Otolaryngology-head Neck Surgery Research Articles

Applications of ChatGPT in Otolaryngology-Head Neck Surgery: A State of the Art Review.

To review the current literature on the application, accuracy, and performance of Chatbot Generative Pre-Trained Transformer (ChatGPT) in Otolaryngology-Head and Neck Surgery. PubMED, Cochrane Library, and Scopus. A comprehensive review of the literature on the applications of ChatGPT in otolaryngology was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. ChatGPT provides imperfect patient information or general knowledge related to diseases found in Otolaryngology-Head and Neck Surgery. In clinical practice, despite suboptimal performance, studies reported that the model is more accurate in providing diagnoses, than in suggesting the most adequate additional examinations and treatments related to clinical vignettes or real clinical cases. ChatGPT has been used as an adjunct tool to improve scientific reports (referencing, spelling correction), to elaborate study protocols, or to take student or resident exams reporting several levels of accuracy. The stability of ChatGPT responses throughout repeated questions appeared high but many studies reported some hallucination events, particularly in providing scientific references. To date, most applications of ChatGPT are limited in generating disease or treatment information, and in the improvement of the management of clinical cases. The lack of comparison of ChatGPT performance with other large language models is the main limitation of the current research. Its ability to analyze clinical images has not yet been investigated in otolaryngology although upper airway tract or ear images are an important step in the diagnosis of most common ear, nose, and throat conditions. This review may help otolaryngologists to conceive new applications in further research.

The race that never slows: Otolaryngology - Head and Neck Surgery residency applicant parameters over time.

There has been an increasing number of Canadian medical graduates who have gone unmatched in the residency selection process. Medical students have been engaging in extracurricular activities outside the formal curriculum which may help to distinguish themselves from their peers in the selection process. To understand how competitiveness in residency selection shapes applicant demographic characteristics and behaviours, this study set out to explore the demographic characteristics and prevalence of reported extra-curricular activities by applicants to Canadian Otolaryngology - Head & Neck Surgery (OTL-HNS) residency across time. A retrospective, descriptive study reviewed specific sections of the curriculum vitae (CV) of applicants to OTL-HNS programs in Canada. These sections were self-reported, and included research productivity, involvement in volunteer and leadership activities, membership in associations, and honours or awards granted. Data was quantified and analyzed descriptively. Between 2013 to 2017, a total of 267 applicants reported a median of 12.6 research publications, 9.6 volunteer activities, six leadership activities, six association memberships and 9.8 honours/awards. Applicants were younger over time, with proportions of applicants over 30 years old decreasing from 56% in 2013 to 9% in 2017. Applicants to Canadian OTL-HNS residency programs are reporting consistently high numbers of extracurricular activities and were of increasingly younger ages. Medical students are investing significant time and energy to pursue these activities which are above and beyond the formal curriculum, possibly contributing to decreased diversity in applicants for competitive residencies, increasing the likelihood of misrepresentation in residency applications, and likely contributing to medical student burnout.

Formation and Assessment of a Laryngology Pathology Video Atlas for Resident Education

Conventional reference images of laryngeal pathologies may provide educational value for Otolaryngology-Head & Neck Surgery (OHNS) residents, but observing dynamic vocal fold function is critical for diagnosis. Our aim was to develop and validate a video atlas of laryngeal pathologies for resident education in OHNS. A multi-institution, prospective case-control study. Ten videos showing 10 representative laryngeal pathologies were verified by two laryngologists. Six videos per category with kappa>0.8 were included in the video database. A collection of the videos was shown to a group of OHNS residents in a quiz fashion to determine if senior trainees would score higher than junior trainees. Another group of residents in OHNS was recruited and randomized to control or intervention. The control group was shown a quiz of 10 laryngeal videos at baseline and 24 weeks later. The intervention group was shown quizzes at baseline and every 6 weeks, ending at 24 weeks. Free-text diagnoses were scored for accuracy. Descriptive statistics, two-tailed tests, and analysis of covariance were performed. Twenty-nine residents participated, with 14 (48.3%) randomized to control, and 15 (51.7%) to the intervention. The postgraduateyear (PGY) level had a significant impact on diagnostic performance. PGY1 and 2 had a significantly lower score than PGY5 (P=0.017 and P=0.035, respectively). PGY3 and PGY4 scores were not statistically different from PGY5 scores. The mean score difference between groups decreases as the PGY level increases (mean difference between groups=0.87, P=0.153), but this was not significant. The current study has created a validated collection of videos that are representative of common laryngeal pathologies and can be easily incorporated into resident video-based learning. Future directions include larger multi-site studies to further elucidate whether repeated viewing of this video atlas can improve OHNS resident laryngology knowledge.

Management of pediatric aural foreign bodies: Towards a universal Otolaryngology referral algorithm

Children with aural foreign bodies (AFB) frequently present to the Emergency Department (ED). Our objective was to analyze patterns of pediatric AFB management at our center to characterize children who are commonly referred to Otolaryngology. A retrospective chart review of all children (ages 0-18 years) presenting with AFB to the tertiary care Pediatric ED over a three-year period was performed. Demographics, symptoms, type of AFB, retrieval strategy, complications, need for Otolaryngology referral, and, use of sedation, were evaluated with respect to outcomes. Univariable logistic regression models were conducted to determine which patient characteristics were predictive of AFB removal success. One hundred and fifty-nine patients seen at the Pediatric ED met the inclusion criteria. Average age at presentation was 6 years (2-18 years). Otalgia was the most common presenting symptom (18.0%). However, only 27.0% of children were symptomatic. ED physicians primarily flushed AFBs out of the external auditory canal with water, whereas Otolaryngologists exclusively used direct visualization. Otolaryngology-Head & Neck Surgery (OHNS) was consulted for 29.6% of children. Of these, 68.1% had complications associated with prior retrieval attempts. Sedation was administered in 40.4% of referred children, with 21.2% in an operative setting. Patients experiencing multiple retrieval methods by ED, and, age less than 3 years, were more likely to be referred to OHNS. Patient's age should be strongly considered as a factor for early OHNS referral. By synthesizing our conclusions with previously published results, we propose a referral algorithm.

Leveraging the virtual landscape to promote diversity, equity, and inclusion in Otolaryngology-Head & Neck Surgery

The pandemic era has wrought disruptive changes across all aspects of academic medicine, transforming clinical care systems, research enterprises, and educational practices. Among these sweeping changes, some of the most significant for Otolaryngology-Head & Neck Surgery (OHNS) relate to innovative use of virtual communication. The virtual landscape has not only redefined the delivery of patient care but also expanded educational interactions across the career continuum. As the architecture of relationships has been reimagined, the traditional Halstedian teaching paradigm has evolved, now integrating in-person, virtual, and hybrid learning. Once formidable barriers to distance learning have diminished, giving way to social networks that support mentorship, coaching, and sponsorship. Creative use of technology supports collaboration, feedback, spaced learning, scaffolding, and interleaving. These advances have immediate significance for OHNS, a highly collaborative specialty that leads in technological innovation and aspires to improve diversity. Whereas traditional efforts to grow the ranks of underrepresented in medicine (URiM) individuals in OHNS yielded only incremental progress, the virtual landscape is unveiling new strategies for reengineering narrow or leaky pipelines. Strategies that can help attract URiM applicants include inclusive departmental web presence, interactive online clinical experiences, virtual interviews, and remote research opportunities. As students, surgeons, and scientists collectively embrace technology, accelerated progress toward diversity, equity, and inclusion (DEI) becomes possible. Maximizing these opportunities requires aligning national and institutional imperatives for diversity with departmental priorities and mission. Finally, intentional outreach and holistic assessment support growth of structured virtual communities that foster equitable access for those who need it most.

Correlation between Current Histopathological Grading and Anatomical Location of Mucoepidermoid Carcinoma of Salivary Glands

Introduction: Mucoepidermoid carcinoma (MEC) is a kind of salivary cancer with a wide range of biologic activity. Mucoepidermoid tumors are the only kind of cancer where histologic grading and clinical behavior features are linked. Given the relative rarity of this disease, while being the most prevalent of the salivary gland malignancies, this is a common problem in the MEC literature. The aim of the study was to observe the correlation of MEC histopathological grading and anatomical location. Methods: This observational descriptive cross-sectional multi-center study was conducted at the Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital, Dhaka, Department of Otolaryngology &Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, and Department of Otolaryngology-Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh The study duration was 1.5 years, from July 2011 to December 2012. A total of 20 patients attending the study centers with diagnosed case of mucoepidermoid carcinoma of salivary glands was selected for the study following inclusion and exclusion criteria. Result: 40% of the participants were from the age group of 31-40 years, while another 30% were under the age of 21 years. 70% of the participants were female. Histological grading of the participants revealed 9 low grade, 8 intermediate grade, and 4 high-grade MEC tumor cases. High-grade tumor MEC had an association with increasing age and male gender. The swelling was a common clinical feature among all the participants, whereas ulceration was observed in 75% of high-grade tumor patients. Parotid gland was the most common location at 45%, followed by 30% tumors occurring at the palate. Among the 9 parotid gland carcinomas, 55.6% were from MEC intermediate grade, 33.3% from low grade and the remaining 11.1% from MEC high grade by histological grading. Among the 6 carcinomas of the palate, 50% were low grade, 33.3% were intermediate grade, ..........

Management of laryngopharyngeal reflux in Brazil: a national survey

IntroductionStudies assessing the management of laryngopharyngeal reflux by otolaryngologists have reported an important heterogeneity regarding the definition, diagnosis, and treatment, which leads to discrepancies in the management of the patient. Information about the current knowledge and practices of Brazilian otolaryngologists in laryngopharyngeal reflux is lacking. ObjectiveTo investigate the trends in management of laryngopharyngeal reflux disease among Brazilian otolaryngologists. MethodsA survey was sent by email to the members of the Brazilian Association of Otolaryngology-Head Neck Surgery. This survey has initially been conducted by the laryngopharyngeal reflux study group of young otolaryngologists of the International Federation of Otolaryngological Societies. ResultsAccording to the survey responders, the prevalence of laryngopharyngeal reflux was estimated to be 26.8% of patients consulting in otolaryngology and the most common symptoms were globus sensation, throat clearing, cough and stomach acid reflux. Nasal obstruction, Eustachian tube dysfunction, acute and chronic otitis media, vocal fold nodules and hemorrhage were considered not associated with laryngopharyngeal reflux by the majority of responders. About 2/3 of Brazilian otolaryngologists based the diagnosis of laryngopharyngeal reflux on the assessment of both symptoms and findings and a positive response to empiric therapeutic trials. Proton pump inhibitor utilized once or twice daily, was the most commonly used therapeutic scheme. Only 21.4% of Brazilian otolaryngologists have heard about nonacid and mixed laryngopharyngeal reflux and the awareness about the usefulness of multichannel intraluminal impedance pH monitoring (MII-pH) was minimal; 30.5% of responders did not consider themselves as well-informed about laryngopharyngeal reflux. ConclusionAlthough the laryngopharyngeal reflux-related symptoms, main diagnostic and treatment approaches referred by Brazilian otolaryngologists are consistent with the literature, the survey identified some limitations, such as the insufficient awareness of the role of laryngopharyngeal reflux in many otolaryngological conditions and of the possibility of non-acid or mixed reflux in refractory cases. Future studies are needed to establish international recommendations for the management of laryngopharyngeal reflux disease.

Design and application of submental island flap to reconstruct non-circumferential defect after hypopharyngeal carcinoma resection: a prospective study of 27 cases

Background This study investigated the effects of reconstruction of hypopharyngeal non-circumferential defects with a submental island flap after ablation of hypopharyngeal carcinoma. Objectives The purpose of our study was to identify advantages and limitations of the submental flap for reconstruction of non-circumferential hypopharyngeal defects. Methods A total of 27 patients who had stage II–IV hypopharyngeal cancer and underwent pharyngeal reconstruction with a submental flap by the senior author in both Department of Otolaryngology Head Neck Surgery, Chinese PLA General Hospital and Department of Otolaryngology Head Neck Surgery, Beijing Friendship Hospital, Capital Medical University. Results 96.3% (26/27) cases of submental island flap survived. There were two pharyngocutaneous fistulas, one recovered spontaneously, and the other was associated with flap necrosis, underwent neck debridement and flap removal. All except for one patient had decannulation of their nasogastric tube 2 weeks postoperatively. There was no evidence of a stricture or stenosis of the laryngopharynx, nor any sign of aspiration, except for one with esophageal inlet stricture caused by radiotherapy. There were two cases of obvious paraesthesia pharynges due to beard growth at the submental flap after reconstruction. 63.0% (17/27) patients are alive and 37% (10/27) have died of disease. The 3-year survival rate is 56.3% and the 5-year survival rate is 50.0%. Conclusion The submental flap reconstruction for moderately sized non-circumferential hypopharyngeal defects is a recommended treatment option.

Study on the relationship between adenoid and tonsil hypertrophy and obesity in children

Objective: To study the relationship between adenoid hypertrophy, tonsillar hypertrophy and overweight or even obesity in children. Methods: A total of 799 children aged 2 to 12 years with tonsillar and adenoid hypertrophy from January 2015 to December 2019 in the Department of Otolaryngology Head Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital were selected. The body mass index (BMI) was calculated according to the height and weight measured routinely at the time of admission. The difference of BMI between children and normal children of the same age, and the correlation between adenoid, tonsil hypertrophy and obesity were compared. Chi-square test was used to compare the surgical children's BMI of different genders with normal children of the same age, and Spearman rank correlation was used to analyze the correlation between BMI and adenoid and tonsil hypertrophy. Results: The Spearman correlation coefficient between tonsil hypertrophy and BMI was 0.078, P=0.077, the Spearman correlation coefficient between adenoid hypertrophy and BMI was -0.058(P=0.100). χ(2) test showed that the proportion of overweight and obesity in school-age children (7~12 years old) was significantly higher than that in preschool children (2~6 years old), and the difference was statistically significant (χ(2)(male)=22.386, P(male)<0.001, χ(2)(female)=4.478, P(female)<0.001). Conclusion: There is no obvious correlation between adenoid hypertrophy, tonsil hypertrophy and overweight or obesity in children, but the probability of children overweight or obesity increases with age, and the proportion of obesity in children aged 7-12 years is higher.

Transnasal puncture technique vs endoscopic transnasal choanal atresia repair

Aim: to evaluate the outcome of endoscopic technique for treating choanal atresia (CA) cases as well as to compare it with that of transnasal puncture. Methods: A retrospective cohort study was performed at the Otolaryngology-Head Neck Surgery department, King Abdulaziz University Hospital, Jeddah, KSA during the period between 2010-2017. Results: The type of first operation (endoscopic or transnasal puncture) was shown to have a significant relation to the restenosis rate after the first operation (P=0.02), where initial puncture repair had less restenosis rate. On the other hand, there was no significant difference between the two surgical techniques regarding the duration between the first and second operations (p-value=0.064), the required stenting period postoperatively (p-value=0.934), nor the total number of required operations (p-value=0.206). The use of Mitomycin, stents and decongestants had no significant effect on restenosis rate (p-values=0.515, 1.00 and 0.838 respectively). Conclusion: Endoscopic transnasal choanal atresia repair technique did not prove to be superior to older puncture technique. Stenting had no significant effect on repair outcome. Mitomycin C had somewhat a positive effect on prolonging restenosis. We believe that a transoral endoscopic approach might be superior technique to current transnal technique.

Barriers to research among residents in Otolaryngology - Head & Neck Surgery around the world

ObjectivesTo document the challenges faced by residents in Otolaryngology - Head & Neck Surgery (OTL-HNS) around the world to successfully complete research projects. The second objective is to assess if the challenges are uniform worldwide. MethodsA survey was sent to all OTL-HNS under 45 years old from the 2017 IFOS meeting. This survey was conducted by the YO-IFOS group (Young Otolaryngologists of the International Federation of Otolaryngological Societies). Data was collected for a period of 1 month. Demographic characteristics, information regarding research projects conducted and data concerning perceived barriers to completion of research projects were collected. ResultsAmong the 2787 attendees, 928 responded to the survey (response rate=33.3%). Of these 928 answers, 267 responses were from residents/interns in OTL-HNS, while 635 responses were from certified otolaryngologists. The three most frequent obstacles to conducting research projects for trainees were limited dedicated time (64%), insufficient financial resources (55%) and lack of education in research (45%). There was no statistical difference in these barriers among the different countries (P>0.05). ConclusionThis is the first international study that provides insight on trainee's challenges to conduct research projects during residency. Despite the notion that research is essential for generating new knowledge to guide patient care, many residents fail to successfully incorporate research in their surgical curriculum. These obstacles must be addressed by Otolaryngology - Head & Neck Surgery programs in order to facilitate and support resident's research.

Diagnosis and treatment of Chronic Rhinosinusitis in Children according European Position Paper on Rhinosinusitis and nasal Polyps –EPOS-2012 and American Academy Otolaryngology-Head and Neck Surgery 2014

Pediatric rhinosinusitis is defined as a presence of two or more symptoms and one of them should be either nasal blockage or nasal discharge and headache/facial pain or cough. Chronic rhinosinusitis - CRS is recognized when the four most common symptoms as cough, rhinorrhea, nasal congestion and post nasal drip with a slightly higher predominance of chronic cough are presented for more than 12 weeks and influence the quality of life. CRS should be considered in respect of unique conditions because of the differences in predisposing factors (immunological and others) and the anatomy of the sinuses between children and adults. The adenoids are a prominent contributor to CRS in young children, both from bacteriologic and immunologic status. The older children suffer from CRS in the same manner as adults. During evaluation a child with symptoms of CRS , one should always consider the possibility of underlying disease as a contributing factor. Diseases impacting sinuses and nasal function include CF, primary ciliary dyskinesia (PCD) and a variety of normal immune deficiencies, including the still-developing immature immunity of healthy young children. Surgical intervention for rhinosinusitis is usually considered for patients with CRS who have failed maximal pharmacological treatment. There are two important consensus statements for pediatric chronic sinusitis (CRS): European Position papers on Rhinosinusitis and Nasal Polyps -EPOS 2012 and Clinical Consensus Statement: Pediatric Chronic Sinusitis American Academy Otolaryngology-Head Neck Surgery 2014. Both of them contain necessary information and recommendation for diagnosis and treatment of CRS in children.

Lateral Rotation of the Basal Turn of the Cochlea with its Impact on Cochlear Implant Feasibility

AbstractPurpose: To investigate variation in cochlear orientation, with respect to rotation of basal turn, and its implication to cochlear implantation.Methods: Prospective observational study including 25 patients that underwent cochlear implantation at Tanta Cochlear Implant Centre (TCIC), Otolaryngology, Head & Neck Surgery (ORL-HNS) Department, Faculty of Medicine, Tanta Univer-sity, that had been done from April 2015 to December 2015, with available charts including Computerized Tomography (C.T.) scan of temporal bone. Axial cut with maximum visu-alization of the round window was identified, then angle of axial rotation of the cochlea was measured using two methods: Angle 1 between the midline and line through the long axis of the basal turn and angle 2 between the long axis of the basal turn and the long axis of horizontal segment of Internal Carotid Artery (I.C.A.) at the same axial level. All angles were measured using computer software. All cases had cochlear implantation using standard trans-mastoid technique. Round window visibility through facial recess was assessed after maximal widening of the facial recess to achieve best exposure. Then, cases were assigned into one of two groups according to the degree of round window visibility, Group I: Case with full exposed Round Window (R.W.) membrane. Group II: Cases with partially exposed R.W. membrane or invisible R.W. membrane.Results: Following review of the Computed Tomography (CT) images of the two patients (Group II) in whom cochlear implant was difficult. It appeared that the orientation of the basal turn of the cochlea relative to the midline (angle 1) was more obtuse or more acute than in other patients with p- value =0.007 & 0.002 respectively. It also showed that the orientation of the basal turn of the cochlear in relation to long axis of horizontal part of internal carotid artery (angle 2) was more obtuse relative to other patient with p-value=0.002 & 0.001 respectively.Conclusion: Our work highlights the importance of pre-operative measuring basal turn angel relative to fixed plane, as the mid-sagittal plane in pre-operative CT, instead of other anatomical structure that could be subjected to developmental remodeling and its impact on surgery of cochlear implantation.

Management of Persistent Epistaxis Using Floseal Hemostatic Matrix vs. traditional nasal packing: a prospective randomized control trial

BackgroundEpistaxis is the most common emergent consultation to otolaryngology-head & neck surgery (OHNS) and with 60% of the population having experienced an episode and 1.6 in 10,000 requiring hospitalization in their lifetime. In preliminary studies Floseal® (Baxter, USA) Hemostatic Matrix has shown efficacy in up to 80% of persistent anterior epistaxis. We sought to evaluate the clinical efficacy and cost-effectiveness of Floseal® (Baxter, USA) compared to traditional nasal packing for persistent epistaxis.MethodsA prospective, randomized controlled trial was conducted on all adult patients consulted to the OHNS service at the tertiary referral centers of the University of Alberta Hospital and Royal Alexandra Hospital for persistent epistaxis. Patients were randomized to the Floseal® (Baxter, USA) or traditional packing study arms. Our main clinical outcome measures were: 1) Hemostasis directly following treatment and at 48 h post-treatment, and 2) self-reported patient comfort at 48 h post-treatment. Further, trial data was used for a formal cost-effectiveness analysis to determine incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis and uncertainty analysis were performed.ResultsThere were no significant differences between groups for initial hemostasis (76.9% vs. 84.6%, p = 1.000) or, hemostasis at 48 h (76.9% vs. 69.2%, p = 1.000), requirement for admission (15.4% vs. 46.1%, p = 0.2016) or 30-day re-presentation rates (15.4% vs. 46.1%, p = 0.2016). Floseal® (Baxter, USA) was superior for decreased pain during placement (2.42 vs. 7.77, p = 0.0022), treatment (0.50 vs. 4.46, p = 0.0007) and removal (0 vs. 3.85, p = 0.0021). Floseal® (Baxter, USA) provides an average $1567.61 per patient savings from the single-payer system point of view and has an ICER of - $11,891 per re-bleed prevented (95% CI: -$37,658 to +$473). Uncertainty analysis shows that Floseal® has >90% chance of not only being cost-effective, but the dominant (preferred) treatment.ConclusionsFloseal® (Baxter, USA) was demonstrated to be an effective, comfortable and cost-effective alternative treatment of persistent epistaxis when compared to traditional packing methods for patients referred to OHNS with a normal coagulation profile.Trial registrationTrial registration number: NCT02488135. Date registered: June 26, 2015.

Identifying high quality medical education websites in Otolaryngology: a guide for medical students and residents

BackgroundLearners often utilize online resources to supplement formalized curricula, and to appropriately support learning, these resources should be of high quality. Thus, the objectives of this study are to develop and provide validity evidence supporting an assessment tool designed to assess the quality of educational websites in Otolaryngology- Head & Neck Surgery (ORL-HNS), and identify those that could support effective web-based learning.MethodsAfter a literature review, the Modified Education in Otolaryngology Website (MEOW) assessment tool was designed by a panel of experts based on a previously validated website assessment tool. A search strategy using a Google-based search engine was used subsequently to identify websites. Those that were free of charge and in English were included. Websites were coded for whether their content targeted medical students or residents. Using the MEOW assessment tool, two independent raters scored the websites. Inter-rater and intra-rater reliability were evaluated, and scores were compared to recommendations from a content expert.ResultsThe MEOW assessment tool included a total of 20 items divided in 8 categories related to authorship, frequency of revision, content accuracy, interactivity, visual presentation, navigability, speed and recommended hyperlinks. A total of 43 out of 334 websites identified by the search met inclusion criteria. The scores generated by our tool appeared to differentiate higher quality websites from lower quality ones: websites that the expert “would recommend” scored 38.4 (out of 56; CI [34.4–42.4]) and “would not recommend” 27.0 (CI [23.2–30.9]). Inter-rater and intra-rater intraclass correlation coefficient were greater than 0.7.ConclusionsUsing the MEOW assessment tool, high quality ORL-HNS educational websites were identified.

Mental practice in postgraduate training: a randomized controlled trial in mastoidectomy skills.

BackgroundMental practice, the cognitive rehearsal of a task in the absence of overt physical movement, has been successfully used in teaching complex psychomotor tasks including sports and music, and recently, surgical skills.The objectives of this study were, 1) To develop and evaluate a mental practice protocol for mastoidectomy 2) To assess the immediate impact of mental practice on a mastoidectomy surgical task among senior Otolaryngology─Head & Neck Surgery (OHNS) residents.MethodThree expert surgeons were interviewed using verbal protocol analysis to develop a mastoidectomy mental practice script. Twelve senior Residents from Canadian training programs were randomized into two groups. All Residents were video-recorded performing a baseline mastoidectomy in a temporal bone lab. The intervention group received mental practice training, while the control group undertook self-directed textbook study. All subjects were then video-recorded performing a second mastoidectomy. Changes in pre- and post-test scores using validated expert ratings, the Task Specific Evaluation of Mastoidectomy and the Global Evaluation of Mastoidectomy, were statistically analyzed.ResultsA mental practice script was successfully developed based on interviews of three expert surgeon-educators. Task Specific Evaluation and Global Evaluation scores increased in both the mental practice and textbook study groups; there was no significant difference between the two groups in the change in scores post-intervention. There was a high and statistically signficant correlation between evaluators on the outcome measures.ConclusionsWe were not able to demonstrate a significant difference for the benefits of mental practice in mastoidectomy, possibly due to the sample size. However, mental practice is a surgical education tool which is portable, accessible, inexpensive and safe.Electronic supplementary materialThe online version of this article (doi:10.1186/s40463-016-0162-2) contains supplementary material, which is available to authorized users.

Efficacy of Surgical Simulators for Otolaryngology Training

Program Description: Recently, there has been growing interest in developing and using simulation technologies for basic surgical skills training for residents. In addition, as our specialty continually evolves and we make efforts for quality and lifelong learning, simulation technologies may also be useful for keeping experienced surgeons up-to-date with their skills. We will present currently available surgical simulators for temporal bone dissection, endoscopic sinus surgery, airway endoscopy, and tonsillectomy. The presenters will provide descriptions and show videos demonstrating the function of these devices. In addition, each panelist will present data evaluating the efficacy of these simulators as being effective teaching instruments. Educational Objectives: 1) Differentiate the variety of simulation technology devices available for surgical skills training in otolaryngology–head neck surgery. 2) Recognize the advantages and limitations of using simulation technologies for acquiring and maintaining surgical skills. 3) Assess the validity of the studies presented to evaluate the efficacy of simulation devices as valuable learning tools.

Microlaryngoscopy and the Hunsaker tube

Clinical OtolaryngologyVolume 37, Issue 6 p. 501-502 Correspondence: Letters Microlaryngoscopy and the Hunsaker tube P.D. Karkos, P.D. Karkos [email protected] Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorC. Repanos, C. Repanos Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorS. Caldera, S. Caldera Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorD. Kim, D. Kim Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorD. Papadopoulos, D. Papadopoulos Department of Anaesthesia, Larissa General Hospital, Larissa, GreeceSearch for more papers by this author P.D. Karkos, P.D. Karkos [email protected] Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorC. Repanos, C. Repanos Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorS. Caldera, S. Caldera Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorD. Kim, D. Kim Department of Otolaryngology-Head Neck Surgery, Queen Alexandra Hospital, Portsmouth, UKSearch for more papers by this authorD. Papadopoulos, D. Papadopoulos Department of Anaesthesia, Larissa General Hospital, Larissa, GreeceSearch for more papers by this author First published: 17 December 2012 https://doi.org/10.1111/coa.12039Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume37, Issue6December 2012Pages 501-502 RelatedInformation

Functional and Aesthetic Approach to Adult Unoperated Möbius Syndrome

Sir:FigureWe read with great interest the article recently published in your Journal by Chou et al., who reported their experience in the treatment of an adult patient with Möbius syndrome.1 This was the first report in the literature of orthognathic surgery in those types of patients, and only one other article has been published.2 Despite the great results obtained by the authors and the innovative approach in Möbius syndrome treatment, we found some points that should be clarified. The authors recommend at the end of the article that the bony procedure be performed before soft-tissue adjustment: although this timing is certainly easier for the surgeon who can perform orthognathic surgery without intraoperative difficulties related to previous muscle transplantation, it could be detrimental to the patient in different ways. Orthognathic surgery should be performed, in Möbius patients and in normal patients, at the end of bony growth, to allow for optimal and stable results, avoiding recurrences and interferences with bony growth, whereas facial animation should be performed as soon as possible (we usually perform it starting from the age of 5 years) to allow for optimal social interactions and psychological development.3 Furthermore, if orthognathic surgery and, in particular, mandibular advancement, is performed before muscle transplantation, the lack of muscular activity in the lower third of the face could lead to a stretching of facial soft tissues and in particular of the inferior lip and pericommissural area that could result in worsening of inferior lip eversion and oral competence. These iatrogenic deformations are very difficult to correct also with muscle transplantation and require special techniques, including lip suspensions with fascia lata strips or commissuroplasty, that complicate soft-tissue rehabilitation and worsen final aesthetic and functional results. It is also important to point out that when gracilis muscle transplanted for facial animation is reinnervated with the motor nerve to the masseter muscle, reinnervation is stronger, safer, and faster than with other donor nerves,4 and there is no interference with the orthognathic procedure that can be safely performed at the end of growth. In conclusion, we commend the authors for their nice job, but we would also like to emphasize that the approach they recommend should be used only for patients in whom Möbius syndrome is diagnosed at the end of growth (such as the one they reported) and not in younger patients, who represent the majority of Möbius cases. In these patients, facial animation should be performed as soon as possible and orthognathic surgery should be delayed until after patient growth. Bernardo Bianchi, M.D. Andrea Ferri, M.D. Silvano Ferrari, M.D. Chiara Copelli, M.D. Maxillo-Facial Surgery Division Teore Ferri, M.D. Otolaryngology Head Neck Surgery Division Enrico Sesenna, M.D. Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy

Inadvertent bleeding in an infant after inguinal hernioplasty leads to diagnosis of hemophilia B

To the Editor: A seven-month-old male infant who was diagnosed with inguinal hernia at routine medical checkup was admitted to our hospital for surgical repair. Past history and family history were negative for bleeding tendencies, purpura, and hemophilia. Preoperative physical examination and laboratory tests indicated no abnormalities. Coagulation tests were not performed. Hernioplasty was performed with no oozing or complications. The patient was discharged from the operating room at 4 p.m. At 7 a.m. on postoperative day (POD) 1, HR had increased to 132 bpm and BP decreased to 90/40 mmHg. The mother noticed blood contamination of the gauze covering the wound at night, but she did not inform the medical staff. At 9 a.m. on POD1, the attending surgeon noticed the patient to be extremely pale and that the gauze covering the wound was soaked with blood. Blood tests confirmed severe anemia (hemoglobin (Hb) 4.8 g/dl). Emergency hemostasis was performed immediately under general anesthesia. After failure to secure another peripheral venous access, we inserted a central venous catheter in the right internal jugular vein. Preparation of red cell concentrate (RCC) took a long time because blood type screening had not been conducted preoperatively. The coagulation tests showed long APTT (125 s), and thus fresh frozen plasma was transfused. Oozing was observed throughout the surgical field. The blood loss measured intraoperatively was 50 g and laboratory tests at the end of surgery showed Hb 8.9 g/dl, and Ht 26.4% after transfusion of two units of RCC. On POD2, the scrotum began to swell because of oozing which required removal of the stitches to reduce the pressure. On POD6, plasma clotting factor IX was reduced to 8% of the normal value, and he was diagnosed as hemophilia B. Therefore, clotting factor IX was transfused which resulted in complete cessation of oozing on POD11. The patient was discharged on POD26. Routine preoperative management does not include coagulation tests, especially before minor pediatric surgery, for example hernioplasty, for children with no family history of bleeding disorders. Routine use of coagulation tests have been discussed by otorhinolaryngologists who perform elective tonsillectomy and adenoidectomy. Houry et al. [1] and the American Academy of Otolaryngology Head Neck Surgery [2] recommended performing preoperative hemostatic screening tests only for patients with abnormal bleeding history. The reported negative predictive value of normal APTT in the absence of symptoms and M. Sumie (&) T. Yokoo-Matsuoka K. Yamaura Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Maidasi 3-1-1, Higasi-ku, Fukuoka 812-8582, Japan e-mail: sumimako@chorus.ocn.ne.jp