ORL-HNS training in South Africa

An out line of the scheme of training specialists in Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) in South Africa is given and the difference with Indian training discussed     

Changes in UK ORL-HNS training scheme: Does the Indian trainee have a place anymore?

The determination of the UK Government to modernise medical careers, the shortage of training jobs for local medical graduates, the establishment of the Postgraduate Medical Training and Education Board (PMETB) and European Union rules have combined to change the scheme of surgical training in the United Kingdom. In the opinion of the author, the Indian Otorhinolaryngological (ORL) trainee can no longer aspire to reasonable higher training in the UK.     

耳鼻喉科住院患者医院感染的原因分析及对策

耳鼻喉科患者具有基数大、病情差异较大的特点,在临床多种因素的影响下,极易导致患者在诊疗的过程中并发感染,促使患者的治疗周期延长,加剧患者的痛苦,严重影响患者的治疗效果,而治疗效果的优劣与医院的声誉和形象之间关系密切,自身的免疫能力低下、气管插管引发的误吸等患者因素;临床护理人员经验的缺乏,未严格遵守无菌操作原则等护理因素;侵入性的操作治疗、手术病灶切除的大小和抗菌药物的使用等治疗因素以及院方的重视度等管理因素均是导致感染症状发生的主要原因。该文对导致耳鼻喉患者发生医院感染的上述原因进行分析,并针对性地提出相关策略,为降低医院感染方案的制定提供借鉴。     

气管造口扩大术

２１例行全喉切除术后０．５￣５年行气管造口扩大术,以能在气管造口置放发音钮,造瘘口上下径为２．０ｃｍ,左右径为１．５ｃｍ。全喉切除术中气管造口狭窄的主要原因有瘘口不够大或瘢痕形成,气管造口扩大术有：各种“Ｚ”字形成形,放射状切口成形,环形皮肤切除,侧裂开鱼嘴形造口成形,三角形皮瓣成形及双“Ｖ”字形切除插入皮瓣等。     

与人类免疫缺陷病毒相关性耳鼻咽喉部卡波济肉瘤21例报告

报告２１例与人类免疫缺陷病毒（ＨＩＶ）相关性耳鼻咽喉部卡波济肉瘤，其主要局部表现是鼻出血、鼻塞、咽喉干燥、异物感及结节状新生物，并对ＨＩＶ感染与卡波济肉瘤的关系、病例特点及诊断依据进行讨论。     

Tracheostomies after SARS-CoV-2 intubation,performed by academic otorhinolaryngologists in the Paris area of France: Preliminary results

ObjectiveTo analyse tracheostomies after intubation for SARS-Cov-2 infection performed by otorhinolaryngologists in 7 university hospitals in the Paris area of France during the month March 24 to April 23, 2020.Material and methodsA multicentre retrospective observational study included 59 consecutive patients. The main goals were to evaluate the number, characteristics and practical conditions of tracheostomies, and the COVID-19 status of the otorhinolaryngologists. Secondary goals were to analyse tracheostomy time, decannulation rate, immediate postoperative complications and laryngotracheal axis status.ResultsTracheostomy indications were for ventilatory weaning and extubation failure in 86% and 14% of cases, respectively. The technique was surgical, percutaneous or hybrid in 91.5%, 3.4% and 5.1% of cases, respectively. None of the operators developed symptoms consistent with COVID-19. Postoperative complications occurred in 15% of cases, with no significant difference between surgical and percutaneous/hybrid techniques (P = 0.33), although no complications occurred after percutaneous or hybrid tracheostomies. No procedures or complications resulted in death. The decannulation rate was 74.5% with a mean tracheostomy time of 20 ± 12 days. In 55% of the patients evaluated by flexible endoscopy after decannulation, a laryngeal abnormality was found. On univariate analysis, no clinical features had a significant influence on tracheostomy time, decannulation rate or occurrence of laryngeal lesions.ConclusionThe main findings of the present retrospective study were: absence of contamination of the surgeons, heterogeneity of practices between centres, a high rate of complications and laryngeal lesions whatever the technique, and the specificities of the patients.     

Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure

ObjectiveTo demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series.MethodsWe performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017.ResultsWe performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients.Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis.ConclusionHolmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.     

Comparison of adverse events between cluster and conventional immunotherapy for allergic rhinitis patients with or without asthma: A systematic review and meta-analysis

BackgroundCluster schedule of allergen-specific immunotherapy (AIT) is a cost-effective choice for allergic rhinitis (AR) patients, but its safety has been questioned due to the greater dosages required at each treatment compared with conventional immunotherapy. It remains a question that whether cluster schedule leads to a higher risk of side effects.ObjectiveThis study was designed to update the evidence and investigate whether cluster schedule leads to a higher risk of local adverse reactions (LARs) and systemic adverse reactions (SARs) than cluster schedule does.MethodsWe searched the Cochrane Central Register of Controlled Trials, EMBASE and Medline thoroughly and included studies comparing cluster and conventional schedules. A meta-analysis of 5 outcomes related to adverse events was performed after bias and heterogeneity assessments. And as a result of language limitations, we considered only articles in Chinese and English.Results5 observational studies and 6 interventional studies were included in the meta-analysis. There were no differences between cluster and conventional schedules when analyzing SARs by the number of patients, delayed SARs, grade 2 SARs and LARs. Analyses of SARs by injection, grade 1 SARs and LARs by injection in observational studies showed that cluster schedule had a lower risk of adverse events than did conventional schedule.ConclusionOur data suggest that cluster schedule is as safe as or even safer than conventional schedule for AR patients with or without asthma (AS).     

Seminar联合病案导入式教学法在耳鼻咽喉科临床见习中的应用

目的研究Seminar联合病案导入式教学法在耳鼻咽喉头颈外科临床见习中的应用效果。 方法将2018年来首都医科大学宣武医院耳鼻咽喉头颈外科见习的七年制学生48人作为研究对象,随机分为两组,将采取传统教学法的设为对照组（n=24）,Seminar联合病案导入式教学法的设为实验组(n=24)。对比两组学生的理论考核成绩、基本检查操作成绩、教学满意度。结果实验组学员理论考核成绩为（93.00±3.13）分,基本检查操作成绩为( 90.25±2.97)分,高于对照组学生的( 87.70±3.57)分、( 85.92±4.68)分,组间比较差异具有统计学意义 (P<0.01);实验组学生的教学质量满意度( 95.80%) 高于对照组学生( 70.80%),组间比较差异具有统计学意义(P<0.05)。结论Seminar联合病案导入式教学法比传统教学法更能提高学生的学习力和操作动手能力,激发学生的兴趣,扩展临床思维,有助于学生对知识系统的掌握,教学效果显著。     

耳鼻咽喉科临床实习医师的规范化管理探讨

目的 探讨如何提高耳鼻咽喉科实习生临床实习的质量及有效性.方法 根据其复杂的自身特点及目前学生临床实习面临的问题,建立耳鼻咽喉科临床实习医师针对性的实习管理模式,包括实习前培训、带教老师的选择、专科知识讲座和出科考试的规范化管理.结果 所有实习医生均圆满完成实习任务,实习医生对我科带教医生综合满意度明显增加.结论 通过教学管理的规范化和带教目标性,从而有效地提高了耳鼻咽喉科实习生临床实习的质量.