Short-term severe thyroid hormone deficiency does not influence sleep parameters

PURPOSE

The influence of short-term severe thyroid hormone deficiency on sleep is currently still unknown. Several studies have demonstrated an effect of long-term hypothyroidism on sleep disorders due to anatomical changes of the pharynx or body mass. The aim of this preliminary study, however, is to evaluate the changes in sleep patterns of patients with short-term hypothyroidism to elucidate the isolated effect of thyroid hormone withdrawal before anatomical changes can potentially occur.

METHODS

Ten patients with differentiated thyroid carcinoma were enrolled in this study. Two patients discontinued the study and one patient was finally excluded due to obesity, so that the datasets of seven patients were available for study analysis. During the course of carcinoma treatment, each patient had previously undergone total thyroidectomy and I-131 remnant ablation. Polysomnographic measurements were performed twice: (1) over the course of two consecutive nights during severe thyroid hormone deficiency after levothyroxine withdrawal and prior to further diagnostics and therapy and (2) during euthyroidism after substitution with levothyroxine.

RESULTS

Comparison of the Epworth Sleepiness Scale during hypo- and euthyroidism for each patient revealed no statistically significant difference. Furthermore, the comparison of polysomnographic parameters like (1) apnea-hypopnea index, (2) the duration of various sleep stages, (3) duration of rapid eye movement sleep, (4) latency until rapid eye movement sleep, (5) total sleep time, (6) periodic leg movements, and (7) arousal index showed no statistically significant differences between the hypothyroid or euthyroid state.

CONCLUSIONS

We conclude that, in this preliminary experimental setting, short-term severe thyroid hormone deficiency per se does not cause sleep disturbances and a feeling of fatigue as described in other studies may be due to changes in perception or brain metabolism during hypothyroidism.

[Direct recording from cochlear nerve via a ball-electrode in transtemporal acoustic neuroma surgery]

BACKGROUND

Intraoperative monitoring (IOM) of the cochlear nerve function during acoustic neuroma surgery is employed to assist in preserving hearing. So far, Auditory Brain-stem Response (ABR) is considered to be an optimal method for intraoperative monitoring in transtemporal approach. The aim of this study was to perform direct recording of the cochlear nerve action potential after resection of the tumor by using a ball-electrode and to evaluate the use of this method in predicting the postoperative hearing. The obtained data were compared to the simultaneous ABR results and to the postoperative hearing.

MATERIAL AND METHODS

In 2009, 38 patients have undergone acoustic Neuroma Surgery at the ENT University hospital, Wuerzburg. In 33 patients an intraoperative ABR as well as a direct measurement from the cochlear nerve using a ball electrode were performed. In 5 patients the postoperative hearing was predicted using the direct measurement at the cochlear nerve only.

RESULTS

The direct recording from the cochlear nerve gave very robust responses. Even in cases where ABR recording was not possible, the identification of clear cochlear nerve action potential could still be reached. Using the direct recordings from the cochlear nerve to predict the post operative hearing turned out to have a sensitivity of 100% and a specificity of 70%.

CONCLUSIONS

These results show that intraoperative monitoring with direct recording from the cochlear nerve via a ball-electrode in transtemporal approaches offers a valuable method to predict the postoperative hearing. Further investigation will be made to provide additional information.

[Traumatic atlanto-occipital dislocation in a calf]

In a 7-week-old calf neurologic symptoms occurred after an accident in the feeding grid. The calf was alert but in left lateral recumbency. After having been placed on its right side it showed a sideward drift to the left. Following head movement, an asynchronous movement of the eyes could be observed. Lesions of the upper motor neuron system, N. vestibulocochlearis, Nn. oculomotorius, trochlearis and/or abducens as well as N. vagus were suspected. Radiological examination of the occipital region and cervical spine revealed an atlanto-occipital subluxation of the atlas. Based on all these findings, the diagnosis of traumatic atlanto-occipital dislocation was made and the calf was euthanized. The pathological findings confirmed this diagnosis.

Traumatische atlantookzipitale Dislokation bei einem Kalb

Bei einem 7 Wochen alten Kalb traten nach einem Unfall im Fanggitter neurologische Symptome auf. Das aufmerksame Tier lag in linker Seitenlage fest und zeigte nach Umlagern in rechte Seitenlage einen Seitwärtsdrang nach links. Nach Lageveränderung des Kopfes bewegten sich die Bulbi asynchron. Es wurde eine Schädigung des oberen motorischen Neuronsystems, des N. vestibulocochlearis, der Nn. oculomotorius, trochlearis und/oder abducens sowie des N. vagus vermutet. Bei einer Röntgenuntersuchung des Okzipitalbereichs und der Halswirbelsäule ließ sich eine Subluxation des Atlas darstellen. Aufgrund sämtlicher Befunde wurde die Diagnose atlantookzipitale Dislokation infolge Trauma gestellt und das Kalb euthanasiert. Die pathologische Untersuchung bestätigte die Diagnose.

Massive haematoma formation associated with proximal popliteal artery haemangioendothelioma in a dog

A mixed breed dog presented with diffuse unilateral hind limb swelling, which ultrasound and cytology confirmed to be caused by severe haematoma formation. Multi-detector computed tomography (MDCT) angiography allowed distinct visualisation of an anomalous segment of the proximal popliteal artery, the presumed origin of the self-sustaining haematoma. Histopathology classified the malformed vessel as a haemangioendothelioma, a neoplasia of intermediate malignancy. Considering this as differential diagnosis to a neoplastic vascular alteration of high malignancy (such as haemangiosarcoma) might alter choice of treatment in future cases with similar clinical and imaging findings.

[Clinical application of computed tomography in cattle]

Computed tomography involves the use of x-rays to produce cross-sectional images of body regions. It provides non-overlapping, two-dimensional images of all desired planes as well as three-dimensional reconstruction of regions of interest. There are few reports on the clinical use of computed tomography in farm animals. Its use in cattle is limited by high cost, the application of off-label drugs and the need for general anaesthesia. In cattle computed tomography is indicated primarily for diseases of the head, e.g. dental diseases and otitis media, and neurological disorders. Less often it is used for diseases of the vertebrae and limbs. In valuable cattle, the results of computed tomography can be an important part of preoperative planning or be used to avoid unnecessary surgery when the prognosis is poor.

[Traumatic optic neuropathy: a review of the literature in the light of personal experiences]

BACKGROUND

Therapy of traumatic optic neuropathy (TON) is still discussed controversially. Studies of medical treatment and surgical decompression of the nerve could not find any correlation between therapy and result. Today's knowledge of the treatment in TON is to be analyzed by the latest results in the literature, supplemented by personal experiences with our own patients, who underwent a combination of corticosteroids and surgical decompression.

METHODS

The study group consisted of 9 patients at the age of 13-58 years. 8 patients suffered from a cranial trauma, 1 patient had sinus surgery, which resulted in an indirect damage of the optic nerve. Pretherapeutically, 5 patients had residual vision, 4 patients were blind. A fracture line through the optic canal in the CT-scan was seen in 6 cases. Decompression was performed within 24 hours in 3 cases; in the worst 3 cases it took up to 8 days. In 8 patients the intervention was performed via an endonasal, microscopic-endoscopic approach, once it was done transfacially. Simultaneously, high-dose corticosteroids were administered.

RESULTS

All patients with a residual vision before therapy showed an improvement of their visual acuity: In the best case visual acuity changed from perception of light to 0.8. All patients with posttraumatic blindness remained blind after therapy.

CONCLUSION

A surgical decompression may be considered in patients with residual vision. Referring to the latest data in the literature endonasal, microscopic-endoscopic decompression is then to be combined with simultaneous application of high-dose corticosteroids. In our opinion, a mere wait-and-see strategy completely without any treatment can hardly be recommended.

[Voice disorders in asthma]

Aasthma is one of the most common chronic diseases with a prevalence of 5% in Germany. Nearly half of the patients complain about permanent voice disorders. Mucosal changes due to the obstructive respiratory disease as well as mucus abnormalities and regularly accompanying chronic rhinosinusitis may explain these symptoms. The additional influence of laryngopharyngeal reflux is discussed controversially. Additionally, dysphonia may as well occur due to side effects of the therapy with inhaled corticosteroids: the ingredients as well as physical effects may be responsible for the development of chronic laryngitis. The concomitant therapy by an ENT specialist is important in asthma-related voice disorders to identify the basic cause of dysphonia systematically and to intervene at an early stage.

The vibrant soundbridge for conductive and mixed hearing losses: European multicenter study results

BACKGROUND/AIMS

The Vibrant Soundbridge (VSB) is an active middle ear implant, 'direct-drive' hearing system for the treatment of hearing loss. Recently, the VSB has been applied to conductive and mixed hearing losses. The aim of this study is to evaluate aided benefit, speech recognition in quiet and noise, subjective benefits, changes in residual hearing, and medical and surgical complications in adults with conductive or mixed hearing losses implanted with the VSB using Round Window (RW) Vibroplasty.

METHODS

Twelve German-speaking adults participated in a single-subject, repeated measures study design comparing their performance using the VSB with their own unaided preoperative performance. Hearing performance and changes in residual hearing were assessed using routine audiometric measures, sound field thresholds, and word and sentence recognition in quiet and in noise. Subjective benefits, including subjective hearing performance, device satisfaction, and quality of life were evaluated using the Abbreviated Profile of Hearing Aid Benefit, the Hearing Device Satisfaction Scale, and the Glasgow Benefit Inventory, respectively.

RESULTS

Aided hearing thresholds, word recognition at conversational levels, and sentence recognition in quiet and noise were significantly improved without significant changes in residual cochlear hearing and without major medical and surgical complications. One subject required repositioning surgery to improve transducer coupling with the RW membrane. Subjective benefit and device satisfaction were good, as were overall and general quality of life.

CONCLUSION

The VSB, implanted using RW vibroplasty, is a safe and effective treatment for adults with conductive and mixed hearing losses who may have few, if any, other options.

[Ultrasonographic and computed tomographic findings in a goat with mediastinal lymphocytic thymoma]

This case report describes the clinical, sonographic, computed tomographic and pathological findings in a 9-year-old goat with mediastinal lymphocytic thymoma. The goat was referred to the Department of Farm Animals because of weight loss and dyspnoea. The lead clinical findings were increased heart rate, increased respiratory rate and heart sounds heard only on the right side. Ultrasonographic examination revealed a massive amount of fluid and an echogenic corrugated mass ventral to the lungs in the thoracic cavity on the left side. Computed tomography showed that the mass was very large and diffusely mineralised. A tentative diagnosis of mediastinal neoplasia was made, and the goat was euthanized. Postmortem examination revealed a cauliflower-like, pedunculated tumour, which occupied the entire left thoracic cavity and displaced the left lung. Based on histological evaluation, the tumour was diagnosed as a lymphocytic thymoma.

[Short and long term results of endolymphatic sac surgery: a patient-questionnaire based study]

INTRODUCTION

The endolymphatic sac surgery for the treatment of Meniere's disease has been described since the 1920s. The success rate of this technique in terms of vertigo control has been reported to be 50-80%. However, the value of this treatment method remained controversial. Furthermore, the reliable identification of the endolymphatic sac intraoperatively can be challenging in some cases. This study examines the short-, middle- and long-term results in a larger cohort of patients.

MATERIALS AND METHODS

In 74 patients, vertigo control, tinnitus and degree of satisfaction was evaluated by means of a questionnaire retrospectively. Additionally, the diagnostic value of the electrocochleography (EcochG) was determined.

RESULTS

The overall vertigo control rate was more than 70% in patients followed up for two years and has reached 81% in patients followed up for more than two years. Hearing preservation rate was 61%. Tinnitus has disappeared in 11% and improved in 23% of the patients. In 47% of the patients it was unchanged and in 19% worsened. The difference in EcochG results pre- versus postoperative was highly significant.

CONCLUSIONS

ELSS is a useful tool in the management of Ménière's disease, in particular in patients that do not benefit sufficiently from conservative therapy.

[Middle ear surgery in Mongolia--first results with middle ear prostheses]

BACKGROUND

Medical care of the Mongolian population is still far behind the standard of industrialised countries. Also in the field of otorhinolaryngology there are clear deficits in regard to an adequate diagnosis and treatment of difficult cases. Microsurgery of the ear is still in the very beginning due to missing essential equipment and surgical skills of the few ORL-units that exists in the country. The integration of tympanoplastic procedures into surgical routine is the main goal of a support programme that exists between the medical faculties of the universities of Wuerzburg (Germany) and Ulan Bator (Mongolia). The aim of this work is to present the outcome of these operations in Mongolia.

METHODS AND PATIENTS

As a result of the continuous education and support programme it was possible to perform 90 tympanoplastic procedures between 2005 and 2006 in the local ORL center of Ulan Bator (EMJJ-clinic). The focus of this report is on the postoperative audiological outcome following reconstruction of the ossicular chain either using autologous ossicles or middle ear prostheses. Besides, prostheses made of polyethylene or Teflon (Russian production) as well as titanium prostheses (Kurz Company, Germany) were implanted.

RESULTS

The final evaluation of the audiological results was performed 6 month postoperatively. The titanium prostheses provided the most favourable hearing improvement (mean 26 dB) when compared to the other materials (polyethylene 7 dB, Teflon 18 dB), but also compared to the autologous ossicles (8,6 dB).

CONCLUSIONS

The standard tympanoplastic procedures, which were developed over decades, proved to be highly reliable also in a country with reduced medical care. The hearing results obtained especially with titanium prostheses demonstrated, that this highly biocompatible alloplastic material is the most suitable and reliable for middle ear reconstruction also in a difficult surrounding.

[Exostoses of the external auditory canal. Is the cold water hypothesis valid for patients in continental areas?]

INTRODUCTION

Exostoses of the external auditory meatus are benign masses of tympanal bone that can lead to infections of the external auditory meatus in advanced cases and then need surgical treatment. Regular irritation of the auditory meatus by exposure to cold water was implicated in the causation of exostoses long ago. The present study investigates the cold water hypothesis in a patient group of continental origin. The surgical procedures and results are discussed.

STUDY DESIGN

Retrospective study.

MATERIALS AND METHODS

We present the epidemiological and aetiological data and postoperative findings recorded for 144 patients (167 procedures) who underwent surgical removal of exostoses from the external auditory meatus in the hospital in Würzburg within 11 years. In attempt to glean further information about the aetiology, patients were also asked to complete a questionnaire on participation in water sports and their symptoms before and since the operation.

RESULTS

Most of the patients (94%) had taken part in water sports for some years, more than 80% of them several times weekly. The most common indication for surgical removal was recurrent infection of the external ear. Although 50% of the patients reported improved hearing, no higher sound threshold was observed. Reversible complications (ear drum performation, tinnitus, opening of mastoid cells) were observed in 18% of the patients. One patient had a stenosis of the auditory canal caused by scar tissue.

CONCLUSIONS

Surgical removal of exostoses in the external auditory canal is frequently fraught with controllable complications. The indications for their surgical removal should be strictly applied; the presence of exostoses in isolation is not an acceptable indication for surgery. Removal of exostoses is an adequate way of avoiding recurrent external ear infections. Improved hearing can be expected only if the self-cleaning function of the external auditory meatus is improved.

[Results in otosurgically treated patients with acoustic neuroma. Part 1: Facial nerve function after translabyrinthine and middle fossa resection]

BACKGROUND

Regardless of all efforts to preserve a residual hearing, facial nerve function is still the primary issue for patients with acoustic neuromas. Since alternative methods like the gamma-knife treatment are of increasing importance, results after surgery have to be compared and discussed critically.

PATIENTS

The results of 538 patients operated at the Dept. of Otolaryngology, Head and Neck Surgery, University of Wuerzburg between 1989 and 2004 are presented. 392 had surgery via a middle fossa, 146 via a translabyrinthine approach.

RESULTS

Shortly after surgery 82.2 % of patients showed no facial palsy. 74 patients had an incomplete, 7 a complete paresis. After 12 months 144 of the patients operated on via middle fossa approach showed no palsy, 13 had an incomplete and one a complete paresis. Out of 76 patients operated on translabyrinthine approach 75 had no paresis, one had an incomplete, and no patient had a complete paresis. There was no difference between intrameatal tumors and tumors extending beyond the porus. Regular facial nerve function was seen in 93 %, postoperatively. Permanent paresis was seen in 0.4 % of cases.

CONCLUSION

Acoustic neuroma confined to the internal meatus or with minor extension into the cerebello-pontine angle (i. e. no contact to structures of the brain stem or vessels of the posterior fossa) are feasible for resection via a middle fossa or translabyrinthine approach. The possibility of hearing preservation combined with low morbidity and good results of facial nerve function makes these approaches the treatment of choice for this group of tumors.