Rise in complications of acute otitis media during and after the COVID-19 pandemic.

PURPOSE: After the lifting of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic, clinical observation showed an increase in complications of acute otitis, followed by a rise in the number of mastoidectomies performed. The aim of this study was to record the number of mastoidectomies performed before, during and after the COVID-19 pandemic as an indicator for complications of acute otitis media. METHODS: Data were collected from a tertiary hospital in a university setting, as well as from four major public health insurance companies in Germany. The data of 24,824,763 German citizens during a period from 2014 until 2023 were analyzed. RESULTS: According to the data, during the COVID-19 pandemic, the number of mastoidectomies performed dropped by 54% for children aged 0-6 and by 62% for children aged 7-18. For adults, there were 30% fewer mastoidectomies performed between 2020 and 2022. After the lifting of most NPI's in the season from July 2022 to June 2023, there was a sharp increase in the number of mastoidectomies performed on patients of all ages. CONCLUSIONS: During the COVID-19 pandemic, a decrease in the number of mastoidectomies performed was seen, suggesting a lower incidence of complicated acute otitis, most likely linked to the general decrease of upper airway infections due to NPI's. In contrast, a sharp increase in the incidence of complicated otitis occurred after the hygiene measures were lifted. The current development causes a more frequent performance of mastoidectomies, thus entailing a change in the challenges for everyday clinical practice.

[Multidimensional formats of surgical anatomy in otorhinolaryngology student teaching-a comparison of effectivity]. / Multidimensionale Formate chirurgischer Anatomie in der studentischen Ausbildung der HNO-Heilkunde ­ ein Effektivitätsvergleich.

BACKGROUND: Technological change in healthcare and the digital transformation of teaching require innovations in student teaching in medicine. New technologies are needed to enable the delivery and use of diverse teaching and learning formats by educational institutions independent of time and place. The aim of this study is to analyze the effectiveness of different multidimensional formats in student teaching in surgical ENT medical anatomy. MATERIALS AND METHODS: During the summer semester 2022 and winter semester 2022/2023, the digital teaching and learning program was expanded by testing different visualization formats (3D glasses, cardboards, or VR glasses) with students in the context of a highly standardized surgical procedure, namely cochlear implantation. A pre- and post-intervention knowledge assessment was carried out in all groups, followed by an evaluation. RESULTS: Of 183 students, 91 students fully participated in the study. The post-intervention knowledge assessment showed a significant increase in correct answers regardless of visualization format. In a direct comparison, the operating room (OR) group answered correctly significantly more often than the cardboard group (p = 0.0424). The majority of students would like to see 3D teaching as an integral part of the teaching program (87.9%) and more streaming of live surgeries (93.4%). They see the use of the various technologies as a very good addition to conventional surgical teaching (72.5%), as good visualization (89%) increases retention (74.7%) and motivation (81.3%). CONCLUSION: Application and use of new visualization technologies in everyday clinical practice is a promising approach to expanding student training. Mobile, interactive, and personalized technical formats can be adapted to the learning behavior of students. Last but not least, the use of new media influences learning motivation. An expansion of digital teaching and learning formats can be expressly recommended on the basis of this study.

[Interactive electronic visualization formats in student teaching]. / Interaktive elektronische Visualisierungsformate in der studentischen Ausbildung.

BACKGROUND: In the context of contact restrictions, conventional teaching is currently in need of optimization and expansion. The range of digital teaching formats in student training is very heterogeneous and their effectiveness uncertain. This study aims to investigate the extent to which an electronic ward round can be used as an alternative to the conventional ENT attendance practical course, and whether the use of electronic teaching formats has an influence on the quality of teaching. MATERIALS AND METHODS: Instead of regular attendance practicals, bedside teaching took place once a week in real time as a video stream via tablet. A total of 43 students in the seventh semester (winter semester 2020/2021) were included in the prospective study. Evaluation forms were used to examine the subjective didactic value of different visualization formats for the students. Examination results from previous years were used for comparison. RESULTS: The majority of students reported knowledge gain from the electronic rounds (93.02%) and that they were a good alternative to the traditional attendance clerkship (69.77%). The quality of the video and audio transmission as well as the comprehensibility of the case studies presented were consistently rated as good to very good. The students' examination results tended to be slightly worse in the test group compared to the control students of previous years. CONCLUSION: Integration of innovative interactive visualization options into teaching shows promising prospects as a supplement to conventional face-to-face teaching. The results of this study can contribute to the further expansion of digital teaching. Scaling up this model could be considered especially in countries with limited availability of face-to-face teaching.

[Interactive intraoperative annotation of surgical landmarks in student education to support learning efficiency and motivation]. / Interaktive intraoperative Annotation chirurgischer Anatomie in der studentischen Ausbildung zur Unterstützung der Lerneffizienz und -motivation.

BACKGROUND: The development of technological innovations has not only changed social life and the healthcare system, but also affects medical education. The aim of this pilot study was to evaluate whether students, when observing a microsurgical procedure of the temporal bone, gain an additional understanding of the anatomical structures and surgical site when visualization is used that provides identical views for the surgeon and viewer in 3D. MATERIALS AND METHODS: During regular attendance tutorials, students were randomly assigned to three different groups: control group, 2D group, or 3D group. Evaluation questionnaires and intraoperative student annotation of the surgical view were used to assess the subjective didactic value of different visualization formats and resultant learning experiences for the students. RESULTS: A total of 47 students were included in the investigations during conventional attendance tutorials. The majority indicated a high added value of the 3D visualization in terms of method (70%) and vividness (80%) compared to the 2D group and self-study; 69% of the students fully agreed with the statement that 2D and 3D visualization increases learning motivation and is a very good way to improve recognition of anatomical topography and structures. CONCLUSION: New interactive visualization options in teaching promote learning efficiency and motivation among students. Especially 3D visualization and intraoperative annotation of the surgical view by the student is a useful didactic tool and increases the quality of clinical teaching. It supports the perception of anatomical topography and enables more focused surgical training.

Smartphone-based nystagmus diagnostics: development of an innovative app for the targeted detection of vertigo.

BACKGROUND: In medicine, the symptom of dizziness is one of the most common multidisciplinary causes of emergency medical presentation. Attending physicians are often faced with difficult decisions when evaluating patients with dizziness. A rapid differential diagnostic decision must be made during the initial examination. The goal of this study, was to develop a smartphone-based app that can diagnose and qualify nystagmus. The app should enable differentiation between acute emergencies such as strokes ("central vertigo") and vestibular disorders ("peripheral vertigo") using and recognizing or analyzing the accompanying symptom "nystagmus". MATERIALS AND METHODS: This prospective study was conducted at the Department of Otolaryngology, Head and Neck Surgery "Otto Körner", Rostock (Germany). The experimental study design consisted of two test runs and two control runs. In the two test runs, nystagmus was tracked and evaluated by caloric and optokinetic stimulation, respectively, through a custom-developed app. Sensitivity and correlation were calculated for the app's application performance and compared under different experimental conditions. RESULTS: The patient sample included twenty healthy participants with a mean age of 25.6 years (± 2.2 SD) who participated in the study. The overall sensitivity of detection of nystagmus averaged 82.14% in the optokinetic stimulation test trials. There is no correlation regarding specific subject data and sensitivity. CONCLUSIONS: The results of our experimental validation study show that a smartphone-based nystagmus app is a useful tool for vertigo diagnosis. The results of our analyses show that it is possible to diagnose nystagmus and determine shape or direction with the app.

Interactive live-stream surgery contributes to surgical education in the context of contact restrictions.

BACKGROUND: Attendance teaching is the predominant teaching method at universities but needs to be questioned in the context of digital transformation. This study establishes and evaluates a method to accomplish electronic learning to supplement traditional attendance courses. MATERIALS AND METHODS: Surgery was transmitted in real-time conditions via an online live stream from the surgical theater. Visualization was transferred from a fully digital surgical microscope, an endoscope or an environmental camera in high definition quality. Students were able to participate at home from their personal computer. After following the surgery, they participated in an online-evaluation. RESULTS: A total of 65 students participated in the live stream. The majority of students (61.54%) indicated a significant subjective increase in knowledge after participation. The majority of students (53.85%) indicated that live surgeries should be offered as a permanent component in addition to classroom teaching. Likewise, a broader offer was desired by many students (63.08%). CONCLUSIONS: Live streaming of surgery is a promising approach as an alternative or supplement to traditional attendance teaching. An expansion of digital teaching can be explicitly supported on the basis of this study.

[Electronic learning for otorhinolaryngology students using the content management system ILIAS]. / Elektronisches Lernen für Studenten in der Hals-Nasen-Ohren-Heilkunde durch Nutzung des Content-Management-Systems ILIAS.

BACKGROUND: With increasing access to online teaching materials, traditional teaching methods at universities need to be questioned in the context of digital transformation. The aim of this study was to evaluate whether electronic learning may serve as or replace conventional internship in otorhinolaryngology. MATERIALS AND METHODS: A completely digital electronic learning concept was created and made available at the online learning platform ILIAS. Students were introduced to the program. Four learning units (neck [I], pharynx/larynx [II], nose [III], ear [IV]) were set up, with a topic-related multiple-choice test at the end of each unit. The students took part in the evaluation before and after completion of the course. RESULTS: A total of 105 students participated in the evaluation before and 85 students after the electronic learning program. After completing the courses, the majority of students (52.94%) stated to be more satisfied with the content and the presentation of the learning sequences as well as with their own self-control concerning learning pace and time management compared to the situation before completing the program (34.29%; p < 0.0001). The majority of students (54.12%) stated that they would appreciate the electronic learning program in addition to practical internship. CONCLUSION: The electronic learning program is a promising approach to supplement traditional learning and internships. An expansion of digital teaching proposals should be supported based on this study.

Evaluating the didactic value of 3D visualization in otosurgery.

INTRODUCTION: Improvements of surgical visualization add value to the quality of clinical routine and offer the opportunity to improve surgical education of medical staff. The aim of this study was to determine whether otorhinolaryngology trainees gain additional comprehension of the anatomical structures and the surgical site when 3D visualization is used. METHODS: Data were collected from ENT trainees of microsurgical courses of the middle ear, inner ear and lateral skull base at four university ENT departments (Charité (Berlin), Martin Luther University Halle-Wittenberg (Halle/Saale), Ludwig Maximilian University (Munich) and Rostock University Medical Center). Participants were asked to complete a questionnaire assessing the subjective value of identical surgical field visualization in 3D for surgeon and observer. RESULTS: A total of 112 participants completed the questionnaire. The majority of participants stated a high additional value of 3D visualization compared to 2D visualization, with 75% fully agreeing to the statement that 3D visualization of the surgical field is superior to perceive the anatomical topography and structures compared to 2D representation. Participants encouraged the storage of data in online learning platforms. CONCLUSION: The results show that 3D visualization with identical imaging for surgeon and observer is a useful tool in teaching of microsurgery. It addresses perception of anatomical topography and structures as well as conception of the surgical workflow.

Chronic otitis media following infection by non-O1/non-O139 Vibrio cholerae: A case report and review of the literature.

We report a case of a chronic mesotympanic otitis media with a smelly purulent secretion from both ears and recurrent otalgia over the last five years in a six-year-old girl after swimming in the German Baltic Sea. Besides Staphylococcus aureus a non-O1/non-O139 Vibrio cholerae strain could be isolated from patient samples. An antibiotic therapy with ciprofloxacin and ceftriaxone was administered followed by atticotomy combined with tympanoplasty. We conclude that V. cholerae should not be overlooked as a differential diagnosis to otitis infections, especially when patients present with extra-intestinal infections after contact with brackish- or saltwater aquatic environments.