Search

Background: The macular hole (MH) is a disorder of the visual center of the retina in humans. An untreated MH leads to loss of central visual acuity and reading ability. Surgery for early-stage macular holes has been very successful for many years and leads to very good anatomical and functional results. Despite continuous improvement of surgical procedures, the outcome for the later stages of MH is still unsatisfactory., Method: In a retrospective analysis, we investigated the effect of autologous platelet concentrates in patients presenting later stages of MHs (stage III-IV) with respect to anatomic success (hole closure) and recovery of vision. The application of platelets was performed during retinal surgery (pars plana vitrectomy, ppV). In addition, selected platelet concentrates were qualitatively analysed for growth factors and platelet adhesion., Results: In the first group, 74% of the patients showed a good anatomical macular hole closure. The analyses of the platelet concentrates indicated a possible wound-healing effect due to growth factors (e.g. the platelet-derived growth factor, PDGF) and lesser to the ability of the platelets to adhere after ristocetin administration. Further optimization of the production process of platelet concentrates and of the surgical procedure in the second group of patients showed an increase of the anatomical success (92%) and a very rapid increase of visual acuity within six weeks., Discussion: In the past, the primary goal of MH surgery was to optimize the surgical procedures. Only few concepts focused on wound healing. Based on our data, we postulate the use of autologous platelet concentrates in MH surgery as a healing concept, which helps to increase the functional success of late-stage macular hole surgery.

Background: Donor vigilance is an important part of the quality management system of blood transfusion services. The evaluation of donor side effects helps to improve the donation process and donor compliance. The aim of the present study was to evaluate donor vigilance data in whole blood and plasmapheresis donors of a blood donor service., Materials and Methods: Donors fulfilling current national and European eligibility criteria underwent whole blood and plasmapheresis donation (PCS and MCS+ (Haemonetics, Braintree, USA), A 200 (Fenwal, Round Lake, USA). Whole blood was collected at fixed and mobile sites while plasmaphereses were performed at 8 plasma centers. From 2011 to 2013 donor information was provided for gender, age, body weight, height, first and repeat donation. Donors were monitored for venipuncture and circulatory associated side effects., Results: The total incidences of adverse events were 5004 (0.56%) in repeat donors and 2111 (2.78%) in first time donors for whole blood donation and 3323 (1.01%) and 514 (7.96%) for plasmaphereses, respectively. Circulatory associated events were 2679 (0.30%) for whole blood donation and 1624 (0.49%) for plasmaphereses., Conclusion: Our donor vigilance data of a blood transfusion service show that whole blood and plasmapheresis are safe with low incidences of adverse events. Repeat donation and age are predictors for low rates of adverse events. On the other hand, first time donation and female gender were associated with higher incidences of adverse events., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: When performing cochlear implant (CI) surgery in ears with residual hearing, cochlear function should be preserved as far as possible. Besides non-traumatic electrode insertion the acoustic-mechanical trauma of the cochleostomy should be minimized. According to experiences from temporal bone preparations the hypothesis that thorough exposition of the endosteal membrane with the drill prior to opening the cochlea might constitute a bigger acoustic mechanical trauma than direct drilling of the inner ear was examined. These experiments were performed in an animal model., Material and Method: In 12 guinea pigs the cochlear capsule was exposed by opening the bulla under general anesthesia. In 6 animals the fluid-filled cochlea was exposed by careful unilateral abrasion of the bone, whereas on the other ear cochleostomy was performed by direct penetration drilling into the perilymphatic spaces. Hearing tests were performed before and after drilling by measuring evoked brainstem potentials (brainstem electric response audiometry, BERA). In 8 other guinea pig ears abrasive exposition of the cochlea was performed again by only softly touching the otic capsule with the running burr for 10 s. After a hearing test the drilling maneuver was repeated 4 times collectively. Thereby the inner ear was gradually opened from the surface but not deeper into the cochlear lumen. A total of 4 guinea pig ears treated with a single abrasion of 10 s were used as controls. Brain stem measurements were performed accordingly., Results: Hearing loss was lower after a quick direct and deep penetration of the cochlea in comparison to a longer, less invasive opening of the inner ear. Hearing thresholds ascended depending on the duration of the drilling procedure., Conclusion: The results support the hypothesis that prolonged drilling of exposed inner ear structures causes more acoustical damage than a direct cochleostomy with the drill.

Objectives: To assess the reliability of visually assessed thresholds of the electrically elicited stapedius reflex, recorded during cochlear implant surgery, compared with intra-operative tympanometric threshold assessment. Intra-operatively recorded electrically elicited stapedius reflex thresholds vary considerably, and differ from those measured post-operatively by means of impedance changes (i.e. using tympanometry). Thus, any confounding effect of different intra-operative techniques and visual assessment inaccuracies should be excluded., Methods: Both techniques (i.e. visual observation and tympanometry) were performed intra-operatively in six patients, and threshold values were compared., Results: Recorded electrically elicited stapedius reflex thresholds were very similar for both techniques. Visually assessed thresholds were slightly higher in some cases and lower in others, compared with tympanometric thresholds., Discussion: There was almost no difference between reflex thresholds measured with the two different techniques under the same intra-operative conditions. Therefore, we conclude that differences between intra- and post-operative thresholds are not due to the use of different measuring techniques. The main reason for such differences is probably the influence of intra-operative narcotics on reflex thresholds.

Conclusion: By means of a direct, though non-invasive experiment on healthy humans we could demonstrate that middle ear (ME) pressure decreases when the eustachian tube (ET) does not open. Thus with a very simple method the basic theory of continuous gas loss from the ME into the circulation and the replenishment of the loss through the ET could be validated., Objectives: To record changes in ME pressure over a period of time in normal human ears, while the ET is kept closed., Subjects and Methods: On-line tympanometry was carried out in three subjects, who refrained from swallowing for 20-120 min., Results: During the time when the ET was kept closed by refraining from swallowing, tympanometric monotonous pressure decrease was recorded. Once the tested subject could not refrain from swallowing any longer and swallowed again, ME pressure equalized immediately.

Objective: To prove the feasibility of recording stapedius reflexes by bipolar electromyography intra-operatively during cochlea implant via a bipolar hook needle electrode., Study Design: Prospective study., Setting: Tertiary referral center., Patients: Adults receiving a MED-EL cochlear implant., Intervention: Diagnostic., Main Outcome Measures: Stapedius reflex responses can be recorded by electromyography., Results: A double hook electrode could be inserted into the muscle tissue via the natural opening of the pyramid process along with the stapedius tendon. In 7 out of 10 patients supplied with MED-EL CIs (PULSARCI100 or SONATATI100), electrically elicited stapedius reflex potentials were recorded after eliminating stimulation artifacts caused by electromagnetic fields during electrical stimulation by low pass filtering., Conclusion: Intraoperative stapedius reflex recording by bipolar electromyography via a hook electrode is feasible. Further research will show whether these signals may be used for establishing a self-adjusting speech processor.

Objective: Aim of this paper is to prove the applicability of intra-operative recordings of auditory brainstem responses during cochlear implantation., Methods: The clinical practicability of intra-operative monitoring of hearing thresholds (Notched-Noise BERA, Amplitude Modulation Following Response [AMFR]) is presented in the respective case. The recordings were performed prior to the cochlear implantation and were compared with those obtained during and after cochlear implantation., Results: It is demonstrated that the patient's cochlear function can be monitored; residual hearing is available after surgery., Conclusion: The possibility of monitoring of hearing thresholds may add some security to the concept of electric-acoustic stimulation.

Conclusions: The results of this study show that in clinical practice it will not be easy to diagnose tonic contractions of the tensor tympani muscle and only a combination of findings will be helpful. Based on these experimental results a clinical study will be started which should clarify the diagnostic relevance of indicators of tonic tensor muscle contractions., Objectives: There are indications from the literature and from personal experience that tonic contractions of the tensor tympani muscle may play a role in some ear symptoms, such as fullness, certain cases of tinnitus, slight hearing loss or Ménière's disease-like findings. In order to prove this theory we looked for indicators, either visual or functional, to help clinically diagnose the functional state of the muscle, particularly its tonic contraction., Material and Methods: Experiments simulating tensor contractions were carried out on temporal bone specimens. Traction was applied either to the isolated muscle, to its tendon or to the malleus neck. Effects were observed either visually via an endoscope or by impedance audiometry using multiple-frequency tympanometry., Results: During simulated tensor traction the aspect of the tympanic membrane changed slightly, i.e. there was some inward movement of the umbo. However, such effects were only identifiable during the pulling action or by directly comparing the "contracted" and "relaxed" states. Tympanometry revealed a decrease in the peak amplitudes and a shift in the middle ear resonance towards higher frequencies during contractions.

Problems Addressed: Despite their abundant spread, mobile phones are suspected by a major share of the population to cause adverse effects on health and welfare. The ear as the sense organ next to the individual device has rarely been investigated for short-term effects in this regard. In a previous article, we could not prove any impact on the vestibular part of the inner ear. Our present examinations are concerned with the question whether mobile phone emissions could affect cochlear or auditory brain stem functions., Methods and Measures: In 12 healthy test persons with normal hearing, auditory brain stem reflexes recordings were performed before, during, and after exposure to electromagnetic emissions by standardized mobile phone devices. Two modes of electromagnetic emissions fields were administered: pulsed and continuous. For acoustic stimulation simultaneous to field exposure, special "plug-in" earphones had to be used., Results: No impact on auditory brain stem reflexes recordings in terms of absolute and interpeak latencies could be found., Clinical Significance: Together with the results of a previous article concerned with the vestibular part of the inner ear, we can state that there are no adverse effects of mobile phone emissions on the ear function, at least on a short-term range. Of course, any long-term effects cannot be excluded by our study.

Objectives: Pulsating electromagnetic (EM) radiation emitted by mobile phones is often incriminated for causing tissue alterations by caloric effects. In particular, the eye and the ear were regarded as possible "hot spots," with heating up to 1 degree C, in which EM radiation might have negative effects. If so, these temperature increments should be large enough to cause vestibular excitation. In this study, we attempted to verify this theory by clinical testing and in vitro experiments., Methods and Measures: In our laboratory, a simulated GSM signal (889.6 MHz/2.2 W) was applied to 1 ear at a time, while video nystagmography was performed. The experimental setup was similar to that used for caloric (hot and cold water) testing of the peripheral vestibular organ. Data were evaluated by a computer system. There were 13 volunteers (26 ears) included in our study. In an additional experiment, temperatures of human temporal bones were measured by thermography, while a continuous or pulsating EM field was applied., Results: In no volunteer could EM radiation-induced nystagmus be recorded. This corresponds well to our findings that in the human temporal bone very weak caloric effects could only be found in the tissue layers next to the radiation source (antenna of the mobile phone), whereas deeper regions (horizontal semicircular canal) seemed unaffected (at least less than 0.1 degree C)., Clinical Significance: These results do not support the theory that mobile phone-induced EM radiation may cause caloric negative effects in the human ear.

Healing and integration of a cochlear implant is largely influenced by good blood circulation in the covering skin, which, on the other hand, is closely correlated to skin temperature. Measuring superficial flap temperatures by thermography is an easy way to get some clues about the corresponding blood supply. These data should allow some implications for the design of skin flaps in cochlear implant surgery. In 15 patients thermography was carried out prior to and after cochlear implantation, using the Agema 550 Thermovision system. It was evident, that the anatomic courses of the major superficial arteries were represented by areas of increased temperature. The pattern of temperature distribution may allow some conclusions concerning site and shape of surgical incisions. From our data we concluded, that most types of incisions do not interfere too much with the arterial blood supply. However, some types like the extended retroauricular C-incision may eventually cause problems. Our data suggest, that the straight or slightly curved vertical retroauricular incision causes the least impairment of blood circulation. After surgery, directly along the incisions (and later along the scars) temperature was diminished, indicating reduced blood circulation. In our series, the thickness of the implant did not impede blood circulation significantly. So far, we could not examine patients with local circulation disorders. Probably local scars, skin atrophies, angiopathies etc. may present typical patterns of temperature distribution, which require individual design of skin flaps. Thermography is an easy method which can give impressions of local blood circulation in skin flaps. If the courses of the major arteries and their branches are respected, blood circulation within the flap should not be problematic. Thermography is likely to help designing optimal flaps in cases with impeded blood circulation e.g. by pre-existing scar formations.

Background: Sufficient blood supply of the flap is a significant factor for proper wound healing and lifelong integration of a cochlear implant. Superficial temperature as an indicator of cutaneous blood circulation can be visualized easily by thermography., Question: We examined the correlation between temperature distribution and the anatomic course of defined arteries, the significance of different types of incisions in this regard, and local irritations of skin temperature/blood circulation by the implant itself., Materials and Method: The partially shaved heads of 15 patients were examined by thermography after cochlear implantation, using the Agema thermovision system., Result: Temperature distribution of the skin can be closely related to the arterial blood supply. In our group of patients, no significant alterations could be found in the skin covering the implant. Hair growth in the area tested does not allow valid thermographies., Discussion: By the pattern of temperature-distribution/blood circulation some conclusions about typical incisions can be drawn. While most types of incisions respect the patterns of blood circulation, the retroauricular C-incision may cause problems. Postoperative scars can be regarded as places of minor resistance., Conclusions: Thermography of the skin is an easy method for estimating the blood circulation of the skin above the implant. It is, however, limited to hair-free or shaved skin areas.

Since Barany's descriptions in 1906, cold and warm irrigations of the external ear canal have been used for unilaterally testing vestibular excitability. The fluid kinetics within the endolymph have been studied thoroughly, whereas relatively few published articles deal with the mechanisms of heat transfer from the external to the internal ear. Even though heat conduction via the bone seemed to be well established in the textbooks, Feldmann and co-workers found heat radiation to be a very important factor. Using a rather uncommon method, we tried to make this heat radiation more apparent: in temporal bone experiments, temperature distribution was followed by thermography. Temporal bone specimens were prepared in such a way that heat distributions became visible after experimental caloric irrigations of the external ear canal. Temperature changes could well be verified by changes in coloration of the 2-dimensional thermograms. Conclusions were drawn from registrations performed in 2 projections, 90 degrees to each other, allowing cautious statements about 3-dimensional distribution. The velocity of heat transfer at the very onset of the reaction can only be explained by radiation, whereas later, other mechanisms, such as conduction via the bone or convection via the middle ear gas, may have some influence. Our results support Feldmann's findings and underline the significance of radiation in the heat transfer mechanism.

A retrospective analysis of 335 patients with laryngeal and hypopharyngeal cancer from the ENT-Hospital of the Wilhelm-Pieck-University Rostock, who died to December 1986, was made. Adjusted five-year survival rates were in glottic carcinoma 54.2 per cent and supraglottic carcinoma 42.9 per cent. This is significantly higher than in carcinoma of hypopharynx with 15.4 per cent. The following prognostic factors were important for the survival rates of the patients without consideration of the therapy of primary tumor: pTNM-stage, evidence and development of regional metastasis, enlarged stage of the primary tumor at the time of diagnosis; intercurrent diseases; development of distant metastasis and/or second carcinoma; localisation of tumor; primary therapy of regional lymph nodes.