[Development and validation of the Tonsillectomy Outcome Inventory 14]. / Entwicklung und Validierung des Tonsillectomy Outcome Inventory 14.

BACKGROUND: Until now, no validated instrument to measure disease-specific, health-related quality of life (HR-QOL) in adults with chronic tonsillitis (CTO) exists. MATERIAL AND METHODS: After an item reduction of the alpha-version of the Tonsillectomy Outcome Inventory (TOI), the TOI-14 resulted. In addition to the total score, it includes the subscales throat problems, overall health, resources, and social-psychological restrictions. In phase 2, the TOI-14 was prospectively validated on 108 adults with CTO, who had undergone a tonsillectomy. RESULTS: The TOI-14 had, on average, good reliability. It included all important aspects of the HR-QOL. Patients with CTO can be distinguished with high sensitivity from healthy subjects. All scores showed moderate to good correlation with the subjective limitation in quality of life. The sensitivity of the questionnaire demonstrated major effects postoperatively. CONCLUSION: The TOI-14 constitutes the first worldwide-validated, disease-specific instrument to measure HR-QOL in adults with CTO. Due to its ease of use, it can be utilized both in the outcome research and in clinical routine.

Teaching Otolaryngology skills through simulation.

Over the last couple of decades, learning through simulation has become popularised for various reasons and is continuing to expand exponentially despite a lack of robust evidence that it actually improves outcomes for patients and learners. There has been a particular growth in the use of high-fidelity virtual reality simulators for surgical training as the technology has become more affordable. In the field of Otolaryngology, simulation appears to help teach simple procedural skills through to complex surgery of the temporal bone and paranasal sinuses. This is happening in an era when quality of care and patient safety are top of the agenda and cadaveric material is in short supply. In this article, we explore the history behind simulation, review the available evidence and discuss its applications within Otolaryngology.

Assessment of the peripheral hearing system of sport divers.

OBJECTIVE: To investigate the effect of regular scuba diving on the hearing thresholds of sport divers who have no history of noise exposure or ear-related accidents. Comprehensive topographic examination of the peripheral hearing system of sport divers. DESIGN: Cross-sectional study. SETTINGS: General sport diving community. PARTICIPANTS: 81 sport divers with a mean of 300 dives each were compared to a control group of 81 non-divers. MAIN OUTCOME MEASURE: Participants were classified into three age groups. Examination included microscopic otoscopy, tympanometry, pure-tone audiometry (PTA) including air and bone conduction, speech audiometry and otoacoustic emissions (OAE). RESULTS: PTA suggested significant differences of the hearing thresholds at several frequencies between sport divers and non-divers in all age groups, although a Bonferroni correction for multiple testing was applied. Interestingly, the results were contradictory. Divers obtained better hearing results in air conduction, whereas non-divers showed better results in bone conduction. Speech audiometry and OAE did not reveal significant differences. CONCLUSION: There are no published studies of the peripheral cochlear system of divers that have used a combination of PTA, speech audiometry and OAE. All studies suggesting hearing impairment in divers were based on PTA and might have been influenced by a lack of accuracy of PTA. Our results suggest that diving does not adversely affect the hearing system of sport divers. A thorough test battery of audiological methods implying PTA, speech audiometry and OAE may contribute to offer more reliable results to answer the question of whether commercial or military divers are at higher risk for hearing detoriation.

Assessment of the central hearing system of sport divers.

OBJECTIVE: To investigate the effect of regular scuba diving on central processing sequences of sport divers who have no history of noise exposure or ear-related accidents using a comprehensive topographic examination of the central hearing system. DESIGN: Cross-sectional controlled comparison study. SETTINGS: General sports diving community. PARTICIPANTS: 81 sport divers with a mean of 300 dives each were compared with a control group of 81 non-divers. MAIN OUTCOME MEASURE: The participants were classified into three age groups. Hearing test results were combined for both ears. Examination included brainstem evoked response audiometry (BERA), cortical evoked response audiometry (CERA) and dichotic listening tests to screen for retrocochlear and central hearing disorders. Testing of brainstem latencies was performed in a gender-dependent manner. RESULTS: BERA showed a pathological extension of the I-V-latency in one diver. Magnetic tomographic imaging ruled out brainstem lesions. No reason for the measured latency could be detected. All other latencies (I-III, III-V and I-V) in both gender groups were within normal limits. No statistically significant differences between divers and non-divers could be detected. Dichotic listening showed no clinical abnormalities in any of the participants, but in the age group 18-29 years divers performed significantly better than non-divers (p = 0.01). CERA revealed no significant differences between divers and non-divers in the age group 18-29 years and 30-39 years, whereas divers in the age group 41-50 demonstrated significantly better test results (p = 0.045) (difference of the means: 4.18 dB). CONCLUSION: Dichotic listening and CERA did not reveal a significant reduction of central hearing performance in divers. Persistent on-shore BERA wave latency prolongations that were present in one study could not be confirmed in our study group. This first comprehensive topographic examination of the central hearing system of divers showed no abnormalities.

[Development and validation of the Parotidectomy Outcome Inventory 8 (POI-8). Measurement of quality of life after parotidectomy in benign diseases]. / Entwicklung und Validierung des Parotidectomy Outcome Inventory 8 (POI-8): Messung der Lebensqualität nach Parotidektomie bei benignen Erkrankungen.

BACKGROUND: To date, no validated instrument for measuring health-related quality of life (QOL) in patients after parotidectomy for benign disease has been available. METHODS: In our retrospective study we included patients who had undergone parotidectomy for benign disease between 2003 and 2006. A group of experts identified single items with a potential impact on postoperative complaints (alpha version). After the patients had filled out the questionnaire item reduction was performed by sequential statistical analysis. The beta version of the instrument resulting from this procedure was then validated by the evaluation of reliability and validity. RESULTS: We included 199 patients in the study, of which 70 (35%) returned the completed questionnaires. The alpha version of the instrument contained 20 items (Parotidectomy Outcome Inventory-20, POI-20), while the beta version consisted of 8 items (POI-8). Cronbach's alpha was 0.84, indicating good internal consistency. The test-retest reliability score for POI-8 in 49 patients was highly correlated (r=0.91). Furthermore, we found a good concurrent validity with a global disease specific question (r=0.78). CONCLUSIONS: The POI-8 is the first reliable and valid instrument for measuring health-related QOL in patients after parotidectomy for benign disease.

[Expression patterns of non-viral transfection with GFP in the organ of Corti in vitro and in vivo. Gene therapy of the inner ear with non-viral vectors]. / Expressionsmuster für nichtviral transfiziertes gfp in der Cochlea der Maus in vitro und in vivo. Gentherapie des Innenohres mit nichtviralen Vektoren.

BACKGROUND: Diseases of the inner ear such as presbycusis, tinnitus, sudden hearing loss, and vertigo affect many patients, but so far there are no specific therapy options. Gene therapy might become a potential modality of treatment. Viral vectors are standard in animal models to date. Future considerations, however, call for a further evaluation of non-viral transfection methods. MATERIAL AND METHODS: The non-viral transfection agents Metafectene, Superfect, Effectene, and Mirus TransIT were incubated with a plasmid coding for GFP. In vivo, the plasmid-agent mix was injected via the membrane of the round window, and 48 h later the inner ear was perfused, harvested, decalcified, and histologically evaluated for GFP expression. RESULTS: Cationic lipids (Metafectene) and dendrimers (Superfect) were able to transfect cells in the area of the organ of Corti and lead to GFP expression. The polyamine (Mirus TransIT) did show expression of GFP in the area of Rosenthal's canal and in the area of the inner hair cell. The combination of a non-liposomal lipid with a DNA condensing component (Effectene) did not show transfection of the organ of Corti. In the area of the spiral ganglia cells, GFP expression was seen with all the transfection agents. CONCLUSIONS: Non-viral transfection agents are able to introduce a reporter gene in cells of the inner ear in vitro and in vivo. There are, however, differences in the efficiency of the transfection. They might be an alternative in gene therapy of the inner ear. Further investigations to elucidate their potential are needed.

[Fitness to dive in the otorhinolaryngological field]. / Tauchtauglichkeit im HNO-Bereich.

In line with the rising number of recreational divers, the otorhinolaryngologist has to deal with growing numbers of diving-associated disorders of the ear, nose and throat (ENT). Nevertheless, the majority of divers present to their ENT doctor for assessment of their fitness to dive. On the basis of long-term follow-up examinations and increasing experience in diving medicine, even divers with a history of ENT problems can be considered fit to dive. Therefore, diving is possible after tympanoplasty, surgery to improve hearing including stapesplasty, after implantation of middle ear amplifiers or cochlear implants, after sinus or scull base surgery and even after canal wall down mastoidectomy, provided that certain requirements are fulfilled. Assessing fitness to dive after inner ear barotrauma as well as after inner ear decompression illness requires meticulous consideration of residual damage and possible underlying conditions like vascular right-to-left shunts. This article is based on the new recommendations of the German Undersea and Hyperbaric Medical Society for the assessment of fitness to dive in the otorhinolaryngological field.

[Otorhinolaryngologic disorders in association with scuba diving]. / Hals-Nasen-Ohren ärztliche Erkrankungen im Zusammenhang mit dem Sporttauchen.

BACKGROUND: Due to the increasing number of scuba divers in Germany, the otorhinolaryngologist has to face rising numbers of diving-associated ENT disorders. However, data about the lifetime prevalence of these disorders are insufficient. The aim of this study was to determine the frequency of ENT disorders in scuba divers correlated with their diving history. METHODS: The study design was a non-randomized, retrospective, cross-sectional study based on questionnaires. The study population included 429 active divers attending three medical diving symposia. RESULTS: The study population consisted of highly experienced divers (mean of logged dives m= 670.0) with a high diving certification level. Otitis externa was the most frequent disorder (43.6%). Barotrauma of the sinuses (10.9%), alternobaric vertigo (9.0%) and barotrauma of the middle ear (8.7%) played an important role as well. In contrast, inner ear barotrauma and decompression illness of the inner ear were less frequent but not rare (1.7 % each). CONCLUSION: A substantial number of scuba divers suffered diving-related ENT disorders.

[Diving fitness of children and adolescents. Importance for ENT doctors]. / Tauchtauglichkeit von Kindern und Jugendlichen. Bedeutung für den HNO-Arzt.

About 10% of all sport scuba divers are children and adolescents. Little is known about the particular risks and consequences of this sport on a child's health. Due to the peculiarities of childhood anatomy and physiology, certain restrictions apply to the diving fitness of children and adolescents. Before starting scuba training, the presence of particular cognitive abilities must be demonstrated and eustachian tube dysfunction must be ruled out by a specialist. Medical contra-indications to scuba diving for adults apply to children too but must be adapted. Relative risks for adults may translate to absolute contra-indications in children and adolescents. When planning dives, there should be rigorous limitations as to depth and time. Experienced adult divers must always assist with dive planning and accompany children and adolescents when scuba diving.

[Chronic rhinosinusitis. Subjective assessment of benefit 1 year after functional endonasal sinus surgery]. / Chronische Rhinosinusitis. Subjektive Nutzenbewertung 1 Jahr nach funktioneller endonasaler Nasennebenhöhlenoperation.

BACKGROUND: Against the background of constantly intensifying economic pressure in the healthcare sector, in the future confirmation of subjective and economic benefit of different forms of therapy will be the criterion applied by the health insurance companies to decide whether to reimburse the costs they involve. The aim of this study was to provide confirmation that patients with chronic rhinosinusitis (CRS) do benefit from functional endonasal sinus surgery (FESS). PATIENTS AND METHODS: One year after undergoing FESS for the treatment of CRS, 82 patients completed various questionnaires. The Glasgow Benefit Inventory (GBI) was used, as it is a validated instrument for the assessment of benefit. In addition, the patients were asked to complete questionnaires relating to pre- and postoperative use of resources (use of antibiotics, visits to their doctors and time unfit for work) and also to give an overall rating of their satisfaction with the outcome, the difference in their symptoms after FESS and the likelihood that they would recommend this treatment to friends or relatives. RESULTS: Three out of four GBI scales [total score (+22.6), general benefit (+26.8), physical functioning (+23.7)] indicated that patients experienced significant benefit. The frequency of visiting their doctors, their intake of antibiotics and the amount of time off work were all significantly reduced. The vast majority of patients were satisfied with the overall result and the level of symptom relief achieved and would recommend FESS to friends and relatives. CONCLUSION: The vast majority of these patients with CRS experienced FESS as highly beneficial. A significant reduction of resource usage was reported after the operation.

[Treatment of acute cochleovestibular damage after diving]. / Behandlung akuter kochleovesibulärer Schädigungen nach dem Tauchen.

BACKGROUND: There has been a steady in-crease of recreational scuba divers in the last years. The majority of diving associated diseases involve otorhinolaryngology, the most important of which are cochleovestibular dysfunctions as these can lead to permanent inner ear failure. MATERIAL AND METHODS: We discuss the origin and clinical symptoms, as well as the therapy, of both inner ear barotrauma and inner ear decompression illness. Our own experiences are considered together with a review of the literature from the last decade. RESULTS: Inner ear decompression illness seems to be a relatively common diving associated incident and is not as rare as previously thought. DISCUSSION: Hyperbaric oxygen therapy is the treatment of choice for patients with inner ear decompression sickness, but is contraindicated in patients with inner ear barotrauma. As long as an inner ear decompression illness can not be ruled out, we suggest that every patient should be treated using hyperbaric oxygen therapy but only after bilateral paracentesis.

[Health aspects of diving in ENT medicine. Part I: Diving associated diseases]. / Tauchmedizinische Aspekte in der HNO-Heilkunde1. Teil: Erkrankungen durch den Tauchsport.

There has been a steady increase in the number of recreational scuba divers in the last years, with a growing number of diving associated diseases involving ENT medicine. Disorders of the ears, sinuses and pharynx are those most common in divers. In particular, external otitis and barotrauma of the middle ear are commonly treated by every ENT specialist. They usually do not lead to any permanent complaints. Incidents involving the cochleovestibular system are less common, but can result in deafness, vertigo and tinnitus, and therefore have to be treated appropriately. To treat diving medical disorders, the physician has to have some basic understanding of the physical laws that lead to diving incidents. This article will inform the reader of the forces that are encountered by divers, and then give details of the treatment of acute ENT diseases which result from diving incidents.

[Health aspects of diving in ENT medicine. Part II: Diving fitness]. / Tauchmedizinische Aspekte in der HNO-Heilkunde. 2.Teil: Tauchtauglichkeit.

Diving has become increasingly popular. With the growing number of patients who want to dive, there is an increasing number of divers who require their regular medical examination. As ENT problems are the most common disorders in divers, otorhinolaryngologists regularly have to assess the diver's fitness. It should be noted that an ENT examination does not certify complete fitness to dive! Diving can be resumed 3 months after middle ear surgery, especially after tympanoplastic type I, II and III with insertion of a PORP, when there is regular middle ear ventilation without atrophic scars of the tympanic membrane. Even after stapes surgery, diving can be resumed when there are no signs of vestibular irritation during a provocation test. By 3 months after sinus surgery, the diver should perform a test dive under supervision before fitness to dive can be certified. After inner ear barotrauma, the diver remains fit to dive depending on his hearing ability in the involved ear. After inner ear decompression illness, one should look for a vascular right-to-left shunt before diving can be resumed. These and many more aspects are discussed in this article on how to determine whether a diver with ENT problems is fit to dive.

Arterial gas embolism after decompression: correlation with right-to-left shunting.

Paradoxical gas embolism is a possible cause of neurologic sequelae after decompression in divers. The authors detected arterial bubbles after decompression from chamber dives in two of six divers using transcranial Doppler sonography (TCD). Arterial bubbles correlated with the size of right-to-left shunting as diagnosed by contrast TCD. The pathway of spontaneous paradoxical embolism was tracked for the first time, supporting the concept of paradoxical gas embolism as a cause of early neurologic sequelae after decompression in at-risk divers.