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OCT complements visual inspection for differentiating UADT-lesions.

Zusammenfassung Einleitung Seit März 2020 wurden infolge des exponentiellen Anstiegs der Infektionen mit SARS-CoV-2 in Deutschland/Europa die Krankenhäuser durch das Gesundheitsministerium aufgefordert, verstärkt Kapazitäten zur intensivmedizinischen Behandlung zu schaffen. An vielen Kliniken wurden deshalb kurzfristig massive Umstrukturierungen und Ressourcenverschiebungen vorgenommen. Ziel der vorliegenden Arbeit war die Erfassung der Auswirkungen der SARS-CoV-2-Pandemie auf die universitäre Hals-Nasen-Ohren(HNO)-Heilkunde in Bezug auf die Krankenversorgung. Material und Methoden Eine Online-Befragung wurde an alle Direktorinnen und Direktoren der 39 Universitäts-HNO-Kliniken in Deutschland versendet. Die Fragen bezogen sich auf den definierten Zeitraum vom 15.03. bis 15.04.2020 und die Beantwortung wurde mithilfe des Online-Befragungstools „SurveyMonkey“ durchgeführt. 87 Fragen bezogen sich auf allgemeine Angaben, die Krankenversorgung und die strukturellen Auswirkungen in der jeweiligen Einrichtung. Ergebnisse An der Befragung beteiligten sich alle Direktorinnen und Direktoren der 39 Universitäts-HNO-Kliniken in Deutschland. Die erhobenen Daten belegen die erheblichen Auswirkungen auf organisatorische, strukturelle und medizinische Aspekte der Krankenversorgung. So gaben die befragten Kliniken einen Rückgang der ambulant behandelten Fälle um 73,8 % auf 26,2 ± 14,2 % und der operativen Behandlungen um 65,9 % auf 34,1 ± 13,9 % an. Im Gegensatz hierzu erfolgte in 80 % der Kliniken eine unveränderte oder sogar vermehrte Notfallbehandlung und in mehr als 90 % eine unveränderte oder sogar vermehrte operative Behandlung von Notfällen. In allen Kliniken war die ambulante und operative Notfallbehandlung während der Pandemie durchgehend gewährleistet. Insgesamt wurden an allen HNO-Universitätsklinken circa 35 000 ambulante und circa 12 000 operative Fälle verschoben. Infolge der akuten strukturellen Veränderungen wurde in einzelnen Bereichen der Krankenversorgung die potentielle Gefahr einer Unterschreitung geltender Behandlungsstandards gesehen. Diskussion Die Bewertung der Auswirkungen der SARS-CoV-2-Pandemie fällt heterogen aus. Kritisch wird mehrheitlich die Gefahr der Unterschreitung geltender Behandlungsstandards oder Leitlinien bewertet. In der Phase der exponentiellen Zunahme der Infektionszahlen mussten teilweise erhebliche Veränderungen von Behandlungsabläufen aus nachvollziehbaren Gründen akzeptiert werden. Mit den aktuell deutlich reduzierten Infektionszahlen darf aber eine Unterschreitung von Behandlungsstandards und Leitlinien nicht verstetigt und toleriert werden. Zusammenfassung Die hier dargestellte Untersuchung zeigt ein differenziertes Bild hinsichtlich der Auswirkungen der SARS-CoV-2-Pandemie auf die ambulante, stationäre und operative Krankenversorgung an den Kliniken der universitären HNO-Heilkunde in Deutschland und verdeutlicht die Bedeutung der Universitätskliniken für die Krankenversorgung während dieser kritischen Phase.

Background:The aim of this multicentre study was to systematically analyse the strengths and weaknesses in the surgical training for endoscopic sinus surgery (ESS) and identify measures that may improve training.Methodology: Using a structured questionnaire, 133 participants of ESS courses in seven centres in Germany, Switzerland andAustralia were asked about their experiences during their dissection courses and how they perceived their course could be improved. Results:Gaining confidence in handling of instruments and endoscopes was only a problem for participants with little experience in ESS. The majority of the participants, independent from their level of training, considered infundibulotomy and anterior ethmoidectomy as the easiest dissection steps, whilst surgery of the frontal sinus posed a considerable challenge for many surgeons even those with a higher level of training. Participants with and without ESS experience thought that emphasis on anatomy was the most important improvement that could be made during their surgical training. Virtually all participants stated that the course improved their anatomical knowledge, their surgical skills and their confidence when performing ESS.Conclusions: ESS dissection courses are considered beneficial by surgical trainees. Participants felt that more emphasis on sinus anatomy in conjunction with private study is essential to maximize their skills in surgical dissection. For beginners with ESS, an infundibulotomy and anterior ethmoidectomy were thought to be the best initial procedures to help develop endoscopic surgical skills.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterised by abdominal pain, associated with stool abnormalities and changes in stool consistency. Diagnosis of IBS is based on characteristic symptoms and exclusion of other gastrointestinal diseases. A number of questionnaires exist to assist diagnosis and assessment of severity of the disease. One of these is the irritable bowel syndrome - severity scoring system (IBS-SSS). The IBS-SSS was validated 1997 in its English version. In the present study, the IBS-SSS has been validated in German language. To do this, a cohort of 60 patients with IBS according to the Rome III criteria, was compared with a control group of healthy individuals (n = 38). We studied sensitivity and reproducibility of the score, as well as the sensitivity to detect changes of symptom severity. The results of the German validation largely reflect the results of the English validation. The German version of the IBS-SSS is also a valid, meaningful and reproducible questionnaire with a high sensitivity to assess changes in symptom severity, especially in IBS patients with moderate symptoms. It is unclear if the IBS-SSS is also a valid questionnaire in IBS patients with severe symptoms because this group of patients was not studied.

Introduction Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease, which is usually type 2-mediated in the western hemisphere, associated with severe therapeutic and socioeconomic challenges. The first targeted systemic treatment option for severe uncontrolled CRSwNP is a human monoclonal antibody against the interleukin-4 receptor α (IL-4Rα) subunit called dupilumab, which was approved for subcutaneous administration in Germany in October 2019. The purpose of this study is to investigate the efficacy of dupilumab in real life in patients treated with dupilumab in label according to license in our department in 2019–2021. Materials and methods Since October 2019, we have investigated 40 patients (18 men, 22 women) treated with dupilumab in a single-center, retrospective single-arm longitudinal study. The following parameters were collected before treatment (baseline), at 1 month, 4 months, 7 months, 10 months, and 13 months: the Sino-Nasal Outcome Test-22 (SNOT-22), the forced expiratory pressure in 1 s (FEV-1), the olfactometry using Sniffin' Sticks-12 identification test (SSIT), a visual analog scale of the total complaints, the Nasal Polyp Score (NPS), histologic findings as well as total serum IgE, eosinophilic cationic protein in serum and blood eosinophils. Results The average age was 52.7 years (± 15.3). The follow-up period was 13 months. The SNOT-22 average was 60 points (± 22.2) at the first visit, 28.2 points (± 17.1) after 4 months and 20.8 points (± 17.7) after 13 months. The NPS was 4.3 points (± 1.5), after 4 months 2.1 points (± 1.3) and after 13 months 1.4 points (± 1.1). Olfactometry showed 3.2 points (± 3.7) at the baseline, 7.0 points (± 4.0) after 4 months and 7.8 points (± 3.5) after 13 months. The other parameters also improved. Most parameters showed linear dependence in the slopes under therapy (p < 0.001). Adverse side effects were mostly only mild, and no rescue therapy was needed. Conclusion There is a clear improvement in the medical condition and symptoms in all categories mentioned under therapy with dupilumab, as well as a reduction in the need for systemic glucocorticoids and revision surgery as rescue treatment. Our results show that dupilumab tends to be an effective therapy alternative for severe CRSwNP.

The various stages of tumor growth are characterized by typical epithelial, vascular, and secondary connective tissue changes. Narrow Band Imaging (NBI) endoscopy is a minimally invasive imaging technique that presents vascular structures in particular at a higher contrast than white light endoscopy alone. In combination with high-resolution image recording and reproduction (high-definition television, HDTV; ultra-high definition, 4K), progress has been made in otolaryngological differential diagnostics, both pre- and intraoperatively. This progress represents an important step toward a so-called optical biopsy. Flexible endoscopy in combination with NBI allows for a detailed assessment of areas of the upper aerodigestive tract that are difficult to assess by rigid endoscopy. Papillomas along with precancerous and cancerous lesions are characterized by epithelial and connective tissue changes as well as by typical perpendicular vascular changes. Systematic use of NBI is recommended in the differential diagnosis of malignant lesions of the upper aerodigestive tract. NBI also offers a significant improvement in the pre- and intraoperative assessment of superficial resection margins. In particular, the combination of NBI and contact endoscopy (compact endoscopy) facilitates excellent therapeutic decisions during tumor surgery. Intraoperative determination of resection margins at an unprecedented precision is possible. In addition, assessment of the form and extent of the perpendicular vessel loops stimulated by epithelial signaling enables differential diagnostic decisions to be made, approximating our goal of an optical biopsy.

In head and neck squamous cell carcinoma (HNSCC), tumors positive for human papillomavirus (HPV) represent a distinct biological entity with favorable prognosis. An enhanced radiation sensitivity of these tumors is evident in the clinic and on the cellular level when comparing HPV-positive and HPV-negative HNSCC cell lines. We could show that the underlying mechanism is a defect in DNA double-strand break repair associated with a profound and sustained G2 arrest. This defect can be exploited by molecular targeting approaches additionally compromising the DNA damage response to further enhance their radiation sensitivity, which may offer new opportunities in the setting of future de-intensified regimes. Against this background, we tested combined targeting of PARP and the DNA damage-induced intra-S/G2 cell cycle checkpoints to achieve effective radiosensitization. Enhancing CDK1/2 activity through the Wee1 inhibitor adavosertib or a combination of Wee1 and Chk1 inhibition resulted in an abrogation of the radiation-induced G2 cell cycle arrest and induction of replication stress as assessed by γH2AX and chromatin-bound RPA levels in S phase cells. Addition of the PARP inhibitor olaparib had little influence on these endpoints, irrespective of checkpoint inhibition. Combined PARP/Wee1 targeting did not result in an enhancement in the absolute number of residual, radiation induced 53BP1 foci as markers of DNA double-strand breaks but it induced a shift in foci numbers from S/G2 to G1 phase cells. Most importantly, while sole checkpoint or PARP inhibition induced moderate radiosensitization, their combination was clearly more effective, while exerting little effect in p53/G1 arrest proficient normal human fibroblasts, thus indicating tumor specificity. We conclude that the combined inhibition of PARP and the intra-S/G2 checkpoint is a highly effective approach for the radiosensitization of HPV-positive HNSCC cells and may represent a viable alternative for the current standard of concomitant cisplatin-based chemotherapy. In vivo studies to further evaluate the translational potential are highly warranted.