Mucocutaneous leishmaniasis: case report and literature review of a rare endonasal infection

Leishmaniasis is a protozoal infection transmittedby a sandfly vector. In Germany, leishmaniasis ofthe mucous membranes is a rare condition andusually due to extension of local skin disease intothe mucosal tissue via direct extension,bloodstream or lymphatics. We report a case ofendonasal leishmaniasis in a female Germanresident who presented in a university hospitalwith nasal obstruction. Histology of the left nasalseptum biopsy was suggestive of leishmaniasis.The molecular detection of DNA was positive forleishmania infantum. The patient was successfullytreated as a case of mucocutaneous leishmaniasisreceiving liposomal amphotericin follow up visitsshowed significant improvement with norecurrence

Rare involvement of paranasal sinuses in sarcoidosis: case report and literature review

Sarcoidosis is a non-caseating inflammatory chronic systemic disease of unknown etiology, which may affect one or more organs. Paranasal sinuses involvement occurs sporadic in sarcoidosis. We report a patient with a medical history of sarcoidosis involving her lungs, liver, and lymphatic system for four years who now presented with nasal and sinuses symptoms. The primary treatment with local cortisone showed no improvement. Computed tomography (CT) scan of the paranasal sinuses (PNS) revealed signs of chronic pansinusitis. She was successfully treated with endoscopic sinonasal surgery. Subsequent histological analysis confirmed the involvement of the PNS with sarcoidosis. Her follow-up during the last 6 months was without recurrence

Deep learning-based denoising streamed from mobile phones improves speech-in-noise understanding for hearing aid users

The hearing loss of almost half a billion people is commonly treated with hearing aids. However, current hearing aids often do not work well in real-world noisy environments. We present a deep learning based denoising system that runs in real time on iPhone 7 and Samsung Galaxy S10 (25ms algorithmic latency). The denoised audio is streamed to the hearing aid, resulting in a total delay of around 75ms. In tests with hearing aid users having moderate to severe hearing loss, our denoising system improves audio across three tests: 1) listening for subjective audio ratings, 2) listening for objective speech intelligibility, and 3) live conversations in a noisy environment for subjective ratings. Subjective ratings increase by more than 40%, for both the listening test and the live conversation compared to a fitted hearing aid as a baseline. Speech reception thresholds, measuring speech understanding in noise, improve by 1.6 dB SRT. Ours is the first denoising system that is implemented on a mobile device, streamed directly to users' hearing aids using only a single channel as audio input while improving user satisfaction on all tested aspects, including speech intelligibility. This includes overall preference of the denoised and streamed signal over the hearing aid, thereby accepting the higher latency for the significant improvement in speech understanding

Unklare chronische Schwindelsyndrome – Erfahrungen mit einem interdisziplinären stationären Diagnostikkonzept

Dizziness is a common leading symptom. Especially patients with chronic vertigo syndromes experience a significant impairment in quality of life up to a limitation of their ability to work in the case of employed persons. The consequences are financial and capacitive burdens on the health system due to frequently multiple examinations and sick leave up to occupational invalidity of the affected patient. In 150 patients with chronic vertigo syndromes and an unclear outpatient diagnosis, at least one diagnosis that justified the complaint was made in over 90% of cases on the basis of a structured interdisciplinary inpatient diagnostic concept. Chronic vertigo syndromes are often multifactorial. Psychosomatic (accompanying) diagnoses were found in more than half of the patients. Targeted therapy can only be recommended after establishing a specific diagnosis. This justifies an interdisciplinary inpatient diagnostic concept for persistently unclear cases

Does sealing the oval window in addition to the round window bring an advantage in reserve therapy of acute idiopathic deafness?

Hintergrund: Bei plötzlich aufgetretener einseitiger hochgradiger sensorineuraler Hörstörung bzw. Ertaubung können Patienten nach frustraner intravenöser Glukokortikoidtherapie einer explorativen Tympanotomie mit Abdeckung des runden und/oder ovalen Fensters (RF und/oder OF) wegen des Verdachts einer Rundfenstermembranruptur mit Perilymphfistel (PLF) oder einer Fissula ante fenestram (FAF) behandelt werden. Die Studie untersucht, ob die zusätzliche Abdeckung des ovalen Fensters im Vergleich zur alleinigen Abdeckung des runden Fensters einen zusätzlichen Hörgewinn bringt. Methodik: Die retrospektive Studie untersucht 54 Patienten mit akuter Ertaubung und durchgeführter Tympanoskopie, bei denen Audiogramme von 3 Zeitpunkten (präoperativ, nach Detamponade sowie mindestens 3–6 Monate postoperativ) vorlagen. Bei 28 Patienten erfolgte neben der Rundfensterabdeckung die zusätzliche Abdeckung des ovalen Fensters. Ergebnis: Eine intraoperativ sichtbare PFL bzw. FAF wurde in keinem Operationsbericht beschrieben. Die Hörschwellen waren im frühen postoperativen Zeitraum bereits hoch signifikant geringer und verbesserten sich im weiteren Verlauf. Zwischen den Subgruppen RF und RF + OF zeigte sich in beiden postoperativen Zeiträumen kein signifikanter Unterschied. Bei 65 % (Kriterien nach Kanzaki) und 74 % (Kriterien nach Siegel) der Patienten konnte postoperativ eine partielle bzw. komplette Hörverbesserung nachgewiesen werden. Beim Vergleich der Patientengruppen mit bzw. ohne postoperative Hörverbesserung zeigten sich keine statistischen Unterschiede bezüglich Geschlecht, Alter, Nebendiagnosen oder Latenz der Operation bis zum Symptombeginn. Schlussfolgerung: In dieser Studie zeigte die zusätzliche Abdeckung des OF keine signifikante Hörverbesserung. Die postoperative Hörverbesserung entspricht den publizierten Spontanremissionsraten. Nur eine prospektive multizentrische Studie mit Kontrollgruppe kann den Stellenwert der Tympanoskopie und mit Rund- bzw. ovaler Fensterabdeckung bei einer akuten hochgradigen sensorineuralen Schwerhörigkeit vor dem Hintergrund der Spontanremissionen klären.Background: Following sudden unilateral deafness or severe sensorineural hearing loss, patients with unsuccessful intravenous steroid therapy can be treated with explorative tympanotomy with sealing of the round (RW) and/or oval window (OW), due to suspected rupture of the RW with perilymph fistula (PLF) or a fissula ante fenestram (FAF). This study investigated whether additional sealing of the oval window (RW+OW) achieved an improved hearing benefit as compared to sealing of the round window only (RW) . Methods: This retrospective study investigated 54 patients with acute profound hearing loss who underwent tympanoscopy. Audiometric examinations were performed preoperatively and at two postoperative intervals (1 month and 3–6 months after surgery). In 28 patients, the OW was sealed in addition to the RW. Results: No intraoperatively visible PLF or FAF were reported. Hearing thresholds were significantly reduced in the early postoperative follow-up period and further improvement was observed 3–6 months later. No significant differences between the RW and RW+OW subgroups were seen at either follow-up timepoint. In 65% (Kanzaki criteria) and 74% (Siegel criteria) of patients, partial or complete postoperative hearing improvement was observed. Upon comparing the groups of patients with and without hearing improvement, no statistical significance was found in terms of gender, age, secondary diagnoses, or latency period between symptom onset and surgery. Conclusion: Additional sealing of the OW did not lead to significantly better postoperative hearing thresholds. In general, postoperative hearing improvement corresponds to published spontaneous remission rates

Elective tracheostomy in COVID-19 patients: experience with a standardized interdisciplinary approach

Berichtet wird über die Erfahrungen mit einer interdisziplinären klinikinternen SOP (Standard Operation Procedure) zur Tracheostomie (TS) bei „Coronavirus-Disease“(COVID-19)-Patienten, unter Berücksichtigung der allgemeinen nationalen und internationalen Empfehlungen. Der interdisziplinär festgelegte operative Zeitpunkt der TS aufgrund einer prolongierten invasiven Beatmung und frustranen Weaning-Versuchen betraf Phasen sowohl hoher als auch niedriger Erkrankungsaktivität. Es wurden 5 TS bei Patienten mit einem Durchschnittsalter von 70,6 Jahren durchgeführt. Neben den Standard-COVID-19-Schutzmaßnahmen für das medizinische Personal zur Vermeidung einer nosokomialen COVID-19-Infektion führt die SOP-unterstützte Kommunikation während der TS zu einer periprozeduralen Sicherheit aller Beteiligten. COVID-19-Erkrankungen des medizinischen Personals der beteiligten Abteilungen sind bisher nicht bekannt.Experience with an interdisciplinary SOP (standard operating procedure) for tracheostomy (TS) in COVID-19 patients, taking into account the general national and international recommendations, is reported. The operative timing of TS due to prolonged invasive ventilation and frustrating weaning attempts was determined on an interdisciplinary level and involved phases of both high and low disease activity. Five TS were performed in patients with an average age of 70.6 years. In addition to the standard COVID-19 protective measures for medical staff to avoid nosocomial COVID-19 infection, SOP-supported communication during the TS leads to periprocedural safety for all involved. COVID-19 infections among medical staff in the departments involved are not yet known