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Objectives: Handheld otoscopy is the standard tool used to teach ear examination in undergraduate and postgraduate medical education. Previous studies have shown that the undergraduate teaching of ear examination with handheld otoscopes is inadequate, resulting in low self-reported levels of student confidence in their diagnostic skills. With the increase in popularity of endoscopic ear surgery, an increasing number of otolaryngologists are using endoscopes for office examinations of the ear due to the method’s superior visualization and excellent image qualities. However, medical students usually do not receive exposure to endoscopic ear examination during their undergraduate curriculum. The aim of this study is to assess our preliminary experience with teaching endoscopic ear examination to undergraduate medical students.Methods: A two-hour-long pilot practical course on basic ear examination was administered to undergraduate medical students with little to no previous experience with ear examination. The course was designed to minimize the duration of campus attendance and patient contact during the COVID-19 pandemic. The course included theoretical didactics, exemplary digital endoscopic images and peer physical practice of ear examination with both a handheld otoscope and a 0-degree endoscope. At the end of the course, the students completed a survey questionnaire consisting of eight questions mainly relating to their subjective confidence level with ear examination using either handheld otoscopes or endoscopes and their overall preference for either examination tool.Results: Most students expressed a preference for ear examination with endoscopes over that with handheld otoscopes and reported an improved confidence level in their diagnostic ability with the former technique. The vast majority of students supported the teaching of endoscopic ear examination to future medical students.Conclusion: The findings of this pilot project report and survey study support the early exposure of novice medical learners to endoscopic ear examination, which may help improve the confidence and diagnostic skill of medical students with regard to ear examination. The findings may have implications for the undergraduate teaching of ear examination in the post-COVID-19 era.

Using cytology, histopathology, and DNA sequencing the diagnosis of canine leproid granuloma (CLG) was made in 2 dogs. The dogs were presented with nodular skin lesions on the head and pinnae. CLG is caused by nontuberculous mycobacteria that have not yet been finally classified. To date, this disease has been reported in Australia, New Zealand as well as North and South America, however no case reports have been published in Germany until now. In both cases, a combination of surgery and long-term drug administration (rifampicin, clarithromycin, doxycyclin and local application of clofazimin) was chosen and successfully eliminated the granulomas., Competing Interests: Die Autorinnen erklären, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Vertigo and dizziness are frequent chief complaints in clinical practice. Symptoms may originate from otological, neurological, medical and psychiatric etiologies, which poses an interdisciplinary challenge. Systematic analysis of case history and clinical examination generally allow classification into peripheral-, central- or non-vestibular disorders. The most important criteria for differentiation are the timeline, quality of symptoms, modulating factors and accompanying symptoms. As concerns the clinical examination, the following tests are relevant: head impulse test, test for spontaneous nystagmus, positional nystagmus, central ocular motor signs and the Romberg test. However, neuro-otological disorders with combined peripheral and central vestibular pathology do exist. Occlusion of the anterior inferior cerebellar artery results in ischemia of the labyrinth and cerebellum and therefore causes acute vestibular syndrome and unilateral hearing loss. Repetitive attacks of vertigo or dizziness which are accompanied by ear symptoms and headaches may be due to an overlap syndrome of Menière's disease and vestibular migraine. In this case patients often have to be treated with a dual prophylactic medication to control symptoms. In case of chronic dizziness and instability of gait a subsample of patients may suffer from CANVAS, which is a combination of bilateral vestibulopathy, a cerebellar syndrome and polyneuropathy. Chronic dizziness with signs of peripheral and central vestibular dysfunction can also originate from tumors of the cerebellopontine angle with compression of central structures. In conclusion, the diagnostic algorithm in the workup of patients with vertigo and dizziness should always include tests for peripheral and central vestibular and ocular motor function.

This article presents a review of diseases of the temporal bone which are relevant for radiologists in routine clinical practice. First the most prominent imaging methods will be briefly summarized with respect to the current state of the art and the most important aspects of cross-sectional anatomy of the temporal bone will be presented. This is followed by the presentation of various inflammatory diseases. Fractures (longitudinal, transverse and mixed fractures), auditory ossicle lesions and contusions of the labyrinth will be discussed in connection with injuries of the temporal bone. Tumors and tumor-like lesions and the clinical symptoms of otosclerosis and malformations will also be discussed. Finally the postoperative use of imaging methods will be presented. Special importance is given to the position of imaging techniques in the diagnostic chain and their evidential value. This is supplemented by special morphological imaging characteristics and aspects of differential diagnostics.

Fractures of the temporal bone result from direct trauma to the temporal bone or occur as one component of a severe craniocerebral injury. Complications of temporal trauma are hemotympanon, facial nerve paralysis, conductive or sensorineur hearing loss, and leakage of cerebrospinal fluid. Early recognition and an appropriate therapy may improve or prevent permanent deficits related to such complications. Only 20-30% of temporal bone fractures can be visualized by plain films (7). CT has displaced plain radiography in the investigation of the otological trauma because subtle bony details are best evaluated by CT which even can be reformatted in multiple projections, regardless of the original plane of scanning. Associated epidural, subdural, and intracerebral hemorrhagic lesions are better defined by MRI.

Unlabelled: The use of T2-weighted spin-echo sequences is mandatory for identifying tumours in the ENT region and for differential diagnosis of pathological findings. A highly promising alternative to time-consuming conventional SE sequences is now available in the fast-spin-echo sequences (FSE). FSE was compared with the conventional SE (CSE) basing on 100 assessments of examinations of 20 patients., Results: Conventional SE = TR/TE = 1800/90 ms with one average (NEX), FSE = TR/TE = 3200/120 ms with 4 averages (NEX). Measurement time CSE 6:59 min, FSE 3:12 min. Analysis was performed in analogy to on ROC analysis by 5 radiologists as a blind study. The anatomic differentiation and contrast performance were compared as well as the differentiation and definition of lesion and lymphatic node and a subjective overall assessment. Differentiation of pathological findings was the same with both sequences. FSE was superior to CSE in the visualisation of normal tissue, lymph nodes and also in the subjective overall assessment. The following criteria were employed in the subjective overall valuation: sum total of impressions gathered from contrast behaviour or performance, susceptibility to artifacts, and signal-to-noise ratio. Due to the definitely improved parameters of image quality and the markedly reduced scanning time--which is reduced to 50%--FSE will replace the conventional spin-echo sequence in routine diagnostics.

According to the majority of cases under observation the following anomalies could be found: extended, separated or manifold developed crura of the stapes, reduction in the circular windings of the cochlea down to 1 1/2 with a normal development of Corti's organum, reduction of the nerve structures of the nervus cochlearis to a munimum and an open facial canal.

The experiences of a simplified multiscreen millimeterlayer ear-tomography technique are reported. The number of patients examined 1969-1978 was 2000 and of these 730 were subjected to microsurgery. The accuracy of the tomographic method was evaluated by a correlation between the preoperative radiographic diagnoses and the peroperative findings. The diagnostic accuracy of multiscreen tomography was much better than expected. The advantages of the method are discussed. It is concluded that multiscreen millimeterlayer eartomography may profitably be used not only in larger departments but also in smaller units.