Increase in acute mastoiditis at the end of the COVID-19 pandemic.

PURPOSE: Common respiratory infections were significantly reduced during the COVID-19 pandemic due to general protective and hygiene measures. The gradual withdrawal of these non-pharmaceutical interventions (NPI) was associated with a notable increase in these infections, particularly in pediatric and adult otorhinolaryngology. The aim of this retrospective monocentric study was to evaluate the impact of NPI during the COVID-19 pandemic on the incidence and severity of acute mastoiditis (AM). METHODS: Pre-pandemic clinical data of AM cases from 2011 to 2019 were compared with infection counts from January 2020 to June 2023 for seasonal periodicity, age-specific differences, pathogens, and complication rates in a German third-level hospital. RESULTS: Out of 196 patients with AM 133 were children, the majority between 1 and 5 years of age. Complications of AM, such as meningitis, brain abscess, and sinus vein thrombosis, were more common in adults (87%) than in children (17%). Morbidity and mortality rates were similar before, during and after the pandemic. Pneumococci were the most common pathogen in both age groups, with a post-pandemic cumulation of Streptococcus pyogenes infections in children. While pre-pandemic cases clustered in spring, seasonality was absent in all age groups during the main phase of the pandemic. The cessation of NPI caused a steep rise in AM cases in both age groups starting from December 2022. CONCLUSION: NPI during the COVID-19 pandemic reduced the incidence of AM. Their reversal led to a substantial increase in the incidence of AM during the post-pandemic period, which may be due to a general increase in viral respiratory infections and an insufficiently trained immune system.

[Emphysema after cochlear implantation - risk factors and therapeutic options]. / Emphyseme nach Cochlea-Implantation ­ Risikofaktoren und Therapieoptionen.

OBJECTIVE: In case of cochlear implantation seroma, hematoma, local wound infections or vertigo are rare but typical complications. In contrast, emphysema is seldom reported. They can occur after cochlear implantation both in the postoperative healing phase and years later. A therapeutic algorithm does not yet exist. METHODS: We report on 3 patients with subcutaneous emphysema in the area of the receiver-stimulator. An unsystematic review of the literature of cases with emphysema after cochlear implantation highlights possible risk factors and the therapeutic options. RESULTS: The 3 cases developed subcutaneous emphysema 2-11 month after cochlear implantation due to nose blowing or CPAP therapy in obstructive sleep apnea. The current literature reports another 35 cases of emphysema after cochlear implantation. Air insufflation via the Eustachian tube is the most frequently described cause. Diseases of the nose and sinuses, tube dysfunction and obstructive sleep apnea are potential risk factors. Pressure bandage, puncture, tympanic tubes, and surgical revision are common treatments. CONCLUSIONS: Most emphysema can be controlled by conservative methods such as pressure bandaging and behavioral instruction. Punctures should be avoided due to the risk of upcoming infections. The prophylactic use of antibiotics seems dispensable. Surgical revision should be considered especially in cases of pneumocephalus with suspected leakage in the dura. The coverage of the mastoidectomy by a bony cap can be precautious and beneficial in cases with risk factors.

[Adaption of the "Empty Nose 6 Item Questionnaire" (ENS6Q) into German language]. / Erstellung einer deutschen Version des "Empty Nose Syndrome 6 Item Questionnaire" (ENS6Q).

OBJECTIVE: The English "Empty-Nose-6-Item-Questionnaire" (ENS6Q) is a validated tool to assess subjective and disease-specific complaints of patients suffering from empty nose syndrome. The aim of this study was to create a validated German adapted version (GAV) of the ENS6Q. MATERIAL AND METHODS: The ENS6Q was translated into German language using a multistage process. Subsequently the translated questionnaire was completed twice by a group of patients suffering from empty nose syndrome (n = 36), a healthy control group (n = 77) and a group of patients with a symptomatic pathology of the nasal septum (n = 78). Additionally, the NOSE© questionnaire was completed twice by all groups. The ENS6Q was then examined regarding internal consistency, test-retest reliability, discriminant validity, sensitivity and specificity. RESULTS: The ENS6Q-GAV shows high internal consistency with Cronbachs α = 0,760 and α = 0,795. It also shows good test-retest reliability with an interclass correlation coefficient of 0,947 [0,930 - 0,961]. The ENS6Q-GAV discriminated significantly between empty nose syndrome patients and the control group. The receiver-operating characteristics curve showed a sensitivity of 83,3 % and a specificity of 88,3 % using a cut-off point of 8,5. The area-under-the-curve threshold score was 0,914 ± 0,029 [0,856 - 0,971]. CONCLUSIONS: The ENS6Q-GAV is the first validated disease-specific questionnaire in German to help identify patients suspected of developing ENS more reliably.

A contemporary review of "realistic" success rates after surgical closure of nasal septal perforations.

OBJECTIVE: The surgical closure of septal perforations is a challenging procedure. Various techniques exist. Each perforation proves that there is not the one precise procedure for all perforations. Nevertheless, success rates of about 90% are reported, although the procedure for closing the defect is challenging. Our goal was to evaluate the existing data. METHODS: We performed a contemporary review of published closure rates of septal perforations on order to compare the present results in the literature. The limitations of the respective studies were analyzed. RESULTS: We found closure rates from 30 to 100%. Numerous procedures were described and combined. Prospective studies comparing different techniques are missing. The follow-up time in studies was quite short or not even specified. Studies on long-term success rates are rare. CONCLUSION: The closure of septal defects is one of the most challenging rhinosurgical interventions. Closure rates ≥90% as described in literature seem relatively high. One reason might be short follow-ups and retrospective study designs. Frequently, precise information on the follow-up and the method of follow up is missing. Thoroughly designed prospective studies are absent. Longer follow-up times are associated with lower complete closure rates. A long-term success rate between 70 and 80% seems realistic.

Anthropometric Evaluation of Photographic Images Before and After Functional Nasal Surgery in Patients With Deviated Noses.

BACKGROUND: Numerous techniques for correction of deviated noses have been described. Nevertheless, surgical management is challenging even for experienced rhinosurgeons. Often, a "residual deformity" after functional septorhinoplasty (SRP) due to a deviated pyramid syndrome may remain. OBJECTIVE: Therefore, the purpose of this study was to determine how frequent functional SRP in patients with a deviated nose results in "successful" straightening of the external nose based on standardized angle measurements. Possible influences having a positive or negative effect on the surgical success were identified. METHODS: Photo documentation of 607 patients with deviated noses (304 women, 303 men, median age 30 years) before and after nasal surgery were retrospectively analyzed using standardized angle measurements. The pre- and postoperative photos of the faces were anthropometrically measured. The median follow-up was 6 months. RESULTS: A "straight" deviated nose (I-type) was present in 225 patients (37%), a C-shaped nose (C-type) in 382 patients (63%). More than 75% of the patients presented a facial asymmetry. Based on angle measurements alone, a total of 452 (75%) noses were straightened or postoperatively improved. 155 noses (25%) still showed a biometric deviation. The I- or C-type had no relevant influence on outcome. CONCLUSION: A purely biometric analysis of crooked noses is difficult and its importance is limited due to commonly pre-existing facial asymmetries. The risk of a "residual deviation" after rhinoplasty in patients with deviated noses must not be underestimated. This fact should be addressed as part of the informed consent. In particular, it should be mentioned that the surgical outcome can remain well below the patient's aesthetic expectations. Not rarely, a revision surgery may be necessary.

[Importance of machine blood count in the diagnosis of infectious mononucleosis by EBV]. / Stellenwert des maschinellen Blutbildes bei der Diagnose der infektiösen Mononukleose durch EBV.

INTRODUCTION: EBV serology is recommended for serological diagnosis of mononucleosis. As results of an automated differential blood count is available more quickly, possible differences between an EBV primary infection and a bacterial tonsillitis were investigated. METHODS: A retrospective evaluation of absolute and relative lymphocyte and monocyte counts of n = 140 patients > 16 years from 01/2008 to 01/2019 (mean age 21.4 years, 51 % ♀, 49 % ♂) with suspected EBV infection was performed. The groups of a serologically confirmed or excluded EBV infection were compared. RESULTS: An automated differential blood count was available in n = 42 patients with primary EBV infection. Average lymphocyte count was 5.5 ±â€Š2.6 giga/l. Patients with acute bacterial tonsillitis (n = 36) had significantly lower values with 1.6 ±â€Š1.3 giga/l, p < 0.05. Equal results were found in relative lymphocyte counts (47.4 ±â€Š17.9 vs. 12.8 ±â€Š9.1 %, p < 0.05). For monocyte counts, neither absolute (1.2 ±â€Š0.8 vs. 1.2 ±â€Š0.6 giga/l, p = 0.617) nor relative (8.8 ±â€Š3.6 vs. 9.8 ±â€Š5.2 %, p = 0.746) monocyte counts showed significant differences. CONCLUSION: Increased lymphocyte counts in an automated differential blood count can be a first indication of primary EBV infection. Perhaps up to 30 % morphologically altered lymphocytes are increasingly counted correctly with modern hematology analyzers and no longer counted as monocytes. These results could be used to make decisions about further diagnosis (abdominal ultrasonography, ECG) and antibiotic therapy before results of EBV serology are available.

[The KINDL questionnaire for assessment of general quality of life in adenotonsillar hyperplasia]. / Der KINDL-Fragebogen zur Erfassung der allgemeinen Lebensqualität bei adenotonsillärer Hyperplasie.

BACKGROUND: There are few systematic studies on the general quality of life of children before and after adenoidectomy and adenotonsillotomy, although interventions on adenoids and tonsils are the most frequent operations in childhood in Germany. For this reason, the established KINDL questionnaire was used to assess the quality of life of children for the first time. METHODS: Study participants (n = 111) and a waiting design control group (n = 35) were recruited consecutively from children (3-6 years) receiving adenoidectomy (66 %) or adenotonsillotomy (34 %). The Kiddy-KINDL® questionnaire was answered by parents on the day of surgery and 3.5 months postoperatively. Parents of the control group were interviewed, when the date of operation was scheduled and on the day of operation. RESULTS: Total scale score of the Kiddy-KINDL of max. 100 points improved slightly in the intervention group from preoperatively 75.9 ±â€Š10.8 (95 %-KI [73.8-77.9]) to postoperatively 77.2 ±â€Š9.2 points (95 %-KI [75.1-79.0]; p = 0.365). Also in the comparison group there was no significant change over time (77.9 ±â€Š9.7; 95 % CI [74.1-81.7] vs. 77.3 ±â€Š11.3; 95 % CI [72.8-81.8]; p = 0.949) or compared to the preoperative score of the intervention group (p = 0.894). The subscales scores for "physical well-being" (p < 0.01), "school" (p = 0.034) and "parents" (p < 0.01) showed significant improvements for the intervention group. Children with additional tonsillotomy also showed a significant postoperative increase of the total scale score (p = 0.049). CONCLUSION: The version of the Kiddy-KINDL we used is therefore not fully suitable for recording the general QOL in adenotonsillar hyperplasia, since an improvement in QOL could only be recorded in subscales. However, since tonsillotomy in particular seems to have a relevant influence on QOL, it should be performed in children with significant hyperplasia.

[Analysis of facial asymmetry in patients with crooked noses]. / Analyse von Gesichtsasymmetrien bei Patienten mit Schiefnasen.

BACKGROUND: Surgical management of crooked nose is challenging even for experienced rhino surgeons, although numerous techniques for correction have been described. Not infrequently, there is a facial asymmetry in addition to the crooked nose influencing the aesthetic results of the operation. Therefore, the purpose of this study was to determine how often there is an asymmetry of the face in addition to a crooked nose. MATERIAL AND METHODS: Retrospectively the data of 607 patients with a crooked nose (304 women, 303 men, mean age 30 years) were evaluated. The preoperative photos of the face were anthrometrically assessed based on angle measurements. RESULTS: 382 of the 607 patients had a c-shaped (63 %) and 225 an i-shaped (37 %) crooked nose. More than three-quarters of the patients had facial asymmetry in respect to the connecting line of the pupils and nasal base line. 49 % of patients reported a history of nasal trauma, but this had no relevant influence on the frequency of facial asymmetry. CONCLUSIONS: Pre-existing facial asymmetry is very common in patients with crooked nose and can significantly affect the aesthetic outcome of nasal surgery. This should be addressed as part of the informed consent. In particular, it should be mentioned that the surgical outcome can remain below the patient's aesthetic expectations. Not rarely, a revision surgery may be necessary.

[Adaptation of the "Nasal Obstruction Symptom Evaluation" (NOSE©) questionnaire in the German language]. / Erstellung einer deutschen Version des "Nasal Obstruction Symptom Evaluation" Fragebogens (NOSE©).

OBJECTIVE: The standardized and validated English NOSE© questionnaire is used to assess subjective complaints of nasal obstruction. The aim of our study was to create and validate a German version of the NOSE© questionnaire. MATERIAL AND METHODS: The original questionnaire was translated into German in multiple steps. The English back translation was sufficiently similar to the original questionnaire. Next, the translated questionnaire was completed twice each by a group of patients with symptoms of nasal obstruction (n = 76) and a group of nose healthy test persons (n = 104). Subsequently, the questionnaire was tested for internal consistency, test-retest reliability, construct validity, discriminant validity and sensitivity to change. Additionally, it was examined whether the rhinomanometric results of the patient group correlated with their questionnaire scores. RESULTS: The created German NOSE questionnaire had high internal consistency with an average result of Cronbach's α ≥ 0.8. The test-retest reliability was also satisfactory with Goodman-Kruskal-γ = 0.826. The discriminant validity showed significant differences between the patient and control group. Furthermore, sensitivity to change was high. The patients' rhinomanometric results before operation did not correlate with the corresponding NOSE questionnaire Scores. CONCLUSIONS: The study showed that the created German Version of the NOSE© questionnaire (NOSE GAV) is a valid method for assessment of subjective nasal obstruction. It can be used throughout German-speaking areas without restriction.

[Symptoms and parental expectation in adenoidectomy and adenotonsillotomy in preschool children]. / Hauptsymptome und Elternerwartung bei Adenotomie und Adenotonsillotomie im Vorschulalter.

OBJECTIVE: In this study, symptoms associated with adenoids and hyperplasic palatine tonsils and parental expectation of surgical outcome were recorded, to provide realistic parental information prior to adenoidectomy (AT) ± tonsillotomy (ATT). MATERIAL AND METHODS: In total n = 111 children (3-6 years, ♂ 65 % ♀ 35 %) were recruited, who received AT (66 %) or ATT (34 %) at ENT University Hospital Ulm. By questionnaire-based survey, the most common symptoms and the main reason for the operation were reported from parent's perspective (operation day, follow-up: 3.5 months). Results were visualized in bar charts for total collective and AT and ATT surgical groups (significance level α = 5 %). RESULTS: Most commonly, parents observed signs of respiratory problems (mouth breathing 87 %, nasal obstruction 86 %, snoring 78 %), hearing loss (68 %) and infection of upper airways (66 %). Nasal obstruction (77.5 %) and hearing loss (53.2 %) were the main reasons for operation. In children with pharyngeal tonsil hyperplasia only, hearing problems dominated, while in additional tonsillotomy, nocturnal apneas were the most frequently reported reason for surgery. For all symptoms, a significant postoperatively improvement was achieved. CONCLUSIONS: With a differentiated indication for surgery, it is possible to inform the parents about a very good and realistic and effective reduction of symptom after AT and ATT.