Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18–34, 35–44, 45–54, 55–64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (Δ0.75–0.82) for those aged <45 compared with those 55+. However, gains in SSQ scores were equivalent across age groups, although postoperative SSQ scores were higher in right-ear implanted subjects. All age groups benefited equally in terms of HUI gain (0.18), with no decrease in scores with age. Overall, younger adults appeared to cope better with a degraded hearing before and after CI, leading to better subjective hearing performance.

Previous published results have revealed that Rhinolight intranasal phototherapy is safe and effective in intermittent allergic rhinitis. The present objective was to assess whether phototherapy is also safe and effective in persistent allergic rhinitis. Thirty-four patients with persistent allergic rhinitis were randomized into two groups; twenty-five subjects completed the study. The Rhinolight group was treated with a combination of UV-B, UV-A, and high-intensity visible light, while the placebo group received low-intensity visible white light intranasal phototherapy on a total of 13 occasions in 6 weeks. The assessment was based on the diary of symptoms, nasal inspiratory peak flow, quantitative smell threshold, mucociliary transport function, and ICAM-1 expression of the epithelial cells. All nasal symptom scores and nasal inspiratory peak flow measurements improved significantly in the Rhinolight group relative to the placebo group and this finding persisted after 4 weeks of follow-up. The smell and mucociliary functions did not change significantly in either group. The number of ICAM-1 positive cells decreased non-significantly in the Rhinolight group. No severe side-effects were reported during the treatment period. These results suggest that Rhinolight treatment is safe and effective in persistent allergic rhinitis.

The proposed method can efficiently detect liver lesions irrespective of their size, shape, density and heterogeneity within half a minute. According to the evaluation, its accuracy is competitive with the actual state-of-the-art approaches, and the contour of the detected findings is acceptable in most of the cases. Future work shall focus on more precise lesion contouring so that the proposed method can be a solid basis for fully automated liver tumour burden estimation.

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BackgroundPassive transcutaneous osseointegrated hearing implant systems have become increasingly popular more recently. The area over the implant is vulnerable due to vibration and pressure from the externally worn sound processor. Good perfusion and neural integrity has the potential to reduce complications. The authors’ objective was to determine the ideal surgical exposure to maintain perfusion and neural integrity and decrease surgical time as a result of reduced bleeding.MethodsThe vascular anatomy of the temporal-parietal soft tissue was examined in a total of 50 subjects. Imaging diagnostics included magnetic resonance angiography in 12 and Doppler ultrasound in 25 healthy subjects to reveal the arterial network. Cadaver dissection of 13 subjects formed the control group. The prevalence of the arteries were statistically analyzed with sector analysis in the surgically relevant area.ResultsThe main arterial branches of this region could be well identified with each method. Statistical analysis showed that the arterial pattern was similar in all subjects. The prevalence of major arteries is low in the upper posterior area though large in proximity to the auricle region.ConclusionsDiverse methods indicate the advantages of a posterior superior incision because the major arteries and nerves are at less risk of damage and best preserved. Although injury to these structures is rare, when it occurs, the distal flow is compromised and the peri-implant area is left intact. Hand-held Doppler is efficient and cost-effective in finding the best position for incision, if necessary, in subjects with a history of surgical stress to the retroauricular skin.Trial registrationThis was a non-interventional study.

Bullous pemphigoid (BP) is characterized immunologically by tissue-bound and circulating autoantibodies targeting the hemidesmosomal proteins BP230 and BP180. Recent evidence suggests a pathophysiological role for autoantibodies against alpha6 integrin in the subepidermal blister formation of oral pemphigoid. The objective of our study was to investigate the presence of anti-alpha6 integrin antibodies in patients with classical BP. The autoantibody profiles of 30 patients with BP, 10 patients with pemphigus vulgaris, and 20 healthy persons were identified. With the use of PeptideStructure and PlotStructure software, four different antigenic epitopes for alpha6 integrin were predicted, and their fusion recombinant constructs were prepared in an E. coli expression system. Sera were tested for alpha6 integrin autoantibodies by an ELISA technique. Altogether, 52% of the patients with BP displayed circulating antibodies against at least one recombinant protein. Our findings provide the first evidence for the presence of anti-alpha6 integrin antibodies in patients with classical BP.

Introduction: Early cochlear implantation enables prelingual deaf individuals to become full members of the hearing society. Although early diagnostics are widely accessible and enable early rehabilitation, implant surgery often may be delayed due to a candidate’s young age. Aim: The authors’ objectives were to determine the anatomical parameters of the pediatric and adult temporal bone that are relevant to cochlear implantation and to ascertain the differences between them in order to assess whether the anatomical differences could influence the surgical technique and the timing of surgery. Method: Along with a survey of the literature, findings from the authors own cochlear implantees were assessed with respect to the most relevant dimensions of the internal electronic package, including the stimulating electrode of the cochlear implant, by measuring the squama of the temporal bone, the mastoid cavity and the facial recess on high resolution computed tomographic images. Results: The skull and the overlying soft tissues proved to be thinner and the mastoid cavity was less developed in children than in adults, while no significant changes were noted in the size of the facial recess. Conclusions: It is recommended to choose modern, thin implants that do not require sinking the implant package into a bone bed. Less bone work in infants and children enables excellent visualization of the round window through the underdeveloped mastoid cavity, which makes the procedure less time-consuming and minimally invasive. Indeed, a young age should alert ear surgeons to be cautious, but no higher risk of injury to important structures is predicted for young subjects than those that might occur in adults. Orv Hetil. 2019; 160(24): 936–943.