Hno最新文献

Skull base surgery is a highly specialized interdisciplinary field, the importance of which has grown significantly in recent decades. It requires a high level of technical equipment, specialized personnel, and interdisciplinary cooperation, and, due to its complexity, it can often only be performed adequately at university hospitals or high-volume centers. The ability to perform skull base surgery requires many years of complex surgical training. Certified interdisciplinary skull base centers are being developed nationally and internationally to provide patients with the highest level of care. The aim of this review is to give an overview of the current situation based on the most common clinical challenges in order to discuss the common typical "unmet clinical needs" and the future perspectives of skull base surgery.

This article examines various legal aspects of outpatient surgery performed by different medical practitioners and institutions in Germany. In addition to outlining the legal basis for the respective practitioners, it also addresses current reform efforts. Due to the need for patient safety, the legal requirements of practice are high. Intersectoral cooperation is encouraged, although it comes with limitations due to compliance concerns. The constant advancement of the model of day surgery in times of limited healthcare and financial resources blurs sectoral boundaries, ultimately exacerbating competition between medical practitioners and institutions.

Necrotizing otitis externa (NOE) is a rare, potentially life-threatening invasive infection of the external auditory canal that predominantly affects elderly and immunocompromised individuals-particularly those with diabetes mellitus. The disease may progress to skull base osteomyelitis and can lead to severe complications such as cranial nerve palsy, meningitis, or dural sinus thrombosis. The most common causative pathogen is Pseudomonas aeruginosa, although invasive fungal infections are increasingly recognized. The primary therapeutic strategy involves extended administration of pathogen-specific systemic antimicrobial agents. Surgical intervention may be required for complicated clinical courses. For monitoring disease progression and evaluating the therapeutic response, fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) in combination with computed tomography (CT) or magnetic resonance imaging (MRI) of the temporal bone has proven valuable. Lifelong closeknit otolaryngological follow-up is essential to detect recurrences early.

After several years of development, a new model regulation of continuing specialist medical education for residents was adopted in Germany in 2018 by the Chamber Assembly of the German Medical Associations (Bundesärztekammer), which was implemented in the following years by the Federal State Medical Associations (Landesärztekammer). It continues to prescribe an oral examination at the end of residency lasting at least 30 min and involving three examiners (at least two colleagues from the related specialist field). Further regulations regarding the examination procedure which would serve to increase the validity, reliability, transparency, and objectivity of the exam are only possible in internal statutes prescribed by the respective State Medical Associations or, in some cases, have been imposed by the examining bodies themselves. There certainly appears to be a need for nationwide improvement in this regard. This could also include training examiners in acquiring modern examination-related didactic knowledge. A look at the situation in neighboring Western and Central European countries shows that the spectrum of procedures for obtaining specialist qualifications varies. Some states do not provide for an examination at the end of the continuing education period at all. Here, the responsibility for achieving the required level of residents' knowledge and expertise is placed entirely in the hands of the continuing education providers during the time of residency. Other countries have also incorporated written examinations (possibly together with oral examinations), proof of practical skills, or production of a scientific theoretical essay into their examination concepts. In this paper, the status quo of German specialist training is presented, quality criteria and potential errors in oral examinations are discussed, a survey of German state/district medical associations addressing the on-site situation is presented, and the German approach to the examination of specialist candidates is examined in the context of the procedure in the neighboring countries.

Background: The COVID-19 pandemic led to physical illness, mental health disorders, social problems, and ongoing societal conflicts that have not yet been entirely resolved. Among the inflammatory processes associated with the virus, organic otorhinolaryngologic diseases occurred, resulting in functional impairments such as voice disorders caused by laryngeal affections. This study focused on the subjective suffering caused by functional dysphonia during the pandemic in patients who had not been affected by COVID-19. The underlying assumption was that the overall pandemic situation would alter both the healthcare-seeking behavior of affected individuals as well as their subjective assessments compared to the periods before and after the pandemic.

Materials and methods: The study was based on clinical routine data collected from the phoniatric and pedaudiologic specialist practice of the second author covering the second quarter of 2019 through to the second quarter of 2023. A total of 972 adult patients who presented for the first time with functional dysphonia were included. Assessment tools were the Voice-Related Quality of Life (VRQoL) questionnaire and the Depression Anxiety Stress Scales (DASS) that measure depression, anxiety, and stress.

Results: In the quarter preceding the first lockdown, the number of patients was higher than the average of all other quarters, while it was lower during the quarter of the first lockdown. For the remainder of the observation period, patient numbers fluctuated without statistical significance. Across all measured domains, no significant differences were observed when comparing the periods before and after the pandemic.

Conclusion: No pandemic-related changes were found in the subjective experience of suffering from functional dysphonia, neither in terms of voice-specific dysfunction nor in emotional domains.

Background: Assessments in undergraduate and graduate medical education are crucial for evaluating the competencies of learners. Assessments have both a control function (summative) and a feedback function (formative). This distinction is important, as the two aspects cannot easily be combined, and, therefore, it must be considered which function should be emphasized in each case.

Objective: This article examines the formal requirements and quality criteria that assessments must meet, particularly with regard to objectivity, reliability, and validity.

Methods: Referring to classical test theory, the three main criteria that are decisive for the quality of examinations are discussed. In addition, potential judgment biases and how to avoid them are outlined, as is how to improve assessment items by means of typical item characteristics.

Results: Assessments should be independent of the examiners. Written exams, especially multiple-choice tests, offer greater objectivity than oral exams. Objective structured clinical examinations (OSCEs) increase the objectivity of practical exams. A reliable exam reflects the actual performance of the examinees and is as free as possible from random effects. Verifying the validity of an exam is an ongoing process that involves many variables. Simple forms of validity are easier to determine but are less meaningful.

Conclusion: The quality of exams depends heavily on whether the abovementioned quality criteria are met. Systematic analysis of exam questions can be used to improve them in a targeted manner.

Background and objective: Speech comprehension in a foreign language under noise conditions presents an increased cognitive demand. For multilingual patients with cochlear implants (PwCI), this poses a particular challenge, as audiological routine diagnostics are typically conducted in the language of the clinical environment. This study investigates speech understanding in noise as well as the subjectively perceived listening effort in PwCI compared to normal-hearing (NH) individuals under both native and nonnative language conditions.

Materials and methods: PwCI and NH completed the Oldenburg Sentence Test (OLSA) in both German and English. The SNR₅₀ and the subjectively perceived mental effort, measured using the Rating Scale Mental Effort (RSME), were assessed. In addition, the subjective language competence in English as a foreign language was collected using the Common European Framework of Reference for Languages (CEFR).

Results: A total of 28 individuals with German as a first language and English as a foreign language (14 PwCI, 14 NH) were included. Among PwCI, the German version of the OLSA was significantly more intelligible than the English version (p = 0.010), whereas no significant difference was found for NH between language conditions. Listening effort was significantly higher during the English version of the OLSA in both PwCI (p = 0.003) and NH (p = 0.003). No correlation was found between self-assessed English language proficiency and perceived effort in either group.

Conclusion: The significantly reduced performance of PwCI in their foreign language under noise conditions reflects the established finding that multilingual individuals experience greater difficulty understanding speech in noise. The additionally reduced automatization of linguistic processing as well as a limited use of top-down listening strategies, that is the use of prior knowledge, context and expectations to fill gaps in the acoustic signal, make understanding in the presence of background noise more difficult, which can lead to increased listening effort and more frequent comprehension gaps. These effects appear to be particularly pronounced in multilingual individuals. These results highlight the importance of individualized, linguistically and culturally sensitive approaches in the clinical management of PwCI.

This case report describes a patient with localized laryngeal immunoglobulin light chain (AL) amyloidosis. The larynx is one of the most common sites of manifestation of localized amyloidosis. Amyloidosis leads to benign, tumor-like lesions caused by the deposition of insoluble protein aggregates, so-called fibrils. The current patient presented with the main symptom of hoarseness. Amyloidosis is most commonly treated by surgical resection of the mass. However, depending on the extent and course of disease, other therapeutic approaches are also feasible, which are discussed in this review.