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Background: Cystic fibrosis (CF) is a complex systemic disease involving numerous organ systems. With improved treatment options and increasing life expectancy of persons with CF (PwCF), extrapulmonary manifestations are coming increasingly into the focus. From birth, almost all PwCF have radiologically detectable pathologies in the upper airways attributable to CF-associated chronic rhinosinusitis (CF-CRS)., Objective: The aim of this work is to provide an up-to-date overview of CF-CRS from the otorhinolaryngology perspective and to provide the reader with background knowledge and current developments., Pathophysiology: The cystic fibrosis transmembrane conductance regulator (CFTR) gene defect leads to increased viscosity of sinonasal secretions and reduced mucociliary clearance, causing chronic infection and inflammation in the upper airway segment and, consequently, to CF-CRS., Clinical Picture and Diagnostics: The clinical picture of CF-CRS comprises a wide spectrum from asymptomatic to symptomatic courses. CF-CRS is diagnosed clinically and radiologically., Therapy: Sinonasal saline irrigation is recommended as a conservative treatment measure. Topical corticosteroids are also commonly used. Surgical therapy is reserved for highly symptomatic treatment-refractory patients without a sufficient response to conservative treatment including CFTR modulator (CFTRm) therapies. Depending on the CFTR mutation, CFTRm therapies are the treatment of choice. They not only improve the pulmonary and gastrointestinal manifestations in PwCF, but also have positive effects on CF-CRS., Conclusion: The ENT specialist is part of the interdisciplinary team caring for PwCF. Depending on symptom burden and treatment responsiveness, CF-CRS should be treated conservatively and/or surgically. Modern CFTRm have a positive effect on the clinical course of CF-CRS., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Digitalization is also becoming increasingly important in medicine. The COVID-19 pandemic has further accelerated this process and politicians are trying to create a framework for successful knowledge transfer and better digital medical care. This article describes the role of telemedicine in the treatment of patients suffering from facial nerve palsy. Facial nerve palsy has a wide range of effects, from limitations in facial mobility to psychological sequelae. While many of the acute, idiopathic facial nerve palsies improve after a few weeks, around a third of those affected develop synkinesis, involuntary movements that have lifelong functional and psychological consequences. Treatment includes various modalities, from medication and surgery to movement training. Telemedicine offers innovative solutions in cases of regional underuse, but also in the treatment of chronic facial nerve palsies. The article defines the term "telemedicine" in the current context and presents different types of application. A detailed analysis of the application scenarios of telemedicine in facial nerve palsy patients shows that despite a lack of evidence, many potentially useful concepts exist., (© 2024. The Author(s).)

Background: There is no established method to objectively measure the moisture status of nasal mucosa. In a pilot study it was shown that a nasal Schirmer test is a possible method. The aim of the current study was to check whether the nasal Schirmer test is suitable to define moisture status in cases with an expected pathological secretion., Materials and Methods: Initially, 154 subjects participated, of whom n = 112 were included (healthy n = 65, deviated septum n = 47, ♂ 60, ♀ 52, median age 33 years). After evaluation of various test strips, the most suitable one was placed on both sides of the mucosa of the anterior septum. Secretion running distance (SRD) was measured in mm after 10 min. In addition, rhinomanometry (AAR) and acoustic rhinometry (AR) were performed. Healthy volunteers and subjects with septum deviation were compared, and subjects were also compared in terms of smoking behavior and age (<60 and ≥60 years)., Results: The total median SRD was 12 mm. SRDs between 9 and 14 mm were considered physiological. In non-smokers, SRD was significantly higher in all groups compared to smokers (p > 0.05). Nasal side, age, and deviated septum had no significant influence on SRD (p < 0.05). There were no correlations between SRD and AAR or AR., Conclusion: Our results confirm that a statement about moisture of the nasal mucosa is possible based on a nasal Schirmer test. Standard values of SRD are relevantly influenced by the respective test strip. Smoking is associated with a drier mucosa. Further investigations on the nasal Schirmer test in patients with expected atrophy of the nose, e. g., Sjogren's or empty nose syndrome, should be performed.

The second part of this continuing medical education article focuses on sonographic assessment of the salivary glands, cervical paraganglioma, angioma, esophagus, extra cranial blood vessels and the temporomandibular joint. The currently available minimally invasive therapeutic options (e. g. sialendoscopy, lithotripsy, therapeutic duct lavage and extracapsular dissection) for salivary gland disease presuppose a precise imaging modality. Modern ultrasound is able to meet this challenge, making additional imaging a rare necessity. Regions of the neck with a difficult topography (esophagus and hypopharynx) can often be successfully portrayed sonographically. Furthermore, ultrasound enables functional evaluation of swallowing in the cervical parts of the esophagus in dysphagia patients. In addition to the branchial cleft anomalies and lymph nodes discussed in part 1, paraganglioma, angiomatosis and neurogenic tumors are important differential diagnoses of solid lesions of the neck. Finally, venous and arterial alterations of the extracranial vessels of the neck relevant to clinical routine are depicted, as are pathological conditions of the temporomandibular joint relevant to the otorhinolaryngologist.

The most common types of vertigo caused by diseases of the peripheral vestibular system are benign paroxysmal positional vertigo (BPPV), Meniere's disease and vestibular neuritis. A thorough examination of the medical history and clinical examination are usually sufficient for the differential diagnostics. Treatment includes differentiated repositioning maneuvers, medicinal treatment and physiotherapy.

Acupuncture as a complementary method provides optimal conditions for ENT specialists, particularly when somatotopic microsystems are used, e.g., ear, skull, and oral acupuncture. Via points of these systems, pain conditions and functional disorders as well as specific ENT indications (e.g., rhinitis pollinosa, sinusitis, pharyngitis) can be treated successfully. Therapy is performed quickly and without side effects.

Facial pain and headaches are heterogeneous, therefore, a differential diagnosis, interdisciplinary survey and mapping of the pain symptoms are essential for determination of treatment concepts. This requires an otorhinolaryngology (ENT) adapted zoning of the various pains in the head and neck in line with the classification of the International Headache Society (IHS). In this review, idiopathic, symptomatic and neuralgic facial pain and headaches will be differentiated and classified according to their location from the ENT medical point of view. This provides otolaryngologists with a simplified, targeted diagnosis and subsequent indication for therapy.

Quality of life is multidimensional and comprises physical, emotional, and social aspects. It has always been the implicit focus of medical work. However, since the 1980s it has been possible to measure it explicitly. Quality of life is impaired in dysphonic patients; this finding is supported by specific studies on self-reported physical, emotional, and social well-being. For practical application of these data, it is recommended to measure all three domains. From a therapeutic point of view, verbal intervention following the PLISSIT model (permission, limited information, special suggestions, intensive therapy) has been proven to enhance patient satisfaction. Therefore, this clinical procedure is recommended for routine application in dysphonic patients.

This review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.

Chronic rhinosinusitis (CRS) is a disease of remarkable medical and economic importance. Therefore, assessment of the objective as well as the subjective outcomes of different therapeutic strategies in CRS patients is of growing interest. Validated quality-of-life (QOL) instruments are one important means of assessing the subjective outcomes of patients. The Short Form 36 Health Survey (SF-36) is the most frequently used generic instrument in medicine and is typically used in prospective studies. A German version of this questionnaire has been validated, providing normative data as well as data for comparison with other diseases. The Glasgow Benefit Inventory, which was designed for retrospective studies, is another frequently used QOL instrument. Several disease-specific measuring instruments for use in CRS patients have been developed during the last 15 years. In this review, we evaluate 11 disease-specific QOL instruments. Only four of these instruments cover the four main symptoms of CRS and are validated instruments as well. The most frequently used instruments [Sino-Nasal Outcome Test 20 (SNOT-20) and the Chronic Sinusitis Survey] do not query all of the main symptoms of CRS, whereas the only validated German instrument (SNOT-20 GAV) meets this requirement. For the latter instrument, a grading scale is available that allows interpretation of the results for a single patient.

Background: Thyroid carcinoma is frequently diagnosed incidentally during routine ENT examinations., Methods: Symptoms and clinical findings of 40 patients with thyroid malignancies presenting in our department were analysed retrospectively. The aim was to define characteristics indicative for the final diagnosis of thyroid malignancy., Results: In 48% the initial presentation was not because of thyroid-specific complaints, however during the course of the general ENT examination, unspecific thyroid pathology was detected and further evaluated using sonography, scintigraphy and fine needle biopsy (FNB). The results of scintigraphy were suspicious in 67% and FNB was positive in 30%, inconclusive in 30% and false negative in 40%. For suspected malignancies a rapid frozen section examination was carried out which was positive only in 60% and false negative or inconclusive in 20% each., Conclusion: Thyroid lesions incidentally found during ENT examination should undergo ultrasound examination, FNB and scintigraphy with the clear understanding that there is no single diagnostic feature leading to the correct diagnosis and that only the synopsis of various findings and sometimes only final histology leads to the correct diagnosis.

This article describes the value of laboratory diagnostic procedures in the diagnostic arsenal of otolaryngologists. The rational and therefore the rationale of the application of laboratory medical methods are critically evaluated. In the era of diagnosis-related groups a high value is placed on a rational laboratory diagnostic, in the sense of a cost-oriented medicine, so that the laboratory diagnostic procedure is always carried out in stages, just as in other diagnostic procedures. The possibilities of clinical chemistry, separated into the theme blocks "clinical chemical basic diagnostics", "haematological parameters", "coagulation investigations" and "immunological diagnostics" are demonstrated based on examples. These are aimed at the needs of otolaryngologists, in that the emphasis in each theme block is centred on the indications and evaluation of the individual laboratory investigation.

The number of Germans practicing sea diving has grown, so doctors are increasingly confronted with questions pertaining to diving. They concern not only patient fitness but also prevention and therapy of associated disorders and disease. This article describes predisposing factors and otologic, rhinologic, and laryngologic problems associated with diving. The most common medical problem is inflammation of the external auditory canal; the most common -Barotrauma is to the middle ear. Case studies are used to demonstrate these and other disorders associated with diving.

In line with the rising number of recreational divers, the otorhinolaryngologist has to deal with growing numbers of diving-associated disorders of the ear, nose and throat (ENT). Nevertheless, the majority of divers present to their ENT doctor for assessment of their fitness to dive. On the basis of long-term follow-up examinations and increasing experience in diving medicine, even divers with a history of ENT problems can be considered fit to dive. Therefore, diving is possible after tympanoplasty, surgery to improve hearing including stapesplasty, after implantation of middle ear amplifiers or cochlear implants, after sinus or scull base surgery and even after canal wall down mastoidectomy, provided that certain requirements are fulfilled. Assessing fitness to dive after inner ear barotrauma as well as after inner ear decompression illness requires meticulous consideration of residual damage and possible underlying conditions like vascular right-to-left shunts. This article is based on the new recommendations of the German Undersea and Hyperbaric Medical Society for the assessment of fitness to dive in the otorhinolaryngological field.

About 10% of all sport scuba divers are children and adolescents. Little is known about the particular risks and consequences of this sport on a child's health. Due to the peculiarities of childhood anatomy and physiology, certain restrictions apply to the diving fitness of children and adolescents. Before starting scuba training, the presence of particular cognitive abilities must be demonstrated and eustachian tube dysfunction must be ruled out by a specialist. Medical contra-indications to scuba diving for adults apply to children too but must be adapted. Relative risks for adults may translate to absolute contra-indications in children and adolescents. When planning dives, there should be rigorous limitations as to depth and time. Experienced adult divers must always assist with dive planning and accompany children and adolescents when scuba diving.

The clinical manifestation of analgesic intolerance (AI) is frequently associated with symptoms examined by ear-nose-throat (ENT) specialists. The prevalence of AI is reported in the literature to be 0.6-2.5%. Even though there are no concluding results concerning its pathogenesis, an altered arachidonic acid metabolism is most likely the underlying pathomechanism. The symptoms include chronic rhinosinusitis with nasal polyps, asthma, gastrointestinal ulcers, angioedema, and urticaria. Clinical reactions after ingestion of nonsteroidal anti-inflammatory-drugs (NSAIDs) are often obvious in the progress of disease. In order to initiate early therapy and therefore prevent the progress of disease, the diagnosis of AI should occur before the complete picture of AI is obvious. Adaptive desensitization is currently the single causal therapy. Frequency of endonasal revision surgery is reduced after desensitization; severe asthma and reactions after ingestion of NSAIDs are avoided. ENT specialists are particularly in a key position for early detection of AI.

The beneficial use of heat in the context of medical treatments was documented even in ancient times. The development of high-frequency alternating current generators led to actual electrosurgery, in which primary heating of the tissue takes place. In day-to-day clinical practice electrosurgery is used for coagulation and for electrotomies. There are both unipolar and bipolar techniques for these procedures. When a unipolar technique is used the active electrode is in the tip of the instrument and the patient plate is usually affixed to the patient's skin at a site outside the operating field. The bipolar technique differs in that there are no electrodes that need to be attached externally; both poles are contained inside the operating instrument, e.g. in the two prongs of a forceps. In radiofrequency surgery high-frequency electrical energy is applied directly into the tissue by a unipolar or bipolar technique. In this way it is possible to cause interstitial tissue lesions while sparing the superficial mucous membranes.

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder characterised by marked problems with inattention and increased impulsiveness, with or without hyperactivity; in most cases it becomes obvious in nursery-school-age children, and the latest point for its initial appearance is while the child affected is at primary school. Even in children of normal intelligence, the cognitive, emotional, and social development is decidedly limited, which can have corresponding ramifications for adult life. If left untreated it can progress to dissocial development and give the impression of an impulsive personality disorder in adulthood.ENT specialists are also confronted with children, adolescents and even adults in whom ADHD has already been diagnosed in the course of investigations/treatment. If the suspicion of hearing impairment as the cause of problems in daily life is not confirmed in a patient not hitherto known to have ADHD ENT specialists should also consider ADHD in the differential diagnosis. In this report the diagnostic and therapeutic strategies currently applied for ADHD and their importance for ENT specialists are presented.

Objective: The occurrence and characteristics of simulation and aggravation in audiology still lack detailed scientific research. A reliable and reasonable classification of simulation and aggravation, which could help assess a patient's cooperative behavior, has not been defined., Patients and Methodology: All patients who underwent an audiological medical examination were included in this study prospectively. These patients were examined based on a well structured and predetermined sequence of actions. As a result, they were grouped into one of four categories, from category 0 for no simulation or aggravation to category III for severe simulation and aggravation. For category III, reliable and valid thresholds for pure tone audiometry only can be achieved by using objective audiological measurements such as brainstem electric response audiometry. Measured thresholds were then compared with simulated or aggravated thresholds and finally correlated with socio-economic factors., Results: A total of 61 individuals were included in this study. Only 42% (26/61) showed no simulation or aggravation (category 0). In all 10% were grouped in category III. The remaining 48% fell into categories I and II. Statistical evaluation revealed no significant differences in thresholds between categories I, II and III. The tendency to simulation or aggravation increased with patient' age, level of education and the frequency of medical examinations prior to this investigation., Conclusion: Simulation and aggravation is a frequent phenomenon (approximately 58% of all audiological examinations). Additional work on defining a unique schema for the classification of simulation and aggravation is necessary. The use of such a schema is highly recommended.

Castleman's disease, also called angiofollicular lymph node hyperplasia or benign giant lymphoma, is a rare lymphoproliferative disorder of unknown etiology. Three histologic subtypes are described--hyaline vascular (80-90%), plasma cell (10-20%), and mixed (rare). In the clinical setting, localized and multicentric entities are distinguished. Due to the lack of tumor-specific clinical, biochemical, and radiological features, final diagnosis of Castleman's disease depends on histopathology. Surgical tumor resection is the treatment of choice for localized disease. Prognosis is good, and adjuvant therapy is not required. Therefore, early invasive removal and histopathological differentiation from neoplasia is mandatory. In contrast, the prognosis for multicentric Castleman's disease remains poor even if multimodal treatment regimens are employed. Major clinical symptoms, histology, and therapy are summarized, and the disease characteristics are highlighted presenting the case of an 11-year-old girl. On admission, the patient complained of a painless pharyngeal tumor mass and ipsilateral lymph node swelling. Magnetic resonance imaging revealed a parapharyngeal contrast-enhancing lesion extending from the hypopharynx to the skull base without signs of infiltration and accompanied by ipsilateral lymph node hyperplasia of the neck. Laboratory test results were within normal limits. After tumor resection, histopathological examination, and clinical staging, localized Castleman's disease was diagnosed (hyaline vascular subtype).

The second part of the article deals with the use ear and body acupuncture for disorders of the nose, the paranasal sinuses and the ear, including the cerebral structures of the hearing system. It is pointed out that acupuncture must be based on orthodox medical diagnosis. The reader will learn when acupuncture may serve as a "stand alone" method, when it may be an additional option supporting orthodox therapy and when it must not be applied.

The two parts of this article describe acupuncture-therapy in several important ear, nose and throat disorders. The first part deals with diseases and functional disorders of the trachea, larynx, pharynx and mouth. The possibilities and limitations of treatment by ear and body acupuncture are discussed. Connections between traditional Chinese medicine and orthodox medicine are pointed out for some diseases.

Plastic and reconstructive ENT surgery serves for reconstruction of form and function. Frequent indications in ENT surgery are the covering of large tissue defects after tumor operations, firing and/or explosion injuries, accidents, burns or massive infections. A high revision rate of up to 20 % in selective patient groups show that more knowledge of both monitoring and ischemia-/reperfusion mechanisms is necessary. Besides improved monitor proceedings biochemical cell procedures in pedicled and free flaps are getting more focused. In the last years certain physical and medical factors appear, which have influence on the long-term surviving of a pedicled or free flap, e. g. pre- and/or postconditioning. The increasing knowledge of changes in perfusion and oxygenation, which prevail in the flap, as well as different options of physical and pharmacological therapies permit a promising view into the future, in order to achieve an improved surviving of a pedicled or free flap in combination with improved monitor proceedings.

The first part of the article deals with the indication of fitting, which mainly is given when the communication is impaired, not only in dialogue with one person, but also in conversation with several persons and in noisy surrounding. Yet, the healthy insurances cover only the expenses if the guidelines on relief-aid are considered, which are exactly listed in this article. Bevor starting the fitting of an Hearing Aid, special diagnostic tests are necessary, such as pure tone audiogram, speech audiogram including dB(opt), freefield measurement in noise, and several retrocochlear tests, as well as tinnitus determination and masking with narrow-band and broad-band noise. Most important is the correct filling in the form "Ohrenärztliche Verordnung einer Hörhilfe", including the necessity of renewal. In addition, it is necessary to accentuate the need of trying out several Hearing Aids and to let the patient know that digital Hearing Aids will not be covered by the health insurance.

The increasing incidence and the potentially life-threatening reactions to venom stings indicate the necessity for otolaryngologists to have a basic knowledge of the diagnosis and treatment of venom allergy. The diagnosis of insect venom allergy is based on the history, skin prick testing (ideally performed as a titration series), and in vitro analysis of specific IgE antibodies to venoms. An emergency medication kit should be prescribed for the patient in case of future venom stings, comprising an H1-blocking antihistamine, a steroid and an adrenaline pen for self-injection. Subcutaneous allergen-specific immunotherapy (sSIT) is the standard treatment to avoid allergic reactions following venom stings in the future. SIT is indicated following all immediate-type reactions to venom stings; contraindications relate to the general recommendations of allergen-specific immunotherapy. Aqueous as well as alum-adsorbed depot allergen preparations can be used for subcutaneous injections. The important dose-increase phase can be performed using conventional, cluster, rush or ultra-rush schedules. Specific immunotherapy is successful in nearly 90% to 100% of patients after 3-5 years of treatment.

This case report shows a typical complication of allergic contact dermatitis as it is often seen in hand and foot eczema: relapsing erysipelas. To our knowledge the occurrence of such a complication in the face has never been reported. In the case presented, relapsing facial erysipelas were treated four times in a period of 2 years symptomatically without having identified or eliminated the causing allergen. This clearly indicates how important it is to have a sound knowledge of allergology and its diagnostic procedures, especially in ENT-practice.

Tinnitus lasting for more than 3 months is considered chronic. It is not a self-contained illness as such, but a symptom of a central information processing malfunction with individually distinguishing emotional reactions. However, it can, as chronically decompensated tinnitus, manifest itself as an ailment which is more or less pronounced in the person afflicted, and it can also, as a subjective sensation, be the symptom of an objective illness which must be excluded by differential diagnosis. In the majority of cases of chronic tinnitus, psychological components play a substantial role and must be taken into account in diagnosis. As a rule, no therapeutic impact can be made on chronic tinnitus. The doctor's target is therefore to achieve and stabilise habituation in the person afflicted so that, although the tinnitus will continue to exist, it will no longer be perceived as burdensome. Amongst the causes or contributory factors of tinnitus are dysfunctions of the upper cervical vertebral column and/or of the mandibular joints. In cases of tinnitus, these should always be diagnostically clarified and, wherever possible, eliminated to make habituation easier and to diminish the likelihood of recidivism.

Background: Flow cytometry is the standard method for the multi-parametric analysis of cells. However, for about a decade, an instrument has been available which analyses fluorescing cells immobilised on slides called a laser scanning cytometer (LSC). Its design, according to the principles of slide-based cytometry, promises many advantages, especially in the analysis of minimal sample volumes., Methods and Patients: To date, applications for cultured cells and animal models have been established. Its use for clinical purposes, however, remains to be critically evaluated. We analysed a variety of specimens obtained in our clinical routine., Results: First, the instrument's resolution was evaluated using standardised particles. This showed a very good sensitivity across a wide range of fluorescence intensities at various wavelengths. Next, diverse applications for tissue engineering, immunophenotyping, and ENT-oncology were tested. Considering its microanalytical capacities, LSC proved to be a convincing tool for clinical use. Additionally, complex structures such as bi-layers of cultured cells were analysed., Conclusion: A broad spectrum of applications in clinical practice and research for the LSC is evident.

Otolaryngological bleeding is a highly dangerous condition because it is frequently located close to the upper airways. Additionally, it is often unexpected, especially in children, and can injure important nervous structures of the craniocervical region. Over the years, a broad spectrum of algorithms, innovative technologies and therapeutic options have been developed to reduce the incidence of hemorrhages and improve therapy. Nowadays, close cooperation with an hemostaseologist, anesthesiologist and interventional radiologist is necessary for finding the best strategies for the management of bleeding disorders and vascular lesions. This interdisciplinary dialog, combined with an intimate knowledge of the specific otolaryngological techniques, is the precondition for finding an adequate therapy and fulfilling the increasing medico-judicial and economic requirements. We present an overview of the actual and proved concepts for the management of hemorrhage in order to enable the reader to optimize treatment, to increase safety and comfort for the bleeding patient, and to fulfill the medico-judicial and economic requirements.

Background: Acute and chronic progressive compression of the optic nerve is mostly caused by tumors and trauma. Special knowledge about the pathophysiological mechanisms of the nerve injury is necessary in all clinical disciplines managing optic nerve neuropathy. Hence, the technique, the indications and limitations of the endonasal endoscopic decompression procedure of the optic nerve will be described from an otolaryngological point of view., Methods: On the basis of our own experience and the international literature, the indications and limitations of the endonasal-endoscopic approach for optic nerve decompression are described and critically reviewed., Conclusions: The management of optic nerve neuropathy, especially in cases of severe trauma, remains controversial. Because the data of the present clinical trials are mostly not evidence based, an efficient transfer of relevant guidelines or recommendations into the clinical practice is difficult. Therefore, the indication for optic nerve decompression surgery, especially in traumatic optic nerve neuropathy, must be individualized.

Diving has become increasingly popular. With the growing number of patients who want to dive, there is an increasing number of divers who require their regular medical examination. As ENT problems are the most common disorders in divers, otorhinolaryngologists regularly have to assess the diver's fitness. It should be noted that an ENT examination does not certify complete fitness to dive! Diving can be resumed 3 months after middle ear surgery, especially after tympanoplastic type I, II and III with insertion of a PORP, when there is regular middle ear ventilation without atrophic scars of the tympanic membrane. Even after stapes surgery, diving can be resumed when there are no signs of vestibular irritation during a provocation test. By 3 months after sinus surgery, the diver should perform a test dive under supervision before fitness to dive can be certified. After inner ear barotrauma, the diver remains fit to dive depending on his hearing ability in the involved ear. After inner ear decompression illness, one should look for a vascular right-to-left shunt before diving can be resumed. These and many more aspects are discussed in this article on how to determine whether a diver with ENT problems is fit to dive.

Unlabelled: We report the standardized postprocessing of high-resolution CT data acquired by incremental CT and multi-slice CT in patients with suspected middle ear disorders to generate three-dimensional endoluminal views known as virtual otoscopy., Materials and Methods: Subsequent to the definition of a postprocessing protocol, standardized endoluminal views of the middle ear were generated according to their otological relevance. The HRCT data sets of 26 ENT patients were transferred to a workstation and postprocessed to 52 virtual otoscopies., Results: Generation of predefined endoluminal views from the HRCT data sets was possible in all patients. Virtual endoscopic views added meaningful information to the primary cross-sectional data in patients suffering from ossicular pathology, having contraindications for invasive tympanic endoscopy or being assessed for surgery of the tympanic cavity. Multi slice CT improved the visualization of subtle anatomic details such as the stapes suprastructure and reduced the scanning time., Conclusion: Virtual endoscopy allows for the non invasive endoluminal visualization of various tympanic lesions. Use of the multi-slice CT technique reduces the scanning time and improves image quality in terms of detail resolution.

The diagnostic procedure for the symptom oropharyngeal dysphagia is described from an otorhinolaryngologic point of view, with emphasis on an interdisciplinary team approach. The various methods used in modern otorhinolaryngology both by the practitioner and the clinician are discussed with regard to a step-like diagnostic approach. The diagnosis should be made on the basis of aetiology, anatomy and function. First all organic changes causing oropharyngeal dysphagia must be recognized, both "typical ENT diseases" and malignant tumors of the oropharynx and hypopharynx which are usually diagnosed only in an advanced stage. If there is no evidence of an organic cause in the field of otorhinolaryngology, as a differential diagnosis a dysfunction of the upper esophageal sphincter and a "globus pharyngus" have to be ruled out.

The article describes the role of sonography in the diagnostic of head and neck tumors, comparing the advantages and disadvantages in regard to other methods. The suprasonic procedure permits the detection of the dimension, type, borderlines and relations of tumors to neighbour tissues. The method has a special value for preoperative staging and surgical planning strategy. But also in long time controls sonographic diagnostic takes a definitive place. The ultrasound controlled biopsy is regarded as an important progress.