Ergebnisse der mit der Obliteration des runden/ovalen Fensters erreichten Behandlungserfolge bei der einseitigen, akut aufgetretenen, idiopathischen sensorineuralen Hörminderung

ZusammenfassungFormerly explorative tympanotomies including sealing of the round/oval window/s have only been used in treating perilymphatic fistulas. During the last years this operation especially in the middle European countries has also been performed more and more in patients suffering from an ISSNHL. In this chapter the effect of this operation including a simultaneous systematic steroid therapy on hearing levels has been collected from data presented in literature and the results will be presented by means of a systematic review. The survey also includes the results of this operative procedure in 41 patients who have been treated by us.Based on 19 publications dealing with the above mentioned topic only 6 studies (4 of them with information about the hearing loss at the time of admission at the hospital and additionally at a follow-up examination (n = 309)) could be integrated in this study and another 2 in which the hearing gains –regardless of the initial hearing loss- according to the modified „Kanzaki“-criteria (n = 288)) have been evaluated- could be used for estimating the therapeutic effects of tympanoscopy with sealing of the round/oval windosw/s in patients with sudden deafness.The follow-up examination had to exceed a 3 weeks interval up from the time of the operation. It is shown that several methods of evaluation the median hearing loss (PTA4 and PTA5) in pure tone audiograms are suitable to be accepted for the analysis of hearing losses in order to compare the results of the treatment.In each study-group collected from literature and two study-groups of our own patients the hearing loss before therapy was significantly higher than that which had been measured at the follow-up examination.Patients in which tympanoscopy was combined with a systematic application of steroids in a „first-line-mode“ (n = 79) had a hearing loss of 94,1 dB. Their hearing improved up to a hearing level of 70,7 dB at the follow-up examination (hearing gain: 23,4 dB; n = 79). Those who first had got systematic steroids followed by the tympanoscopy („second-line-mode“) had an intitial hearing loss of 105,1 dB and a hearing gain of 38,6 dB. So the final hearing level reached 66,5 dB (n = 197).Median hearing thresholds still rose after detamponation of the external ear canal which was usually done 10 days after the operation up to the follow-up examination.Based on the modified „Kanzaki“-criteria 58,7 % of the patients had a restoration in their hearing exceeding 30 dB. In 18,7 % of the cases the hearing improvement was between 10 and 30 dB. 23,1 % of the patients didn`t profit from tympanoscopy.Indications for deciding to perform an explorative tymapnosocopy which are mentioned in literature are collected and discussed.Explorative tympanotomy including sealing of the round/oval window/s seems to be a very valuable method in treating sudden deafness especially when the hearing loss was severe, profound or even when the patients were totally deaf and the therapeutic procedure had been done sequentially after having performed a systematic steroid application before operation. Further studies have to find out if tympanoscopy used in a „first-line-mode“ can also be a method in which the hearing gain is successful enough that this form of therapy can also be recommended.

Englische Zusammenfassungen der Kapitel 1–9

ZusammenfassungAs a whole the effect of an explorative tympanoscopy with sealing the round/oval window(s) in cases of a profound idiopathic unilateral sudden hearing loss (ISSNHL) has been analyzed (data: own study cases and review of literature) and the results have been compared to that of intratympanal steroid injections published elsewhere. In detail the topics of the chapters focused on: Comparison of epidemiologic data, anamnestic and clinical findings including hearing results of our study group with those published Time course of hearing improvement after explorative tympanoscopyand sealing of the round/oval window Compilation of parameters influencing the extent of the initial hearing loss and the hearing gain after surgical therapy Perilymphatic fistulas as an etilogical factor causing a sudden profound hearing loss Comparison of those cases which have been treated by obliteration of the round/oval window with and without corticoid-soaked connective tissue Comparison of patients (data sampled by literature and own cases) treated with intratympanal corticoid injections on the one side or explorative tympanscopy with sealing of the round/oval window on the other side.

Atrial flutter in newborns

Objective. To describe a case of atrial flutter in a newborn.Results. The child in the maternity hospital was found to have a heart rhythm disorder of the type: atrial flutter, constant form. Examination revealed an atrial septal defect and an increase in the level of natriuretic peptide. Subsequently, the child was diagnosed with atrial flutter, constant form. NK 0-1. Open oval window. Treatment with drugs from the group of antiarrhythmics, antioxidants and cardiac glycosides made it possible to avoid pronounced hemodynamic disorders.Conclusion. The presented case demonstrates that timely diagnosis and medical correction prevent possible complications.

The Audiometric Assessment of the Effectiveness of Surgical Treatment of Otosclerosis Depending on the Preoperative Incidence of Carhart’s Notch

Objective: The presence of Carhart’s notch at 2000 Hz in otosclerosis links the changed bone conduction for this frequency with the otosclerotic process occurring in the oval window. The aim of this study is to perform an audiometric assessment of the effectiveness of surgical treatment of otosclerosis depending on the incidence of Carhart’s notch. Methods: The analysis included 116 patients treated surgically for the first time due to otosclerosis. Patients were divided into 4 groups depending on the occurrence of Carhart’s notch, determined by pure-tone audiometry (PTA) before the surgery and 36 months afterward. The mean value of bone conduction thresholds was calculated for 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz in the groups in which the Cahart’s notch was observed. This value of bone conduction (BC) was a reference point for further analysis in patients who had no preoperative or postoperative Carhart’s notch. Results: The analysis indicated that Cahart’s notch in preoperative PTA is a statistically significant improvement factor for average BC. It was found that over a longer observation period, the presence of Carhart’s notch has adverse effects on the size of the postoperative air-bone gap, and consequently on hearing improvement after surgical treatment. A comparison between patients from the two groups without preoperative Carhart’s notch found that no beneficial effects of the surgery on speech comprehension were observed regarding high-level sensorineural hearing loss (SNHL). Conclusions: (1) In a long-term observation post-stapedotomy, average BC values were found to improve. Nevertheless, the improvement is less evident in patients with preoperative Carhart’s notch. (2) Disappearance of Cahart’s notch after surgical treatment of otosclerosis is a good prognosis of improvement in speech audiometry. (3) Deep SNHL in the absence of Carhart’s notch in PTA constitutes a bad prognostic factor for improvement in speech audiometry in patients qualified for surgical treatment of otosclerosis.

The ear

The delicate yet definitive deflections of the pinna (wing/fin) of the external ear contribute to the collection of sound. The external acoustic meatus is responsible for the transmission of sounds to the tympanic membrane, which in turn separates the external ear from the middle ear. The middle ear is an air filled (from the nasopharynx via the eustachian tube), mucous membrane lined space in the petrous temporal bone. It is separated from the inner ear by the medial wall of the tympanic cavity – bridged by the trio of ossicles. The inner ear refers to the bony and membranous labyrinth and their respective contents. The osseus labyrinth lies within the petrous temporal bone. It consists of the cochlea anteriorly, semicircular canals posterosuperiorly and intervening vestibule – the entrance hall to the inner ear whose lateral wall bears the oval window occupied by the stapes footplate.

Roles of Key Ion Channels and Transport Proteins in Age-Related Hearing Loss

The auditory system is a fascinating sensory organ that overall, converts sound signals to electrical signals of the nervous system. Initially, sound energy is converted to mechanical energy via amplification processes in the middle ear, followed by transduction of mechanical movements of the oval window into electrochemical signals in the cochlear hair cells, and finally, neural signals travel to the central auditory system, via the auditory division of the 8th cranial nerve. The majority of people above 60 years have some form of age-related hearing loss, also known as presbycusis. However, the biological mechanisms of presbycusis are complex and not yet fully delineated. In the present article, we highlight ion channels and transport proteins, which are integral for the proper functioning of the auditory system, facilitating the diffusion of various ions across auditory structures for signal transduction and processing. Like most other physiological systems, hearing abilities decline with age, hence, it is imperative to fully understand inner ear aging changes, so ion channel functions should be further investigated in the aging cochlea. In this review article, we discuss key various ion channels in the auditory system and how their functions change with age. Understanding the roles of ion channels in auditory processing could enhance the development of potential biotherapies for age-related hearing loss.

The Biophysical Function of the Human Inner Ear

The ear transforms soft mechanical vibration of air particles into electrical signals, which reach the appropriate part of the cerebral cortex for processing by means of auditory nerves. The process of the hearing is next: the eardrum vibrates from the sound waves; auditory ossicles amplify the stimulus; in an oval window, the vibration is transmitted to the fluid space of the inner ear; iIt vibrates the basilar membrane; what is pressed against the membrane tectoria; the stereocilliums of the hair cell bend, ion channels open; hair cell depolarizes; stimulus is dissipated in cerebrospinal fluid VIII (vestibulocochlearis); temporal lobe primary auditory cortex (Brodman 41, 42); association pathways: speech comprehension (Wernicke area). For the rising prevalence of psychoses (mental disorders) in the last decades among towns­people, these stimuli – as compared to the abandoned environment – and the adaptation to them may also play a definite role. The man, therefore, enjoying worths and conveniences of the civilization has to size every opportunity to get into the open, to compensate the monotony of the external stimuli, in a word, to grant his organism those stimuli which he claims as a biological creature. This human demand – it seems – is such a great physiological need that our organism cannot be without even in the evening. At least this turns out according to the researches relating sleep and dreaming.