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Background: Electrocochleography (ECochG) records electrical potentials of the inner ear and is used, among other applications, in the diagnostic work-up of Ménière's disease. For extratympanic recordings, age-dependent reference values are currently lacking, which limits clinical interpretation.

Objective: This study aims to establish age-stratified reference ranges for the summating potential (SP)/action potential (AP) amplitude and area ratios for noninvasive diagnostics in patients with suspected endolymphatic hydrops.

Materials and methods: A total of 47 ears from 26 normal-hearing volunteers aged 20-70 years were examined using an extratympanic tympanic membrane electrode. The SP and AP potentials were recorded in a standardized manner. Amplitude and area ratios were calculated and analyzed with respect to age and laterality.

Results: The reference ranges (P5-P95) were 0.13-0.46 for the SP/AP amplitude ratio and 0.72-1.72 for the SP/AP area ratio. No significant side differences were observed. A slight age-related increase in both parameters was detected, without a clinically relevant impact.

Conclusion: Extratympanic ECochG enables a minimally invasive and reliable diagnostic approach with age-stratified reference values. It represents a practical adjunct to imaging in Ménière's disease and allows a more differentiated assessment of pathological inner ear function.

Menière's disease is a chronic inner ear disorder characterized by recurrent vertigo attacks, tinnitus, and fluctuating hearing loss, which may progress to severe sensorineural hearing impairment in a subset of patients. Since 2015, international consensus criteria distinguish between definite and probable disease. Current therapeutic strategies follow a stepwise approach, ranging from non-ablative to ablative interventions. Cochlear implantation (CI) has emerged as an effective option for auditory rehabilitation and has also shown beneficial effects on vertigo and tinnitus. Combined strategies with endolymphatic sac surgery are discussed, while labyrinthectomy with simultaneous CI represents a highly effective yet irreversible intervention. Particular challenges arise in bilateral cases, where radiological endotyping (e.g., hypoplastic vestibular aqueduct type) may improve future treatment planning. Evidence demonstrates that CI is feasible after ablative procedures as well as in unilateral Menière's disease with hearing preservation, resulting in significant improvements in quality of life. Systematic reviews confirm the safety and efficacy of CI, establishing its central role in the management of advanced disease stages. Early developments of vestibulocochlear implants (VCI) additionally open perspectives for combined auditory and vestibular rehabilitation, although clinical application remains experimental.

This study investigates the relationship between hearing loss and cognitive decline in elderly people living in care facilities in the greater Hanover area. Hearing loss was assessed using pure-tone and speech audiograms, while cognitive decline was assessed using the mini-mental status test (MMST) and the clock-drawing test. A follow-up examination was carried out on 38 participants after 1 year. The data suggest a tendency toward residents with poorer hearing exhibiting a faster rate of cognitive decline. These results emphasize the importance of treating hearing impairment in elderly care to mitigate cognitive decline and the progression of possible dementia.

Background: In otorhinolaryngology, the majority of specialist training takes place in inpatient facilities. Against the backdrop of current structural reforms in the hospital sector, it is necessary to collect fundamental structural data of these training institutions. To date, no centrally collected data exist that capture the number of inpatient training centers, the number of trainees and authorized trainers, or the scope of training accreditation. The aim of this study was therefore to establish a nationwide baseline assessment to support evaluation of the potential impact of the ongoing hospital reform.

Materials and methods: The German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC) conducted a nationwide digital survey among the heads of ENT departments in Germany. The survey collected structural and capacity-related parameters relevant to specialist training.

Results: A total of 95 fully completed questionnaires were returned (response rate 54.9%). All federal states were represented (32 university and 63 non-university hospitals). In 2024, 84 clinics (88,4 %) reported more than 1500 inpatient cases. On average, 1.5 physicians per institution held formal authorization to conduct specialist training. The number of trainees remained stable in 56.8% of clinics and increased in 32.6%. Overall, 96.8% of departments had full accreditation for the complete 5‑year training period.

Conclusion: Otorhinolaryngology specialist training in Germany is broadly available and delivered at a consistently high level within hospitals. Based on the collected data, a stable and robust training structure can be expected to persist, even when considering potential effects of the Hospital Care Improvement Act (Krankenhausversorgungsverbesserungsgesetz, KHVVG). These training capacities remain essential for ensuring nationwide high-quality specialist care.

A well-founded view of the future of otological surgery requires reflection on its history and, in particular, its current state of development. This discipline has always been shaped by detours, coincidences and groundbreaking turning points and will likely continue to be so. At present, however, highly dynamic developments are emerging that indicate a transition from purely reconstructive approaches toward surgically assisted, functionally restorative and regenerative and individualized treatment for disorders of the middle and inner ear. Major innovations in imaging and visualization, materials science, microelectronics and nanoelectronics, computer technology, bioengineering and molecular biology are currently driving this transformation. These advances are increasingly converging into an interdisciplinary field of innovation that will decisively influence the future direction of otological surgery.

Background: Chronic rhinosinusitis (CRS) has a prevalence of up to 11% in Europe and the USA, making it one of the most common chronic diseases. Classification based on immunological endotypes is increasingly being integrated into the disease definition, particularly for chronic rhinosinusitis with nasal polyps (CRSwNP). Depending on the specific mechanisms underlying chronic tissue inflammation, different endotypes are characterized. Genetic and epigenetic changes in the mucosal immune system play a significant role in this context. Identifying endotypes can help to better understand disease heterogeneity and develop personalized treatment approaches. In part 1 of this publication, we discussed the immunological classifications of type IV hypersensitivity reactions (T1-, T2-, and T3-endotypes), while part 2 focused on type V hypersensitivity reactions (epithelial barrier defects). The aim of part 3 is to describe type VI hypersensitivity immune reactions and highlight their implications for extended diagnostics and treatment.

Methods: The European Academy of Allergy and Clinical Immunology (EAACI) recently published a position paper presenting an updated nomenclature for immunological hypersensitivity reactions, now encompassing nine distinct immunological reaction types. The antibody-mediated reactions originally classified by Coombs and Gell as types I, II, and III have been expanded and described in greater detail. Direct cellular and inflammatory responses to chemical substances are defined as type VI hypersensitivity reactions and are the focus of this third part of the publication series.

Results: In CRSwNP patients with type VI hypersensitivity immune reactions, an imbalance between cyclooxygenase (COX) isoforms 1 and 2 can be observed. This imbalance is exacerbated by COX-1-inhibiting drugs, leading to reduced prostaglandin E2 (PGE2) synthesis and overproduction of leukotriene C4 (LTC4) and PGD2. As a result of the chronic mucosal inflammation, alarmins such as interleukin-33 (IL-33) and thymic stromal lymphopoietin (TSLP) are released. These cytokines activate Th2 lymphocytes and type 2 innate lymphoid cells (ILC2s), prompting the release of cytokines such as IL‑4, IL‑5, and IL-13.

Conclusion: Expansion of the immunological classification to include type VI hypersensitivity reactions represents an important step toward a better understanding of the pathophysiology of CRSwNP. Identifying these specific reaction patterns-particularly those triggered by chemical substances-highlights the complexity of the underlying immune mechanisms and emphasizes the need for endotype-based diagnostics. Incorporating these insights into clinical practice allows for more targeted individualized therapies and marks another step toward personalized medicine in CRS.

Background: Hearing loss in midlife is considered one of the most important modifiable risk factors for dementia; however, standard cognitive tests often fail to adequately detect cognitive deficits in individuals with hearing loss.

Objective: The aim of the study was to present and evaluate the digital cognitive diagnostics (DiCoDi®), a digital cognitive test designed for individuals with and without hearing loss.

Material and methods: The DiCoDi® comprises 9 subtests, is independent of hearing, can be self-administered and takes 20-30 min to complete. A total of 373 individuals were assessed: 204 control participants (mean age: 67.48±12.2 years, women: 58.0 %) and 173 individuals with hearing loss (mean age: 72.86±8.7 years, women: 46.8 %). Based on a combined cognitive index 2 groups were formed: 314 individuals without cognitive impairment (age: 69.38±12.2 years, women: 54.1 %) and 58 individuals with cognitive impairment (age: 72.93±12.2 years, women: 46.6 %). In addition, a comprehensive neuropsychological test battery was employed.

Results: In most DiCoDi® subtests there were no significant differences between control participants and individuals with hearing loss. Participants with hearing loss performed significantly better than controls in the subtests "Trail Making A" (_pη² = 0.24) and "Time Estimation" (_pη² = 0.05). Individuals with cognitive impairment performed significantly worse in most DiCoDi® subtests (0.13 ≤ _pη² ≤ 0.28). The DiCoDi® demonstrated high validity, high reliability and good classification accuracy (area under the curve, AUC = 0.80).

Conclusion: The results show that the DiCoDi® can be a valid and reliable tool for the early detection of cognitive deficits in people with and without hearing loss.

Background: Children with hearing impairment are at an increased risk of vestibular disorders. Due to the diagnostic challenges associated with pediatric populations, corresponding assessments are rarely performed, resulting in a lack of prevalence data in Germany. The findings, however, could have significant implications for subsequent diagnostic processes, therapeutic interventions, and preventive measures.

Objective: This study investigated the feasibility of balance diagnostics for children of all age groups and emphasizes the necessity of their routine application in children with hearing impairment. Additionally, the prevalence of balance disorders in this population was assessed.

Materials and methods: A retrospective analysis was performed on 124 children with hearing disorders who had undergone neurootologic assessment over a 12-month period. The children were aged between 6 months and 17 years (median age 5.5 years). Diagnostic workup included a detailed medical history, examination with Frenzel glasses, cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP), and a video head impulse test (vHIT).

Results: Vestibular dysfunctions were identified in 52% of the 122 children with hearing impairment who underwent instrumental assessment, with 4.5% exhibiting isolated semicircular canal abnormalities (5/110), 34.5% showing otolith dysfunctions (38/110), and 20.4% presenting with combined dysfunctions (20/98). Instrumental diagnostics could not be performed in two children. Additionally, a diagnosis of bilateral vestibulopathy was established for the first time in seven children.

Conclusion: This study demonstrates that vestibular diagnostics are feasible in children with hearing impairment of all age groups and advocates for their routine integration into clinical practice. Future longitudinal studies are needed to better understand the long-term consequences of vestibular dysfunctions and the effectiveness of therapeutic interventions.

Starting with the question of why the German Institute for State Examinations in Medicine, Pharmacy, Dentistry and Psychotherapy (IMPP) was founded more than 50 years ago, existing working methods and processes for preparing the written parts of the medical licensing examinations are described. With a special focus on the second part of the medical examination, recent developments of the past decade are described, followed by an outlook for the future.