Medication use in patients with chronic rhinosinusitis in Germany - a large retrospective patient-based study.

BACKGROUND: The aim of the present study was to provide an insight into medical treatment practices among patients with chronic rhinosinusitis (CRS) in Germany. An investigation of ICD codes and ATC classes of CRS patients in general and otolaryngology offices in Germany should reveal the prevalent treatment behaviors of German physicians. METHODS: The present study used data from the Disease Analyzer database (IQVIA). The study sample included patients from 940 general (GP) and 106 otolaryngology (ENT) practices who were coded as having chronic sinusitis (ICD-10: J32) or nasal polyps (ICD-10: J33) in 2015 (index date). The primary outcome measures were the number of patients with these diagnoses per practice as well as the proportion of patients with prescriptions for topical corticosteroids, systemic corticosteroids, antibiotics, antihistamines, and local decongestants within 365 days after the first diagnosis. RESULTS: This retrospective study included 26,768 patients with coding for chronic sinusitis (ICD-10: J32) and 516 patients for nasal polyps (ICD-10: J33) in 940 GP practices and 19,826 patients with coding for chronic sinusitis (ICD-10: J32) and 1,773 patients for nasal polyps (ICD-10: J33) in 106 ENT practices. In patients coded as having chronic sinusitis (ICD-10: J32), topical corticosteroids were prescribed at a low rate (GP: 12.3%, ENT: 34.3%). In patients coded as having nasal polyps (ICD-10: J33), topical corticosteroid usage was higher in GP practices (27.3%) and in ENT practices (71.2%). CONCLUSIONS: Topical corticosteroid usage in CRS patients in GP practices in Germany is as low as in other Western countries. Increased usage of topical corticosteroids in CRS patients with polyposis should be encouraged in GP and ENT practices.

[Diagnoses of thyroid disorders in ENT and general practices in Germany between 2008 and 2016]. / Diagnosen von Schilddrüsenerkrankungen in HNO-Praxen und Hausarztpraxen in Deutschland 2008­2016.

OBJECTIVE: The aim of this study was to investigate thyroid disorder diagnoses in otorhinolaryngologic (ENT) practices in Germany compared to general (GP) practices using data from a representative Germany-wide practice database. METHODS: The database was retrospectively searched for diagnoses of thyroid disorders made in ENT and GP practices between January 2008 and December 2016. Data were collected on the most common three-character disease classes (categories) from the "Disorders of thyroid gland" (E00-E07) group as well as the "Benign neoplasm of thyroid gland" (D34) and "Malignant neoplasm of thyroid gland" (C73) categories. The periods 2008-2010, 2011-2013, and 2014-2016 were evaluated. RESULTS: The database included 71 ENT and 506 GP practices with continuous participation from 2008 to 2016. The relative frequency (patients/practice) of diagnoses from the "Disorders of thyroid gland" group was 4.4-times higher in GP than in ENT practices. The relative frequency of benign neoplasms of the thyroid gland was 5­times higher in GP than in ENT practices. The relative frequency of malignant neoplasms of the thyroid gland was almost identical in GP and ENT practices. The most frequent diagnoses in both ENT and GP practices were found in the categories "Other nontoxic goiter" (E04) and "Other hypothyroidism" (E03). Diagnoses in the categories "Hyperthyroidism" (E05) and "Thyroiditis" (E06) were less frequent. Diagnoses of thyroid neoplasms were the least frequent, with benign neoplasms diagnosed more frequently in GP practices and malignant neoplasms diagnosed more frequently in ENT practices. During the study period, the diagnostic frequency of thyroid diseases decreased in ENT practices, whereas it increased in GP practices. CONCLUSION: Despite the increasing interest in establishing thyroid surgery in ENT clinics in Germany in recent years, thyroid diagnoses in ENT practices in Germany have been continuously declining, whereas they have considerably increased in GP practices. The reason for this may be health insurance provider-related differences in reimbursement practices for GPs and specialists.

Risk factors for epistaxis in patients followed in general practices in Germany.

BACKGROUND: The goal of the present study was to analyze the risk factors for epistaxis in patients followed in general practices in Germany. METHODS: The current study sample included patients aged 18 years or older who received a first epistaxis diagnosis between January 2012 and December 2016 (index date). Epistaxis patients and controls without epistaxis were matched (1:1) on the basis of age, gender, insurance status and physician. RESULTS: A total of 16,801 patients with epistaxis and 16,801 control subjects were included in this study. Of the subjects, 53.2% were men, and the mean age was 59.6 years (SD=21.2 years). Epistaxis was found to be positively associated with hypertension, obesity, chronic sinusitis, other disorders of the nose and nasal sinuses, anxiety disorder, and adjustment disorder (ORs ranging from 1.13 to 1.44). Epistaxis was also associated with the prescription of vitamin K antagonists, preparations from the heparin group, platelet aggregation inhibitors excluding heparin, direct thrombin inhibitors, direct factor Xa inhibitors, other antithrombotic agents, selective serotonin reuptake inhibitors and nasal steroids (ORs ranging from 1.15 to 3.55). CONCLUSIONS: Overall, epistaxis risk is increased by multiple medical and psychiatric disorders. Several antithrombotic and nasal steroid therapies are also associated with this risk.

Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view.

From 2006 to 2013, 12 patients with severe epistaxis refractory to prior conservative and surgical therapy were treated by superselective embolization of nasal arteries. Supersoft platinum microcoils with smallest diameters were used as the sole embolic agent in all cases. Coils were applied far distally in a stretched position for obtaining ideal target vessel superselectivity. The objective of this study is to evaluate efficacy and complications of superselective coil embolization for treatment of severe intractable epistaxis and to discuss results from an otorhinolaryngologic and an interventional neuroradiologic point of view. Retrospectively, all epistaxis inpatients between 2006 and 2013 were identified and subdivided by form of treatment: conservative, surgical and interventional therapy. Medical records of interventionally treated patients were reviewed for demographics, medical history, risk factors, clinical data, complications and short-term success, and patients were followed up for long-term success. Mean follow-up was 37 months. In 12 patients, 14 embolizations were carried out, with short-term success in 9 patients (75%), while early post-interventional rebleeding occurred in 3 patients (25%). Of 9 patients with short-term success, 1 died during stay, 1 was lost to follow-up and 1 had minor re-bleeding after 30 months. Six patients had short-term and long-term success. Before the first embolization, 3 ± 1 conservative and/or surgical procedures had been undertaken. Length of stay was 12.8 ± 3.6 days. 8 patients (67%) received red cell concentrates. Most frequent complications were mucosal damage and nasal pain, but these were related to repeated packing and surgery. Typical embolic complications as neurological or visual impairment or soft tissue necrosis were not observed in any patient. From the otorhinolaryngologic point of view, surgery is the treatment of choice in severe refractory epistaxis, but in case of repeated failure, superselective microcoil embolization is a valuable addition to the therapeutic spectrum. From the interventional neuroradiologic point of view, superselective microcoil embolization is an effective, well tolerable and safe procedure and complications may be reduced in comparison to microparticle embolization. Modern supersoft microcoils with smallest diameters enable ideal superselectivity of the target vessels.

[Total laryngopharyngectomy and reconstruction with a jejunum speech siphon : A case report]. / Totale Laryngopharyngektomie und Rekonstruktion mit Jejunumsprechsiphon : Fallbericht.

Advanced laryngeal and hypopharyngeal carcinomas are associated with a poor prognosis and a pronounced loss of quality of life due to impairment of the swallowing and voice function. The fundamental therapeutic challenge is successful tumor control with concomitant rehabilitation of swallowing and voice functions. Further objectives are a low complications rate (fistula, aspiration) and prompt transfer to the adjuvant radio-oncologic therapy. With these factors in mind, the microvascular anastomosed jejunum speech siphon with a biventer rein has proven to be an effective method of reconstruction following extensive circular laryngopharyngeal resections. In this case report, a typical operative and postoperative course is presented, as are the functional results.

[Vertigo induced by noise or pressure to the left ear]. / Schwindel durch Lärm oder Druck auf dem linken Ohr.

A 49-year-old male patient presented with recently acquired vertigo induced by noise or pressure to the left ear. With appropriate stimulation, oscillopsia with a rotatory component could be reproduced in videooculography. Cervical vestibular evoked myogenic potentials (VEMP) showed increased amplitudes and a lowered threshold on the left side. CT of the petrous bone showed a bony dehiscence of the left superior semicircular canal. Conservative therapy was initiated as a first step.