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Eosinophilic granulomatosis with polyangiitis (EGPA, previously known as Churg-Strauss syndrome) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) often presenting with chronic rhinosinusitis, pulmonary infiltrates, gastrointestinal and cardiac disorders, or renal lesions. Sinonasal and inner ear manifestations are common, but other affections of the head and neck area are rarely reported. Here we report a case of a young woman with a histopathological diagnosis of eosinophil-rich granulomatous inflammation affecting solely the tongue without other local or systemic lesions. It suggests histopathologically a localized EGPA according to the 1992 Chapel Hill classification but does not formally meet the recent 2022 joint classification criteria for EGPA of the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR). In this report, we also describe the difficulty associated with the treatment.

Background: The technical inspection of internal and external components is an integral part of cochlear implant (CI) aftercare. The speech processor (SP) is routinely checked to ensure that the microphones are fully functional. Depending on the SP, these can be listened to by specialist personnel or checked in the CI fitting software. Microphone defects can also be revealed by poor hearing performance. Modern CI systems also record the duration of use of the SP and exposure to certain listening environments via data logging. In a bilateral CI fitting, large deviations in the detected hearing environment between both processors could indicate faulty microphones. The aim of this study is to compare the data logging entries of bilateral CI users in order to identify potential microphone failures.

Methodology: The retrospective data analysis includes 359 bilateral CI users who received a Cochlear Nucleus 6 system or higher. The individual data logging entries were analyzed with respect to the duration of CI use and duration of the listening scenarios quiet, speech in quiet, speech in noise, noise and music and both sides were compared. With a comparable duration of CI use, deviations of more than 15% between the listening scenarios of the left and right SP were considered conspicuous.

Results: Of the 718 SPs examined 9 were rated as conspicuous. With a comparable CI use of the left and right SP, significant differences of up to 54% were detected between the two devices in the quiet listening environment. One of the SPs recognized only the quiet scene to 100%. Based on two case examples the period of the patient's wearing behavior, the listening environments and the detectable differences between the two individual SPs during CI aftercare are presented in detail.

Conclusion: The information from the data logging enables the detection of possible microphone defects. The data are automatically read out and displayed anyway during the CI fitting. It is recommended to integrate the data logging information into the clinical routine as part of the technical check.

Background: Remote care (RC) opens up new possibilities in cochlea implant (CI) aftercare, such as real-time remote fittings, implant and speech processor checks, and hearing checks using smartphone apps. These applications offer CI recipients and clinics numerous options, but successful implementation in everyday life depends on various factors. To date, there have been few studies that have investigated the demand of RC on the part of CI recipients.

Objectives: The study analyses the demand for RC in CI aftercare from the perspective of CI recipients, regardless of the manufacturer. It demonstrates which aspects are important to the participants in CI aftercare, which arguments they cite for or against the use of RC, and which RC functions they would like to use.

Methods: The paper is based on a survey conducted at Hörzentrum Hagen Südwestfalen in December 2024 using a self-developed questionnaire. A total of 86 answers were evaluated.

Results: A total of 64.3% of respondents answered yes or rather yes to the question of whether they would use RC. In all, 82.6% fulfill the basic requirement for RC through regular smartphone use. The lack of personal contact is the strongest argument against the use of RC. However, the majority of respondents see an advantage in saving time.

Conclusion: Overall, the majority of respondents showed an interest in RC. Nevertheless, personal contact with specialized staff is still considered important. Interest in RC also decreases significantly with increasing age (p < 0.05). In the future, RC will be an innovative addition to conventional CI aftercare with on-site appointments, which will be in demand.

Background: Due to their high prevalence the management of thyroid nodules requires a particularly systematic approach. If the diagnostics reveal a suspected or confirmed thyroid cancer, in most cases surgical treatment remains the primary treatment option.

Objective: The aim of this work is to provide an overview of the guideline-based approach to thyroid nodules and carcinomas with a focus on diagnostics and surgical treatment. The essential differences in content between the previous and current guidelines are identified.

Material and methods: Selection of the most practice-relevant recommendations of the guidelines on thyroid cancer published in 2025 and comparison of these with the recommendations of the guidelines on surgical treatment of malignant thyroid diseases published in 2012.

Results: The new guidelines are significantly more comprehensive and detailed. The recommended diagnostic procedure is more precise and supplemented by examination techniques such as elastography. The surgical procedure keeps its role as the primary treatment approach. In accordance with the current study situation new options, such as the observational behavior for papillary microcarcinomas under defined conditions, are included. The recommendations on the diagnostics and treatment of undifferentiated thyroid cancer have been substantially expanded.

Conclusion: The new guidelines provide a comprehensive overview of the diagnostics and treatment of thyroid cancer and expands on the previous guidelines with consideration of the current study situation.

Objective hearing test procedures are of great importance in the expert opinion, as their results cannot be manipulated by the person being examined and they increase the correctness, accuracy, diagnostic depth, and forensic quality of an expert opinion. According to the systematic of the ascending processes of hearing, they are divided into tympanometry to examine sound conduction and peripheral neuronal processing in the acoustic reflex; otoacoustic emissions (OAE) to assess the outer hair cells in the inner ear; and the broad field of acoustic evoked potentials (AEPs), which can be used to examine various aspects of neuronal excitation processing from the spiral ganglion to the auditory center. Of all objective methods, AEPs are the most versatile because they can be used to estimate hearing thresholds in air and bone conduction, detect aspects of maturation and deprivation, and assess functional aspects of retrocochlear hearing disorders that can only be examined and detected in this way. Sufficient audiometric knowledge and strict quality assurance are absolute prerequisites for the use of all objective procedures.

Foreign body aspiration in children represents an acute pediatric emergency, requiring immediate interdisciplinary evaluation and intervention. Infants and toddlers under the age of four are particularly at risk due to immature coordination of the swallowing mechanism and a tendency toward oral exploration. Clinical symptoms vary depending on the location of the foreign body and can range from mild coughing to severe respiratory distress. Anamnesis is often unreliable, making diagnosis and therapeutic decision-making more difficult. Bronchoscopy remains the gold standard for both diagnosis and treatment, even in cases with inconspicuous imaging findings. The urgency of endoscopic removal must be assessed on a case-by-case basis, depending on the patient's clinical condition, the type of foreign body, and potential risks such as airway obstruction or ingestion of batteries or magnets.

A fundamental hospital reform is urgently needed due to the existing shortage of specialists, postpandemic productivity changes, and increasing financial deficits faced by hospitals in Germany. Starting from a hospital reform initiated in North-Rhine Westphalia (NRW), the so-called Hospital Care Improvement Act ("Krankenhausversorgungsverbesserungsgesetz", KHVVG) was launched at the federal level with the aim of ensuring more adequate funding, safeguarding and improving treatment quality, and reducing bureaucracy. This was passed by the Federal Council and officially came into force on 1 January 2025. For the specialty of Otorhinolaryngology, two categories-general ENT and cochlear implants-were selected for future hospital planning. The new law also established minimum physician requirements (e.g., 3 full-time physicians including 24/7 on-call duty) and defines so-called "oncological capping" as well as minimum number of cases for each defined entity. These measures are expected to lead to significant changes in the hospital landscape, including centralization of highly specialized services, with potential implications for specialist training. In summary, the KHVVG will ultimately alter patient care, thus, requiring flexible adaptation processes, which will be supported by professional societies. For this reason, we have simulated and discussed the effects of the KHVVG on our field to better assess possible consequences and initiate adjustment processes at an early stage.

Background: External auditory canal (EAC) atresia is a congenital anomaly leading to hearing impairment. Various techniques have been used for its surgical correction, but no gold standard exists.

Method: This paper describes a fascia-skin composite grafting technique utilizing temporal muscle fascia and postauricular skin for EAC reconstruction.

Conclusion: Temporal fascia-skin composite grafting offers a reliable and effective option for EAC reconstruction with favorable results and minimal complications.

Background: For the correlation report the expert needs support for the recommended comparison of the course of the effective noise dose (ELD) determined by the statutory accident insurance institution (UVT) with the findings.

Objective: How can the noise-induced permanent threshold shift (NIPTS) course of the UVT be used qualitatively and quantitatively for the discussion of the causal relationship?

Material and methods: Use of predictions of expected noise effects in the tone audiogram according to ISO (International Organization for Standardization) 1999 and ISO 7029.

Results: Possibilities of qualitative and quantitative use of ISO 1999 and ISO 7029 for the interpretation of tone-audiometric findings in the present individual cases for the discussion of the causal relationship.

Conclusion: Noise effects can be well observed in the group under 40 years old as the age-related effect is still low in this group. The rapidly increasing age-related effect in the group over 40 years old can easily mask the noise effects in the tone audiogram, especially in the case of previous noise exposure.