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Biomedical subjects

R Laszig

Publications and source records attributed to R Laszig.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Effect of anesthesia on the intraoperative elicited stapedius reflex].

Evaluation of the intraoperative electrically evoked stapedius reflexes during cochlear implant surgery has two purposes: (1) The functioning of the device and the peripheral auditory pathways can be proven immediately and (2) The data of reflex threshold can be used for the prediction of later threshold (T)- and maximum comfortable (C) levels. This is especially useful for the later fitting of the speech processor in very young children. When trying to use the stapedius reflex data for the prediction of T- and C-levels it must be considered that during surgery the drugs used for general anaesthesia influence the values of the stapedius reflex. Depending on the drug, the stapedius reflex threshold can be increased or the reflex can even be totally blocked. This is not only due to relaxants but also to anaesthetics. To investigate this influence we first determined the acoustically evoked stapedius reflex threshold in normal hearing adults under general anaesthesia with 7 different anaesthetics without additional relaxation. It was found that especially with Dormicum and Brevimytal the stapedius threshold increased only very lightly or did not change at all. In a second investigation the electrically evoked stapedius reflex thresholds were obtained in adults who underwent a cochlear implant surgery using the same anaesthetics for anaesthesia. The intraoperatively evaluated reflex data were compared with postoperatively obtained data. It was found that both reflex thresholds were similar if evaluated in Dormicum or Brevimytal anaesthesia. This suggests that only with the use of the right anaesthetics the data of the electrically evoked stapedius reflex obtained intraoperatively can be used for predicting T- and C-levels.

Anesthesia, General↗
PubMed1994

[Implantation on the cochlear nucleus. Apropos of a patient with bilateral neuroma].

A new auditory brainstem implant (ABI), manufactured by Cochlear, was implanted in a young patient suffering from a large bilateral acoustic neuroma, associated with multiple other tumors due to a tuberor sclerosis of Bourneville. The operating procedure and the first results are described. A short historical summary, the anatomical basis and the difficulties due to side effects of stimulation are exposed.

Adult↗
PubMed1994

Complicated Cogan's syndrome with aortic insufficiency and coronary stenosis.

We describe a case of Cogan's syndrome in a 19-year-old woman with tinnitus, deafness, interstitial keratitis, and complicating aortic insufficiency and coronary stenosis. Serological testing revealed IgG and IgA antibodies against Chlamydia trachomatis. In spite of very high antibody titers there was no direct evidence for C. trachomatis in her urogenital smears or in biopsies of her aortic adventitia, and therefore these findings are of uncertain significance. Reconstruction of the aortic valve and bypass surgery for an ostial stenosis of the left coronary artery were necessary. Ten months after starting cyclosporine treatment her course was stable and cochlear implant surgery was successfully performed.

Adult↗
PubMed1994

[Preoperative diagnosis in children with congenital and acquired deafness with reference to cochlear implants].

Total deafness in children can be covered with cochlear implants. There are only few general guidelines which have to take into considerations. We have not the same diagnostic tools available like in adults. More than in adults an individual decision has to be made in children. To provide children with an intracochlear multichannel device it has to be organized a sufficient working system of rehabilitation.

Audiometry, Evoked Response↗
PubMed1993

Stimulus-inadequate sensations in cochlear implant patients.

From August 1984 to April 1987 the Department of Otolaryngology at the Medizinische Hochschule in Hannover implanted the NUCLEUS 22 channel cochlear implant system (CI) in their first 56 adults. Since implantation, 27 (51%) patients have described undesirable sensations from their implant. These were defined as stimulus-inadequate sensations (SIS) and were classified into three types: 1) pain-like sensations; 2) high-frequency sensations; and 3) non-stimulation. Twenty-three patients were radiographically investigated by polytomography. All of the intracochlear electrodes were visualised and a correlation between SIS and the radiological findings was established. It was found that i) SIS similar to pain are caused by electrical stimulation of the mucous membranes and periosteum of the tympanic cavity; ii) the high-frequency SIS seemed to be due to non-physiological electrical stimulation of the basal ganglion cells; and iii) the reason for non-stimulation is probably damaged electrodes and fibrosis around the electrode. Conventional tomography is the method of choice for estimating the number and configuration of intracochlear electrodes.

Adolescent↗
PubMed1993

Osteogenesis imperfecta: clinical symptoms and update findings in computed tomography and tympano-cochlear scintigraphy.

Osteogenesis imperfecta (OI) is an autosomal-dominantly inherited connective tissue disorder characterized by abnormal bone fragility combined with blue sclerae. The association of OI with hearing impairment is commonly known as Van der Hoeve-de Kleyn syndrome. Besides typical symptoms we here report on findings by high resolution CT and by high resolving scintigraphy of the labyrinthine capsule in 3 families (9 patients) with OI, which resemble those in otosclerosis (OS): In 4 of 6 cases with OI and mixed hearing loss, severely decreased peri-cochlear bone density was established by CT. In these cases, increased bone metabolism could be revealed by high resolving tympano-cochlear scintigraphy (TCS) in the cochlear region. In 2 patients with mixed hearing loss and 3 cases without hearing impairment or with slight conductive hearing loss, bone alteration was not detectable by CT and TCS. These results raise the question whether OI and OS lead to similar labyrinthine bone alterations, based on different aetiologies or whether these diseases may co-exist, OS being part of OI.

Adolescent↗
PubMed1993

[Extensive hearing loss and deafness in adults].

Hearing and understanding are two related, yet different processes. Hearing is the perception of sound. It can be of enormous value to patients with severely impaired hearing, as it facilitates acoustic orientation. An understanding of speech, however, remains virtually impossible for most of these patients. Nevertheless, early habituation to their acoustic situation makes lip-reading much easier, thus enabling conversations to be possible in good listening environments. Severely impaired patients, however, are still not in a position to follow conversation in larger groups. Even with hearing aids and the deployment of the latest technology, sufficient help is not always given. Before making a decision on the use of these technical aids, the ENT specialist should discuss the needs of the particular individual with the hearing-aid specialist. Provided that residual hearing can be used to understand speech with the help of a hearing aid, intracochlear implantation of an electronic prosthesis is not indicated. A cochlear implant is indicated when there is a complete hearing loss on both sides. Such a profound loss means that sufficient understanding of speech is no longer possible, even with the assistance of the latest hearing aids. For most adults, deafness is a postlingual phenomenon. Adults who were born deaf or who lost their hearing in childhood tend to be unsuitable for cochlear implantation. Up to the age of six years, however, children born deaf can benefit considerably from a cochlear implant. Children who are provided with a cochlear implant shortly after becoming deaf also have a good chance of being capable of learning and understanding speech.

Adult↗
PubMed1992

[Rosai-Dorfman syndrome. On the differential diagnosis of lymph node swelling].

The Rosai-Dorfman syndrome is a benign disease, one of its commonest affected sites being the cervical lymph nodes. This disease should be considered in the differential diagnosis of a cervical lymphadenopathy. The syndrome often begins with a chronic rhinitis, and is accompanied by sinusitis, tonsillitis or pharyngitis; blood tests indicate chronic infection. The pathogenesis of the disease is still unknown but may include infection or an abnormal autoimmune reaction. The diagnosis is established by the findings of characteristic histiocytes with haemophagocytosis. We report a female patient with persistent cervical lymph node swelling resistant to treatment. The cause was proved by histology to be a Rosai-Dorfman syndrome.

Diagnosis, Differential↗
PubMed1992

[Late results of endonasal ethmoid bone operation with special reference to polypous sinusitis].

Out of total of 164 patients with chronic sinusitis undergoing intranasal microsurgery, 94 patients were submitted to a detailed analysis one year later. The patients were divided into groups of polypoid and hyperplastic sinusitis, depending on the morphological appearances and the histology of the tissue removed. Patients with polyps showed a significantly higher rate of recurrent (47%) than patients with hyperplastic sinusitis (8.6%). Allergy or bronchial asthma did not influence significantly the rate of recurrence in patients with nasal polyposis, whereas patients with a hyperplastic sinusitis showed a higher recurrence rate if they were atopic as well. However, even patients with polypoid sinusitis gained marked long-term relief of nasal obstruction and other symptoms.

Asthma↗
PubMed1991

Transoral transpalatal removal of a giant premesencephalic clivus chordoma.

Due to their surgical inaccessibility and resistance to radiotherapy, clivus chordomas represent a formidable therapeutic challenge. The transoral approach to chordomas of the clivus has been usually restricted to relatively small or midsized neoplasms, located at the lower end of the clivus or at the anterior clival-cervical junction. In this report the transoral transpalatal transclival removal of a giant recurrent chordoma occupying the whole length of the clivus with considerable premesencephalic extension and brain stem compression is described. Regression of preoperative symptoms without additional postoperative morbidity could be achieved by radical transoral tumour extirpation documented by magnetic resonance imaging.

Aged↗
PubMed1991

[Postoperative conventional tomography of the temporal bone in the assessment of inadequate perception in patients with cochlear implants].

Between August 1984 and August 1990, 166 patients received a 22-channel cochlear implant (Nucleus) in the ENT clinic in Hannover. Some of these patients who were able to understand speech nevertheless complained of inadequate perception. To study this further a phantom skull with a cochlear implant was examined by CT and by conventional tomography of the petrous bone in various image planes. The method of choice for evaluating the position and appearance of the cochlear implant proved to be conventional tomography of the petrous bone in the frontal transorbital plane. In 7/23 patients examined it was possible to demonstrate dislocation of the electrodes; this is evidently responsible for the faulty perception.

Adolescent↗
PubMed1991

Surgical complications with the cochlear multiple-channel intracochlear implant: experience at Hannover and Melbourne.

The surgical complications for the first 153 multiple-channel cochlear implant operations carried out at the Medizinische Hochschule in Hannover and the first 100 operations at the University of Melbourne Clinic, The Royal Victorian Eye and Ear Hospital, are presented. In the Hannover experience the major complications were wound breakdown, wound infection, electrode tie erosion through the external auditory canal, electrode slippage, a persistent increase in tinnitus, and facial nerve stimulation. The incidence of wound breakdown requiring removal of the package was 0.6% in Hannover and 1.0% in Melbourne. The complications for the operation at both clinics were at acceptable levels. It was considered that wound breakdown requiring implant removal could be kept to a minimum by making a generous incision and suturing the flap without tension.

Australia↗
PubMed1990

Electrically elicited stapedius reflex in cochlear implant patients.

Electrically elicited stapedius reflexes were examined in 25 deaf patients who had received a 22-channel Clark/NUCLEUS cochlear implant. Using an apical, a medial and a basal electrode pair, different stimulation positions within the cochlea and different stimulation modes were examined. For threshold determination, 10 reflexes were averaged with reflexes recorded on the nonoperated side. Reflexes were elicited in 19 of the 25 patients (76%); a saturation of reflex amplitude could be recorded in 14 (56%) subjects. In two additional cases, a reflex could be obtained by increasing the bipolar stimulation width (changing the stimulation mode). In comparison with different stimulation positions within the cochlea, the stimulation of apical electrodes produced more distinctive reflexes and required lower current levels. An increase in the bipolar stimulation width also decreased the intensity required for stapedius reflex threshold. Our data suggest that stapedius reflex evaluation may be a useful tool for speech processor fitting.

Adult↗
PubMed1990

Acute onset deafness in a 4-year-old girl after a single infusion of cis-platinum.

Dose-dependent reduction of auditory function mainly in the high frequency range has been described as a common adverse side effect of cis-platinum. Here we report on a 4-year-old girl with osteosarcoma of the right distal femur who developed acute bilateral deafness 3 days after a single infusion of high-dose cis-platinum (150 mg/m2) during preoperative chemotherapy. Sudden disabling ototoxicity should be considered when administering high-dose cis-platinum to young children.

Acute Disease↗