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M Suckfüll

Publications and source records attributed to M Suckfüll.

At least 19 recordsLinked to original sources
PubMed2004

[Acute diseases of the inner ear--are cardiovascular treatment strategies lacking?].

The underlying cause of acute functional disorders of the inner ear (sudden hearing loss) is usually not detectable with clinical diagnostic measures. It is assumed that functional disorders of the inner ear are merely symptoms and not a disease entity in itself. In particular regional perfusion disturbances, but also autoimmune phenomena, viral infections and micromechanical disorders of the cochlea are seen as pathogenetic principles in inner ear disturbances. Although numerous effective therapeutic options and prophylactic measures for such diseases as myocardial infarction and stroke are available to cardiovascular medicine, they have so far not been applied to the treatment of inner ear problems. Here there is a promising and wide field of options for such diseases that can be traced back to regional perfusion disorders.

Blood Component Removal↗
PubMed2004

[Synovial sarcoma of the hypopharynx - two case reports].

BACKGROUND: Synovial sarcoma is a rare soft tissue malignancy that most often occurs in the extremities of young adults. Approximately 3 % of these mesenchymal malignant tumors occur in the head and neck region. Up to now about 100 cases have been published. PATIENTS: We report on two cases of a synovial sarcoma of the hypopharynx. In the first case the patient died 3.5 years after beginning of therapy including all therapeutical efforts (surgery, chemotherapy, radiotherapy). The second patient with a synovial sarcoma of his left hypopharynx and a distant metastasis in his 8th thoracic vertebral body is actually treated by neoadjuvant chemotherapy and included into a clinical study to optimize therapy of advanced soft tissue sarcomas. Further surgical treatment depends on the success of this therapeutic approach. CONCLUSION: Despite multitherapeutic approaches over all 5-year survival rates for advanced synovial sarcomas of the head and neck have moderately improved in the recent decades and an ideal treatment has not yet surfaced. Modification of accepted treatment modalities is discussed and therapy options in controlled clinical studies are described.

Adult↗
PubMed2003

[Treatment of sudden hearing loss through Fibrinogen/LDL-apheresis. A prospective, randomized multicenter trial].

INTRODUCTION: Sudden sensorineural hearing loss (SSHL) is thought to be of various origins. Disturbances of microcirculation, autoimmune pathology and viral infection are among the most likely causes. Acute reduction of plasma fibrinogen and serum LDL positively influences hemorheology and endothelial function and might thus be an effective therapy for SSHL. OBJECTIVE: To test the hypothesis that fibrinogen/LDL-apheresis is as effective or superior to conventional therapy with plasma expanders and prednisolone in the treatment of SSHL. DESIGN: controlled, prospective, randomized, multicenter trial. SETTING AND PATIENTS: 201 patients were recruited from 01/2000 to 6/2001 at the University Clinics of Munich, Berlin, Hamburg and Bochum. Inclusion criteria was sudden sensorineural hearing loss of unknown origin within 6 days of onset. INTERVENTIONS: Single fibrinogen/ LDL-apheresis infusion of prednisolone (250 mg, tapered by 25 mg daily), hydroxyethyl starch (500 ml, 6%) and pentoxifylin (400 mg/day). MAIN OUTCOMES: Improvement of pure tone thresholds 48 h after onset of therapy. RESULTS: Over all improvement of pure tone thresholds in the fibrinogen/ LDL-apheresis treated patients is slightly but not significantly better than in the standard therapy group. After 48 h, 50% speech perception in the fibrinogen/ LDL-apheresis group (21.6+/-20.1 dB) is significantly (p<0.034) better than in the standard group (29.3+/-29.4 dB). Patients with plasma fibrinogen levels of more than 295 mg/dl have a substantial and significantly (p<0.005) better improvement of speech perception (15.3+/-17.3 dB) than standard treated patients (6.1+/-10.4 dB). CONCLUSIONS: Fibrinogen/LDLapheresis is at least equally effective compared to prednisolone treatment in sudden hearing loss. Selected patients with plasma fibrinogen of more than 295 mg/dl improve significantly better when treated with fibrinogen/LDLapheresis.

Adolescent↗
PubMed2003

[Audimont--a scientific research expedition to Mount Cho Oyu in the Himalayas].

Even though hearing and vestibular disorders at high altitude have been reported since 1938, their reasons are still unknown. During the Audimont Research Expedition the risk for cochlear and vestibular sensory cells has been quantified by otoacoustic emissions and videonystagmography. Vestibular disorders could not be observed up to 7050 meters. However, the outer hair cells in the inner ear showed a reduction of emissions at increasing height. The pattern of the inner ear reply, depending on the altitude, complies with an increase of the perilymphatic pressure. As the perilymphatic space corresponds directly to the subarachnoid space, the limitation of hearing thus appears to be a direct consequence of raised intracranial pressure.

Acclimatization↗
PubMed2002

Fibrinogen and LDL apheresis in treatment of sudden hearing loss: a randomised multicentre trial.

BACKGROUND: Sudden sensorineural hearing loss (SSHL) is thought to have many different origins, including disturbances of microcirculation, autoimmune pathology, and viral infection. We aimed to determine whether acute reduction of plasma fibrinogen and serum LDL is effective for treatment of SSHL of suspected vascular origin. METHODS: Between January, 2000, and June, 2001, we recruited 201 patients with sudden hearing loss from four otorhinolaryngology clinics in Germany. Patients were randomly allocated to single fibrinogen/LDL apheresis or standard treatment (250 mg prednisolone reduced by 25 mg per day, 500 mL 6% hydroxyethyl starch, 400 mg pentoxifylline per day). The primary outcome was recovery of hearing as measured by pure-tone audiometry 48 h after the start of treatment. Secondary outcomes were recovery of hearing 6 weeks after treatment, improvement of speech audiometry, tinnitus, and frequency of side-effects. Analysis was done per protocol. FINDINGS: Overall improvement of pure-tone thresholds was slightly but not significantly better in patients given apheresis than in those given standard treatment (difference 7.7, 95% CI -8.2 to 23.6). However, the mean sound level at which 50% of recorded digits were recognised was significantly lower after 48 h in the apheresis group (21.6 dB, SD 20.8) than in the standard group (29.3 dB, 29.4; p=0.034). After 6 weeks, the mean 50% speech perception was at 13.6 dB (SD 14.3) in the apheresis group and at 20.8 dB (25.4) in those on standard treatment (p=0.059). At 48 h, in patients with plasma fibrinogen concentrations of more than 295 mg/dL, speech perception was improved much more in those on apheresis (15.3 dB, 17.3) than in those on standard treatment (6.1 dB, 10.4; p=0.005). INTERPRETATION: A single fibrinogen/LDL apheresis lasting for 2 h could be used as an alternative to conventional infusion treatment and prednisolone for 10 days. Patients with a plasma fibrinogen of more than 8.68 micromol/L improve much better when treated with apheresis, especially if serum LDL concentrations are also raised.

Adolescent↗
PubMed2002

[Cochlear and vestibular risk at high altitude].

Exposure to lowered oxygen pressure at high altitude results in various physiological reactions. The most important response besides hyperventilation is the elevation of the oxygen transport capacity, which simply is achieved by plasma diuresis. Hemoconcentration however not only increases oxygen uptake but also raises blood viscosity, serum osmolality and impairs blood flow. Various observations have suggested that hearing and postural properties deteriorate under these conditions at high altitude. Studies in hypobaric chambers and our own data indicate that the elevated hematocrit levels and hypoxemia may impair the central nervous system functions, resulting in altered speech discrimination, directional hearing, and postural control. However, there is no evidence that cochlear and vestibular sensory cells are affected, whether by acute hypoxia, nor by elevated hematocrit levels up to 58 %. Even an greater increase in serum osmolality or an impaired osmoregulation may not interfere with the outer hair cell function resulting in threshold shift and hearing loss.

Altitude Sickness↗
PubMed2001

[A patient with acoustic neuroma--The reason for the functional disorder of his inner ear?].

BACKGROUND: Acoustic neuroma is one of the classic causes of retrocochlear hearing disorders. Auditory brainstem response (ABR) testing with a sensitivity of about 90 % in the diagnosis of acoustic neuroma plays an important role as a screening method. CASE REPORT: A patient suffering from an acute, unilateral sensorineural hearing loss with tinnitus recovered for a short period of time after being treated with low density lipoprotein (LDL-) apheresis improving hemorheology. Surprisingly, the reason for the sudden hearing loss was a tumor in the cerebellopontine angle with a maximum diameter of 2 cm, which was detected by magnetic resonance imaging (MRI). Auditory brainstem response testing (ABR), audiovestibular tests and other standard tests were negative concerning this diagnosis. There was no previous evidence for an acoustic neuroma in all investigations of cochlear disfunction except MRI. CONCLUSIONS: The acoustic neuroma caused a compression of the labyrinthine artery in the inner auditory canal resulting in an acute unilateral hearing loss with tinnitus. Low Density Lipoprotein-apheresis was able to achieve a short term improvement of blood supply to the inner ear. Thus the compression of the labyrinthine artery caused by an acoustic neuroma could be compensated for the duration of about one week. Within this time the effect of LDL-apheresis decreased more and more. After a sudden unilateral hearing loss an acoustic neuroma must be ruled out even if the retrocochlear testing by ABR primarily shows no prolonged interpeak latency.

Adult↗
PubMed2001

Heparin-Induced extracorporeal low-density lipoprotein precipitation apheresis: a new therapeutic concept in the treatment of sudden hearing loss.

Vascular events, immunological processes, and viral infections have to be considered as pathomechanisms for most cases of sudden hearing loss (SHL). In order to clarify predisposing conditions for vascular events. hemorheological parameters have been studied in 53 patients suffering from SHL within 5 days of onset, along with a control group. The striking result was a significantly elevated level of plasma fibrinogen leading to a significantly increased erythrocyte aggregation and plasma viscosity. No significant difference could be found in all other parameters of clinical chemistry, hematology, and hemostasis. These results encouraged us to use heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) apheresis, which acutely and drastically reduces LDL. fibrinogen, and lipoprotein (a) in the treatment of patients suffering from sudden hearing loss and hyperfibrinogenemia or hypercholesterolemia. In a pilot study including 30 patients, we found a better recovery of hearing in the patients treated with a single HELP apheresis when compared to conventional treatment for 10 days with prednisolone and dextranes. Currently, we verify these results in a larger multicenter trial in patients regardless of their fibrinogen or LDL levels. In the future, there will be different specific treatments of sudden hearing loss based on the different pathomechanisms. The clinical impression and first controlled data make it likely that HELP apheresis is useful in the therapy of sudden hearing loss with suspected vascular origin.

Adolescent↗
PubMed2000

Heparin-induced extracorporal low-density-lipoprotein precipitation (H.E.L.P.) to improve the recovery of hearing in patients with sudden idiopathic hearing loss.

The pathogenesis of sudden hearing loss (SHL) is still not well understood. Possible causes include increased blood viscosity, microthrombosis or altered blood flow. Hypercholesterolemia, hyperfibrinogenemia and increased platelet aggregation are frequently observed in patients with SHL. The aim of this study was to investigate whether drastic lowering of plasma cholesterol and fibrinogen by selective extracorporal apheresis could have a beneficial effect on hearing recovery in these patients. Seven patients with SHL were treated with an extracorporal procedure removing fibrinogen and cholesterol from plasma. Six of the seven patients showed an immediate improvement in auditory thresholds following a single treatment of heparin-induced low-density lipoprotein precipitation. These findings indicate for the first time that acute and drastic removal of plasma fibrinogen and low-density lipoproteins may be an effective clinical method for the treatment of patients with SHL.

Adult↗
PubMed1999

[All sudden hearing losses are not alike. Away from infusion therapy?].

The number of patients requiring treatment for acute functional disorders of the inner ear has increased over the last decades. The diagnosis sudden loss of hearing is made when the cause of a precipitous hearing impairment cannot be determined with clinical diagnostic means. In the large majority of such cases, the pathogenesis is unclear, with vascular, viral and autoimmune processes most commonly being considered. Against this background, numerous polypragmatic therapeutic measures are employed. In general treatment of sudden loss of hearing employs a combination of several drugs with perfusion-promoting or anti-inflammatory effects. However, the efficacy of such an approach has not been established. The present article discusses a number of known ideas on the pathogenesis of this condition, together with the associated therapeutic strategies, and reports on the importance of nitrogen oxide (NO), which as recent studies appear to show, plays an important role in the physiology of the cochlea.

Anti-Inflammatory Agents↗
PubMed1999

Evaluation of the middle and inner ear structures: comparison of hybrid rendering, virtual endoscopy and axial 2D source images.

Recent developments in 3D reconstructions can enhance the quality and diagnostic value of axial 2D image data sets with direct benefits for clinical practice. To show the possible advantages of a hybrid rendering method [color-coded 3D shaded-surface display (SSD)- and volume rendering method] with the possibility of virtual endoscopy we have specifically highlighted the use in relation to the middle and inner ear structures. We examined 12 patients with both normal findings and postoperative changes, using image data sets from high-resolution spiral computed tomography (HRSCT). The middle and inner ear was segmented using an interactive threshold interval density volume-growing method and visualized with a color-coded SSD rendering method. The temporal bone was visualized using a transparent volume rendering method. The 3D- and virtual reconstructions were compared with the axial 2D source images. The evaluated middle and inner ear structures could be seen in their complete form and correct topographical relationship, and the 3D- and virtual reconstructions indicated an improved representation and spatial orientation of these structures. A hybrid and virtual endoscopic method could add information and improve the value of imaging in the diagnosis and management of patients with middle or inner ear diseases making the understanding and interpretation of axial 2D CT image data sets easier. The introduction of an improved rendering algorithm aids radiological diagnostics, medical education, surgical planning, surgical training, and postoperative assessment.

Adult↗
PubMed1999

[Exploratory analysis of risk factors of acute inner ear dysfunctions].

Aside from the clinical picture, the frequent occurrence of vascular risk factors favors a vascular pathogenesis of acute sensorineural hearing loss. However, the data on the association of vascular risk factors with sensorineural hearing loss are controversial. Achieving a sufficient number of patients and establishing a suitable control group is difficult. We analyzed the data of 393 patients suffering from acute sensorineural hearing loss. Risk factors, general, audiological, and laboratory parameters were investigated. Mean hearing loss and remission during 10 days of hospital treatment were calculated. The patient group was divided into patients with a certain risk factor and those without this risk factor, and mean remission and hearing loss were compared. Patients suffering from hyperlipidemia or hypotension had substantial and significantly higher mean hearing losses than patients not suffering from these diseases. Thrombosis, embolism, and hypertension were associated with a significantly worse remission of hearing loss. Repeated episodes of sensorineural hearing loss showed a significant worse remission, but less mean hearing loss before therapy. Smoking, diabetes mellitus, infections of the upper airways, and allergies had no influence on remission and mean hearing loss.

Adolescent↗
PubMed1999

[Pseudoaneurysm of the lingual artery after tonsillectomy. A rare complication].

BACKGROUND: Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology; however, life-threatening complications can occur in rare cases. PATIENTS: We report about a seven-year-old girl who developed a pseudoaneurysm of the lingual artery following elective routine tonsillectomy. RESULTS AND CONCLUSION: Initial ENT examination will reveal a painful cervical mass or unilateral palatal swelling that can easily be misinterpreted as a peritonsillar (or parapharyngeal) abscess. Computed tomography and angiography are indicated to confirm the diagnosis. Bleeding from a pseudoaneurysm of any branch of the external carotid artery represents a serious and life-threatening complication. Surgery is the treatment of choice.

Aneurysm, False↗
PubMed1999

Clinical utility of LDL-apheresis in the treatment of sudden hearing loss: a prospective, randomized study.

Although the pathogenesis of sudden hearing loss (SHL) is not as yet known, the clinical picture and the frequent association with vascular risk factors make an ischaemic event likely. This study aimed to assess the effect of an extracorporeal procedure (H.E.L.P.) in removing LDL-cholesterol, fibrinogen and lipoprotein (a) from the plasma, on the recovery of hearing SHL. This procedure using the HELP-system was compared with the usual standard treatment with prednisolone, dextranes and pentoxifyllin. We undertook a single centre, prospective, randomized study in which 18 patients were assigned to H.E.L.P.-apheresis and 9 patients were assigned to standard treatment (2:1 randomization). Audiometric and laboratory testing was performed at baseline, 24 h and 6 weeks after start of treatment. Primary endpoint was the improvement of the average pure-tone threshold between 0.125 and 8 kHz after 24 h. Twenty-four hours after H.E.L.P. treatment average pure-tone threshold recovered by 10.4 dB and by 26.4 dB after 6 weeks. The recovery of hearing of the standard treated patients was 5.8 dB and 16.8 dB after 24 h and 6 weeks respectively. LDL-cholesterol, fibrinogen and lipoprotein (a) were significantly reduced in the HELP treated patients compared with standard therapy, resulting in a significant improve in plasma viscosity, erythrocyte aggregation and resistance to oxidative stress of LDL particles. Our results suggest that the clinical outcome of SHL after a single extracorporeal LDL-apheresis is superior or at least equal to the more expensive standard treatment with prednisolone, dextranes and pentoxifyllin. Re-establishment of vascular endothelial function and improved blood rheology may be the underlying cause. These results must be confirmed in larger-scale trials.

Acute Disease↗
PubMed1999

Changes in serum osmolarity influence the function of outer hair cells.

Fast motility of outer hair cells (OHC) is thought to be based on a hydromechanic principle. In vitro, the function of OHCs can be disturbed by a change in the osmolarity of the culture medium. Whether changes in the serum osmolarity in vivo can also interfere with OHC motility has not been investigated as yet. Serum osmolarity of New Zealand White rabbits (n = 18) was elevated by a continuous infusion of glucose 40%, decreased by an infusion of aqua dest, or kept constant by an infusion of saline. OHC function was monitored using distortion products of otoacoustic emissions (DPOAE). Input output curves were established between 2 and 5 kHz (geometric mean of f2) with primaries of levels between 35 and 55 dB SPL. Cochlear perfusion was measured using a fluorescence microsphere method. Elevation of the serum osmolarity from 306 +/- 17 mosm/l to 365 +/- 23 induced a decrease of DPOAE between 3 and 12 dB SPL. Cochlear blood flow increased from 0.11 +/- 0.09 to 0.15 +/- 0.10 ml/min/g. When decreasing the serum osmolarity from 303 +/- 9 to 281 +/- 8 mosm/l, only slight changes of the DPOAE could be verified. As in the control group, cochlear perfusion was almost unchanged. In the control group, neither serum osmolarity nor DPOAE changed. Comparable to findings in vitro, increasing the serum osmolarity can lead to a disturbance of OHC function. In patients suffering from sudden hearing loss. dehydration due to physical or mental stress is often observed. This new and promising pathophysiological concept needs further clinical evaluation.

Acoustic Stimulation↗
PubMed1998

Hemoconcentration as a possible pathogenic factor of sudden hearing loss.

Hemodilution is considered to be a useful therapy for sudden hearing loss by improving cochlear blood flow (COBF) as a result of decreasing viscosity of the whole blood. The purpose of this investigation was to evaluate whether hemoconcentration actually leads to a diminished COBF and impaired function of the cochlea to thus play a role in the pathogenesis of sudden hearing loss. Ten New Zealand White rabbits were anesthetized and ventilated. Cochlear function was evaluated by measuring distortion products of otoacoustic emissions (DPOAEs) at the beginning of each experiment and after 120 min. In the interim, each test animal's hematocrit was raised by an infusion of packed red cells. Control animals were not infused, so hematocrits were left unchanged. Reproducibility of DPOAE measurements were found to be dependent upon the stimulus level. Correlation coefficients were 0.83 for 65 dB SPL and 0.78 for 45 dB SPL. Although no changes in the absolute level of DPOAEs were observed after raising the hematocrit, correlation coefficients were diminished to 0.68 at 65 dB SPL and 0.58 at 45 dB SPL. Hemoconcentration caused no apparent changes in the cochlear function in our animals. Although these findings may reflect species differences, hemoconcentration might still be a factor causing sudden hearing loss in older, atherosclerotic patients.

Acoustic Stimulation↗