Abstract Objectives A cricothyrotomy represents an emergency procedure that may be considered a last option for securing the airway. While fortunately rare, it is important to note that such invasive procedures must be mastered if they are to be used. Therefore, regular training is essential to gain routine. The aim of the present study was to investigate whether professional groups with different levels of experience with the procedure succeed in learning the procedure with a virtual reality trainer. Materials and methods In a multicenter approach, 146 employees with four different professional backgrounds—otorhinolaryngologists, anesthesiologists, emergency physicians and certified nurses—were included in the study. The participants were required to complete a virtual reality (VR) cricothyrotomy scenario in three consecutive runs, and the time required and errors in the procedure were recorded. The training experience was subsequently evaluated subjectively using a questionnaire. Results The study included 146 participants with an average age of 33 years and an average of 5 years of professional experience. The majority of participants (74%) reported an improvement in the speed of the procedure and in the procedural steps (87%). These subjective improvements were confirmed objectively by the time required for completion of the procedure and the points achieved. Gaming experience had a significant effect on both the score (p = 0.023) and procedure time (p = 0.039), whereas age and medical specialization did not. Real-life experience with cricothyrotomy had no significant effect on performance in VR. Conclusion Virtual reality provides an effective method for training healthcare professionals in cricothyrotomy, regardless of their specialty or prior experience. The participants showed significant improvements in both the speed and accuracy of the procedure after training, regardless of their prior experience or medical background. Further research is necessary to assess the benefits of VR simulation for training cricothyrotomy in real-world procedures. Trial registration DRKS00031736, registered on the 20th of April 2023.

We examined neuronal activation patterns in single-sided deaf (SSD) cochlear implant (CI) recipients and normal-hearing (NH) controls to unravel neuronal mechanisms underlying binaural integration in SSD-CI. 20 SSD-CI (CI left) and 10 NH controls underwent [15O]water PET (assessing relative cerebral blood flow, rCBF) during auditory stimulation (forward or time-reversed, unilaterally to NH ear or bilaterally). Subjects were divided into SSD-CI with good (≥ 80

Introduction The development of telemedical methods is being discussed as an important tool in today's medical care as it opens up an approach to optimize the efficiency of patient pathways and time processes. The aim of this study was to evaluate the usability of telemedicine and video-consultation at the ENT Medical Center-University Freiburg.

Hintergrund Die Koniotomie ist ein invasiver und seltener Notfalleingriff zur Sicherung der Atemwege in einer "cannot intubate, cannot ventilate" Situation. Dies führt zu einem Mangel an Routine und somit wird die Koniotomie nur zögerlich durchgeführt. Um die Lehre dieser Notfallsituationen zu verbessern, haben wir eine virtual reality (VR) Koniotomie eingeführt.

Abstract Background Cricothyrotomy is an invasive and rare emergency intervention to secure the airway in a “cannot intubate, cannot ventilate” situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool. Methods We programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps. Results The majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group (p > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group (p < 0.05). Conclusions Virtual reality is an innovative learning tool to improve teaching of emergency procedures. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This is of great value when focusing on extension of factual knowledge. Trial registration DRKS00031736, registered on the 20th April 2023.

OBJECTIVES Virtual reality (VR) appears to be a promising educational tool for otorhinolaryngology (ORL) residency training, as it allows for safe and effective practice immediate feedback and potential improvements in patient outcomes. Despite these advantages, VR has not yet been incorporated into residency training in ORL, which may be due to limited availability or validation and skepticism toward incorporation of new training methods. This study investigates whether a VR model of the temporal bone improves learning success for ORL residents in comparison to standard plastic models and whether it depends on surgeon's experience. We also included a subjective evaluation of the learning experience with both models. METHODS ORL residents and specialists at 2 German university hospitals were tested on their knowledge of temporal bone anatomy after training with either VR or standard plastic models. In addition, we compared knowledge of the temporal bone anatomy before- and after-VR training. Lastly, a subjective survey on the benefits and limitations of VR was conducted to assess participants’ views on this new technology. RESULTS About 85% of the participants considered VR to be better than conventional models and agreed that VR was a useful tool for teaching complex anatomy. Objective evaluation showed significant improvement in knowledge after using VR (before/after comparison), especially in participants with a higher level of preexisting knowledge. Direct comparison to conventional plastic models showed no superiority of the VR model. CONCLUSION VR models in ORL are not only appealing and motivating for residents, but also objectively improve their anatomical knowledge, especially in advanced residency. In addition, VR—in contrast to the plastic model—offers opportunities for further development and optimization.

Introduction An undiagnosed aberrant internal carotid artery (ICA) in the middle ear constitutes a life-threatening risk of injury during elective myringotomy. We report a case of a 4.5-year old undergoing elective myringotomy at an outpatient ENT practice"s surgery. The tympanic membrane was described as thickened, but without otherwise pathologic findings.

Purpose The new active transcutaneous partially implantable osseointegrated system Cochlear™ Osia® System is indicated in case of conductive or mixed hearing loss (CHL/MHL) with a maximum average bone conduction hearing loss of 55 dB, or in single-sided deafness (SSD). The implant directly stimulates the bone via a piezoelectric transducer and is directed by an external sound processor. We conducted a monocentric retrospective longitudinal within-subject clinical study at our tertiary academic referral center. The aim was to investigate long-term data (2017–2021) on audiological outcomes and hearing-related quality of life for the Osia system. Methods Between 2017 and 2020, 22 adults (18: CHL/MHL; 3: SSD) were implanted with the Osia100 implant; seven received bilateral implants. As of 10/2020, the sound processor was upgraded to Osia 2. Results Mean Osia system use by 04/2021 was 30.9 ± 8.6 months (range 17–40 months). Unaided bone conduction thresholds were unchanged postoperatively. One patient had to be explanted because of prolonged wound infection. Aided hearing thresholds were significantly lower compared to the unaided thresholds preoperatively, along with a marked increase in speech recognition in quiet. Speech processor upgrade resulted in a stable benefit. Patients with CHL/MHL and SSD showed a similar improvement in self-rated hearing performance revealed by SSQ, APHAB, and HUI questionnaires. Conclusion The Osia system is a safe, effective and sustainable option for treatment of conductive and mixed hearing loss or single-sided deafness.

Hintergrund Unterschiede in Integrität der grauen und weißen Substanz bei asymmetrischem Hörverlust (AHL) und normalem Hören (NH) wurde mit Hilfe von strukturellem MRI und Diffusions-Tensor-Imaging (DTI) untersucht.

Purpose To explore the differences in gray and white matter integrity between patients with asymmetric hearing loss (AHL) and normal-hearing controls (NH) using structural MRI and diffusion tensor imaging (DTI).

Einleitung Das aktive, teilimplantierbare Knochenleitungshörgerät Bonebridge (BB, Med-El, Innsbruck) ist seit nunmehr 10 Jahren auf dem deutschen Markt. Ziel war es, die zugrundeliegende ätiologie der Schwerhörigkeit, den operativen Verlauf und die audiologischen Ergebnisse prä- und postoperativ der mit einer BB in der HNO-Universitätsklinik Freiburg implantierten Patienten zu analysieren. Methodik Seit 2012 wurden 37 Patienten mit dem BB-Implantat uni- oder bilateral versorgt. Die demografischen Daten inklusive ätiologien und operativer Verlauf und Platzierung der BB wurden retrospektiv ausgewertet. Die audiologischen Ergebnisse wurden mittels Audiometrie (Functional/Effective gain) und Freiburger Einsilbertestung (FBE, 65 dB Sprachschallpegel im Freifeld) ermittelt.

Introduction The active, semi-implantable bone conduction hearing aid Bonebridge (BB, Med-El, Innsbruck, Austria) has been on the German market for 10 years now. The aim was to analyse the underlying aetiology of hearing loss, the surgical course and the audiological outcomes pre- and postoperatively of patients implanted with a BB at the ENT University Hospital Freiburg.

Purpose Our aim was to investigate the course of the hearing capacity of the better-hearing ear in single-sided deafness (SSD) and asymmetric hearing loss (AHL) over time, in a multicenter study. Methods We included 2086 pure-tone audiograms from 323 patients with SSD and AHL from four hospitals and 156 private practice otorhinolaryngologists. We collected: age, gender, etiology, duration of deafness, treatment with CI, number and monosyllabic speech recognition, numerical rating scale (NRS) of tinnitus intensity, and the tinnitus questionnaire according to Goebel and Hiller. We compared the pure tone audiogram of the better-hearing ear in patients with SSD with age- and gender-controlled hearing thresholds from ISO 7029:2017. Results First, individuals with SSD showed a significantly higher hearing threshold from 0.125 to 8 kHz in the better-hearing ear compared to the ISO 7029:2017. The duration of deafness of the poorer-hearing ear showed no relationship with the hearing threshold of the better-hearing ear. The hearing threshold was significantly higher in typically bilaterally presenting etiologies (chronic otitis media, otosclerosis, and congenital hearing loss), except for Menière’s disease. Second, subjects that developed AHL did so in 5.19 ± 5.91 years and showed significant reduction in monosyllabic word and number recognition. Conclusions Individuals with SSD show significantly poorer hearing in the better-hearing ear than individuals with NH from the ISO 7029:2017. In clinical practice, we should, therefore, inform our SSD patients that their disease is accompanied by a reduced hearing capacity on the contralateral side, especially in certain etiologies.

Zusammenfassung Hintergrund Das aktive transkutane, teilimplantierbare, osseointegrierte Knochenleitungssystem Cochlear™ Osia® (Fa. Cochlear, Sydney, Australien) ist seit April 2021 im deutschsprachigen Raum zugelassen. Das Osia ist für Patienten mit Schallleitungs- (SL-SH) oder kombinierter Schwerhörigkeit (komb-SH) mit einem mittleren Knochenleitungshörverlust von maximal 55 dB HL oder bei einseitiger Taubheit („single-sided deafness“, SSD) indiziert. Ziel der Arbeit Ziel dieser retrospektiven Untersuchung war es, die Prädiktion des postoperativen Sprachverstehens mit Osia zu untersuchen sowie die Ergebnisse des Sprachverstehens von Patienten mit komb-SH und einem geringen Dynamikbereich von weniger als 30 dB nach erfolgter Osia-Versorgung zu evaluieren. Material und Methoden Zwischen 2017 and 2022 wurden 29 erwachsene Patienten mit dem Osia versorgt, davon 10 Patienten (11 Ohren) mit SL-SH und 19 Patienten (25 Ohren) mit komb-SH. Die Patienten mit komb-SH wurden in 2 Gruppen aufgeteilt: komb-SH‑I mit über 4 Frequenzen gemittelter Hörschwelle in Knochenleitung („four-frequency pure-tone average“,(PTA4-KL)) ≥ 20 dB HL und < 40 dB HL ( n = 15 Patienten, 20 Ohren) vs. komb-SH-II mit PTA4-KL ≥ 40 dB HL ( n = 4 Patienten, 5 Ohren). Alle Patienten testeten präoperativ ein Knochenleitungsgerät am Softband. Präoperativ wurde das Sprachverstehen im Freiburger Einsilbertest unversorgt und mit Testsystem erfasst. Das maximale Einsilberverstehen (mEV) unversorgt und das Einsilberverstehen (EV) mit Testsystem bei 65 dB SPL wurde mit dem postoperativ erreichten EV mit Osia bei 65 dB SPL korreliert. Ergebnisse Die präoperative Vorhersage für das postoperative Ergebnis mit Osia war anhand des mEV mit höherer Varianzaufklärung als mit dem EV bei 65 dB SPL mit KL-Testgerät am Softband möglich. Das postoperative EV war am besten für die Patienten mit SL-SH und am schlechtesten für Patienten mit komb-SH mit einer PTA4-KL ≥ 40 dB HL vorhersagbar. Die Ergebnisse mit dem Testgerät am Softband zeigen eher das minimal erreichbare Ergebnis und das mEV eher das realistisch zu erreichende Ergebnis mit Osia. Schlussfolgerung Das Osia kann für die Versorgung von SL-SH und komb-SH unter Beachtung der Indikationsgrenzen eingesetzt werden. Auch die mittlere präoperative Knochenleitungshörschwelle liefert näherungsweise eine Abschätzung des postoperativen EV mit Osia, für das die genaueste Vorhersage anhand des präoperativen mEV erzielt wird. Die Vorhersagegenauigkeit reduziert sich ab einer PTA4-KL von ≥ 40 dB.

Ziel Ziel der retrospektiven Studie war die Untersuchung, inwieweit Kinder mit einseitiger Taubheit (SSD) von ihrem Cochlea Implantat (CI) während und nach der dreijährigen Rehabilitation profitieren. Der Einfluss des Ertaubungszeitpunktes und der Taubheitsdauer auf das Sprach- und Lokalisationsvermögen mit CI wurden untersucht.

Purpose We assessed overall hearing outcome after tympanoplasty type III in chronically infected ears with cholesteatoma (CH) and without cholesteatoma: otitis media chronica mesotympanalis, tympanosclerosis, and adhesive process (COM_T_AP). Methods 303 surgeries were evaluated: 229 CH-group and 74 COM_T_AP-group. Air-bone gaps (PTA-ABG) with pure-tone averages (PTA-4) at four frequencies (0.5, 1, 2 and 4 kHz) were compared preoperatively, early postoperatively (< 40 days) and late postoperatively (40–400 days). Hearing outcome was compared in various types of middle-ear reconstruction and in smokers and non-smokers. Correlations between hearing outcome and predictive staging indices were evaluated: Middle Ear Risk-Index (MER-I) and Ossiculoplasty Outcome Parameter Staging-Index (OOPS-I). Results Mean PTA-ABG in the CH-group increased from 20.9 ± 11.3 dB to 22.3 ± 10.4 dB early postoperatively and decreased significantly to 19.2 ± 10.1 dB late postoperatively. Mean PTA-ABG in the COM_T_AP-group decreased significantly from 27.3 ± 10.9 dB to 20.6 ± 10.9 dB early postoperatively and decreased to 20.0 ± 12.2 dB late postoperatively. No significant difference was seen between PTA-ABG-closures of partial or total ossicular replacement prosthesis (PORP/TORP) and cartilage ossiculoplasty in the CH-group. Patients receiving TORP showed a significantly higher preoperative PTA-ABG. All reconstruction types exhibited postoperative PTA-ABG around 20 dB. In the COM_T_AP-group, smokers had a significantly higher mean PTA-ABG early postoperatively; this equalized with that of non-smokers late postoperatively. PTA-ABG-closures and MER-I or OOPS-I were not significantly correlated. Conclusion Tympanoplasty type III maintains hearing in patients with cholesteatoma and significantly improves hearing in chronically inflamed ears without cholesteatoma. All investigated ossicular replacement prostheses are equally beneficial. Healing postoperatively takes longer in smokers, but they eventually catch up with non-smokers.

Introduction We examined regional cerebral blood flow (rCBF) as a marker of neuronal activity in single-sided deaf CI recipients (SSD-CI) and normal-hearing controls (NH) using [15O]water PET.

Einleitung Die Adenotomie (AT) ist einer der häufigsten operativen Eingriffe im Kindesalter mit ca. 40.000 ATs jährlich in Deutschland. Das primäre Ziel war es die Inzidenz von mehrfachen Re-Adenotomien am Universitätsklinikum Freiburg zwischen 2005 bis 2020 zu erfassen und potenzielle Einflussfaktoren zu untersuchen.