Low-fidelity otoscopy simulation and anatomy training: A randomized controlled trial

ObjectivesTo evaluate whether the use of low-fidelity otoscopy simulation improved medical students’ theoretical knowledge of middle ear anatomy and pathologies compared to traditional teaching methods.MethodsThis was a randomized controlled trial. Simulation workshops were conducted in April 2019 in the Lyon Sud University medical faculty, France. Students were randomly assigned to the simulation group (n = 105) or to the control group (n = 95). The students in the control group answered a questionnaire evaluating theoretical knowledge (25 true-false questions) before the simulation tutorial, while the students in the simulation group answered the same questions after the tutorial. Both groups also filled out a satisfaction questionnaire for feedback.Results196 of the 200 students who participated in the study completed the knowledge assessment questionnaire. Scores were 32.0% higher in the simulation group than in the control group (mean scores, 12.0/20 vs. 9.1/20; P < 0.0001). 184 of the 191 students who completed the satisfaction questionnaire (96.3%) were satisfied or very satisfied with the workshop, and all but one (99.5%) recommended keeping it in the curriculum. In the free comments fields, students highlighted the educational value of learning without the stress of patient discomfort.ConclusionOtoscopy simulation is an effective training method, improving theoretical knowledge compared with conventional theoretical training.     

Diagnostic utility of flexible fiberoptic nasopharyngolaryngoscopy recorded onto a smartphone: A pilot study

ObjectivesTo evaluate the diagnostic accuracy of flexible fiberoptic examinations of the larynx recorded onto smartphones.MethodsProspective, blinded study of inpatients requiring laryngoscopy. A live exam was performed, then a smartphone was attached to the endoscope using a novel coupling device and the same examination was recorded. The live and recorded exams were evaluated by two laryngologists, each blinded to the findings of the other.ResultsEighteen subjects were evaluated. Evaluation of airway patency was identical (Kappa = 1.0 [1, 1]). Evaluation of vocal cord motion was identical for 14 subjects: 9 normal, 3 paretic, 2 paralytic (Kappa = 0.69 [0.38, 1]).ConclusionThere is high correlation between laryngeal diagnoses using live flexible fiberoptic laryngoscopy and recordings using a coupling device to transfer the recordings on to smartphones. Critical findings such as airway patency and vocal fold motion showed the highest correlation.     

Development of video otoscopy quiz using a smartphone adaptable otoscope

Background:Otoscopy examination can be challenging.Traditional teaching uses still image illustrations.Newer attempts use video samples to simulate the otoscopy exam which is a dynamic process.Aims/Objective:To assess whether recorded otoscopy videos from a smartphone adaptable otoscope can be used to develop a video-based otoscopy quiz which may be used for instructing and familiarizing participants to normal anatomy and pathologic ear conditions.To use this quiz to assess current pediatric residents’competency of common otoscopy diagnosis.Method and materials:This study was conducted in 2018.Video samples of ear pathology were collected at the Albany Medical Center using a smartphone adaptable otoscope-Cellscope.The videos were used to create a video otoscopy quiz(VOQ)without clinical vignettes.45 pediatric residents from 3 academic institutions were evaluated with the quiz.Results:The weighted mean for the VOQ was 66.90%(95%CI 58.89%-68.42%).The breakdown by questions are:myringosclerosis 72.88%,retraction pocket 80.65%,cholesteatoma 42.22%,hemotympanum 75.04%,tympanic membrane perforation 79.62%,cerumen impaction 95.46%,otitis externa 52.54%,otitis media with effusion 63.30%,acute otitis media 75.55%,normal ear 36.39%.Conclusion:We found that videos of otoscopy exams can be obtained with a smartphone adaptable otoscope and validated to develop a video-based quiz,which may be used to supplement otoscopic instruction.Following our testing process,we found pediatric residents are relatively well equipped to identify ear pathology on VOQ.     

Chiari Malformation in otology practice

The purpose of the study was to evaluate prevalence, characteristic symptoms, and management of Chiari Malformation 1 (CM1).     

Clinical trials in otology: Examining trends and framework for prioritization

Objective:To characterize otologic clinical trials and examine otologic clinical trial trends from 2008 to 2018 using the clinicaltrials.gov database.Methods:Data was collected from clinicaltrials.gov and included all clinical trials that focused on otology from 2008 to 2018.Outcome measures include status of trials,funding sources,details regarding otologic conditions studied,and trends in clinical trials.Results:There were 992 otology clinical trials from 2008 to 2018.457(46.1%)were completed and 94(9.5%)were discontinued.Industry remained the highest(76.5%)contributor to otology clinical trials.The otologic conditions studied,from most common to least common,include hearing loss(40.6%),vestibulopathy(18.8%),tinnitus(18.8%),and otitis media(15.1%).The number of otology clinical trials increased by an average of 12.0 trials per year from 2008 to 2018(p<0.001).The number of otology clinical trials focusing on hearing loss and vestibulopathy significantly increased over the studied period(p<0.001),while those focusing on tinnitus and otitis media did not(p=0.09 and p=0.20,respectively).The majority of clinical trials on each of these four conditions focused on treatment options.Conclusion:Our study describes trends in otology clinical trials registered on clinicaltrials.gov from 2008 through 2018.The total number of clinical trials over this time period increased significantly,driven by trials investigating hearing loss and vestibulopathy.Furthermore,most clinical trials were industrysponsored and focused on treatment modalities.Our study provides an outline of otology clinical trials registered in a US web-based database,which may be of use for the development of future clinical trials.     

Successful telemedicine programs in otolaryngology

This article discusses the types of telemedicine technologies that are currently in place and being used successfully in otolaryngology. It examines how these technologies have been applied in several different otolaryngology telemedicine programs and discusses their relative merits and successes.     

A novel method to measure the external auditory canal: Normative data and practical implications

Purpose

To accurately measure external auditory canal (EAC) dimensions by high resolution computed tomography (CT), and compare results with a traditional method of EAC measurement.

Is otoscopy reliable? A structured teaching method to improve otoscopic accuracy in trainees

Otoscopy is an important skill for primary care physicians and otologists. Until now, training has been by repeated exposure to patients with ear disease. Structured instruction in how to assess an ear has not previously been reported. Not-diseased ears and those with varying types of chronic (suppurative) otitis media were chosen to be photographed as this is an important condition to be able to diagnose and in which pneumatic otoscopy has no role. Two sets of 30 slides of equal difficulty were shown to 10 trainees, one before and one after structured teaching. The overall error rate fell from 44 to 21% (P < 0.001). Most importantly, the error rate in assessing ear activity fell from 35 to 17% (P < 0.05). In conclusion, a structured approach to otoscopy has been shown to improve the diagnostic ability of trainess tested with photographs of ears with chronic otitis media. Such a teaching approach is likely to be equally beneficial to other otological conditions and to live otoscopy.     

原发性小血管炎首诊耳科2例报告并文献复习

目的 通过报告2例以耳部症状首发并首诊耳科的原发性小血管炎患者的临床表现、诊断并文献复习,探讨原发性小血管炎基本发病机制、病理、临床表现及诊断。方法 对2例患者的临床资料及诊疗经过进行分析,并复习相关文献加以探讨。结果 2例患者临床表现不一,多种途径确诊后治疗,效果良好。结论 原发性小血管炎临床表现复杂多样,极易误诊,特别是以往临床上对血管炎导致的耳科疾病认识较少,在耳科的主要表现为耳痛、耳闷、流脓、听力下降等。早期诊治是改善预后的关键,综合判断分析能减少对此病的误诊。     

Day-surgery in otology: Impact study of a dedicated organizational model

AimDay surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in “major otology” cases in a hospital center after launching a dedicated ENT DS unit.Material and methodsThis new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded.ResultsBetween the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%).ConclusionMajor otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons’ growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.     

Hearing loss due to urate deposition in the middle ear: A case report and literature review

Gout is the most common cause of monoarthritis in men occurring classically in the great toe and the knee.Extra-articular gout manifestations are rare.Only a few cases of head and neck urate crystals deposits have been described in the literature.Precipitations in the middle ear cause conductive hearing loss with common otoscopic anomalies and difficult imaging diagnosis.We report a case of a healthy 58-years-old man with a middle ear urate deposit causing a progressive hearing loss as the very first symptom of gout.The nature of the deposit was unsure on computer tomography(CT)due to atypical density.The final diagnosis was revealed after surgical procedure and histologic examination.A review of the literature is also presented.Seven cases of middle ear urate deposit as the first symptom of gout were found and compared.Progressive conductive hearing loss in middle-aged patients with abnormal otoscopy and middle ear atypical density mass on CT scan must lead to a minimal surgical procedure with a histologic examination to exclude urate crystals deposits.     

Results of an evaluation of clinical practice in orthognathic surgery in France in 2002

BACKGROUND: Over the years, orthognathic surgery has become a mainstay of maxillofacial surgery and is the object of many publications and oral communications. However, in spite of well-established methodology, disparities still exist in France basically concerning the way orthognathic surgery is performed. MATERIALS AND METHODS: In relation with the XXXIXth congress of Stomatology and Maxillofacial surgery, a questionnaire was mailed to 100 French maxillofacial surgeons. Questions dealing with some practical points of orthognathic surgery (condylar positioning, osteosynthesis technique, rate of condylar resorption.) were asked. RESULTS: Overall reply rate was 37%. Condylar positioning was performed empirically in 73% of the cases. Mandibular osteosynthesis was achieved by titanium miniplates alone in 70%. Post-operative condylar resorption rate was about 2%. This survey produced numerous astute comments. DISCUSSION: This survey highlighted the interest of maxillofacial surgeons for practical aspects of orthognathic surgery including the questions of condylar positioning or osteosynthesis technique. These points are instrumental in achieving high-quality surgical result.