Hearing threshold level data were available for 12 patients recruited from 6 of the centres. Median increases in hearing threshold levels were 23, 27 and 33 dB for the frequencies 125, 250 and 500 Hz, respectively. These median increases include the data for two patients who had total loss of residual hearing due to difficulties encountered during surgery. "Cochlear view" X-ray images indicated that the depth of insertion varied between 300 and 430 degrees, despite modest variations in the length of the electrode inserted (17-19 mm). The insertion angle had some influence on the preservation of residual hearing at frequencies of 250-500 Hz. Six of the 12 patients retained sufficient hearing for effective use of an ipsilateral ITE hearing aid (< or = 80 dB HL at 125 and 250 Hz; < or = 90 dB HL at 500 Hz). Word recognition scores in quiet were improved from 10% to 30% with the cochlear implant plus ipsilateral hearing aid in 3 patients who had at least 3 months postoperative experience. Signal:noise ratio thresholds for sentence recognition were improved by up to 3 dB. Patients reported that they experienced greatly improved sound quality and preferred to use the two devices together.
The present multicentric clinical study involves 19 centres, 16 of them in German-speaking countries, 1 British, 1 Polish and 1 Hungarian. 60 postlingually deafened adults with a mean age of 47.5 years (20–70) and a mean duration of deafness of 5.3 years (0.5–20) have been evaluated with the MED-EL COMBI 40 cochlear implant which implements a high-rate continuous-interleaved-sampling strategy with 8 channels. Safety and effectiveness data have been collected. Speech perception tests include a 16-consonant, an 8-vowel, a sentence and a monosyllabic-word test in all languages and a 2-digit figure test in all languages but English. Test intervals are 1,3,6 months and 1 year after first fitting. 41 of the 60 postlingually deafened adult study patients have completed their 6-month evaluation. While their pre-operative monosyllabic-word score was 0%, their mean monosyllabic-word score 6 months after first fitting was 48% (8–90) with a median of 50%. The mean sentence understanding was 84% (24–100) with a median of 90%. The respective values for the 1-year evaluations with 25 patients are a mean of 50% (5–85), with a median of 60%, for the monosyllables and a mean of 89% (30–100), with a median of 97%, for the sentences.
Die pathophysiologischen Ursachen des Tinnitus sind nicht gesichert. Nach Auslösung des Tinnitus, z.B. durch eine Schädigung des Cortischen Organs, kommt es bei den Betroffenen mit verstreichender Zeit häufig zu zentralnervösen Funktionsänderungen auch gesunder Strukturen mit Manifestation als chronischer Tinnitus. Nach Beck [4] reagieren die Stria vascularis und die Zellen des Cortischen Organs einförmig auf die unterschiedlichen Schädigungen. Ein Ödem führt evtl. bis zum Verschluß der funktionellen Endgefäße und blockiert letztlich die Mikrozirkulation. Sauerstoffmangel in der Cochlea behindert zumindest den Funktionsstoffwechsel. Er wird letztendlich, unabhängig von der Art der Noxe, als Endursache für den akuten Tinnitus gesehen [61, 20, 3, 5]. Histologisch wurden u.a. Verände-rungen der Mitochondrien und des Zytoskeletts, Ablösung der Haarzellen von der Tektorialmembran [55], Schwellung und Strukturveränderung der Nervenfaserenden [50] beobachtet. Positive Behandlungsergebnisse beweisen, daß ein irreversibler Zelluntergang nicht zwingend ist.Ti nnitus, in akuter oder chronischer Form, ist eine der häufigsten Diagnosen in einer Hals-Nasen-Ohren-Praxis. Sowohl der individuelle Fall als auch die Organisation einer Tinnitussprechstunbedürfen eines klaren Behandlungskonzepts.Beim chronischen Tinnitus ist dies mit der Einführung der Retrainingtherapie durch Jastreboff (1994( ) und Hazell (1994 in den angloamerikanischen Staaten und durch Biesinger ( ) und Kellerhals (1996 im deutschsprachigen Raum gegeben.In Deutschland wird im Gegensatz zu den angloamerikanischen und vielen europäischen Ländern auch die Akutbehandlung des Tinnitus durchgeführt und wissenschaftlich untersucht . Die Leitlinien hierfür wurden von der DEUT-SCHEN GESELLSCHAFT FÜR HALS-NASEN-OH-RENHEILKUNDE, KOPF -UND HALSCHIRURGIE erarbeitet. Die Literatur zu diesem Thema ist spärlich und hat bislang zu keinen feststehenden und geprüften Therapiemaßnahmen geführt.Interpretiert man einen akuten Tinnitus als Hörsturzäquivalent, so wird nach den Behandlungsmöglichkeiten des Hörsturzes verfahren. Auch diese Verfahren sind bislang nicht in ausreichender Form gesichert.Die vorliegende Arbeit soll zum gegenwärtigen Stand der Diskussion über die pathophysiologischen Modelle und zur Therapie des akuten und chronischen Tinnitus Stellung nehmen und die klinischen Erfahrungen aus Praxis und Klinikalltag einbeziehen.Die Betreuung der Tinnituspatienten ist oft aufwendig, und die notwendigen ausführlichen Gespräche sind zeitraubend.Durch Kürzung und Budgetierung der Gesprächsleistungen ist dem niedergelassenen HNO-Arzt und den ambulant tätigen Kliniken eine adäquate Abrechnung zur Zeit allerdings nicht möglich.
The localization and distribution of vasoactive intestinal polypeptide (VIP), peptide histidine methionine (PHM), the novel peptide helospectin, neuropeptide tyrosine (NPY) and its C-flanking peptide (C-PON), substance P and calcitonin gene-related peptide (CGRP) were studied in the middle and inferior turbinate of the human nose using sensitive immunocytochemical and radioimmunological methods. For light microscopy, double immunofluorescence and immunogold-silver staining methods were applied. Ultrastructural immunoelectronmicroscopy was performed using a pre-embedding method. In addition, semithin Epon resin sections were immunostained. The concentrations of VIP, NPY, CGRP, substance P and neurokinin A were measured using radioimmunological methods. A dense network of autonomic and peptidergic nerve fibers in the normal human nasal mucosa was demonstrated. Colocalization studies showed the coexistence of peptides with components of the autonomic nervous system. Scattered chromogranin A-, CGRP and bombesin-flanking peptide (BFP)-immunoreactive endocrine-like cells were detected within the lamina propria and in groups within exocrine ducts. Highest radioimmunoassay (RIA) tissue concentrations were detected for VIP, followed by NPY, substance P, CGRP and neurokinin A.
Recently, a 342-kb deletion involving GJB6 was associated with autosomal-recessive nonsyndromic hearing loss (NSHL) and in combination with a GJB2 mutation with digenic NSHL. This deletion was the second most common mutation causing prelingual NSHL in Spain, and was frequently observed in patients from France and Israel. We screened 393 patients with NSHL being negative or heterozygous for GJB2 mutations for this GJB6 deletion using a multiplex PCR. Most patients were of Austrian (84.2%), and the other patients were of Turkish, Serbian, and Bosnian origin. None of these patients was carrying the deletion in GJB6 indicating that the occurrence of this deletion is restricted to certain populations.
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