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This article examines various legal aspects of outpatient surgery performed by different medical practitioners and institutions in Germany. In addition to outlining the legal basis for the respective practitioners, it also addresses current reform efforts. Due to the need for patient safety, the legal requirements of practice are high. Intersectoral cooperation is encouraged, although it comes with limitations due to compliance concerns. The constant advancement of the model of day surgery in times of limited healthcare and financial resources blurs sectoral boundaries, ultimately exacerbating competition between medical practitioners and institutions.

Background and objective: Speech comprehension in a foreign language under noise conditions presents an increased cognitive demand. For multilingual patients with cochlear implants (PwCI), this poses a particular challenge, as audiological routine diagnostics are typically conducted in the language of the clinical environment. This study investigates speech understanding in noise as well as the subjectively perceived listening effort in PwCI compared to normal-hearing (NH) individuals under both native and nonnative language conditions.

Materials and methods: PwCI and NH completed the Oldenburg Sentence Test (OLSA) in both German and English. The SNR₅₀ and the subjectively perceived mental effort, measured using the Rating Scale Mental Effort (RSME), were assessed. In addition, the subjective language competence in English as a foreign language was collected using the Common European Framework of Reference for Languages (CEFR).

Results: A total of 28 individuals with German as a first language and English as a foreign language (14 PwCI, 14 NH) were included. Among PwCI, the German version of the OLSA was significantly more intelligible than the English version (p = 0.010), whereas no significant difference was found for NH between language conditions. Listening effort was significantly higher during the English version of the OLSA in both PwCI (p = 0.003) and NH (p = 0.003). No correlation was found between self-assessed English language proficiency and perceived effort in either group.

Conclusion: The significantly reduced performance of PwCI in their foreign language under noise conditions reflects the established finding that multilingual individuals experience greater difficulty understanding speech in noise. The additionally reduced automatization of linguistic processing as well as a limited use of top-down listening strategies, that is the use of prior knowledge, context and expectations to fill gaps in the acoustic signal, make understanding in the presence of background noise more difficult, which can lead to increased listening effort and more frequent comprehension gaps. These effects appear to be particularly pronounced in multilingual individuals. These results highlight the importance of individualized, linguistically and culturally sensitive approaches in the clinical management of PwCI.

This case report describes a patient with localized laryngeal immunoglobulin light chain (AL) amyloidosis. The larynx is one of the most common sites of manifestation of localized amyloidosis. Amyloidosis leads to benign, tumor-like lesions caused by the deposition of insoluble protein aggregates, so-called fibrils. The current patient presented with the main symptom of hoarseness. Amyloidosis is most commonly treated by surgical resection of the mass. However, depending on the extent and course of disease, other therapeutic approaches are also feasible, which are discussed in this review.

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.

Chronic tinnitus is a common symptom of the auditory system. Its pathophysiology remains incompletely understood, primarily due to its multifactorial etiology, which resembles that of other chronic conditions. As a result, effective clinical management requires interdisciplinary diagnostics and personalized therapeutic strategies. A search in PubMed using the keyword "tinnitus" covering the period from September 2023 to September 2024 yielded 1079 publications, of which the most relevant were selected and analyzed for this review summarizing current knowledge. Recent advances in tinnitus research have further refined our understanding of its pathophysiology, diagnosis, and treatment. Tinnitus is frequently triggered by cochlear damage, leading to central neuronal alterations and maladaptive plasticity. Progress in neuroimaging and psychoacoustic testing is improving diagnostic precision, while multidisciplinary treatment approaches are gaining clinical relevance and should be increasingly emphasized.

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

Objective: This paper provides an 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.

Continuous monitoring of the technical and physiological function of cochlear implants (CI) is a central part of the care process. Despite worldwide efforts to standardise procedures, there is still considerable variation between CI centres, particularly in terms of the methods used, their practical implementation and the definition of meaningful target parameters. A standardised structured test procedure is needed for reliable quality assurance and better comparability. Against this background, the ADANO Working Group for Evoked Response Audiometry (AG-ERA), in close cooperation with the Cochlear Implants and Implantable Hearing Systems Committee of the German Society of Audiology (DGA), developed a minimum standard for audiological and technical functional testing of CIs in an open consensus process. This standard defines basic requirements for performance and documentation and serves as a practical recommendation for CI centres. It is intended to improve interdisciplinary cooperation, increase the quality of care and enable structured long-term optimised care for CI patients.