Onychomykose: Konzepte für die Praxis

Zusammenfassung

Hintergrund

Die Onychomykose ist die häufigste infektiöse Nagelerkrankung, wobei die Fallzahlen stetig ansteigen. Eine Nagelpilzinfektion hat keine Selbstheilungstendenz, sondern muss immer therapiert werden. Das Krankheitsbild gehört deshalb zur Kernkompetenz des Dermatologen.

Schlussfolgerung

Eine wichtige Voraussetzung zur erfolgreichen Behandlung ist eine korrekte Diagnose, basierend auf der sorgfältigen Anamnese, der Klinik sowie dem mikroskopischen und kulturellen Erregernachweis. Außerdem kommt hier der Dermatoskopie und der histologischen Untersuchung eine wichtige Bedeutung zu. Der beigefügte Algorithmus verknüpft anschaulich Diagnostik und Therapie bei Verdacht auf Onychomykose.

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European position paper on drug‐induced sleep endoscopy (DISE): 2017 update

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


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Correction to: “Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds”

The article "Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds", written by María J. Ferreira Ruiz and Jon Umerez, was originally published electronically on the publisher's internet portal (currently SpringerLink) on June 29, 2018 without open access.

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Effect on Quality Of Life of Patients Before and After Functional Endoscopic Sinus Surgery

Abstract

Rhinosinusitis is defined as an inflammatory process involving the mucosa of the nose and one or more of the paranasal sinuses. Rhinosinusitis is not associated with increased mortality, but may have an impact on the quality of life (QOL). Current study is aimed at investigating the role of FESS in the enhancement of QOL of the patients with rhinosinusitis. Several instruments have been designed to assess the QOL, among which Glasgow Benefit Inventory (GBI) questionnaire, has been used in this study. This cross sectional study of duration of 1 year and 6 months was conducted on 30 patients between the age group 18–60 years in the Department of Otorhinolaryngology at Safdarjung Hospital in New Delhi. Our results showed that FESS was associated with improved QOL in patients with Chronic Sinusitis. Observations were made on the basis of the GBI questionnaire which is designed to measure outcomes of the surgical procedures in form of 4 different scores. Mean total score before surgery was (−) 65.28 ± 7.39 and after surgery was 21.22 ± 11.24. Mean general Subscale Score before surgery was (−) 60.56 ± 9.14 and after surgery was 25.28 ± 13.40. Mean Social Support Score before surgery was (−) 79.44 ± 14.31 and after surgery was 17.78 ± 16.34. Mean Physical Health score before surgery was (−) 70.00 ± 10.17 and after surgery 10.00 ± 14.25. A statistically significant improvement was observed in all the four scores before and after surgery. The present study demonstrates that radical surgery has led to improvement in the QOL of chronic rhinosinusitis.

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Tonsillectomy by Cold Dissection and Coblation Techniques: A Prospective Comparative Study

Abstract

Inflammatory and infectious diseases of tonsils are common in paediatric and adult otolaryngological practice and ensue in tonsillectomy which is a common surgical procedure. Dissection and snare method is being performed for ages and has evolved over a period of time while coblation is a newer technique started in 1997. It combines radiofrequency energy and normal saline, resulting in a plasma field of highly ionized particles which dissociates intercellular bonds and thus melts tissue at low temperatures (40–70 °C) thereby reducing tissue damage. To compare the intraoperative time, intraoperative blood loss, post operative pain and post operative blood loss between dissection tonsillectomy and coblation tonsillectomy. This study was carried out at the outpatient Department of Otorhinolaryngology and Head and Neck Surgery in Meenakshi Medical College, Hospital and Research Institute, Tamil Nadu. Patients with chronic and recurrent tonsillitis who were planned electively for tonsillectomy were included in this study. Study was based on the analysis of 60 patients aged between 5 and 40 years. All these 60 patients were thoroughly investigated by doing a complete surgical workup. They all were subjected to 2 different tonsillectomy procedures—dissection and snare method and coblation technique. Patients were assigned into two groups of 30 each by simple random sampling. Among these 60 patients, blood loss and post operative pain was less in Group 2 (coblation) and the duration of surgery was less in Group 1 (dissection and snare). In this study, patients who underwent surgery in Group 2 (coblation) showed better outcome when compared to Group 1 (dissection and snare method).

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Laryngopharyngeal Reflux and GERD: Correlation Between Reflux Symptom Index and Reflux Finding Score

Abstract

To study the relationship between laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD) using clinical scoring and endoscopy. Data was collected from a sample of 100 patients with GERD symptoms who presented to ENT out-patient department, for a duration of 2 years. Patients were evaluated using Reflux Symptom Index (RSI) questionnaire and Reflux Finding Score (RFS). All patients underwent videolaryngoscopy and upper gastrointestinal endoscopy. Patient with positive findings underwent treatment with proton pump inhibitors and were followed up for 3 months. Out of 100 patients, 23 had LPR, 19 had GERD, 40 had LPR + GERD, 18 were normal. Among the LPR group, the predominant symptoms were hoarseness of voice, globus sensation and heartburn. Majority of GERD group had globus sensation, dysphagia and heartburn as their predominant symptoms. On laryngoscopy, in both LPR and LPR + GERD group, most common finding was interarytenoid erythema and vocal cord edema. On esophagogastroduodenoscopy, in both GERD and LPR + GERD group, esophagitis was the most common finding. RSI value was highest in patients with LPR + GERD. RFS value was high in LPR group followed by groups of LPR + GERD and GERD. RSI and RFS are easily administered, highly reproducible, low cost clinical scoring symptom questionnaire which can identify the patients with LPR. 82.6% of LPR patients had significant RFS scoring but with no significant findings in OGD. This study also illustrates the importance of PPI therapy in LPR patients with no evidence of GERD.

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Design and Implementation of Competency Based Postgraduate Medical Education in Otorhinolaryngology: The Pilot Experience in India

Abstract

The worldwide call for a shift towards competency based postgraduate medical education has until recently gone largely unheeded in India, despite the Medical Council of India enshrining the principle in its regulations for postgraduate institutions. This paper details the first concrete attempt at establishing a CBME curriculum in Otorhinolaryngology in India. The design and implementation of the CBME curriculum was carried out in four phases, in a time-bound manner over a period of 6 months. Phase I consisted of an extensive literature review and a clarification of the major objectives of the program. Phase II involved the listing out of 20–30 entrustable professional activities (EPAs) for each specialty and the 13 core EPAs common to all incoming residents and the subsequent mapping of these EPAs to their respective domains of competence and year-wise levels of competence. This was followed by the development of milestones for each EPA and appropriate clinical vignettes. Phase III focused on development of 360° assessment strategies, including the in-house development of an e-portfolio. Phase IV was dedicated to the implementation of the CBME curriculum, and involved various sensitization and orientation programs for faculty and the new residents. This exercise in designing and implementing a CBME program showed the important role that intra-departmental and inter-institutional cross-communication and exchange of ideas vies-a-vie workshops and personal communication play in bridging the lapses in knowledge in this emerging area, reaching consensus to achieve project goals and for finding relevant solutions to common problems. Medical education in India presents its own peculiar set of logistical and cultural challenges. Keeping in line with the recommendations of the Medical Council of India regarding Postgraduate Medical Education, it is essential that medical colleges in India not fall behind the international paradigm shift towards CBME.

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