Higher surgical training in Otolaryngology

The views of the membership of the Association of Otolaryngologists in Training (all current UK Senior Registrars and Consultants in their first year of post) were sought on topical aspects of Higher Surgical Training. 80 members (72.3%) participated. The main points to emerge were that the intercollegiate exam is unpopular. 66% feel it is neither well suited to the developing career structure nor a good assessor of trainees, 80% of Senior Registrars for whom the exam is voluntary say they will not sit it, 66% have doubts about the confidentiality of the Specialist Advisory Committee (SAC) interview and 73% felt the need for a separate faculty for Otolaryngology at the Royal College of Surgeons.     

Clinical diagnosis and histological analysis of vocal nodules and polyps

Recent studies emphasize the importance of the clinical-histology correlation in laryngeal pathologies.ObjectiveTo compare the ENT diagnosis with the pathology diagnosis one of 132 surgical specimens, from 119 patients with vocal nodules and polyps.MethodRetrospective study. We investigated the paraffin blocks corresponding to the lesions of the operated patients. We made new histology cross-sections, totaling 396 new slides, divided into three groups: hematoxylin and eosin, Gomori trichrome and PAS. We analyzed the following histological parameters: epithelium, lamina propria, basement membrane, vascular changes. We compared the laryngological and pathological diagnoses, and we did the statistical analysis, checking the predominant histological aspects in each lesion.ResultsThere was an agreement between the clinical and pathological diagnoses in 123 (93.18%) of 132 lesions analyzed (42.42% nodules and 50.76% polyps). In the histological parameters we found: epithelial changes such as nodules hyperplasia (82.14%) and polyp atrophy (31.34%). Lamina propria: edema in polyps (71.43%), fibrosis in the nodules (57.14%). Basement membrane: thickened nodules (100%), thin/no change in polyps (100%). There was a predominance of vascular changes in the polyps.ConclusionWe found a high correlation between the ENT diagnosis and the pathology report. Histopathologically, the nodules presented with predominantly epithelial changes, lamina propria and basement membrane fibrosis, while the polyps by changes strictly on the lamina propria and vascular aspects.     

Experiences of day care surgery in otolaryngology

Day care surgery in otolaryngology is gradually gaining popularity all around the world and the scope of day care surgery has improved significantly in recent years. 380 patients underwent ear, nose and throat surgery during the period Sep 2002–Aug2004. All the cases were done under local anaesthesia. Strict criteria were adopted for admission and discharge of the patients. Most of the patients (90.6%) who underwent ENT day care surgery did not experience unusual peroperative or postoperative discomfort. There was no case requiring postoperative admission to a hospital. There was a high degree of patient preference and satisfaction to day care surgery. Following proper guide lines for day care surgery and strict admission and discharge criteria has gone a long way in making day care surgery a success. It can be concluded that high medical standards can be achieved with low expenditure with this form of management.     

Historical patterns in presentations at the American Society of Pediatric Otolaryngology (ASPO): Using a searchable database of the ASPO Program to show the trends of an otolaryngology subspecialty

Objectives

•

To describe the development of American Society of Pediatric Otolaryngology (ASPO).

•

To utilize a searchable database of meeting programs to demonstrate content presented at a major meeting since its inception.

•

To utilize a searchable database of meeting programs to show trends of pediatric otolaryngology.

Methods

Programs of ASPO meetings from 1986 to 2011 were reviewed using a searchable database. Number of podium presentations and length of podium presentations per meeting were collected. Podium presentations were placed into broad categories from reviewing presentation title. Broad categories included tonsils and adenoid, otology, airway, head and neck masses, and sinus disease. First author, location of first author, length of presentation, and publication status were collected for each podium presentation.

Results

An average of 49 (range 31–76) podium presentations were presented at each meeting. The average length of podium presentation was 8.3 min (range of 5–20 min). Tonsil and adenoids made up 9% (range 0–22%) of the program, otology made up 26% (range 15–44%) of the program, airway made up 34% (18–48%) the program, head and neck masses made up 8.7% (0–18.5%) of the program, sinus disease made up 6.2% (0–23%) of the program. Fifty-four percent (54%) of podium presentations were published.

Conclusion

This is a unique example of utilizing searchable databases constructed from published programs of a major otolaryngology meeting to assess topics presented and areas of emphasis. The areas of emphasis at ASPO over its 26 years are airway, otology, tonsil and adenoid issues, head and neck masses, and sinus disease in the pediatric population. Percent of time given to each topic has changed from ASPO's beginning to today.     

Senior registrar training in otolaryngology: an audit of trainees

Senior registrars in otolaryngology were asked to complete a questionnaire about the opportunities for training and research offered by their current post. Trainees were asked whether, in their opinion, the post complied with the SAC requirements for a training post. Completed replies were received from 53 (66%) trainees. Most trainees were fairly satisfied with their post but 26% considered that it did not meet with the ideals of a training post as laid down by the SAC. Large variations were noted between posts in the exposure to specialist clinics, own operating lists and research opportunities. Outpatient experience and, in particular, whether the trainee was able to follow up their own post-operative cases adequately appeared to be an important determinant in whether or not trainees were satisfied with their current post.     

Profile of otorhinolaryngology emergency unit care in a high complexity public hospital

Urgent and emergency care are common happenings in ENT practice and most carry low morbidity and mortality. There are but few studies that address the epidemiology of these situations.ObjectiveTo evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital.MethodEpidemiological, cross-sectional study, retrospective with data collection carried out from medical records from the emergency department of otorhinolaryngology of a high complexity hospital in São Paulo, for a period of 12 months. Data collected: age, gender, clinical diagnosis and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngealstomatology and head and neck surgery. We evaluated the level of urgency/emergency, etiology and monthly distribution of visits.Results17,503 medical records were obtained; 1,863 were excluded. Of the 15,640 cases included, the average age was 36.3 years. 9,818 (62.77%) corresponded to cases considered as emergency/ urgency. Among the urgency/emergency cases, 6,422 (65.41%) were diagnosed in the ear and among the 10 most prevalent diagnostics, 7 were in the subspecialty of otology.ConclusionAmong the patients seen in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty.     

The urban/rural divide in head and neck cancer—the effect of atmospheric pollution

Inter-district variations in the incidence of head and neck squamous carcinoma in the period 1978–1987 have been identified from records at the West Midlands Cancer Registry, England. Analysis of the records reflect the national and international trend of higher urban cancer rates compared with neighbouring rural communities. Atmospheric pollution data (mean sulphur dioxide and smoke concentrations) from a national survey are positively correlated with squamous cancer of the larynx and pharynx. The correlation is most significant between laryngeal cancer rates and atmospheric sulphur dioxide levels. The periods 1950–1970 and 1970–1990 have been analysed separately to reflect the reduction in atmospheric pollution that has occurred over these years and thus avoid missing a latent effect that this might have on cancer rates.     

Analysis of theoretical knowledge and the practice of science among brazilian otorhinolaryngologists

Physicians from all medical specialties are required to understand the principles of science and to interpret medical literature. Yet, the levels of theoretical and practical knowledge held by Brazilian otorhinolaryngologists has not been evaluated to date.ObjectiveTo assess the background and level of scientific knowledge of Brazilian otorhinolaryngologists.MethodParticipants of two national ENT meetings were invited to answer a questionnaire to assess scientific practice and knowledge.Results and ConclusionThis study included 73 medical doctors (52% otorhinolaryngologists and 38% residents) aged between 18 and 65 years. About two-thirds have been involved in some form of scientific activity during undergraduate education and/or reported to have written at least one scientific paper. Physicians who took part in research projects felt better prepared to interpret scientific papers and carry out research projects (p = 0.0103 and p = 0.0240, respectively). Respondents who claimed to have participated in research or to have written papers had higher scores on theoretical scientific concepts (p = 0.0101 and p = 0.0103, respectively). However, the overall rate of right answers on questions regarding scientific knowledge was 46.1%. Therefore, a deficiency was observed in the scientific education of Brazilian otorhinolaryngologists. Such deficiency may be mitigated through participation in research.     

Pectus excavatum in children with laryngomalacia

Background

Laryngomalacia is the most common congenital laryngeal anomaly and is associated with several disorders including gastric reflux, sleep apnea, hypotonia and failure to thrive. Pectus excavatum (PE) is the most common chest wall deformity affecting 1–300/1000 individuals. Though many authors presume a relationship between PE and laryngomalacia, there is no published data to establish this association.

Goal

To test the hypothesis that patients referred to our pediatric otolaryngology clinic for evaluation of laryngomalacia exhibit higher rates of PE than the general population.

Methods

Retrospective review of prospectively enrolled children who presented with laryngomalacia (January 2008–June 2012) to a tertiary care, hospital based, pediatric otolaryngology practice. Each chart was examined for a concurrent diagnosis of pectus deformity.

Results

Of the 137 laryngomalacia patients, 9 (6.6%) had documented PE. This represents a significantly increased rate of PE when compared to children without laryngomalacia (p = 0.001). Four of the 9 children with PE underwent supraglottoplasty for laryngomalacia, a significantly greater proportion than the 9/128 of the children with isolated laryngomalacia who underwent supraglottoplasty (p = 0.004).

Conclusions

This study suggests an association between laryngomalacia and PE. Pediatric otolaryngologists should be cognizant of this relationship, though further studies are needed to elucidate the nature of this association.