The development and design of the European Board of Otorhinolaryngology-Head and Neck Surgery Examination (EBEORL-HNS).

The UEMS Otorhinolaryngology-Head and Neck Surgery section is a dedicated body formed to promote the standardisation and harmonisation of European Otorhinolaryngology (ORL). The European Examination Board of Otorhinolaryngology and Head and Neck Surgery was created to establish a supranational final exam and accreditation for ORL Surgeons. It is open to candidates both from the European Union and outside the EU. The exam is composed of a written examination to assess mainly the theoretical knowledge of Otorhinolaryngological diseases. The second part, a viva voce examination, is designed to test the clinical application of knowledge based on case scenarios and clinical conditions presented to the candidates. The inaugural examination written component took place in Mannheim/Germany in 2009 and the inaugural Viva Voce examination in Vienna/Austria in 2010. Up to and including the year 2013, 858 participants have attempted one of the two exam components. Of the 858 participants, 305 were successful in both examinations and obtained the accreditation of the European Diploma (European Board Certification). The historical origins, development of the examination, its formal arrangements and the format of the examination are presented in this article.

Psychological factors associated with acute and chronic central serous chorioretinopathy.

BACKGROUND: Central serous chorioretinopathy (CSC) has been associated with several psychological factors. But previous psychological data are limited and mainly restricted to male patients and small sample size. In this study we investigated psychosomatic complaints, personality factors, life events, and stress coping in acute and chronic recurrent CSC patients. METHODS: Ninety-five patients (71 men, 24 women) with either acute or chronic CSC were evaluated regarding critical life events before diagnosis, psychosomatic complaints, personality traits and coping style. The characteristics of CSC patients were compared with a control group comprising 75 patients (46 men, 29 women) suffering from acute or chronic ophthalmic disorders other than CSC. RESULTS: Compared with patients of the control group, CSC patients reported more psychosomatic problems, unfavourable stress coping strategies and critical life events as well as elevated tension, aggression, strain, emotional instability and achievement orientation. Except for aggression the observed characteristics were more pronounced in acute than in chronic CSC patients. CONCLUSIONS: The appearance of CSC may be associated with an accumulation of stressful life events with an unfavourable coping style and distinctive personality factors. Acute CSC is related to more unfavourable stress coping and more physical complaints compared to its chronic course. Elevated aggression may imply one potential risk factor for CSC manifestation and also may have an adverse effect with its chronification.

Suction-generated noise in an anatomic silicon ear model.

The objectives of this study were to evaluate noise levels generated during micro-suction aural toilet using an anatomic silicon ear model. It is an experimental study. In an anatomic ear model made of silicone, the eardrum was replaced by a 1-cm diameter microphone of a calibrated sound-level measuring device. Ear wax was removed using the sucker of a standard ENT treatment unit (Atmos Servant 5(®)). Mean and peak sound levels during the suction procedure were recorded with suckers of various diameters (Fergusson-Frazier 2.7-4 mm as well as Rosen 1.4-2.5 mm). Average noise levels during normal suction in a distance of 1 cm in front of the eardrum ranged between 97 and 103.5 dB(A) (broadband noise). Peak noise levels reached 118 dB(A). During partial obstruction of the sucker by cerumen or dermal flakes, peak noise levels reached 146 dB(A). Peak noise levels observed during the so-called clarinet phenomena were independent of the diameter or type of suckers used. Although micro-suction aural toilet is regarded as an established, widespread and usually safe method to clean the external auditory canal, some caution seems advisable. The performance of long-lasting suction periods straight in front of the eardrum without sound-protecting earwax between sucker and eardrum should be avoided. In particular, when clarinet phenomena are occurring (as described above), the suction procedure should be aborted immediately. In the presence of dermal flakes blocking the auditory canal, cleaning with micro-forceps or other non-suctioning instruments might represent a reasonable alternative.

The Influence of Social Support and Coping on Quality of Life Among Elderly With Age-Related Hearing Loss.

PURPOSE: The consequences of hearing loss hinder the everyday life of older adults and are associated with reduced well-being. The research aim was to explore the influence of hearing problems, various coping strategies, and perceived social support on quality of life. METHOD: Sixty-five older adults with age-related hearing loss (≥55 years) in Austria participated and completed a paper-pencil survey with standardized questionnaires: Hearing Handicap Inventory for the Elderly (Ventry and Weinstein, 1982), Assessment for Coping and Stress (Laireiter, 1997), short form of the Social Support Questionnaire (Fydrich, Sommer, Tydecks, & Brähler, 2009), and World Health Organization Quality of Life Scale-Brief Version (World Health Organization, 1996). RESULTS: Quality of life was predicted by perceived social support and the number of comorbid diseases (i.e., the physical, psychological, environmental, and social quality of life was better the greater the extent of perceived social support and poorer the more diseases from which the participants suffered). CONCLUSIONS: Perceived social support may be a relevant factor to focus on in auditory rehabilitation programs, in particular, for participants who communicate little support in hearing-related situations and are, hence, at a relative disadvantage. The involvement of significant others in counseling could facilitate the everyday life for older adults with age-related hearing loss and their significant others.

Endolacrimal KTP laser-assisted dacryocystorhinostomy.

OBJECTIVE: To describe our experience with potassium-titanyl-phosphate (KTP) laser-assisted dacryocystorhinostomy, controlled via endolacrimal and endonasal endoscopy. The development of miniendoscopes enables endoscopy of the lacrimal drainage system via the lacrimal puncta to visualize the exact site of a stenosis. DESIGN: A case series of 78 patients, with 1-year postoperative follow-up. SETTINGS: A university medical center. PATIENTS: Consecutive sample of 78 adult patients who required surgery for dacryostenosis. INTERVENTION: Endolacrimal use of a KTP laser to perform a bony osteotomy of the lacrimal sac into the nasal cavity. The position for the perforation was controlled by endonasal endoscopy. The procedure was performed under either general or local anesthesia. RESULTS: One year after surgery, 65 (83%) of the 78 patients were free of symptoms. Seven patients experienced intermittent tearing, and 6 had revision surgery because of restenosis. CONCLUSIONS: The success rate of 83% achieved with KTP laser-assisted dacryocystorhinostomy, using miniendoscopes for lacrimal endoscopy to visualize the exact site of obstruction, is better compared with that of prior studies without the use of miniendoscopes (with success rates of 47%-85%). The advantages of this technique are that it is a minimally invasive procedure, requires a short operating time, and avoids use of an external incision.

Sudden unilateral hearing loss as first sign of cerebral sinus venous thrombosis? A 3-year retrospective analysis.

INTRODUCTION: Recently, several studies and case reports have dealt with the topic of cerebral sinus venous thrombosis (CSVT) and focused on sudden hearing loss as an early and rare symptom, to diminish the delay in diagnosing this serious disease. MATERIALS AND METHODS: We conducted a retrospective analysis over 3 years and investigated MRIs of all inpatients who were treated for sudden sensorineural hearing loss. The aim of the study was to evaluate whether sudden hearing loss could be an early indicator, or the first sign, of CSVT. RESULTS: In total, 554 patients were included. Only 2 patients with CSVT could be identified. In both, sudden unilateral sensorineural hearing loss was not the only symptom. They also reported headache, and 1 patient also reported tinnitus and vertigo. CONCLUSION: In our opinion, sudden unilateral sensorineural hearing loss alone is not a reliable indicator of CSVT. In combination with headache or visual impairment, this rare vascular disease should be taken into account.