Key Points: • The use of drills in endoscopic rhinosurgery allows for precise, safe and rapid removal of solid bone in standard procedures such as dacryo-cysto-rhinostomia and has become indispensable in complicated surgical interventions such as median maxillectomy • Conventional otologic drills are often used as they are readily available, economical and very robust in use • Injuries caused by the rotating shaft of the burr are rare yet it can represent a serious complication following drilling procedures in extended endonasal surgery • The use of low-cost, reusable otology speculum eliminated this complication of nasal entrance lacerations throughout our institution to this date • As a simple safety measurement, we can recommend the application of ear speculum as a reliable protection against drill related nasal entrance laceration

Rhino-orbital-cerebral mucormycosis (ROCM) is a rare angioinvasive fungal infection known to be associated with high morbidity and over 50% mortality and has increased lately due to increasing predisposing immunocompromising comorbidities as well as COVID-19. In addition to the common acute disease progression, chronic less aggressive courses have been described less often. In this paper we report two cases – a 75-year-old woman with diabetes and a 39-year-old man with recurrent diabetic ketoacidosis. Both presented initially with acute sinonasal symptoms, were positive for SARS-COV-2 and later diagnosed with acute ROCM.  Both underwent mutilating surgical therapy as well as high administered dose Amphotericin B and long term continuous antifungal therapy. Patient 1 showed stable symptoms with radiographically increasing disease and died of urosepsis 5 months after first surgery. Patient 2 was first lost to follow-up after repatriation to his home country and 1 year later sent us a holiday picture of himself, having recovered from the disease.Key words:Rhino-orbital-cerebral mucormycosis, mucormycosis, Amphotericin-B, COVID-19, invasive fungal infection

Objective: This study evaluates the benefits and limitations of selected modalities of digital image enhancement in detection of cholesteatoma remnants during endoscopic ear surgery (EES) and compares their usefulness in recognizing residual disease. Study Design: Cross-sectional study Setting: Tertiary referral hospital Methods: A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image enhancing modalities (clara, spectra A, spectra B), were generated. Fifty-one experienced ear surgeons participated in the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. Results Clara showed the highest accuracy in cholesteatoma detection, followed by spectra A and lastly spectra B. In contrast, spectra B showed the highest sensitivity and clara the highest specificity, while spectra A was placed in the middle for both values. Using the spectra B modality, most responses agreed across the two time points,. Ear surgeons assessed the usefulness, as well as preference among image modalities in the following order: clara, spectra B, spectra A. Conclusion The suitability of image enhancement techniques for application in EES could be shown. Clara can be considered the state-of-art technique throughout the procedure and has subjectively been evaluated best by surgeons. Due to its high sensitivity, spectra B is recommended regarding the final check after resection to prevent cholesteatoma residuals.

We present the case of a 65 years old patient who developed a complete, sensorineural hearing loss on the right side due to an intravestibular schwannoma. Our video shows a transcanal, endoscopic approach with complete schwannoma removal on the right side, subsequent e-BERA recordings, and cochlear implantation.

Objectives: We aimed to investigate the diagnostic accuracy of Caloric Testing and video Head Impulse Testing (vHIT) in differentiating between vestibular neuritis and strokes in acute dizziness. Design: Prospective cross-sectional study. Setting: Emergency department of a tertiary referral center. Participants: 1677 adult patients were screened between 2015 and 2020 for AVS, of which 152 met the inclusion criteria. Inclusion criteria consisted of a state of continuous dizziness, associated with nausea or vomiting, head-motion intolerance, new gait or balance disturbance and nystagmus. Patients were excluded if symptoms lasted <24 hours or if the index ED visit was >72 hours after symptom onset. Eighty-five patients completed testing of which 58 were vestibular neuritis and 27 strokes. Main outcome measures: All patients underwent calorics and vHIT followed by a delayed MRI (gold standard for vestibular stroke confirmation). Results: The sensitivity/specificity for detecting stroke (caloric asymmetry cut-off of 30.9%) was 75% and 86.8% respectively (Negative likelihood ratio (NLR) 0.29) compared to 91.7% and 88.7% for vHIT (NLR 0.094). Best VOR gain cut-off was 0.685. Twenty-five percent of vestibular strokes were misclassified by calorics, 8% by vHIT. Conclusions: Caloric testing demonstrated lower accuracy than vHIT in discriminating stroke from vestibular neuritis in acute dizziness. Asymmetric caloric responses can also occur with vestibular strokes and might put the patient at risk for misdiagnosis. We therefore recommend replacing calorics with vHIT in the acute setting. Caloric testing has still its place as a diagnostic tool in an outpatient setting.