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Biomedical subjects

F Rosanowski

Publications and source records attributed to F Rosanowski.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Interdisciplinary management of chronic tinnitus (II)].

Tinnitus is defined as the perception of sound in the absence of any appropriate external stimulation. It is a common, bothersome and hard-to-evaluate symptom and in most cases it cannot be objectified. Its incidence in Germany and the western world is about 10%. About 1-2% of the population are severely disturbed by tinnitus and it may disrupt everyday activities and sleep. Recent theoretical developments favour a neurophysiological approach as an explanation for tinnitus in addition to a psychoacoustic model based on peripheral lesion in the cochlea or auditory nerve. In the neurophysiological model, the processing of the tinnitus signal plays a dominant role in its detection, perception and evaluation. Therefore, attention and other psychological factors become important in the understanding and treatment of tinnitus. Many treatments of chronic tinnitus have been proposed and implemented. Today, cognitive-behavioural treatment is regarded as an important part of an integrative therapy which may be compiled of counselling, relaxation therapy, instrumental (hearing aid, tinnitus masker, tinnitus instrument, tinnitus noiser) and pharmacological tools (lidocaine, neurotransmitters). In well-controlled studies the empirical support for other therapeutical approaches such as acupuncture is weak. This work gives a review of the current knowledge of the etiology, pathogenesis, epidemiology, the interdisciplinary diagnostic approach and treatment of tinnitus and especially focuses on insurance and medico-legal aspects.

Chronic Disease↗
PubMed2001

[Rare audiometry findings in progressive, monosymptomatic low frequency deafness].

BACKGROUND: Objective audiometric methods such as the measurement of otoacoustic emissions and auditory evoked potentials (click evoked and notched-noise auditory evoked brainstem potentials, auditory evoked cortical potentials) can provide helpful information. However, information derived from the individual test is limited and each method contains specific restrictions. To illustrate the possible audiometric pitfalls this work presents a case history. CASE REPORT: The puretone audiometry showed a severe hearing loss at low frequencies up to 2 kHz, a slight hearing loss for higher frequencies up to 6 kHz and almost normal hearing thresholds above 6 kHz. Transitory evoked otoacoustic emissions could not be detected. While the auditory evoked brainstem responses (ABR) using click-stimuli showed a normal pattern no reproducible responses could be derived using the notched-noise technique. Auditory evoked cortical potentials exhibited a normal N1/P2-complex and were detectable down to stimulus levels 0-20 dB above the individual hearing threshold. DISCUSSION: Click-evoked auditory evoked brainstem potentials are widely regarded as the "gold-standard" of objective audiometry. The example presented in this work shows that in special cases it may provide false negative results. In these special cases auditory tone-evoked cortical potentials may provide better objective information. When objectively assessing the determination of the hearing threshold it may be necessary not only to use all electrophysiological measurements but also to know their methodical restrictions and pitfalls.

Adult↗
PubMed2001

[Reflux-associated diseases of the otorhinolaryngology tract].

Gastroesophageal reflux disease (GERD) is the most common esophageal disease. It typically presents with heartburn and regurgitation, but it may also cause atypical symptoms, either alone or in combination. About 20 to 60 percent of patients with GERD have ENT symptoms without any heartburn. The most common ENT symptom is a globus sensation, yet there are many possible clinical signs such as laryngitis, pharyngitis, sinusitis, laryngospasm, laryngeal edema and granuloma that may mislead the initial work-up. In this work the pathophysiology, symptomatology, diagnostic measurements and therapeutic options of GERD are discussed. It is suggested that GERD has to be included into differential diagnostic approaches especially when routine treatment of these ENT diseases failes.

Chronic Disease↗
PubMed2001

Loudness perception and late auditory evoked potentials in adult cochlear implant users.

In clinical routine the adjustment of speech processors in cochlear implant users is based on the patients' subjective statements about the loudness of specific electrical stimuli. From hearing patients it is known that the latencies and amplitudes of late auditory evoked potentials (LAEP) which are generated within the auditory cortex correlate with the loudness perception of acoustical stimuli. The aim of this study was to investigate the correlation between LAEP and loudness perception in adult cochlear implant users. We investigated 8 adult subjects who had been provided with a 22 electrode Cochlear Implant (nucleus CI24M) at least 6 months prior to the investigation. All subjects showed open speech understanding. Electrical pulse trains of 300 ms duration presented at a single electrode served as stimuli. Electrically LAEP morphologies were similar to normal hearing subjects. In all subjects and each intracochlear electrode position LAEP were well identifiable down to low loudness sensations. Both amplitudes and latencies depended on the loudness perception. The best correlation was observed for the N1 deflection. The results show that LAEP can be used for estimation of both hearing thresholds and most comfortable levels.

Adult↗
PubMed1999

[Expert phoniatric assessment of voice adaptation in male to female transsexualism].

Sex change surgery for patients with gender identity disorders has been performed successfully during the last decade, especially for males becoming females. A troublesome problem for some of these individuals is the retention of a male voice. Castration and estrogen therapy may produce only minor changes in pitch, with patients requiring further surgical treatment. Techniques used include glottoplasty, crico thyroid approximation and/or anterior commissure advancement. Although the voice is highly gender-specific, the standards of care for transsexuals do not cover guidelines for a diagnostic approach and surgical therapy. For medical jurisprudence, questions concerning specific aspects of German social law are answered in a representative case of a male-to-female transsexual. A review of the literature shows that there is no common thought about whether and when a specific surgical procedure should be performed in a gender-transforming process and which method should be used for long-term results and patient satisfaction. Although worldwide experience with these operations and overall good results are assumed, further reports by phonosurgeons performing these operations are required concerning actual results. We propose that medical scientific societies should offer phonosurgery as an optional treatment for male-to-female transsexuals in their guidelines and standards of care.

Adult↗
PubMed1998

[Johanson-Blizzard syndrome. A complex dysplasia syndrome with aplasia of the nasal alae and inner ear deafness].

BACKGROUND: The Johanson-Blizzard syndrome is a rare autosomal recessive syndrome with ectodermal dysplasia. ENT findings in the syndrome include profound bilateral hearing loss, aplasia of the alae nasi and dental malformations. To date approximately 30 cases have been described. CASE REPORT: We report our findings in a female patient who was born as the second child of consanguine parents. Pregnancy was normal, birth weight 3620 g and body length 52 cm. She was hospitalized immediately after birth because of anal atresia and facial dysmorphism with aplastic alae nasi, mongoloid eye slant and slightly dystopic ears. Bilateral symmetric profound hearing loss was diagnosed by subjective hearing tests and confirmed by auditory evoked brainstem potentials. Otoacoustic emissions were absent. Hearing aids were successfully fitted. Other malformations were a duplex of the uterus and vagina and exocrine pancreatic insufficiency. The anal atresia was corrected surgically. DISCUSSION: In general, the exocrine pancreatic insufficiency in the Johanson-Blizzard syndrome requires careful medical management. The aplastic alae nasi require no specific therapy, while in our case in the hearing loss could be treated with hearing aids.

Abnormalities, Multiple↗
PubMed1998

[Evaluating the patient satisfaction questionnaire after inpatient treatment in phoniatrics and pediatric audiology--a contribution to quality control?].

PURPOSE: In Germany public hospitals are compelled to evaluate patient satisfaction with their treatment as a part of quality management. The purpose of this study was to assess by means of a short questionnaire inpatient satisfaction with medical care in a phoniatric-paedaudiologic department. MATERIALS AND METHODS: From April 1995 until March 1997, 638 patients underwent inpatient treatment for phoniatric or paedaudiologic diseases in our department. A confidential questionnaire was handed out to the patients or to accompanying parents. 13 questions covered different aspects of hospital treatment, such as satisfaction with diagnostic and therapeutic measures, nursing care, accommodation, catering and administration. The participants were asked to rate on a scale of 1 (very good) to 6 (very poor). RESULTS: 306 (48%) of the patients returned their questionnaires. 16% of them expressed substantial dissatisfaction both with administration and accommodation. Only 2.7% of the patients conveyed a poor overall impression of their inpatient treatment. 3% asserted they would not want to be treated in the department again as the inpatient. However, the mean overall assessment indicated a high degree of patient satisfaction. CONCLUSIONS: Although the self-explaining 13-item questionnaire is easy to evaluate at low cost, it appears to be an inadequate measuring device for routine assessment of inpatient satisfaction since only 48% of the questionnaires could be analysed.

Adolescent↗
PubMed1998

[Auditory speech-evoked cerebral cortex potentials in patients with stuttering syndromes].

BACKGROUND: The cause of stuttering is unknown. For clinical purposes it proved to be useful to assume a multifactorial genesis with organic psychological and social aspects. A longstanding organic theory focussed on the failure to develop left-hemispheric dominance for speech, whereas others favoured deficits of the speech motor system. Positron emission tomography (PET) studies support organic theories for the development of stuttering. The purpose of this study was to find out whether in stutterers auditory cortical potentials evoked by pure tones, noise and words are different to those of healthy controls. PATIENTS AND METHODS: 10 young adults having suffered from stuttering since infancy were examined. The potentials were measured and analysed as previously described. RESULTS: No correlation of clinical and electrophysiological findings were found. In one case the evoked potentials were normal, in all other patients heterogeneous results were obtained in respect of tone-evoked and both noise- and speech-evoked potentials. Cortical hemispheric differences could be detected. CONCLUSIONS: In agreement with PET findings reported in the literature the data obtained in this study indicate an organic, central nervous cause of stuttering. Obviously both speech motoric components and perception elements are affected. These facts have to be taken into account whenever a psychological cause of stuttering is suspected. Nevertheless, psychosomatic aspects of the disturbances must be considered since they influence the patients' ability to cope with their symptom.

Adolescent↗
PubMed1997

[Chronic tinnitus in children and adolescents].

BACKGROUND: The problem of tinnitus in adults is reviewed systematically in nearly all standard otolaryngology reference works, whereas textbooks and monographs that focus on pediatric otorhinolaryngology or audiology and hearing in children and adolescents provide only little information concerning the epidemiology, etiology and therapy of tinnitus. The purpose of this study was to evaluate the psychosomatic aspects of chronic tinnitus in this younger age group. A rational diagnostic approach is discussed as to which diagnostic measures are necessary in the pediatric group for deciding which therapeutic option to chose. The therapeutic outcome of tinnitus counselling in non-severe cases and of parenteral lidocaine infusions in cases of a troublesome tinnitus is presented. PATIENTS AND METHODS: From January 1992 to December 1995, 31 children and adolescents in the age range from 6 to 17 years were treated for a chronic tinnitus without a measurable hearing loss. In 20 cases the tinnitus was bilateral; in 11 cases it was unilateral, without side preference. In 24 patients the case history gave no hint of a major annoyance by the tinnitus or significant psychological components. In these cases tinnitus counselling was carried out. In 7 cases-3 girls and 4 boys in the age range from 10 to 17 years-the kind and grade of symptom satisfied the ICD-10 criteria of a depressive episode. These patients were hospitalized for 10 days and a lidocaine infusion therapy (2 mg/kg Xylocain Cor in 500 ml HAES 6%) was performed as treatment for the somatic component of the disorder. Data were analyzed catamnestically using the patients' files. RESULTS: In all cases normal hearing threshold and speech intelligibility were ascertained by pure-tone and speech audiometry. Auditory evoked brainstem potentials gave no further information. The measurement of transient evoked otoacoustic emissions gave no consistent results in either of the two groups. Tinnitus measurement and audiometric masking could only be carried out in patients older than 10 years and showed non-reproducible results. In all cases with no major symptoms tinnitus disappeared. During a follow-up of 12-44 months, 4 cases treated with lidocaine achieved complete remission; in 3 cases the tinnitus eased off to such an extent that it was no longer regarded as annoying. In one girl of the lidocaine group a somatisation disorder developed independently of the tinnitus and was treated by psychotherapy. No side-effects of the lidocaine occurred. CONCLUSIONS: All aspects of chronic tinnitus in children and adolescents can be covered best when regarding this symptom as a psychosomatic disorder. The diagnostic approach in this age group has to include a detailed case history embracing both organic and psychological and social aspects. It should also include pure-tone and speech audiometry. Only in cases with an uncertain hearing threshold auditory evoked brainstem potentials have to be measured. Otoacoustic emissions give no further information about the development and therapeutic outcome of the tinnitus. In this age group tinnitus measurement and masking is of no diagnostic value. In patients with no signs of a hearing loss and no other organic symptoms there is no need for further diagnostic measures such as imaging or serological investigations. In cases with severe annoyance, tinnitus counselling is sufficient therapy. In cases with severe symptoms, lidocaine infusion therapy may be a therapeutic option for the somatic component of the disorder. In adolescents with chronic tinnitus psychotherapy will be necessary only in rare cases. The overall prognosis of this disorder is good.

Adolescent↗
PubMed1996

[Early indications for surgical vocal cord medial relocation in unilateral recurrent nerve paralysis in advanced age].

BACKGROUND: Unilateral vocal cord paralysis is usually treated conservatively. Phonosurgery is not indicated before 1 year after the onset of the palsy as during this period spontaneous recovery can be expected. In the elderly patient conservative voice rehabilitation is often limited by a restricted general condition. In these cases a severe communication disorder may result unless vocal cord function recovers spontaneously. PATIENTS AND METHODS: In 4 patients aged 68 to 79 years who had suffered from latrogenic unilateral vocal cord paralysis for 6 to 9 months, surgical medialisation of the paralysed vocal cord was carried out in local anaesthesia as an Isshiki-Type-I-operation after unsuccessful conservative treatment prior to surgery. RESULTS: In all cases a definite amelioration of voice function could be reached. There were no local or general complications. No spontaneous recovery of nerve function could be detected by electromyography between 6 to 9 months after the operation. Voice function remained stable during this period. CONCLUSIONS: We conclude that in elderly patients with unilateral vocal cord paralysis with no signs of spontaneous recovery and unsuccessful conservative treatment, surgical voice rehabilitation may be indicated before 1 year after the onset of the palsy.

Aged↗
PubMed1996

[Speech-specific cortical potentials--methodologic aspects and initial clinical results].

BACKGROUND: The purpose of this study was to find out whether specific cortical potentials can be evoked and identified after word stimulation. The clinical relevance was to be investigated in patients with aphasic syndromes. MATERIALS AND METHODS: In 20 young adults with no signs of hearing impairment and in patients with manifest aphasic syndromes, word-evoked cortical potentials were compared with those after an equivalent noise stimulus. The test words were selected from the Freiburger Speech Comprehension Test. The duration of the words was between 450 and 640 ms. The stimulus was presented monaurally. The peak level was 70 dB HL. The noise stimulus was produced by modifying a low-band noise. Potentials were measured between the ipsilateral mastoid and the contralateral forehead. Data were analysed offline. RESULTS: In healthy persons, the potentials after word and noise stimulation did not differ until 100 ms after the stimulus onset. After noise stimulation a negative maximum could be seen 100 ms after the stimulus onset, and a positive maximum 200 ms after the stimulus onset. After word stimulation, a positive maximum of higher amplitude than after noise stimulation was measured 150 ms after the stimulus onset, and a negative maximum was measured 270 ms after the stimulus onset. In all test persons the difference curve of word-and noise-evoked potentials revealed a speech-specific component 170 ms (N 170) after the stimulus onset. The single-word analysis showed that the potentials depend on the phonemes of the test word. The potentials do not alter when the stimulus side is changed. In patients with aphasia the potentials depend on the grade of the disturbance of speech perception: global and Wernicke's aphasia show no significant difference of speech-and noise-evoked potentials, whereas in Broca's aphasia a speech specific maximum is apparent. CONCLUSION: The speech-specific component may be regarded as a paradigm of cortical speech detection processes. Electrophysiological speech audiometry by means of word-evoked cortical potentials seems possible and may be used for clinical purposes.

Adult↗