OBJECTIVE:To explore the origin of "physiological" ear clicks during deglutition or other pharyngeal movements, which, in contrast to disturbing frequent clicks under pathologic conditions, mostly remain unnoticed by the patient.STUDY DESIGN:Clinical experimental study at a tertiary referral center.METHODS:Ear clicks were recorded by a microphone sealing the external ear canal parallel to endoscopic or manometric evaluations of the Eustachian tube function.RESULTS:Obviously, the acoustic signals (clicks) appear when the tube opens. The clicks might be explained by a disruption of fluid or mucus films covering the mucosa. As in our tests clicks could be recorded regularly, they might potentially be used as indicators in a new tube function test, which has to be elaborated.

To explore the origin of "physiological" ear clicks during deglutition or other pharyngeal movements, which, in contrast to disturbing frequent clicks under pathologic conditions, mostly remain unnoticed by the patient.Clinical experimental study at a tertiary referral center.Ear clicks were recorded by a microphone sealing the external ear canal parallel to endoscopic or manometric evaluations of the Eustachian tube function.Obviously, the acoustic signals (clicks) appear when the tube opens. The clicks might be explained by a disruption of fluid or mucus films covering the mucosa. As in our tests clicks could be recorded regularly, they might potentially be used as indicators in a new tube function test, which has to be elaborated.

This retrospective analysis focusses on the impact of therapy on perceived long-term post-cancer treatment function. A validated questionnaire including items and components for the assessment of communicative ability, quality of voice and swallowing was sent to 129 patients. All patients were treated between 1998 and 2007. A total of 76 patients (58.9%) with carcinoma of the larynx or hypopharynx replied to the questionnaire. Data was evaluated retrospectively. Therapy delivered was definitive radio(chemo)therapy (defchRT/RT) (21/76, 28%), laryngectomy + radio(chemo)therapy (LE + chRT/RT) (28/76, 37%), or larynx conservation surgery + radio(chemo)therapy (LCS + chRT/RT) (27/76, 36%). Radiotherapy was administered using 2D- or 3D-conformal planning. The most common concomitant chemotherapy delivered was cisplatin + 5FU. For statistical analyses of the components, averages were calculated and tested using the Kruskal-Wallis test and the U-test of Mann and Whitney. Differences were assessed by the Monte Carlo method or Fisher's exact test. The single item rates were compared with Fisher's exact test. Mean follow-up was 56.7 months (range, 8-130 months). After defchRT/RT, patients trended towards more substantial-strong hoarseness compared with LCS + chRT/RT (P = 0.2). After LE, patients were dissatisfied with their artificial larynx/electrolarynx and the tone of their voice (P = 0.3, P = 0.07) and communicative ability (P = 0.005, P = 0.008) compared with those treated with defchRT/RT and LCS + chRT/RT, respectively. Dysphagia and additional percutaneous endoscopic gastrostomy (PEG) feeding were more frequent after defchRT/RT in comparison with the other two groups (P < 0.05). Voice quality and communicative ability were slightly worse after defchRT/RT and LE + chRT/RT, but satisfying with all treatment modalities. Further development of the therapy approach is necessary to reduce long-term side effects, with measures of post-treatment function as important endpoints.

Drilling a promontory window and coupling an FMT into the scala tympani may be a surgical alternative to stapes surgery in obliterative tympanosclerosis. Aim of this experimental study on human temporal bones was to measure changes of the acoustic transfer function from the tympanic membrane to the round window membrane after drilling a promontory window and insertion of a floating mass transducer.Laser vibrometry and acoustic measurements were performed on 11 temporal bone preparations equipped with a microphone attached to the round window. Calibrations were carried out to allow determination of SPLs affecting the cochlea after drilling a promontory window leaving the membranous inner ear intact and after insertion of an FMT into the cavity (with or without slight pressure).Drilling a promontory window does influence the transfer function. Insertion of the FMT with additional slight pressure further changes the transfer function.The presence of a promontory window changes the acoustic transfer function to the round window. Further investigations are needed to correlate the qualitative results with the audiological results after "third window vibroplasty" (inserted floating mass transducer without stimulation).

Drilling a promontory window and coupling an FMT into the scala tympani may be a surgical alternative to stapes surgery in obliterative tympanosclerosis. Aim of this experimental study on human temporal bones was to measure changes of the acoustic transfer function from the tympanic membrane to the round window membrane after drilling a promontory window and insertion of a floating mass transducer.Laser vibrometry and acoustic measurements were performed on 11 temporal bone preparations equipped with a microphone attached to the round window. Calibrations were carried out to allow determination of SPLs affecting the cochlea after drilling a promontory window leaving the membranous inner ear intact and after insertion of an FMT into the cavity (with or without slight pressure).Drilling a promontory window does influence the transfer function. Insertion of the FMT with additional slight pressure further changes the transfer function.The presence of a promontory window changes the acoustic transfer function to the round window. Further investigations are needed to correlate the qualitative results with the audiological results after "third window vibroplasty" (inserted floating mass transducer without stimulation).

BACKGROUND:An open mastoid cavity might lead to various problems for the patient. Chronic inflammation of the cavity with secretion, changes in the acoustic behavior, vertigo in restricted situations and an impaired self-cleaning function might affect the patient. For surgical treatment reducing of the size of such cavities have been described. Besides autologous materials such as hydroxyapatite or alloplastic substances as tricalcium phosphate have been previously used. A very slow resorption of these materials with rejection has been described. The new ceramic NanoBone® was fabricated in a sol-gel process at 700 °C depositing unsintered hydroxylapatite in a SiO2 structure. This method provides a nano/microstructure of high porosity of the resulting matrix.MATERIAL AND METHODS:20 patients were reexamined after an average of 2 years and 5 months after obliteration of the open mastoid cavity with NanoBone®. We compared pre- and postoperative findings in terms of otorrhea, frequency of medical consultation, vertigo and otoscopic findings. In 5 patients, in addition, a postoperative CT scan of the temporal bones was used for evaluation of osteoinduction and osteointegration.RESULTS:After obliteration of the open mastoid cavity with NanoBone ® we observed an uneventfully healing. After surgery we achieved a reduction of vertigo, otorrhea and frequency of medical consultations for the single patient.CONCLUSION:The obliteration of an open mastoid cavity with NanoBone ® is a safe alternative method relative to the surgical techniques with autologous materials.

BACKGROUND Many different surgical techniques have been developed to remove open mastoid cavities. In addition to autologous materials, alloplastic substances have been used. A very slow absorption of these materials and extrusion reactions have been reported. We investigated a newly developed, highly porous bone grafting material to eliminate open mastoid cavities, in an animal model. To characterise the transformation process, the early tissue reactions were studied in relation to the matrix transformation of the bone material. MATERIAL AND METHODS NanoBone (NB), a highly porous bone grafting material based on calcium phosphate and silica, was filled into the open bullae from 20 guinea pigs. The bullae were examined histologically. Energy dispersive X-ray spectroscopy (EDX) was used to investigate the change in the elemental composition at different sampling times. The surface topography of the sections was examined by electron microscopy. RESULTS After 1 week, periodic acid-Schiffs (PAS) staining demonstrated accumulation of glycogen and proteins, particularly in the border area of the NB particles. After 2 weeks, the particles were evenly coloured after PAS staining. EDX analysis showed a rapid absorption of the silica in the bone grafting material. CONCLUSIONS NanoBone showed a rapid matrix change after implantation in the bullae of guinea pigs. The absorption of the silica matrix and replacement by PAS-positive substances like glycoproteins and mucopolysaccharides seems to play a decisive role in the degradation processes of NB. This is associated with the good osteoinductive properties of the material.

HYPOTHESIS:Development of silicone films with hydrophilic surface properties and with associated fibroblast colonization for tympanic membrane reconstruction.BACKGROUND:Silicone films are used in ear surgery for splinting fresh eardrum perforations. The cure rate is high if the perforation is small and fresh. Persistent eardrum perforations have been treated in tympanoplasty procedures by splinting the tympanic membrane with silicone film. Silicone has hydrophobic properties and is poorly populated by cells.METHODS:Silicone films with a thickness of 0.13 mm were treated in a low-pressure oxygen plasma for different times. Oxidation of the surface allowed hydroxyl groups to form. The altered surface properties of the film were measured using the method of contact angle against water. Treated and untreated films (d = 22 mm) were placed in 12-well culture plates with 50000 L929 fibroblasts and in a standard medium for different lengths incubated at 37 °C. The quantification of the vegetation was performed after 5 days using WST-1 Cell Proliferation Reagent. The resulting cell growth was visualized after different incubation times through the Live/Dead Assay by fluorescence microscopy and scanning electron microscopy.RESULTS:The treatment of the films with low-pressure oxygen plasma resulted in a hydrophilic film surface. There were significant differences in fibroblast colonization in treated compared with untreated films. The hydrophilic silicone films had a higher quantity and quality of fibroblasts.CONCLUSION:Further surface modifications could improve the film in respect of fibroblast vegetation. The effectiveness of the modified silicone sheets should be evaluated in vivo before clinical trials.

Hintergrund: Die Tuba auditiva ist für den Druckausgleich des Mittelohrs verantwortlich. Bisher gibt es keine Untersuchungsmethode, die eine verlässliche Langzeitaussage über die Tubenfunktion ermöglicht. In der vorliegenden Arbeit möchten wir die Machbarkeitsstudie für ein optisches Langzeitmessverfahren der Tubenfunktion – Optotensometrie – vorstellen.

Background: The amount of pressure in the middle ear depends mainly on the function of the Eustachian tube. Currently there are no continuous recording techniques measuring Eustachian tube function in clinical context and under physiological conditions over extended periods of time. In this paper we investigate the suitability of an active optic triangulation method on the basis of a projected laser-point-pattern in measuring tympanic membrane movement during pressure variations in a middle ear model. Material and Methods: For projection we used a green semiconductor laser with an output of 1 mW and a diffractive optical element (DOE). As our measured object we used purple latex-foil (Kimberley-Clarke (R)), fixed airtight on the cut-offend of a 2 ml syringe-tube. The movement of the foils was measured by an active optic triangulation method. To simulate pathological variations of the tympanic membrane we prepared the latex-foils in specific ways. One foil was perforated and then covered again (simulating tympanic membrane perforation), another one was partly strengthened by sticking a piece of thick, hard paper to it from the inside (simulating calcification). Results: The test-setup, as well as the appliance of pressure-changes worked fine and measurement of foil movement in all the modified foil surfaces was possible. This shows that it is possible to record foil-movement with this system even in tympanic membranes with pathological variations. Conclusions: In the course of this study we were able to show that it is possible to assess and record foil movement using a system of optic triangulation and to simulate different tympanic membrane pathologies. This could be used both in ENT medicine, as well as in aviation and diving medicine.

OBJECTIVE:We report an ex vivo and in vivo experimental study of a device designed to measure tympanic membrane movement under normal and pathological conditions, assessed using optical coherence tomography.MATERIALS AND METHODS:We designed two types of flexible, round film patch with integrated strain gauge, to be attached to the tympanic membrane in order to measure tympanic membrane movement. Tympanic membrane attachment was assessed using optical coherence tomography. The devices were tested experimentally using an ex vivo model with varying middle-ear pressure.RESULTS:Optical coherence tomography reliably assessed attachment of the film patch to the tympanic membrane, before and after middle-ear pressure changes. Strain gauge voltage changes were directly proportional to middle-ear pressure recordings, for low pressure changes. Tympanic membrane perforations smaller than 2 mm could be sealed off with the film patch.CONCLUSION:Attachment of the film patch with integrated strain gauge to the tympanic membrane was not ideal. Nevertheless, the strain gauge was able to precisely detect small pressure changes within the middle ear, in this experimental model.

Bei CI-Versorgung eines Ohrs mit Tieftonrestgehör sollte die cochleäre Funktion für die Möglichkeit einer elektrisch-akustischen Stimulation (EAS) erhalten bleiben. Neben möglichst atraumatischer Elektrodeninsertion sollte auch das akustisch-mechanische Trauma bei der Cochleostomie minimiert werden. Ausgehend von Felsenbeinversuchen stellten wir die Hypothese auf, dass eine sorgfältige Exposition der Endostealmembran mit dem Bohrer vor gezielter Eröffnung der Schnecke ein größeres akustisch-mechanisches Trauma bedeuten kann als ein rasches direktes Aufbohren des flüssigkeitsgefüllten Innenohrs. Dies sollte tierexperimentell überprüft werden.

Zur Therapie schlafbezogener Atmungsstörungen (SBAS) wird das Prinzip einer Vorverlagerung der Zunge verfolgt, um ihr Zurücksinken mit Einengung der Atemwege während des Schlafs zu verhindern. Die vorliegende Studie erprobt eine passive Fixierung der Zunge über ein Implantat an einer speziell dazu entwickelten Unterkieferschiene.

Forward displacement of the tongue is a verified principle in the therapy of sleep disorders which prevents the tongue from sinking backwards thus avoiding obstruction of the upper respiratory tract during sleep. In this feasibility study a novel oral appliance which connects to a pin implanted within the tongue was investigated.A new tongue positioning system using previously implanted tongue piercings as a pivot was developed. By pulling the tongue forward the oral device prevents airway obstruction. In our study we fitted 10 subjects who already had the tongue pierced with the developed oral device. The subjects underwent two nights of polysomnography with and without using the tongue positioning system. Wearing comfort and side effects were evaluated using a questionnaire. Moderate alcohol consumption was used to provoke snoring or apnea in the subjects. Tongue positioning with and without the device was visualized with oropharyngeal MRI.Subjects did not report any discomfort or side effects wearing the device. Subjects showed only moderate snoring or apnea after alcohol consumption and snoring after alcohol consumption was reduced with the device. The average apnea/hypopnea index (AHI) was 0.8/h without the device. Using the device led to an increase of apnea in the subjects. MRI visualization showed that the device did not keep the upper airway space opened by fixing the tongue.The effectiveness of the tongue positioning system should be improved by a modification which should be investigated in patients with preexisting sleep disorders.

BACKGROUND:Many different techniques for obliterating open mastoid cavity have been described. The results after the application of alloplastic materials like Hydroxyapatite and Tricalciumphosphate were poor due to long-lasting resorption. Extrusion of those materials has been described. We investigated the applicability of a new high-porosity ceramic for obliterating large open mastoid cavities and tested it in an animal model (bulla of guinea pig).METHODS:A highly porous matrix (NanoBone) bone-inductor fabricated in a sol-gel-technique was administered unilaterally into the opened bullae of 30 guinea pigs. In each animal the opposite bulla was filled with Bio-Oss, a bone substitute consisting of a portion of mineral bovine bone. Histological evaluations were performed 1, 2, 3, 4, 5 and 12 weeks after the implantation.RESULTS:After the initial phase with an inflammatory reaction creating a loose granulation tissue, we observed the formation of trabeculare bone within the fourth week in both groups. From the fifth week on we found osteoclasts on the surface of NanoBone and Bio-Oss with consecutive degradation of both materials.CONCLUSION:In our animal model study we found beneficial properties of the used bone-inductors NanoBone and Bio-Oss for obliterating open mastoid cavities.

Conclusions: Tympanometry in ears with retracted or partially atelectatic tympanic membranes does not reflect the true middle ear (ME) pressure. The position of the tympanogram peak depends on the size of a retraction pocket and the remaining ME gas volume. Thus tympanometry in such cases cannot be used for measurements of ME pressure. Objective: To prove the hypothesis that tympanometry in ears with retraction pockets or atelectasis does not measure ME pressure correctly. Materials and methods: Tympanometry was performed in a simplified artificial ME model, in which different ‘tympanic membranes’ with pockets could be integrated. Results: We found a shift of the tympanogram peaks, either towards negative or positive pressures, depending on the position of the pocket: in case of an ‘inward’ direction (towards the ME like a retraction pocket) the peak was in the negative pressure range, in case of an ‘outward’ direction (bulging into the ear canal) the shift was towards positive pressures. The shift increased with decreasing volume behind the tympanic membrane. The effect cannot be simply be explained by hysteresis but by the air ‘cushion’ that is ‘trapped’ behind the membrane, limiting its excursions during the tympanometric sweep.