The toll of noninfected CRS patients to the COVID-19 pandemic.

Social distancing with the aim of avoiding infections and pre-serve critical care capacities during the COVID-19 pandemic has been implemented in Germany according to World Health Organization (WHO) recommendations from early March onwards. Limitations of physical contacts to reduce exposure to SARS-CoV-2 infected individuals were handled strictly, particularly in medical centers dealing with airway diseases, like rhinology and pneumology clinics. Such measures and reluctance to visit out- and inpatient services resulted in a 82% decrease in consultations to the 12 German oto-rhino-laryngological (ORL) centres forming our database during the 50 days following March 09 in 2020 if compared to the same period in 2019. Our data on CRS care underline reports on undertreatment of non-COVID-19 individuals with several different diseases during the current pandemic. We should try to reduce the toll these patients have to pay as much as possible. We established telemedicine, e-Health and artificial intelligence-supported triage for selecting the right patients for onsite-consultations and to advise patients in several demands.

[Prevalence of peripheral vestibular diseases in children in Germany]. / Prävalenz peripher-vestibulärer Erkrankungen bei Kindern in Deutschland.

INTRODUCTION: Dizziness is a common complaint among patients; however, a lack of valid data concerning age and gender distribution of dizziness disorders among children under the age of 15 years can preclude effective diagnosis and treatment. The goal of this study was to describe the prevalence and gender distribution of three classical peripheral vestibular disorders; benign paroxysmal positional vertigo (BPPV), vestibular neuritis (VN), and Menière's disease (MD) as well as unspecific dizziness (UV) in children between 0 and 15 years of age, using state sponsored health insurance data. METHODS: A population-based epidemiological survey based on confirmed International Classification of Diseases (ICD) 10 codes of all persons aged 0-15 years in a national population was performed. Outcome measures were age and gender distribution and prevalence of BPPV, VN, and MD in this population. RESULTS: Dizziness diagnosed as being of peripheral vestibular origin was found in 1414 patients. The prevalence of peripheral vestibular disorders was found to be 15.16 per 100,000 individuals. The BPPV was coded most frequently with a prevalence of 10.21 per 100,000 individuals, followed by VN with a prevalence of 3.5 per 100,000 and MD at 1.54 per 100,000. CONCLUSION: Peripheral vestibular disorders can occur in childhood and the prevalence increases with age. In childhood, girls and boys are similarly affected. Peripheral vestibular disorders should be taken into consideration when a young child presents with vertigo or dizziness and are even more important when a child presents with unclear symptoms, as very young children might not be able to adequately verbalize dizziness and vertigo. For that reason peripheral vestibular disorders in childhood are probably underdiagnosed.

[Anaphylactic reactions to vaccines : Chicken egg allergy and the influenza H1N1 vaccination]. / Anaphylaktische Reaktionen auf Impfstoffe : Hühnereiweißallergie und Influenza-H1N1­Impfung.

BACKGROUND: Allergic reactions to influenza vaccinations are a well-known phenomenon; however, only a few published statistics give information on the risks. Patients with a chicken egg allergy must be particularly carefully handled during an influenza epidemic where vaccines produced using embryonated chicken eggs are primarily employed. METHODS: A selective literature review and analysis of the problem of allergic reactions to vaccinations was performed. RESULTS: The two most common relative contraindications among patients to be vaccinated are the presence of an egg allergy and a previous anaphylactic reaction to vaccination. These patients have a significantly increased risk of sustaining an adverse reaction. These high-risk patients should therefore only be vaccinated on the basis of thorough assessment of medical history, and then only with caution. The emergency routine must include sufficient precautionary measures, in case an anaphylactic reaction occurs. CONCLUSION: Current guidelines for the treatment of anaphylactic reactions are to be observed. Immediate treatment of the first symptoms of an anaphylactic reaction-i.v. administration of adrenalin, antihistamines, cortisone, and in some cases betamimetics-can usually prevent anaphylactic shock. Alternatively, a graded vaccination ("split protocol") and overnight surveillance can be considered in this group of patients.

[Treatment of supine position-related obstructive sleep apnea with smartphone applications]. / Therapie rückenlagebezogener obstruktiver Schlafapnoe mittels Smartphone-App.

BACKGROUND: Positional obstructive sleep apnea (POSA) is common in mild and moderate forms of obstructive sleep apnea (OSA). Two smartphone applications (apps) professing to avoid the supine position (SP) are available: for Android the "Apnea Sleep Position Trainer" and for iOS the "SomnoPose-Sleep Position Monitor". The smartphone needs to be attached to the chest to recognize SP, which then triggers a vibration alarm. This is intended to encourage the patient to change position and the vibration stops as soon as SP is left. These apps, however, have not yet undergone a systematic evaluation. METHODS: Adult patients with polysomnographically diagnosed POSA were invited to participate in the study. POSA was defined as an apnea-hypopnea index (AHI) in SP >10, with AHI in a lateral position <10 and doubling of the AHI in SP. After 1 month, a control polysomnography (PSG) was performed and compliance (at least 4 h/night on 5 of 7 days) was evaluated after 6 months by phone. A sufficient therapy was defined as reduction in SP to <10% of the total sleep time and to an overall AHI <10. RESULTS: Although 57 patients entered the study, 24 did not appear to the PSG control; therefore, 33 patients finished the study, of whom 25 were treated successfully. The overall AHI in 33 patients was reduced from 14.5 ± 9.0 to 9.5 ± 12.6 and the time in SP decreased significantly from 71.1 ± 50.5 to 25.4 ± 65.0 min. Compliance among the 25 continuously treated patients after 6 months was 79.2%. CONCLUSION: Both smartphone apps have the capability to prevent PS in POSA patients and can potentially offer a cost-effective option in the treatment of POSA.

Mupirocin reduces ciliary beat frequency of human nasal epithelial cells.

Mupirocin is used worldwide for topical treatment of infected skin lesions, impetigo, and especially for nasal decolonization of patients with carriage of Staphylococci, including methicillin-resistant Staphylococcus aureus. Nevertheless, data regarding the effects of mupirocin on the nasal mucosa, in particular on ciliary beat frequency (CBF), is lacking to date. We tested the CBF of ciliated nasal epithelial cells under the influence of Mupirocin-calcium dissolved in tert-butyl alcohol (TBA) containing media in different concentrations comparable to clinical use. Ringer's lactate solution and TBA served as negative control. Cells were visualized with a phase contrast microscope, and the CBF was measured with the SAVA system's region of interest method. Mupirocin-calcium dissolved in TBA led to a statistically significant time- and concentration-dependent decrease in CBF compared to the negative control. TBA addition without mupirocin also led to a significant decrease in CBF, although to a lesser extent than mupirocin/TBA. In conclusion, CBF of human nasal epithelia is significantly reduced by mupirocin-calcium-containing solutions in therapeutic concentrations. Due to our results in this study, mupirocin as a nasal decolonization agent should be used only with care, with a strictly set medical indication, and additional care measures should be considered.

Polyhexanide-containing solution reduces ciliary beat frequency of human nasal epithelial cells in vitro.

In ENT, polyhexanide-containing solutions are used to treat nasal infections caused by multiresistant bacteria like methicillin-resistant Staphylococcus aureus. Many forms of commercial nasal solutions containing polyhexanide exist, such as gels or solutions for topical use. Data regarding the influence of polyhexanide on ciliary beat frequency (CBF) are lacking to date. We tested the CBF of nasal ciliated epithelial cells under the influence of a commercially available polyhexanide-containing solution (Lavasept(®) Concentrate) in a therapeutic concentration (0.04, 0.02%). In addition, we tested the concentrations of 0.1 and 0.01%. Cells were visualized with a phase contrast microscope, and the CBF was measured with the SAVA system's region of interest method. Ringer's solution and macrogol served as negative controls. A therapeutic concentration of Lavasept significantly reduced CBF in a time- and concentration-dependent manner. After 1 min, the CBF was reduced from 8.90 ± 1.64 to 5.00 ± 3.72 Hz with a concentration of 0.04% (p value = 0.001). After 10 min, all cilia stopped beating. After 5 min, a 0.02% solution of Lavasept concentrate decreased CBF significantly from 8.64 ± 1.71 to 3.30 ± 3.27 Hz (p value < 0.001). In conclusion, CBF of human nasal epithelia is significantly reduced with the use of the polyhexanide-containing solution Lavasept in some therapeutic concentrations. Due to our findings in this study, Lavasept should be used on ciliated mucosa only with caution and in a concentration of 0.02%.

[Prophylactic antibiotic use in ENT surgery]. / Perioperative Antibiotikaprophylaxe in der HNO.

Surgical antibiotic prophylaxis (SAP) is defined as the administration of an antimicrobial agent prior to contamination in previously sterile spaces and fluid. SAP should not be confused with the therapeutic use of antibiotics. There are a growing number of studies with the goal of answering the question which patients benefit most from SAP during which specific surgical procedure. However, in the specific surgical field of head and neck surgery and otolaryngological surgery, there are only a few guidelines answering that question for specific procedures. The aim of this study was to analyze the evidence found in the literature and to develop a standard operating procedure, which specifically addresses head and neck and otolaryngeal surgical procedures.

[Perioperative antibiotic prophylaxis during standard interventions in ear, nose and throat medicine]. / Perioperative Antibiotikaprophylaxe bei Standardeingriffen in der HNO-Heilkunde.

BACKGROUND: The majority of standard interventions in otorhinolaryngology are classified as "clean contaminated" according to international classifications; correspondingly, no generally accepted recommendations regarding perioperative antibiotic prophylaxis (pAP) exist. The value of such pAP for these interventions remains unclear. Aim of the study was to assess the effects of pAP in selected standard otorhinolaryngologic procedures. MATERIALS AND METHODS: In August 2012 a standard operating procedure (SOP) was implemented, which lead to termination of routine pAP for the majority of standard operations. All patients included in this retrospective study had undergone a standard procedure (tonsil, septum or paranasal sinus surgery) during a period either 6 months before or 6 months after the inauguration of the SOP. The charts were reviewed for demographic factors, postoperative complications and length of hospital stay. RESULTS: The group before the inauguration of the SOP consisted of 316 patients (132 female, 184 male), aged 30±20 years. The group after the inauguration comprised 308 patients (128 female, 180 male), aged 31±19 years. For the entire patient collective, the termination of pAP led to a statistically significant increase in postoperative antibiotic treatment for all types of interventions tested. A statistically significant change in noninflammatory complications or the length of hospital stay was not detected. DISCUSSION: The termination of pAP during standard procedures in otorhinolaryngology is associated with an increase in postoperative antibiotic treatment but has no effect on other postoperative complications tested or the length of hospital stay.

[Long-term Development of Acute Tinnitus]. / Langzeit-Entwicklung von akutem Tinnitus.

BACKGROUND: Aim was to assess correlations between hearing threshold and mental health measures at tinnitus onset and tinnitus severity after 6 months. Short self-report questionnaires were used to permit later use in ENT-practices. METHOD: 28 patients with tinnitus of no longer than 4 weeks filled out questionnaires at inclusion (T1), and at 6 weeks (T2), 3 (T3) and 6 months (T4) after tinnitus onset. An audiogram was recorded at T1. Tinnitus loudness and sound sensitivity were assessed by numeric rating scales, tinnitus-distress was recorded with the short form of the tinnitus questionnaire. Mental health and personality factors were measured by the depressivity, anxiety and somatic severity scales of the Patient Health Questionnaire, and the resilience scale. RESULTS: Tinnitus loudness and distress were stable throughout the investigation period whereas sound sensitivity decreased. Resilience did not represent a predictor for tinnitus severity after 6 months. Depressivity and hearing loss at T1 had an effect on later tinnitus loudness, while depressivity and age at T1 showed an effect on sound sensitivity and tinnitus-related distress at T4. CONCLUSION: Stability of tinnitus severity during the 6 months after onset supports the hypothesis of early manifestation. RESULTS also support the hypothesis that later tinnitus severity is related to psychological distress and hearing impairment at onset. RESULTS suggest to use hearing aids to alleviate tinnitus loudness, and to include tools for the identification of depressive disorders at an early stage to identify patients that might benefit from psychotherapeutic interventions.

[Frequency-specific analysis of the hVOR Prior of Cochlear Implant Operation]. / Frequenzspezifische Untersuchung des hVOR im Vorfeld einer CI-Operation.

Dizziness is one of the most common postoperative complications after a cochlear-implant (CI) surgery. With our prospective, matched-paired controlled study, we could demonstrate that patients with distinctive sensorineural hearing loss--even without any complaints of dizziness--already have a reduced horizontal vestibular-ocular-reflex (hVOR). Compared to controls, CI patients presented with a significantly reduced gain. 9 out of 17 CI patients showed physiological results in rotatory testing and video head thrust testing. One patient presented with pathological results in both tests. Remarkably, there were 2 patients who presented with pathological head impulse testing but normal values in rotatory testing and 5 patients who showed normal gains in video head impulse testing but abnormal rotatory tests. These findings clearly show the importance of a differentiated, frequency-dependent pre-operative vestibular assessment including rotatory testing and video-head impulse testing. Additionally, only an accurate pre-operative vestibular testing allows evaluating possible post-operative dizziness related complications and should be documented precisely, also for forensic reasons. This is the key to differentiate post-operative dizziness from an pre-operatively existing vestibular disorder that possibly might not be clinically apparent by the time of testing.

[New perspectives in skeletal muscle tissue engineering]. / Neue Perspektiven des Skelettmuskel-Tissue-Engineerings.

Due to the enormous expansion of knowledge in the fields of stem cell research and biomaterials, skeletal muscle tissue engineering represents a rapidly developing field of biomedical research. This article provides a general overview of skeletal muscle tissue engineering, including a discussion of recent findings and future research perspectives. Additionally, the results of myogenic differentiation of human mesenchymal stem cells and satellite cells are presented.

[Functional and aesthetic therapy concepts of keloids in the head- and neck area]. / Funktionelle und ästhetische Therapiekonzepte von Keloiden im Kopf-Hals Bereich.

Keloids are fibroproliferative extreme variants of an impaired wound healing, developing a tumour-like growth. In the ENT area keloids arise mainly at auricle. Often caused by piercings or trauma. They grow bulging excessively over the original scar edges and adopt sometimes bizarre morphologies. The patients complain often of dysesthesias such as burning pain, severe itching and are suffering often from stigmatization. The huge number of therapy methods, for the treatment of keloids described in the literature (silicon therapy, compression, intralesional corticoids, intra- or extralesional surgical excision, kryosurgery, radiatio, Interferon- or Bleomycin-therapy) emphasize the enormous challenge for the treating doctor, particularly in facial plastic surgery.

[Correction of complex facial scars]. / Die Behandlung komplexer Narben im Gesicht.

Correction of complex facial scars frequently requires individualized, multimodal strategies, which are composed of various therapeutic measures. This report provides information on techniques for correction of contractures, atrophic scars, scars within hair-bearing regions of the face and auricular keloids. Additionally, we present adjuvant procedures in a subject-related manner.

[Orbitocutaneous fistula after orbital reconstruction]. / Orbitokutane Fistel nach Orbitarekonstruktion.

A 73-year old man presented with a lesion inferior to his left medial canthus with discharge and headache. Fifteen years previously, the patient had undergone reduction of an orbital fracture and reconstruction of the orbit with silicone. An orbitocutaneous fistula was found to originate from the implant which was displaced in the ethmoid, obstructing frontal sinus outflow. Symptoms disappeared after explantation of the implant, reconstruction of the orbit with a titanium plate and frontal sinus surgery. Although the use of silicone in facial trauma has declined, complications have to be expected even years after implantation.

Complementary and alternative medications consumed by patients with head and neck carcinoma: a pilot study in Germany.

Complementary and alternative medicine (CAM) represents a wide range of treatment modalities. CAM products may interact with enzymes, transport proteins, and may therefore influence drug metabolism. The prevalence and patterns of CAM usage among patients with head and neck carcinoma (HNC) are largely unknown. This cross-sectional study was designed to document pattern of CAM consumption in patients with HNC. Statistical differences in a significantly higher prevalence of CAM consumption between tumor patients (n = 107) and the control group (n = 112) could be detected. Concerning the frequency of CAM usage, we could document a significant increased consumption of CAM among tumor patients (42.8% vs. 62.6%) especially for herbal teas (P < 0.05), phytotherapy (P < 0.001), supplement products (P < 0.05), and "other" supplements (P < 0.005) comparing the controls. Furthermore a significant influence of female gender and an increased CAM usage could be illustrated. Concerning the knowledge of potential interactions of CAM consumption, only 6.25% of the controls and 19.6% of tumor patients know about possible side effects but only 1.7% of the controls and 6.5% of the tumor patients informed their physician about the CAM usage. The frequency of CAM in head and neck tumor patients seems to be relevant in the supervision of anticancer therapies.

Palatal implants in the treatment of obstructive sleep apnea: a randomised, placebo-controlled single-centre trial.

Palatal implants have been used to treat snoring and mild to moderate obstructive sleep apnea (OSA). Two previous controlled trials have published conflicting results regarding the effects of palatal implants on objective outcome measures, although they both could demonstrate superiority over placebo. The aim of the present study was to assess the effects of palatal implants in patients with mild to moderate sleep apnea in a randomised, placebo-controlled trial. Twenty-two patients with mild to moderate OSA (AHI 18 ± 5, BMI 28 ± 3, age 51 ± 13 years) due to palatal obstruction were enrolled in this randomised, double-blind, placebo-controlled trial. Respiratory parameters and sleep efficiency (evaluated by polysomnography), snoring (evaluated by the bed partner), and daytime sleepiness (evaluated by ESS) were assessed before and 90 days after surgery. One patient in each group did not show up for follow-up. The AHI, HI and LSAT showed statistically significant improvement in the treatment group (p < 0.05). Snoring as rated by bed partners also showed statistically significant improvement within the treatment group (p = 0.025). There was no statistical difference when comparing the means of the treatment group with the placebo group. There were no peri- or post-operative complications and no extrusions during the follow-up period. The study supports the idea that palatal implants lead to a reduction in respiratory events in patients with mild to moderate OSA, although a statistically significant superiority of palatal implants over placebo could not be demonstrated in this trial.

Cyclamen europaeum nasal spray, a novel phytotherapeutic product for the management of acute rhinosinusitis: a randomized double-blind, placebo-controlled trial.

AIM: To evaluate the efficacy and safety of a phytotherapeutic nasal spray containing Cyclamen europaeum (CE) in the treatment of acute rhinosinusitis (ARS). MATERIAL/METHODS: We performed a randomized, double-blind, placebo-controlled trial of CE nasal spray once daily for 15 days in 99 adult patients with moderate-to-severe ARS who also received amoxicillin 500 mg three times daily for the first 8 days. The primary endpoint was the change in mean total symptom scores (TSS) on day 7. Secondary endpoints included individual symptom scores (nasal congestion, mucus secretion, facial pain, impairment of smell) and endoscopic findings on days 7 and 15 and others. RESULTS: No statistically significant difference in TSS was noted for CE versus placebo on day 7. Moreover, the individual scores were not statistically different between the groups for the ITT-population on day 7. However, both a reduction in facial pain and an improvement in endoscopically-assessed mucosal obstruction significantly favoured CE on day 7. The most common adverse events were nasal burning and mild epistaxis, but no severe adverse events were documented. CONCLUSION: In summary, this is the first randomized controlled trial on phytotherapy in patients with moderate-to-severe ARS demonstrating clinical safety and some encouraging effects of CE which merit to investigate phytotherapeutic products in further large-scale clinical trials.

[Receptor function of the semicircular canals: Part 1: anatomy, physiology, diagnosis and normal findings]. / Rezeptorfunktion der Bogengänge: Teil 1: Anatomie, Physiologie, Diagnostik und Normalbefunde.

The perception and conversion of motion stimuli by the vestibular receptors, unimpaired postural control and intact visual acuity are essential for spatial orientation. Disturbances in these three sensory systems can manifest as "vertigo", "dizziness" or "imbalance". The integrity of peripheral receptor function, especially of the three semicircular canals, plays a superficial role. They are sensitive to acceleration stimuli, which they transmit via reflexes to the eye muscles. The stabilization of a visual target is via vestibulo-ocular reflexes, which have a very short latency and thus ensure a permanently stable image on the retina. Modern lateral-specific testing procedures are available to diagnose the receptor function of the peripheral vestibular system. The function of the semicircular canals can be analyzed using a head impulse test (HIT) and, more recently, by means of video-HIT as well as on the basis of a caloric test. Using these techniques, all three semicircular canals can be assessed in a side- and receptor-specific manner.

[Receptor function of the semicircular canals. Part 2: pathophysiology, diseases, clinical findings and treatment aspects]. / Rezeptorfunktion der Bogengänge. Teil 2: Pathophysiologie, Erkrankungen, klinische Befunde und therapeutische Aspekte.

Perturbation of semicircular canal function may result in a pathological angular vestibulo-ocular reflex (aVOR). The resulting impairment in gaze stabilization is perceived as "vertigo" or "dizziness" and may occur following receptor function impairment of all three semicircular canals. The head impulse test reveals hidden (covert-catchup) or visible (overt-catchup) saccades in disturbances of semicircular function. Most peripheral vestibular disorders can be treated conservatively. There are surgical treatment options for some diseases, such as intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence. Vestibular training promotes central reorganization of the VOR. Impaired semicircular receptor function, in particular bilateral vestibulopathy, may affect spatial orientation and cognitive processes. Balance prostheses could serve as a replacement for receptors in the future.

[Results of clinical use of the German version of the APHAB]. / Klinische Ergebnisse bei der Anwendung des APHAB (deutsche Version) in der Hörgeräteversorgung.

OBJECTIVE: Speech audiometry studies do not deliver structured testimony of patients as to the actual benefit of hearing aids based on individual daily life experiences. This deficiency can be resolved by applying structured inventory questionnaires. The APHAB (German version) is an evaluated inventory questionnaire consisting of six questions put to patients with hearing deficiencies with and without hearing aids in four different hearing situations. MATERIALS AND METHODS: We collected the APHAB data of 560 patients before and after fitting hearing aids. We also gathered personal data as to age, prior experience with hearing aids, duration of daily use of the hearing aid and degree of hearing loss. RESULTS: The average age of the patients was a little under 70 years, 84% had just received their first hearing aid, and 83% exhibited moderate or severe hearing loss. The APHAB results were classified in percentile and contingency tables. The latter allow one to determine conditional probabilities of the potential success of fitting a hearing aid to a new patient for each APHAB scale. CONCLUSIONS: The APHAB can be applied regularly to measure the benefit of fitting a hearing aid to a patient in particular in problematic hearing situations. By registering the personal view of the patients, it expands the scope of the standard methods (e.g., speech audiometry) so that the quality of diagnostics and therapy can be improved. It qualitatively records the success of hearing aid fitting, predicts potential problem areas and thereby may reduce the number of unused hearing aids.