Status quo after one year of COVID-19 pandemic in otolaryngological hospital-based departments and private practices in Germany.

PURPOSE: The COVID-19 pandemic has affected healthcare systems worldwide. Data on the impact on otolaryngological clinics and private practices is sparse. This study aimed to present data on healthcare worker (HCW) screening, status of HCW, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic. METHODS: Otolaryngological private practices and hospital-based departments were surveyed nationwide using an online questionnaire. Participating facilities were recruited via the German Society for Oto-Rhino-Laryngology and the German Association for Otolaryngologists in Bavaria. RESULTS: 365 private practices (2776 employees) and 65 hospitals (2333 employees) were included. Significantly more hospitals (68.7%) than practices (40.5%) performed pre-interventional testing in their outpatients (p < 0.00). Most inpatients were tested in practices and hospitals (100.0% and 95.0%; p = 0.08). HCW screening was performed in 73.7% of practices and in 77.3% of hospitals (p = 0.54). Significantly more HCW infections were reported in private practices (4.7%) than in hospital (3.6%; p = 0.03). The private or home environment was the most frequent source of infection among HCW in hospitals (44%) and practices (63%). The use of PPE increased over the course of the pandemic. The number of procedures and the revenue decreased in 2020. CONCLUSION: The rate of pre-interventional testing among outpatients in otolaryngological practices is low and HCW infections were found to be more frequent in practices than in hospitals. In addition, a high rate of infections in otolaryngological HCW seems to stem from the private or home environment.

Results in using the Freiburger monosyllabic speech test in noise without and with hearing aids.

The Freiburger Speech Test (FST) has been the gold standard in speech testing by word recognition score in Germany for many years. Recently, it has been demonstrated that for an amount of 104 test-persons there is no significant deviation within the lists. The objective of this study was to determine the percentiles of the distinct measuring situations in quiet and with noise (e.g. applied in hearing aid fitting) and the average benefit using hearing aids. In this prospective study, 623 patients with SNHL and equipped with hearing aids for at least 3 months have been investigated by means of the Freiburger monosyllabic test (FBE) without and with hearing aids and in quiet or with noise (CCITT noise, 65/60 dB signal-noise ratio) in free field conditions at 65 dB to determine the ratio of intelligibility. To investigate the different diagnostic conditions a linear mixed model was applied. The dependent binary variable corresponds to the number of understood syllables. The average age of all subjects was about 72.6 years. The average rate of understanding in the FBE without hearing aids and in quiet was 38.5 %, with hearing aids and in quiet 67.7 %, without hearing aids and with noise 22.4 %, and with hearing aids and with noise 39.8 %. All results were presented with the depending confidence intervals. The extent of hearing loss and the quality of hearing aid fitting can be successfully measured using the FST in quiet and with background noise (CCITT noise). In quiet, an average hearing improving gain of 29.2 % points and with noise a gain of 17.4 % points could be estimated with a successful hearing aid fitting.

The use of an ambulatory, automatic sleep recording device (QUISI version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea.

Electroencephalogram (EEG) evaluation with polysomnography (PSG) according to the Rechtschaffen & Kales (R&K) rules is time and cost consumptive, but ambulatory polygraphy systems do not allow EEG recording routinely. As a consequence, the number of sleep disordered events cannot be calculated exactly. QUISI is a one-channel, self-applicable ambulatory EEG recording device. The present study was designed as a prospective, non-randomized clinical trial. This investigation evaluated the results of 40 patients with primary snoring and obstructive sleep apnoea measured with level 1 PSG and QUISI simultaneously. Fifteen patients (37.5%) were primary snorers with normal sleep profiles, whereas 25 patients (62.5%) suffered from obstructive sleep apnoea (OSA) with a Respiratory Disturbance Index (RDI) of 38.6 +/- 23.8. The mean total sleeping time (TST) was underestimated by 4.5%, while Sleep Efficiency Index (SEI) was understimated by 4.6% by the QUISI device compared with PSG. The correlation between the QUISI and the PSG estimates for single sleep stages demonstrated only moderate correlation. The statistical significance for sleep stage 2 was r = 0.42, P = 0.002; for sleep stage 3/4, r = 0.31, P = 0.02; and for WAKE, r = 0.33, P = 0.01. Sleep stage 2 as well as sleep stage 3/4 were underestimated by QUISI substantially (difference: -5.6% and -10.3%), while WAKE was overestimated by QUISI to a larger amount (difference: +10.4%). Sensitivity and specificity of QUISI to recognize pathological sleep profiles compared with PSG/R&K were 0.92 and 0.96 respectively. QUISI is able to evaluate normal versus altered sleep profiles in patients with primary snoring and OSA. Comparing the quartile ranges, we found substantial differences between QUISI and PSG/R&K. QUISI gives an impression of sleep architecture and objective verification of a sleep disturbance in an ambulant setting but cannot replace the sleep laboratory-based PSG.

Validation of the POLY-MESAM seven-channel ambulatory recording unit.

STUDY OBJECTIVES: To determine the recording capabilities of the POLY-MESAM (PM) unit (MAP; Martinsried, Germany), an American Sleep Disorders Association level III system, and to compare it with simultaneous 12-channel polysomnography in the sleep laboratory. MEASUREMENTS AND RESULTS: Fifty-three patients (49 men and 4 women) with obstructive sleep-related breathing disorders of varying severity were included. The apnea-hypopnea indexes (AHIs) obtained using the two methods differed significantly from each other, although the correlation was close. The PM unit produced false-negative results in patients with mild to moderate obstructive sleep apnea (OSA). The sensitivity of the PM unit in detecting patients with an AHI > 10 was 92%, while the specificity was 96.3%. CONCLUSIONS: The correlation of AHIs obtained with polysomnography and with the PM unit is close. However, in some cases, the PM may underestimate OSA parameters. The PM unit produces false-negative results in patients with mild to moderate OSA. While inpatient polysomnography remains the "gold standard," the PM unit may provide an inexpensive alternative in some special cases.

[What are the side-effects of nocturnal continuous positive pressure ventilation (nCPAP) in patients with sleep apnea for the head-neck region?]. / Welche Nebenwirkungen hat die nächtliche kontinuierliche Uberdruckbeatmung (nCPAP) bei Schlafapnoikern im Kopf-Hals-Bereich?

BACKGROUND: Nasal continuous positive airway pressure ventilation therapy is the present gold standard in the treatment of obstructive sleep apnea. Depending on the definitions used, about 60% of the patients tolerate nCPAP therapy. The reason for this limited tolerance is a varying number of side effects. The aim of the present retrospective study was to analyze the incidence and intensity of otorhinolaryngological side effects of nCPAP therapy. METHOD: Questionnaires inquiring about the frequency of using nCPAP and objective and subjective complaints were sent to 92 patients who were treated with nCPAP in our department within the last years. Six of 92 patients also used a heated humidifier. A telephone interview was added to complete the questionnaires as correctly as possible. RESULTS: Eighty questionnaires were sent back completely answered. The mean frequency of using nCPAP (+/- standard deviation) was 6.8 +/- 1.6 hours per night and 6.5 +/- 1.4 nights per week. The mean duration of nCPAP therapy was 28.0 +/- 21.0 months; the mean pressure used was 6.8 +/- 1.2 cm H2O. The following side effects were specified most frequently: disturbance of sleep during the night (71.3%), dry mouth (47.5%), dry nose (46.3%), pressure marks by the mask (41.3%), crusts within the nasal cavity (38.8%), and hearing loss (26.3%). Dryness within the nose and mouth was considered the most irritating side effects. CONCLUSIONS: NCPAP therapy has a number of different side effects in the head and neck. These side effects are seen frequently. Prospective analysis must show whether there are correlations between the intensity and frequency of side effects and the duration of therapy, and whether technical improvements (quality of masks, noise reduction, humidifiers) are able to reduce the frequency of side effects.

[Validating a 7-channel ambulatory polygraphy unit. 1: Operating instructions for the physician and patient]. / Validierung einer 7kanaligen ambulanten Polygraphieeinheit. Teil 1: Handhabung des Gerätes für Arzt und Patient.

PURPOSE: For some time, the ambulatory diagnosis of sleep-related breathing disorders has included the use of seven-channel recording units. One such unit is the POLY-MESAM (MAP, Martinsried, FRG). The first part of the present study prospectively investigated the handling of the system for physicians and patients, its technical reliability, reliability of the software used and the results in comparison to handscoring. METHODS: In all, 104 patients (95 males, 9 females) were studied for different severities of obstructive sleep-related breathing disorders. The first 51 patients were connected to the POLY-MESAM in the evening within the clinic. The patients then slept at home and returned the next day. Another 53 patients received only a short briefing in the clinic and connected themselves at home to the POLY-MESAM System. Each patient's status was monitored by means of a visual analogue scale. Automatic evaluation of the data was compared with the results of manual scoring. RESULTS: From the data recorded only 6% of the results were not usable. Patients acceptances of the system were very high (94.3%). On average each patient required 21 minutes for attaching and detaching the device. Scoring and instructing the patients required an average of 23 min. Regarding the apnea-hypopnea index (AHI), the correlation between automatic (AHI = 11.1) and manual (AHI = 11.3) evaluations was high. Analysis of snoring turned out to be insufficient. CONCLUSIONS: The POLY-MESAM proved to be reliable and user-friendly. Our findings show that the system can be recommended for outpatient screening of sleep-related breathing disorders, with patients able to manage the system without help. Validation by using simultaneous polysomnography is the subject of part two of the study.

[Validating a 7-channel ambulatory polygraph unit. 2: Simultaneous polysomnography]. / Validierung einer 7kanaligen ambulanten Polygraphieeinheit. Teil 2: Simultane Polysomnographie.

PURPOSE: For some time, the ambulatory diagnosis of respiratory disturbances during sleep has included the use of seven-channel recording units. One of these systems is the POLY-MESAM unit (MAP, Germany). METHODS: The aim of the present study was to validate the POLY-MESAM system by simultaneously performing 12-channel polysomnography. Forty-nine patients (45 males and 4 females) with different severities of obstructive sleep-related breathing disorders were included. Obstructive sleep apnea was diagnosed, when an apnea-hypopnea index (AHI) > 15 was found by polysomnography. The sensitivity and specificity for POLY-MESAM were calculated on the basis of the polysomnographic AHI. RESULTS: The sensitivity of POLY-MESAM for detecting patients with an AHI > 15 was 86.4% and the specificity was 100%. CONCLUSIONS: The POLY-MESAM system was easy to use. The sensitivity and specificity for the MESAM4 unit were 92% and 97% respectively, which was similar to POLY-MESAM. Additionally, POLY-MESAM provided the possibility for distinguishing the different kinds of apneas. Thus, POLY-MESAM was considered to be a useful development of the previous MESAM4 unit. In some cases, use of the POLY-MESAM unit resulted in underestimation of the AHI. POLY-MESAM produced false-negative results in patients with mild to moderate OSA. This finding was reflected in the relatively poorer sensitivity of the method (86.4%). Cardiorespiratory sleep studies (as possible with POLY-MESAM) are best limited to patients for whom the diagnosis of OSA is highly probable or as a follow-up tool in selected circumstances.

First results of a prospective study validating the method of ambulatory polysomnography using the POLY-MESAM unit.

PURPOSE: For some time, ambulatory diagnosis of respiratory disturbances during sleep has included the use of seven-channel recording units. One such unit is the POLY-MESAM (MAP, Martinsried, FRG). The present study prospectively investigated the operation of the unit by both physician and patient, the technical capacity of the unit, and the reliability of the automatic scoring of data by means of the accompanying software in comparison to scoring by hand. METHODS: Included in the study were 104 patients of both sexes with obstructive sleep apnoea of varying severity. The first 51 patients were fitted in the evening with the POLY-MESAM unit and instructed in its function by two physicians in the clinic. The second group of 53 patients were only instructed in the use of the POLY-MESAM unit in the afternoon; they attached the unit by themselves. The patients' status was monitored by means of a visual analogue scale. The automatic evaluation of the data was compared with the results of manual scoring. RESULTS: In all, results in 6% of cases were unusable. Patients' acceptance of the unit was very high. The correlation between automatic and manual scoring regarding the apnoeahypopnoea index (AHI) was surprisingly good. CONCLUSIONS: The POLY-MESAM unit proved robust and user-friendly and was well suited as an ambulatory screening method for obstructive sleep respiratory disturbances which could be attached by the patients themselves. Validation using simultaneous polysomnography is the subject of ongoing studies.

Expansion of neopterin and beta 2-microglobulin in cerebrospinal fluid reaches maximum levels early and late in the course of human immunodeficiency virus infection.

Elevated cerebrospinal fluid (CSF) levels of neopterin and beta 2-microglobulin (beta 2MG) reflect activation of the cellular immune response in the central nervous system (CNS). In 118 consecutive subjects [15 controls and 103 patients with human immunodeficiency virus (HIV) infection classified according to the Walter Reed staging system (WR)], neopterin and beta 2MG were determined in paired samples of CSF and serum. The permeability of the blood-CSF barrier and local release of neopterin and beta 2MG were taken into account: The molecular weight and diameter were used to determine filtration at the blood-CSF barrier. CSF neopterin levels were increased in all stages of HIV infection. beta 2MG levels were elevated in WR2 and later stages. Neopterin, beta 2MG, and cell counts similarly showed peaks in WR2, as did neopterin and beta 2MG also in the later stages WR5 and WR6. Neurologically asymptomatic patients exhibited higher neopterin CSF levels than did controls (12.67 +/- 11.6 vs. 2.34 +/- 1.05 nmol/l, P less than 0.001) and higher CSF beta 2MG (2.12 +/- 1.25 vs. 1.3 +/- 0.37 mg/l, P = 0.001). Patients with HIV encephalopathy had higher levels of beta 2MG (3.75 +/- 1.83 mg/l) than asymptomatic patients (P less than 0.01). CSF levels of neopterin were markedly different in patients with HIV encephalopathy and toxoplasmosis (P less than 0.01). A high quantity of local release of the markers neopterin and beta 2MG may reflect HIV infection of the CNS in early and late stages and additional release upon opportunistic infections.