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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.

In 2017, a statement was released by the executive boards of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC) and the German Society of Oral and Maxillofacial Surgery (DGMKG) declaring the equal necessity of both medical disciplines, particularly regarding emergency services. The current consensus paper provides an updated and expanded version of this statement. Owing to the structure of their continuing education programs, the practice of both specialties in conservative and surgical treatment areas, and their economic bases, Oto-Rhino-Laryngology and Oral and Maxillofacial Surgery are independent disciplines. However, due to the anatomic involvement, the fields have various points of contact and interfaces as well as boundaries, which are summarized in this joint statement and consensus paper. These include jointly run center structures, working groups, training and continuing education initiatives, economic issues, health care policy interest groups, and research activities. To facilitate constructive discussions between the executive boards of the two societies, the "board consultations" begun in 2025 are to be continued on a regular basis, and mutual invitations to congresses are to be extended to promote scientific and professional dialogue.

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.

Digitalization opens up a wide range of didactic and organizational possibilities for examinations in medical curricula. This article provides a systematic overview of the potential, challenges, and current implementation scenarios of digital examinations-from computer-based exams and video-based formats to virtual reality applications. The focus lies on both the didactic opportunities for assessing medical competencies and on the new challenges related to organization, technology, and legal certainty. The article also highlights the dynamic role of artificial intelligence. Its integration creates new possibilities for formative and competence-oriented assessment but also raises questions regarding equal opportunities, fraud prevention, and ethical considerations. The successful implementation of digital examinations requires a clear orientation towards didactic goals, close cooperation among various university stakeholders, and continuous professional development. Overall, it is evident that digital examinations contribute to increased efficiency and improved examination quality, while also requiring ongoing evaluation and continuous improvement.

In the field of systemic cancer therapy for head and neck neoplasms, new approvals have led to several changes in treatment standards, primarily in the palliative situation. At the same time, molecular biomarkers have been established that can contribute to therapeutic decision-making in addition to clinical factors. These developments are summarized, and potential strategies to resolve the tension between standardization and personalization are described. Results from randomized phase III studies with therapeutic antibodies targeting the PD1/PD-L1 axis in combination with definitive chemoradiation are described and discussed. Finally, inspired by the press release about the positive results of the neoadjuvant KEYNOTE-689 trial in locoregionally advanced resectable disease, potential measures and suggestions for integrating neoadjuvant immunotherapy into clinical routine are discussed.

The German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) and the German ORL Academy (DAHNO), in cooperation with the relevant working groups, have developed expert certificates for the field of "Head and Neck Surgical Oncology" and now also for "Paranasal Sinus and Skull Base Surgery". The aim is to document the applicants' expertise in the respective subfield, in line with international standards. For the "Head and Neck Surgical Oncology" certification, the qualification criterion "activity in a head and neck tumor center certified by the German Cancer Society (DKG)" was supplemented by the criterion "or comparable institution (structural features: regular interdisciplinary case conference and collaboration with main cooperation partners with defined treatment pathways)" and modified with regard to further training or participation in studies. For the expert certificate "Paranasal Sinus and (Anterior) Skull Base Surgery," criteria for a corresponding logbook were developed in collaboration with the Working Group for Rhinology/Rhinosurgery (ARHIN) and the Working Group for Skull Base and Craniofacial Surgery (ASKRA). These certificates can be used to demonstrate individual expertise. Practical implementation is carried out by an independent certification institute (ClarCert GmbH) on behalf of the DGHNO-KHC and in cooperation with DAHNO and the respective working groups. Applications for the aforementioned expert certificates can now be submitted by members of the DGHNO-KHC or the DAHNO. Further expert certificates are in preparation.

Background: Ultrasound is an indispensable diagnostic tool in head and neck specialties. Despite technological advances, examination quality remains highly dependent on the examiner's qualification, thus placing substantial demands on training standards. Although the content of head and neck ultrasound courses in Germany (UK-KH) is homogeneous, the course formats and assessment modalities vary.

Objective: This study provides a comparative overview of the UK-KH available in Germany in 2025, both with and without thyroid-focused content. Particular emphasis is placed on the chosen teaching formats (in-person, digital, hybrid) and the assessment methods used to evaluate competency.

Materials and methods: First, all UK-KH offered in Germany were identified and systematically analyzed using publicly available course flyers. To verify and supplement course-specific information, structured telephone interviews based on a predefined protocol were subsequently conducted.

Results: Twelve course providers were identified, with the majority (n = 10) offering in-person courses. In addition, one fully digital, one established hybrid, and one hybrid concept currently in the testing phase were identified. Applied assessment formats included practical examinations and multiple-choice tests as well as instances in which no performance assessment was undertaken.

Conclusion: Although digital teaching and assessment methods are considered increasingly relevant, their systematic integration into UK-KH remains limited. To reliably evaluate the effectiveness of different formats and to promote upcoming innovation, further studies and standardized procedures for measuring examination quality and skill acquisition are required.

Background: The European Board Examination in Otorhinolaryngology, Head and Neck Surgery (EBEORL-HNS) is a Europe-wide specialty examination consisting of a written multiple-choice test and a standardized oral examination. Only limited psychometric analyses have been published to date.

Objective: This study aimed to evaluate examination data from recent years and assess the formats regarding difficulty, reliability, and pass rates.

Materials and methods: Aggregated data from 2013-2024 were analyzed. Mean scores, standard deviations, item difficulty, item discrimination, Cronbach's alpha, and Angoff's score were calculated. The written and oral parts were examined descriptively and comparatively.

Results: The written examination demonstrated a mean difficulty of 67% (proportion of correctly answered items), a pass rate of 82%, and Cronbach's alpha of 0.83 (internal consistency). The passing cutoff (according to the Angoff method) was 59 points on average. The oral part showed a mean difficulty of 70%, a pass rate of 74%, and an average score of around 3.0 on a four-point scale. Year-to-year variability largely reflected differences in the international candidate cohorts.

Conclusion: The findings confirm that the EBEORL-HNS demonstrates stable psychometric quality. Compared to national specialty examinations, it offers high transparency and clearly defined quality criteria. Variations in performance appear more related to heterogeneous training backgrounds than to shortcomings of the assessment tools.

Leishmaniasis, caused by protozoa of the genus Leishmania, comprises visceral, cutaneous, and mucocutaneous forms. It is mainly endemic in South and Central America as well as the Mediterranean region, while being very rare in Europe. Mucocutaneous leishmaniasis may affect the nasal and oral mucosa, and the current case highlights the importance of interdisciplinary collaboration: both cutaneous and mucocutaneous lesions with nasal septum perforation were present. Close cooperation between the departments of otorhinolaryngology, infectious diseases, and tropical medicine are key to ensuring rapid and sufficient treatment.

Noise has the potential to exert a harmful effect on the auditory system. Whether damage actually results depends primarily on the individual susceptibility of the auditory system as well as on the intensity and duration of exposure. Occupational noise-induced hearing loss typically develops over years to decades of hazardous exposure, affects only a subset of those exposed, and is irreversible. To assess whether an insured activity constitutes a health-relevant noise exposure in terms of causal attribution ("Einwirkungskausalität"), a fundamental understanding of physical and technical parameters is required; a medical diagnosis alone is insufficient for establishing causality. In part 1 of this article, the fundamentals of exposure assessment and causal relationship (e.g., daily noise exposure level normalized to 8 h [L_EX,8h], single event sound exposure level [L_AE], effective noise dose [ELD]) are outlined, while part 2 addresses the medically professional requirements for recognizing occupational noise-induced hearing loss as an occupational disease under item 2301 of the Occupational Diseases Ordinance (BKVO).