INTRODUCTION:For the diagnosis of Eustachian tube dysfunction (ETD), clinical procedures such as tympanometry, micro-otoscopy, and maneuvers according to Toynbee and Valsalva only allow an indirect assessment for the moment. With a prevalence of up to 5%, the selection of patients with ETD and its subtypes is clinically relevant. Dynamic methods of Eustachian tube function assessment include a hypo/hyperbaric pressure chamber and Estève's tubomanometer (TMM). One method of assessing ETD is the evaluation of Eustachian tube opening pressure (ETOP). MATERIAL AND METHODS:We performed a concordance analysis between pressure chamber and TMM to determine ETOP. For this purpose, we analyzed the measurements of both methods from 28 healthy subjects using Bland-Altman plots, regression according to Passing-Bablok and Lin's concordance correlations coefficient. The maximum tolerated clinical deviation of measured values was set at 10%. RESULTS:A maximum of 53 measurements of ETOP between pressure chamber and TMM were compared. Mean ETOP for TMM was 28.7 hPa, passive opening was 32 hPa, Toynbee maneuver was 28.4 hPa, and Valsalva maneuver was 54.6 hPa. Concordance analysis revealed following results: passive opening versus TMM: Bland-Altman mean difference 3.3 hPa, limits of agreement ±31.8 hPa; Passing-Bablok regression y = 0.67 x + 9.36; Lin's rccc = 0.18. Toynbee versus TMM: Bland-Altman mean difference 0.7 hPa, limits of agreement ±35.8 hPa; Passing-Bablok regression y = 0.47x + 14.03; Lin's rccc = 0.14. Valsalva versus TMM: Bland-Altman mean difference 24.2 hPa, limits of agreement ±117.5 hPa; Passing-Bablok regression y = 0.17x + 25.12; Lin's rccc = 0.18. CONCLUSION:Estève's tubomanometer and pressure chamber measurements of ETOP are not concordant. The two methods cannot be interchanged without reservation.

Background: Salivary gland diseases are an important part of the work of ENT physicians in hospitals. The treatment strategies depend, among other things, on the doctrine at the respective location. Objective: The aim of this questionnaire-based study was to assess the current diagnostic workup and therapeutic strategies for salivary gland diseases in German otorhinolaryngology departments. Materials and methods: A survey was performed using a 25-question online questionnaire sent to all German otorhinolaryngology department directors. Results: The questionnaire was answered by 92 of 175 otorhinolaryngology departments (52.6%). In the diagnosis of salivary gland tumors, a dominance of sonography and MRI was shown. Fine- and core-needle aspiration were not performed by more than 50% of the clinics. The dominant technique for parotidectomy was under microscopic control (82%). In 99% of clinics, EMG was used during resection of the parotid gland for intraoperative monitoring of the facial nerve. There was a trend towards performing partial parotidectomies (85%), lateral parotidectomies (70%), and extracapsular dissections (57%) for benign tumors of the parotid gland. The treatment concepts for malignant tumors were inconsistent. Conclusion: In particular, the treatment strategy and extent of surgery for benign and malignant salivary gland tumors differed depending on location. The choice of palliative (drug) therapy was also diverse. Prospective multicenter studies could help to develop evidence-based treatment strategies.

Speicheldrüsenerkrankungen sind ein wichtiger Bestandteil der Tätigkeit von HNO-Ärzt:Innen in Kliniken. Die Behandlungsstrategien sind dabei unter anderem von der Lehrmeinung am jeweiligen Standort abhängig. Ziel der fragebogenbasierten Datenerhebung war es, die aktuelle praktische Umsetzung der Behandlung von Speicheldrüsenerkrankungen in deutschen HNO-Kliniken zu erfassen. Die Befragung wurde in Form eines Online-Fragebogens mit 25 Fragen umgesetzt. Hierzu wurden Einladungs-E-Mails an alle deutschen Klinikleiter:Innen verschickt. Insgesamt wurden 175 Kliniken angeschrieben, von denen 92 Kliniken teilnahmen (52,6

The aim of this project was to provide an overview of the epidemiology of primary salivary gland carcinomas (SGC) in terms of incidence, distribution of clinicopathological features and survival in one of the largest cancer registries in Europe. Data were collected from patients with SGC of the major salivary glands registered in the population-based state cancer registry (Landeskrebsregister LKR) in North Rhine-Westphalia (NRW), Germany from 01/01/2009 to 12/31/2018. Age standardization of incidence was performed and relative survival estimates were computed by sex, histological group, age group and T-, N-, and M-stage. A total of 1680 patients were included in this analysis. The most frequent tumor localization was the parotid gland (78

Zielsetzungen Die Behandlungsmöglichkeiten für inoperable, rezidivierende oder metastasierende Speicheldrüsenkarzinome sind begrenzt. Trophoblast cell surface antigen 2 (Trop-2) spielt eine Rolle bei der Karzinogenese und dient als target für das neuartige sacituzumab govitecan bei verschiedener Tumorentitäten. Zur Behandlung des metastasierenden dreifach-negativen Brustkrebs ist das Antikörper-Wirkstoffkonjugat in den USA bereits zugelassen. Das Ziel der aktuellen Studie ist die Rolle von Trop-2 bei Speicheldrüsenkarzinomen zu untersuchen.

Einleitung Die intraoperative Elektrocochleographie (EcochG) ist eine vielversprechende Möglichkeit, den Restgehörerhalt während einer Cochlea Implantation zu messen. Bislang hatte der Operateur jedoch keine Möglichkeit die Aufzeichnung der Messkurve während der Insertion zu beobachten, da der Blick durch das Mikroskop ausschließlich auf die Elektroden-Insertion konzentriert war. Mit einem voll digitalen Mikroskop konnte nun erstmals der gleichzeitige Blick auf den Situs und auf die EcochG – Kurve umgesetzt werden.

Objectives Treatment options for unresectable, recurrent or metastatic salivary gland cancers (SGC) are scarce. Trophoblast cell surface antigen 2 (Trop-2) is involved in tumorigenesis and its potential as a target for the antibody-drug conjugate sacituzumab govitecan has already been demonstrated in a number of different tumor entities. In metastatic triple-negative breast cancer, the United States Food and Drug Administration has already approved this antibody drug conjugate. Here, we aimed to investigate the role of Trop-2 in SGC.

Introduction The Frenzel maneuver describes a technique for middle ear equalizing which is frequently used by apnea divers. It offers advantages compared to the most commonly used techniques such as the Valsalva or Toynbee maneuver. Until now, there is insufficient literature about the pressure dynamics and Eustachian tube (ET) function during the Frenzel maneuver. The aim of the present study was to characterize the ET function during the Frenzel maneuver. Materials and methods By means of an established standardized profile of compression and decompression in a hypo/hyperbaric pressure chamber, we examined different parameters such as the ET opening pressure (ETOP), ET opening duration (ETOD), and ET opening frequency (ETOF) in 11 experienced apnea divers and compared them to the parameters during the Valsalva and Toynbee maneuver. Results Standard values for ETOP, ETOD, and ETOF could be established for the Frenzel maneuver under standardized conditions in a hypo/hyperbaric pressure chamber. Compared to the Frenzel maneuver, ETOP was higher and ETOD longer (both p < 0.001) during the Valsalva maneuver whereas ETOP was lower and ETOD shorter (both p < 0.001) during the Toynbee maneuver. No difference regarding ETOF was observed between the Frenzel, Valsalva, and Toynbee maneuver. Discussion The Frenzel maneuver was shown to be at least as effective as the Valsalva maneuver concerning ET opening. We believe that knowledge of the Frenzel technique might facilitate the pressure equalization during diving and recommend implementation of an appropriate equalization training in apnea and scuba diving education.

ZusammenfassungDas Mukoepidermoidkarzinom ist das häufigste primäre Speicheldrüsenmalignom im Kopf-Hals-Bereich. Das Tumorgrading hat eine erhebliche prognostische Bedeutung. Die 5-Jahres-Überlebensrate ist für Low-grade-Mukoepidermoidkarzinome deutlich höher als für Intermediate-grade- oder High-grade-Mukoepidermoidkarzinome. Für das Mukoepidermoidkarzinom scheint die Translokation von t(11;19)(q21;p13) mit der resultierenden CRTC1-MAML2-Transfusion ebenfalls von prognostischer Relevanz zu sein. Diese Translokation ist in 38–82 % aller Mukoepidermoidkarzinome nachweisbar. In Studien konnte für Patienten mit CRTC1-MAML2-positiven Mukoepidermoidkarzinomen eine deutlich bessere Prognose als für Patienten mit Translokations-negativen Mukoepidermoidkarzinomen nachgewiesen werden. Die t(11;19)(q21;p13) -Translokation wird deutlich häufiger bei Low- und Intermediate-grade-Mukoepidermoidkarzinomen detektiert als bei High-grade-Tumoren derselben Entität. Darüber hinaus wurden Translokations-positive Mukoepidermoidkarzinome häufiger bei jüngeren Patienten, kleineren Tumoren und niedrigeren Tumorstadien diagnostiziert sowie seltener Lymphknoten- und Fernmetastasierung gefunden. Bislang ist die Translokation nicht von therapeutischer Bedeutung. Jedoch sollte aufgrund der prognostischen Relevanz eine Diagnostik regelhaft erfolgen. Bei Grenzfällen kann der fehlende Nachweis der Translokation eine Entscheidungshilfe zu einer Therapieeskalation geben. Um den individuellen prognostischen und therapeutischen Wert des Fusionsgens genauer zu beurteilen, werden weitere Untersuchungen notwendig sein.

Introduction: During descent in freediving there is exposure to rapidly increasing pressure. Inability to quickly equalise middle ear pressure may cause trauma to the ear. This study aimed to evaluate the occurrence of pressure-related damage to the middle ear and the Eustachian tube during freediving and to identify possible risk factors. Methods: Sixteen free divers performed diving sessions in an indoor pool 20 metres' freshwater (mfw) deep. During each session, each diver performed four own free dives and up to four safety dives. Naso- and oto-endoscopy and Eustachian tube function tests were performed on the right and left ears before diving, between each session and after the last session. The otoscopic findings were classified according to the Teed classification (0 = normal tympanic membrane to 4 = perforation). Additionally, ENT-related complaints were assessed using a questionnaire. Results: Participants performed 317 dives (on average 20 dives per diver, six per session). The average depth was 13.3 mfw. Pressure-related changes (Teed 1 and 2) were detected in 48 % of ears. Teed level increased significantly with an increasing number of completed sessions (P < 0.0001). Higher pressure-related damage (Teed 2) occurred in less experienced divers, was associated with significantly lower peak pressures in the middle ear and led to more ear-related symptoms. A preference for the Frenzel technique for middle ear pressure equalisation during freediving was shown. Conclusions: Pressure exposure during freediving had a cumulative effect on the middle ear. Factors such as diving depth, diving experience and number of diving sessions correlated with the occurrence of higher Teed levels.

PURPOSE:Malignant tumours in the parotid gland can originate either from the gland itself or as a result of metastatic spread of other tumours, such as cutaneous squamous cell carcinomas (CSCC) of the head and neck area. The aim of this study was to analyse and compare the clinical behaviour of primary as well as CSCC metastatic parotid cancers with special emphasis on therapy and oncologic outcome.METHODS:Clinical and histopathological data of 342 patients with parotid gland malignomas surgically treated in a tertiary referral centre between 1987 and 2015 were retrospectively assessed. Oncologic outcomes of all cases with CSCC metastasis of the parotid gland (n = 49) were compared to those of primary parotid gland carcinomas (n = 293).RESULTS:Mean age at diagnosis was 72.3 years for CSCC patients versus 56.8 years in patients with primary parotid carcinoma. A total of 83.7% of CSCC patients were male, compared to 48.8% in the group of primary carcinomas. Forty-five out of 49 CSCC patients underwent total parotidectomy and neck dissection (91.8%). A total of 93.9% out of all CSCC patients received adjuvant radiotherapy. Five-year overall survival (OS) was 32.6% in CSCC patients versus 77.2% in primary parotid carcinoma patients.CONCLUSION:As compared to primary parotid cancers, we could show that patients suffering from CSCC metastases to the parotid gland presented with significantly higher age and worse survival.

Introduction:The Eustachian tube plays a crucial role in pressure equalization between the middle ear and ambient pressure for fast and large pressure differences. In patients with chronic Eustachian tube dysfunction, Eustachian tube balloon dilatation is increasingly used as surgical therapy. Subjectively, many patients report an improvement of the symptoms postoperatively. Hence, there is a need to objectively measure this effect.Methods:The objectivity of Eustachian tube balloon dilatation was evaluated using a precise method of measuring Eustachian tube function. In a hypo/hyperbaric pressure chamber, 23 ears in 13 patients were exposed to a standardized profile of compression and decompression before Eustachian tube balloon dilatation and 4 weeks afterwards. Standardized parameters of Eustachian tube function were determined and statistically compared before and 4 weeks after intervention. In addition, an Eustachian Tube Dysfunction Questionnaire-7 (ETDQ7) questionnaire was completed beforehand and 4 weeks postoperatively to determine subjective surgical success.Results:The results from the ETDQ7 questionnaire showed a significant improvement in symptoms after Eustachian tube balloon dilatation (p=0.0002). Objective measurements results showed a significant reduction of the Eustachian tube opening pressure during pressure decrease 4 weeks after intervention (p=0.0012).Conclusion:Eustachian tube balloon dilatation significantly reduced Eustachian tube opening pressure, in addition to subjective improvement of symptoms determined by ETDQ7.

Mucoepidermoid carcinoma is the most common primary salivary gland malignancy and its tumor grading has an important prognostic significance. The 5 year overall survival rate is significantly higher for low grade mucoepidermoid carcinomas than for intermediate grade and high grade mucoepidermoid carcinomas. The translocation of t(11;19)(q21;p13) with the resulting CRTC1-MAML2 transfusion appears to be of prognostic relevance in patients with mucoepidermoid carcinoma. The translocation is detectable in 38-82 % of all mucoepidermoid carcinomas. Study results have shown a significantly better prognosis for patients with fusion-positive mucoepidermoid carcinomas than fusion-negative mucoepidermoid carcinomas. The t(11;19)(q21;p13) translocation can be found more often in low and intermediate grade mucoepidermoid carcinomas than in high grade tumors of the same entity. Moreover, fusion positive mucoepidermoid carcinoma were found more frequently in younger patients, smaller tumors, lower tumor stages and less frequently lymph node and distant metastases. Up to now, the translocation has not been of therapeutic importance. In selected cases, the lack of t(11; 19)(q21; p13) translocation might facilitate the decision towards further escalation of therapy. More studies will be necessary to evaluate the individual prognostic and therapeutic value of CRTC1-MAML2 transfusion.

HYPOTHESIS The hypothesis of the study is that the mean impedance (MI) during compression and decompression provides additional information of the Eustachian tube (ET) function. BACKGROUND The continuous impedance measurement in a pressure chamber can provide valuable information about the opening function of the ET. METHODS Around 55 ear-healthy volunteers were examined in a pressure chamber. These were subjected to a decompression phase and a compression phase. The pressure change was constantly 20 kPa/min. Using evaluation software, the MI could be determined for both ears in each case for the phases of compression and decompression. RESULTS In 49 participants, we could interpret the data successfully. On average, an output value (without pressure changes) of the impedance of 0.58 ±0.11 Pa on the right side and 0.43 ± 0.1 Pa on the left side were measured. During decompression, 0.098 ± 0.05 Pa (right) and 0.087 ± 0.043 Pa (left) could be determined. For compression, values of 0.086 ± 0.044 Pa on the right and 0.079 ± 0.045 Pa on the left were detected. The retest reliability was higher with an intraclass correlation coefficient for the decompression MI of 0.833 than the 0.772 compression MI. CONCLUSIONS It is possible to measure MI in healthy subjects during compression and decompression. This value represents a good average in terms of the pressure tolerance of the middle ear. In future, studies will be required to determine whether MI will be a useful parameter in differentiating normal and abnormal ET function.

Die bereits etablierten Parameter Tubenöffnungsdruck, Tubenöffnungszeit und Tubenverschlussdruck in der Auswertung der kontinuierlichen Impedanzmessung in einer Druckkammer können bei dauerhaft geöffneter Tube und blockierter Tube nicht sinnvoll ausgewertet werden. Um diese Patienten möglicherweise in Zukunft unterscheiden zu können, erfolgte eine automatisierte Auswertung der Druckkurven am Trommelfell. Ziel der Studie war es, Standardwerte für die Mittlere Impedanz (MI) in einem gesunden Probandenkollektiv zu sammeln und die Zuverlässigkeit des Messwertes zu bestimmen.

The already established parameters Eustachian tube opening pressure, Eustachian tube opening duration and Eustachian tube closing pressure in the evaluation of the continuous impedance measurement in a pressure chamber cannot be evaluated sensibly when the Eustachian tube is permanently open and the Eustachian tube is blocked. In order to be able to distinguish these patients in the future, an automated evaluation of the pressure curves on the tympanic membrane was carried out. The aim of the study was to collect standard values for mean impedance (MI) in a healthy group of volunteers and to determine the reliability of the measured value.

The determination of Eustachian tube dysfunction (ETD) subtypes in daily routines is based on symptoms of the patient, otoscopy, nasopharyngoscopy, tympanometry, pure tone audiometry, and Valsalva’s test, even though this clinical assessment is often not sufficient to clearly diagnose the subtype. In the study, we have evaluated the possibility of the determination of different subtypes of ETD by pressure chamber measurements.

In light of future space exploration missions far away from low-earth orbit, Therefore, the ability to provide safe anesthesia for urgent operations represents a crucial step to ensure mission continuation. So far, surgery has never been performed in space under microgravity. Thus, there is no Therefore, it is important to look at environments with similar properties and at the way anesthesia is handled there. Those environments should, at least, possess one of the essential characteristics of space exploration medical equipment or the ability to evacuate patients to a hospital. This review summarizes the available literature and gives an overview concerning the provison of anesthesia under spaceflight conditions.

ZusammenfassungIm Lichte zukünftiger Langzeitraumfahrtmissionen fernab der Erdumlaufbahn besitzt die Fähigkeit der Crew zur autonomen, medizinischen Versorgung einen besonderen Stellenwert. Hier ist insbesondere die Durchführung einer Anästhesie bei einer dringend notwendigen Operation von entscheidender Bedeutung, um unter Umständen die Mission weiter fortsetzen zu können. Bisher musste noch keine Allgemeinanästhesie in der Raumfahrt durchgeführt werden, sodass die praktische Erfahrung entsprechend limitiert ist. Es erscheint sinnvoll, in Umgebungen mit vergleichbaren medizinischen Versorgungssituationen nach Erfahrungswerten und Behandlungsstrategien zu suchen. Diese Umgebungen sollten über eine oder mehrere der Eigenschaften von Raumfahrtmissionen verfügen. Beispielsweise könnten dies Limitationen bei medizinischem Personal und Ausstattung oder die Unmöglichkeit einer zeitnahen Evakuierung zu einer höherwertigen Versorgungseinrichtung sein. Die vorliegende Übersichtsarbeit fasst die bisher zu diesem Thema publizierte Literatur zusammen und gibt einen Überblick über wichtige und bisher bekannte medizinische Maßnahmen in Schwerelosigkeit.