1
|
Stöver T, Plontke SK, Guntinas-Lichius O, Welkoborsky HJ, Zahnert T, Delank KW, Deitmer T, Esser D, Dietz A, Wienke A, Loth A, Dazert S. [Structure and establishment of the German Cochlear Implant Registry]. HNO 2023; 71:767-778. [PMID: 37198274 PMCID: PMC10663275 DOI: 10.1007/s00106-023-01309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/19/2023]
Abstract
Hearing rehabilitation of patients with severe hearing loss or deafness using cochlear implants (CI) is a very successful but also complex and lifelong process that requires high quality standards for structure, process, and results. Medical registries represent an ideal tool for conducting quality control relevant to care while at the same time collecting scientific data. Therefore, at the initiative of the Executive Committee of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), a Germany-wide CI registry (the German Cochlear Implant Register, DCIR) was to be established. The following goals were to be achieved: 1) legal and contractual basis for the register; 2) definition of the register contents; 3) development of evaluation standards (hospital-specific and national annual reports); 4) development of a logo; 5) practical operation of the registry. After defining a catalog of services that defines the content, structure, and operation of the DCIR, a registry operator with audiological expertise was sought. After considering various offers, the registry was technically implemented in cooperation with the provider INNOFORCE (Ruggell, Liechtenstein) as registry operator. This also included the realization of an interface for data transfer from previously existing databases and development of a data protection concept for productive operation of the DCIR under the scientific leadership of the DGHNO-KHC Executive Committee. Since January 2022, it has been possible for participating hospitals to enter pseudonymized data into the DCIR. To date, 75 hospitals in Germany have contractually agreed to participate in the registry. During the first 15 months, data from over 2500 implants in over 2000 patients were registered in the DCIR. The work presented here describes the structuring, development, and successful establishment of the DCIR. Introduction of the DCIR represents an important milestone of future scientifically based quality control in CI care. The registry presented here can therefore be considered as an example for other areas of medical care and thus also sets an international standard.
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - S K Plontke
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsmedizin Halle, Halle (Saale), Deutschland
| | - O Guntinas-Lichius
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - H-J Welkoborsky
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Klinikum Nordstadt, Hannover, Deutschland
| | - T Zahnert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Dresden, Dresden, Deutschland
| | - K W Delank
- Hals-Nasen-Ohren-Klinik, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | | | | | - A Dietz
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - A Wienke
- Kanzlei WBK, Rechtsanwalt Fachanwalt Medizinrecht, Köln, Deutschland
| | - A Loth
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - S Dazert
- Universitätsklinik für Hals‑, Nasen-, und Ohrenheilkunde, St. Elisabeth Hospital, Bochum, Deutschland
| |
Collapse
|
2
|
Stöver T, Plontke SK, Guntinas-Lichius O, Welkoborsky HJ, Zahnert T, Delank KW, Deitmer T, Esser D, Dietz A, Wienke A, Loth A, Dazert S. Structure and establishment of the German Cochlear Implant Registry (DCIR). HNO 2023; 71:82-92. [PMID: 37462684 PMCID: PMC10409674 DOI: 10.1007/s00106-023-01310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 08/09/2023]
Abstract
Hearing rehabilitation of patients with severe hearing loss or deafness using cochlear implants (CI) is a very successful but also complex and lifelong process that requires high quality standards for structure, process, and results. Medical registries represent an ideal tool for conducting quality control relevant to care while at the same time collecting scientific data. Therefore, at the initiative of the Executive Committee of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), a Germany-wide CI registry (the German Cochlear Implant Register, DCIR) was to be established. The following goals were to be achieved: 1) legal and contractual basis for the register; 2) definition of the register contents; 3) development of evaluation standards (hospital-specific and national annual reports); 4) development of a logo; 5) practical operation of the registry. After defining a catalog of services that defines the content, structure, and operation of the DCIR, a registry operator with audiological expertise was sought. After considering various offers, the registry was technically implemented in cooperation with the provider INNOFORCE (Ruggell, Liechtenstein) as registry operator. This also included the realization of an interface for data transfer from previously existing databases and development of a data protection concept for productive operation of the DCIR under the scientific leadership of the DGHNO-KHC Executive Committee. Since January 2022, it has been possible for participating hospitals to enter pseudonymized data into the DCIR. To date, 75 hospitals in Germany have contractually agreed to participate in the registry. During the first 15 months, data from over 2500 implants in over 2000 patients were registered in the DCIR. The work presented here describes the structuring, development, and successful establishment of the DCIR. Introduction of the DCIR represents an important milestone of future scientifically based quality control in CI care. The registry presented here can therefore be considered as an example for other areas of medical care and thus also sets an international standard.
Collapse
Affiliation(s)
- T Stöver
- Department of Otorhinolaryngology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - S K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Halle, Halle (Saale), Germany
| | - O Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - H-J Welkoborsky
- Hospital for Otorhinolaryngology, Klinikum Nordstadt, Hanover, Germany
| | - T Zahnert
- Department of Otorhinolaryngology, Dresden University Hospital, Dresden, Germany
| | - K W Delank
- Department of Otorhinolaryngology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | | | | | - A Dietz
- Department of Otorhinolaryngology, Leipzig University Hospital, Leipzig, Germany
| | - A Wienke
- Law office WBK, lawyer specialist medical law, Cologne, Germany
| | - A Loth
- Department of Otorhinolaryngology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - S Dazert
- Department of Otorhinolaryngology, University Hospital (St. Elisabeth Hospital), Bochum, Germany
| |
Collapse
|
3
|
Stöver T, Plontke SK, Guntinas-Lichius O, Welkoborsky HJ, Zahnert T, Delank KW, Deitmer T, Esser D, Dietz A, Wienke A, Loth A, Dazert S. Conception and implementation of a certification system for quality control of cochlear implant treatment in Germany. HNO 2023; 71:73-81. [PMID: 37306745 PMCID: PMC10409661 DOI: 10.1007/s00106-023-01306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/13/2023]
Abstract
A standardized and structured process is indispensable for optimal hearing rehabilitation with cochlear implants (CI). The Executive Committee of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC), initiated the conception of a certification program and a Whitepaper based on the Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline (CPG) describing the current medical standards of CI care in Germany. The goal was to independently confirm implementation of this CPG and make this information publicly available. With the support of an independent certification organization, successful implementation of the CI-CPG by a hospital would then be verified and confirmed by awarding the "Cochlear implant-provision institution" (Cochlea-Implantat-versorgende Einrichtung, CIVE) quality certificate. A structure for implementation of a certification system was developed based on the CI-CPG. The following steps were required: 1) conception of a quality control system for certification of hospitals working in accordance with the CI-CPG; 2) development of required structures for an independent review of quality-relevant structure, process, and result parameters; 3) development of a standard procedure for independent certification of hospitals; 4) development of a certificate and a logo to demonstrate successful certification; 5) practical implementation of the certification. Following design of the certification program and the required organizational structure, the certification system was successfully launched in 2021. Applications for the quality certificate could be formally submitted from September 2021. A total of 51 off-site evaluations were performed by December 2022. In the first 16 months from introduction, 47 hospitals were successfully certified as CIVE. In this period, 20 experts were trained as auditors, who have since then carried out 18 on-site audits in hospitals. In summary, the conceptual design, structure, and practical implementation of a certification program for quality control in CI care was successfully implemented in Germany.
Collapse
Affiliation(s)
- T Stöver
- Department of Otorhinolaryngology, Frankfurt University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - S K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Halle, Halle (Saale), Germany
| | - O Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - H-J Welkoborsky
- Hospital for Otorhinolaryngology, Klinikum Nordstadt, Hanover, Germany
| | - T Zahnert
- Department of Otorhinolaryngology, Dresden University Hospital, Dresden, Germany
| | - K W Delank
- Department of Otorhinolaryngology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | | | | | - A Dietz
- Department of Otorhinolaryngology, Leipzig University Hospital, Leipzig, Germany
| | - A Wienke
- Law office WBK, Cologne, Germany
| | - A Loth
- Department of Otorhinolaryngology, Frankfurt University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - S Dazert
- Department of Otorhinolaryngology, University Hospital (St. Elisabeth Hospital), Bochum, Germany
| |
Collapse
|
4
|
Stöver T, Plontke SK, Guntinas-Lichius O, Welkoborsky HJ, Zahnert T, Delank KW, Deitmer T, Esser D, Dietz A, Wienke A, Loth A, Dazert S. [Conception and implementation of a certification system for quality control of cochlear implant treatment in Germany. German version]. HNO 2023:10.1007/s00106-023-01305-x. [PMID: 37115246 DOI: 10.1007/s00106-023-01305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
A standardized and structured process is indispensable for optimal hearing rehabilitation with cochlear implants (CI). The Executive Committee of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC), initiated the conception of a certification system and a Whitepaper based on the Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline (CPG) describing the current medical standards of CI care in Germany. The goal was to independently confirm implementation of this CPG and make this information publicly available. With the support of an independent certification organization, successful implementation of the CI-CPG by a hospital would then be verified and confirmed by awarding the "Cochlear implant-provision institution" (Cochlea-Implantat-versorgende Einrichtung, CIVE) quality certificate. A structure for implementation of a certification system was developed based on the CI-CPG. The following steps were required: 1) conception of a quality control system for certification of hospitals working in accordance with the CI-CPG; 2) development of required structures for an independent review of quality-relevant structure, process, and result parameters; 3) development of a standard procedure for independent certification of hospitals; 4) development of a certificate and a logo to demonstrate successful certification; 5) practical implementation of the certification. Following design of the certification system and the required organizational structure, the certification system was successfully launched in 2021. Applications for the quality certificate could be formally submitted from September 2021. A total of 51 off-site evaluations were performed by December 2022. In the first 16 months from introduction, 47 hospitals were successfully certified as CIVE. In this period, 20 experts were trained as auditors, who have since then carried out 18 on-site audits in hospitals. In summary, the conceptual design, structure, and practical implementation of a certification system for quality control in CI care was successfully implemented in Germany.
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - S K Plontke
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsmedizin Halle, Halle (Saale), Deutschland
| | - O Guntinas-Lichius
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - H-J Welkoborsky
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum Nordstadt, Hannover, Deutschland
| | - T Zahnert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Dresden, Dresden, Deutschland
| | - K W Delank
- Hals-Nasen-Ohren-Klinik, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | | | | | - A Dietz
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - A Wienke
- Kanzlei WBK, Rechtsanwalt Fachanwalt Medizinrecht, Köln, Deutschland
| | - A Loth
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - S Dazert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum (St. Elisabeth Hospital), Bochum, Deutschland
| |
Collapse
|
5
|
Becker S, Laudien M, Förster-Ruhrmann U, Olze H, Rudack C, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Bärhold F, Klimek F, Kianfar R, Zuberbier J, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Werminghaus P, Gröger M, Beutner C, Weber RK, Hildenbrand T, Hoffmann AS, Klimek L. Erratum: Positionspapier: ICD-Codierung der chronischen Rhinosinusitis mit Nasenpolypen (CRSwNP) im ICD-10-GM als Grundlage für eine Therapie mit Biologika. Laryngorhinootologie 2023; 102:e2. [PMID: 37023780 DOI: 10.1055/a-2069-1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - M Laudien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
- Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - F Bärhold
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - R Kianfar
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - P Werminghaus
- Praxis für Hals-Nasen-Ohrenheilkunde und Allergologie, Düsseldorf
| | - M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Südniedersachsen, Universitätsmedizin Göttingen
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| |
Collapse
|
6
|
Becker S, Laudien M, Förster-Ruhrmann U, Olze H, Rudack C, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Bärhold F, Klimek F, Kianfar R, Zuberbier J, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Werminghaus P, Gröger OM, Beutner C, Weber RK, Hildenbrand T, Hoffmann AS, Klimek L. Positionspapier: ICD-Codierung der chronischen Rhinosinusitis mit Nasenpolypen (CRSwNP) im ICD-10-GM als Grundlage für eine Therapie mit Biologika – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA), der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC) und des Deutschen CRS-Registers. Laryngorhinootologie 2023; 102:349-356. [PMID: 36882095 DOI: 10.1055/a-2039-1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Zusammenfassung
Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. In Deutschland sind 3 verschiedene monoklonale Antikörper für die Indikation „Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen“ zugelassen. Um die Verordnung in der zugelassenen Indikation (In-Label) zu dokumentieren, ist neben einer Dokumentation zahlreicher medizinischer Parameter die korrekte Auswahl der ICD-10-GM-Codierung entscheidend. Hierfür existieren in Deutschland bislang keine konsentierten Empfehlungen.
Methoden Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium von AeDA, DGHNO-KHC und Deutschem CRS-Register Codierungsmöglichkeiten von CRS und CRSwNP analysiert und auf dieser Basis eine konsentierte Empfehlung für die ICD-10-GM-Codierung in Deutschland ausgesprochen.
Ergebnis Die Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme ICD-10-GM (International Classification of Diseases, 10. Revision, German Modification) ist die amtliche Klassifikation zur Verschlüsselung von Diagnosen in der ambulanten und stationären Versorgung in Deutschland. Der ICD-10-GM unterscheidet nicht adäquat zwischen heute anerkannten klinischen und immunologischen Differenzierungen der CRSsNP und der CRSwNP. Dennoch wird insbesondere bei indiziertem Einsatz von Biologika in der Therapie der schweren CRSwNP eine möglichst exakte Verschlüsselung mit den Codes J33.8 (im Einzelfall J33.1 oder J33.9) empfohlen.
Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue Behandlungsansätze mit monoklonalen Antikörpern für Patienten mit schwerer, unkontrollierter Erkrankung. Hier geben wir Empfehlungen für eine adäquate ICD-10-GM-Codierung in Deutschland.
Collapse
Affiliation(s)
- S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - M Laudien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - F Bärhold
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - R Kianfar
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - P Werminghaus
- Praxis für Hals-Nasen-Ohrenheilkunde und Allergologie, Düsseldorf
| | - O M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Südniedersachsen, Universitätsmedizin Göttingen
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| |
Collapse
|
7
|
Klimek L, Förster-Ruhrmann U, Olze H, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Bärhold F, Klimek F, Casper I, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Werminghaus P, Pfaar O, Gosepath J, Gröger M, Beutner C, Laudien M, Weber RK, Hildenbrand T, Hoffmann AS, Bachert C. Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Mepolizumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2023; 102:89-99. [PMID: 36750110 DOI: 10.1055/a-2003-4730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy is to be monitored, what follow-up documentation is necessary, and when it should be terminated if necessary. METHODS A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. RESULTS Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given on the basis of a documentation sheet. CONCLUSIONS Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.
Collapse
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster.,Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Universitätsmedizin Greifswald
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Bärhold
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - P Werminghaus
- Praxis für Hals-Nasen-Ohrenheilkunde und Allergologie, Düsseldorf
| | - O Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg
| | - J Gosepath
- Klinik für Hals-, Nasen- und Ohrenheilkunde, HSK Wiesbaden
| | - M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Südniedersachsen, Universitätsmedizin Göttingen
| | - M Laudien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
| |
Collapse
|
8
|
Klimek L, Förster-Ruhrmann U, Olze H, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Klimek F, Sperl A, Casper I, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Pfaar O, Gosepath J, Gröger M, Beutner C, Laudien M, Weber RK, Hildenbrand T, Hoffmann AS, Bachert C. Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Dupilumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2022; 101:855-865. [PMID: 36150698 DOI: 10.1055/a-1908-3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the nasal and paranasal mucosa. A Type-2 inflammation is described as the most common endotype. Since October 2019 the anti-IL-4/-IL-13 antibody dupilumab has been approved in Germany as an add-on therapy to intranasal corticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps, when systemic corticosteroids alone or surgery do not provide adequate disease control. While recommendations for the use of dupilumab in CRSwNP exist at both national and international levels, until now it has not been adequately established, how therapy should be monitored and when it should be discontinued in the German Health Care System. METHODS A literature search was performed analyzing previous data on the treatment of CRSwNP with dupilumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to 05/2022 were included. RESULTS Based on international literature and previous experience, recommendations are given by an expert panel for follow-up and possible therapy breaks, therapy intervals or termination of therapy when using dupilumab for the indication CRSwNP in the German health care system based on a documentation form. CONCLUSIONS Understanding the immunological basis of CRSwNP opens new non-surgical therapy approaches with biologics for patients with severe courses. The authors give recommendations for follow-up, possible therapy breaks, therapy intervals and a termination for dupilumab treatment as add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP that cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
Collapse
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster.,Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Universitätsmedizin Greifswald
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Ruhr-Universität Bochum, St. Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-, Nasen-, Ohren-Heilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - A Sperl
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Mainz
| | - C Bergmann
- Praxis für Hals-, Nasen-, Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - O Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Marburg
| | - J Gosepath
- Klinik für Hals-, Nasen- und Ohrenheilkunde, HSK Wiesbaden
| | - M Gröger
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - M Laudien
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie der Christian-Albrechts-Universität zu Kiel und des Universitätsklinikums Schleswig-Holstein, Campus Kiel
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
| |
Collapse
|
9
|
Klimek L, Olze H, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Klimek F, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Bachert C. Positionspapier: Empfehlungen zur Anwendung von Mepolizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC). Laryngorhinootologie 2022; 101:284-294. [PMID: 35168284 DOI: 10.1055/a-1752-8462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021. METHODS A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered. RESULTS Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form. CONCLUSIONS Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
Collapse
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - U Förster-Ruhrmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik u. Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | | | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
| |
Collapse
|
10
|
Loth A, Vazzana C, Leinung M, Guderian D, Issing C, Baumann U, Stöver T. Quality control in cochlear implant therapy: clinical practice guidelines and registries in European countries. Eur Arch Otorhinolaryngol 2022; 279:4779-4786. [PMID: 35041068 PMCID: PMC9474413 DOI: 10.1007/s00405-022-07263-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The treatment with a cochlear implant (CI) is the gold standard in therapy of patients with profound hearing loss or deafness. Successful hearing rehabilitation with a CI is a complex, multi-stage process. In medicine, "Clinical Practice Guidelines" (CPG) are widely accepted for the standardization of such processes. These are supplemented by medical registries in which data regarding the treatment can be collected and evaluated. The aim of this paper is to identify currently existing CI-related CPGs and registries in Europe. METHODS Between 01/2021 and 06/2021, 42 countries on the European continent, including the United Kingdom, Russia and Turkey, were screened using an internet search (search engine: Google) and a key word search in the Pubmed database. Search terms were the respective country name combined with the following terms: "Cochlear Implant", "CI", "Cochlear implant clinical practice guideline", "CI Guideline", "Cochlear Implant Registry", "CI Registry", "Ear nose throat society". The internet search was conducted in English as well as in the corresponding national language. The objective was to identify a CI-related CPG or registry. RESULTS A CPG was found in 16 of 42 (38%) countries. In terms of population, this accounts for 645 million out of 838 million people (77%). A registry existed in 4 of the 42 (10%) countries assessed. This corresponds to 102 million out of 838 million (12%) people. In total, 4 out of 42 countries (10%) had both a CPG and a registry. CONCLUSION Our work shows numerous efforts in Europe to standardize CI care at the national level. While most people in Europe already live in countries with a CPG, this is not the case for CI registries. European-wide consensus on CPGs or registries does not yet exist. The present study thus provides a first assessment of the distribution of CI-related CPGs and registries.
Collapse
Affiliation(s)
- A Loth
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - C Vazzana
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - M Leinung
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - D Guderian
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - C Issing
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - U Baumann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - T Stöver
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| |
Collapse
|
11
|
Dietz A, Welkoborsky HJ, Guntinas-Lichius O, Stöver T, Wiederkranz M, Thorleuchter M, Rosenkranz O, Deitmer T, Plontke S. [First time online 92nd annual meeting of the DGHNO-KHC 2021 - a critical assessment based on the participant's evaluation]. Laryngorhinootologie 2021; 100:781-790. [PMID: 34428797 DOI: 10.1055/a-1579-8096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
First time ever, the 92nd annual meeting of the DGHNO-KHC was carried out completely in an online format in May 2021 due to the new framework conditions caused by the corona pandemic. The participants from the ranks of members, guests and industrial partners were asked to complete an evaluation questionnaire from the responsible State Medical Association of North Rhine, which was supplemented with questions about the new virtual format. The publication summarizes the evaluation of the 187 (10 % of the total number of participants) medical/scientific and 25 industrial exhibitors (60 % of the participating industrial partners) responses and provides an initial conclusion. Roughly speaking, the congress was rated positively by the medical/scientific participants despite the total lack of social interaction and scientific open debates. On the industrial side, the picture was different. The medical participants were asked about the future format of the next annual ENT congresses. 16 % were in favor of a purely online congress, 67 % in favor of a face-to-face congress with online elements, and only 17 % in favor of a purely face-to-face congress. The question, which type of exhibition would be preferred in the future for industrial partners, 68 % were in favor of a purely face-to-face exhibition as part of a face-to-face congress. 32 % accepted a combination of presence with online elements. A future complete online industrial exhibition was voted out with 0 % approval.
Collapse
Affiliation(s)
| | | | | | - T Stöver
- HNO-Universitätsklinik Frankfurt a. Main, Frankfurt am Main
| | | | | | | | | | - S Plontke
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie Halle, Halle (Saale)
| |
Collapse
|
12
|
Guderian D, Leinung M, Weiss R, Diensthuber M, Stöver T, Loth A. [Development of the publication activity at the German university hospitals for Otorhinolaryngology, Head and Neck Surgery during the SARS-CoV-2-pandemic in 2020]. Laryngorhinootologie 2021; 100:364-371. [PMID: 33761572 DOI: 10.1055/a-1430-7735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The SARS-CoV-2 pandemic has led to profound limitations in patient care and student teaching at the University Hospitals of Otorhinolaryngology (ORL). In contrast, the impact on research has been variable. To classify the pandemic-related effect on research, the development of the number of scientific publications of the German ORL university hospitals before and during the pandemic was analyzed. MATERIAL AND METHODS The publication performance between 2015 and 2020 of the 39 current chairmen was surveyed using a literature search (Pubmed). All entries relating to the chairmen of the university hospital as first, last or co-author were included. The absolute and relative development of each author's publication performance was determined and evaluated using nonparametric statistical methods. RESULTS A total of 2420 publications could be documented. From 2015 to 2019, an average of 368 publications were published per year. In 2020, this number increased by 57.9 % to 581 publications. While the number of monthly publications remained constant between 2015 and 2019, a significant increase was seen from May 2020 up to a maximum of 74 publications in September 2020. In 2020, 34 articles (5.9 %) had a thematic relation to the SARS-CoV-2 pandemic, with 7 of these papers (20.6 %) resulting from cross-site publications. CONCLUSION In 2020, the number of scientific publications was raised to more than 1.5 times the usual annual publications. This increase was clearly related in time to the reduction of elective patient care during the SARS-CoV-2 pandemic starting in mid-March 2020. Probably, free time capacities enabled this increased publication output. Our results confirm the great scientific potential of the ORL university hospitals, which has been successfully implemented despite the pandemic.
Collapse
Affiliation(s)
- D Guderian
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M., Goethe-Universität Frankfurt a. M
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M., Goethe-Universität Frankfurt a. M
| | - R Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M., Goethe-Universität Frankfurt a. M
| | - M Diensthuber
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M., Goethe-Universität Frankfurt a. M
| | - T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M., Goethe-Universität Frankfurt a. M
| | - A Loth
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M., Goethe-Universität Frankfurt a. M
| |
Collapse
|
13
|
Stöver T, Dazert S, Plontke SK, Kramer S, Ambrosch P, Arens C, Betz C, Beutner D, Bohr C, Bruchhage KL, Canis M, Dietz A, Guntinas-Lichius O, Hagen R, Hosemann W, Iro H, Klussmann JP, Knopf A, Lang S, Leinung M, Lenarz T, Löwenheim H, Matthias C, Mlynski R, Olze H, Park J, Plinkert P, Radeloff A, Rotter N, Rudack C, Bozzato A, Schipper J, Schrader M, Schuler PJ, Strieth S, Stuck BA, Volkenstein S, Westhofen M, Wolf G, Wollenberg B, Zahnert T, Zenk J, Hoffmann TK. [Effects of the SARS-CoV‑2 pandemic on the otolaryngology university hospitals in the field of research, student teaching and specialist training]. HNO 2021; 69:633-641. [PMID: 33502578 PMCID: PMC7839289 DOI: 10.1007/s00106-021-01001-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Ab Frühjahr 2020 kam es zur weltweiten Verbreitung von SARS-CoV‑2 mit der heute als erste Welle der Pandemie bezeichneten Phase ab März 2020. Diese resultierte an vielen Kliniken in Umstrukturierungen und Ressourcenverschiebungen. Ziel unserer Arbeit war die Erfassung der Auswirkungen der Pandemie auf die universitäre Hals-Nasen-Ohren(HNO)-Heilkunde für die Forschung, Lehre und Weiterbildung. Material und Methoden Die Direktorinnen und Direktoren der 39 Universitäts-HNO-Kliniken in Deutschland wurden mithilfe einer strukturierten Online-Befragung zu den Auswirkungen der Pandemie im Zeitraum von März bis April 2020 auf die Forschung, Lehre und die Weiterbildung befragt. Ergebnisse Alle 39 Direktorinnen und Direktoren beteiligten sich an der Umfrage. Hiervon gaben 74,4 % (29/39) an, dass es zu einer Verschlechterung ihrer Forschungstätigkeit infolge der Pandemie gekommen sei. Von 61,5 % (24/39) wurde berichtet, dass pandemiebezogene Forschungsaspekte aufgegriffen wurden. Von allen Kliniken wurde eine Einschränkung der Präsenzlehre berichtet und 97,5 % (38/39) führten neue digitale Lehrformate ein. Im Beobachtungszeitraum sahen 74,4 % der Klinikdirektoren die Weiterbildung der Assistenten nicht gefährdet. Schlussfolgerung Die Ergebnisse geben einen Einblick in die heterogenen Auswirkungen der Pandemie. Die kurzfristige Bearbeitung pandemiebezogener Forschungsthemen und die Einführung innovativer digitaler Konzepte für die studentische Lehre belegt eindrücklich das große innovative Potenzial und die schnelle Reaktionsfähigkeit der HNO-Universitätskliniken, um auch während der Pandemie ihre Aufgaben in der Forschung, Lehre und Weiterbildung bestmöglich zu erfüllen.
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland.
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle/S., Halle/S., Deutschland
| | - S Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - P Ambrosch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Kiel, Kiel, Deutschland
| | - C Arens
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - C Betz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - D Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Göttingen, Göttingen, Deutschland
| | - C Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - K-L Bruchhage
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Lübeck, Lübeck, Deutschland
| | - M Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, LMU München, München, Deutschland
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - O Guntinas-Lichius
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - R Hagen
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Greifswald, Greifswald, Deutschland
- Helios Hanseklinikum Stralsund, Stralsund, Deutschland
| | - H Iro
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J P Klussmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Uniklinik Köln und Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - T Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Löwenheim
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Matthias
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mainz, Mainz, Deutschland
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Park
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - P Plinkert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Radeloff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Oldenburg, Oldenburg, Deutschland
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - C Rudack
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
| | - A Bozzato
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum des Saarlandes, Saarlandes, Deutschland
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Schrader
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Minden, Minden, Deutschland
| | - P J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - B A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - S Volkenstein
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - M Westhofen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - G Wolf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Gießen, Deutschland
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - B Wollenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - T Zahnert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Dresden, Dresden, Deutschland
| | - J Zenk
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| |
Collapse
|
14
|
Stöver T, Zeh R, Gängler B, Plontke SK, Ohligmacher S, Deitmer T, Hupka O, Welkoborsky HJ, Schulz M, Delank W, Strobel M, Guntinas-Lichius O, Lang S, Dietz A, Dazert S, Diensthuber M. [Regional distribution of the cochlear implant (CI) centers in Germany]. Laryngorhinootologie 2020; 99:863-871. [PMID: 33167056 DOI: 10.1055/a-1302-0368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children (< 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - R Zeh
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - B Gängler
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle (Saale)
| | - S Ohligmacher
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie e. V., Bonn
| | - O Hupka
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - M Schulz
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - W Delank
- HNO-Klinik, Klinikum der Stadt Ludwigshafen, Ludwigshafen
| | - M Strobel
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St.-Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum
| | - M Diensthuber
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| |
Collapse
|
15
|
Stöver T, Dazert S, Hoffmann TK, Plontke SK, Ambrosch P, Arens C, Betz C, Beutner D, Bohr C, Bruchhage KL, Canis M, Dietz A, Guntinas-Lichius O, Hagen R, Hosemann W, Iro H, Klussmann JP, Knopf A, Kramer S, Lang S, Leinung M, Lenarz T, Löwenheim H, Matthias C, Mlynski R, Olze H, Park J, Plinkert P, Radeloff A, Rotter N, Rudack C, Bozzato A, Schipper J, Schrader M, Strieth S, Stuck BA, Volkenstein S, Westhofen M, Wolf G, Wollenberg B, Zahnert T, Zenk J. [Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]. Laryngorhinootologie 2020; 99:694-706. [PMID: 32767296 PMCID: PMC7645814 DOI: 10.1055/a-1232-4911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care. MATERIALS AND METHODS An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15th to April 15th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution. RESULTS All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8 % to 26.2 ± 14.2 % and in surgical treatments by 65.9 % to 34.1 ± 13.9 %. In contrast, emergency treatment remained unchanged or even increased in 80 % of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90 %. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35 000 outpatients and about 12 000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care. DISCUSSION The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated. SUMMARY This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle/S
| | - P Ambrosch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Kiel
| | - C Arens
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg
| | - C Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg Eppendorf
| | - D Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Göttingen
| | - C Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | - K-L Bruchhage
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Lübeck
| | - M Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, LMU München
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig
| | | | - R Hagen
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Würzburg
| | - W Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Greifswald
| | - H Iro
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Erlangen
| | - J-P Klussmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Uniklinik Köln und Medizinische Fakultät, Universität zu Köln
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg
| | - S Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - T Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover
| | - H Löwenheim
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Tübingen
| | - C Matthias
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mainz
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité Berlin
| | - J Park
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Witten/Herdecke
| | - P Plinkert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Heidelberg
| | - A Radeloff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Oldenburg
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim
| | - C Rudack
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster
| | - A Bozzato
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum des Saarlandes
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - M Schrader
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Minden
| | - S Strieth
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Bonn
| | - B A Stuck
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg
| | - S Volkenstein
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital
| | - M Westhofen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Aachen
| | - G Wolf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Gießen
| | - B Wollenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München
| | - T Zahnert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Dresden
| | - J Zenk
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Augsburg
| |
Collapse
|
16
|
Klimek L, Förster-Ruhrmann U, Becker S, Chaker A, Strieth S, Hoffmann TK, Dazert S, Deitmer T, Olze H, Glien A, Plontke S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Beule AG, Rudack C, Wagenmann M, Stöver T, Huppertz T, Hagemann J, Bachert C. Positionspapier: Anwendung von Biologika bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2020; 99:511-527. [PMID: 32575138 DOI: 10.1055/a-1197-0136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Hintergrund Die chronische Rhinosinusitis (CRS) betrifft weltweit ca. 5–12 % der Allgemeinbevölkerung und wird traditionell eingeteilt in einen Phänotyp ohne (CRSsNP) und einen mit Ausbildung von Nasenpolypen (CRSwNP). Wurden Nasenpolypen bis vor kurzem eher als mechanisches Hindernis mit der Notwendigkeit einer operativen Beseitigung betrachtet, wird die CRSwNP heute als eine multifaktorielle entzündliche Erkrankung der nasalen und paranasalen Schleimhäute angesehen, der als Endotyp häufig eine T2-Inflammation zugrunde liegt. Biologika, die mit diesen Entzündungsmechanismen interferieren, stellen interessante neue Therapiemöglichkeiten dar.
Methoden Das aktuelle Wissen zur Immunologie der CRSwNP und Wirkung von Biologika wurde mittels einer Literaturanalyse durch Recherchen in Medline, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library zusammengestellt.
Ergebnisse Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Anwendung von Biologika bei CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben.
Schlussfolgerung Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren Verlaufsformen.
Collapse
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Charité, Berlin
| | - S Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - A Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München
| | - S Strieth
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Charité, Berlin
| | - A Glien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Halle
| | - S Plontke
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Halle
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Dreieich
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Wagenmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - T Stöver
- Klinik für Hals, Nasen- und Ohrenheilkunde Universitätsklinikum Frankfurt am Main
| | - T Huppertz
- Klinik fur Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - J Hagemann
- Klinik fur Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
| |
Collapse
|
17
|
Klimek L, Becker S, Buhl R, Chaker AM, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Förster-Ruhrmann U, Olze H, Hagemann J, Plontke SK, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Beule AG, Rudack C, Strieth S, Mösges R, Bachert C, Stöver T, Matthias C, Dietz A. Positionspapier: Empfehlungen zur Behandlung der chronischen Rhinosinusitis während der COVID-19-Pandemie im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNO-KHC) – Diese Empfehlungen basieren auf dem EAACI Positionspapier „Treatment of chronic RhinoSinusitis with nasal polyps (CRSwNP) in the COVID-19 pandemics – An EAACI Position Paper”, Allergy, 2020 und wurden auf die Situation im deutschen Gesundheitswesen angepasst. Laryngorhinootologie 2020; 99:356-364. [PMID: 32384572 PMCID: PMC7362395 DOI: 10.1055/a-1164-9696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hintergrund Von der chronischen Rhinosinusitis (CRS) sind weltweit etwa 5–12 % der Allgemeinbevölkerung betroffen. Die CRS gilt als chronische Atemwegserkrankung, die nach den Empfehlungen der WHO ein Risikofaktor für COVID-19-Patienten sein kann. Die entzündlichen Veränderungen der Nasenschleimhäute bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) sind in den meisten Fällen vom Entzündungsendotyp 2 (T2). Methoden Der aktuelle Wissensstand sowohl zu COVID-19 als auch zu den Behandlungsmöglichkeiten von CRSwNP wurde durch eine Literaturrecherche in Medline, Pubmed, internationalen Leitlinien, der Cochrane Library und im Internet analysiert. Ergebnisse Auf Grundlage der internationalen Literatur, der aktuellen Empfehlungen der WHO und anderer internationaler Organisationen sowie der bisherigen Erfahrungen gab ein Expertengremium von EAACI und ARIA Empfehlungen für die Behandlung von CRSwNP während der COVID-19-Pandemien. Schlussfolgerung Intranasale Kortikosteroide stellen die Standardbehandlung für CRS bei Patienten mit einer SARS-CoV-2-Infektion dar. Chirurgische Behandlungen sollten auf ein Minimum reduziert werden und nur bei Patienten mit lokalen Komplikationen und solchen, für die keine anderen Behandlungsmöglichkeiten bestehen, durchgeführt werden. Systemische Kortikosteroide sollten bei COVID-19-Patienten vermieden werden. Die Behandlung mit Biologika kann bei nicht infizierten Patienten unter sorgfältiger Überwachung fortgesetzt werden und sollte während einer SARS-CoV-2-Infektion vorübergehend unterbrochen werden.
Collapse
Affiliation(s)
- L. Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden, Präsident des AeDA
| | - S. Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - R. Buhl
- III. Medizinische Klinik, Universitätsmedizin Mainz
| | - A. M. Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TU München
| | - T. Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T. K. Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Ulm
| | - S. Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T. Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - U. Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - H. Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - J. Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - S. K. Plontke
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle
| | - H. Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | | | | | - B. Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TU München
| | - A. G. Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - C. Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - S. Strieth
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bonn
| | - R. Mösges
- CRI-Clinical Research International Ltd., Hamburg
| | - C. Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
| | - T. Stöver
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Frankfurt/M.
| | - C. Matthias
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - A. Dietz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig, Präsident der DGHNO, KHC
| |
Collapse
|
18
|
Affiliation(s)
- T Stöver
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| |
Collapse
|
19
|
Abstract
Despite impressive technical progress in the field of conventional hearing aids and implantable hearing systems, the hopes for the treatment of inner ear diseases such as hearing loss and tinnitus have become increasingly directed toward regenerative therapeutic approaches. This review discusses the currently most promising strategies for hair cell regeneration in the inner ear to treat hearing loss, including stem cell-based, gene transfer-based, and pharmacological interventions. Furthermore, previous milestones and ground-breaking work in this scientific field are identified. After many years of basic research, the first clinical trials with a regenerative therapeutic approach for hearing-impaired patients were recently initiated. Although there is still a long and bumpy road ahead until a true breakthrough is achieved, it seems more realistic than ever that regenerative therapies for the inner ear will find their way into clinical practice.
Collapse
Affiliation(s)
- M Diensthuber
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland.
| | - T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland
| |
Collapse
|
20
|
Leinung M, Zaretsky E, Ernst BP, Trier B, Stöver T, Hey C. [Vibrant Soundbridge®: An Alternative Hearing System for Preschool Children with Aural Atresia]. Laryngorhinootologie 2016; 95:E1. [PMID: 27728919 DOI: 10.1055/s-0042-117597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt am Main
| | - E Zaretsky
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt am Main.,aktuelles Institut: Abteilung für Phoniatrie und Pädaudiologie, Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Gießen-Marburg, Standort Marburg
| | - B P Ernst
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt am Main.,aktuelles Institut: Hals-, Nasen-, Ohrenklinik und Poliklinik - Plastische Operationen, Johannes Gutenberg Universität Mainz
| | - B Trier
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt am Main
| | - T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt am Main
| | - C Hey
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt am Main.,aktuelles Institut: Abteilung für Phoniatrie und Pädaudiologie, Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Gießen-Marburg, Standort Marburg
| |
Collapse
|
21
|
Leinung M, Zaretsky Y, Ernst B, Vaerst B, Stöver T, Hey C. [Vibrant Soundbridge®: An Alternative Hearing System for Preschool Children with Aural Atresia]. Laryngorhinootologie 2016; 95:627-33. [PMID: 27626815 DOI: 10.1055/s-0042-100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The audiological treatment of children with aural atresia makes high demands on physicians and acousticians. Conventional hearing systems are often not tolerated by children and therefore do not meet the needs of the early and efficient therapy of hearing disorders. Aim of the present study was the evaluation of the audiological functional gain in children with uni- and bilateral aural atresia provided with the middle ear implant Vibrant Soundbridge(®) (VSB(®)) below the age of 6 years as well as the analysis of parents' satisfaction assessed with questionnaires. MATERIAL AND METHODS The VSB(®) was implanted in 16 children, 13 with unilateral and 3 with bilateral aural atresia, with the mean age of 2;11±1;6 years. 3 months after the first fitting of the audio processor, pure-tone audiometry via free field testing with and without the hearing system was performed. Furthermore, parents completed a standardized questionnaire to evaluate their satisfaction with the VSB(®) treatment quality. The questionnaire included items on the acceptance by children, handling, listening effort, behavior, satisfaction, quality of life, aesthetics, and the length of daily use. RESULTS The use of the VSB(®) resulted in a significantly improved hearing level: 20 dB on average (Z=- 3.06; p=0.002; n=12). The analysis of parents' questionnaire demonstrated high or very high satisfaction with VSB(®) in all subjects. Primarily, the length of daily use of the VSB(®) was significantly higher than that of the hearing system used before with 10.0±2.1 vs. 2.7±2.2 h per day (Z=- 3.06; p=0.002; n=14). CONCLUSION The VSB(®) presented a good alternative for audiological treatment of uni- and bilateral aural atresia at toddler and pre-school age.
Collapse
Affiliation(s)
- M Leinung
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum der J.W. Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Y Zaretsky
- Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Giessen und Marburg, Marburg
| | - B Ernst
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Johannes Gutenberg Universitat Mainz, Mainz
| | - B Vaerst
- Department for Ear Nose Throat Medicine, University of Frankfurt/Main, Frankfurt
| | - T Stöver
- HNO, Universitätsklinikum Frankfurt, Frankfurt
| | - C Hey
- Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Gießen-Marburg, Standort Marburg, Marburg, Hessen
| |
Collapse
|
22
|
Leinung M, Zaretsky E, Lange BP, Hoffmann V, Stöver T, Hey C. Vibrant Soundbridge® in preschool children with unilateral aural atresia: acceptance and benefit. Eur Arch Otorhinolaryngol 2016; 274:159-165. [DOI: 10.1007/s00405-016-4265-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
|
23
|
Vogl T, Tawfik A, Emam A, Naguib N, Nour-Eldin A, Burck I, Stöver T. Pre-, Intra- and Post-Operative Imaging of Cochlear Implants. ROFO-FORTSCHR RONTG 2015; 187:980-9. [DOI: 10.1055/s-0035-1553413] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- T. Vogl
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - A. Tawfik
- Department of Diagnostic and Interventional Radiology, Mansoura University, Mansoura, Egypt
| | - A. Emam
- Department of Diagnostic and Interventional Radiology, University Hospital, Alexandria, Egypt
| | - N. Naguib
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - A. Nour-Eldin
- Department of Radiology, University Hospital Cairo, Egypt
| | - I. Burck
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - T. Stöver
- Department of Otolaryngology, University Hospital of Frankfurt, Germany
| |
Collapse
|
24
|
Pluschinski P, Zaretsky Y, Almahameed A, Koseki JC, Leinung M, Girth L, Wagenblast J, Sader R, Stöver T, Hey C. [Secretion scale by Murray et al. for FEES®: comparison of reliability and validity of the German long and short version]. Nervenarzt 2015; 85:1582-7. [PMID: 25476187 DOI: 10.1007/s00115-014-4192-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accumulation of secretions in the hypopharynx, aditus laryngis and trachea constitute a cardinal trait of oropharyngeal dysphagia. For the evaluation of the degree of severity a 4-point secretion scale by Murray et al. is used internationally in a long and a short version. However, a validated German translation of the long version of this scale does not yet exist. Also, it has not yet been scientifically proven that both versions of the scale are equally valid. OBJECTIVES This study aimed at the validation of the German translation of the long version of the secretion scale by Murray et al. and at a comparison of reliability and validity of the short and long versions. MATERIAL AND METHODS A total of 40 videos of fiberoptic endoscopic evaluation of swallowing (FEES(®)), 10 for each severity level, were rated by 4 otorhinolaryngologists (ENT specialists) independently and with different randomizations for examination of the reliability and validity. Two rating sessions for each of the scale versions were conducted. Intrarater and interrater reliability as well as the agreement of the ratings with a reference standard were analyzed. RESULTS Both the intrarater reliability (Spearman correlations: ρs > 0.840***) and the interrater reliability (Krippendorff's alpha: α > 0.850) yielded very good results and the concurrent validity was highly significant (ρs > 0.981***). DISCUSSION The German translation of the secretion scale by Murray et al. can be considered reliable and valid, with comparable test accuracy of the short and long versions. Hence, the scale can be recommend for the graduation of pharyngolaryngotracheal secretions and should be integrated into the standardized evaluation of FEES(®) diagnostics for clinical and scientific purposes.
Collapse
Affiliation(s)
- P Pluschinski
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, Haus 7A, 60590, Frankfurt am Main, Deutschland,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Jäger A, Herbeck R, Wagenblast J, Stöver T, Diensthuber M. [Destructive lesion of the middle ear]. HNO 2014; 63:312-4. [PMID: 25527382 DOI: 10.1007/s00106-014-2958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Jäger
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Klinikum der Goethe-Universität, Uniklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland,
| | | | | | | | | |
Collapse
|
26
|
Abstract
BACKGROUND A fiberoptic endoscopic evaluation of swallowing (FEES) is well established internationally as gold standard of the instrument-based diagnostics if it is performed according to the Langmore-protocol. For the quality assurance of FEES, videotaping is recommended. However, often no videotaping is carried out due to a limited availability of portable recording systems, for instance, in the bedside diagnostics. This study aimed at the comparison of FEES quality assurance with and without videotaping by rating of the main finding in swallowing disorders, the penetration and aspiration, as defined in the penetration-aspiration scale by Rosenbek. MATERIAL AND METHODS An examination of agreement of penetration and aspiration ratings with the defined reference standard was conducted by means of 80 videotaped recordings. The ratings were carried out independently by 4 raters in 2 settings: A) "real time" and B) "frame-by-frame". RESULTS As far as the interrater- and intrarater-reliability is concerned, the association between the ratings in the rating setting B were higher than those in the rating setting A. Furthermore, examination of the validity showed higher correlation in setting B than in setting A. The difference between correlations was significant in favor of setting B (videotaped FEES). CONCLUSION The results of the present study, namely better rating reliability and validity in case of the penetration and aspiration, emphasize the importance of the videotaping of the FEES diagnostics, at least for the evaluation of penetration or aspiration.
Collapse
Affiliation(s)
- P Pluschinski
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt
| | - Y Zaretsky
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt
| | - T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt
| | - C Hey
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt
| |
Collapse
|
27
|
Hey C, Pluschinski P, Stöver T, Zaretsky Y. [Validation of the German short version of the Murray Secretion Rating Scale]. Laryngorhinootologie 2014; 94:169-72. [PMID: 25111447 DOI: 10.1055/s-0034-1385848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Accumulation of secretions in hypopharynx, aditus vestibule, and trachea is often found in cases of severe dysphagia and is considered a cardinal trait of high clinical and therapeutic importance. For the graduation of the severity level of accumulated secretions, a short version of the 4-point Murray secretion scale is available, which is also integrated into the protocol of the fiberoptic endoscopic evaluation of swallowing (FEES) according to the Langmore standard. This study aimed at the validation of the German translation of this short version in order to facilitate a uniform, standardized evaluation of the accumulation of secretions in dysphagic patients in the German language area. MATERIAL AND METHODS For the examination of reliability and validity, a reference standard was defined by 2 dysphagia experts on the basis of 40 video files of the FEES examination, 10 videos for each of the severity grades. Afterwards, these videos were rated independently by 4 raters and re-rated in a new randomized order 2 weeks later. RESULTS Both the intra-rater reliability (τ>0,830***) and the inter-rater reliability (Kendalls W>0,890***) were highly significant and can be considered good. The same is valid for the correlation of ratings with the reference standard (τ=0,969***). CONCLUSIONS The German translation of the short version of the 4-point Murray secretion scale is recommendable as a reliable and valid instrument for the graduation of the cardinal trait of oropharyngeal dysphagia and also as an evidence-based instrument for standardized use in the German language area.
Collapse
Affiliation(s)
- C Hey
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Frankfurt am Main
| | - P Pluschinski
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Frankfurt am Main
| | - T Stöver
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Frankfurt am Main
| | - Y Zaretsky
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Frankfurt am Main
| |
Collapse
|
28
|
|
29
|
Rader T, Helbig S, Stöver T, Baumann U. [Hearing preservation: Better hearing with advanced technology]. Laryngorhinootologie 2014; 93:337-49. [PMID: 24782208 DOI: 10.1055/s-0034-1371796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Preservation of residual hearing after cochlear implantation allows patients the synergetic use of electric and acoustic stimulation (EAS). The application of specific surgical and therapeutic techniques enables the reduction of inner ear trauma, which leads otherwise to complete hearing loss. Due to simultaneous electric and acoustic stimulation, speech understanding is improved especially in noise. EAS is a well-accepted therapeutic treatment for subjects with profound hearing loss in the higher frequencies and no or mild hearing loss in the low frequencies. Several Manufacturers offer individual soft electrodes specially designed for hearing preservation as well as combined electric-acoustic audio processors.
Collapse
Affiliation(s)
- T Rader
- Klinik für HNO-Heilkunde, Audiologische Akustik, Goethe-Universität Frankfurt am Main
| | - S Helbig
- Klinik für HNO-Heilkunde, Audiologische Akustik, Goethe-Universität Frankfurt am Main
| | - T Stöver
- Klinik für HNO-Heilkunde, Audiologische Akustik, Goethe-Universität Frankfurt am Main
| | - U Baumann
- Klinik für HNO-Heilkunde, Audiologische Akustik, Goethe-Universität Frankfurt am Main
| |
Collapse
|
30
|
Hey C, Pluschinski P, Zaretsky Y, Almahameed A, Hirth D, Vaerst B, Wagenblast J, Stöver T. Penetrations-Aspirations-Skala nach Rosenbek. HNO 2014; 62:276-81. [DOI: 10.1007/s00106-013-2815-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
31
|
Ceschi P, Bohl A, Sternberg K, Neumeister A, Senz V, Schmitz K, Kietzmann M, Scheper V, Lenarz T, Stöver T, Paasche G. Biodegradable polymeric coatings on cochlear implant surfaces and their influence on spiral ganglion cell survival. J Biomed Mater Res B Appl Biomater 2014; 102:1255-67. [DOI: 10.1002/jbm.b.33110] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/08/2013] [Accepted: 01/04/2014] [Indexed: 12/31/2022]
Affiliation(s)
- P. Ceschi
- Hannover Medical School; Department of Otolaryngology; Hannover Germany
- School of Veterinary Medicine Hannover Foundation; Department of Pharmacology; Toxicology and Pharmacy Hannover Germany
| | - A. Bohl
- University of Rostock, Institute for Biomedical Engineering; Rostock Germany
| | - K. Sternberg
- University of Rostock, Institute for Biomedical Engineering; Rostock Germany
| | | | - V. Senz
- University of Rostock, Institute for Biomedical Engineering; Rostock Germany
| | - K.P. Schmitz
- University of Rostock, Institute for Biomedical Engineering; Rostock Germany
| | - M. Kietzmann
- School of Veterinary Medicine Hannover Foundation; Department of Pharmacology; Toxicology and Pharmacy Hannover Germany
| | - V. Scheper
- Hannover Medical School; Department of Otolaryngology; Hannover Germany
| | - T. Lenarz
- Hannover Medical School; Department of Otolaryngology; Hannover Germany
| | - T. Stöver
- Hannover Medical School; Department of Otolaryngology; Hannover Germany
- KGU; Department of Otolaryngology; Frankfurt Germany
| | - G. Paasche
- Hannover Medical School; Department of Otolaryngology; Hannover Germany
| |
Collapse
|
32
|
Balermpas P, Bauer C, Fraunholz I, Ottinger A, Wagenblast J, Stöver T, Seitz O, Fokas E, Rödel C, Weiss C. Concomitant chemoradiotherapy versus induction chemotherapy followed by chemoradiotherapy as definitive, first line treatment of squamous cell carcinoma of the head and neck. A retrospective single center analysis. Strahlenther Onkol 2014; 190:256-62. [PMID: 24413895 DOI: 10.1007/s00066-013-0509-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/08/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite the lack of evidence to support its implementation in the clinical practice, induction chemotherapy (IC) before chemoradiotherapy (CRT) is often used in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). We retrospectively examined the tolerability, feasibility, and clinical outcome of both concepts in a single center analysis. PATIENTS AND METHODS In all, 83 patients were treated between 2007 and 2010 with IC + CRT (n = 42) or CRT alone (n = 41). IC consisted of docetaxel, cisplatin and 5-fluorouracil (TPF), or cisplatin and 5-fluorouracil (PF). All patients were scheduled to receive 2 cycles of PF during concurrent CRT. Adverse events were assessed according to the common toxicity criteria of adverse events (CTCAE v. 3.0). Associations were tested using the χ² test, and survival estimates were calculated according to Kaplan-Meier. RESULTS The median follow-up was 30.35 months (range 2.66-61.25 months). At 2 years, the overall survival rate was significantly higher for primary CRT compared to IC + CRT group (74.8 % vs. 54 %, respectively; p = 0.041). Significantly more treatment-related overall grade 4 toxicities were documented in the IC + CRT group compared to the CRT group (42.9% vs. 9.8%; p = 0.001). Renal toxicity ≥ grade 2 occurred in 52.4 % vs. 7.3 % (p < 0.001), respectively. In all, 93 % of the patients with primary CRT compared to 71 % with IC + CRT received the planned full radiotherapy dose (p = 0.012). CONCLUSION This is, to our knowledge, the largest retrospective study to compare IC + CRT with primary CRT. IC showed high acute toxicity, compromised the feasibility of concurrent CRT, and was associated with reduced overall survival rates compared to primary CRT. The lack of clinical benefit in conjunction with the increased toxicity does not support implementation of IC.
Collapse
Affiliation(s)
- P Balermpas
- Department of Radiation Therapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Strieth S, Stöver T. [Functional soft-palate reconstruction with radial forearm free flaps]. Laryngorhinootologie 2013; 92:347-58. [PMID: 23633097 DOI: 10.1055/s-0033-1341491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Oropharyngeal cancer of the soft palate is a therapeutic challenge. This is due to crucial importance of velopharyngeal competence for articulation and swallowing. Patient counseling must present the whole therapeutic spectrum in order to receive informed consent. Basically, in primary therapy of oropharyngeal cancer multimodal concepts have to be considered including surgical resection and radiochemotherapy. With regard to the occasional difficulties predicting the functional outcome after primary therapy the ladder of reconstructive options has to be discussed a priori. Among numerous pedicled flaps the radial forearm free flap nowadays belongs definitely in the surgical armoury, which offers almost ideal reconstructive possibilities after extensive resections. This implies some additional aspects in pre- and postoperative workup that are reviewed in this article.
Collapse
Affiliation(s)
- S Strieth
- Klinik für Hals-Nasen-Ohrenheilkunde der Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/M, Germany.
| | | |
Collapse
|
34
|
Brom J, Stöver T, Wagenblast J. [Epithesial craniofacial reconstructions after mutilating surgery in head and neck cancer patients]. Laryngorhinootologie 2012; 92:51-9; quiz 60-1. [PMID: 23264076 DOI: 10.1055/s-0032-1331189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The construction of facial prostheses is frequently used as a remedial treatment method in otorhinolaryngology. Modern prostheses are often attached to the face via bone anchored titanium implants and magnetic attachments. The use of specialised silicones and colouring techniques produces prostheses which realistically mimic lost facial tissues and significantly enhance patient quality of life. The article provides an overview of the possibilities of modern epithetics in the treatment of facial defects resulting from head and neck tumors.
Collapse
Affiliation(s)
- J Brom
- Brom Epithetik, Heidelberg
| | | | | |
Collapse
|
35
|
Abstract
Adenoid cystic carcinoma (ACC) is a slowly growing tumor with a particular tendency to infiltrate the surrounding tissue by perineural spread. The clinical diagnosis may prove difficult due to the submucons extension of the tumor, especially at the skull base. This article outlines the clinical characteristics, diagnostics, and treatment modalities in a series of 56 patients with an ACC in the head and neck diagnosed between 1970 and 1998 in 32 females and 24 males. The youngest patient was aged 24 years, the oldest 77 years. The average age was 54 years. In 16 patients the tumor originated in the paranasal sinuses or the nasopharynx and involved the skull base. As a rule, several months passed between the manifestation of the first symptoms such as pain, blocked nose, epistaxis, or diplopia and the initial clinical diagnosis. All patients received surgical treatment, however, complete microscopical resection could only be achieved in approximately one third of the cases. Therefore, nine patients were postoperatively treated with radiotherapy. The average survival rates of the patients with an ACC of the skull base were only 99 months as compared to 144 months in the patients without skull base involvement.
Collapse
|
36
|
Abstract
Chronic inflammatory tumor-like lesions of the temporal bone represent a difficult clinical task for the skull base surgeon. Their osteolytic aggressiveness endangers vital structures and may not be controlled by surgery alone. We present the course of four cases of fibroinflammatory pseudotumor of the temporal bone which were treated by a combined approach of skull base surgery and chemotherapy. Three patients were deafened by the disease and underwent several operafive measures. One patient was lost, most likely due to an arrosive bleeding of the internal carotid artery. The chronic and recurrent process could only be stopped by petrosectomy, followed by antiproliferative chemotherapy. Two patients were subsequently provided with a cochlear implant. The differential diagnosis, diagnostic, and operative options of this rare but severe disease are discussed.
Collapse
|
37
|
|
38
|
Paasche G, Ceschi P, Löbler M, Rösl C, Gomes P, Hahn A, Rohm HW, Sternberg K, Lenarz T, Schmitz KP, Barcikowski S, Stöver T. Effects of metal ions on fibroblasts and spiral ganglion cells. J Neurosci Res 2011; 89:611-7. [PMID: 21312225 DOI: 10.1002/jnr.22569] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 10/13/2010] [Accepted: 11/04/2010] [Indexed: 11/11/2022]
Abstract
Degeneration of spiral ganglion cells (SGC) after deafness and fibrous tissue growth around the electrode carrier after cochlear implantation are two of the major challenges in current cochlear implant research. Metal ions are known to possess antimicrobial and antiproliferative potential. The use of metal ions could therefore provide a way to reduce tissue growth around the electrode array after cochlear implantation. Here, we report on in vitro experiments with different concentrations of metal salts with antiproliferative and toxic effects on fibroblasts, PC-12 cells, and freshly isolated spiral ganglion cells, the target cells for electrical stimulation by a cochlear implant. Standard cell lines (NIH/3T3 and L-929 fibroblasts and PC-12 cells) and freshly isolated SGC were incubated with concentrations of metal ions between 0.3 μmol/liter and 10 mmol/liter for 48 hr. Cell survival was investigated by neutral red uptake, CellQuantiBlue assay, or counting of stained surviving neurons. Silver ions exhibited distinct thresholds for proliferating and confluent cells. For zinc ions, the effective concentration was lower for fibroblasts than for PC-12 cells. SGC showed comparable thresholds for reduced cell survival not only for silver and zinc ions but also for copper(II) ions, indicating that these ions might be promising for reducing tissue growth on the surface of CI electrode arrays. These effects were also observed when combinations of two of these ions were investigated.
Collapse
Affiliation(s)
- G Paasche
- Department of Otolaryngology, Medical University of Hannover, Hannover, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Eckardt A, Mörtel S, Wagenblast J, Stöver T, Hambek M. [Laryngeal reconstruction after resection of a subglottic adenocarcinoma]. Laryngorhinootologie 2010; 90:163-4. [PMID: 20799157 DOI: 10.1055/s-0030-1262796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
40
|
Hambek M, Mörtel S, Wagenblast J, Eckardt A, Stöver T. Comparison of primary site biopsies and transverse surgical sections of squamous cell carcinoma of the head and neck for translational research analysis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
41
|
Büchner A, Schüssler M, Battmer RD, Stöver T, Lesinski-Schiedat A, Lenarz T. Impact of Low-Frequency Hearing. Audiol Neurootol 2009; 14 Suppl 1:8-13. [PMID: 19390170 DOI: 10.1159/000206490] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 11/21/2008] [Indexed: 11/19/2022] Open
Affiliation(s)
- A Büchner
- Department of Otolaryngology, Medizinische Hochschule Hannover, Hannover, Germany.
| | | | | | | | | | | |
Collapse
|
42
|
|
43
|
Teschner M, Hinz K, Stöver T, Lenarz T, Becker H. Diffusion-Weighted MRI in the Diagnosis of Cholesteatomas. ORL J Otorhinolaryngol Relat Spec 2009; 71:99-104. [DOI: 10.1159/000194662] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 11/03/2008] [Indexed: 11/19/2022]
|
44
|
Nakamura M, Stöver T, Rodt T, Majdani O, Lorenz M, Lenarz T, Krauss JK. Neuronavigational guidance in craniofacial approaches for large (para)nasal tumors involving the anterior skull base and upper clival lesions. Eur J Surg Oncol 2008; 35:666-72. [PMID: 19056201 DOI: 10.1016/j.ejso.2008.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/18/2008] [Accepted: 10/23/2008] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Due to the destruction of osseous landmarks of the skull base or paranasal sinuses, the anatomical orientation during surgery of frontobasal or clival tumors with (para)nasal extension is often challenging. In this relation computer assisted surgical (CAS) guidance might be a useful tool. Here, we explored the use of CAS in an interdisciplinary setting. METHODS The surgical series consists of 13 patients who underwent a lateral rhinotomy combined with a subfrontal craniotomy in case of significant intracranial tumor extension. The procedures were planned and assisted by advanced CAS techniques with image fusion of CT and MRI. Tumors included carcinomas (one case associated with an olfactory groove meningioma), esthesioneuroblastoma, chordoma, chondrosarcoma and ganglioglioma. RESULTS The application of CAS in the combined approaches was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors. There was no perioperative 30-day mortality; however two patients died 5 weeks and 5 months after craniofacial tumor resection due to worsening medical conditions. The most common perioperative morbidity was postoperative wound complication in two cases. Tumors were either removed completely, or subtotal resection was achieved allowing targeted postoperative radiotherapy. CONCLUSION Craniofacial approaches with intraoperative neuronavigational guidance in a multidisciplinary setting allow safe resection of large tumors of the upper clivus and the paranasal sinuses involving the anterior skull base. Complex skull base surgery with the involvement of bony structures appears to be an ideal field for advanced navigation techniques given the lack of intraoperative shift of relevant structures.
Collapse
Affiliation(s)
- M Nakamura
- Department of Neurosurgery, Medical University Hannover, Hannover, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Willenborg K, Götz F, Klein R, Lenarz T, Stöver T. Tuberkulose in der Glandula parotidea bei HIV-Infektion. Laryngorhinootologie 2008. [DOI: 10.1055/s-2008-1077330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
46
|
Abstract
A 35-year-old man with HIV-infection presented with a progressive swelling of the left parotid gland lasting for 3 months. Physical examination revealed a firm mass on the tail of the parotid gland. Ultrasound examination of the left parotid showed a well-circumscribed round lesion. MR imaging demonstrated a 2 cm lesion in the ventral subcutaneous part of the parotid gland. Lateral parotidectomy was performed with suspected pleomorphic adenoma. Histologic analysis revealed a granulomatous necrotising inflammatory lesion of an intra- and extraparotideal lymph node. The patient had no family history of tuberculosis. Hematologic investigations were within normal limits. Chest X-ray was normal. Primary tuberculosis of the parotid gland in a patient with HIV-infection was diagnosed and anti-mycobacterial therapy was started. In HIV-patients with unilateral swelling of the parotid gland, tuberculosis should be considered in the differential diagnosis of pleomorphic adenoma and fine needle aspiration cytology should be performed to avoid unnecessary surgery.
Collapse
Affiliation(s)
- K M Willenborg
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, Hannover.
| | | | | | | | | |
Collapse
|
47
|
Majdani O, Bartling SH, Leinung M, Stöver T, Lenarz M, Dullin C, Lenarz T. Navigationsgeführte minimal-invasive Cochlea-Implantation - Untersuchungen am humanen Felsenbein. Laryngorhinootologie 2008; 87:18-22. [PMID: 17713878 DOI: 10.1055/s-2007-966775] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The accuracy of navigation systems can be improved significantly by using high-resolution flat panel-based Volume Computed Tomography (fpVCT) so that new surgical therapeutic concepts become feasible. A navigation-guided minimally-invasive cochleostomy places highest requirements on the accuracy of intraoperative navigation. METHODS A flat-panel Volume Computed Tomograph (fpVCT) was used to scan four human temporal bones. The isometric voxel size was 200 microm. The preoperative planning was used to define an optimized drilling channel from the mastoid surface to the round window niche and the scala tympani providing a safety margin to critical anatomical structures such as facial nerve, chorda tympani, sigmoid sinus and posterior wall of auditory canal. The canal was drilled hand-operated with a navigated drill following the previously planned trajectory. Afterwards the drilled canal was imaged by fpVCT. Conventional dissection including mastoidectomy and posterior tympanotomy assured correct localization of the cochleostomy. RESULTS Path planning took an average of 54 minutes (range 35-85 minutes). Installation took an average of 16 minutes (range 14-19 minutes). The drilling procedure itself took an average of 7.75 min (range 5-12 minutes.) The RMSE-values varied between 0.1 and 0.2 mm (Table 1). All four specimens showed a cochleostomy located at the scala tympani anterior inferior to the round window. The chorda tympani was damaged in one specimen--this was preoperatively planned as a narrow facial recess was encountered. The time needed for planning and system-installation could be reduced continuously. CONCLUSIONS This feasibility study demonstrates that using current image-guided surgery technology in combination with fpVCT allows drilling of a minimally invasive channel to the cochlea with loco typico cochleostomy. The necessary accuracy of intraoperative navigation can be achieved by use of fpVCT (technical accuracy between 0.1 and 0.2 mm). Our results demonstrate the feasibility of a navigation-guided minimally-invasive cochleostomy loco typico. While we are enthused by this preliminary work, we recognize the barriers which exist in translation to clinical application. These include surgical issues (e.g. control of unexpected bleeding) and electrode issues (e.g. development of insertion tools).
Collapse
Affiliation(s)
- O Majdani
- HNO-Klinik der Medizinischen Hochschule Hannover, Hannover.
| | | | | | | | | | | | | |
Collapse
|
48
|
Stöver T, Paasche G, Lenarz T, Ripken T, Breitenfeld P, Lubatschowski H, Fabian T. Development of a drug delivery device: using the femtosecond laser to modify cochlear implant electrodes. Cochlear Implants Int 2007; 8:38-52. [PMID: 17479965 DOI: 10.1179/cim.2007.8.1.38] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Animal experiments suggest that pharmacological intervention could possibly enhance cochlear implant performance. One of the key aspects is therefore a drug delivery device for the human inner ear. The objective of this study was to investigate the possibility of using the femtosecond laser for modifying a cochlear implant electrode for the purpose of drug delivery to the cochlea. Using silicone sheets, the best parameters for creating defined channels at calculated diameters were investigated using a femtosecond laser. The results were transferred to a cochlear implant electrode array (Nucleus Contour). The capability of delivering substances through the drilled openings was tested in vitro. By variation of the output of the laser, spot distance, repetition rate, number of cycles and introducing several focus planes, it was possible to drill holes with nearly vertical walls in the silicone sheets. Transferring these data to the cochlear implant electrode resulted in prototypes for drug delivery with various openings along the array. The use of the femtosecond laser allows rapid modification and adaptation of designs to experimental prototypes of cochlear implant electrodes for the purpose of drug delivery to the inner ear.
Collapse
Affiliation(s)
- T Stöver
- Department of Otolaryngology, Medical University of Hannover, Germany.
| | | | | | | | | | | | | |
Collapse
|
49
|
Stöver T, Scheper V, Diensthuber M, Lenarz T, Wefstaedt P. Neuritenwachstum in vitro durch BDNF und GDNF in Kombination mit Dexamethason auf kultivierte Spiralganglienzellen. Laryngorhinootologie 2007; 86:352-7. [PMID: 17163378 DOI: 10.1055/s-2006-945005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The efficacy of cochlear implant performance depends, among many other factors, on the number of excitable spiral ganglion cells (SGCs) and the nerve-electrode interface. In earlier animal studies it has been demonstrated that neurotrophic factors are effective to improve SGC survival after experimentally induced deafness. With regard to their anti-inflammatoric and anti-proliferative effects, glucocorticoids (e. g. dexamethasone) are potentially interesting therapeutic agents to reduce connective tissue formation around the inserted electrode. The biological effects of a combined intervention of neurotrophic factors with steroids on SGCs are unknown. Therefore the objective of the study was to investigate possible trophic or even toxic effects of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF) and dexamethasone on neurite outgrowth of cultivated SGCs. METHODS By using dissociated postnatal spiral ganglion cells (p3-5) for cultivation in the present study, the influence of the mentioned factors in various concentrations and combinations on neurite outgrowth of SGCs was analysed. RESULTS Our results indicate significant trophic effects for BDNF (50 ng/ml) and a combination of BDNF with dexamethasone (100 ng/ml) on SGC neurite outgrowth. In contrast, single application of GDNF or dexamethasone in different concentrations caused no significant changes on neurite outgrowth when compared to the control condition. CONCLUSIONS Neurite outgrowth induced by neurotrophic factors could not be observed to be reduced when dexamethasone is given at the same time. Therefore the demonstrated results provide a basis for further animal studies in this field of research.
Collapse
Affiliation(s)
- T Stöver
- Hals-Nasen-Ohrenklinik der Medizinischen Hochschule Hannover.
| | | | | | | | | |
Collapse
|
50
|
Diensthuber M, Ilner T, Samii M, Brandis A, Lenarz T, Stöver T. Erythropoietin and Erythropoietin Receptor Expression in Vestibular Schwannoma: Potential Role in Tumor Growth. Skull Base 2007. [DOI: 10.1055/s-2006-957289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|