Hno最新文献

Background: The current Bárány Society diagnostic criteria for Meniere's disease (MD) do not include radiological aspects. However, computed tomography (CT), native magnetic resonance imaging (MRI), and time-delayed contrast-enhanced inner ear MRI (iMRI) for visualization of endolymphatic hydrops (ELH) have been used in research for years.

Objective: The aim of this narrative review is to present the current state of research and provide an outlook on future developments. Furthermore, existing possibilities for quantifying inner ear imaging data are shown.

Materials and methods: PubMed, MEDLINE, and EuropePMC were used for the literature search.

Results: Semiquantitative visual evaluation of ELH is increasingly supplemented by more accurate, objective quantification. Morphometric assessment of the vestibular aqueduct (VA) can be used for MM phenotyping, and analyses of contrast agent uptake in the endolymphatic duct located in the VA can help to differentiate between MM and vestibular migraine. Decreased vestibulocochlear nerve diameter can be associated with ELH. Image-based group analyses are currently under development.

Conclusion: Multimodal inner ear imaging can already contribute to the differential diagnosis of MM and other vestibular disorders. A lack of standardization and limited availability currently prevent its widespread use. In unclear cases, patients should be offered detailed inner ear imaging, both for differential diagnostic and scientific reasons.

With the recent results of large phase III trials, immuno-oncological concepts are moving into the focus of curative treatment for locally advanced head and neck cancers. In particular, perioperative immunotherapy-i.e., the combination of neoadjuvant and adjuvant checkpoint inhibition-has emerged as a promising approach to improve event-free survival. This article presents current strategies of neoadjuvant therapy and systematically compares neoadjuvant with purely adjuvant immunotherapy in the curative setting of HNSCC. It contrasts the current data from the KEYNOTE-689 study (perioperative pembrolizumab) with those from the NIVOPOSTOP trial (adjuvant nivolumab), analyzing study designs and endpoints, as well as differences in risk definitions, distant metastasis rates, and surgical implications. In addition, the article discusses the potential roles of pathological response and microenvironment-dependent immune activation in therapeutic decision-making. The aim is to provide a current overview of which immuno-oncological strategies are presently available in the treatment of head and neck cancers and to highlight the key questions that need to be addressed in future studies.

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.

Individualization and standardization are seemingly contradictory requirements in medicine. In the treatment of head and neck cancer, both terms have a direct influence on diagnostic procedures, which are usually carried out in pathology institutes. The current article examines the conflicting requirements arising from various technical analyses, regulatory requirements, structural changes due to digitalization, and the advent of personalized medicine. On the one hand, the goal is to promote interdisciplinary exchange by understanding the challenges and, on the other, to provide the otorhinolaryngologist with a practical understanding of the common and current pathological diagnostic tests. Using pathology as an example, it can be shown that standardization of procedures ultimately serves to improve individualized treatment. At the same time, however, the following challenges are also apparent: despite comprehensive regulations and a laboratory environment with digital support, standardization is very time consuming and costly. If similar standardization approaches are to be implemented in an operative environment such as, e.g., ENT surgery, the effort involved can be expected to be equivalent or higher due to the human factor.

Background: Objective assessment of surgical skills remains challenging due to informal, non-standardized formats. Simulation enables controlled evaluation. In otologic surgery, myringotomy with tube placement is a suitable standard procedure.

Objective: This work aimed to develop and evaluate a simulation-based model of minor tympanic membrane surgery in terms of acceptance and suitability for differentiated and standardized skill assessment.

Materials and methods: A realistic model was developed and evaluated by 31 ENT physicians of varying experience. A pilot study with 20 medical students (group A) and 10 senior ENT specialists (group E) was conducted using standardized criteria.

Results: The model was positively rated across experience levels. Group E achieved 100%, while group A showed more variability. No significant differences were found in terms of orientation, technique, structure, or hygiene. Tube placement accuracy differed significantly (group A 50% vs. group E 100%).

Conclusion: The model offers realistic simulation and shows strong potential for competency-based training and valid assessment.

Background: Structured oral examinations (SOEs) are valid instruments to assess applied knowledge and reasoning skills (competency level 2). They bridge the gap between written examinations focusing on factual knowledge (level 1) and practical formats such as objective structured clinical evaluations (OSCEs) assessing performance skills (from level 3). Through standardized case vignettes, checklists, and defined scoring criteria, SOEs offer potential for enhanced objectivity, reliability, and comparability.

Objective: Using pure tone audiometry (PTA) and rhinomanometry (RMM) as examples, this study examined the feasibility, psychometric quality (internal consistency, item discrimination, factor analysis), and examiner effects of an SOE designed according to the Nationaler Kompetenzbasierter Lernzielkatalog Medizin (NKLM), competency level 2.

Methods: Within the curricular ENT teaching program, PTA (n = 217) and RMM (n = 190) were taught and subsequently assessed in an SOE. Five categories were rated (identification, performance, description, interpretation, and differential diagnosis; maximum 27 points), with point deductions for examiner assistance. Eight medical examiners conducted the exams in a 1:1 setting. Descriptive statistics and a one-way analysis of variance (ANOVA) were used to analyze examiner differences.

Results: The mean total score was 25.20 ± 1.94 for PTA and 24.84 ± 1.94 for RMM. The highest scores were obtained for identification and performance, the lowest for description (PTA) and interpretation (RMM). Significant examiner differences were found for PTA (p = 0.001) but not for RMM (p = 0.078).

Conclusion: The SOE proved to be a feasible and reliable format for assessing applied knowledge and reasoning. The observed examiner differences highlight the need for examiner training, calibration, and standardized scoring instruments. Structured oral examinations can substantially contribute to implementing competency-based assessment in medical education.

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.