Hno最新文献

Treatment of patients with severe hearing loss or deafness using cochlear implants (CI) is nowadays clinical routine. In the Hannover Medical School alone, more than 500 patients are treated with CI annually, meaning that the pool of patients with CI increases significantly each year. Worldwide, there are over 1 million patients with a CI system; in Germany the figure is estimated at over 60,000. With such a huge number of CI patients, centralized annual routine follow-up of all patients in the implant centers is obviously not possible in the long term. Many patients would also like to reduce travel and time expenditures without missing out on the competencies of large hospitals. Simultaneously, the financial pressure exerted by health insurance providers is increasing, resulting in the requirement to provide treatment of the same or even heightened quality more efficiently. Telemedicine in the form of app-based aftercare can help to realize these goals and will play an increasingly important role in the future.

In Germany, an increased volume of patient cases in the emergency department has been observed for several years, many of which do not represent hospital emergencies. To improve the triage and management of patient flows, the Structured Initial Medical Assessment (Strukturierte medizinische Ersteinschätzung in Deutschland, SmED) triage system was developed. This certified medical product is intended to assess both the urgency of everyday complaints and their adequate medical care in a targeted, faster, and safer manner. It supports medical professionals in triage by suggesting courses of action, whereby the ultimate responsibility remains with the professionals themselves. For otorhinolaryngology, a content review was carried out with regard to plausibility and patient safety in the head and neck region on the basis of nine specific emergencies. The cases were simulated by nine otorhinolaryngologists and triaged on the basis of the SmED by medical staff and medical students by assigning a care level and timepoint (urgency). The majority of cases were correctly assigned. The SmED initial assessment system is a good tool for assessing urgent clinical pictures in ear, nose, and throat (ENT) medicine. The long-term goal of the initial assessment is to relieve the capacities of outpatient departments. In order to achieve this and to shorten patient waiting times, it would be necessary to refer patients quickly to otorhinolaryngology. It is therefore necessary to ensure that patients are referred to an ENT on-call service via the online tool.

The current article presents and explains methods for clinical examination of the vestibular system that have been used from the 1950s to the present day. It spans 230 years of clinical vestibular research, giving the reader a better overview and filling in the gaps in the history. Whilst only limited topographic regions could be examined in the early years, it is nowadays possible to collect objective results independently of patient compliance. Not only qualitative but also quantitative testing of the three semicircular canals and the otolith organs is now possible in clinical practice.

Background: Reconstruction of the pharynx after ablative cancer surgery is challenging. Restoration of function and esthetics is at the forefront. There is currently no gold standard for reconstruction. The workhorses for free flap reconstruction are the radial free forearm flap or the anterolateral thigh flap. For medium size defects the free lateral arm flap is an excellent alternative.

Objective: The current article discusses the advantages and disadvantages of the different free flap options from the perspective of two experiences head and neck surgeons and describes the usual steps in pharyngeal reconstruction.

Conclusion: The ideal choice of reconstruction depends on the size and volume of the defect, the availability of donor vessels, and also on the experience and preference of the surgeon.

Background: The diagnosis of third window syndromes often poses a challenge in clinical practice.

Objective: This paper provides an up-to-date overview of diagnostic procedures in third window syndromes, with special emphasis on superior canal dehiscence syndrome (SCDS), large vestibular aqueduct syndrome (LVAS), and X-chromosomal malformation of the cochlea.

Materials and methods: A literature search was performed in PubMed up to December 2023. Furthermore, a selection of the authors' own cases is presented.

Results: Audiovestibular tests for the diagnosis of third window syndromes are most often reported for patients with SCDS in the literature. In this context, cut-off values with different sensitivities and specificities have been defined for different outcome parameters of vestibular evoked myogenic potentials. Current developments include the application of electrocochleography, broadband tympanometry, video head impulse testing, and vibration-induced nystagmus. Genetic analyses are increasingly applied in LVAS.

Conclusion: The diagnosis of third window syndromes is always based on the synthesis of patients' symptoms, clinical signs, audiovestibular test results, and imaging.

Background: Planning of surgical procedures in patients suffering from oropharyngeal cancer requires appropriate imaging, particularly in consideration of the spatial relationship to the mandible. Resection of portions of the mandible (box, marginal, or segmental resection) is often necessary, while simultaneously avoiding overtreatment. Typically, a computed tomography (CT) scan is initially performed. However, the question arises of whether CT alone is adequate for reliable assessment of mandibular involvement.

Materials and methods: A patient cohort of 25 individuals aged 44-79 years (mean 62 years) undergoing partial oropharyngeal resection with segmental mandibular resection was examined. The indication for segmental resection was based on the close relationship of the tumor to the mandible observed in imaging. Reconstruction was consistently carried out with a reconstruction plate and free or pedicled flaps. Preoperative radiological findings were compared with histopathology results after decalcification of the mandibular bone.

Results: Cortical tumor infiltration was observed in the mandible in 9 patients (36%). Preoperatively, clear bone infiltration had been identified in CT in only 2 of these 9 patients; in the remaining 7, only direct tumor contact with the mandible was evident. Magnetic resonance imaging (MRI) revealed bone infiltration in 1 of these 7 patients.

Discussion: Adhering to safety margins requires a radical surgical approach and reliable intraoperative frozen section analysis. However, at the bone level, intraoperative frozen section analysis is technically impractical due to the required decalcification. Only after decalcification can the entire specimen be assessed for tumor infiltration. In our cohort, a significant discrepancy in terms of bone infiltration was noted between preoperative imaging assessments and postoperative histopathology. CT preoperatively identified bone infiltration in only 8% of our patients. In two thirds of the specimens, no bone infiltration was evident after decalcification and histopathological processing, retrospectively indicating overtreatment by segmental resection; box or marginal resections may have been sufficient in these cases. Therefore, when tumors are adjacent to the bone in CT, MRI should also be performed preoperatively to more reliably detect bone infiltration.