[Providing practical skills in curricular teaching-effect of SkillsLab and flipped classroom]. / Vermittlung praktischer Fähigkeiten in der curricularen Lehre ­ Effekt von SkillsLab und "flipped classroom".

BACKGROUND: In the course of the restructuring of medical studies, practical competencies are clearly defined as learning objectives for the first time. In order to make most effective use of the short attendance time available in otolaryngology, the aim of this study was to teach practical skills with the help of flipped classroom, digital teaching, and a newly established SkillsLab. MATERIALS AND METHODS: During their ENT internship, two groups of students-group A = 93 students (male n = 42, female n = 51) and group B = 113 students (male n = 42, female n = 71)-first worked through material provided online, which explained the individual examinations. This was followed by face-to-face teaching, which consisted of observation and practical exercise of the different examination techniques. While group A practiced on each other or on dummies, group B used structured workstations in the ENT SkillsLab, which was newly built for this purpose. The effects on motivation and subjective competence were measured using a questionnaire developed for this study. RESULTS: After working through the online material, both groups showed a high level of motivation and competence. On the day of face-to-face teaching, there was a gain in motivation and competence, which was statistically significant only in the SkillsLab group (p < 0.001). Although the SkillsLab group was inferior in terms of its subjective competence at the beginning, it was superior to the other group after the face-to-face teaching. CONCLUSION: Combination of digitized teaching in the flipped classroom with structured workstations in the setting of a SkillsLab enables more effective teaching of practical skills, which was reflected by increases in motivation and subjective competence in group B. In particular, the presentation of all collected findings on monitors allows verification of learning success and stimulates discussion.

Subjective Smell Disturbances in Children with Sars-Cov-2 or Other Viral Infections do not Correspond with Olfactory Test Results.

BACKGROUND: Olfactory dysfunction associated with SARS-CoV-2 infection in children has not been verified by a validated olfactory test. We aimed to determine whether these complaints are objectifiable (test-based hyposmia), how often they occur during acute SARS-CoV-2 infection compared to other upper respiratory tract infections (URTI), as well as in children recovered from COVID-19 compared to children with long COVID. METHODS: Olfactory testing (U-sniff test; hyposmia<8 points) and survey-based symptom assessments were performed in 434 children (5-17 years; 04/2021-06/2022). 186 symptom-free children served as controls. Of the children with symptoms of acute respiratory tract infection, SARS-CoV-2 PCR test results were positive in 45 and negative in 107 children (URTI group). Additionally, 96 children were recruited at least 4 weeks (17.6±15.2 weeks) after COVID-19, of whom 66 had recovered and 30 had developed long COVID. RESULTS: Compared to controls (2.7%), hyposmia frequency was increased in all other groups (11-17%, p<0.05), but no between-group differences were observed. Only 3/41 children with hyposmia reported complaints, whereas 13/16 children with complaints were normosmic, with the largest proportion being in the long-COVID group (23%, p<0.05). CONCLUSION: Questionnaires are unsuitable for assessing hyposmia frequency in children. Olfactory complaints and hyposmia are not specific for SARS-CoV-2 infection. The number of complaints in the long-COVID group could result from aversive olfactory perception, which is undetectable with the U-sniff test.

[Nonsurgical attachment possibilities for bone conduction hearing aids : Comparison of coupling using external pressure versus an adhesive plate]. / Nichtoperative Ankopplungsmöglichkeiten von Knochenleitungshörgeräten : Vergleich der Ankopplung mittels äußeren Andrucks und Klebung.

BACKGROUND: Bone conduction hearing systems are used for patients with conductive or combined hearing loss who cannot be adequately treated with air conduction hearing aids or surgery. These hearing systems can be surgically implanted or reversibly attached using bone conduction eyeglasses or a rigid or soft headband. A nonsurgical and pressure-free alternative is fixation via an adhesive plate. OBJECTIVE: The aim of this study was to compare the energy transferred from the hearing aid to the mastoid when attached via a new adhesive plate versus via a soft headband. In addition, the comfort and the durability of the adhesive plate was evaluated. MATERIALS AND METHODS: A total of 30 subjects were tested. The transferred energy was measured by accelerometer, which recorded the sound energy at the maxillary teeth. Wearing comfort, fixation duration (until plate becomes loose), and the skin reaction were examined using a questionnaire after the subjects had worn the adhesive plate with and without hearing aid for a maximum of 7 days. The skin reaction was also assessed clinically. RESULTS: There was a significant difference in the transferred energy in favor of the soft headband at 0.5, 1, and 2 kHz. On the other hand, there was a high level of satisfaction and acceptance regarding the aesthetics and the wearing time of the adhesive plate, without skin irritations. CONCLUSION: The difference in the transferred energy up to 2 kHz is probably due to the lack of pressure from the adhesive plate. This could possibly be compensated after appropriate adjustment of the speech processor. Based on the positive properties of the adhesive plate in terms of comfort, it could be used as an alternative to the soft headband.

Efficacy of human C1 esterase inhibitor concentrate for treatment of ACE-inhibitor induced angioedema.

BACKGROUND: ACE inhibitor (ACEi) induced angioedema predominantly affects the upper aerodigestive tract. As ACEi induced angioedema is mediated by bradykinin, therapeutic response to antihistamines and glucocorticoids remains unsatisfactory. In bradykinin mediated hereditary angioedema, C1-esterase inhibitor (C1INH) is an effective and approved treatment since many years. Our aim was to evaluate the therapeutic effect of C1INH in ACEi induced angioedema. METHODS: We performed a double-blind, parallel-group, multicentre randomised placebo-controlled trial between December 2013 and September 2018. Eligible were adults with ACEi induced angioedema with airway obstruction. Participants were randomised 1:1 to single doses of either C1INH (20 IU/kg) or placebo (0.9% NaCl) i.v in addition to standard care (i.v. 500 mg prednisolone and 2.68 mg clemastine) i.v. Composite symptom scores were assessed at baseline and up to 48 h, at discharge and 1 week after discharge. Physician assessed time to complete oedema resolution (TCER) and time to onset of relief (TOR). RESULTS: 30 patients (16 C1INH, 14 placebo) were randomised and dosed. 25 (9 C1INH, 12 placebo) completed the study. TCER was 29.63 h ± 15.56 h in the C1INH and 17.29 h ± 10.40 h in the placebo arm (p = 0.0457). TORs were 4.13 h ± 3.38 h and 2.86 h ± 1.29 h for C1INH and placebo, respectively (p = 0.4443). There were no adverse events related to study medication. CONCLUSIONS: In the context of baseline application of steroids and antihistamines C1INH was inferior in the treatment of ACEi induced angioedema when compared to placebo with respect to time to complete resolution of symptoms. Eudra-CT Number: 2012-001670-28.

Volumetry improves the assessment of the vestibular aqueduct size in inner ear malformation.

OBJECTIVES: Enlarged vestibular aqueduct (EVA) is a common finding associated with inner ear malformations (IEM). However, uniform radiologic definitions for EVA are missing and various 2D-measurement methods to define EVA have been reported. This study evaluates VA volume in different types of IEM and compares 3D-reconstructed VA volume to 2D-measurements. METHODS: A total of 98 high-resolution CT (HRCT) data sets from temporal bones were analyzed (56 with IEM; [cochlear hypoplasia (CH; n = 18), incomplete partition type I (IPI; n = 12) and type II (IPII; n = 11) and EVA (n = 15)]; 42 controls). VA diameter was measured in axial images. VA volume was analyzed by software-based, semi-automatic segmentation and 3D-reconstruction. Differences in VA volume between the groups and associations between VA volume and VA diameter were assessed. Inter-rater-reliability (IRR) was assessed using the intra-class-correlation-coefficient (ICC). RESULTS: Larger VA volumes were found in IEM compared to controls. Significant differences in VA volume between patients with EVA and controls (p < 0.001) as well as between IPII and controls (p < 0.001) were found. VA diameter at the midpoint (VA midpoint) and at the operculum (VA operculum) correlated to VA volume in IPI (VA midpoint: r = 0.78, VA operculum: r = 0.91), in CH (VA midpoint: r = 0.59, VA operculum: r = 0.61), in EVA (VA midpoint: r = 0.55, VA operculum: r = 0.66) and in controls (VA midpoint: r = 0.36, VA operculum: r = 0.42). The highest IRR was found for VA volume (ICC = 0.90). CONCLUSIONS: The VA diameter may be an insufficient estimate of VA volume, since (1) measurement of VA diameter does not reliably correlate with VA volume and (2) VA diameter shows a lower IRR than VA volume. 3D-reconstruction and VA volumetry may add information in diagnosing EVA in cases with or without additional IEM.

Effect of Cochlear Implant Electrode Insertion Depth on Speech Perception Outcomes: A Systematic Review.

Objective: The suitable electrode array choice is broadly discussed in cochlear implantation surgery. Whether to use a shorter electrode length under the aim of structure preservation versus choosing a longer array to achieve a greater cochlear coverage is a matter of debate. The aim of this review is to identify the impact of the insertion depth of a cochlear implant (CI) electrode array on CI users' speech perception outcomes. Databases Reviewed: PubMed was searched for English-language articles that were published in a peer-reviewed journal from 1997 to 2022. Methods: A systematic electronic search of the literature was carried out using PubMed to find relevant literature on the impact of insertion depth on speech perception. The review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines of reporting. Studies in both, children and adults with pre- or postlingual hearing loss, implanted with a CI were included in this study. Articles written in languages other than English, literature reviews, meta-analyses, animal studies, histopathological studies, or studies pertaining exclusively to imaging modalities without reporting correlations between insertion depth and speech outcomes were excluded. The risk of bias was determined using the "Risk of Bias in Nonrandomized Studies of Interventions" tool. Articles were extracted by 2 authors independently using predefined search terms. The titles and abstracts were screened manually to identify studies that potentially meet the inclusion criteria. The extracted information included: the study population, type of hearing loss, outcomes reported, devices used, speech perception outcomes, insertion depth (linear insertion depth and/or the angular insertion depth), and correlation between insertion depth and the speech perception outcomes. Results: A total of 215 relevant studies were assessed for eligibility. Twenty-three studies met the inclusion criteria and were analyzed further. Seven studies found no significant correlation between insertion depth and speech perception outcomes. Fifteen found either a significant positive correlation or a positive effect between insertion depth and speech perception. Only 1 study found a significant negative correlation between insertion depth and speech perception outcomes. Conclusion: Although most studies reported a positive effect of insertion depth on speech perception outcomes, one-third of the identified studies reported no correlation. Thus, the insertion depth must be considered as a contributing factor to speech perception rather than as a major decisive criterion. Registration: This review has been registered in PROSPERO, the international prospective register of systematic reviews (CRD42021257547), available at https://www.crd.york.ac.uk/PROSPERO/.

Cochlear and Vestibular Volumes in Inner Ear Malformations.

A "gold standard" for quantitatively diagnosing inner ear malformations (IEMs) and a consensus on normative measurements are lacking. Reference ranges and cutoff values of inner ear dimensions may add in distinguishing IEM types. This study evaluates the volumes of the cochlea and vestibular system in different types of IEM. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary academic center. PATIENTS: High-resolution CT scans of 115 temporal bones (70 with IEM; cochlear hypoplasia [CH]; n = 19), incomplete partition (IP) Types I and III (n = 16), IP Type II with an enlarged vestibular aqueduct (Mondini malformation; n = 16), enlarged vestibular aqueduct syndrome (n = 19), and 45 controls. INTERVENTIONS: Volumetry by software-based, semiautomatic segmentation, and 3D reconstruction. MAIN OUTCOME MEASURES: Differences in volumes among IEM and between IEM types and controls; interrater reliability. RESULTS: Compared with controls (mean volume, 78.0 mm3), only CH showed a significantly different cochlear volume (mean volume, 30.2 mm3; p < 0.0001) among all types of IEM. A cutoff value of 60 mm3 separated 100% of CH cases from controls. Compared with controls, significantly larger vestibular system volumes were found in Mondini malformation (mean difference, 22.9 mm3; p = 0.009) and IP (mean difference, 24.1 mm3; p = 0.005). In contrast, CH showed a significantly smaller vestibular system volume (mean difference, 41.1 mm3; p < 0.0001). A good interrater reliability was found for all three-dimensional measurements (ICC = 0.86-0.91). CONCLUSION: Quantitative reference values for IEM obtained in this study were in line with existing qualitative diagnostic characteristics. A cutoff value less than 60 mm3 may indicate an abnormally small cochlea. Normal reference values for volumes of the cochlea and vestibular system may aid in diagnosing IEM.

Olfactory Stem Cells for the Treatment of Spinal Cord Injury-A New Pathway to the Cure?

OBJECTIVE: Because full functional recovery after spinal cord injury (SCI) remains a major challenge, stem cell therapies represent promising strategies to improve neurologic functions after SCI. The olfactory mucosa (OM) displays an attractive source of multipotent cells for regenerative approaches and is easily accessible by biopsies because of its exposed location. The regenerative capacity of the resident olfactory stem cells (OSCs) has been demonstrated in animal as well as clinical studies. This study aims to demonstrate the feasibility of isolation, purification and cultivation of OSCs. METHODS: OM specimens were taken dorso-posterior from nasal middle turbinate. OSCs were isolated and purified using the neurosphere assay. Differentiation capacity of the OSCs in neural lineage and their behavior in a plasma clot matrix were investigated. RESULTS: Our study demonstrated that OSCs differentiated into neural lineage and were positive for GFAP as well as ß-III tubulin. Furthermore, OSCs were viable and proliferated in a plasma clot matrix. CONCLUSIONS: Because there are no standard methods for purification, characterization, and delivery of OSCs to the injury site, which is a prerequisite for the clinical approval, this study focuses on the establishment of appropriate methods and underlines the high potential of the OM for autologous cell therapeutic approaches.

Webinar-based continuing medical education in otorhinolaryngology during the COVID-19 pandemic in Germany: a longitudinal study.

OBJECTIVE: Reliance on webinars for continuing medical education (CME) has increased since the onset of the COVID-19 pandemic. Here, we aimed to evaluate the teaching methods used in these webinars. DESIGN: Retrospective, longitudinal study. SETTING: 20 CME-approved webinars, conducted March-December 2020 in Germany, and lasting 2.25 hours each. PARTICIPANTS: Otorhinolaryngologists pursuing CME credits. INTERVENTIONS: Postwebinar participant assessments of the speaker, effects on practical work, desired scientific content, technical quality, interactions, attention and future training behaviour. RESULTS: On average, 780 participants joined each webinar. The mean survey response rate was 35% (n=282). When asked how well the speaker had mastered the content, 38% responded 'very well', 44% responded 'well', 14% indicated 'satisfactory' and 4% chose 'sufficient'. The frequency of webinars was considered appropriate by 92%, too high by 4% and too low by 4% of participants. The measured attention of the participants was 90%. After the COVID-19 pandemic lockdown, 68% of participants preferred online teaching. The average costs per participant were €3.50 (about $4.25 or £3.15) per webinar. CONCLUSIONS: Although the pandemic context likely influenced the results, we conclude that periodic ear, nose and throat webinar training during COVID-19 in 2020 was an effective alternative delivery method. We found high attention rates, high levels of participant satisfaction and low costs. Evaluations and re-evaluations will be necessary to adapt teaching concepts successfully and ensure high levels of teaching and learning efficiency.

Pain in children undergoing tonsillotomy with alternating ibuprofen and paracetamol - a prospective observational study.

BACKGROUND: The optimal pain therapy for children undergoing tonsillotomy remains unknown. Our aim was to evaluate a standard pain therapy including the alternating application of ibuprofen and paracetamol. METHODS: Pain intensity of 81 in-patients after tonsillotomy aged 2-12 years was evaluated three times daily (mean observation 3.85 days) using the Children's and Infants' Postoperative Pain Scale (CHIPPS) in children <5 years, or with the Faces Pain Scale-Revised (FPS-R) in older children. Parents completed the Parents' Postoperative Pain Measure (PPPM-D) in addition. Exceeding the cut-off value in one of the scores implied the indication for an opioid rescue medication (RM). Endpoints were number of children with indication for the RM, course of pain, concordance between pain scales, and adverse events. RESULTS: Overall, 45.7% of children needed the RM either in the recovery room or on the ward. The rate of children having an indication for RM on the ward was 30.9%. The highest proportion of affected children was identified on the day of surgery (32.1%). Most indications were detected with the PPPM-D only. A comparison with an earlier study showed less affected children compared to ibuprofen monotherapy on the day of surgery and the first postoperative day. Eleven children (13.6%) developed fever. CONCLUSION: Although our pain therapy concept was effective from postoperative day 1 onwards, it needs improvement for the day of surgery. The overall concordance between the PPPM-D and CHIPPS or FPS-R was low. Fever might be a confounder for the pain intensity measurement with the PPPM-D.

Fast-track flipping: flipped classroom framework development with open-source H5P interactive tools.

BACKGROUND: The availability and popularity of laptops, tablet PCs and smartphones in private and work environments offers considerable potential for reasonably integrating blended learning formats into structured medical learning environments. The promising educational principle of the flipped classroom (FC) provides the opportunity to effectively combine e-learning and face-to-face teaching within a single framework. However, similar to most blended learning formats, the FC requires a solid groundwork of structured digitized learning content. As rearranging a whole curriculum is intense and time consuming, physicians occupied simultaneously in clinical practice and teaching may be confronted with a lack of time during this process. METHODS: We developed two straightforward approaches to transforming a pre-existing, lecture-based otolaryngology curriculum into interactive videos within a Moodle learning management system. Special attention was given to reducing individual working time for medical professionals. Thus, while one approach was mainly guided by a medical professional to control the content-related quality of video processing, we investigated an alternative approach outsourcing work to a technician. Afterwards, the working time was analysed and compared. The resulting videos were revised with the H5P plugin for moodle to adjust the content where necessary. RESULTS: We identified a fast-track approach for creating structured e-learning content suitable for flipped-classroom-based lectures, other blended learning formats, or even providing a whole curriculum online. The alternative approach significantly reduced working time for medical professionals but did not impair the content-related quality significantly. CONCLUSIONS: The use of H5P interactive tools via Moodle LMS provides a major procedural benefit by allowing the easy adjustment of pre-existing video material into suitable online content. Reasonably outsourcing work to technicians can significantly reduce the working time of medical professionals without decreasing the quality of learning content. The presented workflow can be used as a flexible approach for flipped classroom frameworks or other blended learning strategies where interactive videos are applicable.