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。     

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。     

Psychological implications in ENT diseases

We are sometimes faced with psychic derangement or overlay in some of the ENT diseases and the link between patient’s psyche and any ENT disease at times becomes signifi cant and troublesome. The conditions in the fi eld between otorhinolaryngology and psychiatry can be classifi ed as psychiatric symptoms resulting from ENT diseases or interventions and those expressing themselves as ENT symptoms due to mental ailment. The former include hearing impairment, dizziness, tinnitus, choked airway, bad oral breath, stuffy nose, traumatic interventions and external nasal deformities. The later include exaggerated and diminished pharyngeal refl ex, globus hystericus, speech disorders, vasomotor rhinitis, nose picking, choked feeling, dizziness and headache. At times diseases originate in the human mind (consciousness), causing negative thoughts like jealousy, anger, and depression due to frustration. p ]A healthy mind in a healthy body generates sound and noble thoughts. Once a healthy body-mind relationship is established, we can be reasonably sure that greater happiness and success is within our reach. Patient seeking help from ENT surgeons to change their physical appearances and or function may not understand that the ultimate goal of surgery is to bring about psychological change by modifying the physical change, which is important aspect in septorhinoplastic surgery. At times patients asking for corrective rhinoplasty for minor external nasal deformities may have underlying psychological disturbance and use even slight external nasal deformity as scapegoat for psychological upset. Males are more diffi cult patients psychologically for any facial cosmetic surgery. These days some patients read about their diseases or treatment on the Internet and get more confused and psychologically disturbed due to rare causes of their illness, rare complications and diversity of treatment available.     

Mucociliary dysfunction in experimental otitis media with effusion

To investigate the morphologic changes of the eustachian tube mucociliary transport systems, experimental otitis media with effusion was induced by immune complex injection into the bullae of experimental animals. Horseradish peroxidase was chosen as an antigen because of its high antigenicity and traceability under light and electron microscopy. Seventy-three guinea pigs and 41 chinchillas were divided into three groups: active Arthus group, passive Arthus group, and control group. Animals were killed under general anesthesia from the first to 30th day after the injection. Within 5 days after injection, effusions were observed consistently in all animals, but in only 80 per cent on the 7th day and in only 50 per cent after the 10th day after injection. The most conspicuous findings were that the interciliary space of the mucociliary system was diffusely occupied by an electron-dense mucus, and the upper part of the ciliary shafts were tightly glued together. These features seem to indicate rheologic alterations of the mucus and a disorder of its coupling to the cilia. This study strongly suggests that the mucociliary coupling disorder caused by altered rheologic properties of the mucus causes clearance dysfunction of the eustachian tube, resulting in middle ear effusion. The various inflammatory products contained in the middle ear effusions elicit a persistent vicious cycle of inflammatory reactions in the tubotympanum.     

PBL教学法在耳鼻咽喉科教学中的应用

在2001级临床专业五年制本科生中尝试应用以问题为基础的教学法（PBL）。结果表明，PBL教学法在激发学习兴趣，培养临床思维能力，增强理论理解能力，改善归纳能力，提高分析能力和教学效率等方面明显优于传统的教学法（P〈0．01）；理论考试PBL教学组（平均分数91．46）成绩亦明显高于传统教学组（平均分数84．88，P〈0．01）。说明PBL教学法有着传统教学法不能比拟的优点，在耳鼻咽喉科临床教学是可行的，有必要改革传统的教学方法来提高耳鼻咽喉科临床教学效果。