Max Kemper

Cholesteatoma recidivism: comparison of three different surgical techniques.

Objective To compare cholesteatoma recidivism rates after exclusive transcanal technique (ETC), combined transcanal and mastoidal technique (TCM, both subsets of intact canal wall technique, ICW), and canal wall down surgery (CWD). Study Design Retrospective case review and clinical case study Setting Tertiary referral center. Patients 406 cholesteatoma surgeries (2007–2009), 116 ears in clinical re-examination at least 1 year postoperatively. Intervention Sequential cholesteatoma surgery with ETC, TCM, or CWD. Main Outcome Measures Cholesteatoma recidivism, residual and recurrent disease, localization of recidivism, validity of clinical findings. Results Out of 406 patients, ETC was performed in 227 (56%), TCM in 122 (30%), and CWD in 57 (14%) cases. Recidivism rates after ICW (15%) and CWD (16%) were almost similar. Recidivism was more frequent after ETC (11%) than after TCM (25%). Residuals were observed in 2% after ETC, 6.5% after TCM, and 7% after CWD. Incidence of recurrent disease was 9% for ETC, 18% for TCM, and 9% for CWD. Preferred localization of recidivism was the tympanic cavity after ETC (92%) and CWD (56%) and the mastoid cavity after TCM (53%). The clinical re-examination showed no further recidivistic disease. Conclusions Sequential surgery is an effective and successful strategy in cholesteatoma eradication, providing a similar recidivism rate compared to following cholesteatoma retrograde and resection of the posterior canal wall. Lower recidivism after ETC was observed as a consequence of limited disease and the postoperative middle ear status determined the higher rate of recurrence after TCM. Therefore, the restricted visualization of the middle ear during ICW surgery does not increase the rate of recidivism, compared with CWD, as described in other studies. Cholesteatoma recidivism is mainly attributed to the surgeon’s experience that outweighs the chosen strategy.

Medical education in otorhinolaryngology in Germany. Implementation of the new licensing regulations for physicians

BACKGROUND In 2003 new regulations for the licensing of German physicians came into effect. The aim of this study was to survey the present status of realization in German otorhinolaryngology (ORL) university departments. METHODS A questionnaire containing 31 items was sent to all German ORL university departments. RESULTS A total of 31 (86%) ORL departments responded to the questionnaire. Most faculties reacted correctly in the practical realization of the new regulation demands. Regarding the quality of written and practical examinations, some changes have to be considered in order to maintain high quality standards. CONCLUSION The demands of the new licensing regulations have not yet been fully implemented. Therefore, medical education must gain importance in the daily clinical routine. Establishment of nationwide learning objectives and resources pooling for written examinations would be helpful.

Microsurgical Skills Training With a New Tympanoplasty Model: Learning Curve and Motivational Impact

Objectives To evaluate the microsurgical skills training on a tympanoplasty model with regard to the learning curve and the participants’ motivation for a surgical specialty. Study Design Randomized controlled prospective study. Setting Department of Otolaryngology, Head and Neck Surgery, Medical Campus Carl Gustav Carus at the Technische Universität Dresden, Germany. Subjects Thirty randomly chosen fifth-year medical students divided into 2 groups. Interventions Group 2 (n = 16) had to perform an ossicular and tympanic membrane reconstruction on a tympanoplasty model on Days 1, 7, 14, and 21 and Group 1 (n = 14) on Days 1 and 21, while observing the procedure at Days 7 and 14. Six otosurgeons served as gold standard. Attempts and time of prosthesis placement and time for tympanic membrane reconstruction were recorded. Tremor frequency and amplitude were obtained at the same time points. An adjusted study interest questionnaire was used to assess students’ motivation. Results Students in Group 2 showed a significant improvement in all reconstruction parameters over the study period compared with both, baseline measurement on first day and Group 1. However, the obtained learning curve did not reach the experts level. Tremor indices and students’ motivation showed no correlation with the reconstruction parameters, whereas the training itself had a positive impact on students’ interest in the surgical specialty. Conclusion Training with the tympanoplasty model is suitable to acquire first microsurgical motor skills in otolaryngology and to arouse students’ interest in the surgical field and otorhinolaryngology.

Imaging the tympanic membrane oscillation ex vivo with Doppler optical coherence tomography during simulated Eustachian catarrh

Recently, optical coherence tomography (OCT) was utilized in multiple studies for structural and functional imaging of the middle ear and the tympanic membrane. Since Doppler OCT allows both, the spatially resolved measurement of the tympanic membrane oscillation and high-resolution imaging, it is regarded as a promising tool for future in vivo applications. In this study, Doppler OCT is utilized for the visualization of the tympanic membrane oscillation in temporal bones with simulated Eustachian catarrh, which was realized by generating a depression in the tympanic cavity. The transfer function, meaning the oscillation amplitude normalized to the applied sound pressure, is measured frequency resolved in the range from 0.5 kHz to 6 kHz and with a lateral spatial resolution of 0.4 mm. Typical oscillation patterns could be observed in case of ambient pressure in the tympanic cavity. Under depression the characteristic oscillation patterns were observed with widely congruent appearance but at higher frequencies.

Lehre der HNO-Heilkunde in Deutschland

BACKGROUND In 2003 new regulations for the licensing of German physicians came into effect. The aim of this study was to survey the present status of realization in German otorhinolaryngology (ORL) university departments. METHODS A questionnaire containing 31 items was sent to all German ORL university departments. RESULTS A total of 31 (86%) ORL departments responded to the questionnaire. Most faculties reacted correctly in the practical realization of the new regulation demands. Regarding the quality of written and practical examinations, some changes have to be considered in order to maintain high quality standards. CONCLUSION The demands of the new licensing regulations have not yet been fully implemented. Therefore, medical education must gain importance in the daily clinical routine. Establishment of nationwide learning objectives and resources pooling for written examinations would be helpful.

Doppler optical coherence tomography as a promising tool for detecting fluid in the human middle ear

Abstract The treatment of otitis media requires classifying the effusion in the tympanic cavity for choosing appropriate therapeutic strategies. Otoscopic examination of the middle ear depends on the expertise of the physician and is often hampered in case of inflammatory alterations of the tympanic membrane. In otologic research, optical coherence tomography is an innovative non-invasive imaging technique utilized for visualizing the tympanic membrane. This ex vivo study presents the possibility of OCT and Doppler-OCT for the detection of effusions in the tympanic cavity. Structural OCT imaging allows the direct visualization of scattering fluids behind the tympanic membrane. In addition, the measurement of the reduced oscillation amplitude by means of Doppler-OCT permits the indirect detection of scattering and transparent fluids.

Evaluation des Dresdner Tympanoplastik Modells (DTM)

The training of microsurgical motor skills is essentiell for surgical education if the interests of the patient are to be safeguarded. In otosurgery the complex anatomy of the temporal bone and variations necessitate a special training before performing surgery on a patient. We therefore developed and evaluated a simplified middle ear model for acquiring first microsurgical skills in tympanoplasty.The simplified tympanoplasty model consists of the outer ear canal and a tympanic cavity. A stapes model is placed in projection of the upper posterior tympanic membrane quadrant at the medial wall of the simulated tympanic cavity. To imitate the annular ligament flexibility the stapes is fixed on a soft plastic pad. 41 subjects evaluated the model´s anatomical analogy, the comparability to the real surgical situation and the general model properties the using a special questionnaire.The tympanoplasty model was very well evaluated by all participants. It is a reasonably priced model and a useful tool in microsurgical skills training. Thereby, it closes the gap between theoretical training and real operation conditions.

Imaging of the human tympanic membrane by endoscopic optical coherence tomography

Abstract Endoscopic optical coherence tomography is a non-invasive and contactless imaging technique based on white light interferometry. It enables high-resolution three-dimensional imaging of scattering tissue up to a depth of about 2 mm. In addition, Doppler-OCT can detect sub-resolution movements. These features can be used to examine the tympanic membrane, the surrounding tissue and nearby areas of the tympanic cavity. For this purpose, we present an endoscopic OCT system, which provides access to the tympanic membrane. The design of the endoscope is based on a gradientindex (GRIN) lens system. This allows a broad field of view and a large working distance. An additional VIS beam path allows visual imaging and orientation inside the auditory canal. Therefore, illumination fibers are attached a round the GRIN-system. The resulting endoscope has a length of 55 mm and a diameter of 3.5 mm. By attaching an earphone and a probe microphone, the oscillation of the tympanic membrane can be measured under acoustic stimulation. With the endoscopic OCT system, we provide an examination tool for the diagnosis of a broad number of diseases like conductive hearing loss.

Functional and morphological imaging of the human tympanic membrane with endoscopic optical coherence tomography

Abstract In this ex vivo feasibility study, endoscopic structural and functional optical coherence tomography (OCT) imaging with a field of view of 8 mm is presented allowing the inspection of nearly the entire tympanic membrane through the ear canal. The endoscope utilizes a gradient index optics for simultaneous OCT and video endoscopy. Additionally, Doppler-OCT allows the measurement of the tympanic membrane oscillation. Due to the fast image acquisition, only minor motion artifacts have been observed, which don’t affect the image quality. In conclusion, endoscopic OCT is considered as a promising tool for the comprehensive examination of the human middle ear.

[Medical examination: Preparation for ENT specialisation : Part 25].

Eine 46-jährige Patientin stellt sich aufgrund einer seit etwa 2Monaten langsam zunehmenden Schwellung rechts zervikal vor. Intermittierend, v. a. bei körperlicher Anstrengung, sei eine kurzzeitige, teilspulsierendeGrößenänderungder Schwellung zu verzeichnen (. Abb. 1). Zudem beklagt sie ein zervikales Druckgefühl rechts, welches beim Schlucken leicht verstärkt sei. Schmerzen oder andere Entzündungszeichen werden, ebenso wie Heiserkeit oder Voroperationen, verneint. Die klinische HNO-Untersuchung zeigt eine etwa 4 × 2 cm große Raumforderung rechts zervikal, welche druckindolent und wenig komprimierbar ist. Bei Palpation fällt eine diskrete Pulsation der Raumforderung auf. Zudem ergibt sich der V. a. eine zusätzliche, jedoch deutlich kleinere Raumforderung derGegenseite. Enoral undflexibel endoskopischzeigensich imHypopharynxsowie laryngeal unauffällige Schleimhautverhältnisse. Nebenbefundlich sei ein arterieller Hypertonus bekannt, der mit einem Antihypertensivum (Ramipril) gut eingestellt sei.WeitereArztkontakte habe die Patientin nur im Rahmen der Geburt ihrer 2 gesunden Kinder und einer Hysterektomie gehabt. Fragen an den Prüfungskandidaten: 1. Wie lautet Ihre Verdachtsdiagnose, und wie ist die Erkrankung definiert? 2. Gehen Sie auf weitere Prädilektionsstellen der Erkrankung im Kopf-Hals Bereich ein. 3. Welche diagnostischen Schritte sind einzuleiten? 4. Welche Differenzialdiagnosen sind zu nennen? 5. Welche therapeutischen Optionen stehen zu Verfügung? 6. Welche Risiken/Komplikationen der Therapie bestehen? 7. Äußern Sie sich zur Prognose der Erkrankung! 8. Welche weiteren Konsequenzen sind aus der Erkrankungen zu ziehen?