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Hintergrund Die Ultraschalldiagnostik gilt für den Radiologen, Hals-Nasen-Ohren-Arzt (HNO) oder Mund-Kiefer-Gesichts-Chirurgen als Standard in der Abklärung zahlreicher Pathologien. Es besteht ein Konsens, dass die digitale Dokumentation heute dringend notwendig ist, um die Qualität der sonographischen Dokumentationen zu verbessern und zu standardisieren. Es häufen sich Publikationen zur Implementierung standardisierter Befunddokumentation einschließlich der Kopf- und Halssonographie. Ziel der Arbeit Die vorliegende Arbeit zielt darauf ab, die Qualität von routinemäßig angefertigten Kopf- und Halssonographiebefunden nach Kriterien der Kassenärztlichen Vereinigung (KV) Bayern an einer Auswahl deutscher HNO-Universitätskliniken stichprobenartig zu ermitteln. Material und Methoden Insgesamt wurden retrospektiv 70 zufällig ausgewählte, anonymisierte schriftliche Befunde einschließlich Bildmaterial von insgesamt 7 HNO-Universitätskliniken stichprobenartig nach KV-Kriterien durch einen erfahrenen Prüfer der KV Bayern ausgewertet und deskriptiv analysiert. Ergebnisse Von 70 Befunden konnten 69 ausgewertet werden. Die Dokumentationsvollständigkeit lag im Mittel bei 80,6 %. Neun Befunde waren vollständig korrekt dokumentiert (13 %). Die Dokumentationsvollständigkeit der einzelnen Kliniken lag zwischen 68,1 % und 93 %. Mit 88,5 % vs. 75 % erbrachte eine strukturierte Befundung eine höhere Befundvollständigkeit. In 75 % der Fälle verfügten die Kliniken mit strukturiertem Befund auch über digitale Dokumentationslösungen. Schlussfolgerung Die Vollständigkeit und Qualität von routinemäßig angefertigten Kopf- und Halssonographiebefunden an einer Auswahl von HNO-Universitätskliniken ist insgesamt optimierbar. Die Implementierung strukturierter Befundmasken und die Umstellung der analogen Dokumentation auf digitale Lösungen sowie Vernetzung mit dem Klinikinformationssystem (KIS) und Bildarchivierungs- und Kommunikationssystem (PACS) sollte weiter vorangetrieben werden. Darüber hinaus sind leitende Ärzte dazu angehalten, die Befundqualität unerfahrener Kollegen regelmäßig zu prüfen und im Rahmen der Facharztausbildung auf die Erfüllung entsprechender Standards wie der KV-Ultraschallvereinbarung hinzuarbeiten. Background Ultrasound diagnostics are widely used and are standard for radiologists, otolaryngologists, and oral and maxillofacial surgeons in the diagnostic work-up of various pathologies. There is agreement that digital documentation is urgently needed at present to improve and standardize the quality of sonographic documentation. There are more and more publications on the implementation of standardized documentation of findings in imaging diagnostics, including head and neck sonography. Objective The present work aims to determine the quality of routine head and neck sonography findings on a random basis, according to the criteria of the Bavarian Association of Statutory Health Insurance Physicians (KVB) at a selection of German university otolaryngology departments (ENT). Materials and methods A total of 70 randomly selected anonymized written findings including image documentation from seven ENT departments were retrospectively analyzed by an experienced KVB examiner concerning fulfilment of KVB criteria. The data were evaluated descriptively. Results Of the 70 reports, 69 were eligible for evaluation. The average documentation completeness was 80.6%. A total of 9 findings were correctly documented in full (13%). The documentation completeness of the individual departments was sorted in ascending order from 68.1% to 93%. With 88.5% vs. 75%, the hospitals with a structured report showed a higher level of completeness. In 75% of the cases the hospitals with structured reports also had digital solutions for reporting and image archiving. Conclusion In general, there is potential for optimization regarding the completeness and quality of routinely prepared head and neck sonography findings at the selected university ENT departments. The implementation of structured reporting masks and the conversion of analogue documentation into digital solutions as well as digital networking with the hospital information systems, picture archiving and communication systems should be promoted. Supervision by senior doctors is required to ensure the quality of findings of inexperienced colleagues and to help to achieve standards in reporting.

To report the standard of care, latest advances, interesting new findings, and controversies about the treatment of Bell’s palsy in the acute phase. Treatment with prednisolone alone within 72 h still is the treatment standard. The role of antivirals still is unclear. Since 2009, no trials with influence on the treatment standards have been performed. A study to clarify the role of prednisolone treatment in children is ongoing. Patient-related outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability Index are important tools to assess the quality of life and psychosocial impact of Bell’s palsy next to the motor deficits. Simplified subjective electronic grading systems like the eFACE and first automated image analysis systems have been introduced. Studies clarifying the role of antivirals for severe cases are urgently needed as well as an international consensus on the outcome measures in diagnostics and follow-up.

Hintergrund: Trotz der Einfuhrung von Sicherheitsgurten und Kopfstutzen ereignen sich weiterhin schwere Halswirbelsaulen (HWS)-Verletzungen bei Verkehrsunfallen. In dieser Untersuchung wurde an gesunden Probanden uberpruft, ob es anthropometrische Faktoren oder muskulare Eigenschaften gibt, welche die Reflexzeiten wahrend einer Heckkollision beeinflussen konnen. Methoden: Bei 32 mannlichen Probanden wurden anthropometrische Daten und die Maximalkraft der Halsmuskulatur bestimmt. Anschliesend wurden die Probanden einer simulierten Heckkollision mit einer Geschwindigkeit von 2 km/h ausgesetzt. Der Aufprall wurde dem Probanden beim ersten Testdurchlauf vorher nicht angekundigt. Die Situation wurde mehrmals wiederholt, um den Effekt der Vorwarnung zu testen. Wahrend der Untersuchung wurde die Muskelaktivitat von Hals- und Schultermuskulatur mittels Oberflachen-Elektromyografie (EMG) abgeleitet. Ergebnisse: Es bestand eine hohe Korrelation zwischen der Reflexzeit der vorderen Halsmuskulatur und der Kraft dieser Muskelgruppe (r=−0,75; r²=0,57). Auserdem stellte sich die Nackenlange als individueller Einflussparameter auf die Reflexzeit dar (r=−0,67; r²=0,45). Als ein weiterer Einflussfaktor auf die muskulare Reaktion wahrend einer Kollision zeigte sich die Vorwarnung. So sind die Reflexzeiten der Probanden signifikant kurzer (p Schlussfolgerung: Hohe Kraftwerte der vorderen Halsmuskulatur haben praventive Wertigkeit fur die Reduktion beschleunigungsinduzierter Verletzungen. Der Einsatz und die Weiterentwicklung von Fruhwarnsystemen in Pkws sollte unterstutzt werden.

Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients' quality of life.This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo.The present review describes a PubMed-based search of the literature of the past 10 years.There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control.There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.

Despite the introduction of safety belts and head restraints, severe neck injuries still occur in traffic accidents. Whether there are anthropometric factors or muscular properties, that affect the reflex times during a rear-end collision, and if they have predictive value for the expected trauma, should be reviewed in this investigation.In 32 male volunteers anthropometric data and the maximal strength of their cervical musculature were measured. Thereafter, the volunteers were subjected to a simulated rear-end collision with a speed of 2 km/h. The impending crash was not announced to the subjects during the first test run. The situation was repeated several times to test the effect of warning. During the investigation, the muscle activity of neck and shoulder muscles was derived with surface electromyography (EMG).There was a strong correlation between the reflex time of the anterior neck muscles and the strength of that muscle group (r=-0.75; r²=0.57). In addition, the neck length correlated to the reflex time (r=-0.67; r²=0.45). The warning provided for the volunteers influences the EMG as well. The reflex times of the subjects were shorter (p Alle statistischen Berechnungen wurden mit IBM SPSS Statistics (Version 18; IBM Inc., Armonk, USA), sowie dem Programm Excel, (Microsoft, Redmond, USA) vorgenommen. Die Reflexzeiten wurden den anthropometrischen Daten, sowie der Muskelkraft gegenübergestellt und nach Pearson korreliert. Als eine angemessene Korrelation wurde das Quadrat des Korrelationskoeffizienten bei Werten r²0,4 festgelegt. Außerdem wurden die Mediane der Reflexzeiten, der verschiedenen Kollisionssituationen miteinander verglichen. Das Signifikanz-Niveau wurde auf p0,05 festgelegt. 0.05), when they knew about the impending collision.A high force capacity of anterior neck muscles has preventive value to reduce the consequences of whiplash accidents. The use and development of early warning systems in cars should be supported.

A validated instrument to measure patient-related outcome and quality of life in facial palsy is not available in German language.2 appropriate questionnaires, the Facial Clinimetric Evaluation (FaCE) scale and the Facial Disability Index (FDI) were translated and validated according to international guidelines. The internal consistency of both German versions was assessed. The results of FaCE and FDI were correlated with results of the SF-36, the House-Brackmann scale and the Stennert index.122 facial palsy patients with a median duration of 4.7 months were included. FaCE and FDI showed good to very good psychometric characteristics with Cronbach's alpha values between 0.667 and 0.907. Both questionnaires were able to distinguish different degrees of facial palsy. The comparison to the SF-36 shows the highest correlation with the subscale social function.The German versions of the FDI and FaCE are valid and should now be applied more frequently to assess the disease-specific quality of life in patients with facial palsy.

Facial palsy is not only a movement disorder but leads also to an emotional and communicative disorder in chronic stage but also in some patients already during the acute phase of the disease. The present review describes the current knowledge of the neurobiological and psychological fundamentals on the relation of facial movement and its emotional context. So far there is not much knowledge on the impact of a facial palsy on the interaction between facial movement, emotional processing and communicative skills of the patient. The emotional contagion seems to be reduced in patients with facial palsy. The ability to express emotions seems also to be reduced. Moreover, the patients feel to be perceived negatively. In fact, most of the expressions of patients with facial palsy are allocated with a negative affect even when the patients are smiling. Patients with facial palsy react with negative stress, anxiety and depression. The patients avoid social contacts. In turn, this reinforces the communicative disorder. The otorhinolaryngologist can use the Facial Disability Index as a simple questionnaire to detect such dysfunctions. Diagnostics that are necessary to develop a therapy program are presented in this review. Standardized therapy concepts that are not only treat the movement disorder but also the emotional context is missing so far. Finally, the review will give an outlook on potential therapy strategies.

A 31-year-old female teacher presented with a 6-month history of progressive hoarseness. The rigid laryngeal endoscopy showed corresponding transversal cream-yellow nodular lesions in the submucosal space of the middle third of both vocal folds. These are characteristic for bamboo nodes which are rare and strongly associated with autoimmune disease. In the present case a hitherto undiscovered Sjögren syndrome was diagnosed. After surgical excision, local steroid therapy and voice training a considerable voice improvement could be achieved.

Tonsillectomy leads to strong postoperative pain. Pain management often is not optimal after tonsillectomy. To date, there exists no clear guideline for pain management after tonsillectomy.In a prospective study 65 tonsillectomy patients were examined at the first postoperative day within the QUIPS project. This allowed a standardised assessment of patients' characteristics, pain parameters, outcome and process parameters. The influence of these parameters on the patients' postoperative pain was estimated with univariate and multivariate statistic analysis.All patients report of constant slight pain during the first postoperative day after tonsillectomy. Although maximal pain intensity was moderate, overall, patients were satisfied with the pain management. Pain management did not result in relevant side effects. Younger patients suffered significantly more from maximal pain than older patients. The same was obvious for patients who needed pain killers already prior to surgery. Perioperative antibiotic treatment and specific counselling about the possibilities of postoperative pain management reduced pain intensity highly significant in univariate and multivariate analysis. Patients receiving opioids on the ward postoperatively had significantly less pain.QUIPS is a very good tool to evaluate the quality of postoperative pain management in one's own hospital. Next step, a detailed comparison to the best practise of other hospitals participating at QUIPS will follow in order to improve and standardize pain management for adult tonsillectomy patients.

Idiopathic facial palsy (IFP), or Bell's palsy, is an acute peripheral unilateral paresis of the facial nerve with an abrupt onset of unknown origin. Primary infection or reactivation of the Herpes simplex virus is suggested as a possible mechanism in some but not all patients. Since IFP is a diagnosis of exclusion, all other causes, especially other neurological diseases or Herpes zoster reactivation need to be excluded, as does Lyme disease in children and endemic areas. If recovery or defective healing has not taken place within 6-12 months, it is mandatory to exclude malignant disease. Severity of the paresis and electromyography are to date the best prognostic markers for defective healing. Steroid application is the only evidence-based therapy to date with recovery rates90%. The spontaneous recovery rate is about 80%. There is a lack of well defined diagnostic procedures to detect those patients who will recover spontaneously. On the other hand, patients with severe complete paresis might profit from additional antiviral drugs. There is an urgent need for further clinical trials in patients with severe IFP.