Laryngo-rhino-otologie最新文献

Background: Tinnitus is one of the most common otologic comorbidities, particularly in older patients with severe hearing loss or deafness. Cochlear implants (CI) have been used for hearing rehabilitation more and more successfully in elderly patients and CI treatment is performed in Germany without an age limit. The aim of this follow-up study was to assess the tinnitus burden in the long-term follow-up of elderly patients with hearing rehabilitation using CI.

Material and methods: This prospective longitudinal study included 15 patients between 72 and 92 years of age with preoperative tinnitus who had been treated unilaterally with a CI for the first time about six years ago. Monosyllabic speech understanding and tinnitus burden were assessed using the Mini-Tinnitus Questionnaire. The results were compared with our previous study 24, focusing on the first six months.

Results: Six years postoperatively, there was a nonsignificant increase in monosyllabic understanding to 61.7 ± 26.3%, compared with the results six months postoperatively (p = 0.069). The burden of tinnitus showed a stable low mean of 3.9 ± 3.6 points six years postoperatively, compared with the six-month control (p = 0.689) and significantly reduced compared to the preoperative status with 6.9 ± 6.5 points (p = 0.016).

Conclusion: Hearing rehabilitation by using CI leads to a stable improvement of monosyllabic discrimination in elderly people as well as to a stable reduction of tinnitus burden over years.

Objective: Teachers are subject to exceptionally high vocal stress throughout their lives and have an increased prevalence of voice disorders. The aim of this study was to evaluate the long-term efficiency of voice training in student teachers during their lifelong career as a teacher. In addition, we investigated the relationship between vocal aptitude tests and teachers' vocal health.

Methods: In a multicentre case-control study, 202 teachers (median age: 48 years, 165 women, 37 men) were examined. The examination consisted of a standardised anamnesis, analysis of the voice, laryngostroboscopy and audiometry. Subjects were attributed to the case group if at least two of the following criteria were met: pathological videolaryngostroboscopic findings, pathological analysis of the voice, subjective vocal complaints.

Results: 65/202 teachers were categorised as cases. Comparing the groups, cases were older (p=0.001), worked more often in primary schools (p=0.008) and had more problems with reflux (p=0.002). 63.8% of the controls had completed a vocal aptitude test before starting their studies, compared to 47.6% of the cases (p=0.031). A multivariate analysis showed an OR of 1.6 for developing dysphonia if neither voice training nor a vocal aptitude test has taken place during the course of study.

Conclusion: Many risk factors associated with dysphonia in teachers are often difficult or impossible to change. Vocal aptitude tests and voice training during the studies represent a primary prevention of occupational dysphonia in the teaching profession.

Background: Due to heterogeneous data, the indication for elective neck dissection (END) in patients with squamous cell carcinoma of the hypopharynx and oropharynx (HPSCC and OPSCC) in stages T1/2N0 is somewhat unclear. Therefore, in this multicenter study, we performed detailed analysis of the metastatic behavior of HPSCC and OPSCC.

Material and methods: The nodal metastatic patterns of 262 HPSCC and OPSCC patients who had undergone surgery was retrospectively investigated. In addition, recurrence-free and overall survival were recorded. Furthermore, a systematic literature review on the topic was completed.

Results: In patients with HPSCC, a discrepancy between clinical and pathologic N status was recorded in 62.1% of patients vs. 52.4% for p16- OPSCC, and 43.6% for p16+ OPSCC. The occult metastasis rate in cT1/2cN0 primary tumors was 38.9% for HPSCC vs. 17.8% (p16- OPSCC) and 11.1% (p16+ OPSCC). Contralateral metastases occurred in 22.2% of cases for HPSCC at stages cT1/2cN0, compared to only 9.1% for p16- OPSCC, and 0% for p16+ OPSCC patients.Patients with p16+ OPSCC had better recurrence-free and overall survival than p16- OPSCC and HPSCC patients. A direct association between patient survival and the extent of neck surgical therapy could not be demonstrated in our patients.

Conclusion: Patients with HPSCC are at risk for bilateral neck metastases from stage cT1/2cN0, justifying bilateral END. Patients with T1/2 OPSCC present with occult metastases ipsilaterally in >20% of cases; however, the risk for contralateral occult metastasis is <10%. Hence, in strictly lateralized cT1/2CN0 tumors, omission of contralateral END may be considered.

Objective: Upper airway obstructions are usually acute emergencies. Coniotomy is the last option to secure the airway and can be supported by sonography. The aim of this study was to establish a training program to teach these skills.

Material and methods: The training consisted of theoretical training with an additional video presentation (10 minutes each) and practical training (45 minutes). Evaluations were completed before (T1) and after (T2) the training to measure prior experience and satisfaction with the training as well as subjective and objective competence levels. At T2, a practical test was also completed by n=113 participants. A standardized evaluation form was used to document the results of the practical test.

Results: A large proportion of the participants had neither seen a coniotomy (64.6%) nor performed one independently (79.6%). Significant improvement (T1 to T2) was measured with regard to the subjective assessment of competence (p<0.001). The training received positive ratings for all items tested (scale ranges 1-2). During practical tests, the participants achieved an average of 89.2% of the possible points and needed a mean of 101 ±23 seconds to identify the conic ligament.

Conclusion: Structured training for sonographic identification of the conic ligament leads to significant improvement in the subjective assessment of competence and a high objective competence level in a short period of time. This type of training should be standardized in head and neck ultrasound training in the future.

Objective: The COVID-19 pandemic has had a profound impact on the healthcare system and medical education. In this publication, the influence of the pandemic on the education of physicians active in Head and Neck oncology was examined using a survey.

Methods: A survey comprising 53 questions was conducted to gather data on work settings, daily activities, team events, and educational aspects during the pandemic. A total of 497 oncologists participated, including 131 individuals working in the field of Head and Neck oncology. This subgroup consisted of 99 (75.6%) radiation oncologists, 10 (7.6%) maxillofacial specialists, and 22 (16.8%) otolaryngologists.

Results: Nearly half of the participants reported experiencing increased clinical burden, which resulted in reduced engagement in scientific activities. Digital platforms became the predominant mode of continuing education, albeit with reduced accessibility. The pandemic significantly impacted clinical training that involved direct patient interaction. On the other hand, positive effects were observed in terms of cost and availability for external educational events such as conferences.

Conclusion: The findings highlight the detrimental effects of the COVID-19 pandemic on various aspects of medical education. While digitalization has accelerated in response, many physicians expressed a lack of professional interaction. Developing alternative digital learning platforms can provide a means to better cope with similar situations in the future. However, the importance of personal contact with colleagues and supervisors should not be overlooked when considering the quality of teaching.