Curriculum design and specific topic selection for on-site practical courses in clinical disciplines with limited teaching time is challenging. An electronic learning supported curriculum based on the flipped classroom principle has a high potential to effectively gain knowledge and education along with improving practical experience. Here, we demonstrate the introduction of a flipped classroom curriculum for practical courses in Otorhinolaryngology (ORL) in real world practice to improve the on-site time management and students’ experience. Educational aims of our practical curriculum were analysed and rearranged into a flipped classroom (FC) framework. Core knowledge was taught preliminary based on a moodle platform in predominantly interactive formats. Two quasi-randomized groups were formed with 212 participants either receiving or not receiving access to the e-learning program to reduce a potential allocation bias to the e-learning group. All students completed a questionnaire with learning related items. Focusing the study on the intervention group, we investigated if students using the flipped classroom more often felt better prepared for the practical course. The online learning platform was highly accepted and frequently used by 66% of participating students in the e-learning group. Students with frequent use of our e-learning platform significantly felt better prepared for the practical course (p = 0.001). The far majority of all students supports the idea of further development of e-learning. More than 70% were generally interested in ORL. Handouts were the overall most important learning resource and more than 50% relied solely on them. Flipped classroom curricula can save time and help improving the on-site experience in practical courses especially in smaller surgical disciplines. The acceptance of digital learning is high, and most students rely on handouts for learning ORL, emphasizing the need for guidance by the teacher e.g. through electronic learning. Our results underline the high potential of FC to address teaching challenges for smaller medical disciplines with limited teaching time like ORL.

Background: The availability and popularity of laptops, tablet PCs and smartphones in private and work environments offers considerable potential for reasonably integrating blended learning formats into structured medical learning environments. The promising educational principle of the flipped classroom (FC) provides the opportunity to effectively combine e-learning and face-to-face teaching within a single framework. However, similar to most blended learning formats, the FC requires a solid groundwork of structured digitized learning content. As rearranging a whole curriculum is intense and time consuming, physicians occupied simultaneously in clinical practice and teaching may be confronted with a lack of time during this process. Methods: We developed two straightforward approaches to transforming a pre-existing, lecture-based otolaryngology curriculum into interactive videos within a Moodle learning management system. Special attention was given to reducing individual working time for medical professionals. Thus, while one approach was mainly guided by a medical professional to control the content-related quality of video processing, we investigated an alternative approach outsourcing work to a technician. Afterwards, the working time was analysed and compared. The resulting videos were revised with the H5P plugin for moodle to adjust the content where necessary. Results: We identified a fast-track approach for creating structured e-learning content suitable for flipped-classroom-based lectures, other blended learning formats, or even providing a whole curriculum online. The alternative approach significantly reduced working time for medical professionals but did not impair the content-related quality significantly. Conclusions: The use of H5P interactive tools via Moodle LMS provides a major procedural benefit by allowing the easy adjustment of pre-existing video material into suitable online content. Reasonably outsourcing work to technicians can significantly reduce the working time of medical professionals without decreasing the quality of learning content. The presented workflow can be used as a flexible approach for flipped classroom frameworks or other blended learning strategies where interactive videos are applicable.

Dupilumab has been shown to be safe and effective in treating chronic rhinosinusitis with polyposis (CRSwNP). There is to this date no published data whether subgroups like patients with aspirin exacerbated respiratory disease (AERD), increased histologic eosinophilia or elevated blood eosinophil or IgE-levels benefit greater from dupilumab therapy. Moreover, there is no data comparing the efficacy of functional endoscopic sinus surgery (FESS) with dupilumab therapy. We conducted a retrospective chart review of all patients that were treated at a tertiary referral center for CRswNP with dupilumab. We also contacted the patients with a questionnaire to evaluate the efficacy of previous surgeries and dupilumab therapy by visual analogue scale (VAS) and the glasgow benefit inventory (GBI) as well as report on side effects. Overall, 75 patients were included in the study at hand that reported back 138 times. While dupilumab treatment was efficient, we found no systematic evidence of greater efficacy of dupilumab in patients with AERD, histologic eosinophilia or increased blood eosinophil or IgE-levels. All patients showed a considerable decrease in subjective burden of disease, objective smell tests and endoscopic findings. From the patients point of view, dupilumab therapy showed greater efficacy both in the VAS and the GBI overall and all subcategories but “social support.” Dupilumab is efficient in treating CRSwNP; this effect is independent from disease characteristics like AERD, histologic eosinophilia, serum IgE-levels or eosinophil counts. There seems to be a group of patients that benefit greater from dupilumab therapy compared to FESS.

Zusammenfassung: Die Entwicklung digitaler Strategien in der Lehre beruht auf den technologischen Fortschritten der letzten Jahrzehnte, aber auch auf der Motivation, ein didaktisches Konzept verstärkt auf den Lernenden zu zentrieren. Aus verfügbaren Daten der deutschen Hochschulmedizin ergibt sich das Bild, dass in der Medizin ganz allgemein und speziell in der HNO-Heilkunde digitale Lehrkonzepte aktuell noch eine untergeordnete Rolle spielen. Durch Erhebung eigener Daten konnten wir zeigen, dass die Studierenden in der HNO-Heilkunde in der Mehrheit auf durch den Dozenten ausgegebene Materialien als einzige Lernquelle zurückgreifen. Die Anwendung fundierter digitaler Lehrstrategien bietet daher, insbesondere fachbezogen für die HNO-Heilkunde, besondere Chancen, u. a. um dem Überangebot von Informationen aus teils unklaren Quellen im Internet entgegenzutreten.Der mögliche Digitalisierungsgrad der Lehre reicht heute von digitalen Serviceangeboten über punktuelle Angebote klassischer Lehrkonzepte und Blended Learning bis hin zum volldigitalen Studium. Die Attraktivität der curricularen Integration digitaler Lehrstrategien beruht dabei weniger auf der Nutzung rein technischer Fortschritte, sondern vielmehr auf den Möglichkeiten der Anwendung innovativer Curricula und neuer didaktischer Konzepte. In Abhängigkeit vom beabsichtigten Lehrzweck werden insbesondere dem Flipped Classroom und der digitalisierten Realität großes Potenzial zugeschrieben, während mobiles Lernen sich in der Praxis bereits individuell etabliert hat. Die Erprobung und Evaluierung digitaler Lehrinnovationen für konkrete Szenarien gehört aktuell zu den wichtigen wissenschaftlichen Herausforderungen digitaler Lehrkonzepte.Der flächendeckenden Etablierung digitaler Lehre stehen heute weniger technische Voraussetzungen, sondern vielmehr fehlende Finanzierungsmöglichkeiten im Wege, da Förderungen derzeit überwiegend projektgebunden stattfinden, bei dauerhafter Umsetzung jedoch regelmäßige Kosten vorhanden sind. Zur Unterstützung dieser vielversprechenden Lehrformen könnte die Förderung der Einrichtung von Abteilungen für digitale Lehre mit Bereitstellung von entsprechenden Hard- und Softwarelösungen an den Universitäten wesentlich beitragen. Durch die Bildung von Kooperationen zur Nutzung solcher digitalen Plattformen ergäbe sich eine hohe Effizienz in der Verbreitung unter gleichzeitiger Ausnutzung von Sparpotenzialen.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition associated with significant morbidity. While established treatments such as functional endoscopic sinus surgery (FESS) and biologic therapy have demonstrated efficacy, they come with limitations, including cost, accessibility, and patient adherence. Growing evidence suggests that dietary factors, particularly arachidonic acid and salicylic acid, influence inflammatory pathways relevant to CRSwNP, yet real-world data on dietary interventions remain scarce. This retrospective study evaluates the mid-term effects of a structured dietary intervention in patients with CRSwNP who were either unwilling to undergo FESS or biologic therapy. The outcomes were compared to those of patients receiving either FESS or dupilumab. The dietary intervention was based on the avoidance of arachidonic acid and salicylates, an increase in fiber-rich foods, and the exclusion of nonsteroidal anti-inflammatory drugs. A total of 45 patients (mean age 46.5 ± 14.1 years; 25 female and 20 male) were included, with 15 undergoing dietary intervention, 15 FESS, and 15 dupilumab therapy. Disease burden was assessed using the sino-nasal outcome test (SNOT-22), visual analog scale, endoscopy scoring, and the brief smell identification test at baseline and follow-ups at 3 and 6 months. Patients undergoing dietary intervention experienced significant symptom improvement, although the response was less pronounced compared to FESS or dupilumab. At 6 months, mean SNOT-22 scores improved from 69.8 to 19.7 (FESS), 58.0 to 16.1 (dupilumab), and 39.5 to 24.2 (dietary intervention). visual analog scale scores showed a similar trend, decreasing from 8.4 to 2.9 (FESS), 8.1 to 2.2 (dupilumab), and 5.6 to 3.5 (dietary). While objective olfactory scores (brief smell identification test) improved in all groups, it was less pronounced in the dietary intervention group. Notably, patients in the dietary intervention group reported continued adherence and tolerability of the intervention. Dietary intervention may serve as a viable adjunct for CRSwNP patients who are unable or unwilling to undergo surgery or biologics. Despite lower efficacy, its safety and accessibility merit further investigation.