This retrospective study examined overall survival (OS), recurrence free survival (RFS), and laryngeal preservation time in a large cohort of 663 patients with T1/2 N0 M0 glottic cancer after transoral laser or open surgery vs radiotherapy. A total of 595 surgically treated patients and 68 individuals after definitive radio(chemo)therapy (R (C)–T) were studied. Patient characteristics including sociological, surgical, and pathological data, OS and RFS as well as laryngeal preservation time were recorded and compared between various groups/cohorts. There were no significant differences in OS and RFS between surgically treated and conservatively treated patients. However, laryngeal preservation time was significantly higher in surgically treated patients (p < 0.001) (mean: 138.3 ± 2.2 months, versus 102.8 ± 7.6 months) than those under conservative treatment. The surgical treatment method (transoral vs. open partial resection) did not influence OS or RFS. Additionally, the rate of transoral vs. open surgery did not change over a decade. T2-stage patients showed significantly lower RFS than T1-stage patients. Initial R status significantly influenced OS and tumor recurrence. The findings of this study exhibited a significantly longer laryngeal preservation time in patients with T1/2 N0 M0 glottic cancer treated surgically than in those treated with radiotherapy. No significant differences in OS or RFS were observed between open partial laryngectomy and transoral laser surgery. The R status had a significant impact on OS and RFS, with OS being significantly associated with an R0 status, regardless of T status or the surgical approach (open versus transoral). Laryngeal preservation surgery is recommended as a central therapeutic strategy for T1/2 N0 M0 glottic cancer because it has a higher laryngeal preservation rate than the conservative treatment. Given the high recurrence rate (18.5

ObjectiveThis retrospective multicenter study aimed to evaluate surgical versus conservative treatment in patients with hypopharyngeal and laryngeal cancer under real world conditions.MethodsThis study included 2307 patients diagnosed with hypopharyngeal or laryngeal squamous cell carcinoma (SCC) in five German tertiary head and neck centers between 01/2004 and 12/2014. Overall, 783 patients with advanced SCC consecutively underwent laryng(opharyng)ectomy (L(P)E). Patient chart data regarding age, sex, tumor location, TNM status, grading, indication for L(P)E, treatment modalities, R status, postoperative complications, and hospitalization time were analyzed. Patients with lacking data and incomplete staging and those who refused treatment or did not comply with the recommended treatment were excluded from survival analysis.ResultsA slight but significant increase was observed in L(P)E, referring to an increasing rate of tumor recurrence. While T1/2N0M0 laryngeal and hypopharyngeal cancer patients showed comparable overall survival (OS) for surgical and conservative treatment, surgery showed significantly better OS in lymph node-positive individuals and locally advanced tumor stages. Tumor recurrence occurred in more than one-third of the cases. In particular, in early glottic cancer recurrence, L(P)E represents a curative and safe treatment option, whereas in supraglottic and hypopharyngeal cancer, L(P)E was associated with reduced survival rates. Notably, 36% of patients with supraglottic cancer and 59% of patients with hypopharyngeal cancer recurrence could only be treated with palliative care.ConclusionComparable survival rates were demonstrated for cT1/2N0M0 laryngeal and hypopharyngeal SCC compared with primary chemo-/radiotherapy and larynx-preserving surgery. Better OS was achieved after surgery in nodal-positive patients and in those with locally advanced disease. Tumor recurrence should be anticipated in up to 39% of cases. Glottic cancer recurrence can be successfully and safely treated with L(P)E, whereas OS is reduced in hypopharyngeal cancer and possibly in supraglottic cancer.

Introduction About 1-3 / 1000 newborns are affected by a profound hearing disorder at birth or in the first two years of life. About 60% of these cases are due to genetic causes. At this juncture 170 gene loci can be associated with this type of hearing disorder, in total there are 127 genes identified for the number of dominant and recessive inheritance.

Purpose To analyze management and outcomes following (chemo)radiation therapy in patients with cervical lymph node metastases from an unknown primary site (CCUP) in a large single-center cohort. Methods Between 2008 and 2019, 58 patients with CCUP were treated with (chemo)radiation therapy at the University of Freiburg Medical Center and were included in this analysis. Overall survival (OS), locoregional progression-free survival (PFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The use of diagnostic procedures and their impact on oncological outcomes was analyzed by Cox regression, and treatment-related toxicities were quantified. Results Median follow-up was 29.9 months (range 4.6–121.9). Twenty-one patients (36.2%) received definitive RT, 35 (60.3%) underwent adjuvant RT, and 2 (3.4%) were treated for oligometastatic disease. Concurrent chemotherapy was prescribed in 40 patients (69.0%). 89.6% of patients completed the prescribed RT, and 65.0% completed the prescribed simultaneous chemotherapy. Locoregional recurrence was observed in 7 patients (12.1%) and distant metastases in 13 cases (22.4%). OS was 81,1, 64.9% and 56,6% after 1, 3 and 5 years, respectively. Univariate analysis of age, gender, extracapsular spread, tumor grading, neck dissection, diagnostic utilization of 18 F-fluorodeoxyglucose positron-emission tomography and concomitant chemotherapy showed no effect on OS ( p > 0.05 for all), while smoking was significantly associated with decreased survival ( p < 0.05). There was a trend towards impaired OS for patients with advanced nodal status (pN3) ( p = 0.07). Three patients (5.2%) experienced grade 3 radiation dermatitis, and 12 (22.4%) developed grade 3 and 1 (1.7%) grade 4 mucositis. Conclusions RT of the panpharynx and cervical lymph nodes with concurrent chemotherapy in case of risk factors demonstrated good locoregional control, but the metachronous occurrence of distant metastases limited survival and must be further addressed.

BACKGROUND:Treatment for local and locoregional recurrence or second head-and-neck (H&N) cancers after previous radiotherapy is challenging, and re-irradiation carries a significantly increased risk for radiotherapy-related normal tissue toxicities and treatment failure due to a radioresistant tumor phenotype. Here, we analyzed re-irradiation management and outcomes in patients with recurrent or second primary H&N carcinoma using state-of-the-art diagnostic procedures and radiotherapy techniques. METHODS:Between 2010 and 2019, 48 patients with recurrent or second primary H&N carcinoma received re-radiotherapy at the University of Freiburg Medical Center and were included in this study. Overall survival (OS) and progression-free survival (PFS) were calculated with the Kaplan-Meier method, and univariate Cox-regression analyses were performed to assess the effects of clinico-pathological factors on treatment outcomes. Acute and chronic treatment-related toxicities were quantified using the Common Terminology Criteria for Adverse Events (CTCAE v4.03). RESULTS:Thirty-one patients (64.6%) received definitive and 17 (35.4%) adjuvant radiotherapy. Simultaneous chemotherapy was administered in 28 patients (58.3%) with cetuximab as the most commonly used systemic agent (n = 17, 60.7%). After a median time of 17 months (range 4 months to 176 months) between first and second radiotherapy, patients were re-irradiated with a median of 58.4 Gy and a treatment completion rate of 87.5% (n = 42). Median OS was 25 months with a 1-year OS amounting to 62.4%, and median PFS was 9 months with a 1-year PFS of 37.6%. Univariate analyses demonstrated that both a lower rT-status and a radiotherapy boost were associated with improved OS (p < 0.05). There was a trend towards superior OS for patients who received > 50 Gy (p = 0.091) and who completed the prescribed radiotherapy (p = 0.055). Five patients (10.4%) suffered from at least one grade 3 toxicities, while 9 patients (27.3%) experienced chronic higher-grade toxicities (≥ grade 3) with one (3.0%) grade 4 carotid blowout and one (3.0%) grade 4 osteoradionecrosis. CONCLUSION:Re-irradiation of recurrent or second primary H&N cancer with modern radiation techniques such as intensity-modulated radiotherapy resulted in promising survival rates with acceptable toxicities compared to historical cohorts. Increased re-irradiation doses, utilization of a radiotherapy boost and completion of the re-irradiation treatment were found to result in improved survival.

Einleitung Etwa 1-3/1000 Neugeborenen ist bei der Geburt oder in den ersten zwei Lebensjahren von einer hochgradigen Hörstörung betroffen. Davon sind 60 % dieser Fälle auf genetische Ursachen zurückzuführen; z.Z. sind 170 Genorte und dafür 127 Gene für dominante und rezessive Erbgänge erfasst.

Sound localization is one of the major challenges for bilateral cochlear implant (CI) users. One reason is their limited perception of binaural cues, especially interaural time difference (ITD). While studies on human implantees hypothesize that the issue lies in the lack of early sensory input, we have shown on neonatally deafened, CI-implanted rats that ITD sensitivity can be developed independent from early sensory input if the bilateral CIs are synchronized. Here, we investigate to what extent the pulse rate influences the ITD performance of early deaf CI users.

Dichotisches Sprachverstehen seitengetrennter Sprachstimuli erfordert deren zentralnervöse Verarbeitung und wurde seit den 1950er-Jahren bei verschiedenen klinischen Fragestellungen eingesetzt.

Die neueste Generation volldigitaler klinischer PET-Scanner erlaubt eine deutlich verbesserte räumliche Auflösung, mit der sich auch Kerngebiete im Hirnstamm klar vom umliegenden Gewebe abgrenzen lassen. In der vorliegenden Arbeit wurde die Auswirkung von asymmetrischer Hörbeeinträchtigung auf den Glukosemetabolismus der inferioren Colliculi sowie des primären auditorischen Kortex untersucht.

Jede Cochlear Implant Operation birgt das Risiko einer späteren Re-Implantation, sei es durch einen Implantatdefekt oder aus medizinischen Gründen. Bei älteren Implantaten wird darüber hinaus ein CI-Wechsel als technisches Update diskutiert, um die Performance der Patienten zu verbessern.

BACKGROUND:Previous research in cochlear implant (CI) recipients with bilateral severe-to-profound sensorineural hearing loss showed improvements in speech recognition in noise using remote wireless microphone systems. However, to our knowledge, no previous studies have addressed the benefit of these systems in CI recipients with single-sided deafness.PURPOSE:The objective of this study was to evaluate the potential improvement in speech recognition in noise for distant speakers in single-sided deaf (SSD) CI recipients obtained using the digital remote wireless microphone system, Roger. In addition, we evaluated the potential benefit in normal hearing (NH) participants gained by applying this system.RESEARCH DESIGN:Speech recognition in noise for a distant speaker in different conditions with and without Roger was evaluated with a two-way repeated-measures design in each group, SSD CI recipients, and NH participants. Post hoc analyses were conducted using pairwise comparison t-tests with Bonferroni correction.STUDY SAMPLE:Eleven adult SSD participants aided with CIs and eleven adult NH participants were included in this study.DATA COLLECTION AND ANALYSIS:All participants were assessed in 15 test conditions (5 listening conditions × 3 noise levels) each. The listening conditions for SSD CI recipients included the following: (I) only NH ear and CI turned off, (II) NH ear and CI (turned on), (III) NH ear and CI with Roger 14, (IV) NH ear with Roger Focus and CI, and (V) NH ear with Roger Focus and CI with Roger 14. For the NH participants, five corresponding listening conditions were chosen: (I) only better ear and weaker ear masked, (II) both ears, (III) better ear and weaker ear with Roger Focus, (IV) better ear with Roger Focus and weaker ear, and (V) both ears with Roger Focus. The speech level was fixed at 65 dB(A) at 1 meter from the speech-presenting loudspeaker, yielding a speech level of 56.5 dB(A) at the recipient's head. Noise levels were 55, 65, and 75 dB(A). Digitally altered noise recorded in school classrooms was used as competing noise. Speech recognition was measured in percent correct using the Oldenburg sentence test.RESULTS:In SSD CI recipients, a significant improvement in speech recognition was found for all listening conditions with Roger (III, IV, and V) versus all no-Roger conditions (I and II) at the higher noise levels (65 and 75 dB[A]). NH participants significantly benefited from the application of Roger in noise for higher levels, too. In both groups, no significant difference was detected between any of the different listening conditions at 55 dB(A) competing noise. There was also no significant difference between any of the Roger conditions III, IV, and V across all noise levels.CONCLUSIONS:The application of the advanced remote wireless microphone system, Roger, in SSD CI recipients provided significant benefits in speech recognition for distant speakers at higher noise levels. In NH participants, the application of Roger also produced a significant benefit in speech recognition in noise.

Für höchstgradig schwerhörige-Patienten bedeutet die Versorgung mit einem Cochleaimplantat (CI) in der Regel eine enorme Veränderung ihrer kommunikativen Möglichkeiten in Bezug auf ihr hörendes soziales Umfeld. Die Teilhabe ist wesentlich durch das erreichte Sprachverstehen mit bedingt. In dieser Studie wurde untersucht, ob durch die Verwendung weiterentwickelter Sprachprozessoren (SP) ein Zugewinn an Sprachverstehen erreicht werden kann. Die vergleichenden Hörprüfungen von 420 CI-Patienten bei SP-Umstellung in den Jahren 2003–2012 wurden retrospektiv ausgewertet. Die audiometrischen Ergebnisse im Freiburger Zahlen- und Einsilbertest, Oldenburger Satztest in Ruhe und im Störgeräusch wurden bei 70 dB erfasst. In allen audiometrischen Messungen stellten die Autoren eine signifikante Verbesserung mit dem neueren SP im Vergleich zum alten SP fest. Dieses Ergebnis bestand für die Mehrzahl der Patienten und unabhängig vom Alter. Die SP-Umstellung führt zu verbessertem Sprachverstehen in unterschiedlichen Hörkonditionen. Eine Überarbeitung der klinischen Empfehlungen und der Voraussetzungen zur Kostenübernahme ist daher notwendig.

Etwa 1 – 3/1000 Neugeborenen ist bei der Geburt oder in den ersten zwei Lebensjahren von einer hochgradigen Hörstörung betroffen. Etwa 60% dieser Fälle sind auf genetische Ursachen zurückzuführen. Bisher wurden für diese Art von Hörstörungen 181 Genorte und für diese Genorte 116 Gene identifiziert. Genetische Veränderungen im DFNB1 Genort, in dem die Gene GJB2 (Connexin-26) und GJB6 (Connexin-30) lokalisiert sind, stellen die Hauptursache für prälinguale nicht-syndromale Hörstörungen dar. Zielsetzung ist es zu klären welche weiteren Gene bei unklarer Ätiologie an prälingualen Hörstörungen beteiligt sind.

There is an inherent focus on larynx-preserving-therapy in pharyngeal and laryngeal cancer. In literature, classical laryng(opharnyg)ectomy (LPE) becomes less important. However, recent data demonstrates a stable LPE rate over the last decades.

Any cochlear implant surgery bears the risk of later re-implantation due to technical or medical failure. In patients with an older implant a re-implantation for technical upgrade may be discussed to improve performance.

Das Vestibularisschwannom (VS) löst durch seine variable Lage entlang des 8. Hirnnerven vielfältige Symptome aus. Man unterscheidet 3 Therapiemöglichkeiten: wait-and-scan, Bestrahlung und die Operation über 3 mögliche Zugangswege, die zu verschiedenen Komplikationen führen kann. Unser Ziel ist es, die Daten über Ausprägungen des VS, Diagnostik, sowie Therapien und Komplikationen zu kategorisieren, um einen Überblick über das Krankheitsbild zu schaffen und Korrelationen aufzudecken.

Das Erreichen einer möglichst guten Sprachdiskrimination ist eine wesentliche Voraussetzung für erfolgreiche Teilhabe nach CI-Versorgung. Ein wichtiger Faktor ist die chirurgische Qualität, insbesondere das Vermeiden von Dislokationen, die Einbußen im Sprachverständnis nach sich ziehen.

Die Wirksamkeit der CI-Versorgung bei SSD (single sided deafness)/AHL (asymmetric hearing loss) Patienten konnte bestätigt werden (Mertens et al., 2016; Arndt et al., 2017). Bisher gibt es kaum Untersuchungen zu Erwartungen an die Rehabilitation nach CI-Versorgung (2007; Nawaz et al., 2014; Finke et al., 2017). Ziel ist die Klärung der Fragen: Benötigen SSD/AHL- CI-Träger eine Rehabilitation mit Hör- und Sprachtherapie (HSTH) und wenn ja, welche neuen Inhalte der HSTH sind ggf. erforderlich.