Biomedical subjects

Ingo Todt

Publications and source records attributed to Ingo Todt.

14 recordsLinked to original sources

PubMed2006

Esophagus atresia after cervical spine surgery: case report and literature review.

We report on a case of esophageal atresia following cervical spine surgery. A swallowing examination was performed using fibre-optic endoscopy and videofluoroscopy. There was scar tissue fixation of the larynx and esophagus to the cervical spine. Operative mobilization of the larynx and esophagus and formation of a sliding layer using a platysma-fascia flap was done. The PEG and tracheal cannula were removed; oral nutrition was initiated after 3 months. Swallowing disorders following operations on the upper cervical spine should be investigated. Careful preparation that preserves the layers should be carried out. Fixation of tissues as a result of scarring should be treated with a sliding layer.

Cervical Vertebrae↗

PubMed2006

Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach--report of six cases.

A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect was then closed using a vascular pedicled musculofascia flap derived from the infrahyoid musculature. In all cases, the flap healed into place without complications. The patients began taking oral nutrients after an average of seven postoperative (5-12) days. In none of the cases did functional disorders or complications arise during the follow-up period (1-5 years). The infrahyoid muscle flap is well suited for reconstruction of the posterior pharyngeal wall and the upper esophagus.

Adult↗

PubMed2006

The application of vestibular-evoked myogenic potentials in otoneurosurgery.

OBJECTIVE: To evaluate the applicability of vestibular-evoked myogenic potentials (VEMPs) in the diagnostics, intraoperative monitoring, and postoperative follow-up of patients in otoneurosurgery. STUDY DESIGN: A prospective study of patients who underwent either cochlear implantation (CI, n = 18) or were diagnosed with an acoustic neuroma (AN, n = 9) or with neuro(micro)vascular compression of the VIIIth nerve (NVC, n = 27) in the period 2002 to 2004. The follow-up was 1 year for all patients. SETTING: A tertiary-referral unit. RESULTS: VEMPs could be recorded in 64% of all patients before CI and in 22% after surgery. The patients with AN had normal VEMPs in 22% of all cases when first diagnosed. Normal VEMPs were found in 37% of those patients with NVC. From the 5 AN patients who had to be operated, only 1 had intact VEMPs after surgery. In contrast, after microvascular decompression all patients (4) had normal VEMPs. CONCLUSIONS: VEMPs are helpful in diagnosing patients with vertigo to better identify saccular defects. They are highly sensitive in the early diagnosis of retrocochlear lesions. SIGNIFICANCE: VEMPs can help to reliably identify patients with a retrocochlerar lesion at an early stage and can be used in intraoperative, neurophysiological monitoring. EBM RATING: C-4.

Adolescent↗

PubMed2006

Perioperative recordings of vestibular-evoked myogenic potentials in otosclerosis.

OBJECTIVES: The aim of the present study was to investigate saccular function in patients with otosclerosis. Furthermore, the influence of stapedotomy on the vestibular-evoked myogenic potentials (VEMPs) should be demonstrated. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. METHODS: Bone-conducted tone-burst-evoked VEMPs were measured in 23 patients (25 ears) with unilateral or bilateral otosclerosis preoperatively and postoperatively. RESULTS: Preoperatively, VEMPs could be recorded in 11 ears (44%). There was no statistically significant correlation among the extent of preoperative sensorineural hearing loss, age, and VEMP measurements. Postoperatively, VEMPs were found in 14 ears (56%). In three cases (12%), VEMPs reappeared after surgery. The rare cases of preoperative vertigo could not be correlated to the nonappearance of VEMPs. CONCLUSION: Stapedotomy surgery does not influence VEMPs, implying that the saccular receptors are not injured by surgery. Moreover, in some cases, the elicitability of VEMPs was improved by stapedotomy surgery. Seemingly, otosclerosis can influence the generation of VEMPs most probably due to an involvement of the otolith organ's saccular receptors. No correlation was found between the clinical occurrence of vertigo and the elicitability of VEMPs.

Adult↗

PubMed2005

Hearing benefit of patients after Vibrant Soundbridge implantation.

The present paper compares the audiometric results of different digital Vibrant Soundbridge audio processors (D and Signia) of patients with mild to severe sensorineural hearing loss. In a retrospective study, the audiometric results were evaluated and compared in terms of functional gain of warble tone measurements and speech audiometric data. 23 patients implanted between 1998 and 2003 with the Vibrant Soundbridge were included. At the time of implantation, they fulfilled the indication criteria for an implantation (7 patients with a D type, 16 with a Signia type while 3 patients changed from the D to the Signia type). The mean functional gain was increased from 22.8 dB (+/-6.5 dB SD) in the D type to 29.8 dB (+/-2.9) in the Signia type group. The speech-in-noise understanding was better in the Signia compared to the D type (59.3 +/- 11.5 dB and 65.7 +/- 10.1 dB, respectively). The latest upgrade of the external processor from the 3-channel, digital D type to the 8-channel, digital Signia type led in our data to an auditory benefit in all patients.

Adult↗

PubMed2005

Vestibular dysfunction of patients with mutations of Connexin 26.

The gap junctional network of the inner ear plays an important role in cochlear ionic homoeostasis. Mutations of connexin 26 can induce different types of hearing loss and even deafness. Therefore, it is hypothesized that gap junctions of the human vestibular organ are functionally impaired by mutations of connexin 26. In a prospective, nonrandomized study, the functional status of the semicircular canals and the otolith organs was assessed in one homozygous and six heterozygous carriers of connexin 26 mutations. Five out of seven patients (71.4%) had pathological vestibular evoked myogenic potentials, indicating a loss of saccular function. The utricular function (as tested by subjective haptic vertical) and the function of the semicircular canals (as tested by recording the vestibuloocular reflex) were largely normal. Thus, connexin 26 mutations can be associated with saccular defects of the vestibular receptors.

Adult↗

PubMed2005

Normative data for P1/N1-latencies of vestibular evoked myogenic potentials induced by air- or bone-conducted tone bursts.

OBJECTIVE: The response characteristics of acoustically elicited vestibular evoked myogenic potentials (VEMPs) largely depend on the stimuli applied. A tone-burst stimulation of 500 Hz seems to be clinically most appropriate because those VEMPs can be elicited at the lowest stimulus intensity possible. The aim of the present paper was to describe normative data for tone-burst evoked VEMPs. METHODS: VEMPs of 64 healthy subjects were recorded ipsilaterally during air- or bone-conducted tone burst stimulation. The EMG of the tonically activated sternocleidomastoid muscle was recorded ipsilaterally by surface electrodes. Averages were taken for P1/N1-latencies and -amplitudes of male and female volunteers within 3 different age groups. RESULTS: The latencies did not show any significant differences between female and male volunteers or between air- and bone-conducted stimulation. The latencies did also not show any significant difference among the 3 age groups. The limits for normal latencies (mean + 2 SD) are, therefore, 20.3 ms for P1 and 28.0 ms for N1. Although the P1/N1-amplitudes were decreased with increasing age, the tonic muscle activity was not significantly different between the age groups. CONCLUSIONS: The present findings strongly suggest the evaluation of VEMP latencies by using normative values obtained exactly with the same stimulus parameters. SIGNIFICANCE: Normative data as described in the present study are required to detect isolated saccular defects which are indicative of a vestibular disorder.

Acoustic Stimulation↗

PubMed2005

Postural control in otolith disorders.

It was the aim of the present paper to investigate the influence of otolith disorders on human postural control by different methods. The 33 patients of our study had undergone a minor head injury and suffered subsequently from an utricular or sacculo-utricular disorder as evidenced by vestibular evoked myogenic potential recordings and eccentric rotation recordings of the otolith-ocular responses. Postural control was assessed by performing stance/gait tests (standard balance deficit test, SBDT) and by evaluating trunk sway (using angular velocity sensors). Moreover, classical tests of the posterior column of the spinal tract (Romberg/Unterberger) and the dynamic posturography (sensory organization test, SOT) were included. It could be shown that SBDT tasks with reduced proprioceptive and visual cues (e.g. standing on foam, eyes closed) are most sensitive for an otolith disorder. The patients showed an increased trunk sway in the pitch plane (i.e. linear motion as adequate utricular stimulus) and an increase in sway velocities (i.e. tilting movements as adequate saccular stimulus) compared to controls. The SOT was most sensitive for combined (sacculo-utricular) otolith disorders (78%) while vestibulospinal tests are not enough sensitive. In essence, otolith disorders evidently impair human postural control and have been possibly underestimated as a source of posttraumatic postural imbalance as yet.

Adult↗

PubMed2005

Management of posttraumatic vertigo.

OBJECTIVE: To evaluate patients after blunt trauma of the head, neck, and craniocervical junction (without fractures) with vertigo and to report the results of treatment after extensive diagnostics. STUDY DESIGN: Prospective study of consecutive new cases with vertigo after trauma at different periods of onset. During 2000-2002, 63 patients were examined and treated. SETTING: Regional trauma medical center for the greater Berlin Area, tertiary referral unit. RESULTS: The primary disorders included labyrinthine concussion (18), rupture of the round window membrane (6), and cervicogenic vertigo (12). The secondary disorders included otolith disorders (5), delayed endolymphatic hydrops (12), and canalolithiasis (9). The patients were free of vertigo symptoms (except cervicogenic and otolith disorder) after treatment, which consisted of habituation training, medical and surgical therapy options. The follow-up was 1 year. CONCLUSION: Posttraumatic vertigo can be treated with a high success rate once the underlying disorder has been identified. The extent of the neurotological test battery determines the precision and quality of diagnostics. Surgical measures should be an integral part of treatment modalities if conservative treatment is not effective. SIGNIFICANCE: Minor trauma of the head, neck, and craniocervical junction can have major impact on the vestibular system at different sites. Patients need to be carefully diagnosed, even if the onset of vertigo occurs a few weeks or months after the initial trauma.

Adolescent↗

PubMed2005

The "pull-back" technique for Nucleus 24 perimodiolar electrode insertion.

OBJECTIVE: To observe the influence of electrode pull-back after cochlear implant insertion of Nucleus 24 perimodiolar electrodes. STUDY DESIGN: In a prospective intraoperative study, we analyzed the impedances, neural response telemetry responses, and the spread of excitation after cochlear implant electrode insertion and compared these data to those obtained after a subsequent, controlled pull-back of the electrode. Postoperative depth of electrode insertion was controlled by x-ray. SETTING: Tertiary referral center. SUBJECTS: Six patients (4 male, 2 female; 18 to 69 years) were implanted with a Nucleus 24 (RCA) cochlear implant with a perimodiolar electrode. RESULTS: After a controlled pull-back, a significant decrease of the spread of excitation at the stimuli electrodes 5, 10, 15, and a nonsignificant decrease at stimuli electrode 20 compared to the recordings after the primary normal insertion procedure was found. The mean electric compound action potential amplitude was increased with an apical-to-basal tendency. Impedances remained unchanged by the pull-back. Mean insertion depth at the postoperative x-ray control was 372 degrees (+/- 10.2). CONCLUSION: Controlled cochlear implant electrode pull-back is a novel technique that optimizes objective intraoperative electrophysiological recordings in patients implanted with a Nucleus 24 perimodiolar cochlear implant by a greater approximation of the electrode to the modiolus.

Adolescent↗

PubMed2004

Pathophysiological changes of the central auditory pathway after blunt trauma of the head.

It is the aim of the present paper to correlate clinical symptoms of auditory dysfunction (tinnitus, hyperacusis, hearing loss) one year on average after a blunt trauma of the head with objective audiological test results (otoacoustic emission and auditory brainstem response testing, impedance audiometry) and to compare these findings to controls without history of head trauma. Thirty-one patients (24-56 years) were included. They were largely female (n = 26). The clinical and otolaryngological examination (including otoscopy) of all patients revealed no pathological abnormalities. Pure-tone audiograms were normal with one exception (pre-existing noise-induced hearing loss) as well as tympanograms. The main auditory symptoms were tinnitus (n = 9), hyperacusis (n = 2) and a reported transient hearing loss immediately after the trauma (n = 16) (which had improved at the time of examination). The results of testing the central auditory pathway showed that the transiently evoked otoacoustic emissions (otoemissions) revealed statistically significant differences between amplitude differences of all patients as well as patients with tinnitus and controls in the linear, but not in the non-linear stimulation mode. A complete loss of stapedial reflex responses was found in 12 of the patients and a partial (irregular) loss (in at least more than two frequencies) in four additional patients. Auditory brainstem responses (ABR) were normal in all patients, but 76% had lowered loudness discomfort levels (LDL). Blunt trauma of the head can lead to auditory dyfunction, probably as a result of diffuse axonal injury of the central auditory pathway. An initial sensorineural hearing loss after the trauma (as a result of the inner ear fluid concussion) was transiently reported only. Auditory symptoms play a minor role in the so-called "postconcussive syndrome," but should be considered and evaluated fully.

Adult↗

PubMed2004

MRI scanning and incus fixation in vibrant soundbridge implantation.

OBJECTIVE: Presentation of patient data after Vibrant Sound-bridge (VS) implantation/explantation with respect to magnetic resonance imaging (MRI) compatibility and stability of incus fixation of the implant. STUDY DESIGN: In a retrospective case review, we report on two patients who had to be diagnosed by cranial MRI scans after previous implantation of a VS. Moreover, in one of these cases, the incus was removed after explantation of the VS because of a peripheral hearing loss. This enabled a microscopic evaluation of the incus. At the long process of the incus, the floating mass transmitter (FMT) has been fixed for 4 years. SETTING: Tertiary referral center. SUBJECTS: Two patients who fulfilled, at the time of implantation, the criteria for implantation of a VS. RESULTS: In both cases, no demagnetization of the external magnet nor of the FMT were found. Device function after the MRI scans were normal. Pure-tone audiometric thresholds remained unchanged after the MRI scanning and the scanning-related magnetic forces. In both cases, the FMT fixation of the incus was found to be regular. In one case, the fixation was checked by an additional tympanoscopy 1 year after the implantation, and in the other case it was assessed by recording the functional gain of the VS (which was normal) after the MRI scanning. One patient complained about a transient hyperacuity due to the loudness during the MRI scanning procedure. MRI scans showed a blackening of the implant area with spherical distortions of the picture. CONCLUSION: Although MRI scanning (at 1.5 tesla [T]) with the FMT in place did not lead to adverse effects in the two patients, systematic in vitro studies are required to determine a possible magnetization threshold that could impair the VS function when MRI scans are applied in those patients. The microscopically observed erosions of the long process of the incus after 4 years of FMT clamp fixation show similarities to findings after stapes revision surgery. However, this limited experience in one case does not allow us to make conclusions on the long-term stability of the incus fixation.

Audiometry, Pure-Tone↗

PubMed2002

Functional gain of already implanted hearing devices in patients with sensorineural hearing loss of varied origin and extent: Berlin experience.

OBJECTIVE: The evaluation process of patients with sensorineural hearing loss (SNHL) as candidates for an implantable hearing device is a complex matter. Different criteria have to be considered, such as audiologic, psychological, and socioeconomic issues, presently fitted hearing aids, and the patient's satisfaction with hearing aids. The objective of this study was to describe the evaluation process to select candidates for implantation of the Vibrant Soundbridge system (Symphonix Devices, Inc., San Jose, CA, U.S.A.) in a capital area such as Berlin, where approximately 4 million people live. STUDY DESIGN: Retrospective chart review with additional clinical and audiologic testing and extensive interview of the patients. SETTING: The study was conducted at two referral centers. PATIENTS: A total of 45,350 pure-tone audiograms (PTAs) and speech audiograms (samples from 1987 to 1999) of patients with different extents and types of SNHL were screened. MAIN OUTCOME MEASURES: The PTA, speech audiograms, Abbreviated Profile of Hearing Aid Benefit questionnaire, and a telephone interview served as major criteria. However, several additional criteria in the evaluation and in the decision-making process were included and are described in detail. RESULTS: Of 45,350 patients' charts with their PTA, 346 patients appeared to be possible implant candidates (0.76%) because of their hearing loss. At the time of the hearing screening, 255 patients (0.56%) were possible candidates for the P-type Soundbridge audio processor, and 91 patients (0.2%) were possible candidates for the HF-type processor. Out of the initial 346 patients, 84 (24.3%) were not interested in being further tested or interviewed and declared their lack of interest in the implant technology for several reasons (e.g., satisfaction with their present hearing aid fitting, anxiety to be operated on). A total of 126 patients (36.4%) could be contacted neither by mail nor by telephone. A total of 61 patients (0.13%) declared that they were basically interested, but wanted to wait for further technological refinements (e.g., fully implantable devices). The remaining 75 patients (i.e., 0.16% of the total population screened) could be clinically reevaluated with regard to our standardized protocol. Because of clinical and other reasons, another 33 patients (0.07%) had to be excluded from this study. The resulting 42 patients (0.09%) were undergoing the final ABHAB interview and were ready to be implanted. CONCLUSION: The number of patients in a stochastic population who are realistic implant candidates for an implantable hearing device is limited. Although there are many more patients suffering from SNHL who meet the requirements of the implant system because of their audiograms, the complexity of a careful evaluation process extremely limits the number of implant candidates. Moreover, reimbursement restrictions in the present health economy worldwide have to be considered.

Adult↗

PubMed2002

Comparison of different vibrant soundbridge audioprocessors with conventional hearing AIDS.

OBJECTIVE: To compare the functional gain of different Symphonix Soundbridge audioprocessors (HF-processor and D-processor) to preoperatively fitted conventional hearing aids of patients with mild to severe sensorineural hearing loss in the high-frequency range. STUDY DESIGN: In a prospective study, the Symphonix Soundbridge (HF-processor and D-processor) fitting results were evaluated and compared with conventional hearing aids. Postoperative air and bone conductances, the functional gain of warble-tone measurements, speech audiometric, and subjective outcome testing (Abbreviated Profile of Hearing Aid Benefit questionnaire) were studied. SETTING: Tertiary referral center. PATIENTS: Five patients (ages, 54-69 yr) with mild to severe sensorineural deafness in the high-frequency range, but no progression of hearing loss during the last two years, were initially fitted with the so-called HF-processor, then subsequently fitted with the D-processor, which was a fully digital one. RESULTS: One year after implantation of the Symphonix Soundbridge device, unchanged, stable air and bone conductances were found (except for one minor change). Over the whole frequency range (0.5-8.0 kHz), a mean gain of 16.1 dB (HF-processor), 27.1 dB (D-processor), and 15.2 dB (hearing aid) was found. The Symphonix Soundbridge device with different audioprocessors led to improved hearing in speech audiometric testing. The data show a significant improvement of hearing compared with conventional hearing aids in quiet, and a better functional gain in noise for the Symphonix Soundbridge system. The Abbreviated Profile of Hearing Aid Benefit questionnaire also revealed that the implant resulted in significant differences compared with conventional hearing aids in almost all subcategories. CONCLUSION: The Symphonix Soundbridge device can improve the hearing benefit of moderately to severely hearing handicapped patients-particularly in those with a high-frequency hearing loss-when compared with the conventional hearing aids of these patients, as evidenced by objective and subjective measurements. The Symphonix Soundbridge D-processor showed further improvements and resulted in an additional hearing benefit that was superior to that of the previously fitted HF-audioprocessor. This is owing to the refinements and upgrades in audioprocessor technology.

Acoustic Stimulation↗