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OBJECTIVES To demonstrate face and content validity of a home-made simulation model as a training tool for front of neck access (FONA) procedures. DESIGN This was a prospective evaluation study, in which experienced otolaryngologists and trainees were recruited to complete 3 tasks using our FONA model. SETTING The study was completed during regular simulation training days and international conferences. PARTICIPANTS A total of 52 participants completed the questionnaire and were included in the study; 25 were experts and 27 were trainees. MAIN OUTCOME MEASURES All participants completed a validated 15-item questionnaire using a 5-point likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task-specific content (TSC) and curriculum applicability (CTR). RESULTS There were no statistically significant differences between the groups ratings for FV, GC, TSC or CTR (P = .76, .13, .4 and .67, respectively). The model achieved a median FV of 4 (IQR 4-5) with the agreement of experienced and trainee groups (68.9% and 92%, respectively). The median GC validity score was 5 (IQR 4-5) with the agreement of 87.6% and 98.4% in respected groups. The model achieved a median TSC of 4.8 (IQR 4-5) with the agreement of 54.5% and 99% in respected groups. The median CTR score was 5 (IQR 4-5) with the agreement of 54.4% and 100% in respected groups. CONCLUSION Our home-made FONA model achieved face and content validity for training and is safe and affordable for teaching basic front of neck access skills to otolaryngology trainees.

Background Management of metastatic N3 nodal disease from primary head and neck squamous cell carcinoma (HNSCC) is controversial. Recently, there has been a move to observation of the neck for those who achieve complete response (CR) after chemoradiotherapy (CRT). We sought to determine survival outcomes for N3 nodal disease, particularly for patients with human papilloma virus (HPV)-positive HNSCC. Methods We carried out a systematic search of MEDLINE and Embase for articles between 01/2008 and 12/2017. Articles on N3 nodal disease in HNSCC patients treated with CRT or surgery + adjuvant RT/CRT were included if they reported on oropharyngeal or HPV+ subgroups. Local control (LC), nodal control (NC), distant metastasis-free survival (DMFS), disease-free survival (DFS) or overall survival (OS) was assessed. Results Nine studies met the inclusion criteria. Eight of these studies (N = 5304) allowed further comparison: 4 were on CRT, 2 on surgery + RT/CRT and 2 on both. Four of these eight studies and the remaining included study reported on residual nodal disease on histology after neck dissection (ND) following CRT. Patients treated with CRT achieved LC rates of 77%-94% at 2-3 years; those who had a CR had LC of >90%. Better NC was noted in patients who achieved a CR. Three-year OS was better for HPV+ HNSCC (range, 55.2%-81%). Patients with CR had better survival outcomes (DMFS 77% at 3 years vs 69.8% for HPV+; OS 68.9% at 3 years vs 55.2% for HPV+). Primary surgery demonstrated similar survival for HPV+ vs HPV- and better survival in oropharyngeal cancers. Five-year DFS rates varied from 30% to 87%, and OS from 26.6% to 84%. For patients with non-CR, positive histology rates varied from 27.3% to 100%, with average positive histology rates of 27.3% in HPV+ patients with non-CR vs 60% for HPV- patients with non-CR. Conclusion The current literature does not support the de-escalation of treatment with HPV- N3 disease. Observation of HPV+ patients who achieve a CR post-CRT is reasonable but further prospective studies are required given the heterogeneity and risk of bias within these current studies. Planned ND should remain standard of care for non-CR cohort.

OBJECTIVE The objective of this study was to identify and investigate the face and content validity of ventilation tube insertion (VTI) training models described in the literature. DESIGN A review of literature was carried out to identify articles describing VTI simulators. Feasible models were replicated and assessed by a group of experts. SETTING Postgraduate simulation centre. PARTICIPANTS Experts were defined as surgeons who had performed at least 100 VTI on patients. Seventeen experts were participated ensuring sufficient statistical power for analysis. MAIN OUTCOME MEASURES A standardised 18-item Likert-scale questionnaire was used. This addressed face validity (realism), global and task-specific content (suitability of the model for teaching) and curriculum recommendation. RESULTS The search revealed eleven models, of which only five had associated validity data. Five models were found to be feasible to replicate. None of the tested models achieved face or global content validity. Only one model achieved task-specific validity, and hence, there was no agreement on curriculum recommendation. CONCLUSIONS The quality of simulation models is moderate and there is room for improvement. There is a need for new models to be developed or existing ones to be refined in order to construct a more realistic training platform for VTI simulation.

Objectives To investigate the utilisation, reliability and validity of clinical evaluation exercise (CEX) in otolaryngology training. Design Retrospective database analysis. Setting Online assessment database. Participants We analysed all CEXs submitted by north London core (CT) and speciality trainees (ST) in otolaryngology from 2010 to 2013. Main Outcome Measures Internal consistency of the 7 CEX items rated as either O: outstanding, S: satisfactory or D: development required. Overall performance rating (pS) of 1–4 assessed against completion of training level. Receiver operating characteristic was used to describe CEX sensitivity and specificity. Overall score (cS), pS and the number of ‘D’-rated items were used to investigate construct validity. Results One thousand one hundred and sixty CEXs from 45 trainees were included. CEX showed good internal consistency (Cronbach's alpha= 0.85). CEX was highly sensitive (99%), yet not specific (6%). cS and pS for ST was higher than CT (99.1% ± 0.4 versus 96.6% ± 0.8 and 3.06 ± 0.05 versus 1.92 ± 0.04, respectively P

Objectives/Hypothesis To investigate the reliability and construct validity of procedure-based assessment (PBA) in assessing performance and progress in otolaryngology training. Study Design Retrospective database analysis using a national electronic database. Methods We analyzed PBAs of otolaryngology trainees in North London from core trainees (CTs) to specialty trainees (STs). The tool contains six multi-item domains: consent, planning, preparation, exposure/closure, technique, and postoperative care, rated as “satisfactory” or “development required,” in addition to an overall performance rating (pS) of 1 to 4. Individual domain score, overall calculated score (cS), and number of “development-required” items were calculated for each PBA. Receiver operating characteristic analysis helped determine sensitivity and specificity. Results There were 3,152 otolaryngology PBAs from 46 otolaryngology trainees analyzed. PBA reliability was high (Cronbach's α 0.899), and sensitivity approached 99%. cS correlated positively with pS and level in training (rs: +0.681 and +0.324, respectively). ST had higher cS and pS than CT (93% ± 0.6 and 3.2 ± 0.03 vs. 71% ± 3.1 and 2.3 ± 0.08, respectively; P

Background The objective of this study was to assess the face and content validity of the sheep head model in endoscopic rhinology training. Methods This study was a prospective evaluation study. Experienced otolaryngologists and trainees were recruited to complete 7 endoscopic rhinology tasks on pre-prepared sheep heads. All participants completed a validated 20­item questionnaire using a 5-point Likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task-specific content (TSC), and curriculum applicability (CTR). Results Participants, including 25 experienced otolaryngologists and 45 trainees, completed all tasks. There were no statistically significant differences between the 2 groups’ ratings for FV, GC, or CTR (p = 0.50.7, 0.278, and 0.157, respectively). The model achieved median face validity of 4 (interquartile range [IQR]: 4 to 5) with the agreement of experienced surgeons and trainees alike (95% and 90%, respectively). The median global content was 4 (IQR: 4 to 5 and agreement of 88% and 87%. There was some variation in the rating of task-specific content. A total of 6 tasks achieved validity with the agreement of experienced otolaryngologists. The highest-rated tasks were “examination under anesthesia” and “foreign body retrieval.” Participants agreed on curriculum incorporation, transferability, and recommendation to trainees (median: 5; IQR: 4 to 5 and 95% to 97% agreement). Conclusion The sheep head model achieved face and content validity for endoscopic rhinology training. It is safe, affordable, and can aid early-years trainees in acquiring a range of basic endoscopic rhinology skills.

Objectives/Hypothesis To demonstrate construct validity of the ovine model as a tool for training in endoscopic sinus surgery (ESS). Study Design Prospective, cross-sectional evaluation study. Methods Over 18 consecutive months, trainees and experts were evaluated in their ability to perform a range of tasks (based on previous face validation and descriptive studies conducted by the same group) relating to ESS on the sheep-head model. Anonymized randomized video recordings of the above were assessed by two independent and blinded assessors. A validated assessment tool utilizing a five-point Likert scale was employed. Construct validity was calculated by comparing scores across training levels and experts using mean and interquartile range of global and task-specific scores. Subgroup analysis of the intermediate group ascertained previous experience. Nonparametric descriptive statistics were used, and analysis was carried out using SPSS version 21 (IBM, Armonk, NY). Results Reliability of the assessment tool was confirmed. The model discriminated well between different levels of expertise in global and task-specific scores. A positive correlation was noted between year in training and both global and task-specific scores (P

The introduction of Choose and Book may have a significant effect on the proportion of urgent referrals seen by ENT surgeons. Much of the responsibility for prioritisation will be transferred to the GP. Patients who are considered urgent by the ENT surgeon will be added to those considered urgent by the GP. Our results show that there was little agreement between GPs and ENT surgeon on what constitutes an urgent referral. The combined effect of joint prioritisation and the removal of the 'soon' category resulted in a 270% increase in 'urgent' referrals in our sample. This potentially unforeseen consequence of the Choose and Book system should be taken into consideration by ENT departments to allow for an expansion of the 'urgent' category.

Objectives: Previous studies have shown that nasendoscopy is made easier with the use of lubrication at the expense of the quality of the view obtained, but had no effect on the discomfort or pain experienced by the patient. We set out to determine whether the advantages of lubrication with a standard lubricant (KY Jelly) could be achieved by using water, without incurring the same disadvantages. Design: Single blind randomized controlled trial. Setting: Outpatient Departments at two District General Hospitals. Participants: One hundred and fifty participants selected sequentially from patients requiring a nasendoscopy where the endoscope would be passed far enough to view the larynx. Patients requiring topical anaesthetic were excluded. Methods: Patients were randomly assigned to have either water or standard lubricant applied to the nasendosope prior to nasendoscopy. Levels of pain experienced by the patient were recorded on a visual analogue score as well as visual analogue scores from the clinician for the levels of difficulty in passing the endoscope. All participants who were entered the study completed the study. Endoscopy was performed by all grades of medical staff. Main outcome measures: Levels of pain experienced by the participants were assessed by a visual analogue scale. Difficulty of passing the scope was indicated by the endoscopist using a visual analogue scale, as was the quality of image obtained. Results: Endoscopists found the insertion of the endoscope was easier and the image better when water was used rather than KY Jelly. There was no significant difference in reported in levels of pain experienced by the patient. Conclusion: Although the use of water as a lubricant during nasendoscopy confers no additional benefit in term of the levels of pain suffered by patients during the procedure, it makes the insertion of the endoscope easier and provides a better quality image than standard lubrication.

Objectives:(1) Examine the discriminant validity of 2 validated assessment tools in endoscopic sinus surgery (ESS) training. (2) Compare the binary versus the 5-point Likert-scale tools in ESS asse...

Objectives:Otolaryngology trainees in the United King-dom undergo regular procedure-based assessments (PBAs) throughout training, however, these are rarely used to monitor progress or measure competence. The assessment tool is procedure specific and produced by the Joint Committee of Surgical Training. It consists of 6 domains: consent, planning, preparation, exposure/closure, operative technique, and postoperative care. The aim of the study was to validate PBA in assessing otolaryngology trainees and to identify the level and pace at which trainees show competence in syllabus otological procedures.Methods:This is a longitudinal study from October 2008 to October 2013. We analyzed all PBAs submitted by North-Thames London otolaryngology trainees, including junior or core trainees (CT) and senior specialty trainees (ST). We calculated and used the overall score (oS) mean and standard deviations to draw procedure-specific learning curves for common otological operations.Results:A total of 3306 PBAs from 46 ...

Objectives:Otolaryngology trainees undergo regular procedure-based assessments (PBAs) throughout training; however, these are rarely used to analyze performance and monitor progress. The aim of the study was to validate PBA in assessing otolaryngology trainees in head and neck surgery (HNS) and identify the pattern by which trainees progress in syllabus HNS procedures.Methods:We analyzed all PBAs from North-Thames otolaryngology trainees, during early years or core (CT) and more senior specialty training (ST) years from 2008 to 2013. We used mean scores and standard deviations to draw procedure-specific learning curves. The PBA tool is procedure-specific. It is produced by the Joint Committee of Surgical Training and is used in assessing UK surgical trainees performance in all specialties. The tool is composed of 6 main domains: consent, planning, preparation, exposure/closure, technique, and postoperative care.Results:A total of 3306 PBAs from 46 trainees were identified; 1806 were HNS. PBA reliability w...

Objectives:(1) Review current validated scar assessment tools and (2) describe the impact of scar cosmesis perception on body image and quality of life.Methods:Three independent reviewers performed...

Background Idiopathic sudden sensorineural hearing loss (ISSHL) is characterised by sudden loss of hearing of cochlear or retro-cochlear origin without an identifiable cause. Antivirals are commonly prescribed, but there is no consensus on the treatment regimen or their effectiveness. Objectives To determine the effectiveness and side effect profile of antivirals in the treatment of ISSHL. Search methods We systematically searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), PubMed, EMBASE, CINAHL and other databases to 12 June 2012. We also scanned the reference lists of identified studies for further trials. Selection criteria Randomised controlled trials comparing different antivirals versus placebo (both with or without other treatment). Data collection and analysis Two authors independently extracted data, met to resolve disagreements and contacted study authors for further information. We assessed study risk of bias independently. We considered meta-analysis inappropriate and ultimately not possible due to differing treatment protocols of varying dose and duration, together with differing inclusion criteria and outcome measures between studies. The results of each study are reported individually. Main results We included four randomised trials (257 participants). The overall risk of bias in the included studies was low. Two trials compared the addition of intravenous acyclovir to a steroid (prednisolone). One included 43 participants, the other 70 patients. Neither demonstrated any hearing improvement with ISSHL. Another (84 patients) did not show any statistically significant difference between groups with the addition of valacyclovir to prednisolone (compared to steroid plus placebo) with respect to change in pure-tone audiogram. Comparing the addition of intravenous acyclovir to hydrocortisone with hydrocortisone alone, the final trial did not show any statistically significant difference between groups (60 patients). No trial documented any serious adverse effects related to the use of antiviral treatment. One study reported slight to moderate nausea equally in the acyclovir and placebo groups (one patient in each). Another reported insomnia, nervousness and weight gain with valacyclovir (number not specified). Even though no meta-analysis was possible, evidence from the four RCTs has demonstrated no statistically significant advantage in the use of antivirals in the treatment of ISSHL. Authors' conclusions There is currently no evidence to support the use of antiviral drugs in the treatment of ISSHL. The four trials included in this review were, however, small and with a low risk of bias. Further randomised controlled trials with larger patient populations, using standardised inclusion criteria, antiviral regimes and outcome measures, are needed in order for adequate meta-analysis to be performed to reach definitive conclusions. A uniform definition of ISSHL should also be established, together with what constitutes adequate recovery.

Objectives:Assess the applicability of cumulative summation (CUSUM) in 1) showing trainees progress, 2) achieving competency, and 3) highlighting concerns in tonsillectomy surgery.Methods:We followed 9 otolaryngology junior trainees in their first 6-12 months in the specialty between 2011-2013. Tonsillectomy is the most common operation that introduces trainees to operative otolaryngology. Two outcome measures were used: operative time and post-operative bleeding. These were then compared to experienced surgeons (>100 tonsillectomies). For time CUSUM, the mean and standard deviation of the experts’ performance was used as the factor to draw the curve applying the formula (Cn=0, Cn-1+Xn-k) on consecutive procedures. k=0.2 to allow for 20% incidence of overrunning. For bleeding CUSUM, any post-operative bleed was regarded a negative outcome and k=0.05 to allow for 5% incidence.Results:Trainees performed 14-35 tonsillectomies each (ongoing). The average time for experts over 150 procedures was 23min (SD:11)....

Objective: 1) To assess the clinical efficacy and cost-effectiveness of the robotic approach compared with conventional targeted minimally invasive parathyroidectomy. 2) To evaluate whether the absence of a neck scar associated with the robotic approach offers any advantage(s) over conventional targeted minimally invasive parathyroidectomy. 3) To compare patient satisfaction between the 2 techniques.Method: Prospective case control study of 30 patients that underwent targeted parathyroidectomy over 4 years (May 2009-February 2012) in a tertiary referral endocrine center. Fifteen patients had a robotic and 15 an endoscopic approach. Outcomes assessed included operative time, blood loss, biochemistry, pain, scar cosmesis, voice, quality of life, and complications.Results: In all cases the parathyroid adenoma was successfully removed. There was 1 robotic conversion. Mean robotic operative time was approximately double that of the conventional approach. There were no significant differences in mean blood loss...

Objective: 1) Investigate face and content validity of the sheep model in operative rhinology skills training. 2) Investigate the applicability and transferability of skills acquired in otolaryngology training curriculum.Method: An evaluation study conducted in February 2012. Fifteen otolaryngology trainees (level: 3-5) and 5 experts completed 9 operative rhinology tasks on a pre-prepared sheep model and assessed face and content validity using a Likert scale across 20-item questionnaire. Participants also evaluated the model in teaching individual tasks and globally as training tool.Results: The model achieved face validity of 4.1 with no significant difference between expert and intermediate groups (4.0 and 4.3, Wilcoxon P = .14). Content validity score was 4.2, with experts scoring higher than the intermediate group (4.0 and 4.5, Wlicoxon P = .043). The highest scoring skills were improving hand-eye-coordination and operative skills (4.7 and 4.6), and the worst was anatomy teaching (3.4). The highest s...

Objective: Investigate the best predictor of performance of otolaryngology trainees in a rhinology skills lab.Method: Cross-sectional study carried out in February 2012 where 15 trainees from the London otolaryngology training program (year 3-5) were asked to complete 9 operative tasks on a sheep head model and were assessed by 5 experts on task-specific and global performance using a previously validated tool. We tested 7 factors as predictors of performance including time (months) in surgical training, time in otolaryngology training and time in rhinology sub-speciality training, practical rhinology courses attended, total rhinology procedures, procedures as main operating surgeon, and precourse operative global scores from video recordings.Results: The task-specific and global scores correlated well (Pearson 0.66). Six out of the 7 factors did not show correlation with performance at the skills lab (time in surgery, time in otolaryngology, time in rhinology, number of courses, total procedures, and pro...

Objective: 1) Assess the impact of using an electronic data collection form on medical documentation accuracy. 2) Test the model longitudinally for reliability and productivity.Method: A prospective longitudinal audit 2008-2012 before and after introducing a Microsoft Access database as the sole form of documenting all ENT emergency clinic ancounters. Documentation was evaluated across 3 domains over 2 months. We then introduced the form for 2 months. The third arm is an automatic continuous audit loop.Results: Data acquired were divided into demographics, clinical, and clerical covering 18 parameters. The first arm included 319 patients and showed 32% booking errors. 61% had missing or illegible information. Only 36% had the source of referral, and 41% had no clear outcome. These improved to 5% booking errors and 3% missing information during the second phasing arm (n = 330) with 98% compliance in using the new database, then to 1% and 0% in the third arm where 6000 cases were seen (chi-square, P < .001)...

Objective: 1) Compare the disease specific T14 outcome measure score to the generic quality of life CHQPF28 score in children with adenotonsillar pathology. 2) Investigate the relation of number of episodes of tonsillitis and presence of sleep apnea to both scores.Method: Cross-sectional study carried out in 2011. Parents of 146 children undergoing tonsillectomy or adenotonsillectomy at 3 London hospitals completed both T14 and CHQPF28 questionnaires. We also inquired about the number of episodes of acute tonsillitis a child suffers from each year and whether they have obstructive sleep apnea (OSA). Their scores were analyzed to measure the relation between the 2 tests and investigate the usefulness of the T14 as a measure of the impact of adenotonsillar pathology on children’s health.Results: The T14 infective and total score correlated well with the number of episodes of tonsillitis children have (Spearman rs = 0.5 and rs = 0.64). The obstructive element differentiated between children with OSA and no O...

Keypoints • Testing for colour vision is important in assessing periorbital cellulitis and its complications. • Electronic Ishihara colour plates are used effectively for this purpose. • Portable LCD devices are widely available and most of us already have one. • We use hand-held computers to store and present the plates to the patient as a quick and readily available method of testing colour vision.

Objectives. To investigate the impact of mixing surgical subspecialty patients on postoperative wound infections. Method. A retrospective analysis of postoperative wound infections in head and neck surgery patients before and after mixing them with urology patients. We selected two periods that are identical in duration and seasonal spread. The first was from March 2005 to November 2005 and the second was from March 2006 to November 2006. Results. 1381 patients underwent head and neck surgery at our institute in the two periods; 705 in the first and 676 in the second. The number of patients with positive swabs was 19 (2.7%) in the first group and 28 (4.1%) in the second group. Positive swabs (infective episodes) increased from 93 (13.2%) to 135 (20%) and the monthly breakdown of the two periods showed a statistically significant increase (P = 0.047). Urogenital microorganisms were the main factor contributing to the increase in wound infection rates in the second period (P = 0.008). Other organisms like MRSA, remained statistically unchanged (P = 0.464). Conclusions. We recommend that head and neck surgery patients are better managed on separate wards. If this is not possible, extra attention should be paid to prevent cross infection. Clinicians must have a low threshold of suspecting relevant microorganisms when other specialty patients are on the same ward.

Objectives. Although widely used, drawings have never been assessed for their accuracy and reproducibility when used to record retraction pockets. We set out to determine the relative reliability of drawings and endoscopic photographs to record retractions of the tympanic membrane. Method. A series of 10 standardised ‘reference’ slides of retraction pockets were shown to 18 Otolaryngologists. Next to each slide were 10 drawings of a retraction pocket and 10 photographs of retraction pockets. Half of the photographs and half of the drawings were of the same ear as the ‘reference’ image and half were of a different ear, chosen at random. Participants were asked if each drawing and photograph was the same ear as ‘reference’ image, and to assess the relative stage of the pathology. Results. Differences between the assessments of the photographs and drawings were dramatic. Where photographs were used, participants were able to identify an identical ear 96.4% of the time and a different ear 81.7% of the time; where drawings were used, this fell to 46.7% and 68.2% respectively (P