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Objective: Currently, there is an intensive discussion about enhancing and expanding outpatient rhinosurgical procedures. Many questions about how to stratify into out- and inpatient procedures are still not sufficiently clarified. Particularly, the use of nasal packing materials is not adequately discussed., Material and Methods: We performed a Germany-wide survey among otorhinolaryngologists regarding the use of nasal packing materials in sinonasal surgery. Additionally, we asked for any complication in relation to nasal packing., Results: In 85,6% nasal packing was used for septal and turbinate surgery at least occasionally, in 44,2% always. In sinus surgery these numbers are 94,1% and 49%, respectively. Non-resorbable nasal packing materials were predominantly used.Most frequent complications were bleeding with nasal packing in situ (> 50% of respondents) and posterior dislocation (24% of respondents), requiring emergency treatment. Death was listed in 5 patients. One patient suffered from permanent brain damage due to hypoxia., Conclusions: Application of non-resorbable nasal packing materials with occlusion of the nasal cavity carry a substantial risk of complications, which necessitate emergency treatment, thus requiring inpatient care., Competing Interests: Rainer Weber: Empfang von Honoraren oder Beratungsgebühren: GSK, Hommel Pharma, Infectopharm, KARL STORZ, Sanofi-Aventis, Sidroga, Spiggle & Theis, Stryker. Bernhard Olzowy: Vortragshonorare für Radiofrequenzchirurgiekurse seitens der Fa. Neuwirth Medical Products, die selbstauflösende Chitosantamponaden (PosisepX) vertreibt. Frank Haubner: Honorare für Vorträge bei folgenden Firmen: Brainlab, Spiggle&Theis, Neuwirth, RG Ärzteberatung. Robert Böscke: Reisekostenerstattungen: Sanofi, GSK, Allergopharma, MedEL, Cochlear; Vortragshonorare: Sanofi, GSK Achim Beule: Vorträge für AstraZeneca, GlaxoSmithKline, Happersberger otopront, Medtronic, Novartis, Sanofi Aventis, Xion; Beratertätigkeit für AstraZeneca, GlaxoSmithKline, Medtronic, Novartis, Sanofi Aventis, Durchführung von wissenschaftlichen Studien an der Uniklinik Münster für Allakos, AstraZeneca, BioMed Elements/EU, Bristol Myers Squibb, GlaxoSmithKline, Happersberger otopront/AiF,Sanofi Aventis, Winicker Norimed; insgesamt aber keine Tätigkeiten mit Schwerpunkt „Nasentamponaden“ oder mit Bezug zu dieser Publikation Thomas Kühnel: Glaxo Smith Kline: Advisory Board; Karl Storz Endoskope: bezahlte Tätigkeit bei Operationskursen; Sanofi: Advisory Board (Einladung), Vortragstätigkeit; Dt. Fachgesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie; Dt. Fachgesellschaft für Schädelbasischirurgie, (Thieme. All rights reserved.)

Competing Interests: Conflict of Interest Julian Künzel received fees for lectures from GE Healthcare (Chicago, IL, USA).

Increasing normative demands on patient safety and quality assurance measures, but also the problem of multi-resistant germs and pathogens with a high potential for infection, increase the need for hygienically correct work.In this study, hygienically relevant potential sources of contamination in ENT examinations were to be identified and possible improvement strategies examined.A complete ENT examination was performed by 5 examiners with different professional experience, whose gloves were wetted with fluorescent lotion prior to the examination. Contaminations especially on the examination unit and on the instruments were identified. The potential risk of transmission of pathogens to subsequent patients was assessed using a specially developed score. Various strategies to reduce identified contamination possibilities were developed and thought through.The score of the investigators was very high with an average of 87.4 points (±3.6). The implementation of individual hygiene measures during the examination process would lead to a significant reduction of the score and thus to an improvement in hygiene: No shaking of hands (81.8), additional disinfection of patient's chair (79.8), disinfection of important surfaces (69.8), provision of standard instruments (60.2) or all instruments (32.2), disinfection of all relevant surfaces and provision of all instruments (7.4).The results show very clearly that an ENT examination is a complex procedure from the point of view of hygiene. For reliable protection against possible transmission events, a structured bundling of hygiene measures is therefore necessary., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

In endonasal endoscopic sinus surgery continuous progress has been made in the last decade due to better understanding of microanatomy, gains in adjunctive medicative therapy and technical innovations. Moreover, continuous research and clinical trials on innovative stents and spacers with and without defined drug eluting features may be mentioned in this context. A narrative review of the current development status and its therapeutic options referring to the latter is presented., Competing Interests: Die vorliegende Studie wurde unterstützt von Fa. Intersect, 1555 Adams Drive, Menlo Park, CA 94025, USA, (© Georg Thieme Verlag KG Stuttgart · New York.)

The nasopharyngeal carcinoma (NPC) is closely associated with the Epstein-Barr virus (EBV) infection. Because each tumor cell in a patient regardless of histological subtype contains an identical copy of the viral clone, the virus is easily detectable at early pre-invasive lesions. Nevertheless, the nasopharyngeal carcinoma is still usually diagnosed late, often not until they exhibit infested lymph nodes and / or distant metastases have occurred. Canadian scientists have now discovered and analyzed a new screening method.

Background: Aim of this study was to evaluate the perioperative level of pain and anxiety for endoscopic sinus surgery, and to compare 3 different types of nasal packing., Material and Methods: Prospective, controlled, randomized study comparing different types of nasal packing in regard to perioperative anxiety and pain. Patients suffered from chronic rhinosinusitis with nasal polyps involving all paranasal sinuses. Patients daily evaluated by standardized questionnaires (FPI-R, KASA, STAI) and also visual analog scale for pain on 5 consecutive days before and after endoscopic sinus surgery of all paranasal sinuses. Nasal packings were removed on 2(nd) postoperative day., Results: A total of 73 patients (polyvinyl acetate packing N = 14, glove packing N = 37, glove packing with breathing tubes N = 22) completed the study. Female gender, bad preoperative mood and absence of pain were associated with increased preoperative state anxiety based on regression analysis. Also, preoperative gathering of additional information from relatives and friends was correlated with increased preoperative anxiety. Patients had significantly minor preoperative anxiety if they could expect use of nasal packings with breathing tubes., Conclusion: Female patients, who gathered information about the operation from friends or relatives or patient in worse preoperative mood are at risk for increased state anxiety and should be identified prior to rhinosurgical procedures. Use of nasal packing with at least partially preserved nasal breathing is recommended in clinically anxious patients.

Dacryocystocele may represent a rare type of connatal stenosis of the lacrimal duct. If conservative measures fail and in case of secondary inflammation, probing or regular surgery is usually recommended. We report on 15 neonates suffering from 18 connatal dacryocystoceles which were presented to the clinic of ophthalmology at the 16th (6 - 44) day of life. There was a definite female preponderance (65 %). Conservative treatment (external massage, at times i. v. antibiotic therapy) had proven to be ineffective. The neonates were subjected to outpatient nasal endoscopy and the ballooning cyst of the inferior nasal meatus was managed by endoscopic marsupialization in 14 cases applying local anesthesia. Two nasal cysts had to be operated on in general anesthesia due to obstructing local anatomy which obviated endoscopical microsurgery. Three additional dacryocystoceles have been detected incidentally in 2 neonates being subjected to surgery in general anesthesia for choanal atresia and lacrimal probing respectively. The corresponding dacryocystoceles were managed by concomitant endonasal microsurgery. We advocate interdisciplinary (ophthalmological and rhinological) outpatient examination in all neonates with suspected dacryocystoceles. Diagnosis is based on palpation, probing and nasal endoscopy applying local anesthesia together with mucosal decongestion. Microsurgical marsupialization immediately follows and will lead to persisting relief of symptoms.

Objective: Endonasal sinus surgery lead to more or less circumscribed mucosa defects exposing the underlying bone. Healing of these wounds is accompanied by crust formation, which may be subjected to mechanical debridement. It is not known whether this wound care impaires or facilitates wound healing., Methods: Following sinus surgery, 72 crusts were removed from the operative site after having taken endoscopic photographs choosing different postoperative intervals. Mucosal biopsies were taken from beneath the crusts. All specimen were submitted to routine histological serial sections as well as immunohistochemical staining of epithelium., Results: Local debridement of crusts avulsed parts of epithelium in 23% of cases during the first postoperative week. There was no histological evidence of avulsed epithelium with crusts removed the second week. This figure later increased to 16%. Possible trauma to regenerating mucosa cannot be predicted solely by the appearance of crusts., Conclusion: In principle, large crusts may disturb ventilation and drainage, causing secondary mucositis. Local care is mandatory in these cases. According to our examinations, mechanical debridement of wounds must respect the time-dependent irritability of the healing wound. There is little risk of impairing epithelization during the second week after surgery and the chance of sustaining the healing process is best.