[Teaching otorhinolaryngology in times of COVID-19: to what extent can digital formats replace face-to-face teaching?] / Unterricht in der Hals-Nasen-Ohren-Heilkunde in Zeiten der COVID-19-Pandemie. Wie gut können digitale Formate die Präsenzlehre ersetzen?

OBJECTIVE: Due to the coronavirus disease 19 (COVID-19) pandemic, postgraduate training in otorhinolaryngology in 2020 was transferred completely from face-to-face to digital teaching. This paper assesses whether this change was possible without a reduction in the quality of teaching and learning. METHODS: Results of final written examinations were compared for the years 2016-2020, and the results of the teaching evaluation by the students for 2017-2020. The evaluation by students in 2020 included additional questions related to the switch from face-to-face to digital teaching. Additionally, the lecturers and teachers were asked for their assessments. RESULTS: Results of the final written examination did not show any significant differences between 2016-2019 and 2020. Students were highly satisfied with the digital format, but values did not reach the level of former years with face-to-face-teaching. Especially the interaction with patients and the teaching of manual skills were rated lower in the digital format. Lecturers emphasized the additional workload for preparation of digital teaching. CONCLUSION: The results of written examinations showed no difference between digital and face-to-face teaching. Online communication and interaction were reduced and regarded as cumbersome by students and faculty. Digital solutions providing more interaction and active participation are required. The digital format is more appropriate for teaching basic knowledge than for teaching practical skills.

HoloSelecta dataset: 10'035 GTIN-labelled product instances in vending machines for object detection of packaged products in retail environments.

To assess the potential of current neural network architectures to reliably identify packaged products within a retail environment, we created an open-source dataset of 295 shelf images of vending machines with 10'035 labelled instances of 109 products. The dataset contains photos of vending machines by the provider Selecta, the largest European operator of vending machines. The vending machines are a mix of machines in public and private office spaces. The vending machines contain food as well as beverage products. The product instances in the vending machine images are labelled with bounding boxes, where a bounding box encapsulates the entire product with as little overlap as possible. The labels corresponding to the bounding box consist of a structured, human-readable labels including brand, product name and size as well as the GTIN of the product. The GTIN is the global standard to identify products in the retail environment and therefore increases the value as a dataset for the retail industry. Contrary to typical object detection datasets that choose labels at a higher level such as a can or bottle for a much wider variety of objects, this dataset chooses a far more detailed label that depends less on the shape but rather on the exact design of the product. The dataset falls into the category of object detection datasets with a large number of objects, which next to the GTIN label, represents a main differentiator of the dataset to other object detection datasets.

[Complex fracture of the larynx caused by a horse kick]. / Komplexe Larynxverletzung durch Pferdetrittverletzung.

Every blunt laryngeal trauma requires examination by an ENT physician and may necessitate observation for a number of hours. The literature shows a heterogeneous picture regarding airway management (tracheotomy vs. intubation). Extremely violence forces such as horse kicks require a tracheotomy, as demonstrated by case studies. In such cases, a high level of responsibility lies with the emergency physician providing the initial treatment. We present the case of a 37-year-old horse trainer, who suffered a horse kick to the larynx with a complex laryngeal fracture. Intubation of the patient by the emergency physician would most probably have led to incorrect placement of the tube or complete displacement of larynx and trachea. In addition to securing a vital airway by tracheotomy, a timely reconstruction of the airways, where necessary by employing the temporary insertion of a tracheal stent, is the treatment of choice. The latter therapy should be applied within the first 6 hours following the accident.

[ENT emergency treatment and alcohol related head and neck injuries]. / HNO-Notfallversorgung mit besonderem Blick auf die Gruppe alkoholisierter Patienten.

The spectrum of ENT-diseases can differ widely among emergency departments (ED) of different geographic regions. Especially in terms of head and neck trauma a higher number of injuries can be expected in large cities due to alcohol related violence.The ED of a large hospital situated in the center of Hamburg Germany was analysed for ENT-emergency treatments in 2011 retrospectively. Beside usual patient statistics, the study focused on alcohol related injuries with an ENT-surgeon involved. All data were compared to reports by other EDs in Germany and alcohol related costs were approximated for initiation of prevention programs in the future.2 339 ENT-patients were admitted to the ED. 19% of all patients used an ambulance whereas 80% reached the ED by private transportation. The majority of patients were between 21 and 30 years of age. For 143 of all trauma cases alcohol involvement was documented. Subanalysis revealed male dominance and a high use of ambulance transportation.The high number of traumata differs considerably from other ENT studies. One reason is the hospital's close proximity to all time party districts like "Reeperbahn" and the "Port of Hamburg". In those areas high amounts of alcohol ingestion takes place leading to more injuries at the head- and neck region. Theoretically financial resources would be plenty after the initiation of those programs as the severe costs for alcohol related medical treatment would decline.

[Multiple hemangiomas, polyposis coli, endometrial and papillary thyroid cancer]. / Multiple Hämangiome, Polyposis coli, Endometrium- und papilläres Schilddrüsenkarzinom.

A 27-year-old female patient presented with multiple lipomas and cavernous hemangiomas of the skin, hemangioma of the parotid gland, polyps of the gastrointestinal tract and endometrial carcinoma. After 1 year the patient presented with papillary thyroid carcinoma and a diagnosis of Cowden syndrome (CS) was made. Genetic testing revealed a pathogenic PTEN gene mutation. Hereditary tumor syndromes, such as CS are underdiagnosed. Clinical management can be adjusted to the needs of CS patients only if an early diagnosis is made. In CS the risk for thyroid, breast and endometrial cancer is severely increased.

[MALT and the Epithelium of the Middle Ear Mucosa. Morphological Studies]. / MALT und Epithel der Mittelohrschleimhaut. Morphologische Untersuchung.

INTRODUCTION: The mucosa of the middle ear and the Eustachian Tube changes in different ways when faced with recurrent episodes of inflammation. It thereby adapts to these new stimuli and insults from the environment. One of these changes is the development of MALT (mucosa associated lymphoid tissue). Another adaptation is an alteration of the epithelium. It was therefore the purpose of this study to look for a connection between the occurrence of these changes. MATERIAL AND METHODS: 90 sections of temporal bones were examined under the light microscope and the incidence of MALT and nature of the epithelium found were compared. RESULTS: Particularly in the middle ear, we demonstrated that in cases where MALT was found within the mucosa, columnar epithelium was frequently found in locations where it is typically rare. Squamous epithelium was in many cases replaced by cuboidal epithelium. DISCUSSION: We demonstrated that the mucosa of the middle ear changed its morphology towards the characteristics typically found in the upper respiratory tract in cases where MALT had developed as subepithelial lymphoid follicles. It can therefore be concluded that both changes represent the mucosa's reaction to recurrent or chronic inflammation.

[Intraorbital wooden foreign body undetected on CT]. / Computertomographisch nicht beschriebener intraorbitaler hölzerner Fremdkörper.

We present the case of an orbital fracture and a wooden foreign body found during surgery. The patient had undergone a pre-operative computed tomography scan but the foreign body had not been seen on these images. We discuss the difficulties in demonstrating wooden objects on CT and describe indicators in patient history, examination findings and radiological signs that might suggest the presence of a wooden object. We emphasise the necessity to explore any orbital injury if there are clinical signs suggesting an intraorbital foreign body.

[Bright white vocal folds and capillary ectasias. Late sequelae after radiotherapy]. / Flächig weisse Stimmlippen und Kapillarektasien. Spätfolgen der Bestrahlung.

We report on visible laryngeal changes after radiotherapy. In this study, three women and two men aged 50-64 years were involved. In three cases, the primary tumor was a carcinoma of the thyroid gland and in one case a carcinoma of the esophagus. Due to dysplasia of the vocal folds, one patient underwent primary radiotherapy. Endoscopy was performed 4 to 22 years after radiotherapy. The larynx was examined by video-laryngoscopy and stroboscopy. We found a characteristic pattern of the vocal folds in all patients: bright white vocal fold surface, ectasia of capillaries and increased angiogenesis. We only found this pattern in patients after radiotherapy. In our opinion, these findings are late sequelae of radiotherapy. The picture of laryngitis due to radiotherapy can be distinguished from chronic laryngitis of other etiology using these criteria.

[Experiences with intraoperative application of prednisolone during Isshiki type I thyroplasty]. / Erfahrungen mit der intraoperativen Prednisolongabe bei der Thyreoplastik Typ I nach Isshiki.

Laryngeal edema is considered a postoperative problem in phonosurgery. In a prospective study we examined if a single intraoperative application of prednisolone can decrease the incidence of postoperative laryngeal edema after Isshiki type I thyroplasty. We examined ten patients undergoing unilateral type I thyroplasty [seven men and three women, age range: 19-60 years (average: 48 years)]. In six patients we administered 250 mg prednisolone i.v. during surgery. In four patients no steroids were given at all. On the 1st and 2nd postoperative day, the larynx was examined in a clinical setting. Five of six patients who received intraoperative steroid medication had no postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region. In all four patients without steroid medication a postoperative edema of the ipsilateral arytenoid hump was seen. Thus, intraoperative intravenous steroid administration seems to prevent, or at least reduce, postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region.

[Is the observation of patients with sleep-apnea-syndrome after surgery of the upper airway in an intensive care unit generally necessary?]. / Ist die postoperative Uberwachung von Patienten mit schlafassoziierten Atemstörungen nach Nasenoperationen auf einer Intensivstation erforderlich?

BACKGROUND: Although it is known that after surgery of the nose and/or the paranasal sinuses serious complications can arise for patients suffering from Sleep-Apnea-Syndrome (SAS), there exists no general recommendation for postoperative care of these patients. This retrospective analysis is dealing with the question whether it is generally necessary to observe SAS-patients after nasal surgery including intubation in an Intensive Care Unit (ICU). PATIENTS AND METHODS: 24 Patients of the ORL-Dept., Marienkrankenhaus Hamburg, suffering from SAS underwent surgery of the nose, the paranasal sinuses and/or the pharynx including total intravenous anesthesia (TIVA) during the period of 1. 10. 2000 until 1. 5. 2004. SAS was diagnosed in 6 cases due to defined clinical criteria and in 18 cases due to the polysomnographic findings in the sleeping laboratory's examination. All patients were observed postoperatively for one night in an ICU. The anesthesia protocol and the intensive care curve of each patient were systematically evaluated with special regard of the following parameters: Risk factors (Body Mass Index; other diseases, ASA-classification), premedication drugs, duration of the surgery, drugs for pain relief, lowest O2-saturation of blood, lowest heartrate, highest systolic blood pressure, adverse effects, intensive care interventions. RESULTS: Intensive care interventions were never needed. 2 patients received a low dosage of oxygeninsufflation via a face mask, in 5 cases calcium-antagonist drugs were administered due to high blood pressure and in 1 case Metamizole administration was necessary due to high temperatures. An accompanying bradycardia of the same patient was treated by administration of Atropine. The lower average O2-saturation was 93.6 +/- 1.7 % (Minimum value: 89 %). The maximum systolic blood pressure was 165.8 +/- 21.2 mm Hg and the lowest average heart rate was 65.4 +/- 13.2 bpm. CONCLUSIONS: Patients suffering from a mild to moderate SAS do not need a general postoperative surveillance in an ICU if the chosen form of anesthesia is considered concerning this sickness.

[Orbital stabilisation with suprabrow myofascial transposition flaps]. / Orbitastabilisierung mit Suprabrow-Periosttranspositionslappen.

BACKGROUND: Common reasons for orbital defects are midfacial traumas or defects following tumor resection within the sinu-orbital region. In these cases, reconstruction of the medial or inferior orbital wall often is required. Common materials for orbital reconstruction, such as titanium-mesh, are used where epithelialisation problems are frequently encountered. METHODS: Three patients with extended resection of malignomas of the medial and inferior orbit wall were reconstructed with a myofascial transposition flap from the suprabrow region. RESULTS: Orbital tumor infiltration was present in 11 of the 54 patients treated from 1997 to 2003 for tumors of the nasal region. In three cases, tumor extension to the medial and caudal orbital wall required extensive tissue resection, including the periorbit. In these cases, we created a new horizontal fascial flap from the suprabrow-region which stabilized the bulbus by fixation to the lateral maxilla. Follow-up 12 months after surgery showed good epithelialisation of the reconstructed region without functional deficits. CONCLUSION: This previously undescribed fascial suprabrow-flap constitutes a valuable method in the reconstruction of large combined defects of the medial and caudal orbit wall profiting particularly from the autologous material used.

[The monthly interesting case - case no. 63]. / Der interessante Fall Nr. 63.

Angiosarcomas are rare, aggressive tumors of vascular origin. They occur most often in areas of long term sun exposed skin in the elderly, in long standing lymphoedema or after radiation therapy. The prognosis is poor, radical surgery required, in addition radiation or chemo-therapy are considered to be therapeutical options. We report on a male patient, 70 years old with a slightly bleeding blueish tumor encompassing the complete nose. This patient treated with several antibiotics while continuous growth led to the described course. After 4 months a biopsy was taken revealing an angiosarcoma of the nose. Subsequently the patient was referred to our department and due to staging results a surgical therapy (ablatio nasi) followed. The final histological diagnosis was a low grade angiosarcoma of the cutaneous and subcutaneous tissue of the nose without infiltration of bone or cartilage, confirmed by immunohistological staining. Angiosarcomas of the head and neck region are extremely rare. Especially only few cases of nasal angiosarcoma infiltrating the complete nose are described in literature. Prognosis, therapy and differential diagnosis have to be discussed.

[Transposition flaps for reconstruction of deep defects of the medial eyelids. Fasciocutaneous rotations- and transposition flaps and modified pure fascial transposition flap]. / Transpositionslappenplastiken zur Rekonstruktion von tiefen Defekten des medialen Lidwinkels. Fasziokutane Rotations- und Transpositionslappenplastik und fasziale Transpositionslappenplastik.

Tumor resection in the medial canthal area may result in deep defects with involvement of the ethmoidal bone and destruction of the lacrimal ducts. While shallow defects with little involvement of bone can be covered with the classic glabellar flap, deep defects require larger fasciocutaneous flaps from the forehead that can also be used for the reconstruction of the involved medial parts of the eyelids. The preferred techniques of the median or paramedian transposition flaps and a modified paramedian fascial flap for reconstruction of the medial orbital wall and support of the orbit are described.

[Reconstruction of the frontal sinus with a calvarium split galea periosteum transplant after inflammatory complications]. / Rekonstruktion der Stirnhöhle mit einem Calvarian-split-Galea-Periost-Transplantat nach entzündlichen Komplikationen.

After reconstruction of the frontal sinus with alloplastic material, with or without obliteration of the lumen, inflammatory complications may occur. The authors present a plastic-surgical functional reconstruction technique for revision surgery in cases of inflammatory complications following frontal sinus implantation of alloplastic material, by means of a modified autologous calvarian split graft. The inflammatory complications after primary reconstruction or obliteration of the frontal sinus occurred after a period of 1-10 years. The previously implanted material was removed from the frontal sinus and the anterior wall was reconstructed with a combined calvarian split/galea periost-transplant. During follow-up, which ranged from 1-5 years, no further inflammatory complications occurred. Furthermore, an appealing cosmetic result was achieved in all cases. We conclude that the functional and aesthetic result depends primarily on (1) embedding and protection of the graft by an additional covering with a galea-periost-flap, and (2) reconstruction of the frontal drainage pathways.

[Therapy of iatrogenic pharyngocutaneous fistulas--possibilities of surgical treatment]. / Die postoperative Pharynxfistel--Möglichkeiten eines operativen Therapiekonzeptes.

BACKGROUND: During tumor surgery of the upper respiratory and digestive tract, pharyngocutaneuos fistulas may occur postoperatively. Predisposing factors are tissue disorders, as can be seen after radiation therapy or wound infections. The aim of this study was to create a systematic approach to the treatment of such complications. METHODS: Patient charts of oncologic patients with postoperative salivary fistulas were analysed retrospectively. According to the surgical technique used for treating these fistulas, a systematic strategy for the therapeutic management of this complication has been created. RESULTS: Out of 212 operatively treated tumor patients with pharyngeal reconstruction, 23 developed pharyngocutaneous fistulas. A significant higher incidence could be observed in patients with wound healing disorders or after radiotherapy. The recurrence rate of salivary fistulas has shown to be comparably high when only single layer muscular flaps were used. The lowest rate of recurrence could be observed after pharyngeal reconstruction using myocutaneous flaps. In only 7 % of our cases, a microvascular anastomosis was possible, due to the vascular status. In 85 % of our cases, additional fasciocutaneous flaps had to be integrated for complete wound closure. This became necessary mainly because of necrosis and dehiscence. In 3 cases of severe wound healing disorders with recurrent fistulas, additional therapeutic options such as hyperbaric oxygen therapy lead to complete remission. CONCLUSION: For the definitive treatment of postoperative salivary fistulas, especially in patients with wound healing disorders, a concept of therapeutic options using myocutaneous flaps in combination with fasciocutaneous flaps, depending on the location, is necessary.