms of COVID-19 disease, but the exact duration of the symptoms is yet unknown. Especially, only a few studies used validated olfactory tests for this.The aim of this study was to investigate how many patients with olfactory function impairment, which was detected in a validated olfactory test 3 months after COVID-19 disease, showed improvement in olfactory function after 6 months.About 26 patients with a PCR-confirmed, former COVID-19 disease, with an impaired olfactory function after three months, were included in the study. The olfactory function was evaluated with the sniffing sticks test, the taste function with taste sprays.Smelling function improved in all but one patient (96%). All measured subitems, i.e. olfactory threshold, identification and discrimination of odours significantly improved. In the whole mouth taste test all patients showed normal taste function.6 months after COVID-19 disease, olfactory function improves in just about all patients. Long-term measurements must investigate whether complete regeneration of the olfactory function will occur in all patients.

BackgroundWhile the leading symptoms during coronavirus disease 2019 (COVID-19) are acute and the majority of patients fully recover, a significant fraction of patients now increasingly experience long-term health consequences. However, most data available focus on health-related events after severe infection and hospitalization. We present a longitudinal, prospective analysis of health consequences in patients who initially presented with no or minor symptoms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. Hence we focus on mild COVID-19 in non-hospitalized patients.MethodsWe included 958 patients with confirmed SARS-CoV-2 infection in this study. Patients were observed for seven months from April 6thto December 2nd2020 for long-term symptoms and SARS-CoV-2 antibodies. We identified anosmia, ageusia, fatigue or shortness of breath as most common, persisting symptoms at month 4 and 7 and summarized presence of such long-term health consequences as post-COVID syndrome (PCS). Predictors of long-term symptoms were assessed using an uni- and multivariable logistic regression model.FindingsWe observed 442 and 353 patients over four and seven months after symptom onset, respectively. Four months post SARS-CoV-2 infection, 8.6% (38/442) of patients presented with shortness of breath, 12.4% (55/442) with anosmia, 11.1% (49/442) with ageusia and 9.7% (43/442) with fatigue. At least one of these characteristic symptoms was present in 27.8% (123/442) and 34.8% (123/353) at month 4 and 7 post-infection, respectively. This corresponds to 12.8% patients with long-lasting symptoms relative to the initial total cohort (123/958). A lower baseline level of SARS-CoV-2 IgG, anosmia and diarrhea during acute COVID-19 were associated with higher risk to develop long-term symptoms.InterpretationThe on-going presence of either shortness of breath, anosmia, ageusia or fatigue as long-lasting symptoms even in non-hospitalized patients was observed at four and seven months post-infection and summarized as post-COVID syndrome (PCS). The continued assessment of patients with PCS will become a major task to define and mitigate the socioeconomic and medical long-term effects of COVID-19.FundingCOVIM:„NaFoUniMedCovid19”(FKZ: 01KX2021)Research in contextEvidence before this studyData about long-term health consequences after SARS-CoV-2 infection and COVID-19 is scarce and most available data describe health consequences in hospitalized patients during acute COVID-19. However, these studies do not take into account the vast majority of patients with a milder course of infection (WHO score1-3).Added value of this studyOur cohort consists of mostly mild COVID-19 cases that have been prospectively followed for a median time of 6.8 months. At least one trained physician critically reviewed the patients’ reported symptoms at each visit. We assessed SARS-CoV-2 IgG at each visit to correlate reported symptoms with serological data. At 4 months after SARS-CoV-2 infection, shortness of breath occurred in 8.6% (38/442), anosmia in 12.4% (55/442), ageusia in 11.1% (49/442), and fatigue in 9.7% (43/442) of patients. At least one characteristic symptom was present in 27.8% (123/442) and 34.8% (123/353) at months 4 and 7 post-infection, respectively. Symptoms were summarized as post-COVID syndrome (PCS). Relative to our initial total cohort (123/958), this corresponds to 12.8% patients with long-lasting symptoms. Lower baseline level of SARS-CoV-2 IgG, anosmia and diarrhea during acute COVID-19 were associated with higher risk of developing long-term symptoms.Implications of all available evidenceWe believe that our findings have important implications for the fields of infectious diseases and public health, because we show long-term health consequences may occur even after very mild COVID-19 in the outpatient setting. As up to 81% of all SARS-CoV-2 infected patients present with mild disease, it can be expected that PCS will affect a larger number of individuals than initially assumed, posing major medical, social and economic challenges.

Complications after cochlear implantation are relatively rare but patients are asked to follow certain behavioral rules. Until now there is no evidence if pressure changes that occur during flying and diving are safe for patients after cochlear implantation. For example, no recommendation exists for SCUBA- diving activities. In a hypo-/hyperbaric pressure chamber patients after cochlear implantation were exposed to a standardized profile of decompression and compression simulating a flight in a common airplane and a dive. Pre and after the exposure in the pressure chamber, ENT examination and a control of impedances of the cochlear implant were performed. Additionally, patients filled in a questionnaire about complaints they had experienced in the pressure chamber or after. A total of 11 subjects (17 ears with CI) were examined in the pressure chamber. 2/3 of the subjects stated that they had slight complaints during the examination. Only in one patient the measurement needed to be stopped due to pain. Seven patients showed a vascular injection of the malleus in ear microscopy. In none of the patients there was a subjective change in hearing after the examination. Objective measurements of the impedance did not show relevant changes. The exposure of cochlear implanted patients to overpressure and underpressure in a pressure chamber did not result in any significant deviation of the impedances, so that no further adjustment was necessary. Since there are no certified in vivo studies on pressure changes while diving and flying with a cochlear implant, further studies are required in order to be able to adequately advise CI patients about diving and flying. Verglichen mit dem Zugewinn an Lebensqualität, den viele Patienten durch ein Cochlea-Implantat (CI) erfahren, bringt das CI nur wenige Einschränkungen im täglichen Leben mit sich. Doch kann man mit einem CI auch Tauchen und Fliegen? Halten das operierte Ohr sowie das Implantat selbst den ausgeprägten Druckveränderungen stand? Bisher gibt es keine klaren Empfehlungen und sehr wenig Literatur über die Risiken des Gerätetauchens sowie des Fliegens mit CI. In einer hypo-/hyperbaren Druckkammer wurden Menschen mit einem CI einem Druckprofil mit Phasen des Druckanstiegs sowie Phasen des Druckabfalls ausgesetzt, sodass zunächst ein Flug und dann ein Tauchgang simuliert wurden. Sowohl vor als auch nach der Druckkammermessung erfolgten eine Ohrmikroskopie sowie eine Messung der Impedanzen des Cochlea-Implantats. Zusätzlich füllte jeder Patient einen symptombezogenen Fragebogen vor sowie nach der Druckkammermessung aus. In der Druckkammer wurden insgesamt 17 CI-implantierte Ohren bei 11 Probanden untersucht. Zwei Drittel der Probanden gaben an, während der Untersuchung leichte Beschwerden gehabt zu haben. Bei einem Probanden musste die Messung aufgrund von Schmerzen abgebrochen werden. Sieben Patienten zeigten im Anschluss an die Druckexposition eine Hammergefäßinjektion in der Ohrmikroskopie. Bei keinem der Patienten kam es nach der Untersuchung zu einer subjektiven Hörverschlechterung. Es kam zu keiner relevanten Änderung der Impedanzen des CI-Implantats. Die Exposition mit Unter- und Überdruck bei Patienten mit Cochlea-Implantaten ergab in der objektiven Überprüfung der Impedanzen keine wesentliche Abweichung der Impedanzen, sodass keine erneute Anpassung notwendig war. Allerdings zeigten sich leichtgradige Barotraumata sowie subjektive, leichte Beschwerden. Weitere Studien sind erforderlich, um eine adäquate Risikoeinschätzung zur Druckexposition bei CI-Trägern geben zu können.

Smell and taste disorders occur in COVID-19 with a high prevalence, but little is known about the duration of the symptoms. In particular, studies using validated olfactory tests are very rare to date.The aim of this study was to determine the olfactory function of COVID-19 recoveries by a detailed olfactory test.91 patients with PCR-confirmed, past COVID-19 disease were included. Olfactory history was taken using a questionnaire. Olfactory function was evaluated with the sniffin' sticks test, tasting function with taste sprays.80 patients had experienced sudden olfactory loss during the course of disease and at the time of testing, 33 patients subjectively still had an impaired olfactory sense. Around 8 weeks had passed since the onset of symptoms. 45.1% of the tested individuals were still hyposmic according to the olfactory test while 53.8% showed an olfactory performance within the normal range. Patients' self-assessment correlated poorly with the measured olfactory performance.Half of the patients with an olfactory loss as a symptom of COVID-19 still have olfactory impairments after two months, although not all of these patients subjectively notice a restriction. Long-term measurements must confirm whether all affected patients will make full recovery.

Early reports of SARS-CoV-2 infections only rarely mentioned smell and taste disorders. Several studies, particularly from Europe and the USA, have now confirmed these symptoms as an early key feature of COVID-19. About 70 % of patients seem to experience a reduction of smell and taste in the course of the disease, with most of the studies published to date based on questionnaires and anamnestic data. Validated smell tests have so far only been used in a few studies. A distinction between taste and taste disorders, i. e. a distinction between retronasal aroma taste and the olfactory system from the dysfunction of taste capsules and the further cranial nerves, was mostly not made in the studies available to date. Some reports associate olfactory disorders with a milder clinical course. At the same time, the olfactory system via the olfactory bulb represents an entry point into the central nervous system, and an olfactory disorder could be a predisposing factor for central neurological symptoms. The clinical significance of smell and taste disorders in COVID-19 patients is currently still unclear. Further open questions concern the exact prevalence and the prognosis, so that overall higher quality studies with validated smell tests and larger numbers of patients are required.Nachdem anfängliche Berichte über die SARS-CoV-2-Infektion Riech- und Schmeckstörungen kaum erwähnten, haben mittlerweile mehrere Studien, insbesondere aus Europa und den USA, diese Symptome als Merkmal von COVID-19 bestätigt. Gut 2 Drittel der Erkrankten scheinen im Verlauf der Erkrankung eine Riech- und Schmeckminderung zu erleiden, wobei die meisten der bislang veröffentlichten Studien auf Fragebögen und anamnestischen Daten basieren. Validierte Riechtests wurden bislang nur in wenigen Studien eingesetzt. Eine Unterscheidung zwischen Schmeck- und Geschmacksstörungen, also eine Abgrenzung des retronasalen Aromaschmeckens über das olfaktorische System von der Dysfunktion von Geschmackspapillen und der weiterführenden Hirnnerven, erfolgte in den bisher verfügbaren Studien zumeist nicht. Einige Berichte assoziieren die Riechstörungen mit einem milderen klinischen Krankheitsverlauf. Gleichzeitig stellt das Riechsystem über den Bulbus olfactorius eine Eintrittspforte in das zentrale Nervensystem dar, und eine Riechstörung könnte ein prädisponierender Faktor für zentral-neurologische Symptome sein. Die klinische Bedeutung von Riech- und Schmeckstörungen bei COVID-19-Patienten ist aktuell noch unklar. Weitere offene Fragen betreffen die genaue Prävalenz und die Prognose, sodass insgesamt höherwertige Studien mit validierten Riechtests und größeren Patientenzahlen zu fordern sind.

ZusammenfassungNachdem anfängliche Berichte über die SARS-CoV-2-Infektion Riech- und Schmeckstörungen kaum erwähnten, haben mittlerweile mehrere Studien, insbesondere aus Europa und den USA, diese Symptome als Merkmal von COVID-19 bestätigt. Gut 2 Drittel der Erkrankten scheinen im Verlauf der Erkrankung eine Riech- und Schmeckminderung zu erleiden, wobei die meisten der bislang veröffentlichten Studien auf Fragebögen und anamnestischen Daten basieren. Validierte Riechtests wurden bislang nur in wenigen Studien eingesetzt. Eine Unterscheidung zwischen Schmeck- und Geschmacksstörungen, also eine Abgrenzung des retronasalen Aromaschmeckens über das olfaktorische System von der Dysfunktion von Geschmackspapillen und der weiterführenden Hirnnerven, erfolgte in den bisher verfügbaren Studien zumeist nicht. Einige Berichte assoziieren die Riechstörungen mit einem milderen klinischen Krankheitsverlauf. Gleichzeitig stellt das Riechsystem über den Bulbus olfactorius eine Eintrittspforte in das zentrale Nervensystem dar, und eine Riechstörung könnte ein prädisponierender Faktor für zentral-neurologische Symptome sein. Die klinische Bedeutung von Riech- und Schmeckstörungen bei COVID-19-Patienten ist aktuell noch unklar. Weitere offene Fragen betreffen die genaue Prävalenz und die Prognose, sodass insgesamt höherwertige Studien mit validierten Riechtests und größeren Patientenzahlen zu fordern sind.

Objectives To describe the long-term results of the titanium angular clip prosthesis 10 years after its initial description. Study design Clinical retrospective study. Setting Tertiary referral center. Patients Sixty three patients with isolated defects of the long process of the incus where the ossicular chain was reconstructed by a titanium angular clip prosthesis. Interventions Therapeutic. Main outcome measures The mean air-bone gap was calculated over the frequencies of 0.5, 1, 2, 3, and 4 kHz. Results The placement of the prosthesis was straightforward in all patients, without any complication. During the first follow-up visit after 3 weeks (n = 61) the mean air-bone gap (ABG) was reduced by 10 dB HL, and from 24 dB HL preoperatively to 14 dB HL. At the long-term follow-up appointment-4 years after implantation (n = 29)-the mean ABG was still reduced by 8 dB HL, from a mean of 26 dB HL preoperatively to 18 dB HL. Conclusion The use of the titanium angular clip prosthesis is a safe and reliable way to bridge an isolated erosion of the long process of the incus, leading to significant and long-lasting improvement of the ABG both in the short and long-term follow-up. A similarly large improvement of the sound transmission can be achieved both in patients with a Type A and a Type B/C tympanogram.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly worldwide. Given scarce resources, nonlaboratory diagnostics are crucial. In this cross-sectional study, two-thirds of European patients with confirmed COVID-19 reported olfactory and gustatory dysfunction, indicating the significance of these symptoms in early diagnostics.

To assess data regarding round window (RW) visibility and surgical approaches in cochlear implant cases, and to describe and analyze surgical steps relevant for the RW approach in cochlear implantation. Prospective clinical study. A questionnaire was completed by surgeons after each of altogether 110 cochlear implantations. Round window membrane (RWM) visibility was graded according to the St Thomas Hospital (STH) classification. Performing different surgical steps during the preparation of the RW niche, the RWM could be fully exposed (STH Type I) in 87%. A RW approach could be used for electrode insertion in 89% of the adult and 78% of the pediatric cases. The distribution of RW types differed significantly between adults and children. Drilling of the superior bony lip was the surgical step most frequently needed in adult as well as pediatric cases to obtain optimal RW exposure. In children, optimized surgical exposure of the RW niche resulted in only 52% full RWM visibility; whereas in adults, this could be achieved in 87%. The facial nerve (FN) had to be exposed at the level of the posterior tympanotomy in more than 70% of pediatric cases with full RWM visibility; while in adult cases with 100% visibility, such specific exposure was necessary in only 33%. Thus, surgical preparation of the RW niche seems to be more demanding in children than in adults.

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.

Objective: Analysis of the audiometric results after repair of a defective footplate with the sandwich cartilage shoe technique in a follow-up study. Study Design: Retrospective analysis of audiometric data. Setting: Hospital. Patients: The cohort consisted of 12 patients, who underwent ossicular reconstruction after sandwich cartilage shoe technique in a case of insecure stapes footplate. The mean age was 42.7 years with an equal sex distribution. In every patient, cholesteatoma was the reason for surgery with 75% being revision cases. Intervention: Sandwich cartilage shoe technique in case of insecure stapes footplate at the department of otorhinolaryngology, head and neck surgery at the University of Cologne over an 8-year period (2007-2015). Main Outcome Measure: The use of the sandwich cartilage shoe technique in case of a broken or unstable footplate allows a safe occlusion of the open vestibule. Results: The statistical analysis revealed a significant improvement of the pure-tone average (p = 0.011) and air-bone gap (ABG) (p = 0.016) after total ossicular replacement prosthesis (TORP) implantation. The hearing was stable at 9 months of follow up. Conclusion: The sandwich cartilage shoe technique offers a safe and effective option as a two-stage procedure in treating patients with fractures of the stapes footplate in case of chronic otitis media. In view of the possible risk of deafness going along with a destruction of an inner ear window, our results can be considered substantial as all our patients will at least be able to regain social hearing as they all either achieved a hearing threshold is less than 30 dB or can be sufficiently supplied with a conventional hearing aid.

The surgical treatment of acquired post-inflammatory atresia of the external auditory canal (EAC) is challenging. Based on the long-term surgical experience, a modified split skin graft technique has been established at our clinic.The aim was to evaluate the clinical and audiological data and patient satisfaction after performing meatoplasty.In total, 16 patients were included who underwent intraoperative enlargement of the bony EAC, resection of the fibrotic scar tissue, reconstruction with split skin grafts and splinting of the anterior tympanomeatal angle in the period of 2004-2016. Patients presented at a long-term follow-up appointment for reevaluation.The mean follow-up time was 52 months after surgery. The pure-tone average (52 dB vs. 31 dB) and the air-bone gap (27 dB vs. 11 dB) decreased significantly compared to the preoperative status. The grade of stenosis also showed a significant improvement during the follow-up visit. Complete re-atresia was observed only in two patients (10.5%).The applied surgical technique is a safe and successful treatment option for acquired atresia of the EAC.The study provides important data for the surgical treatment of acquired atresia of the EAC and corroborates the significance of intensive aftercare.

Aims: The aim of the study was to evaluate different irrigation solutions during sialendoscopy to reduce complaints caused by sialodochitis. Methods: The investigators designed and implemented a retrospective study composed of 94 patients with sialodochitis but no sialolithiasis or relevant stenosis of the salivary duct system. Three different irrigations (normal saline, cortisone single-shot, and cortisone) were used. After the sialendoscopy, the patients were asked about the current status of the affected salivary gland, and the quantity and quality of the gland swelling/inflammation over a follow-up period of 11.6 months (6–24 months). Results: At the time of follow-up, 41 patients (43.6%) no longer had any complaints with the salivary gland in question. In 75.5% of the patients, a satisfying result was achieved. In total, only 3 patients needed submandibulectomy in the course of the study due to persistent complaints. The outcome showed no statistical differences between the mean of the 3 groups (p = 0.149). Conclusion: Sialendoscopy with flushing/lavage seems to be a good treatment option for patients with sialodochitis lacking sialolithiasis. The results of this study suggest that the type of irrigation used during sialendoscopy seems to be secondary.

The opening of the round window and the insertion of the electrode array into the scala tympani during cochlear implant surgery can lead to a pressure shock of the delicate inner ear structures. By filling the tympanic cavity with Ringer Solution during these surgical steps (underwater technique), the hydrostatic pressure of the fluid acts as a smooth pressure stabilizer, avoiding a pressure shock of the inner ear structures. The aim of this retrospective study was to present long-term results of this new method of cochlear implantation in underwater technique. Altogether, 47 implantations in 43 patients with residual hearing at the frequencies 250, 500 and 1000 Hz in the unaided preoperative pure tone audiometry were included. A cochlear implantation via round window with a conventional full-length electrode was performed in underwater technique. Changes of residual hearing 7 weeks and 24 months after surgery were analyzed. Overall postimplant hearing preservation 7 weeks after implantation was achieved in 22 ears (47%). Subsequent follow-up was performed on average 24 months after surgery (range 12 months–4.2 years) in all patients. At this late postoperative evaluation, preservation of hearing was recorded in 18 ears (38%). Neither the follow-up time nor the type of electrode had a significant impact on the postoperative hearing loss. The underwater technique is an atraumatic cochlear implantation technique with hearing preservation rates comparable to results in literature and a very small hearing preservation decline rate over time even when using full-length CI electrodes.

The aim of this retrospective study was to evaluate the effect of sealing of the round window membrane in patients with severe to profound unilateral sudden sensorineural hearing loss (SSNHL). 101 Patients with unilateral SSNHL were treated with tympanotomy and sealing of the round window membrane if hearing did not improve after conservative treatment. Preoperative and postoperative pure tone audiograms after removal of the ear packing were evaluated. A 4-PTA (pure tone audiometry) was used as reference value. The improvement of 4-PTA was analysed; in addition, recovery was evaluated using Siegel’s criteria. Mean initial hearing threshold was 101.1 dB. Eighty-one patients had a hearing threshold of 80 dB or more. The average improvement at the time of ear packing was 21.7 dB and a further average recovery of 13.4 dB was recorded in the follow-up. Patients who underwent rapid tympanotomy within 5 days showed a significantly better hearing improvement than patients with delayed tympanotomy (26.9 vs. 14.0 dB, p < 0.02). Age was significantly correlated with the degree of hearing improvement. There was no significant difference of recovery between patients with detected lesions of the round window membrane and those without. Concomitant vertigo and tinnitus showed no significant effect on recovery. Tympanotomy and sealing of the round window membrane is effective in the treatment of severe to profound SSNHL. There is evidence that early surgery performed within 5 days is more effective than later surgery. The existence of a detectable lesion of the round window membrane has no significant influence on recovery.

To summarize new application methods of an active middle ear implant (Vibrant Soundbridge) in patients with conductive or mixed hearing loss.Publications listed in the Medline/PubMed database.All publications published in English language; search term Vibrant Soundbridge AND floating mass transducer in all fields.Structured analysis of all publications.Extraction of significant findings and conclusions and audiometric data.Modern application methods of an active middle ear implant (VSB) open new therapeutic options for patients with various outer and middle ear diseases resulting in conductive or mixed hearing loss. Titanium couplers can help to couple the active middle ear implant in a standardized way to remnants of the ossicular chain or to the round window. Thus, the active middle ear implant has been established as an alternative treatment option for patients with mixed and conductive hearing. However, the heterogeneity of the studies published so far complicates the analysis of the audiometric results, and thus, the functional hearing gain after VSB implantation varies a lot.

Objectives/Hypothesis The hypoglossal-facial-anastomosis is the most often applied procedure for the reanimation of a long lasting peripheral facial nerve paralysis. The use of an interposition graft and its end-to-side anastomosis to the hypoglossal nerve allows the preservation of the tongue function and also requires two anastomosis sites and a free second donor nerve. We describe the modified technique of the hypoglossal-facial-jump-anastomosis without an interposition and present the first results. Study Design Retrospective case study. Methods We performed the facial nerve reconstruction in five patients. The indication for the surgery was a long-standing facial paralysis with preserved portion distal to geniculate ganglion, absent voluntary activity in the needle facial electromyography, and an intact bilateral hypoglossal nerve. Following mastoidectomy, the facial nerve was mobilized in the fallopian canal down to its bifurcation in the parotid gland and cut in its tympanic portion distal to the lesion. Then, a tensionless end-to-side suture to the hypoglossal nerve was performed. The facial function was monitored up to 16 months postoperatively. Results The reconstruction technique succeeded in all patients: The facial function improved within the average time period of 10 months to the House-Brackmann score 3. Conclusion This modified technique of the hypoglossal-facial reanimation is a valid method with good clinical results, especially in cases of a preserved intramastoidal facial nerve. Level of Evidence Level 4. Laryngoscope, 123:2392–2396, 2013

Urbach-Wiethe disease (lipoid proteinosis) is an autosomal recessive disorder that is characterized by a general thickening of the skin and mucous membranes. We report the case of a 22-year-old woman with lipoid proteinosis who presented with hoarseness, poor dentition, and skin lesions, and we discuss the management of this rare disease.

The Eustachian tube (ET) is the key to pressure equalization between the middle ear and ambient pressure. To date, little is known about differences of the opening mechanisms under hyper- or hypobaric conditions. Aim of this study was to compare standard ET opening parameters during standardized hypo- and hyperbaric exposures.Thirty healthy participants were exposed to a standardized profile of decompression and compression (SPDC) in a hypo-/hyperbaric pressure chamber. Impedance, expressed as tympanic membrane compliance, was recorded at intervals during the excursions from 1 atmosphere absolute (atm abs) to 0.8 and 1.2 atm abs respectively. Parameters for tubal opening were obtained during SPDC: ET opening pressure (ETOP), ET opening duration (ETOD) and ET opening frequency (ETOF), hypobaric (Phase 1) and hyperbaric (Phase 2) data were compared.Mean value for Valsalva maneuver ETOP was 40.10 ± 19.02 mbar in Phase 2 vs. 42.82 ± 21.75 mbar in Phase 1. For ETOD it was 2.80 ± 2.09 seconds in Phase 2 vs. 2.51 ± 1.90 seconds in Phase 1. For swallowing, mean value for ETOP was 33.47 ± 14.50 mbar in Phase 2 vs. 28.44 ± 14.04 in Phase 1. ETOD was 0.82 ± 0.60 seconds in Phase 2 vs. 0.76 ± 0.55 seconds in Phase 1. There was no statistical significance for ETOP, ETOD and ETOF between the two phases.No statistical significant difference was evident for active pressure equalization (Valsalva and swallowing) between a hyperbaric setting (dive) and a hypobaric setting (flight) in healthy subjects.

Objectives: We sought to investigate patients' tolerance of sialendoscopy of the parotid and submandibular glands with local anesthesia. Methods: In a retrospective case series of 84 adult patients who underwent sialendoscopy with local anesthesia at an academic tertiary referral hospital, we analyzed patients' demographic data, American Society of Anesthesiologists (ASA) status score, perioperative cardiovascular parameters, and results on a 2-question survey. Results: Of the 84 patients, 44 were female and 40 were male (mean age, 48.6 years). The patients had a mean ASA status score of 1.57. On average, 2.16 mL of local anesthetic was used. The mean systolic blood pressure was 137 mm Hg, and the mean diastolic blood pressure was 80 mm Hg. The duration of the procedure showed a significant correlation with the maximum systolic blood pressure (r = 0.35; p = 0.001), the mean systolic blood pressure (r = 0.25; p = 0.02), the maximum diastolic blood pressure (r = 0.37; p = 0.001), and the mean diastolic blood pressure (r = 0.31; p = 0.005). The mean heart rate was 77 beats per minute. The majority of patients considered the procedure to be tolerable. In this series, the indications for conducting sialendoscopy under general anesthesia were procedures of greater invasiveness and complex situations with multiple sialolithiases, difficult anatomic preconditions, or a very long expected operation time. Conclusions: Sialendoscopy performed with local anesthesia is well tolerated, provided that the patient has a good general health status and the operative procedure is not expected to be complex or long-lasting.

Lymph node metastasis is one of the most important factors in therapy and prognosis for patients with parotid gland cancer. Nevertheless, the extent of the primary tumor resection and the necessity of a neck dissection still is a common issue. Since little is known about lymph node metastasis in early-stage parotid gland cancer, the purpose of the present study was to evaluate the occurrence of lymph node metastases in T1 and T2 carcinomas and its impact on local control and survival. We retrospectively analyzed 70 patients with early-stage (T1 and T2) primary parotid gland cancer. All patients were treated with parotidectomy and an ipsilateral neck dissection from 1987 to 2009. Clinicopathological and survival parameters were calculated. The median follow-up time was 51.7 months. A positive pathological lymph node stage (pN+) was found in 21.4% of patients with a significant correlation to the clinical lymph node stage (cN) (p = 0.061). There were no differences in the clinical and histopathological data between pN- and pN+ patients. In 73.3% of pN+ patients, the metastases were located intraparotideal. The incidence of occult metastases (pN+/cN-) was 17.2%. Of all patients with occult metastases, 30.0% had extraparotideal lymphatic spread. A positive lymph node stage significantly indicated a poorer 5-year overall as well as 5-year disease-free survival rate compared to pN- patients (p = 0.048; p = 0.011). We propose total parotidectomy in combination with at least a level II-III selective neck dissection in any case of early-stage parotid gland cancer.

To describe an active auditory rehabilitation method (clip vibroplasty) for conductive or mixed hearing loss in cases of a preserved stapes superstructure.After temporal bone experiments, the new clip vibroplasty was clinically used in 4 patients with chronic otitis media.A new titanium double clip device (clip vibroplasty) was developed for a standardized and effective coupling of the floating mass transducer of the Vibrant Soundbridge to the intact stapes. Temporal bone experiments using laser Doppler vibrometry were performed to evaluate the device's acoustic efficiency. The audiologic outcomes of the first 4 patients were analyzed. The subjective benefits and satisfaction were assessed using the standardized International Outcome Inventory for Hearing Aids in all patients.Transfer characteristics of laser Doppler vibrometry experiments; audiologic outcomes of the 4 patients.In the temporal bone experiment, coupling of the FMT using the titanium double clip support produced transfer characteristics across all tested frequencies comparable to our former total ossicular reconstruction prosthesis or an optimal round window application. The intraoperative application of the clip vibroplasty was uneventful in all cases. No signs of prosthesis dislocation were noted within the follow-up period of approximately 12 months. The audiologic outcome of the first patients showed good hearing gain in pure-tone and speech audiometry, with results that are unobtainable using a conventional air conduction hearing aid.The concept of a partial ossicular reconstruction prosthesis vibroplasty using a titanium clip support entails a straightforward procedure similar to a classic partial ossicular reconstruction prosthesis tympanoplasty. The unoccluded ear canal and the superior auditory performance offer an advantageous application of this "power clip" in cases of chronic middle ear dysfunction.

Background The objective of this study was to investigate whether patients with a short-term and long-term disease course of sialolithiasis show differences in the clinical picture and the outcome after sialendoscopy. Methods We retrospectively analyzed the findings and clinical courses of 62 consecutive patients who received sialendoscopy for sialolithiasis. Results In 30 patients stones could be removed by pure endoscopic means. Stone size and stone mobility were significant predictors and the duration of symptoms was a marginally significant predictor for the endoscopic removability of stones. Patients with a good outcome had a significant shorter duration of symptoms than patients with a worse outcome. Conclusions The results of our study indicate an association between the duration of symptoms and the outcome after sialendoscopy for sialolithiasis. Early sialendoscopic treatment indicates a favorable outcome and is recommended for sialolithiasis after failure of conservative treatment. © 2011 Wiley Periodicals, Inc. Head Neck, 2012.

To describe a new titanium angular clip prosthesis for bridging the incudostapedial joint in the event of an isolated lesion of the distal end of the long process of the incus.Clinical retrospective study.We retrospectively reviewed the course of 22 patients with isolated defects of the long process of the incus where the ossicular chain was reconstructed by a titanium angular clip prosthesis.The placement of the prosthesis was successful in all patients, and no complication was encountered during its installation. At the first follow-up visit after 3 weeks, the mean air-bone gap (ABG) was reduced by around 10 dB from a mean of 26 dB preoperatively to 16 dB postoperatively. The mean postoperative hearing result of patients with a Type A tympanogram (7-dB ABG) was consistently better than for patients with a Type B or a Type C tympanogram (19-dB ABG in both).Despite the limited number of patients, this preliminary study demonstrates the effectiveness of the angular clip prosthesis in reconstructing the ossicular chain. In cases of a normal aeration of the tympanic cavity, this reliable reconstruction of the biological chain offers a near-to-normal hearing restoration.

Middle ear surgery is strongly influenced by anatomical and functional characteristics of the middle ear. The complex anatomy means a challenge for the otosurgeon who moves between preservation or improvement of highly important functions (hearing, balance, facial motion) and eradication of diseases. Of these, perforations of the tympanic membrane, chronic otitis media, tympanosclerosis and cholesteatoma are encountered most often in clinical practice. Modern techniques for reconstruction of the ossicular chain aim for best possible hearing improvement using delicate alloplastic titanium prostheses, but a number of prosthesis-unrelated factors work against this intent. Surgery is always individualized to the case and there is no one-fits-all strategy. Above all, both middle ear diseases and surgery can be associated with a number of complications; the most important ones being hearing deterioration or deafness, dizziness, facial palsy and life-threatening intracranial complications. To minimize risks, a solid knowledge of and respect for neurootologic structures is essential for an otosurgeon who must train him- or herself intensively on temporal bones before performing surgery on a patient.

Conclusion: Salivary stones in the parotid gland that are not amenable to endoscopic extraction can safely be removed by a combined, endoscopic-external approach. Objective: Limitations for endoscopic removability of salivary stones from the parotid gland are immobile stones in the deeper salivary duct system. A combined endoscopic and transcutaneous approach gives access to these stones with possible preservation of the parotid gland. Methods: A total of 10 consecutive patients were treated using the combined approach for the management of sialolithiasis of the parotid gland. The patients had previously undergone a sialendoscopy under local anesthesia and were proven to have large, immobile salivary stones in the salivary duct. Results: In all patients, the procedure was successfully conducted with extraction of impacted stones. In 60% of the patients, a temporary stenting of the salivary duct was performed. All patients showed good clinical results with restored drainage of the salivary duct sys...

OBJECTIVE Active and passive opening of the Eustachian tube (ET) enables direct aeration of the middle ear and a pressure balance between middle ear and the ambient pressure. The aim of this study was to characterize standard values for the opening pressure (ETOP), the opening frequency (ETOF), and the opening duration (ETOD) for active tubal openings (Valsalva maneuver, swallowing) in healthy participants. DESIGN/PARTICIPANTS In a hypobaric/hyperbaric pressure chamber, 30 healthy participants (19 women, 11 men; mean age, 25.57 ± 3.33 years) were exposed to a standardized profile of compression and decompression. The pressure values were recorded via continuous impedance measurement during the Valsalva maneuver and swallowing. Based on the data, standard curves were identified and the ETOP, ETOD, and ETOF were determined. RESULTS Recurring patterns of the pressure curve during active tube opening for the Valsalva maneuver and for active swallowing were characterized. The mean value for the Valsalva maneuver for ETOP was 41.21 ± 17.38 mbar; for the ETOD, it was 2.65 ± 1.87 seconds. In the active pressure compensation by swallowing, the mean value for the ETOP was 29.91 ± 13.07 mbar; and for the ETOD, it was 0.82 ± 0.53 seconds. CONCLUSION Standard values for the opening pressure of the tube and the tube opening duration for active tubal openings (Valsalva maneuver, swallowing) were described, and typical curve gradients for healthy subjects could be shown. This is another step toward analyzing the function of the tube in compression and decompression.

If people lose a sense organ, there is thought to be an increase in the remaining sensory functions. Previous studies showed ambiguous results on this topic. In a prospective matched pair case-control study on 46 blind and 46 normal-sighted subjects, the olfactory performance was examined using the Sniffin’ Sticks Test [threshold-discrimination-identification (TDI) test], determining the olfactory threshold, the identification and the discrimination performance. There was no significant difference between the groups. Neither the overall olfactory performance (TDI score) nor any of its subtests did correlate with the vision or with the duration of blindness. The study could not detect any superior smell abilities of blind subjects as compared to sighted subjects.

Objective Intraductal laser lithotripsy is a preferred method to fragment large, immobile intraglandular salivary stones. A number of different laser systems has been investigated for this purpose. It was our aim to study the effectiveness of a 980 nm diode laser when fragmenting salivary stones in an experimental set up. Methods In an experimental set up we used a 980 nm diode laser for the lithotripsy of 9 salivary stones. The temperature circle around the laser fibre tip was measured and stone remnants were chemically analysed for their composition. Results The salivary stones had a mean diameter of 6.7 mm × 5.6 mm × 3.0 mm. Laser fragmentation with the diode laser was successful at all stones. The temperature next to the salivary stone increased to around 30 °C during the active lithotripsy with continuous rinsing (fluid temperature 21 °C). At a distance of 2 mm the temperature around the laser fibre's tip is reduced by already about 50%. The salivary stones mainly consisted of carbonate apatite, followed by β-calcium phosphate and other calcium phosphates. Conclusion The fragmentation of salivary stones with a 980 nm diode laser is possible in principle. Under a continuous irrigation with a positioning of the laser fibre's tip at the centre of the stone, no relevant temperature increase in the vicinity of the stone occurs. However, before the laser is used in humans, in vivo experiments on animal material seem to be advisable.

Background. The aim of our study was to evaluate the effects of neoadjuvant platinum-based radiochemotherapy (RCT) in patients with maxillary sinus squamous cell carcinoma and to compare the results with other multimodality treatment concepts for advanced-stage maxillary sinus carcinoma in the literature. Methods. In total, 53 patients with squamous cell carcinoma of the maxillary sinus were reviewed retrospectively. All patients received a neoadjuvant RCT containing either cisplatin or carboplatin followed by radical surgery. Overall survival and locoregional control were plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. Results. Five-year overall survival for all patients was 35%. Eleven patients achieved a complete response after radiochemotherapy. The complete response rate was significantly higher for patients treated with cisplatin (P=0.028); however the 5-year overall survival rates did not differ significantly (P=0.673) for patients treated with cisplatin (37%) and carboplatin (32%). Orbital invasion (P=0.005) and complete response to radiochemotherapy (P=0.021) had a significant impact on overall survival in univariate analysis. Conclusions. Neoadjuvant radiochemotherapy followed by radical surgery is an effective treatment for patients with advanced maxillary sinus squamous cell carcinoma. In terms of treatment response cisplatin seems to be more effective than carboplatin.

The objective of this study was to evaluate retrospectively the risk of cochlear implant migration and complications related to the here presented alternative surgical fixation technique of the receiver/stimulator without any foreign body materials. Fixation of the implant was achieved by an "L-shaped" muscle-periosteal flap and an exactly shaped bony well. Between January 2006 and December 2009, 247 consecutive primary cochlear implantations have been performed with the described technique in the Department of Otorhinolaryngology, Head and Neck surgery of the University of Cologne (tertiary referral center). Devices from different manufacturers have been implanted. Implantation age ranged from 6 months to 78 years (mean age: 24.50 years). Follow-up time ranged from 12 to 60 months. Neither implant dislocations nor migrations were observed in our patients. In four very young children (1.6 %), additional suture fixation of the implant was performed. Postoperative complications, i.e. seroma or hematoma were observed in a total of six cases (2.4 %). The here presented surgical fixation technique is a sufficient and reliable way for fixation of cochlear implants independent of the device type.

Although cell proliferation is related to tumour aggressiveness and prognosis, there are few studies describing the expression of proliferative markers in salivary gland cancer. Our aim was to assess the long-term prognostic value of the proliferating cell nuclear antigen (PCNA) in a large group of histologically different salivary gland cancers. We analysed the expression of PCNA in 159 patients with parotid gland cancer by means of immunohistochemistry. The mean follow-up time was 56.6 months. A high expression of PCNA showed a significant correlation to the patients' pathological lymph node stage (p = 0.004). A high PCNA expression significantly indicated a poor 5-year disease-free (p = 0.046) and overall survival rate (p = 0.018). The PCNA expression was the only prognostic factor for a worse 5-year disease-free and overall survival in acinic cell carcinomas (p = 0.004, p = 0.022). The correlation between PCNA expression and survival probabilities of salivary gland cancer might make proliferation markers helpful tools in patient follow-up, prognosis and targeted therapy in salivary gland cancer in future.

Objective: To describe a new titanium clip prosthesis for partial ossicular reconstruction with a micro ball joint in the headplate for compensation of tympanic membrane displacements. Patients: Laboratory experiments followed by 18 consecutive patients. Interventions: A micro ball joint was implemented into a headplate of titanium middle ear prosthesis. First, the new prosthesis was tested in the laboratory in temporal bone experiments. Second, the new prosthesis was clinically installed in 18 patients. Outcome Measures: Results of laser Doppler vibrometry and force measurements in the laboratory experiments, analysis of a questionnaire, and preoperative and postoperative pure tone audiometry. Results: The frictional resistance in the joint was measured to be 12 mN that should allow for adequate mobility under physiologic conditions. The effective sound transmission of the prosthesis was demonstrated by laser Doppler vibrometry. Intraoperatively, the installation of the prosthesis was always straightforward with headplate prosthesis shaft angles between 60 and 90 degrees. Postoperatively, pure tone audiometry revealed satisfying hearing results with a remaining average air-bone gap of 18.2 dB over the frequencies 500, 1,000, 2,000, and 3,000 Hz. No signs of prosthesis dislocation were discovered within the follow-up period of approximately 6 months. Conclusion: The experimental data show that the new modified prosthesis headplate fulfills the requirements necessary for sound transmission. The joint allows the plate to follow movements of the tympanic membrane. This characteristic in conjunction with the proven clip design ensure for optimal prosthesis placement and effectiveness.

Background Cancer of the major salivary glands comprises a morphological diverse group of rare tumours of largely unknown cause. Survivin, an inhibitor of apoptosis has shown to be a significant prognostic indicator in various human cancers. The aim of this study was to assess the long-term prognostic value of survivin in a large group of histological different salivary gland cancers. Methods We analysed the survivin expression in 143 patients with parotid gland cancer by means of immunohistochemistry and tissue micro array. Survivin expression was categorised into a low and a high expressing group. The experimental findings were correlated with clinicopathological and survival parameters. The mean follow-up time was 54.8 months. Results A positive cytoplasmic expression of survivin was found in 61.5%, a high expression in 25.9% of all specimens. In the whole group, high cytoplasmic survivin expression significantly indicated a poor 5-year disease-free and overall survival rate ( p p =0.003). This applied for all adeno-, adenoid cystic and undifferentiated carcinomas whereas in mucoepidermoid carcinomas an analogical non-significant trend could be observed. A high cytoplasmic survivin expression significantly indicated a poor survival in high grade but not in low grade tumours. A multivariate analysis revealed that high cytoplasmic survivin expression was the only significant negative prognostic indicator for a poor 5-year disease-free survival rate in all patients ( p =0.042). Conclusion The correlation between cytoplasmic survivin expression and survival probabilities of salivary gland cancer might make this an effective tool in patient follow-up, prognosis and targeted therapy in future.

Objective To evaluate the influence of our technique of partial mastoid obliteration with autologous bone pâte covered by cartilage plates on vestibular stimulation. Methods Twenty-six patients who were treated for recurrent chronic otitis media by revision canal wall down tympanomastoidectomy and subsequent partial obliteration were invited for follow-up; 18 patients agreed to a complete follow-up including vestibular testing. Patients received questionnaires for evaluating preoperative and postoperative symptoms associated with vertigo. Examination comprised otomicroscopy, pure-tone audiometry, and caloric testing. Results Mean follow-up was 6 years. Before surgery, 54% of the patients reported vertigo on caloric stimuli such as wind, water, or suction cleaning of the tympanomastoid cavity. In all patients, these symptoms were suspended after partial mastoid obliteration. The postoperative obliterated cavity volume averaged 3.1 ml. All cavities after surgery appeared completely epithelialized and dry. The postoperative caloric vestibular tests revealed an average nystagmus count of 46 beats per minute compared with 72 beats before surgery. Thus, the partial mastoid cavity obliteration led to a mean nystagmus reduction of 36% in our study group. Conclusion Our technique of partially obliterating tympanomastoid cavities with autologous bone pâte being covered by cartilage plates results in small cavities with complete epithelialization of all surfaces. Furthermore, obliteration of mastoid cavities confers protection to the labyrinthine organ, thereby reducing postoperative vertigo on caloric stimulation.

Objective To assess the learning curve of sialendoscopy with modular endoscopes based on operative parameters and a postoperative performance rating. Design Prospective study, case series. Setting Tertiary referral hospital. Patients The study included 50 consecutive patients who underwent sialendoscopy by a single surgeon (J.C.L.) between September 2007 and March 2009 at University Hospital of Cologne, Cologne, Germany. The patients were chronologically arranged into 5 groups of 10 patients. Interventions Diagnostic and interventional sialendoscopy using local anesthesia. Main Outcome Measures Operative parameters and postoperative performance ratings. Results The average operative time was 39 minutes, with a ratio of diagnostic to interventional sialendoscopy of 62%:38%. There was a significant improvement in the average operative time ( P P = .007) after the first 10 patients and again after the first 30 patients ( P = .003 and P = .01, respectively). A continuous decrease in operation time was measurable up to the last patients. Performance ratings reached a level of excellence within the last group of patients. Conclusions The performance of sialendoscopy improves with time and experience. With endoscopes of a modular design, the surgeons have a remarkable learning curve. The surgeons' learning curve in this study required 30 cases to reach satisfactory operation times and performance ratings. Both parameters showed continuous improvement and a leveling off after 50 cases. Published online June 21, 2010 (doi:10.1001/archoto.2010.109).

Objective: To detect prognostic factors for successful sialoendoscopic removal of salivary stones. Design: Retrospective case series. Setting: Tertiary referral hospital. Patients: Forty-nine consecutive patients who underwent sialoendoscopy for sialolithiasis between January 1, 2008, and January 1, 2010, at University Hospital of Cologne, Cologne, Germany. Interventions: Diagnostic and interventional sialoendoscopy using local anesthesia. Main Outcome Measures: Stone removal rate, size, mobility, shape, and location, as well as clinical follow-up data. Results: Sixty-one percent (39 of 64) of all salivary stones were removed endoscopically. The cutoff point for endoscopic removal was between 5 and 6 mm in stone diameter. Small size, good mobility, round or oval, and distal location of a salivary stone were positive prognostic factors for sialoendoscopic removal, with sialolith mobility having the greatest effect in multivariate analysis. Conclusion: Small size, good mobility, round or oval, and distal location of a salivary stone in the main duct predict significantly greater probability of endoscopic removal and consequently are positive prognostic factors.