Hno最新文献

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.

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.

Background: Patient-reported outcome (PRO) measures lead to improved quality of life in cancer patients and possibly to earlier detection of tumor recurrence.

Objective: Patient interest in complementing tumor follow-up care with apps for recording PROs was assessed using a questionnaire.

Materials and methods: An independently created questionnaire to record the interest of tumor patients in a digitalized form of tumor follow-up care was evaluated (n = 110).

Results: In the study, the majority of tumor patients were interested in using an app for tumor disease. Taking age into account, the number increased even further for patients < 60 years of age, as expected. In line with this, human papillomavirus (HPV)-positive patients showed significantly greater interest (p = 0.021).

Conclusion: The introduction of an app is supported by the majority of tumor patients. In addition to recording PROs, other applications (appointment reminders, patient files, sports/nutrition programs) could also be integrated.

Background: There are various views in the literature regarding the influence of chronic rhinosinusitis (CRS) as a comorbidity on the occurrence of COVID-19 disease.

Objective: Did CRS prevent or promote infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the coronavirus pandemic?

Materials and methods: We conducted a retrospective case-control study with 252 adult CRS patients who underwent sinus surgery between 2020 and 2023 and a non-CRS control group; both groups were comparable in terms of age and gender. The association between a history of COVID‑19 and CRS according to its phenotype and endotype was examined using cross tables and chi-square tests. We also analyzed self-reported and measured olfactory ability. Additionally, patients were asked about continuous preoperative use of inhaled corticosteroids.

Results: There was no association between CRS and COVID‑19. This applied both to CRS patients with or without nasal polyps (CRSwNP or CRSsNP) and to endotyping according to tissue eosinophilia. The majority of operated CRS patients were CRSwNP patients, predominantly male and younger compared to CRSsNP patients. CRSwNP presented eosinophilia 2.8 times more frequently than CRSsNP. CRSsNP patients had better reported and measured olfactory ability compared to CRSwNP patients. The measured olfactory ability of the CRS patients with COVID‑19 did not differ from that of CRS patients without C‑19. Preoperative use of inhaled corticosteroids was more frequent among CRSwNP patients than CRSsNP patients.

Conclusion: Chronic rhinosinusitis was neither a risk nor a protective factor for COVID‑19.

Background: With targeted inhibition of type 2 inflammation, biologics represent the standard add-on therapy for inadequately controlled severe forms of chronic rhinosinusitis with nasal polyps (CRSwNP). Despite standardization with paper-based checklists, the documentation of medical history and current findings pertinent to indication criteria are a significant challenge for physicians. Through development of an application based on structured reporting, the current study aimed to improve documentation quality and simplify the decision-making process. Previously available paper checklists served as a comparison.

Methods: For this study, a digital incremental tool was programmed to record current findings and check for fulfilment of indication criteria. The tool was compared with other checklists in terms of completeness, time required, and readability.

Results: A total of 20 findings were collected for each of the three documentation options and included in the analysis. Documentation with the two paper-based checklists had comparable information content: 17.5 ± 5.1/21.7 ± 7.6 points out of a maximum of 43 points; p > 0.05. Documentation using the digital application led to a significant increase in information content compared to all paper-based documentation. The average score was 38.25 ± 3.7 (88.9% of maximum; p < 0.001). On average, user satisfaction was high (9.6/10). Use of the digital application was initially more time consuming, but as more cases were documented, the time taken improved significantly.

Conclusion: In the future, structured reporting using apps could replace paper-based reporting for the indication of biologic therapy in CRSwNP patients and offer additional benefits in terms of data quality and traceability of results. The increasing volume of documentation in the future, the progress of digitalization, and the possibility of networking between individual centers make introduction of the app in the near future both likely and economical.

Background: 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.

Objective: This work outlines the implementation process for ePROs at the University Hospital for Otorhinolaryngology at the Medical University of Innsbruck (ENT Innsbruck).

Methods: The implementation is carried out by a project team in a pre-implementation phase (needs assessment, implementation planning, identification of intra-hospital barriers, prototype development, testing and adaptation, and user training), an implementation phase (implementation and user training), and a post-implementation phase (quality control and project expansion).

Results: The project team at ENT Innsbruck, consisting of 10 members, identified the need for digitalization in cancer follow-up. A hybrid implementation solution (Computer-Based Health Evaluation System, CHES; Evaluation Software Development, ESD, Innsbruck, Austria) was chosen. ePROs (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - 30 items, EORTC-QLQ-C30; Head and Neck Functional Integrity Scale, HNC-FIT scale; and EORTC Head and Neck Cancer Module, EORTC H&N43) will be collected 12 times over 5.5 years. A total of 25 users rated the prototype as user friendly (patient perspective: 8.1 ± 1.6, 3-10; user perspective: 8.6 ± 1.1, 6-10). The main advantage was faster medical history taking (72%), and the main disadvantages were a lack of personnel, time, and motivation (52%).

Conclusion: The feedback on the ePRO prototype at ENT Innsbruck was positive. The implementation phase commenced in the first quarter of 2024. Goal achievement will be evaluated in the post-implementation phase in the fourth quarter of 2024.

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.