Mode of communication, perceived level of understanding, and perceived quality of life in youth who are deaf or hard of hearing

Given the important role of parent-youth communication in adolescent well-being and quality of life, we sought to examine the relationship between specific communication variables and youth perceived quality of life in general and as a deaf or hard-of-hearing (DHH) individual. A convenience sample of 230 youth (mean age = 14.1, standard deviation = 2.2; 24% used sign only, 40% speech only, and 36% sign + speech) was surveyed on communication-related issues, generic and DHH-specific quality of life, and depression symptoms. Higher youth perception of their ability to understand parents' communication was significantly correlated with perceived quality of life as well as lower reported depressive symptoms and lower perceived stigma. Youth who use speech as their single mode of communication were more likely to report greater stigma associated with being DHH than youth who used both speech and sign. These findings demonstrate the importance of youths' perceptions of communication with their parents on generic and DHH-specific youth quality of life.

[Lacrimal systems endoscopy with a new endoscope system]

BACKGROUND

Successful therapy of postsaccal stenosis in the lacrimal system can be done by an ENT Surgeon by endonasal dacryocystorhinostomy. It is desirable to have a good diagnostic method of the lacrimal system before undertaking surgery. This study describes the first experiences of endoscopic diagnostics of the lacrimal system with a new endoscope.

MATERIAL AND METHODS

24 patients (10 male and 14 female, between 3 and 65 years old) with epiphora and chronic lacrimal system infections were examined in the ENT Department Homburg/Saar with a 0.53 mm modular endoscope, between 11/2008 and 12/2009. The result were evaluated and analysed.

RESULTS

The endoscopic lacrimal system examination was done in all 24 patients. 8 patients with high stenosis postsaccal and purulent epiphora had an endonasal dacryocystorhinostomie. 13 patients with prasaccal stenosis or stenosis in the ductus nasolacrimalis with clear epiphora were treated with irrigation, dilatation and U-intubation. The removal of the Endoscopic dilatation was undertaken in 3 children without using bicanicular intubation.

CONCLUSION

Lacrimal system endoscopy with a modular endoscope with the possibility of interventional procedures is an efficient option in the widening diagnosis and therapy of the lacrimalm system disease. With this technique is it possible with selected patients to do interventional therapy. On the basis of the endoscopic findings an interventional therapy or an endonasal dacryocystorhinostomie can be done.

Imaging of cochlear implant electrode array with flat-detector CT and conventional multislice CT: comparison of image quality and radiation dose

CONCLUSION

Cochlear implantation assessment is possible using commercially available standard flat-detector computed tomography (FD-CT) protocols. Image quality is superior to multislice CT (MSCT). The radiation dose of FD-CT is lower in comparison with MSCT standard protocols and may therefore overcome the limitations of MSCT in the evaluation of cochlear implants.

OBJECTIVE

FD-CT offers higher spatial resolution than MSCT. Our objective was to compare the image quality of FD-CT to conventional MSCT in the visualization of a cochlear implant electrode array with respect to radiation exposure.

METHODS

An isolated temporal bone specimen was scanned using a commercially available FD-CT system and a 4 and 64 row MSCT scanner. Different scanning protocols were used. Image quality was assessed by four independent readers using a scoring system with different criteria describing delineation of the cochlea and the electrode array, image noise and spatial resolution. Radiation dose was measured using the CT dose index (CTDI) and a 16 cm acrylic phantom.

RESULTS

Image quality was rated superior for FD-CT for all criteria by all readers. Single electrode contacts were only visible in FD-CT and assessment of implant position was improved by FD-CT. The radiation dose of FD-CT was half that of MSCT standard protocols.

[Malignant melanoma of the lacrimal sac]

A 68-year-old woman presented with a 10-month history of right-sided epiphora, bloody tears, and medial canthal mass. Computed tomography revealed a soft tissue mass of the right lacrimal sac with widening of the bony nasolacrimal canal. External dacryocystorhinostomy with incisional biopsy confirmed the diagnosis of malignant melanoma. After staging, further therapy included orbital exenteration, lateral rhinotomy with en bloc resection of the lacrimal drainage apparatus, and adjuvant radioimmunotherapy. One year after surgery, no evidence of local recurrence or metastatic disease could be detected.

In vitro adhesion measurements between skin and micropatterned poly(dimethylsiloxane) surfaces

Micropatterned adhesive surfaces may have potential in reconstructive surgery. The adhesion performance of mice ear skin to micropatterned poly(dimethylsiloxane) (PDMS) was investigated, under in vitro conditions, and compared to flat substrates. No significant difference in separation force F was observed between flat substrates and micropatterned surfaces with pillar arrays. However, the energy necessary for separation of the substrate from the skin was sensitive to the topography. Furthermore, our results show that the force-displacement curves depended on the wetness of the skin: Highest force values were obtained for fresh skin while the forces decreased as the skin dried out. The results are encouraging for further studies on the potential of patterned PDMS in biomedical applications.

A series of notched-noise embedded chirps for objective frequency specific hearing examinations

Chirp-evoked auditory brainstem responses (ABRs) have shown a better performance compared to click-evoked ABRs, due to their temporal organization which compensates for the traveling wave delay achieving a synchronous discharge of the cochlea. In this paper we present the development and evaluation, in healthy subjects, of a series of notched noise embedded frequency specific chirps to evoke ABRs. Results of the ABRs using Phase Synchronization Stability are also reported. The assessment of frequency specific responses by using noise embedded chirps was possible, and the PSS analysis supported previous findings which stated that low frequency channels are better for the recognition and analysis of chirp-evoked ABRs. Accordingly, future analysis can be done to make a faster recognition of frequency specific chirps-evoked ABRs.

Update on hemangiomas and vascular malformations of the head and neck

Although the current classification systems of vascular malformations and hemangiomas are increasingly accepted, there are nonetheless several aspects that show us how special and at the same time difficult it is to diagnose, evaluate, and treat some of those diseases. Close interdisciplinary cooperation of all involved disciplines is essential; the discussion of the adequate individual procedure must be performed in angioma boards, as it is already well established in the context of tumor boards. The interface of angioma therapy and tumor therapy seems to be very close, which is certainly true for the aspect of angiogenesis and of course for the inhibited proliferation as promising therapeutic approach of complex vascular malformations. This leads to another obvious necessity of intensifying experimental scientific research on vascular malformations and hemangiomas, which is a precondition for optimizing or elimination of different current problems and deficits in the mentioned field.

Liposarkom

With less than 100 cases described in the literature, the incidence of liposarcoma in the head and neck is very low. We report on a 54-year-old patient with a liposarcoma of the right cervical soft tissue. After complete tumor extirpation the patient underwent radiotherapy. Diagnostics, histopathological classification, therapy and prognosis of liposarcoma are discussed in this case report and review of the literature.

[Salivary gland tumor of the hard palate]

BACKGROUND

Pleomorphic adenomas of the small salivary glands are very rare and usually arise from the hard palate.

CASE REPORT

We present a female patient who was referred to our Department because of a bleeding enoral tumor, which persisted for 35 years. Histopathological examination after complete tumor excision showed a pleomorphic adenoma.

CONCLUSION

Pleomorphic adenomas are an important differential diagnosis for tumors of the hard palatine. The therapy of choice is surgical excision.

Laminin expression in juvenile angiofibroma indicates vessel's early developmental stage

CONCLUSION

This study confirms the wide range of vascular architecture in juvenile angiofibromas. Proof of laminin alpha2 expression in tumour vessels is suggested to indicate presence of vessels of early developmental stage in juvenile angiofibromas, supporting the concept that plexus remnants of the first branchial arch artery contribute to the vascular tumour component.

OBJECTIVES

Laminins, one of the major components of vascular wall basement membranes, have been implicated in tumour growth and have been shown to have developmentally regulated expression patterns. The goal of this study was to analyse the expression of laminins in juvenile angiofibromas.

MATERIALS AND METHODS

A detailed analysis of the laminin isoform expression was performed by immunofluorescence staining for laminin chains alpha1, alpha2, alpha3, alpha4, alpha5, beta1, beta2, beta3, gamma1, gamma2, and gamma3 on cryosections of 10 juvenile angiofibromas and inferior nasal turbinate tissue for control.

RESULTS

Vascular staining of the different laminin chains revealed areas of differential vessel density in juvenile angiofibromas and irregularities in vessel size, configuration and architecture. Similar to vessels in nasal turbinates, laminins alpha4, alpha5, beta1, beta2 and gamma1 were found to be expressed in juvenile angiofibroma vessels. In contrast to vessels of nasal turbinates, staining for alpha2 and alpha3 chains was only detected in vessels of juvenile angiofibromas.

Metalloproteinases in juvenile angiofibroma--a collagen rich tumor

Matrix metalloproteinases (MMPs) act in diverse physiological and pathological conditions such as tumor growth and angiogenesis by cleaving extracellular matrix and nonmatrix substrates. MMPs with gelatinase/collagenase activity have not yet been studied in juvenile angiofibroma, a unique fibrovascular tumor with prominent collagen expression. Quantitative real-time polymerase chain reaction studies, Western blot analysis, immunofluorescence studies, gel zymography, and in situ zymography were used to analyze MMP-1, MMP-2, MMP-9, MMP-13, MMP-14, TIMP-1, and TIMP-2 in 9 juvenile angiofibromas and 2 inferior nasal turbinate specimens. Quantitative real-time polymerase chain reaction found significantly elevated expression of MMP-2, MMP-9, and MMP-14 (P < .05) in tumor tissue compared with the inferior nasal turbinate specimens. Western blot analysis detected more prominent MMP-1, MMP-2, and MMP-9 protein levels in juvenile angiofibromas compared with inferior nasal turbinates, but not MMP-13, MMP-14, TIMP-1, and TIMP-2. Immunofluorescent staining proved a mainly stromal localization of the analyzed MMPs. Only MMP-9 and MMP-14 were also detected in vessel walls. MMP-1, MMP-2, and MMP-13 also stained mast cells. Gel zymography indicated increased MMP-2 and MMP-9 gelatinase activity in juvenile angiofibromas compared with inferior nasal turbinates. Finally, in situ zymography detected very high stromal gelatinase/collagenase activity. This study indicates significant expression of MMPs with gelatinase/collagenase activity in juvenile angiofibromas with evidence of a disturbed balance of MMPs to TIMPs toward enhanced MMP activity. These MMPs are assumed to be involved in tumor pathology with an influence on tumor growth and angiogenesis.

[First experiences with a new nickel-titanium piston with a shape memory feature]

BACKGROUND

The aim of this study was to describe a new stapes prosthesis with memory characteristics for wire crimping (SMart-Piston).

PATIENTS AND METHODS

This technique was used in 15 patients (mean age 43.4 years; range 28-71) undergoing routine stapes surgery. SMart-Piston prostheses with a shaft diameter of 0.5 mm and length ranging from 4.25-4.5 mm were used. Heat induced wire crimping was performed by CO2 laser in five patients, and by bipolar diathermy forceps in ten patients. In 15 patients, postoperative audiological testing was performed at an average 21.9 days and in another 10 again after 435 days following surgery.

RESULTS

The median observed air-bone-gap (ABG) postoperatively was 8.7 dB+/-7.7 dB. A total of 73% of all patients had an ABG of 10 dB or less, and all patients had less than 20 dB. In the ten patients controlled after 435 days, the ABG was 4.4 dB+/-2.4 dB. It was lower than 10 dB in all individuals.

DISCUSSION

A critical point in every stapes surgery, the prosthesis fixation to the incus, is greatly facilitated by this novel technique. Long-term results in a larger group of patients are pending.

Proline 35 of human immunodeficiency virus type 1 (HIV-1) Vpr regulates the integrity of the N-terminal helix and the incorporation of Vpr into virus particles and supports the replication of R5-tropic HIV-1 in human lymphoid tissue ex vivo

Mutational analysis of the four conserved proline residues in human immunodeficiency virus type 1 (HIV-1) Vpr reveals that only Pro-35 is required for efficient replication of R5-tropic, but not of X4-tropic, viruses in human lymphoid tissue (HLT) cultivated ex vivo. While Vpr-mediated apoptosis and G(2) cell cycle arrest, as well as the expression and subcellular localization of Vpr, were independent, the capacity for encapsidation of Vpr into budding virions was dependent on Pro-35. (1)H nuclear magnetic resonance data suggest that mutation of Pro-35 causes a conformational change in the hydrophobic core of the molecule, whose integrity is required for the encapsidation of Vpr, and thus, Pro-35 supports the replication of R5-tropic HIV-1 in HLT.

Transsynaptic delivery of nanoparticles to the central auditory nervous system

CONCLUSION

Silica nanoparticles may serve as a nonviral delivery system to the sensory hair cells, spiral ganglion cells within the cochlea, and the vestibular organ, as well as the cochlear nucleus.

OBJECTIVES

At present there are no targeted therapeutics for inner ear disease. A variety of viral vector systems have been tested in the inner ear with variable efficacy but they are still not regarded as safe systems for inner ear delivery. Nanoparticles are a nonviral method of delivering a variety of macromolecules that potentially can be used for delivery within the auditory system. In this study, we evaluated the distribution and safety of nanoparticles in the inner ear.

MATERIALS AND METHODS

Cy3-labeled silica nanoparticles were placed on the round window membrane of adult mice. Hearing thresholds were determined after nanoparticle delivery by auditory brainstem responses (ABRs). Distribution of particles was determined by histological evaluation of the cochlea, vestibular organs, and brain stem.

RESULTS

Fluorescent microscopy demonstrated Cy3-labeled nanoparticles signals in the sensory hair cells and the spiral ganglion neurons of both the treated and contralateral inner ears. Additionally, the distal part of the central auditory pathway (dorsal cochlear nucleus, superior olivary complex) was found to be labeled with the Cy3-linked silica nanoparticles, indicating a retrograde axonal transport. No hearing loss or inflammation was noted in the treated cochlea.

Delayed Formation of Actin Filaments in the Outer Pillar Head Plate of VASP–/– Mice

Pillar cells with their rich network of tubulin and actin filaments have been reported to contribute to the rigidity of the organ of Corti. As the earliest expression of the actin filament enhancer vasodilator-stimulated phosphoprotein (VASP) in the outer pillar head plate has been found to be associated with the onset of hearing, we tested hearing development in VASP-/- compared to wild-type mice. Performing measurements of auditory brainstem responses on postnatal days (P) P14 and P21, we detected statistically significantly higher thresholds in VASP-/- compared to wild-type mice at P14, but no hearing differences at P21. Staining for prestin and synaptophysin at P12 in morphologically regularly developed cochleae of VASP-/- mice provided an immature prestin protein pattern but no evidence of developmental delay in hair cell innervations. Regularly intense staining of actin filaments in the outer pillar head plate was found only in wild-type but not in VASP-/- mice at P14. At P21, intensive actin filament staining was also observed in the outer pillar head plates of VASP-/- mice. The delayed hearing development in VASP-/- mice is supposed to be caused by a delayed formation of actin filaments in the outer pillar head plate indicating the importance of appropriate pillar cell stiffness in cochlear mechanics.

Mast cells and T-lymphocytes in juvenile angiofibromas

Juvenile angiofibroma (JA) is regarded as a benign fibrovascular tumour of unknown aetiology. Due to its fibrovascular architecture the fibrous and vascular tumour component have been in the focus of most studies. This investigation aimed at characterizing inflammatory cells in JAs by immunohistochemical stainings and western blot analysis. Number and type of mast cells as well as T-lymphocytes were evaluated in a series of 10 JAs and 5 nasal mucosa (NM) specimens used as control tissue. A remarkable number of mast cells were found in JAs (14.6% of all cells). By using a combination of the mast cell markers tryptase and chymase three distinct mast cell populations could be identified: 12% expressed tryptase (T+) only, 3% stained for chymase (C+) only, and 85% were positive for both tryptase and chymase (TC+). Western blot analysis supported finding of remarkable expression of the mast cell markers tryptase and chymase in JAs and indicated for both proteins similar but also different molecular weights than being observed in NM. Furthermore an infiltration of the tumour by CD4- and CD8-positive T-lymphocytes (15.4% of all cells) was evident in immunofluorescent stainings. Compared to NM, a significantly higher number of TC+ (6.9% in JAs versus 2.7% in NM) and CD8-positive (9.7% in JAs versus 5.8% in NM) cells were found in the tumour tissue. Thus, mast cells and T-lymphocytes were identified as predominant cell types in JAs representing 30% of the cells in the tumour specimens analysed. Regarding these observations JAs are certainly not only built up by vascular cells and fibrous stroma cells. High rates of inflammatory cells like mast cells and T-lymphocytes have to be considered in this tumour.

[Experience with laryngotracheal reconstruction in subglottic stenosis in a 30 years time period]

BACKGROUND

Severe subglottic stenosis is a difficult condition to manage. It can be treated by laryngotracheal reconstruction or cricotracheal resection.

PATIENTS AND METHODS

In this retrospective study the experiences for treatment of isolated subglottic stenosis in 37 patients (age: 3-78 years; stenosis grading: 20 x grade II, 13 x grade III, and 4 x grade IV) by laryngotracheal reconstruction in a 30-years experience are presented.

RESULTS

In 33 out of 37 patients (89.2 %) a sufficient subglottic patency (postoperative endoscopic finding: stenosis less than 30 %) was achieved by laryngotracheal reconstruction. However, 5 patients of this series had required revision of laryngotracheal recontruction and in 22 patients endoscopic removal of granulation tissue had been performed. Sufficient widening of the subglottic space had been possible in all grade II stenosis (20/20), in 11 out of 13 patients with grade III stenosis, and in 3 out of 4 patients with grade IV stenosis. In one child an accidental decannulation occurred and due to asphyxia an apallic syndrome developed.

CONCLUSIONS

Even through laryngotracheal reconstruction is a demanding surgical technique requiring great experience it is an effective option for treatment of subglottic stenosis less than 90 %. For severe subglottic stenosis (> 90 %) treatment by laryngotracheal reconstruction is possible and should be considered if mobilisation of the trachea by scar tissue is suited to be worse or to extended cricotracheal stenosis is present, both being not good candidates for cricotracheal resection.