HNO

[Patient-reported outcome measures-use in diagnosing depression, anxiety, and stress]
Brüggemann P, Böcking B, Steinmetzger K, Winter E, Fischer F, Rose M and Mazurek B
Patient-reported outcome measures (PROMs) is an umbrella term for various self-report instruments used to assess subjective health-related impressions and treatment success from the patient's perspective. In psychosomatic medicine, PROMs are often used to record subjective symptoms, psychosocial distress, and changes in health status, particularly in patients with comorbid (affective) disorders and frequent contact with physicians, but also in preventive health care and to monitor the effectiveness of treatment. In otolaryngology (ENT), self-report questionnaires (PROMs) are used, among other things, to assess the impact of hearing, speech, swallowing, and breathing disorders on patients' quality of life. Such scientifically validated tools make it possible to better understand the needs and priorities of patients and to integrate them into clinician-patient communication and treatment to promote individual, patient-centered care. Three dimensions for the assessment of subjective health-related experiences (depression, anxiety, stress) with corresponding instruments for the German-speaking area for use in clinical and research settings are presented in more detail, specifically for otolaryngology.
[Psychosomatic Medicine in ENT-German version]
Mazurek B and Rose M
[Epidemiology and prevention of oropharyngeal cancer : Summary of the new German S3 guideline]
Dietz A
Due to the association with the causal human papillomavirus 16 (HPV16) infection, oropharyngeal squamous cell carcinoma is now separated into two distinct entities depending on HPV16 positivity. More recent data show a diversified picture of the importance and prevalence of the surrogate parameter p16 (discordance) for a definitive HPV16 association, which varies worldwide. In the context of preventive options, vaccination is of major importance and HPV screening of healthy people of less importance. The current CME article excerpts parts of the new German S3 guideline on diagnosis, treatment, prevention, and aftercare of oro- and hypopharyngeal cancer (version 1.0, March 2024; Association of the Scientific Medical Societies in Germany [AWMF] registration number 017-082OL).
[Visitors in the operating room-just let them watch?!]
Seibert KV
[Paresthesia after climbing-a rare case of a clival mucocele]
Santschi M, Kyriakou M and Negoias S
We describe an extremely rare case of a clival mucocele and complement the case report with a literature review. A 30-year-old woman presented to the emergency department with unclear neurologic symptoms after bouldering and left-sided hyposensitivity in her face and radial surface of the forearm. Magnetic resonance imaging was suspicious of a clival mucocele, which was confirmed in computed tomography. Endoscopic drainage of the mucocele was undertaken, after which the patient recovered fully.
[Chronic rhinosinusitis was neither a risk nor a protective factor during the COVID-19 pandemic]
Gudziol H, Hummel T and Guntinas-Lichius O
There are various views in the literature regarding the influence of chronic rhinosinusitis (CRS) as a comorbidity on the occurrence of COVID-19 disease.
[Superior semicircular canal dehiscence isolation by transmastoid two-point canal plugging with preservation of the vestibulo-ocular reflex. German version]
Seiwerth I, Dlugaiczyk J, Schmäl F, Rahne T, Kösling S and Plontke SK
This article describes the surgical treatment of superior semicircular canal dehiscence syndrome (SCDS) by isolating the dehiscence using transmastoid two-point canal plugging while preserving the high-frequency vestibulo-ocular reflex (VOR) of the affected semicircular canal. The superior semicircular canal is opened via a transmastoid approach anterior (as far from the ampulla as possible) and posterior to the dehiscence and then plugged with connective tissue and bone dust. In two clinical exemplary cases, vestibular testing showed that the VOR measured by video head impulse (vHIT) test was preserved (patient 1: gain preoperative 0.7, long-term postoperative 0.75; patient 2: gain preoperative 0.64, long-term postoperative 0.79; reduction of corrective saccades in each case) with a simultaneous reduction in pathologically increased amplitudes of vestibular evoked myogenic potentials (VEMPs) and a significant improvement in clinical symptoms with almost complete freedom from symptoms. One possible explanation for preservation of the high-frequency VOR of the superior semicircular canal would be the deformability of the endolymphatic space described at high stimulation frequencies, which can lead to endolymph movements in the area of the ampulla with deflection of the cupula despite blockage of the semicircular canal.
[The use of fracture sonography in midface traumatology]
Rink M, Ackermann O, Sproll C, Symeou L, Pillong L, Weimer J and Künzel J
Ultrasound is today an essential element of otorhinolaryngology. During the course of (technical) development, fracture sonography has also gained increasing clinical and scientific interest. Sonography can already be used today as the imaging method of choice for isolated suspected fractures of the nasal or zygomatic bone. Sonography can also be helpful for immediate monitoring of repositioning. In the diagnosis of more complex fractures, however, cross-sectional imaging is still required. This article provides an overview of the possibilities and limitations of fracture sonography in the midface region and offers an introduction to the topic. The performance of the most important examinations is explained using images, and possible pitfalls are outlined.
[Empowering patients through app-based cochlear implant self-adjustment]
Büchner A
Treatment of patients with severe hearing loss or deafness using cochlear implants (CI) is nowadays clinical routine. In the Hannover Medical School alone, more than 500 patients are treated with CI annually, meaning that the pool of patients with CI increases significantly each year. Worldwide, there are over 1 million patients with a CI system; in Germany the figure is estimated at over 60,000. With such a huge number of CI patients, centralized annual routine follow-up of all patients in the implant centers is obviously not possible in the long term. Many patients would also like to reduce travel and time expenditures without missing out on the competencies of large hospitals. Simultaneously, the financial pressure exerted by health insurance providers is increasing, resulting in the requirement to provide treatment of the same or even heightened quality more efficiently. Telemedicine in the form of app-based aftercare can help to realize these goals and will play an increasingly important role in the future.
[Medical examination: preparation for ENT specialisation : Part 75]
Gutekunst I and Zenk J
[Pre-implementation of electronic patient-reported outcomes at reference centers for head and neck oncology : A roadmap towards patient-centered digitalization]
Dejaco D, Gottfried T, Santer M, Thurner A, Lehmann J, Riedl D, Rumpold G, Holzner B, Schmutzhard J and Hofauer B
Electronically captured patient reports (electronic patient-reported outcomes, ePROs) are digital questionnaires filled out by cancer patients. Despite indications of improved clinical care, the integration of ePROs into clinical head and neck oncology is uncharted territory.
[Digitalization in otorhinolaryngology: data as the key to improved healthcare]
Schönermark MP and Hofauer B
[Is AIT worth your while? Economic evaluation of allergen-specific immunotherapy (AIT) for otorhinolaryngologists in private practice]
Reineke U and Cappello C
The burden of allergic diseases is significant for patients, payers in the healthcare system, and the political economy. Numerous studies have demonstrated the efficacy and cost-effectiveness of allergen immunotherapy (AIT) compared to symptomatic treatments. However, allergic patients in Germany often do not receive adequate treatment. This study aims to investigate the reimbursement of allergy diagnostics and AIT for ear, nose, and throat (ENT) physicians in private practice. A model calculation was conducted to assess the reimbursement of allergology services across 12 statutory health insurance associations (Kassenärztliche Vereinigungen, KV) based on the Physician Fee Schedule (Einheitlicher Bewertungsmaßstab, EBM) and KV-specific regulations for the year 2022 [20, 22]. Reimbursement was calculated according to EBM values and with a reduced point value. Quarterly reimbursement for a 3-year therapy and hourly rates for subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) were analyzed and compared with the average reimbursement per case (durchschnittlicher Honorarumsatz je Behandlungsfall, DHPB). Adherence to the budget resulted in ENT physicians being reimbursed above the DHPB for SCIT in every KV. This remained true for most KVs, even when the excess to the case value was only rewarded at 15%. Reimbursement for a 3-year SLIT was lower than the DHPB across all KVs. Allergy diagnostics and AIT represent economically advantageous options for ENT practices. Maintenance therapy demonstrates a positive cost-benefit ratio, supporting the call for a consistent 3‑year treatment regimen.
[Vestibular testing-from the 1950s to today]
Wilcke PK, Hoffmann AS and Praetorius M
The current article presents and explains methods for clinical examination of the vestibular system that have been used from the 1950s to the present day. It spans 230 years of clinical vestibular research, giving the reader a better overview and filling in the gaps in the history. Whilst only limited topographic regions could be examined in the early years, it is nowadays possible to collect objective results independently of patient compliance. Not only qualitative but also quantitative testing of the three semicircular canals and the otolith organs is now possible in clinical practice.
[Otorhinolaryngology in Austria and German-speaking Switzerland]
Dlugaiczyk J, Arnoldner C, Caversaccio MD and Thurnher D
[State of the art-pharyngeal reconstruction]
Brunner M and Haerle S
Reconstruction of the pharynx after ablative cancer surgery is challenging. Restoration of function and esthetics is at the forefront. There is currently no gold standard for reconstruction. The workhorses for free flap reconstruction are the radial free forearm flap or the anterolateral thigh flap. For medium size defects the free lateral arm flap is an excellent alternative.
[Not Available]
[Development of paranasal sinus surgery in Austria and Switzerland: past, present, and future]
Vyskocil E, Wolf A and Hinder D
Thanks to our predecessors and technical progress, we can nowadays offer our patients a safe and modern paranasal sinus surgery. This article provides an overview of the historical development of paranasal sinus surgery in Austria and Switzerland and to shed light on the dynamic progress of this discipline in an international context. Paranasal sinus surgery has undergone significant change in recent decades, driven by rapid technological advances that have significantly improved surgical procedures and operative outcomes. While indications were originally limited to treatment of inflammatory diseases, today, endoscopic procedures cover interventions in the area of the anterior skull base, the orbit and sinonasal tumors. The concept of functional endoscopic sinus surgery (FESS) may seem simple, but the anatomic variability, especially in the area of the frontal sinus, as well as the wide spectrum and severity of diseases can be a challenge. Therefore, paranasal sinus surgery should not be a casual operation and should only be performed by well-trained surgeons to prevent disease recurrence as well as medical and economic follow-up costs. Standardized surgical training for aspiring paranasal sinus and skull base surgeons is critical. Preoperative planning through systematic analysis of CT images is an essential factor to achieve optimal results and to avoid intraoperative complications. The pathophysiological understanding of sinonasal disease and the recent developments of new drug therapies such as monoclonal antibodies also enable excellent results in the small subgroup of patients who do not benefit from a combination of surgical rehabilitation and long-term drug therapy. The dynamic development of endoscopic paranasal sinus surgery in recent decades shows the potential of the field for the coming decades.
[Speech development test for 2-year-olds (2;0-2;11 years)-evaluation of multicentric data of children after bilateral cochlear implant treatment : A retrospective longitudinal study]
Kröger S, Aschendorff A, Glaubitz C, Kreibohm-Strauß K, Kronesser D, Seebens Y, Streicher B, Overlach F, Rother S and Beck R
Age-appropriate speech development is a primary aim of the rehabilitation of children treated with cochlear implants (CI). Various assessment tools are available, including the speech development test for 2‑year-olds (SETK-2). All tests are normalized to normal-hearing children; additionally, results are evaluated according to age and the duration of CI (hearing age). The present study presents current practices and evaluates them as far as is possible.
Superior semicircular canal dehiscence isolation by transmastoid two-point canal plugging with preservation of the vestibulo-ocular reflex
Seiwerth I, Dlugaiczyk J, Schmäl F, Rahne T, Kösling S and Plontke SK
This article describes the surgical treatment of superior semicircular canal dehiscence syndrome (SCDS) by isolating the dehiscence using transmastoid two-point canal plugging while preserving the high-frequency vestibulo-ocular reflex (VOR) of the affected semicircular canal. The superior semicircular canal is opened via a transmastoid approach anterior (as far from the ampulla as possible) and posterior to the dehiscence and then plugged with connective tissue and bone dust. In two clinical exemplary cases, vestibular testing showed that the VOR measured by video head impulse (vHIT) test was preserved (patient 1: gain preoperative 0.7, long-term postoperative 0.75; patient 2: gain preoperative 0.64, long-term postoperative 0.79; reduction of corrective saccades in each case) with a simultaneous reduction in pathologically increased amplitudes of vestibular evoked myogenic potentials (VEMPs) and a significant improvement in clinical symptoms with almost complete freedom from symptoms. One possible explanation for preservation of the high-frequency VOR of the superior semicircular canal would be the deformability of the endolymphatic space described at high stimulation frequencies, which can lead to endolymph movements in the area of the ampulla with deflection of the cupula despite blockage of the semicircular canal.
[Recurrent cholesteatoma after reconstruction of the auditory canal : Contradictory findings and differential diagnostic challenges]
Koller F, Schmit C, Henninger B, Fischer N, Hofauer B and Schmutzhard J