HNO
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The procedure of instrument navigation has been an established one since its introduction in ENT by Schloendorff. It facilitates better intraoperative orientation. The opto-electric and electromagnetic procedures are sophisticated principles of intraoperative position recognition. ⋯ The current boundaries of simple instrument navigation in the frontal skull base are set by the attainable accuracy of approx. 2 mm and the relatively simple representation of the information in planar sectional views. Instrument navigation should be used in the frontal skull base as frequently as possible, even in less complex procedures. Only in this way can familiarity with the system be achieved.
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Computer-aided microscopic surgery of the lateral skull base is a rare intervention in daily practice. It is often a delicate and difficult minimally invasive intervention, since orientation between the petrous bone and the petrous bone apex is often challenging. ⋯ However, there are no internationally standardised indications for navigated surgery on the lateral skull base. Miniaturised robotic systems are still in the initial validation phase.
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Ever faster processor capacity is having an impact on computer-assisted or computer-aided surgery (CAS). The fusion of different imaging modalities enables functional data such as PET-CT, for example, to be available in image-guided surgery. Referencing of image data is the key to precise navigation. ⋯ Alternatively, intraoperative magnetic resonance imaging or intraoperative sonography can be performed. Ultrasound systems have already been successfully integrated in existing navigational systems to compensate for intraoperative tissue shifting. Ultrasound systems may play a role in the future as a single modality in image-guided surgery in soft tissue of the neck and skull bone.
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The symptom headache is very frequent. Most frequently headache is the leading symptom of a primary headache syndrome such as migraine or tension-type headache. Sometimes it is caused by another disease. ⋯ It is even more important not to miss a secondary headache, which is rare, but if misdiagnosed could conceal life-threatening conditions. This review provides an overview of the clinical picture, diagnostic procedures and treatment strategies of frequent headache syndromes such as migraine, tension-type headache, medication overuse headache, trigeminal autonomic cephalgias and trigeminal neuralgia. This is followed by a brief summary on symptomatic headache caused by non-neurological diseases as well as on diagnostic procedures and management of headache in the emergency situation.
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Clinical experience has shown that chronic otitis media (COM) affects health-related quality of life (HR-QOL) of the patients. Nevertheless, up to now no validated measurement instrument encompassing all the relevant dimensions of HR-QOL is available. ⋯ COMOT-15 is a reliable, valid and sensitive instrument for measurement of HR-QOL of COM patients. The results obtained with the questionnaire can be interpreted very well by the investigator. COMOT-15 should be used in otological outcomes research.