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Objectives/Hypothesis: To describe a modified facial nerve reconstruction technique for complex defects of the facial fan after parotid surgery that avoids synkinesis between upper and lower face. Study Design: Retrospective case series. Methods: Patients who had undergone radical parotidectomy with a large defect of the facial fan, reconstruction of the upper face by facial nerve interpositional graft, and reconstruction of the lower face by hypoglossal-facial nerve jump nerve suture were included in this series. Results: Four patients underwent the modified combined approach after tumor resection and prior to postoperative radiotherapy in three of the four cases. Surgery was combined with an upper lid weight implantation. Regeneration of the face was successful in all cases within 12 to 16 months. Most important, the separated reanimation of the upper and lower face circumvented synkinesis of the upper and lower face. This factor was essential for good functional results. Using the hypoglossal jump technique instead of a classical cross-nerve suture technique prevented the sacrifice of ipsilateral tongue function. Conclusions: The presented method offers satisfactory results for facial reanimation and avoids synkinesis between the upper and lower face. Using the jump technique instead of a classic hypoglossal transfer as it was described originally for the combined approach avoids long-term sequelae for the tongue. Laryngoscope, 121:2402–2405, 2011

THE IMPACT OF A UNIVERSITY ENT EMERGENCY CENTRE FOR THE AMBULATORY CARE OF ENT EMERGENCY PATIENTSBACKGROUND: The impact of a German University ENT emergency unit has not been investigated yet. The present study had the aim to define the role of such an ENT emergency unit for the medical supply of ENT emergency cases. Patients' characteristics, diagnostics and therapeutical processes have been analysed. METHODS: In a retrospective study 3 695 emergency cases of the year 2004 have been characterized. RESULTS: Patients referring to the ENT emergency unit are relative young with an average age of 36 years. 72% are coming from the urban area. Two thirds referred themselves without seeing another physician before. The spectrum of diagnoses was broad, mainly similar to the normal spectrum of diseases seen in daily outpatient practice. 17% were emergency cases in narrower sense needing direct help because of real threat. 25% of the patients needed more than a clinical ENT examination. 9% of the cases were admitted to the hospital. DISCUSSION: In a major city without specialised outpatient ENT emergency system patient are attracted regularly to present at the University ENT emergency unit. This means a significant work load for the resident on duty. Most of the patients have ENT diseases treatable with this one and last patient contact. On the other hand, the hospital recruits an important amount of patients for inpatient treatment through the emergency unit.

Carcinoma ex pleomorphic adenoma (CXPA) is a rare parotid malignancy and until today no standardized concept exists for its therapy apart from recommendations for parotid carcinoma in general. Prognosis is thought to be poorer than for other parotid malignancies. We sought to describe a general diagnostic and therapy strategy and assess factors predicting the outcome.We retrospectively analysed the courses of 22 patients with a CXPA of the parotid gland treated at a tertiary medical care centre for otorhinolaryngology. We examined parameters of medical history, diagnostics, surgical and adjunctive therapy and analysed overall and disease-specific survival.About half of the patients had evidence of a parotid mass of up to 1 year only while maximum of the others was 48 years. Nine patients were primarily operated without suspicion for malignancy. Both 5-year disease-specific and overall survival were 60%. Recurrence-free survival rate after 5 years was 85%. Any patients with a stage I or II disease had an uneventful follow-up. To date, no patient with a stage IV disease has survived longer than 5 years.Surgical therapy (total or radical parotidectomy) is the method of choice for CXPA of the parotid gland. Stage I tumors have a very good and stage IV tumors a bad prognosis.

Background The facial nerve function after facial-facial nerve anastomosis, grafting, hypoglossal-facial nerve anastomosis, hypoglossal-facial interpositional jump nerve anastomosis, or a combined approach was analyzed. Methods Facial function was assessed after operation using a 7-point visual analog scale (VAS) and by electromyography (EMG) in 53 patients. The final result was judged by May’s facial nerve grading system. Results Voluntary EMG activity occurred on average 4.52 ± 1.31 months after operation. Initial facial movements were visible after 5.41 ± 1.80 months. Facial function related to the VAS finally reached 44% of normal value. The result was judged May’s grade I in 13%, grade II in 34%, grade III in 28%, and grade IV in 25% of patients. A significant difference in outcome between different reconstruction types was not seen. Age over 60 years was related to worse outcome. Conclusions A correct selection of the best method in the individual situation presumed, all analyzed facial reanimation techniques seem to lead nearly similar and satisfactory results.

Recent evidence suggests that T-lymphocyte extravasation and CNS-parenchymal infiltration during autoimmune disease might be regulated by antigen-presenting (ED2 + ) cerebral/spinal perivascular phagocytes (CPP/SPP). Since the massive erythrocytic and leukocytic infiltrates in the CNS of rats with experimental allergic encephalomyelitis do not allow a precise differentiation between CPP/SPP and the invading cells in the Virchow–Robin space, we developed a new immune-response model whereby the extravasation of T-lymphocytes was not followed by other blood cells. Adult Lewis rats were sensitized to horseradish peroxidase (HRP). Subsequent intracerebroventricular (i.c.v.) injections of HRP and/or Fluoro-Emerald (FE) served to: (1) challenge the primed T-lymphocytes and (2) label the CPP/SPP for additional immunocytochemical analysis. We found that 24 h and 3 days after single, double, or triple antigen boosting T-lymphocytes (R73 + , W3/25 + , OX50 + ) entered the Virchow–Robin space but did not break through the astrocytic glia limitans. Instead they adhered to HRP-containing activated CPP/SPP (mabs OX-6 + , SILK6 + , CD40 + , CD80 + , CD86 + ). This selective contact was mediated neither by cell adhesion molecules (P-selectin, ICAM-1, VCAM-1), nor promoted by chemokine receptors (CCR1, CCR5) or chemokines (monocyte chemoattractant protein (MCP)-1, MIP-1α, MIP-1β, RANTES). This non-inflammatory, but antigen-dependent lymphocyte extravasation provides optimal conditions to further study the CNS immune response.

Bereits Aristoteles, Herophilos und Galen gelangen in der Antike entscheidende anatomische Entdeckungen. Der Romer Paul von Aegina fixierte die Idee einer Nervennaht als erster im 7. Jahrhundert, die aber erst im 17. Jahrhundert durch den Mailander Chirurgen Gabriele Ferrara ihre praktische Umsetzung fand. Systematische Untersuchungen zu tierexperimentellen Nervennahten datieren auf das fruhe 19. Jahrhundert durch Jean Pierre Flourens. 35 Jahre spater wurde die Technik beim Menschen eingesetzt. Zeitgleich fuhrten in Paris 2 Chirurgen (Nelaton und Laugier) eine Nervennaht durch. Wegen der Durchfuhrung selber, aber erst recht wegen der Behauptung, diese Nervennahte hatten eine sofortige Funktionswiederherstellung zur Folge gehabt, entstand eine enorme Konfrontation unter den Chirurgen der damaligen Zeit. Die erste gekreuzte Nervennaht (Accessorius-Fazialis-Anastomose) wurde von Charles Ballance 1895 durchgefuhrt. Werner Korte gebuhrt das Verdienst, als erster eine Hypoglossus-Fazialis-Anastomose durchgefuhrt zu haben. Am 20.12.1901 operierte er eine 38-jahrige Witwe aufgrund einer eitrigen Entzundung des Felsenbeins. Da der zentrale Anteil des N. facialis fur eine Anastomose nicht mehr zu verwenden war, anastomisierte er den N. hypoglossus mit dem N. facialis End-zu-Seit. Seine positiven Beobachtungen uber die Funktionswiederkehr fuhrten zur allgemeinen Einfuhrung dieser Methode in die Klinik.

Die Neuromyographie ist ein objektives Mesverfahren zur Bestimmung eines evozierten Summenaktionspotentials der mimischen Muskulatur. Die prozentuale Seitendifferenz zwischen der gelahmten und der gesunden Seite wird dabei als quantitativer Ausdruck der Nervendegeneration gewertet. Die Seitendifferenz beim Gesunden soll nur 3% betragen. Wir untersuchten an gesunden Testpersonen, ob diese geringe Seitendifferenz reproduzierbar ist und ob das Verhaltnis der Amplituden bei wiederholten Messungen konstant bleibt. 20 gesunde Probanden (12 Manner, 8 Frauen, 23–36 Jahre alt) wurden viermal in Abstanden von jeweils einer Woche beidseits neuromyographiert. Die mittlere prozentuale Amplitudendifferenz betrug 32,5%. Die einzelnen Messungen zeigten Schwankungen von 0–80% Seitendifferenz am gleichen Individuum zu unterschiedlichen Zeitpunkten. In dieser Studie kann die Hypothese einer intraindividuellen Symmetrie der Neuromyographie nicht bestatigt werden. Wie bereits andere Autoren zuvor fanden wir signifikante Seitendifferenzen bei gesunden Probanden. Zudem wird erstmals gezeigt, das die Neuromyographie beim selben Individuum zu verschiedenen Meszeitpunkten eine erhebliche Variabilitat aufweist. Im Licht dieser Daten sollte die Interpretation der Neuromyographie bei der Verlaufsbeurteilung von Fazialisparesen zuruckhaltend erfolgen.

Objectives/Hypothesis In carcinoma in situ (CIS) tumors malignant cells have not penetrated the basement membrane and therefore have no metastatic potential. Treatment strategies of CIS are topics of ongoing discussion. The aim of this study was to evaluate long-term results of CO2 laser therapy in laryngeal CIS. Methods From 1986 to 1995, 29 patients with glottic CIS with a minimum follow-up of 2 years were treated initially with transoral CO2 laser surgery and were included is this series. Results A complete removal of the tumor was possible with superficial laser cordectomy in 21 patients and with subligamental laser cordectomy in 8 cases. There was no tumor-related death in this series. Repeated laser resections were performed in four patients for local recurrences. No patient required total laryngectomy or radiotherapy during a follow-up ranging from 25 to 143 months. Conclusions Local control rates presented in this study are superior to those previously reported with conventional surgery and similar to those after radiotherapy. The ultimate rate of larynx preservation was seven times higher than reported after radiotherapy. Our results add further support to the observation that laser surgery is the best treatment option for CIS of the larynx. Based on the material of this study, recommended treatment for CIS is CO2 laser resection in combination with a meticulous follow-up for early recognition of local recurrence.

BACKGROUND: Nerve sutures such as facial-facial anastomosis are helpful methods for recovery of facial movements after peripheral nerve lesions. Most of the results on neuronal regeneration were based on experiments with young or young adult animals. In contrary the vast majority of the diseases (cholesteatoma or tumors of the parotid gland) causing facial nerve lesions are in aged patients. METHODS: Therefore, we compared the original data from two recently published articles concerning the axonal outgrowing process after facial-facial-anastomosis in young-adult and aged rats. In additional, we tried to explain the clinically observed postparalytic syndrome (synkinesia, autoparalytic syndrome,...) after surgical interventions on the facial nerve with the experimental results in the rat. RESULTS: As an important result, we could not find spontaneous loss of facial motoneurons on the control side in the aged rats. On the operated side, two results have to be emphasized. The initial regeneration (10-42 days after the operation) showed a significant faster reinnervation in the group of young rats. The aged rats showed an apparent hyperinnervation after axonal outgrow to the mimic muscles has been accomplished. CONCLUSION: Both experimental observations are in agreement with our clinical experiences. After facial nerve surgery, aged patients show a delayed recovery of the mimic functions and a more pronounced postparalytic syndrome. A morphological explanation one can bear is that the delayed reinnervation causes the extreme hyerinnervation, which leads to a simultaneous innervation of different muscles by same facial motoneurons.

BACKGROUND The possibility of hearing aid induced deterioration was first described in 1939 (Berry 1939, Holmgren 1939). Since then numerous studies discussed this problem controversely. However, it is undisputed that in cases of profound sensorineural hearing loss in childhood powerful hearing aids are necessary for maturation and auditory and speech development. An increase of progressive sensorineural hearing loss in the last three years in children with profound sensorineural hearing loss fitted with hearing aids (2 children in 1993, 6 children in 1996) drew our attention to this problem. METHOD Over a period of four years, we collected the data of 16 children with progressive hearing loss. RESULTS The comparison of the duration of the hearing aid use since fitting and the maximum output level fail to explain this increase. Moreover our strategy in hearing aid fitting remained unchanged during this period especially with regard to SSPL max. We also performed an analysis of the childhood disorders associated with the sensorineural hearing losses. This analysis provided no further information for the increase of hearing loss. CONCLUSION There is no evidence that powerful hearing aids damage hearing and induce progressive sensorineural hearing loss in childhood. Therefore we believe that there is no need to change our hearing aid fitting strategy particularly with regard to the maximum output level up to 135 dB SPL measured in situ. The increase in the number of progressive cases in the last two years indicates the necessity of further investigations in this field.

Aspergillosis belongs to the group of mycotic diseases of the paranasal sinuses. The invasive forms, and particularly the fulminant forms, are potentially fatal. Primary surgical intervention with complete removal of the mycotic mass should be performed. Additionally an antimycotic drug therapy with amphotericin B must be started. In a review of the literature, there is no case surviving an extended invasive aspergillosis after failure of the operative therapy and after failure of the postoperative amphotericin B treatment. We report an interesting case of a complete remission of an invasive, partially fulminant aspergillosis of the paranasal sinuses and frontal and basal regions. After incomplete removal of the mycotic mass by an endo- and extranasal approach, we started postoperative drug therapy with amphotericin B. Under this treatment the mycosis progressed. Additionally the patient developed severe renal side effects requiring suspension of the treatment. At this time, we started a combined antimycotic drug therapy with liposomal amphotericin B (AmBisome) and itraconazol. Within 10 weeks there was complete clinical and radiologic remission. The patient died 63 weeks after this treatment because of a fulminant bacterial pneumonia. Post mortem examination showed no aspergillosis in the skull base, the paranasal sinuses, or in the lung. The question arises as to whether this drug combination of liposomal amphotericin B (AmBisome) and itraconazol is a real alternative to high-risk surgical interventions in this region.

BACKGROUND: Apart from all advances made in the management of central airway infections, Acute Epiglottitis (AE) and Bacterial Tracheitis (BT) continue to be causes of life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in the diagnostical protocol, to clarify the role of airway endoscopy in acute childhood stridor, and to identify current reasons for fatalities in these diseases. MATERIAL: In the observation period between 1980-92, we found 12 patients suffering from BT and 21 from AE managed in close cooperation of the involved disciplines at the pediatric intensive care unit of the University of Cologne. RESULTS: Laryngoscopy with fiberoptic or small rigid endoscopes allowed in awake cooperative children accurate diagnose of AE, and the exclusion of supraglottic inflammation in BT without complications. Furthermore, additional endoscopic information of the degree of inflammation was helpful in the next critical decision, whether artificial airway or rigid tracheobronchoscopy was required. Nasotracheal intubation was necessary in 76% of our patients, in one child tracheostomy was performed (5%). Premature extubation necessitating reintubation occurred in 33% of the children suffering from BT. In these patients, our method of advancing a flexible endoscope for tracheoscopy through the respiration tube failed because of a low tube diameter. Another remarkable finding was the high mortality in AE (14%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest. CONCLUSION: In the analysis of the clinical course we found three decisive turning points in managing the disorder; First, the confirmation of the correct admission diagnosis; second, the decision, as to whether an artificial airway should be established; and third, the proper time of extubation. The most decisive factor in decreasing mortality seems to be timely, appropriate presentation at referral centers if AE or BT is suspected. Clinically, progressive management of childhood stridor requires close cooperation between the Pediatric, Anesthesiologic, and ENT Departments. Fiberoptic endoscopy as a guide to current airway management is a major step forward and should be a part of every established protocol.

Background Extratemporal processes are rare causes of peripheral facial palsy. Only 17 cases of facial palsy in association with a suppurative or necrotic parotitis are reported in the literature. Patient and results We present a case of a peripheral facial palsy initiated by an infection of a epidermoid cyst, which consecutively involved the whole parotid gland. After abscess drainage and antibiotic therapy the inflammation process receded. The palsy persisted over a period of 4 weeks but improved completely. Conclusions As the facial nerve was not enclosed by the abscess formation the palsy must have been caused indirectly. It may be assumed the inflammation spread into the Fallopian canal through the stylomastoid foramen and caused a metabolic imbalance similar to the supposed vicious circle for Bell's palsy. Due to the relapse tendency of inflammations of epidermoid cysts it is recommended to remove the entire cyst.

Invasive aspergillosis and fulminant aspergillosis are rarities with a high mortality. In the literature there is no patient surviving an extended invasive aspergillosis of the paranasal sinuses and skull base after failure of operative intervention and of postoperative amphotericin B therapy. We report a complete remission of an invasive, partially fulminant aspergillosis. After an incomplete removal of the mycotic mass, we started postoperative drug therapy with amphotericin B. Under this treatment, the mycosis progressed. Additionally, the patient developed severe side effects, so that the treatment was interrupted. At this moment, we started a combined antimycotic drug therapy with liposomal amphotericin B and itraconazole. Within 10 weeks, clinically and radiologically, there was complete remission. The patient died 63 weeks after this treatment, due to a fulminant bacterial pneumonia. Postmortem histologic examination showed no aspergillosis in the skull base, paranasal sinuses, or lung.

During delivery the delicate structures of the face are predominantly exposed to external force effects and hence deformities on the nose can emerge as a birth-related trauma in newborns. As self-straightening of the nasal septum commonly occurs, a conservative therapy is recommended for most cases. We report on a case where a birth-related trauma of the nose leaded to acute breathing problems in a newborn with insufficient oxygenation. An overview about the available literature is given. A cautious reposition of the nose proved to be an appropriate management for short- and long-term development.

Objectives: Analyze the postoperative quality of life (QoL) in patients after surgical nerve repair for facial nerve lesion. Study Design: Descriptive study using questionnaire data and medical chart review. Methods: Forty-nine patients answered the Short Form-36 (SF-36), the European Organization for Research and Treatment (EORTC) questionnaires QLQ-C30 and QLQ-HN35, and a modification of the Acoustic Neuroma Hospital of Norway Survey. Facial function was self-evaluated by the patients using the House-Brackmann (HB) scale and the Stennert index (SI). The questionnaire data were analyzed in relation to the medical chart data. Results: The follow-up time ranged from 12 to 202 months. The underlying disease was benign in 34 (61%) patients and malignant in 15 (39%) patients. Facial nerve repair was successful in all patients, with a mean HB scale of 3.1, a mean SI of 4.9, and a mean May grading of 2.7. The facial function self-evaluation was not significantly different. Seventy-five percent of the patients were satisfied with the operation. The SF-36 demonstrated a significantly lower social functioning, emotional role, general mental health, and vitality lower than in the normal German population. In the EORTC QLQ C30, emotional function was low and the insomnia rate high. EORTC QLQ HN35 showed a high rate of trouble with social eating, less sexuality, problems opening mouth, and weight gain problems. Age 45 years or older, female sex, May grading 3 or greater, SI self-assessment 5 or greater, HB self-assessment greater than 2 had a significant negative effect on some QoL items, but not factors such as type or histology of the disease or delayed reconstruction. Conclusions: Although grading of facial function after nerve repair revealed satisfying results, the patients experience a reduced QoL.

OBJECTIVE: A clinical staging system for children with lymphatic malformations that would allow for a standardized comparison of disease and treatment outcomes. METHODS: We developed an examination sheet for the determination of a disease score ranging from 0 (worst) points to 10 (best) points, Cologne Disease Score (CDS). Disfigurement, dysphagia, dysphonia, dyspnea and an observer statement towards progression were contributing to CDS. Each parameter yielded two, one or zero points. Two points were given when no limitation was seen in the patient concerning the respective item. One point was given at mild limitation and zero points were given when considerable limitation in the respective item could be observed. We evaluated 26 patients with lymphatic malformations of the head and neck retrospectively by completing one examination sheet for each patient-visit. RESULTS: Four patients had an initial CDS value of three or less points (severe disease-group). After therapy the mean value of their score increased only slightly to 3.9+/-2.6 points. Six patients had an initial CDS value of four, five or six points (advanced disease-group). After treatment their mean score value increased dramatically to 9.0+/-1.5 points (P

Despite the availability of antibiotics, acute otitis media can still lead to major complications. Bezold's abscesses are very rare complications and are usually found only in adults with well-pneumatized mastoid bones. We present the case of a 10-week-old newborn with a Bezold's abscess. It is stressed that acute otitis media can be silent and undetected in infants and can lead to major complications such as Bezold's abscess.

BACKGROUND: Lesions of the laryngotrachea due to repeated intubation trauma after birth are reported. CASE: A macrosomic neonate was born at term after uneventful pregnancy. On the basis of diminished uterine contractions and arrest of descent, the head was delivered by using obstetric forceps. No intubation was attempted after birth. Ten hours later, the infant developed acute life-threatening respiratory distress and subcutaneous emphysema. Intubation was impossible. Open surgical exploration of the neck revealed a rupture of the cricothyroid ligament within the larynx. The defect was closed immediately, and after artificial ventilation for 7 days, the infant was extubated. One year later, the child is developing satisfactorily, without stridor or hoarseness. CONCLUSION: In macrosomic neonates after traumatic delivery, a laryngotracheal lesion should be considered when respiratory distress syndrome combined with subcutaneous emphysema occurs.

Hypertrophy of the cricopharyngeal muscle is a serious clinical condition that can cause severe dysphagic symptoms, including prolonged deglutition and postdeglutitive aspiration. Although the therapeutical concepts are well established, the pathogenic mechanism of cricopharyngeal hypertrophy remains unclear. We present a patient with a ten-year history of progressive dysphagia. The neurological and MRI findings were normal. However, videocineradiography showed severe hypertrophy of the cricopharyngeal muscle. This condition was first treated by injections of botulinum toxin, which did not alleviate the symptoms. Next, myotomy and muscle biopsy were performed. Histological evaluation disclosed lymphoplasmacellular florid myositis, single-fiber atrophy, and muscle fiber necrosis with phagocytosis. There were no signs of inclusion body myositis or oculopharyngeal muscular dystrophy. Our finding of severe cricopharyngeal muscle hypertrophy associated with myositis has been published previously (n = 34). The study presented here shows cricopharyngeal dysphagia associated with various systemic diseases, including motor neuron disease, general granulomatous disease, dermatomyositis, or inclusion body myositis. Isolated changes of the cricopharyngeal muscle were described in 65% of the cases.

Objective: The question whether progressive sensorineural hearing loss during childhood is the fateful course of a main illness has been discussed controversially over 60 years. No medicamentous therapy with satisfactory results has been described in the literature. The goal of this study was to determine whether an infusion therapy, developed for the treatment of sudden hearing loss in the elderly, can induce recovery after progression in sensorineural hearing loss during childhood. Methods: Out of 20 children suffering from acute progression in sensorineural hearing loss, seven children were treated with an infusion therapy containing prednisolone, pentoxifylline and a plasma expander (group I), and 13 children were not treated (group II). All children were advised not to use hearing aids for 6 weeks. Results: In group I, we observed partial to complete restoration of hearing threshold towards the original hearing threshold given by previous routine controls in 6/7 children. In group II, only three children recovered, with the state of ten children's’ hearing loss remaining unchanged. The long-term follow-up, however, showed no distinct difference in either group. Conclusion: Infusion therapy can be helpful when treating acutely progressing sensorineural hearing loss during childhood. The benefit for communicative competence has to be discussed. Further studies should be conducted.

Background Facial electroneurography is an objective measurement of a muscle compound action potential. The amplitude ratio between the paretic and the normal side is used as a basis for estimating the prognosis of facial palsy. According to Esslen, the difference of amplitudes in healthy subjects is only 3%. Twenty healthy test persons were investigated with the aim of 1. reproducing the published data on the left-right difference in normal test subjects and 2. determining whether the amplitude ratio is constant over time after repeated measurements. Study design Bilateral electroneurography was conducted on 20 healthy volunteers (age range, 23-36 y; 12 men, eight women). Two investigators performed four measurements at 1-week intervals on every subject. Results Mean amplitude ratio was 32.5%. Repeated measurements on the same individual differed considerably-- from 0% to 80%. The 99% confidence interval computed from the data ranged from 26% to 39% amplitude ratio. Conclusion The symmetry of facial evoked compound potentials postulated by Esslen and Fisch is not supported by these data. As have other investigators, the authors found significant left-right differences in healthy subjects. Furthermore, they showed for the first time that the amplitude ratio is not constant in every individual at repeated measurements. In light of these data, prognosis of facial palsy based on electroneurographic data alone seems doubtful.

The unsatisfactory results obtained from tone and speech audiometric studies in identifying the effects of hearing disability, in particular the psychosocial factors, prompted us to adopt a psychological test to determine the "social hearing ability". The test consists of 20 questions which all relate to "social hearing ability" in urban society. Ten questions concern hearing ability in situations where background noise plays either a negligible role or none at all. The remaining 10 questions concern selectivity ability, that is hearing with additional background noise. The evaluation of the questionnaire results in a classification of the so-called Social Hearing Handicap Index (SHHI) in percentages together with a breakdown of the deafness components and the selectivity components into percentages. This differentiation provides additional information about the demands placed on the hearing ability of humans in quiet or noisy surroundings. The information obtained from the test enables longitudinal studies on the course of a hearing disability or the effectivity of a particular therapy, e.g. hearing aid, to be carried out in the elderly.

Most listening environments contain some noise which is mixed up with the speech. The effects of noise on speech perception depend on the parameters of the noise (long term spectrum, fluctuations of the intensity in time and average intensity relative to the intensity of speech) and on the speech material (sentences, monosyllables, CV-, CVC-, VC-syllables). The most effective at masking are noises with spectra similar to the speech spectrum, such as the speech simulating noise (CCITT-noise) or cocktail-party-noise. The cocktail-party situation is judged to be a difficult communication situation not only by the hearing impaired but also by patients with presbycusis. We examined different age-dependent changes of the speech discrimination in noise ability. Using sentences and CV-syllables (rhyme test) the critical signal-to-noise ratios (S/N-dB) for a speech discrimination of 35%-45% were investigated for monaural and binaural noise representations for different age groups. The results are compared to several types of hearing loss and to those of similar studies in literature. The data of this study prove that hearing impaired and elderly patients are greatly affected by noise. While younger patients with moderate high-tone hearing loss may profit from a special hearing aid device with an integrated noise suppression-system, an improvement of speech discrimination in noise for the elderly can be achieved only by enhancing the signal-to-noise ratio by more than 10 dB. This is possibly because of the reduced capacity for frequency-, intensity- and time-resolution in the peripheral and central pathways of the hearing organ of the aged.

Background T-cells extravasation and CNS parenchyma infiltration during autoimmune neurodegenerative disease can be evoked by local antigen presenting cells. Studying the chemoattracting potential of spinal perivascular macrophages (SPM) during experimental allergic encephalomyelitis (EAE), we observed numerous infiltrates of densely-packed mononuclear cells. Apart from the poor spatial and optical resolution, no differentiation between the resident SPM (mabs ED1+, ED2+) and the just recruited monocytes/macrophages (mab ED1+) was possible.

Microglial activation in response to pathological stimuli is characterized by increased migratory activity and potential cytotoxic action on injured neurons during later stages of neurodegeneration. The initial molecular changes in the CNS favoring neuronofugal migration of microglia remain, however, largely unknown. We report that the extracellular matrix protein tenascin-R (TN-R) present in the intact CNS is antiadhesive for activated microglia, and its downregulation after facial nerve axotomy may account for the loss of motoneuron protection and subsequent neurodegeneration. Studies on the protein expression in the facial and hypoglossal nucleus in rats demonstrate that TN-R is a constituent of the perineuronal net of motoneurons and 7 d after peripheral nerve injury becomes downregulated in the corresponding motor nucleus. This downregulation is reversible under regenerative (nerve suture) conditions and irreversible under degenerative (nerve resection) conditions. In short-term adhesion assays, the unlesioned side of brainstem cryosections from unilaterally operated animals is nonpermissive for activated microglia, and this nonpermissiveness is almost abolished by a monoclonal antibody to TN-R. Microglia-conditioned media and tumor necrosis factor-alpha downregulate TN-R protein and mRNA synthesis by cultured oligodendrocytes, which are one of the sources for TN-R in the brainstem. Our findings suggest a new role for TN-R in neuronal protection against activated microglia and the participation of the latter in perineuronal net destruction, e.g., downregulation of TN-R.