Otolaryngology Training Research Articles

Validation of a 3D-printed human temporal bone model for otology surgical skill training.

HypothesisThree-dimensional (3D) printed temporal bones are comparable to cadaveric temporal bones as a training tool for otologic surgery.BackgroundCadaveric temporal bone dissection is an integral part of otology surgical training. Unfortunately, availability of cadaveric temporal bones is becoming much more limited and concern regarding chemical and biological risks persist. In this study, we examine the validity of 3D-printed temporal bone model as an alternative training tool for otologic surgery.MethodsSeventeen otolaryngology trainees participated in the study. They were asked to complete a series of otologic procedures using 3D-printed temporal bones. A semi-structured questionnaire was used to evaluate their dissection experience on the 3D-printed temporal bones.ResultsParticipants found that the 3D-printed temporal bones were anatomically realistic compared to cadaveric temporal bones. They found that the 3D-printed temporal bones were useful as a surgical training tool in general and also for specific otologic procedures. Overall, participants were enthusiastic about incorporation of 3D-printed temporal bones in temporal bone dissection training courses and would recommend them to other trainees.Conclusion3D-printed temporal bone model is a viable alternative to human cadaveric temporal bones as a teaching tool for otologic surgery.

Image-guided Temporal Bone Dissection Course.

Introduction Temporal bone anatomy is complex and demands a profound anatomical knowledge. Association between surgery and imaging helps in the process of learning three-dimensional (3D) anatomy and surgical techniques. High definition temporal bone imaging can play an important role in dissection training. Objective To describe a computed tomography (CT) image-guided temporal bone dissection course for surgical training in otolaryngology and to verify the satisfaction level of the students with the course. Methods Descriptive research. The course took place at a research laboratory, with three experienced temporal bone surgeons. The participants were 12 otolaryngology residents. The laboratory has 7 modern workstations with microscope and monitors linked with a computerized video system. Cadaveric temporal bones were donated to the university. Imaging acquisition of the cadaveric temporal bones used in the course was performed in a multislice CT scanner. The CT images of cadaveric temporal bones were available with real-time access on the laboratory monitor's screens during dissections. Results A total of 13 temporal bones were included for dissection. Students had the opportunity to view on the same screen, simultaneously, both the dissection video and the respective CT images of their temporal bone anatomical specimens. This allowed correlating surgical and imaging aspects of temporal bone anatomy. At the end of the course, participants answered a satisfaction survey. Conclusion Considering imaging methods are routinely used during most otologic surgeries, detailed knowledge of CT imaging should be explored in conjunction with the temporal bone anatomical dissection.

The effect of surgical complications on ENT trainees.

The 'second victim phenomenon' is a term attributed to the traumatic effect a medical error can have on healthcare professionals. Patient safety incidents have been shown to occur in as many as one in seven patients in hospital. These incidents cause significant, potentially devastating, trauma to patients and their relatives, and can have deep and long-lasting effects on the health professionals involved. These incidents can have a negative impact on doctors' emotional wellbeing; their professional practice in relation to this impact has not been extensively investigated in surgical trainees. A survey of UK otolaryngology trainees was conducted to investigate the effects of complications and medical errors on trainees, and examine how these are discussed within departments. The findings suggest that further training is required and would be warmly received by otolaryngology trainees as part of higher surgical training.

Otolaryngology education and training in the COVID-19 and post-COVID-19 digital era: a developing world perspective.

This article reviews the literature on the challenges to Otolaryngology training in the developing world, the solutions that have been implemented thus far and the role of technology in first the Digital, and now the Covid era. There is an increasing prevalence of Otolaryngological pathology in the developing world. Efforts to treat this are hampered by multiple factors including appropriate medical training. A number of solutions have been implemented for this both in terms of face-to-face as well as virtual training. The Covid era has created new challenges for Otolaryngology training in the developed world, sparking a huge shift in the delivery of education. Traditional forms of training have disadvantaged colleagues in the developing world and so this change in training modalities may benefit the developing world.

What is a Pediatric Otolaryngologist?

Patient Education| 2021 What is a Pediatric Otolaryngologist? Connected Content Translation: ¿Qué es un Otolaringólogo Pediátrico?: (What is a Pediatric Otolaryngologist?) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation What is a Pediatric Otolaryngologist?. Pediatric Patient Education 2021; 10.1542/peo_document167 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Pediatric Specialist Handouts Topics: ear, nose, otolaryngologists, pediatric otolaryngology, pharynx, ear, nose and throat disorders If your child needs surgical or complex medical treatment for illnesses or problems affecting the ear, nose, or throat, a Pediatric Otolaryngologist has the experience and qualifications to treat your child. Many general otolaryngologists provide surgical care for children. However, in many areas of the country, more specialized otolaryngology care is available for children. Pediatric otolaryngologists are medical doctors who have had At least 4 years of medical schoolOne year of surgical internshipOften 1 additional year of residency training in general surgeryAt least 3 to 4 additional years of residency training in otolaryngology and head and neck surgeryPediatric otolaryngologists often complete additional training in fellowship programs at a large children's medical center Pediatric otolaryngologists treat children from the newborn period through the teenage years. They choose to make pediatric care the core of their medical practice, and the... Copyright © 20002000American Academy of Pediatrics You do not currently have access to this content.

Pediatric Otolaryngology Training Program and Surgical Exposure in Western Province, Saudi Arabia; Toward Surgical Competency in Pediatric Otolaryngology

Introduction: King Abdulaziz University, in the Western Province of Saudi Arabia, in collaboration with King Saud Bin Abdulaziz University, has had a pediatric otolaryngology fellowship program in place since 2013, but no clear competency surgical caseload has been identified. Objective: To review the surgical load at the otolaryngology department in Saudi Arabia and to compare the currently implemented fellowship program with international standards. Methods: This was a descriptive cross-sectional study performed in King Abdulaziz University (KAU) hospital and King Saud Bin Abdulaziz University hospital. The number of otolaryngology surgeries was collected from the hospitals’ medical records for all patients <18 years who underwent surgical interventions from 2013 to 2018. The data collected were compared with the accreditation council for graduate medical education (ACGME) international benchmarks. Results: The average annual number of procedures performed versus benchmarks were 10.2 Vs. 20 for congenital anomalies procedures (p=0.003), 15.7 Vs. 12 for head and neck surgeries (p=0.231), 3.4 Vs. 30 for otology procedures (p<0.001), 11.8 Vs. 5 for closed airway procedures for children<3 years (p=0.088), 16.8 Vs. 5 for endoscopic airway procedures for children>3 years (p<0.001), 9.4 Vs. 8 for open airway procedures (p=0.439), 172.2 Vs. 50 for endoscopic interventions (p=0.006), 34.6Vs. 40 for rhinology procedures (p=0.189) and 2.8 Vs. 5 for facial plastic surgeries (p<0.001). Conclusion: The number of surgical endoscopic airway procedures and head and neck surgeries meets the international benchmarks, whereas procedures of congenital anomalies, otology, rhinology and facial plastics do not meet the international benchmarks within a single year, so a reduction of the two-year fellowship to one year would not be appropriate.

Mastery of Basic Rhinology: An Important Tool for the Modern Rhinoplasty Specialist.

Rhinology is the branch of medicine that deals with nasal function as part of the respiratory apparatus. It is a fundamental component of otolaryngology curricula and thus generously found in that specialty's literature. Ear, nose, and throat specialists who have made aesthetic rhinoplasty a cornerstone of their practice have understood the importance of rhinology for years. We propose that deeper knowledge and understanding of rhinology would be incredibly useful for the cosmetic rhinoplasty surgeon, especially the one who has no formal training in otolaryngology. This is of critical importance because sometimes, cosmetic rhinoplasties may have negative repercussions on nasal function, a problem that must be dealt with either preemptively at the time of surgery or at a revision procedure. Moreover, many of today's rhinoplasty patients are seeking comprehensive surgical care by a specialist who can manage both aesthetic and functional concerns in a single operation.

On the Importance of Proper Window and Level Settings in Temporal Bone CT Imaging

During a discussion on temporal bone imaging, a group of resident trainees in otolaryngology were asked to corroborate the finding of a fracture in set of images that were supposed to be representative of a fracture involving the otic capsule.1 (Figure 1)
 Their comments included the following statements:“The image still does not clearly identify the fracture. It would have been better if the images were set to the optimal bone window configuration...”
 “The windowing must be of concern as well. The exposure setting for the non-magnified view is different from the magnified ones. One must observe consistent windowing in order to assess the fractures more accurately.”
 “...the images which demonstrate a closer look on the otic capsule areas are not rendered in the temporal bone window which makes it difficult to assess.”“...aside from lack of standard windowing...”

Assessing Operative Competency in Cochlear Implantation Across the Residency Training Continuum.

To derive normative data based on postgraduate year (PGY) and number of completed otology rotations using a validated tool for cochlear implant surgical competency assessment. Prospective, blinded validation study. Otolaryngology-Head and Neck Surgery residency training program at a tertiary academic medical center. Fourteen unique otolaryngology trainees, ranging from PGY-1 to PGY-6, were assessed a total of 26 times in a temporal bone laboratory setting using a validated assessment tool for cochlear implantation. Construct validity, internal consistency, and inter-rater reliability. Inter-rater reliability was calculated using the Cohen's kappa. Overall agreement between raters was excellent (κ = 0.82). Construct validity was supported by a positive association between higher task-based checklist and global rating scale scores with both trainee PGY level and number of otology rotations completed. Time to complete the exercise was inversely associated with PGY level and number of otology rotations completed. Herein, we build upon a previously validated instrument to provide a method to reliably assess surgical competency in a core otologic procedure among residents across the training continuum. This data can be used to provide objective feedback on overall and task-specific competency in cochlear implantation to identify surgical deficiencies early on and to guide supportive course correction.

Twice as Nice: How Doubling Otolaryngology Rotation Time Affects the Intern Experience Nationwide.

Describe the current state of otolaryngologic residency training with recent changes to the program requirements by the Accreditation Council for Graduate Medical Education (ACGME) which increased the amount of time on intern year otolaryngology rotations from 3 to 6 months. A cross-sectional study was performed and recruitment was done via personalized email sent to program coordinators of 113 ACGME-accredited otolaryngology training programs within the Unites States. The message requested a breakdown of the amount of time and specialty in which first year otolaryngologic residents rotated. Interval follow ups were sent at 3 and 6 months for coordinators who had not responded. Response rate was 79.7% (90/113). General surgery and surgical intensive care unit were the two most common non-otolaryngologic rotations (92.2% and 96.6% respectively) while ophthalmology and radiation oncology were the least common at 7.8% each. All first year residents spend time on an inpatient otolaryngologic rotation, while 30.7% spend time on outpatient rotations. The most common subspecialties were head and neck oncology (40.0%) followed by pediatric otolaryngology (36.0%). Otolaryngologic training continues to become more slanted towards specialty-specific training and a concurrent reduction in "off-service" rotations. General inpatient services still predominate the intern year both inter- and intra-departmentally. These data provide insight into the training environment of the otolaryngologic trainees set to graduate residency for the first time this year.

Needlestick Injury in Otolaryngology-Head and Neck Surgery Resident Programs.

Up to 800,000 percutaneous injuries involving healthcare workers occur each year. The morbidity of needlestick injuries (NSIs) ranges from nothing to death. The incidence of NSI in otolaryngology residency is deemed to be high based on prior studies. This study aimed at defining the trends in otolaryngology residents regarding sharps exposure. Cross-sectional study using survey/questionnaire. Otolaryngology accredited residency programs in North America were surveyed in 2013 and 2017 regarding their experience with NSI and perceived risk of acquiring a blood-borne infection. Surveys were received from 314 residents (31 programs). There was a total of 509 needlesticks, primarily occurring during junior years (post-graduate year 1-3, 81%). Sixty-eight percent of residents had experienced an NSI. Of the residents that had an injury, the mean number of sticks was 2.37 sticks/resident. Junior residents were less likely to report their injury compared to senior residents (50% vs. 30%). The primary reason for not reporting was the time commitment. Residents underestimated their risk of acquiring human immunodeficiency virus (51% of residents) and overestimated their risk of acquiring hepatitis C virus (90% of residents). Occupational exposure is high in healthcare and particularly high in surgical trainees. The majority of otolaryngology trainees undergo a needlestick injury in their junior years. There continues to be underreporting of these injuries by residents, who report that the process is too time-consuming. Most residents do not have an accurate understanding of their actual risk of acquiring a blood-borne disease. These findings emphasize the need for education regarding risks and development of strategies to encourage reporting of injuries. VI Laryngoscope, 131:E1076-E1080, 2021.

National, Virtual Otolaryngology Training Day in the United Kingdom During the COVID-19 Pandemic: Results of a Pilot Survey

The COVID-19 pandemic has forced an unprecedented worldwide change in our daily lives, particularly in healthcare. In response to the lockdown measure it has brought on, some deaneries cancelled planned teaching days, while others had delivered remote smaller scale teaching sessions electronically. Due to significant regional variation, the National Association of Program Directors in ENT (NAPDENT) set up a national educational program, matched to the Intercollegiate Surgical Curriculum Program. This is delivered virtually and for free. This pilot survey evaluates participants’ learning experience of the first NAPDENT National Otology Training Day, which was held on 20 April 2020 via Zoom. This is a pilot survey evaluating the first online, national educational program delivered by the NAPDENT in the United Kingdom. In the times of the COVID-19 pandemic, our program has rapidly learnt from this initial experience and continues to build on lessons learnt for future editions. It is feasible to augment the national ENT curriculum with a collaborative, online teaching program. Regional buy-in is required to make this work. This modality allows for access to subject experts across the country. Synchronous delivery allows for participant interaction, while an online repository allows for asynchronous viewing when work or personal commitments do not allow live attendance. The key to participant engagement is adequate structure, appropriate breaks and opportunities for interaction. Even once the COVID-19 pandemic has passed, this teaching modality will remain as an opportunity to educate ENT surgeons of the future.

Perspectives of Young Otolaryngologists on Pediatric ENT and the Future of the Field in Turkey.

The purpose of this study was to examine the current status and the future of pediatric otolaryngology in Turkey by evaluating the opinions of young otolaryngologists on pediatric otolaryngology. The study included 224 otolaryngology physicians who were senior residents registered with the Turkish Otolaryngology and Head-Neck Surgery Association (TORL-HNS). The physicians were in their last two years of otolaryngology training (154 physicians) or had completed their residency training and were in their first year of otolaryngology practice (70 physicians). They were approached via e-mail and Short Message Service (SMS) in October through December 2019 with a descriptive letter and asked to voluntarily complete an online questionnaire consisting of total 25 questions in five sections. The online questionnaire was sent to 224 physicians, and 109 (49%) participated in the survey. All 109 participants answered all the questions. Overall, 71 participants (65.1%) were in training for residency and 38 (34.9%) were in their first year of expertise. According to their professional interests, the participants listed rhinology (45 participants, 41.3%), head and neck surgery (27 participants, 24.8%), facial plastic surgery (19 participants, 17%), otology-neurotology (16 participants, 14.7%), and laryngology-phoniatry (2 participants, 1.8%) as their first preference for subspecialty. Pediatric otolaryngology was never a first choice among the participants, although four (3.7%) listed pediatric otolaryngology as their second preference. The aim of this study was to shed light on the current and future status of pediatric otolaryngology in Turkey. We believe the establishment of exclusive pediatric otolaryngology clinics under the umbrella of general ear, nose and throat (ENT) clinics and the foundation of officially approved fellowship programs would bring this subspecialty field to its deserved and desired level in our country.

Clinical Radiographic Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.

To determine if clinically acquired cephalometric measurements, specifically soft palate size, can predict hypoglossal nerve stimulation outcomes. Combined prospective cohort study and retrospective review. US sleep otolaryngology training program. Adults with obstructive sleep apnea and apneahypopnea index greater than 15 events/h who underwent hypoglossal nerve stimulation. Eligible subjects had diagnostic preoperative sleep studies and full-night efficacy postoperative studies for analysis. Lateral neck x-rays were obtained as part of routine clinical care and measured for key cephalometric variables by trained head and neck radiologists. Continuous variables were compared using the Student t test, while χ2 testing was used for categorical variables. Fifty-one patients met all study criteria. On average, patients were white, middle aged, and overweight. Following hypoglossal nerve stimulation, the overall cohort achieved a significant apnea-hypopnea index reduction from 36.7 events/h to 20.6 events/h (P < .01) and a response rate of 47% (defined as apnea-hypopnea index reduction >50% and apnea-hypopnea index <20 events/h). On average, therapy responders had significantly thinner soft palates than nonresponders (13.4 ± 3.8 mm vs 16.0 ± 3.4 mm, P = .045). Patient-specific anatomic factors, specifically soft palate thickness, may help identify optimal candidates for hypoglossal nerve stimulation. A larger, prospective study including both anatomic and physiologic variables is required to validate these findings.

Editorial introductions

Editorial introductions

Combined web and haptic simulation system: A pilot study

ObjectivesSimulation education is increasingly used in otolaryngology training. The objective of this pilot study is to describe a mixed web-based and haptic modular platform for pediatric airway conditions. MethodsA web-based modular case presentation and evaluation system were developed to correspond to a pediatric laryngeal condition represented on the haptic models created using 3D printing and silicone elastomer. The haptic microlaryngoscopy simulation training and web module were evaluated by participants using a Likert scale. The mixed modular apparatus systematized the open web platform and haptic simulator, videos, text, questions, and evaluation to provide a more comprehensive simulation experience. ResultsSeventeen otolaryngology trainees participated, each completing a post-simulation survey. All participants responded 4 or higher (agree or strongly agree) on the Likert scale that the virtual training and case presentations improved their understanding of the pediatric laryngeal conditions presented. ConclusionA modular system constitutes a variety of web-based cases for evaluating, diagnosing, and performing procedures on a haptic surgical simulator taking the physician in training from diagnosis to treatment thereby expanding our current use of haptic simulators in surgical education to include case based learning and decision making.

The Advantages of a Rural Residency Rotation in Otolaryngology Training

The Advantages of a Rural Residency Rotation in Otolaryngology Training

Laryngology Education in Otolaryngology Residency Programs – A Pilot Study

To evaluate resident exposure to laryngology during otolaryngology residency. An anonymous, web-based, multiple choice, electronic questionnaire was sent to all 125 accredited otolaryngology training programs in the United States to distribute to otolaryngology senior residents (postgraduate year [PGY]-4, PGY-5). Sixty-four residents (33 PGY-4 and 31 PGY-5) responded to the survey. 85.9% had had training in strobovideolaryngoscopy. Only 7.8% of residents had had training in performing or interpreting objective voice measurements, and 26.6% had had training in performing or interpreting laryngeal electromyography. 42.2% of residents had participated in a laryngeal surgical laboratory. Only 19.4% of residents had attended a national laryngology meeting during the preceding 12 months. 92.2% of residents reported that their program had a laryngologist attending, 95.3% had a speech-language pathologist in their department, and 21.9% had a laryngology fellow. 87.5% of residents reported that they do not have to transfer any laryngeal cases to another facility. Exposure to microdirect laryngoscopy, vocal fold mass excision with microflap technique, type I thyroplasty, and subglottic stenosis repair was (100%, 92.2%, 84.4%, and 96.9%, respectively). 54.7% of residents were exposed to arytenoidectomy, and 14.1% of residents were exposed to reduction of arytenoid dislocation/subluxation. 45.3% of residents reported that they had an interest in music, 25% had an interest in singing, 14.1% had an interest in acting. More comprehensive laryngeal education could be achieved during otolaryngology residency by increasing exposure to objective voice measurements, laryngeal electromyography, and laryngeal surgery, especially arytenoid procedures including dislocation/subluxation reduction and arytenoidectomy.

Trends in Subglottic Stenosis Management: Resource Utilization and Pediatric Otolaryngology Training.

The role for endoscopic management in children with subglottic stenosis (SGS) has grown, but there are no data on resource utilization or the impact on surgical training in pediatric otolaryngology. This study hypothesizes that this shift has increased resource utilization and has impacted surgical training by shifting the focus toward more endoscopic techniques. Retrospective database review. The Kids' Inpatient Database for 2003, 2006, 2009, and 2012 was queried for admissions with the diagnosis of SGS. Surgical caseload was studied using the Accreditation Council for Graduate Medical Education Accreditation data system for 2010 to 2017. Admissions with SGS remained constant between 2003 and 2012. Hospital charges per admission did not change between 2003 and 2009 but increased in 2012. Tracheostomy decreased from 10.5% of admissions in 2003 to 6.8% in 2012. The percentage requiring repair of the larynx did not change; other operations on the larynx increased from 4.5% in 2003 to 11.6% in 2012. The median number of laryngoplasties performed per trainee decreased from 14 to nine between 2010 and 2017, whereas the number of laryngoscopy with intervention procedures increased from 34 to 56. The evolution of SGS management appears to have led to a decrease in tracheostomy and an increase in certain procedures that may include endoscopic procedures. Recently, there has been a shift in airway surgical training, with trainees logging less open laryngotracheoplasty and more interventional laryngoscopy. Although these trends cannot be directly linked, the changes in trainee surgical experience may be justified by the decrease in larger open procedures and associated resource utilization. 2c Laryngoscope, 132:S1-S9, 2022.

The impact of COVID-19 on global disparities in surgical training in pediatric otolaryngology

ObjectiveTo assess global trends in otolaryngologic and non-otolaryngologic education in response to COVID-19, specifically with regard to surgical simulation and personnel reallocation needs in case of patient demand. Study designOnline survey. MethodsA multiple-choice survey regarding operative caseload and impact on resident education was sent to Otolaryngology residents and Pediatric Otolaryngology faculty globally. The survey was open for responses for ten days in March 2020. ResultsA total of 96 completed surveys were received across 22 countries. 87.5% of respondents reported that no supplementary operative education is being provided. Despite 71.43% of responses indicating that simulation was useful for all levels of residents, 20.95% of responses indicated that simulation is not possible at their institution, with the majority of these being skewed toward responses from South America. ConclusionDespite the majority of respondents stating that simulation was helpful, there were disparities in access to simulation seen across countries. The results inform the need for a coordinated effort to expand educational efforts outside of the operating room and clinical environment. A major limitation of this study is the low domestic response rate.