Extraoral Osseous Choristoma in the Head and Neck Region: Case Report and Literature Review

An osseous choristoma is a benign tumor consisting of regular bone tissue in an irregular localization. Choristomas in the head and neck region are rare. Most frequently, they are found in the region of the tongue or oral mucosa. There are also very few reports on osseous choristomas in the submandibular region. We present the case of a woman with a large, caudal osseous choristoma within the lateral cervical triangle. Literature review is given about all of the reported cases in the region of the neck. The pathogenesis is yet unexplained. Our case supports the theory that the development of an osseous choristoma is a reaction to a former trauma. Cervical osseous choristomas are seldom, but they represent an important differential diagnosis when dealing with a cervical tumo

Generation, Recording and interindividual Transmission of Biosignals

Die Messung der Gehirnströme mittels Elektroenzophalographie (EEG) ist ein Standardverfahren in der heutigen medizinischen Diagnostik. Neben der diagnostischen Anwendung werden aktuell Brain-Computer-Interface-Anwendungen (BCIs) entwickelt, welche EEG als Eingabemöglichkeit am PC nutzen. Dies ist insbesondere für Patienten mit Locked-In-Syndrom, welche keine Möglichkeit zur Kommunikation haben, wie ALS-Patienten, eine Chance, sich in Zukunft verständigen zu können. In dieser Arbeit wird mit einem kapazitiven EEG-Helmsystem das Potential visueller Stimulation via Schachbrettmusterumkehr bei unterschiedlichen Frequenzbereichen und Farbkombinationen analysiert. Dabei wurde der Bereich der Stimulationsfrequenzen, welcher standardmäßig im Bereich zwischen 8 und 20 Hz liegt, auf 40 Hz erweitert, um in einer störungs- und rauscharmen Frequenzumgebung bessere Ergebnisse zu erzielen. Neben dem gewünschten Resultat, dass diese zusätzlichen Frequenzen ein nutzbares Signal mit individuellen Unterschieden in der Signalstärke zeigen, wurde beobachtet, dass die Signalfrequenzen im aufgenommenen EEG von der im Stimulationsprogramm eingestellten abweichen. Dadurch wurden neben den EEGMessungen auch u. a. Messungen der real dargestellten Frequenzen mittels eines am Monitor angebrachten Phototransistors durchgeführt, um die Ursache dieser Abweichung zu finden. Dabei wurde beobachtet, dass die Anzeige zwischen zwei Frequenzen wechselt und das EEG einen Peak bei der gemittelten Frequenz aufweist. Die Hauptursache für die Abweichung wurde in dem bislang verwendeten Programm zur Stimulationserzeugung in Kombination mit dem nicht echtzeitfähigen Windows als Betriebssystem gefunden. Zum Vergleich wurde ein alternatives Stimulationsprogramm mittels DirectX entwickelt und getestet. Die eingestellten Frequenzen wurden exakt angezeigt, bei keiner Messung gab es Abweichungen. Als zweites Thema wurden Haut- und Übergangswiderstände zwischen zwei Menschen unter diversen Randbedingungen behandelt und das Übertragungsverhalten elektrischer Signale zwischen Personen untersucht.The measurement of brain activity by electroencephalography (EEG) is commonly used for medical diagnoses. Furthermore, there is much research in the field of brain computer interface applications (BCI). BCIs use EEG signals to provide an alternative input device for handicapped people suffering from the locked in syndrome. In this thesis EEG measurements were performed with a capacitive EEG helmet system while visual stimulation with color reversing checkerboards with different colors and frequencies. The aim was to find stimulation parameters which could provide good response so they can be used for BCI applications. One issue was to avoid the frequency range with high noise. Hence, the most often used frequencies between 8 and 20 Hz were extended to 40 Hz. Additional to the desired result of good response at higher frequencies it was found that the measured frequencies differed from those chosen in the software. Therefore, further investigations were performed to find the source of this phenomenon, for example the displayed stimulation was measured by photo transistors. It was observed that the displayed pattern switches between two frequencies. The peak in the EEG spectrum fits to the average of these two frequencies. The main source was detected as the used stimulation program in combination with Windows as not real time capable operating system. An alternative stimulation program was implemented with DirectX and measurements for comparison were performed. The frequencies were stable and not varying, not a single aberration was observed. The second aim of this thesis was to analyze the skin resistance and the resistance between two people on different conditions. Furthermore, the interpersonal transmission behavior of bioelectrical signals was observed

Stress and tinnitus—from bedside to bench and back

The aim of this review is to focus the attention of clinicians and basic researchers on the association between psycho-social stress and tinnitus. Although tinnitus is an auditory symptom, its onset and progression often associates with emotional strain. Recent epidemiological studies have provided evidence for a direct relationship between the emotional status of subjects and tinnitus. In addition, studies of function, morphology, and gene and protein expression in the auditory system of animals exposed to stress support the notion that the emotional status can influence the auditory system. The data provided by clinical and basic research with use of animal stress models offers valuable clues for an improvement in diagnosis and more effective treatment of tinnitus

Granulomatosis with polyangiitis in a patient with polydipsia, facial nerve paralysis, and severe otologic complaints: a case report and review of the literature

Background: Granulomatosis with polyangiitis, formerly known as Wegener granulomatosis, is a necrotizing vasculitis with granulomatous inflammation that belongs to the class of antineutrophil cytoplasmic antibodies-positive diseases. It occurs in a localized and a systemic form and may present with a variety of symptoms. Involvement of the upper respiratory tract is very common, while neurologic, endocrinological, and nephrological dysfunction may occur. Case presentation: We describe the case of a 29-year-old Central European male patient presenting with severe bilateral sensorineural hearing loss, otorrhea, and one-sided facial nerve paralysis. The patient was unsuccessfully treated with i.v. antibiotics at another hospital in Berlin, and tympanic tubes were inserted. After presentation to our emergency room, he was hospitalized and further diagnostics started. Increased fluid intake and 12 kg weight gain over the last months were reported. The patient was diagnosed with granulomatosis with polyangiitis and diabetes insipidus. The patient's condition improved after treatment with rituximab. Discussion: A comprehensive PubMed search of all articles with granulomatosis with polyangiitis and diabetes insipidus was conducted to assess which combination of symptoms occurs simultaneously and whether other parts of the pituitary are commonly involved. The 39 selected articles, describing 61 patients, showed that ear-nose-throat involvement occurred most commonly, in 71% of cases. Of patients, 59% had involvement of the anterior pituitary gland, while true panhypopituitarism occurred in 13% of cases. Only one case report featured the same set of symptoms as described herein. Conclusion: Granulomatosis with polyangiitis is a highly variable disease, commonly involving the upper airways, but that may present with symptoms solely related to the pituitary gland. Clinicians should have a low threshold to investigate for granulomatosis with polyangiitis in patients with therapy-resistant otorrhea. Patients may present with a complex set of symptoms, and integrating different specialists when additional symptoms occur may lead to faster diagnosis

Определение ускорений и сил инерции при вращении валков вибрационного классификатора

У статті представлено результати досліджень із визначення прискорень і сил інерції при обертанні валків вібраційного класифікатора. Встановлено величини прискорень і значення переносної сили інерції при відносному русі валка навколо осі.The article presents findings on acceleration and inertia force determination at rotation of vibrating classifier rolls. Values of acceleration and force of moving space are specified at relative roll movement about axis

Cochlear Implantation of Bilaterally Deafened Patients with Tinnitus Induces Sustained Decrease of Tinnitus-Related Distress

Objective: Tinnitus is a common symptom of hearing impairment. Patients who are bilaterally hard of hearing are often affected by tinnitus. However, they cannot undergo any of the standard tinnitus therapies, since they rely on hearing. Cochlear implantation (CI) used to treat severe hearing disabilities, such as bilateral hearing loss, was also shown to reduce tinnitus. Our goal was to determine if CI induces sustained reduction of tinnitus. We performed prospective, longitudinal analyses of tinnitus-related distress in a uniform group of bilaterally deafened patients after CI. Patients and Methods: The homogenous sample consisted of 41 patients who met the inclusion criteria and were consecutively included in this study. The impact of unilateral CI on tinnitus-related distress, health-related quality of life (HRQoL), and hearing abilities was studied with validated instruments. The follow-up appointments were scheduled at 6, 12, and 24 months after CI surgery. During the appointments, hearing abilities were estimated with monosyllabic Freiburg test, whereas the tinnitus-related distress, the HRQoL, and the subjective hearing were measured with standard questionnaires [Tinnitus Questionnaire (TQ), Nijmegen Cochlear Implantation Questionnaire, and Oldenburg Inventory, respectively]. Results: Tinnitus-related distress decreased significantly from the mean TQ score of 35.0 (SD = 19.6) prior to surgery to the mean TQ = 27.54 (SD = 20.0) 6 months after surgery and remained sustained low until the end of follow-up period. In addition, CI significantly improved the hearing abilities and the HRQoL of all patients. Conclusion: The results from our prospective study suggest that in a homogenous sample of bilaterally deafened, implanted patients who report having tinnitus prior to surgery, CI alone not only improves the hearing abilities but also significantly reduces the tinnitus- related distress and improves the HRQoL in a sustained way

Comorbid symptoms occurring during acute low-tone hearing loss (AHLH) as potential predictors of Meniere's disease

Acute low-tone sensorineural hearing loss (ALHL) is a type of idiopathic sudden sensorineural hearing loss. ALHL is rarely a solitary condition but rather co-occurs with vertigo and tinnitus, being an element of contemporary diagnostic criteria for Meniere's disease (MD). The goal of our present study was to determine the value of ALHL for the early diagnosis of MD in patients presenting in the emergency room with AWL as a main complaint. The files of 106 patients with ALHL who were admitted to the emergency room over the period of 7 years and 104 patients with acute high- tone sensorineural hearing loss (AHHL) from the same period were included in this retrospective study. Forty ALHL patients presented with recurrent episode of hearing loss and 66 remaining patients presented with ALHL for the first time. Of the latter group, 25 patients gave consent for the follow-up. First, we analyzed the difference in the occurrence of tinnitus and vertigo between the ALHL and AHHL groups. In patients with ALHL, the incidence of vertigo with tinnitus and the number of recurrent episodes were statistically higher than in patients with AHHL. Next, we focused on the ALHL follow-up group (25 patients). In that group, two patients had all MD symptoms at presentation, 18 had ALHL and tinnitus and five ALHL only. Of 18 patients with ALHL and tinnitus at admission, five developed vertigo and thus the triad of Meniere's disease. None of the five patients with AHLH as a sole symptom developed MD during the follow-up time but four of them have developed tinnitus. Patients with recurrent ALHL had significantly higher incidence of MD than the patients with first episode. We conclude that some patients who present with ALHL and concomitant tinnitus or have recurrent episodes of ALHL are more likely to develop Meniere's disease than these patients, who present with ALHL as a sole symptom. Nonetheless, we recommend otological follow-up for all patients presenting with ALHL

In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation

Cochlear implantation (CI) is increasingly being used in the auditory rehabilitation of deaf patients. Here, we investigated whether the auditory rehabilitation can be influenced by the psychological burden caused by mental conditions. Our sample included 47 patients who underwent implantation. All patients were monitored before and 6 months after CI. Auditory performance was assessed using the Oldenburg Inventory (OI) and Freiburg monosyllable (FB MS) speech discrimination test. The health-related quality of life was measured with Nijmegen Cochlear implantation Questionnaire (NCIQ) whereas tinnitus- related distress was measured with the German version of Tinnitus Questionnaire (TQ). We additionally assessed the general perceived quality of life, the perceived stress, coping abilities, anxiety levels and the depressive symptoms. Finally, a structured interview to detect mental conditions (CIDI) was performed before and after surgery. We found that CI led to an overall improvement in auditory performance as well as the anxiety and depression, quality of life, tinnitus distress and coping strategies. CIDI revealed that 81% of patients in our sample had affective, anxiety, and/or somatoform disorders before or after CI. The affective disorders included dysthymia and depression, while anxiety disorders included agoraphobias and unspecified phobias. We also diagnosed cases of somatoform pain disorders and unrecognizable figure somatoform disorders. We found a positive correlation between the auditory performance and the decrease of anxiety and depression, tinnitus-related distress and perceived stress. There was no association between the presence of a mental condition itself and the outcome of auditory rehabilitation. We conclude that the CI candidates exhibit high rates of psychological disorders, and there is a particularly strong association between somatoform disorders and tinnitus. The presence of mental disorders remained unaffected by CI but the degree of psychological burden decreased significantly post-CI. The implants benefitted patients in a number of psychosocial areas, improving the symptoms of depression and anxiety, tinnitus, and their quality of life and coping strategies. The prevalence of mental disorders in patients who are candidates for CI suggests the need for a comprehensive psychological and psychosomatic management of their treatment

Impact of Multiple Factors on the Degree of Tinnitus Distress

Objective: The primary cause of subjective tinnitus is a dysfunction of the auditory system; however, the degree of distress tinnitus causes depends largely on the psychological status of the patient. Our goal was to attempt to associate the grade of tinnitus-related distress with the psychological distress, physical, or psychological discomfort patients experienced, as well as potentially relevant social parameters, through a simultaneous analysis of these factors. Methods: We determined the level of tinnitus-related distress in 531 tinnitus patients using the German version of the tinnitus questionnaire (TQ). In addition, we used the Perceived Stress Questionnaire (PSQ); General Depression Scale Allgemeine Depression Skala (ADS), Berlin Mood Questionnaire (BSF); somatic symptoms inventory (BI), and SF-8 health survey as well as general information collected through a medical history. Results: The TQ score significantly correlated with a score obtained using PSQ, ADS, BSF, BI, and SF-8 alongside psychosocial factors such as age, gender, and marital status. The level of hearing loss and the auditory properties of the specific tinnitus combined with perceived stress and the degree of depressive mood and somatic discomfort of a patient were identified as medium-strong predictors of chronic tinnitus. Social factors such as gender, age, or marital status also had an impact on the degree of tinnitus distress. The results that were obtained were implemented in a specific cortical distress network model. Conclusions: Using a large representative sample of patients with chronic tinnitus permitted a simultaneous statistical measurement of psychometric and audiological parameters in predicting tinnitus distress. We demonstrate that single factors can be distinguished in a manner that explains their causative association and influence on the induction of tinnitus-related distress