Visualization of bone formation in sheep's middle ear by using fluorochrome sequential labelling (FSL).

One factor for the lacking integration of the middle ear stapes footplate prosthesis or the missing healing of stapes footplate fractures could be the known osteogenic inactivity. In contrast, it was recently demonstrated that titanium prostheses with an applied collagen matrix and immobilised growth factors stimulate osteoblastic activation and differentiation on the stapes footplate. Regarding those findings, the aim of this study was to evaluate the potential of bone regeneration including bone remodeling in the middle ear. Ten one-year-old female merino sheep underwent a middle ear surgery without implantation of middle ear prostheses or any other component for activating bone formation. Post-operatively, four fluorochromes (tetracycline, alizarin complexion, calcein green and xylenol orange) were administered by subcutaneous injection at different time points after surgery (1 day: tetracycline, 7 days: alizarin, 14 days: calcein, 28 days: xylenol). After 12 weeks, the temporal bones including the lateral skull base were extracted and histologically analyzed. Fluorescence microscopy analysis of the entire stapes with the oval niche, but in particular stapes footplate and the Crura stapedis revealed evidence of new bone formation. Calcein was detected in all and xylenol in 60% of the animals. In contrast, tetracycline and alizarin could only be verified in two animals. The authors were able to demonstrate the osseoregenerative potential of the middle ear, in particular of the stapes footplate, using fluorescence sequence labelling.

Influence of inner ear impedance on middle ear sound transfer functions.

Introduction: For experimental studies on sound transfer in the middle ear, it may be advantageous to perform the measurements without the inner ear. In this case, it is important to know the influence of inner ear impedance on the middle ear transfer function (METF). Previous studies provide contradictory results in this regard. With the current study, we investigate the influence of inner ear impedance in more detail and find possible reasons for deviations in the previous studies. Methods: 11 fresh frozen temporal bones were prepared in our study. The factors related to inner ear impedance, including round window membrane stiffness, cochleostomy, cochlea fluid and cochlea destruction were involved in the experimental design. After measuring in the intact specimen as a reference (step 1), the round window membrane was punctured (step 2), then completely removed (step 3). The cochleostomy was performed (step 4) before the cochlear fluid was carefully suctioned through scala tympani (step 5) and scala vestibuli (step 6). Finally, cochlea was destroyed by drilling (step 7). Translational and rotational movement of the stapes footplate were measured and calculated at each step. The results of the steps were compared to quantify the effect of inner ear impedance changing related to the process of cochlear drainage. Results: As the inner ear impedance decreases from step 1 to 7, the amplitudes of the METF curves at each frequency gradually increase in general. From step 6 on, the measured METF are significantly different with respect to the intact group at high frequencies above 3 kHz. The differences are frequency dependent. However, the significant decrement of rotational motion appears at the frequencies above 4.5 kHz from the step 5. Conclusion: This study confirms the influence of inner ear impedance on METF only at higher frequencies (≥3 kHz). The rotational motions are more sensitive to the drainage of fluid at the higher frequency. Study results that found no influence of cochlea impedance may be due to incomplete drainage of the cochlea.

Influence of cochlear implantation on the working ability of hearing-impaired patients: A prospective study on potential influencing factors.

PURPOSE: This study evaluates the effect of cochlear implantation (CI) on work ability. The influences of quality of life (QOL), age, mental health, and hearing were analyzed. METHODS: Seventy-nine patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Work ability was evaluated using the Work Ability Index (WAI). QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and the WHOQOL-BREF. Mental health was assessed with the Patient Health Questionnaire. RESULTS: The WAI was unaffected by CI (Δ 0.8 ± 6.8, p = 0.42). No significant changes in WAI were observed for employees (Δ - 1.1 ± 5.7, p = 0.25) and pensioners (Δ -0.4 ± 7.8, p = 0.73). Patients without elevated depressiveness, stress, or somatoform symptoms had significantly better WAI.The multiple regression analyses show that WHOQOL-BREF (ß = 0.49, p ≤ 0.001), age (ß = -0.34, p ≤ 0.001), and depressiveness (ß = 0.33, p = 0.04) were significantly associated with WAI. In the employee group, the NCIQ (ß = 0.58, p = 0.008) had the strongest association with the WAI. CONCLUSION: Age, mental health, and QOL are predictive factors for work ability. This should be considered in the consultation and the rehabilitation process.

High-Dose Glucocorticoids for the Treatment of Sudden Hearing Loss.

BACKGROUND: Systemic glucocorticoids are commonly used for primary therapy of idiopathic sudden sensorineural hearing loss (ISSNHL). However, the comparative effectiveness and risk profiles of high-dose over lower-dose regimens remain unknown. METHODS: We randomly assigned patients with sudden hearing loss of greater than or equal to 50 dB within 7 days from onset to receive either 5 days of high-dose intravenous prednisolone at 250 mg/d (HD-Pred), 5 days of high-dose oral dexamethasone at 40 mg/d (HD-Dex), or, as a control, 5 days of oral prednisolone (Pred-Control) at 60 mg/d followed by 5 days of tapering doses. The primary outcome was the change in hearing threshold (pure tone average) in the three most affected contiguous frequencies from baseline to day 30. Secondary outcomes included speech understanding, tinnitus, communication competence, quality of life, hypertension, and insulin resistance. RESULTS: A total of 325 patients were randomly assigned. Mean change in 3PTAmost affected hearing threshold from baseline to 30 days was 34.2 dB (95% CI, 28.4 to 40.0) in the HD-Pred group, 41.4 dB (95% CI, 35.6 to 47.2) in the HD-Dex group, and 41.0 dB (95% CI, 35.2 to 46.8) in the Pred-Control group (P=0.09 for analysis of variance). There were more adverse events related to trial medication in the HD-Pred (n=73) and HD-Dex (n=76) groups than in the Pred-Control group (n=46). CONCLUSIONS: Systemic high-dose glucocorticoid therapy was not superior to a lower-dose regimen in patients with ISSNHL, and it was associated with a higher risk of side effects. (Funded by the Federal Ministry of Education and Research [BMBF]; EudraCT number, 2015­002602­36.)

The Dresden in vivo OCT dataset for automatic middle ear segmentation.

Endoscopic optical coherence tomography (OCT) offers a non-invasive approach to perform the morphological and functional assessment of the middle ear in vivo. However, interpreting such OCT images is challenging and time-consuming due to the shadowing of preceding structures. Deep neural networks have emerged as a promising tool to enhance this process in multiple aspects, including segmentation, classification, and registration. Nevertheless, the scarcity of annotated datasets of OCT middle ear images poses a significant hurdle to the performance of neural networks. We introduce the Dresden in vivo OCT Dataset of the Middle Ear (DIOME) featuring 43 OCT volumes from both healthy and pathological middle ears of 29 subjects. DIOME provides semantic segmentations of five crucial anatomical structures (tympanic membrane, malleus, incus, stapes and promontory), and sparse landmarks delineating the salient features of the structures. The availability of these data facilitates the training and evaluation of algorithms regarding various analysis tasks with middle ear OCT images, e.g. diagnostics.

In Vivo Thickness of the Healthy Tympanic Membrane Determined by Optical Coherence Tomography.

OBJECTIVE: Tympanic membrane (TM) thickness is an important parameter for differentiation between a healthy and a pathologic TM. Furthermore, it is needed for modeling the middle ear function. Endoscopic optical coherence tomography (eOCT) provides the opportunity to measure the TM thickness of the entire TM in vivo. MATERIALS AND METHODS: A total of 27 healthy ears were examined by eOCT. The system uses a light source with a central wavelength of 1,300 nm. The endoscope with an outer diameter of 3.5 mm provides a field of view of 10 mm and a working distance of 10 mm. Thickness measurements were carried out at 8 points on the TM. Additionally, the existing literature was analyzed, and a mean TM thickness value was determined. RESULTS: The mean thickness of the TM over all measurement points of the pars tensa was 120.2 µm, and the pars flaccida was significantly thicker with a mean thickness of 177.9 µm. Beyond that, there were no significant differences between the single quadrants. The mean TM thickness in the literature was 88.8 µm. DISCUSSION: EOCT provides the possibility for in vivo thickness determination of the TM. The mean thickness seems to be higher than in the previous studies, which were mostly carried out ex vivo. Our study takes the three-dimensional refraction into account and provides a method for the refraction correction.

[Interprofessional evaluation of "soft skills" of students in the practical year]. / Interprofessionelle Evaluation der "Soft Skills" von Studierenden des Praktischen Jahres.

OBJECTIVE: The present study deals with the implementation of a questionnaire with 360° evaluation to assess the performance of students in the practical year (PJ). A special focus is put on the "soft skills" (self-competence, methodological competence, social competence), whose evaluation in medical studies has not yet taken place comprehensively. MATERIAL & METHODS: The study was conducted prospectively with 21 PJ students of the Medical Faculty of the TU Dresden. The assessment was performed by means of a self-designed questionnaire, which was divided into 4 sub-competencies (self-competence, methodological competence, social competence, clinical skills and abilities), which could be assessed by means of a 6-point Likert scale. Four professions were involved in the assessment: Medical Service, Nursing Service, Functional Service, and Administration. RESULTS: On average, the strongest deficits in terms of self-confidence, willingness to perform, and ability to deal with conflict were revealed by students in the PJ. Students showed a very good performance in performing a medical history and basic skills of clinical examination. CONCLUSION: The implementation of 360° feedback is possible and useful for students in the internship year across disciplines and professions. Such personal and interprofessional feedback has not been widely available. The questionnaire represents the first comprehensive measurement tool of soft skills for medical students and provides a good basis for comprehensive feedback.

Non-rigid point cloud registration for middle ear diagnostics with endoscopic optical coherence tomography.

PURPOSE: Middle ear infection is the most prevalent inflammatory disease, especially among the pediatric population. Current diagnostic methods are subjective and depend on visual cues from an otoscope, which is limited for otologists to identify pathology. To address this shortcoming, endoscopic optical coherence tomography (OCT) provides both morphological and functional in vivo measurements of the middle ear. However, due to the shadow of prior structures, interpretation of OCT images is challenging and time-consuming. To facilitate fast diagnosis and measurement, improvement in the readability of OCT data is achieved by merging morphological knowledge from ex vivo middle ear models with OCT volumetric data, so that OCT applications can be further promoted in daily clinical settings. METHODS: We propose C2P-Net: a two-staged non-rigid registration pipeline for complete to partial point clouds, which are sampled from ex vivo and in vivo OCT models, respectively. To overcome the lack of labeled training data, a fast and effective generation pipeline in Blender3D is designed to simulate middle ear shapes and extract in vivo noisy and partial point clouds. RESULTS: We evaluate the performance of C2P-Net through experiments on both synthetic and real OCT datasets. The results demonstrate that C2P-Net is generalized to unseen middle ear point clouds and capable of handling realistic noise and incompleteness in synthetic and real OCT data. CONCLUSIONS: In this work, we aim to enable diagnosis of middle ear structures with the assistance of OCT images. We propose C2P-Net: a two-staged non-rigid registration pipeline for point clouds to support the interpretation of in vivo noisy and partial OCT images for the first time. Code is available at: https://gitlab.com/nct_tso_public/c2p-net.

Validation of the German language version of the Chronic Ear Survey and its psychometric comparison with an established German measurement instrument.

BACKGROUND: With the Chronic Ear Survey (CES), a validated measurement instrument for the assessment of disease-specific health-related quality of life (HRQoL) has been available internationally since 2000. The aim of this study was to provide a validated German version of this international instrument and to compare it with the German Chronic Otitis Media Outcome Test 15 (COMOT-15). METHODOLOGY: The CES was translated into German via a forward-backward translation process. For validation, 79 patients with COM undergoing middle ear surgery were prospectively included. HRQoL was determined preoperatively and 6 months postoperatively using the CES and the COMOT-15. Pure tone audiometry was also performed at both measurement time points. In the control examination, an additional retrospective assessment of the preoperative situation was additionally performed using the CES and the COMOT-15 to assess the response shift. The determined psychometric characteristics were internal consistency, test-retest reliability, discrimination validity, agreement validity, responsiveness, and response shift for both measurement instruments. Convergent validity of both measurement instruments was assessed using linear regression. RESULTS: On the basis of the CES, patients with COM could be reliably distinguished from patients with healthy ears. The CES showed satisfactory reliability with high internal consistency (Cronbach α 0.65-0.85) and high retest reliability (r > 0.8). The global assessment of HRQoL impairment correlated very well with the scores of the CES (r = 0.51). In addition, it showed a high sensitivity to change (standardized response mean -0.86). Compared to the COMOT-15, it showed a lower response shift (effect size -0.17 vs. 0.44). Both measurement instruments correlated only slightly with air conduction hearing threshold (r = 0.29 and r = 0.24, respectively). The concordant validity of both measurement instruments was high (r = 0.68). CONCLUSION: The German version of the CES shows satisfactory psychometric characteristics, so that its use can be recommended. The CES focuses on the influence of ear symptoms on HRQoL, whereas the COMOT-15 also includes functional and psychological aspects. Due to only minor response shift effects, the CES is particularly suitable for studies with multiple repeat measurements.

Influence of depressive disorders, stress, and personality traits on quality of life after cochlear implantation.

PURPOSE: This study aimed to determine whether preoperative depressiveness, stress, and personality influence quality of life (QOL) after cochlear implant (CI) surgery. METHODS: In this prospective study, 79 patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Disease-specific QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and general QOL with the WHOQOL-BREF. Depressiveness and stress were assessed with the Patient Health Questionnaire (PHQ-D). The Charlson Comorbidity Index (CCI) was used to classify comorbidities. The Big Five Personality Test (B5T) was used to assess the basic personality dimensions. Speech comprehension was evaluated in quiet with the Freiburg monosyllable test and in noise with the Oldenburg sentence test. RESULTS: After CI surgery, the total NCIQ score improved significantly (Δ 17.1 ± 14.7, p < 0.001). General QOL (WHOQOL-BREF, Δ 0.4 ± 9.9, p = 0.357), stress (Δ 0.25 ± 3.21, p = 0.486), and depressiveness (Δ 0.52 ± 3.21, p = 0.121) were unaffected by CI surgery. Patients without elevated depressiveness (p < 0.01) or stress (p < 0.001) had significantly better total NCIQ scores. The results of the multiple regression analyses show that, after adjusting for the CCI, personality, age, and mental health stress (ß = - 0.495, p < 0.001) was significantly associated with postoperative NCIQ outcome scores. Depressiveness and neuroticism had the strongest influence on the generic QOL (ß = - 0.286 and ß = - 0.277, p < 0.05). CONCLUSION: Stress symptoms and personality traits are significant predictive factors for disease-specific QOL, as well as hearing status. This should be considered in the preoperative consultation and in optimizing the rehabilitation process.

Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants.

BACKGROUND: Patients with a cochlear implant (CI) should be evaluated for a new speech processor every 6 years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. METHODS: Speech understanding and subjective benefit were analyzed in 99 patients with the old and the new speech processor after 4 weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. RESULTS: The speech processor upgrade resulted in a significant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9 percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7 percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dB signal-to-noise ratio [S/N], p = 0.006). Using the APHAB, a significant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006). A comparative assessment of the benefit based on subjective and speech audiometric results identified a proportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. CONCLUSION: There was a significant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only a small improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.

Auditory thresholds compatible with optimal speech reception likely evolved before the human-chimpanzee split.

The anatomy of the auditory region of fossil hominins may shed light on the emergence of human spoken language. Humans differ from other great apes in several features of the external, middle and inner ear (e.g., short external ear canal, small tympanic membrane, large oval window). However, the functional implications of these differences remain poorly understood as comparative audiometric data from great apes are scarce and conflicting. Here, we measure the sound transfer function of the external and middle ears of humans, chimpanzees and bonobos, using laser-Doppler vibrometry and finite element analysis. This sound transfer function affects auditory thresholds, which relate to speech reception thresholds in humans. Unexpectedly we find that external and middle ears of chimpanzees and bonobos transfer sound better than human ones in the frequency range of spoken language. Our results suggest that auditory thresholds of the last common ancestor of Homo and Pan were already compatible with speech reception as observed in humans. Therefore, it seems unlikely that the morphological evolution observed in the bony auditory region of fossil hominins was driven by the emergence of spoken language. Instead, the peculiar human configuration may be a by-product of morpho-functional constraints linked to brain expansion.

Stapedius reflex thresholds obtained in a free sound field as an indicator for over- and understimulation in cochlear implant listeners.

OBJECTIVE: The goal of this study was to determine open field stapedius reflex thresholds (oSRTs) in CI patients with fittings based on subjective loudness ratings. A further objective was to compare these oSRTs and those of eSRT-based fittings that are similar to the oSRTs of normal hearing. DESIGN: Impedance measurements of the ear drum were taken while subjects were wearing their audio processors. The stapedius reflex was elicited by electrical stimulation transmitted through the activated CI system in response to an acoustic stimulus presented in the free sound field. STUDY SAMPLE: Subjects were 50 experienced CI users (n = 57 ears) with CI fittings based on subjective loudness scaling. RESULTS: A reference range for the oSRTs was defined that was identified in CI patients with eSRT-based fittings. Sound levels for stapedius reflex detection were inside the reference target range in 70% of the cases, below the reference range (i.e. down to 40 dB HL) in 20% of the cases, and above the reference range in 10% of the cases. CONCLUSION: Stapedius reflex detection in a free sound field may help detect fittings with too high or too low stimulation levels that might reduce audiological performance.

Multimodal additive manufacturing of biomimetic tympanic membrane replacements with near tissue-like acousto-mechanical and biological properties.

The three additive manufacturing techniques fused deposition modeling, gel plotting and melt electrowriting were combined to develop a mimicry of the tympanic membrane (TM) to tackle large TM perforations caused by chronic otitis media. The mimicry of the collagen fiber orientation of the TM was accompanied by a study of multiple funnel-shaped mimics of the TM morphology, resulting in mechanical and acoustic properties similar to those of the eardrum. For the different 3D printing techniques used, the process parameters were optimized to allow reasonable microfiber arrangements within the melt electrowriting setup. Interestingly, the fiber pattern was less important for the acousto-mechanical properties than the overall morphology. Furthermore, the behavior of keratinocytes and fibroblasts is crucial for the repair of the TM, and an in vitro study showed a high biocompatibility of both primary cell types while mimicking the respective cell layers of the TM. A simulation of the in vivo ingrowth of both cell types resulted in a cell growth orientation similar to the original collagen fiber orientation of the TM. Overall, the combined approach showed all the necessary parameters to support the growth of a neo-epithelial layer with a similar structure and morphology to the original membrane. It therefore offers a suitable alternative to autologous materials for the treatment of chronic otitis media. STATEMENT OF SIGNIFICANCE: Millions of people worldwide suffer from chronic middle ear infections. Although the tympanic membrane (TM) can be reconstructed with autologous materials, the grafts used for this purpose require extensive manual preparation during surgery. This affects not only the hearing ability but also the stability of the reconstructed TM, especially in the case of full TM reconstruction. The synthetic alternative presented here mimicked not only the fibrous structure of the TM but also its morphology, resulting in similar acousto-mechanical properties. Furthermore, its high biocompatibility supported the migration of keratinocytes and fibroblasts to form a neo-epithelial layer. Overall, this completely new TM replacement was achieved by combining three different additive manufacturing processes.

[Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants. German version]. / Wertigkeit von Patient-Reported Outcome Measures zur Bewertung des Versorgungsvorteils der Sprachprozessorumversorgung bei Patient/-innen mit Cochleaimplantaten.

BACKGROUND: Patients with a cochlear implant (CI) should be evaluated for a new speech processor every 6 years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. METHODS: Speech understanding and subjective benefit were analyzed in 99 patients with the old and the new speech processor after 4 weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. RESULTS: The speech processor upgrade resulted in a significant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9 percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7 percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dB signal-to-noise ratio [S/N], p = 0.006). Using the APHAB, a significant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006). A comparative assessment of the benefit based on subjective and speech audiometric results identified a proportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. CONCLUSION: There was a significant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only a small improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.

[Validation of the German language version of the Chronic Ear Survey and its psychometric comparison with an established German language measurement instrument. German version]. / Validierung der deutschsprachigen Version des Chronic Ear Survey und dessen psychometrischer Vergleich mit einem etablierten deutschsprachigen Messinstrument.

BACKGROUND: With the Chronic Ear Survey (CES), a validated measurement instrument for the assessment of disease-specific health-related quality of life (HRQoL) has been available internationally since 2000. The aim of this study was to provide a validated German version of this international instrument and to compare it with the German Chronic Otitis Media Outcome Test 15 (COMOT-15). METHODOLOGY: The CES was translated into German via a forward-backward translation process. For validation, 79 patients with COM undergoing middle ear surgery were prospectively included. HRQoL was determined preoperatively and 6 months postoperatively using the CES and the COMOT-15. Pure tone audiometry was also performed at both measurement time points. In the control examination, an additional retrospective assessment of the preoperative situation was additionally performed using the CES and the COMOT-15 to assess the response shift. The determined psychometric characteristics were internal consistency, test-retest reliability, discrimination validity, agreement validity, responsiveness, and response shift for both measurement instruments. Convergent validity of both measurement instruments was assessed using linear regression. RESULTS: On the basis of the CES, patients with COM could be reliably distinguished from patients with healthy ears. The CES showed satisfactory reliability with high internal consistency (Cronbach α 0.65-0.85) and high retest reliability (r > 0.8). The global assessment of HRQoL impairment correlated very well with the scores of the CES (r = 0.51). In addition, it showed a high sensitivity to change (standardized response mean -0.86). Compared to the COMOT-15, it showed a lower response shift (effect size -0.17 vs. 0.44). Both measurement instruments correlated only slightly with air conduction hearing threshold (r = 0.29 and r = 0.24, respectively). The concordant validity of both measurement instruments was high (r = 0.68). CONCLUSION: The German version of the CES shows satisfactory psychometric characteristics, so that its use can be recommended. The CES focuses on the influence of ear symptoms on HRQoL, whereas the COMOT-15 also includes functional and psychological aspects. Due to only minor response shift effects, the CES is particularly suitable for studies with multiple repeat measurements.

[Health-related quality of life in chronic otitis media-measurement methods and their application in surgical therapy]. / Gesundheitsbezogene Lebensqualität bei der chronischen Otitis media ­ Messmethoden und deren Anwendung bei chirurgischen Therapien.

BACKGROUND: Chronic otitis media (COM) can lead to significant impairment of health-related quality of life (HRQoL) due to symptoms such as otorrhea, pain, hearing loss, tinnitus, or dizziness. A systematic assessment of HRQoL in COM is becoming increasingly important as it complements (semi-)objective outcome parameters in clinical practice and research. HRQoL is measured by means of patient-reported outcome measures (PROMs). There are two disease-specific validated PROMs available for COM in German-the Chronic Otitis Media Outcome Test (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21)-which have become increasingly popular in recent years. OBJECTIVE: The purpose of this narrative review is to present the current state of research on measuring HRQoL in COM before and after surgical procedures. RESULTS AND CONCLUSION: Hearing is the most important factor influencing HRQoL in COM. Surgical procedures usually result in a clinically relevant improvement in HRQoL in COM with or without cholesteatoma. However, if cholesteatoma is present, its extent does not correlate with HRQoL. While HRQoL plays a secondary role in establishment of the indication for surgical therapy in COM with cholesteatoma, it plays an important role in terms of relative surgical indications, e.g., a symptomatic open mastoid cavity after resection of the posterior canal wall. We encourage the regular use of disease-specific PROMs preoperatively as well as during follow-up to assess HRQoL in COM in individual patients, in research, and in the context of quality monitoring.

A bone conduction implant using self-drilling screws : Self-drilling screws as a new fixation method of an active transcutaneous bone conduction hearing implant.

BACKGROUND: The active transcutaneous bone conduction implant (tBCI; BONEBRIDGE™ BCI 601; MED-EL, Innsbruck, Austria) is fixed to the skull with two self-tapping screws in predrilled screw channels. The aim of this prospective study was to evaluate the safety and effectiveness of fixation with self-drilling screws instead of the self-tapping screws, in order to simplify the surgical procedure. MATERIALS AND METHODS: Nine patients (mean age 37 ± 16 years, range 14-57 years) were examined pre- and 12 months postoperatively for word recognition scores (WRS) at 65 dB SPL, sound-field (SF) thresholds, bone conduction thresholds (BC), health-related quality of life (Assessment of Quality of Life, AQOL-8D questionnaire), and adverse events (AE). RESULTS: Due to avoidance of one surgical step, the surgical technique was simplified. Mean WRS in SF was 11.1 ± 22.2% (range 0-55%) pre- and 77.2 ± 19.9% (range 30-95%) postoperatively; mean SF threshold (pure tone audiometry, PTA4) improved from 61.2 ± 14.3 dB HL (range 37.0-75.3 dB HL) to 31.9 ± 7.2 dB HL (range 22.8-45.0 dB HL); mean BC thresholds were constant at 16.7 ± 6.8 dB HL (range 6.3-27.5 dB HL) pre- and 14.2 ± 6.2 dB HL (range 5.8-23.8 dB HL) postoperatively. AQOL-8D mean utility score increased from 0.65 ± 0.18 preoperatively to 0.82 ± 0.17 postoperatively. No device-related adverse events occurred. CONCLUSION: Implant fixation by means of self-drilling screws was safe and effective in all nine patients. There was significant audiological benefit 12 months after implantation.

Digital teaching and assessment of psychomotor skills of the clinical head and neck examination during COVID-19 pandemic.

PURPOSE: During COVID-19, a fully digital course was established for teaching and assessing the psychomotor skills of clinical head and neck examination. Influence of different digital teaching formats was investigated. METHODS: The students (n = 286) received disposable instruments, a manual, and instructional videos for the examination. 221 students additionally received 45 min of interactive teleteaching. After 5 days of practice, all students were required to submit a video of their examination and report their spent practice time. The assessment was carried out using a checklist which was already established in presence teaching. RESULTS: The average score achieved by digital teaching was 86%. Previously published data show that presence teaching achieved 94%. With a teleteaching unit the total score was significantly better than without (87% vs 83%). Teleteaching leads to a significant positive correlation between practice time and total score. Without teleteaching there is a negative correlation. After the same practice time, presence teaching leads to better total scores than digital teaching. CONCLUSION: Digital teaching and assessing of a complex psychomotor skill is possible. Interactive teaching methods increase learning success. Nevertheless, presence teaching seems to be better at teaching these skills. The results can provide a basis for developing hybrid teaching models.