The aim of this study was to examine the functional hearing results regarding speech perception and auditory sound localization in a high-resolution directional hearing setup following implantation with a new bone conduction device (MED-EL Bonebridge, Innsbruck, Austria). In addition, we assessed the patient acceptance of the Bonebridge system using a questionnaire. The study design is retrospective study. The setting is University Hospital Frankfurt. 18 patients implanted with a Bonebridge device from May 2012 to January 2015 were participated in this study. Speech perception in quiet was tested with the Freiburg monosyllable test at a presentation level of 65 dB SPL. Speech perception in noise was tested post-operatively with the Oldenburg sentence test (OLSA) in best-aided condition. We assessed auditory sound localization with a high-resolution directional hearing setup. To evaluate the acceptance by patients using the Bonebridge in daily life, we used a modified questionnaire. The overall average of functional hearing gain (n = 18) was 29.3 dB (±20.7 dB). Speech perception of monosyllabic words in quiet improved by 20.7% on average, compared with the pre-operative aided condition. Mean speech reception thresholds (SRTs) of the Oldenburg sentence test (OLSA) improved significantly from -3.8 dB SNR (range -5.7 to 5.8 dB SNR) to -5.2 dB SNR (range -6.3 to -0.6 dB SNR) after implantation. Regarding localization abilities, no significant difference was found between the unaided and aided conditions following Bonebridge implantation. A survey of patients' acceptance and handling of the Bonebridge implant in daily life revealed high patient satisfaction. All patients accepted and benefited from the implanted system. No infections or adverse surgical effects occurred. Speech perception significantly improved in quiet and in noise. No significant difference in sound localization was observed. Acceptance of the Bonebridge implant, tested with a modified questionnaire, was high.

Introduction Based on current knowledge, the SARS-CoV-2 is transmitted via droplet, aerosols and smear infection. Due to a confirmed high virus load in the upper respiratory tract of COVID-19 patients, there is a potential risk of infection for health care professionals when performing surgical procedures in this area. The aim of this study was the semi-quantitative comparison of ENT-typical interventions in the head and neck area with regard to particle and aerosol generation. These data can potentially contribute to a better risk assessment of aerogenic SARS-CoV-2-transmission caused by medical procedures. Materials and methods As a model, a test chamber was created to examine various typical surgical interventions on porcine soft and hard tissues. Simultaneously, particle and aerosol release were recorded and semi-quantitatively evaluated timedependently. Five typical surgical intervention techniques (mechanical stress with a passive instrument with and without suction, CO 2 laser treatment, drilling and bipolar electrocoagulation) were examined and compared regarding resulting particle release. Results Neither aerosols nor particles could be detected during mechanical manipulation with and without suction. The use of laser technique showed considerable formation of aerosol. During drilling, mainly solid tissue particles were scattered into the environment (18.2 ± 15.7 particles/cm 2 /min). The strongest particle release was determined during electrocoagulation (77.2 ± 30.4 particles/cm 2 /min). The difference in particle release between electrocoagulation and drilling was significant (p < 0.05), while particle diameter was comparable. In addition, relevant amounts of aerosol were released during electrocoagulation (79.6% of the maximum flue gas emission during laser treatment). Discussion Our results demonstrated clear differences comparing surgical model interventions. In contrast to sole mechanical stress with passive instruments, all active instruments (laser, drilling and electrocoagulation) released particles and aerosols. Assuming that particle and aerosol exposure is clinically correlated to the risk of SARS-CoV-2-transmission from the patient to the physician, a potential risk for health care professionals for infection cannot be excluded. Especially electrocautery is frequently used for emergency treatment, e.g., nose bleeding. The use of this technique may, therefore, be considered particularly critical in potentially infectious patients. Alternative methods may be given preference and personal protective equipment should be used consequently.

Computed tomography (CT) scans represent the gold standard in the planning of functional endoscopic sinus surgeries (FESS). Yet, radiologists and otolaryngologists have different perspectives on these scans. In general, residents often struggle with aspects involved in both reporting and operation planning. The aim of this study was to compare the completeness of structured reports (SR) of preoperative CT images and structured operation planning (SOP) to conventional reports (CR) and conventional operation planning (COP) to potentially improve future treatment decisions on an individual level. In total, 30 preoperative CT scans obtained for surgical planning of patients scheduled for FESS were evaluated using SR and CR by radiology residents. Subsequently, otolaryngology residents performed a COP using free texts and a SOP using a specific template. All radiology reports and operation plannings were evaluated by two experienced FESS surgeons regarding their completeness for surgical planning. User satisfaction of otolaryngology residents was assessed by using visual analogue scales. Overall radiology report completeness was significantly higher using SRs regarding surgically important structures compared to CRs (84.4 vs. 22.0%, p<0.001). SOPs produced significantly higher completeness ratings (97% vs. 39.4%, p<0.001) regarding pathologies and anatomical variances. Moreover, time efficiency was not significantly impaired by implementation of SR (148 s vs. 160 s, p = 0.61) and user satisfaction was significantly higher for SOP (VAS 8.1 vs. 4.1, p<0.001). Implementation of SR and SOP results in a significantly increased completeness of radiology reports and operation planning for FESS. Consequently, the combination of both facilitates surgical planning and may decrease potential risks during FESS.

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Background Due to the coronavirus disease 2019 (COVID-19) pandemic, interventions in the upper airways are considered high-risk procedures for otolaryngologists and their colleagues. The purpose of this study was to evaluate limitations in hearing and communication when using a powered air-purifying respirator (PAPR) system to protect against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission and to assess the benefit of a headset. Methods Acoustic properties of the PAPR system were measured using a head and torso simulator. Audiological tests (tone audiometry, Freiburg speech test, Oldenburg sentence test (OLSA)) were performed in normal-hearing subjects (n = 10) to assess hearing with PAPR. The audiological test setup also included simulation of conditions in which the target speaker used either a PAPR, a filtering face piece (FFP) 3 respirator, or a surgical face mask. Results Audiological measurements revealed that sound insulation by the PAPR headtop and noise, generated by the blower-assisted respiratory protection system, resulted in significantly deteriorated hearing thresholds (4.0 ± 7.2 dB hearing level (HL) vs. 49.2 ± 11.0 dB HL, p < 0.001) and speech recognition scores in quiet (100.0 ± 0.0% vs. 2.5 ± 4.2%, p < 0.001; OLSA: 20.8 ± 1.8 dB vs. 61.0 ± 3.3 dB SPL, p < 0.001) when compared to hearing without PAPR. Hearing with PAPR was significantly improved when the subjects were equipped with an in-ear headset (p < 0.001). Sound attenuation by FFP3 respirators and surgical face masks had no clinically relevant impact on speech perception. Conclusions The PAPR system evaluated here can be considered for high-risk procedures in SARS-CoV-2-positive patients, provided that hearing and communication of the surgical team are optimized by the additional use of a headset.

ZusammenfassungDie SARS-CoV-2-Pandemie stellt das gesamte medizinische Versorgungssystem vor große Herausforderungen. Gerade in universitären Einrichtungen als Maximalversorger ist eine höhere Exposition zu potenziell infektiösen Patienten oder tatsächlichen COVID-19-Kranken zu erwarten. Es musste kurzfristig ein Betriebskonzept entwickelt werden, das den aktuellen Hygiene-Empfehlungen des Robert Koch-Instituts (RKI), den Empfehlungen der führenden Fachgesellschaften und dem daraus abgeleiteten internen Hygieneplan entsprach. Hierbei sind die Patientensicherheit und der Mitarbeiterschutz gleichermaßen zu beachten.In Zusammenarbeit mit dem Institut für Medizinische Mikrobiologie und Krankenhaushygiene sowie dem Betriebsärztlichen Dienst wurden Maßnahmen festgelegt, um trotz begrenzter diagnostischer und Ausrüstungsressourcen Lösungen zu erarbeiten, um die COVID-19-Übertragungsgefahr für Untersucher und Patienten zu minimieren. Hierzu wurde ein Betriebskonzept erarbeitet, das aus verschiedenen Einzelmaßnahmen bestand, wie z. B. der Reduktion der ambulanten Patientenbehandlung auf Notfälle, lebensbedrohliche Erkrankungen und dringliche Nachsorgen, eine Doppeltriage von Patienten sowie die Einführung von Behandlungsteams.Das neue erarbeitete Betriebskonzept konnte erfolgreich innerhalb weniger Tage umgesetzt werden. Nach ersten Erfahrungen aus dem Realbetrieb und mehreren „Hygienebegehungen“ waren lediglich geringfügige Nachbesserungen des Konzeptes erforderlich. Alle Maßnahmen wurden schriftlich im klinikinternen Qualitätshandbuch dokumentiert und sind allen Mitarbeitern zugänglich. Da es sich bei der SARS-CoV-2-Pandemie um einen dynamischen Prozess mit regelmäßiger Änderung des Entwicklungs- und Informationsstandes handelt, wird das Betriebskonzept regelmäßig neu auf Gültigkeit überprüft und ggf. angepasst.

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Objective: To examine the number of magnetic resonance imaging (MRI) examinations performed in patients with hearing implants and to quantify side effects or complications related to this procedure. Study Design: Questionnaire. Setting: Tertiary referral center, academic hospital. Patients: One thousand four hundred sixty-onepatients with an implanted hearing system. Intervention: Patients were asked to complete a questionnaire either during a visit to the clinic (304) or by mail contact (1,157) between February 2018 and March 2019. Main Outcome Measures: Number of examinations by means of MRI per patient and number of side effects or complications.Results: A total of 711 questionnaires were returned. After excluding nonvalid information on the questionnaire, 12.8% of patients were identified who had undergone an MRI after having received their hearing implant. Within this group of 91 patients, the most common precaution undertaken was a head bandage (69%). Side effects were mainly pain (37%), followed by anxiety (15%) and tinnitus (9%). The MRI had to be aborted in 14% and dislocation of the magnet occurred in 7% of examinations. Conclusions: Our data indicate that patients undergoing hearing implant surgery need better information about the limitations and requirements of MRI. The occurrence of side effects is likely as only half of the patients in our study group were completely free of symptoms. Dislocation of the implant magnet was observed in several cases, hence patients and physicians need to be educated about this potential complication.