任务驱动式费曼学习法在耳鼻咽喉科教学中的探索与应用

目的 分析费曼学习法教学模式在耳鼻咽喉科学理论教学中的应用实践,为耳鼻咽喉头颈外科学本科教学改革提供参考。方法 选择某院2016级临床医学八年制学生52人为研究对象,采用随机数字法分为实验组与对照组,每组26名学生,全体学生首先接受教师的传统理论教学授课,随后实验组学生根据费曼学习法对对照组学生进行模拟教学。理论教学结束后均有一次课堂测验,其中实验组学生模拟教学前后的测验分数分别记为A1、A2组,对照组分数记为B组。通过A1、A2和B组分数和问卷调查评估研究结果。结果 A2组测验成绩(80.92±2.76)分高于A1组(76.23±3.29)分、B组(76.38±3.38)分,差异均具有统计学意义(P均＜0.05),A1组与B组分数比较,差异无统计学意义(P＞0.05)。实验组教学整体满意度优于对照组,问卷调查条目2、3、4、6、7差异均具有统计学意义(P均＜0.05)。结论 费曼学习法应用于耳鼻咽喉科学理论教学中可提高教学质量与效果,教学模式得到学生的认可。     

梅尔频率倒谱系数在声带息肉手术前后嗓音分析中的价值研究

目的 本研究拟通过提取患者嗓音中的梅尔频率倒谱系数(MFCC)指标,探讨其在声带息肉手术前后嗓音分析中的临床价值。方法 回顾性分析于2018年1月—2019年8月行声带息肉手术且术前及术后1个月均行嗓音评估的患者41例,男31例,女10例;平均年龄(42.9±11.4)岁。另选取无声嘶且无声带病变的正常受试者21例作为基线对照。使用基于Python编程语言的librosa语音处理包进行MFCC特征提取,分别提取每位患者的MFCC均值,MFCC方差与MFCC标准差,使用配对样本t检验比较声带息肉手术前后上述各MFCC特征的差异。结果 声带息肉患者术后MFCC均值1.25±1.01、MFCC方差561.34±154.98及MFCC标准差21.74±4.03比术前MFCC均值6.81±2.05、MFCC方差1 019.66±295.87及MFCC标准差34.37±6.63显著下降,差异具有统计学意义(t=18.596,P=0.000;t=10.338,P=0.000;t=11.852,P=0.000)。声带息肉组患者术后1个月其MFCC均值、MFCC方差及MFCC标准差与正常受试者相比差异均无统计学意义,表明绝大部分声带息肉患者术后嗓音得到良好的恢复。结论 本研究首次探索了MFCC在声带息肉手术前后嗓音分析中的价值, MFCC各特征可作为评估声带息肉术后嗓音恢复的指标。     

以症状为主线的教学模式在耳鼻咽喉头颈外科规范化培训教学中的应用

耳鼻咽喉头颈外科住院医师规范化培训教学对临床思维的要求日益提高,传统以理论授课为主的教学模式难以使学生对耳鼻咽喉头颈外科形成系统的临床思维,本文探讨了“以症状为主线,充分培养临床思维”的教学模式在耳鼻咽喉头颈外科基地住院医师规范化培训培养中的应用及心得体会.     

先天性耳廓畸形耳模矫正的疗效分析

目的 分析先天性耳廓畸形耳模矫正治疗的临床疗效。方法 回顾2019年1月—2021年12月在湖南省妇幼保健院耳鼻咽喉科门诊进行耳模矫正的201例（318耳）先天性耳廓畸形患儿，按患儿开始治疗的日龄将其分为3组：109例（181耳）<14 d的患儿为1组，75例（117耳）14～42 d的患儿为2组，17例（20耳）43～89 d的患儿为3组；分析3组患儿的治疗效果、治疗时长、并发症发生率等。结果 201例（318耳）先天性耳廓畸形患儿治疗的显效及治愈率为93.4%，佩戴时长平均（32.4±10.8） d，并发症发生率45.9%。3组的治疗显效及治愈率分别为96.7％、90.6％、80.0％，组间差异具有统计学意义（χ²=10.479，P=0.005）；3组的矫正时长分别为（30.2±10.4）、（35.2±10.8）、（35.5±9.7） d，组间差异具有统计学意义（F=8.940，P=0.000）；3组的并发症发生率分别为37.0％、59.8％和45.0％，差异具有统计学意义（χ²=14.900，P=0.001）。结论 先天性耳廓畸形患儿通过耳模矫正可获得良好的治疗效果，14 d内开始治疗有助于提高治疗效率，缩短治疗时长，降低并发症发生率。     

小钳口LigaSure在腮腺肿瘤切除术中的应用

目的 探讨小钳口LigaSure在腮腺深浅叶良恶性肿瘤切除术中的应用。方法 前瞻性的纳入西安交通大学第二附属医院耳鼻咽喉头颈外科病院2016年1月—2018年12月行腮腺来源肿瘤接受手术的47例患者,分为利用LigaSure切除（A组）27例及电刀结合传统刀片切除（B组）20例。对两组间的手术时间、术中出血量、术后48 h引流量及术后并发症进行比较。结果 A组的手术时间（85.56±43.94）min与B组（123.00±44.14）min相比,明显缩短（P<0.05）;两组术中出血量[（46.67±42.34）mL vs（75.00±49.92）mL]比较,差异具有统计学意义（P<0.05）;两组术后引流量[（38.15±17.16）mL vs（63.25±21.59）mL]比较,差异有统计学意义（P<0.05）;两组间术后并发症各参数无统计学差异。浅叶切除中A组和B组手术时间[（70.00±17.54）min vs（104.00±25.58）min],术中出血量[（33.81±21.79）mL vs（54.67±19.32）mL]及术后引流量[（32.62±11.36）mL vs（54.33±8.84）mL]比较,差异均具有统计学意义（P均<0.05）。腮腺全切（包括扩大切除）术中使用LigaSure的患者手术时间,术中出血量及术后引流量与对照组比较,差异均无统计学意义（P均>0.05）。结论 小钳口LigaSure在切除腮腺良恶性肿瘤的应用是安全的,与传统手术方式相比尤其在浅叶手术中LigaSure有出血少,手术时间短等优势。     

日间手术模式下内镜辅助低温等离子腺样体消融术的临床探讨

目的 探讨日间手术模式下内镜辅助低温等离子腺样体消融术的可行性和安全性。方法 回顾分析2018年1—12月佛山市第一人民医院耳鼻咽喉头颈外科收治的108例腺样体肥大患者的临床资料，根据住院流程分为日间组65例和住院组43例。日间组于门诊完成各项检查，24 h内完成入院、手术、出院。比较两组患者手术情况（手术时间、出血量）、围手术期并发症（术后疼痛、发热、出血）和住院相关指标（术前等待时间、住院时间、住院总费用、西药费）。结果 日间组65例患者均顺利完成手术，日间组和住院组的手术时间分别为（6.9±2.3） min和（7.5±2.8） min，出血量分别为（5.2±3.6） mL和（5.5±2.4） mL，组间比较差异无统计学意义（P>0.05）。日间组3例出现术后发热、无术后出血、平均疼痛指数评分为（1.6±0.5）分；住院组6例出现术后发热、无术后出血、平均疼痛指数评分为（2.1±1.1）分，组间比较差异无统计学意义（P>0.05）。日间组和住院组临床疗效分别是96.9%（63/65）和95.3%（41/43），两组差异无统计学意义（P=0.935）。日间组术前等待时间和住院时间分别为（1.2±0.6） h和（10.5±2.8） h，较住院组术前等待时间（21.5±5.8） h和住院时间（76.2±12.5） h均明显缩短（P<0.001）。日间组住院总费用和西药费分别是（9 629.1±206.8）元和（650.4±54.3）元，亦较住院组住院总费用（11 672.7±1 016.2）元和西药费（779.5±103.9）元明显减少，差异具有统计学意义（P<0.05）。结论 日间手术模式下开展内镜辅助低温等离子腺样体消融术是安全、有效的，与住院手术相比可大大缩短术前等待时间和住院时间，降低住院费用，有助于减少医疗资源的消耗，加快病房运行效率。     

新冠肺炎疫情期间网络课程在耳鼻咽喉头颈外科教学工作中的应用

目的 探讨新冠肺炎疫情期间网络教学授课形式在耳鼻咽喉头颈外科医学教学中的应用效果。方法 将上海交通大学医学院2016级临床医学五年制和八年制学生作为研究对象,按照有或无网课学习经历分为两组,两组学生均因疫情原因,在家学习同一网络课程。疫情缓解期间,学生均已回归校园,于同时同地用同一份试卷进行考核,并进行主观问卷填写,结果应用SPSS 21.0作分析。结果 作为客观指标的理论考试成绩结果显示,实验组（82.04±5.87）分,对照组（84.22±4.12）分,两组间比较差异无统计学意义（P>0.05）,表明本次网课内容适当合理,同学们面对新的教学形式未见明显的适应不良,教学质量较满意。作为主观测试指标的教学质量问卷显示：对于网络教学的公认优缺点和特殊时期开展的必要性,两组均比较认同,但对于对于网课的实际效果、自身适应能力等仍存在一定疑虑。结论 网络教学是未来发展必不可少的教学形式,也是较为肯定的发展趋势,但目前可能仍不适合完全替代传统的线下课堂。借由此次的宝贵经验,让线上及线下课程相辅相成,使线上教学成为医学教育中行之有效的方式方法。     

晕动病的精准前庭康复治疗

目的 研究精准前庭康复训练对晕动病的治疗效果。方法 收集门诊62例晕动病患者,所有受试者在训练前2周内乘坐同一大巴车,乘坐30 min后采用视觉模拟评分量表（VAS）对其晕车症状进行自我评分;所有受试者接受3次精准前庭康复训练治疗。治疗后1周再次乘坐同样的大巴车,并再次行VAS评分。并分别按病情轻重、性别、年龄进行分组,将不同组别受试者治疗前、后晕动病症状得分进行比较,评价精准前庭康复治疗对晕动病的治疗效果。结果 所有受试者在精准前庭康复训练1周后其晕动病症状得分较训练前明显降低（8.18±4.67 vs 27.67±7.16,P<0.01）,其中症状重度和极重度组较中度组治疗效果好（χ²=21.98,P<0.05）;男女受试者之间的治疗效果无明显差异（χ²=0.008,P>0.05）;青少年组治疗效果较青中年组好（χ²=5.57,P<0.05）。结论 精准前庭康复训练对晕动病有明显的治疗效果,可使晕动病敏感度降低,重度以上及青少年患者的治疗效果较明显。     

重度阻塞性睡眠呼吸暂停低通气综合征患者血清同型半胱氨酸及脑源性神经营养因子水平与认知功能的相关性研究

目的探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)血清中同型半胱氨酸(Hcy)和脑源性神经营养因子(BDNF)水平与认知功能的关系。方法随机抽取60例重度OSAHS患者,使用蒙特利尔认知评估量表(MoCA)评估认知功能,根据评估结果分为认知障碍组(18例)和认知正常组(42例),30例健康体检者为对照组。利用ELISA法测定各组血清中Hcy和BDNF水平。结果认知障碍组与认知正常组和对照组比较,MoCA总分、视空间与执行能力、注意力、抽象及延迟回忆存在差异(P < 0.01),而命名、语言能力及定向评分无明显差异(P>0.05)。认知障碍组血清Hcy水平(34.12±2.85)较认知正常组(30.88±2.10)增高,而血清BDNF水平(9.00±1.67)较认知正常组(11.64±1.73)降低。认知障碍组最低动脉血氧饱和度(LSaO₂)、睡眠呼吸暂停低通气指数(AHI)与认知正常组存在差异(P < 0.01)。认知障碍组血清Hcy与MoCA总分(r=-0.880, P=0.000)、LSaO₂(r=-0.595, P=0.009)及BDNF(r=-0.818, P=0.000)呈负相关,与AHI(r=0.681, P=0.002)呈正相关;血清BDNF与MoCA总分(r=0.751, P=0.000)及LSaO₂(r=0.521, P=0.026)呈正相关,与AHI(r=-0.553, P=0.017)呈负相关。血清Hcy和BDNF水平预测认知功能障碍ROC曲线下面积分别为0.902和0.927。结论OSAHS患者血清Hcy和BDNF水平的改变与认知障碍的形成有一定相关性,可作为生物标志物用于认知障碍的早期诊断和预测。     

29例外伤性大脑半球间硬膜下血肿的临床分析

目的 探讨外伤性大脑半球间硬膜下血肿(TISH)的治疗方法和预后。方法 回顾性分析华中科技大学同济医学院附属同济医院2014年8月—2019年5月收治的29例TISH患者的临床资料。患者治疗后2周由Glasgow预后量表(GOS)评估短期疗效。GOS 1~3分为疗效差,GOS 4~5分为疗效好。结果 疗效良好者20例,占69.0%,疗效差者9例,占31.0%。疗效好组治疗后2周Glasgow昏迷评分(GCS)平均为(14.6±0.7)分,疗效差组为(9.4±2.2)分,两组间比较差异具有统计学意义(P＜0.001)。单因素分析显示影响TISH疗效的因素包括合并合并脑挫裂伤(P=0.032),入院时GCS评分(P＜0.001),住院期间病变变化(P=0.049),住院期间GCS极低值(P＜0.001),治疗方式(P=0.016)和手术方式(P＜0.05)。重症TISH患者(GCS≤8分)中7例行手术治疗,3例非手术治疗。手术组预后良好者4例,预后差者3例;而非手术组3例患者短期预后均较差。结论 TISH临床少见,多数患者病情较轻经保守治疗效果较好。部分患者出现迟发性出血,颅内压增高,神经功能障碍等,需严密监护。重症TISH患者手术治疗能够改善预后。     

Development of proficiency-based knot-tying and suturing curriculum for otolaryngology residents: A pilot study

ObjectiveBasic surgical skills such as knot-tying and suturing are important for all otolaryngologists, regardless of subspecialty. The present study was undertaken in order to assess basic surgical techniques such as knot-tying and suturing required for novice otolaryngology residents with taking the variety of subspecialties into consideration, and evaluate the impact of a proficiency-based training curriculum based on these techniques.MethodsA prospective study was performed for developing of proficiency-based knot-tying and suturing curriculum for otolaryngology residents in the third post-graduate year (PGY-3). The proficiency-based training curriculum was developed based on the tasks selected by RAND/UCLA method with expert panel, which is an iterative and anonymous survey used to establish consensus among participants. Expert panelists were selected from various divisions to reflect variety of their subspecialties. PGY-3 residents trained with the developed curriculum that included proctored pre-test, self-training to proficiency, and proctored post-test. Visual analogue scale (VAS) of trainees’ overall competence in the operating room was self-assessed by each resident, before and after completing the training curriculum.ResultsNine PGY-3 residents were enrolled as trainees. Eleven experts chosen as panelists had various subspecialty, including 2 from otology, 2 from rhinology, 2 from laryngology, 2 from head and neck surgery, and 3 from general otolaryngology. Seven tasks were selected from RAND/UCLA method and used to develop the curriculum. Trainee scores at pre-test were significantly lower than expert scores for all 7 tasks (p < 0.01) and each coefficient of variation of trainee score was larger than that of expert score (p < 0.05), supporting construct validity. The mean of composite scores between pre-test and post-test had statistical significance (68.6 ± 11.6 vs 95.9 ± 3.6, p < 0.01), documenting substantial improvement after training. Self-assessment VAS was also improved pre- to post-training (1.2 ± 0.9 vs 4.5 ± 1.4, p < 0.01). A follow-up questionnaire showed that trainees felt the educational curriculum to be beneficial.ConclusionIn the present study, seven basic technical skills were selected using the RAND/UCLA method and used to create a proficiency-based training curriculum. Our results indicate that this curriculum significantly improves proficiency of basic surgical skills of junior otolaryngology residents.     

耳内镜下内衬法与夹层法鼓膜修补术的疗效观察

目的 对耳内镜下内衬法和夹层法完成慢性化脓性中耳炎(CSOM)患者鼓膜修补术进行疗效观察.方法 回顾性分析2019年6月-2021年6月收治的经耳内镜内衬法和夹层法行鼓膜修补的CSOM患者的临床资料,共66例CSOM患者入组观察,随机分为两组由同一术者分别以内衬法(33例)和夹层法(33例)完成Ⅰ型鼓室成形术.比较其鼓...     

耳内镜与显微镜下Ⅰ型鼓室成形术的临床疗效分析

目的 探讨耳内镜与显微镜下Ⅰ型鼓室成形术治疗鼓膜穿孔患者的临床疗效。方法 收集2017年1月-2020年10月因慢性化脓性中耳炎行Ⅰ型鼓室成形术122例（122耳）,其中耳内镜下Ⅰ型鼓室成形术（ETT）62例;显微镜下Ⅰ型鼓室成形术（MTT）60例。所有患者术后均随访6个月以上,比较两组患者术中出血量、鼓索神经损伤率、手术时间、术后出院时间、住院费用,鼓膜愈合情况,对手术前与术后6个月的平均气导听阈（PTA）,气骨导差（ABG）进行分析,采用视觉模拟评分（VAS）评估患者术后24h疼痛反应。结果 ETT组具有术中出血量少、手术时间短、术后疼痛反应轻、出院时间缩短、住院总费用少等优越性,两组差异具有统计学意义（P<0.05）。ETT和MTT组中鼓膜愈合率分别为93.5%和90.0%,鼓索神经损伤率分别为6.5%和8.3%;ETT组术前PTA为（43.2±11.3）dB、AGB为（19.8±8.6）dB,MTT组术前PTA为（45.6±12.1）dB,AGB为（21.3±9.4）dB。术后6个月复查PTA两组均下降,ETT组为（33.7±8.3）dB,MTT组为（35.3±9.1）dB;复查ABG两组均下降,ETT组为（9.4±6.1）dB,MTT组为（10.7±6.4）dB。两组术式差异无统计学意义（P>0.05）。结论 与MTT相比,ETT能明显减轻术后疼痛、缩短手术时间、住院时间,减少总住院费。在术后穿孔修补、听力改善以及并发症等方面与传统手术MTT疗效相当,值得在中耳手术中推广使用。     

Assessing physical functioning in otolaryngology: feasibility of the short physical performance battery

PurposeObjective measures of physical functioning and mobility are considered to be the strongest indicators of overall health and mortality risk in older adults. These measures are not routinely used in otolaryngology research. We investigated the feasibility of using a validated physical performance battery to assess the functioning of older adults seen in a tertiary care otolaryngology clinic.Materials and methodsThe Short Physical Performance Battery was performed on 22 individuals aged 50 years or older enrolled in the Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) study at Johns Hopkins.ResultsWe successfully administered the SPPB to 22 participants, and this testing resulted in minimal participant and provider burden with respect to time, training, and space requirements. The mean time to complete 5 chair stands was 13.0 ± 3.8 seconds. The mean times for the side-by-side, semi-tandem, and tandem stands were 10.0 ± 0.0, 9.5 ± 2.1, and 8.8 ± 3.2 seconds, respectively. Mean walking speed was 1.1 ± 0.3 meters per second, and composite SPPB scores ranged from 6 to 12 (mean = 10.45, S.D. = 1.6).ConclusionsOur results demonstrate the feasibility of implementing a standardized physical performance battery to assess physical functioning in a cohort of older adults seen in a tertiary otolaryngology clinic. We provide detailed instructions, references, and analytic methods for implementing the SPPB in future otolaryngology studies involving older adults.     

Does “Just in Time” teaching of ergonomic principles improve posture of trainees during otologic microscopic surgery?

PurposeMusculoskeletal disorders are prevalent among otolaryngologists and otologists with symptoms starting during residency. Prior data suggested that high-risk joint angles were often adopted at procedure onset, suggesting a detrimental “natural” operating position. Despite its importance, dedicated ergonomic teaching is not systematically introduced into residency training. The objective of this study was to compare initial ergonomic positioning during microscopic temporal bone surgery between those who receive “Just in Time” ergonomic teaching prior to starting dissection with those who did not.Materials and methodsThis was a pilot, prospective trial in which otolaryngology residents at an urban, multicenter tertiary care academic institution (n = 14) wore ergonomic sensors (inertial measurement units) during microscopic temporal bone lab drilling. Prior to recording, participants were randomized to receive an instructional presentation on ergonomic principles (n = 8, intervention group) or not (n = 6, control group). The inertial measurement units analyzed neck and back angles for the initial 5 min of drilling.ResultsOf 14 trainees, 78.6 % had prior experience with otologic microscopic cases and 14.3 % reported prior surgical ergonomic training or instruction. The groups were matched in trainee height (P = 0.54), handedness (P = 0.83), stage of otolaryngology training (P = 0.64), prior otologic microscopic surgery experience (P = 0.35), prior temporal bone drilling experience (P = 0.35), and prior teaching in ergonomic principles (P = 0.47). Junior trainees (PGY 1–3) who did not receive “Just in Time” teaching adopted a posture with significantly higher risk back flexion compared to junior trainees who received the training (25.3° vs. 5.7°, P = 0.04). There was no difference in back positioning among senior trainees (12.6° vs. ?5.7°, P = 0.13). While there was a trend towards those in the intervention group adopting safer procedural posture, there was no significant difference in the overall cohort between the intervention and control groups in both neck positioning (?11.0° vs. ?19.1°, P = 0.17) and back positioning (8.6° vs. 19.1°, P = 0.18).ConclusionsMusculoskeletal related pain is prevalent among otolaryngologists and otologists with data suggesting that symptoms begin during residency. Targeted “Just in Time” teaching of ergonomic principles is feasible and may be effective for development of healthy postural habits, especially among junior trainees.