Steffen Knopke

This study aimed to evaluate the long-term benefits of cochlear implantation (CI) on cognitive performance, speech perception, and psychological status in post-lingually deafened patients older than 65 (n = 33). Patients were consecutively enrolled in this prospective study and assessed before, one year after, and two years after CI for speech perception, depressive symptoms, perceived stress, and working memory and processing speed. The Wechsler Adult Intelligence Scale (WAIS) was used for the latter. Thirty-three patients (fourteen men and nineteen women) were included. The scores indicating “hearing in quiet” and “hearing with background noise” improved significantly one year after CI and remained so two years after CI. The sound localization scores improved two years after CI. The depressive symptoms and perceived stress scores were low at the study’s onset and remained unchanged. Working memory improved significantly two years after CI, while processing speed improved significantly one year after CI and was maintained after that. The improvement in working memory and processing speed two years after CI suggests there is a sustained positive effect of auditory rehabilitation with CI on cognitive abilities.

Several studies demonstrated the association of hearing disorders with neurocognitive deficits and dementia disorders, but little is known about the effects of auditory rehabilitation on the cognitive performance of the elderly. Therefore, the research question of the present study was whether cochlear implantation, performed in 21 patients over 70 with bilateral severe hearing impairment, could influence their cognitive skills. The measuring points were before implantation and 12 months after the first cochlear implant (CI) fitting. Evaluation of the working memory (WMI) and processing speed (PSI) was performed using the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). The audiological assessment included speech perception (SP) in quiet (Freiburg monosyllabic test; FMT), noise (Oldenburg sentence test; OLSA), and self-assessment inventory (Oldenburg Inventory; OI). Twelve months after the first CI fitting, not only the auditory parameters (SP and OI), but also the WMI and PSI, improved significantly (p < 0.05) in the cohort. The presented results imply that cochlear implantation of bilaterally hearing-impaired patients over 70 positively influences their cognitive skills.

The presented prospective study investigated whether structural brain damage, measured with the Fazekas score, could predict hearing rehabilitation outcomes with cochlear implantation (CI). With a follow-up period of 24 months, this study included 49 bilaterally, postlingually hearing impaired CI candidates for unilateral CI (67.3 ± 8.7 years; 20 men, 29 women) older than 50 at the time of implantation. The differences in the predictive value between two age groups, 50–70 year-olds (mid-age; n = 26) and over 70-year-olds (elderly; n = 23), were analyzed. The patients were evaluated using speech perception (SP) measured in quiet (Freiburg monosyllabic test; FMT) and noise (Oldenburg sentence test; OLSA). The subjective hearing ability was assessed using Oldenburg inventory (OI). The Fazekas PVWM score predicted postoperative speech perception two years after CI in the mid-age population. The periventricular white matter lesions (PVWM) could explain 27.4% of the speech perception (FMT) variance. Our findings support the hypothesis about the influence of pre-existing WMLs on CI outcome. We recommend the evaluation of Fazekas score as a predictive factor for post-implantation hearing ability.

The relevance of assessing cognitive functioning is increasing against the background of the continuing demographic changes. Up to a few years ago the focus was on the effects of cochlear implantation in children born deaf in comparison to healthy individuals. Currently, the question arises whether hearing rehabilitation in the elderly, e.g. by postlingual cochlear implantation, has a protective effect on cognitive functioning and therefore on the risk of onset of dementia. This review describes the association of cognitive functioning with hearing disorders and cochlear implantation. Historical aspects of intelligence testing are illustrated. Knowledge on cognitive aspects in elderly persons with hearing disorders and cochlear implants is rare in the currently available literature. Initial findings indicate a positive correlation between hearing improvement and cognitive functioning. Further studies are urgently required in order to elucidate appropriate guidelines for the treatment of patients with cognitive deficits and hearing impairment.

Objective: The aim of the present study was to investigate the influence of cochlear implantation (CI) on the cognitive abilities of people aged 70 years or older. Patients and method: 15 post-lingual deafened CI candidates, aged 70 years or older (77.2 ± 5.3 years) with unilateral CI were examined in this prospective study. The study took place between 2015 and 2017. In the follow-up period of at least 12 months the cognitive abilities, measured by the working memory and the processing speed (Wechsler intelligence test 4th ed.) as well as the speech recognition (Freiburg monosyllable test 65 dB SPL; adaptive OLSA) were determined and statistically evaluated. Depressive symptoms were asked with the (ADS-L). Results: Postoperatively, there is a significant correlation between processing speed and speech perception (OLSA; p < 0.05, rs =-0.569). Cognitive abilities were stable for 12 months. Speech perception showed a significant improvement. Depression in the elderly population was preoperatively low (11.4 ± 6.8). Conclusion: The results show the influence of speech perception in the sentence test by cognitive abilities in CI users aged 70 years or older. The cognitive outcome 12 months after implantation was stable. This supports the hypothesis that CI improves cognitive ability. The findings can be useful in upcoming patient counseling and education.

Introduction: Cochlear implantation is increasingly used for the treatment of patients with single sided deafness with or without tinnitus and with reduced quality of life. The current study additionally investigates the influence on health related quality of life and psychological comorbidities during a 6-month follow-up. Methods: Twenty-nine patients with single sided deafness were included in this prospective study and were assessed with the „Charité Test Battery“ before and 6 months after cochlear implantation. Assessment tools included Freiburg Monosyllabic Test (FES) and Oldenburg Inventory (OI) questionnaire for subjective speech perception, Tinnitus Questionnaire (TQ) for tinnitus distress and Nijmegen Cochlear Implant Questionnaire (NCIQ) for health-related quality of life, psychological comorbidities with PSQ, ADSL, GAD 7, PSQ Scores. Results: The 6-month follow-up after cochlear implant treatment showed a significant improvement of subjective speech perception (FES, OI) and tinnitus distress (TQ). Furthermore there was a significant improvement of two subcategories of COPE (elusive coping, seeking for support) and PSQ (stress, requirement). After 6 months health related quality of life (NCIQ) and anxiety (GAD) have not yet improved. Conclusion: When considering a cochlear implant treatment for single sided deaf patients with a high tinnitus prevalence, it is important to also think about the improvement of tinnitus distress and health-related quality of life as well as psychological comorbidities during the 6-month follow-up. Further prospective data is in progress.

Einleitung: Das Ziel der präsentierten Studie war es, kindliche Rhabdomyosarkome (RMS) des Kopf-Hals-Bereichs in Bezug auf klinische Präsentation, Therapie und Überleben zu bestimmen. Methoden: Die Daten von kindlichen RMS-Patienten der Charité – Universitätsmedizin des Zeitraums von 1996 bis 2016 wurden retrospektiv aus digitalen und Papier-Akten gesammelt und bezüglich klinischem Verlauf, Therapiemodalitäten und Nebenwirkungen analysiert. Die Überlebenszeitanalyse erfolgte mittels Kaplan-Meier-Methode. Ergebnisse: Achtundzwanzig Pateinten (17 männlich, 11 weiblich) mit einem mittleren Alter von 6,8+/-5,0 Jahren wurden eingeschlossen. Vierzehn Patienten (50,0%) zeigten eine schmerzlose Schwellung im Kopf-Hals-Bereich, neun (32,1%) hatten Hirnnervenausfälle bei Erstvorstellung. Hauptlokalisation der RMS war die Orbita (n = 9; 32,1%) gefolgt von parapharyngealer (n = 4; 14,2%) und sinunasaler (n = 3; 10,7%) Manifestation. Alle Patienten erhielten eine Polychemotherapie nach histologischer Sicherung. Eine adjuvante Radiatio erfoglte bei 24 Patienten (85,7%). Bei 12 Patienten (42,9%) erfolgte eine chirurgische Therapie. Die 5-Jahrs-Gesamtüberlebensrate betrug 91,3%. Das mediane progressionsfreie Überleben war 46+/-67,4 Monate. Als Hauptnebenwirkungen der multimodalen Therapie zeigten sich Mukositis, Neutropenie, Übelkeit und Erbrechen sowie Radiodermatitis. Langzeitschäden waren faziale Entstellungen und Mikrosomien. Schlussfolgerungen: Bei pädiatrischen Kopf-Hals-RMS kann mit einem multimodalen Therapiekonzept eine hervorragende 5-Jahres-Gesamtüberlebensraten von bis zu 91,3% erreicht werden.

Introduction: Masson tumor is a benign intravascular tumor, which is seen typically in the fingers. Histologically featured by endothelial papillary projection limited in the intravascular space associated with thrombi, with no pilling up of of the endothelial, Atypia or necrosis aren't usual. CD 31 and CD 34 stains were the most efficient markers to identify the vascular origin. The pathogenesis is still unknown. Surgical excision is the method of treatment. Method: a Case report of Masson tumor as lateral neck mass. Results: A 55 year old man presented with a right lateral neck mass for 3 weeks. CT scan of the neck showed an oval, well circumscribed cystic mass and measured by 20 mm × 9 mm over the right Sternocleidomastoid muscle with peripheral vessel draining into the right anterior Jugular Vein. The mass was surgically excised and pathologically reported with a thrombosed material in the intralumen of a small vein with differentiated papillary structure and there was no nuclear atypia or necrosis. The patient recovered without complications and he was followed up for 8 months without any evidence of recurrence. Conclusion: Masson tumor is an extremely rare presentation of masson tumor. The diagnosis of IPEH important and challenging, because it could mimic angiosarcoma.

Hintergrund: Neben neurophysiologischen resp. elektrophysiologischen Markern und Methoden zur Abschätzung des rehabilitativen Erfolges existieren keine sinnvollen klinischen Methoden, um den Erfolg der CI-Versorgung präoperativ abzuschätzen. Zielstellung: Ziel der Studie war die Untersuchung eines neuroradiologischen Demenz-Scores als Vorhersagewert für das rehabilitative Outcome von CI-Trägern. Patienten und Methode: 63 postlingual an Taubheit grenzend schwerhörige Patienten (60,4 ± 15,8; 20,6 – 88,9 Jahre) mit unilateraler CI wurden zwischen 03/2009 und 03/2014 in dieser Studie untersucht. Im Nachbeobachtungszeitraum von mindestens 24 Monaten wurde der neuroradiologische Fazekas-Score (PVWM, DWM, Total) im präoperativen MRT-Scan durch einen erfahrenen Neuroradiologen bestimmt. Prospektiv wurde das Sprachverstehen (Freiburger Einsilber Test in Ruhe 65 dB SPL; adaptiver OLSA) erhoben. Es schloss sich eine statistische Analyse mit Korrelationsanalyse nach Spearman an. Ergebnisse: Postoperativ besteht ein signifikanter Zusammenhang zwischen dem Fazekas-Score PVWM und dem Sprachverstehen im OLSA bei über 50-Jährigen (> 50a: p < 0,01; rs =-0,525; > 70a: p < 0,05; rs =-0,523). Nach 24 Monaten bestand ebendiese Korrelation im selben Kollektiv nicht fort. Das Sprachverstehen zeigte über den gesamten Zeitraum eine signifikante Verbesserung. Schlussfolgerung: Die Vorhersage des postoperativen Sprachverstehens durch den Fazekas-Score erscheint möglich. Am Fazekas-Score gemessen scheinen rein organische Defizite über eine verlängerten Nachbeobachtungszeitraum ausgeglichen zu werden. Dies kann Ausdruck der Neuroplastizität sein.

Background: Neurophysiological resp. electrophysiological markers and methods for the assessment of rehabilitative success after cochlear implantation (CI) were described in the past. Prior surgery, useful clinical predictors are not known to assess audiological outcome after cochlear implantation (CI). Objective: The aim of the present study was to evaluate a neuroradiological dementia score as a predictive value for the rehabilitative outcome after CI. Patients and methods: 63 patients with postlingual severe to profound hearing loss (60.4 ± 15.8, 20.6 – 88.9 years) and unilateral CI were studied between 03/2009 and 03/2014. In the follow-up period of at least 24 months, the neuroradiological Fazekas score (PVWM, DWM, total) was gathered by an experienced neuroradiologist in the preoperative MRI scan. Prospectively, the speech perception (Freiburg monosyllabic test; adaptive OLSA) was evaluated. This was followed by a statistical analysis with correlation analysis according to Spearman. Results: Postoperatively, we found a significant relationship between the Fazekas score PVWM and the speech perception in the OLSA in over 50 years old patients (> 50a: p < 0.01, rs =-0.525,> 70a: p < 0.05, rs =-0.523). After 24 months, this correlation did not persist any longer. Speech perception showed a significant improvement over the entire period. Conclusion: The prediction of postoperative speech perception by the Fazekas score appears possible. Measured by the Fazekas score, anatomical deficits appear to be compensated over a prolonged follow-up period. This may be an expression of neuroplasticity.