Consensus Statement on Bone Conduction Devices and Active Middle Ear Implants in Conductive and Mixed Hearing Loss

Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care

A Practical Guide to the Eustachian Tube

VI, 74 p. 35 illus., 29 illus. in color.online re

Realistic Haptic Interaction in Volume Sculpting for Surgery Simulation

Realistic haptic interaction in volume sculpting is a decisive prerequisite for successful simulation of bone surgery. We present a haptic rendering algorithm, based on a multi-point collision detection approach which provides realistic tool interactions. Both haptics and graphics are rendered at sub-voxel resolution, which leads to a high level of detail and enables the exploration of the models at any scale. With a simulated drill bony structures can be removed interactively. The characteristics of the real drilling procedure like material distribution around the drill are considered to enable a realistic sensation. All forces are calculated at an extra high update rate of 6000 Hz which enables rendering of drilling vibrations and sti# surfaces. As a main application, a simulator for petrous bone surgery was developed. With the simulated drill, access paths to the middle ear can be studied. This allows a realistic training without the need for cadaveric material

The Eustachian tube redefined

4 page(s

Loss of K-Cl co-transporter KCC3 causes deafness, neurodegeneration and reduced seizure threshold

K-Cl co-transporters are encoded by four homologous genes and may have roles in transepithelial transport and in the regulation of cell volume and cytoplasmic chloride. KCC3, an isoform mutated in the human Anderman syndrome, is expressed in brain, epithelia and other tissues. To investigate the physiological functions of KCC3, we disrupted its gene in mice. This severely impaired cell volume regulation as assessed in renal tubules and neurons, and moderately raised intraneuronal Cl(–) concentration. Kcc3(–/–) mice showed severe motor abnormalities correlating with a progressive neurodegeneration in the peripheral and CNS. Although no spontaneous seizures were observed, Kcc3(–/–) mice displayed reduced seizure threshold and spike-wave complexes on electrocorticograms. These resembled EEG abnormalities in patients with Anderman syndrome. Kcc3(–/–) mice also displayed arterial hypertension and a slowly progressive deafness. KCC3 was expressed in many, but not all cells of the inner ear K(+) recycling pathway. These cells slowly degenerated, as did sensory hair cells. The present mouse model has revealed important cellular and systemic functions of KCC3 and is highly relevant for Anderman syndrome