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Objective: Following our preliminary study on junior medical students' comfort levels in performing the head and neck physical examination (H&NPE) before and after a department-led teaching session, we assessed the longitudinal effect of this session on students during the core clinical clerkship year, in which these skills were performed on real patients., Design: Anonymous cross-sectional survey study as a follow-up to previous intervention., Methods: Overall, 101 and 90 second-year medical students participated in an H&NPE teaching session 1 year before the current survey administration in 2 consecutive years. The same cohorts of students, as third years, were asked to rate their comfort levels (0-5-point Likert scale) in performing the H&NPE and the importance of otolaryngology rotations in medical school and primary care residency training., Results: Of the 101 and 90 students, 53 and 46 medical students completed the follow-up survey in each respective year. For both classes, compared with before the teaching session, students reported an average comfort level of 2.8 (somewhat to moderately comfortable) in performing the complete H&NPE (p < 0.0001) during the core clinical clerkship year. Similar changes were observed for the individual ear, nose, mouth, and neck components of the examination (all p's < 0.0002). Students at follow-up reported statistically similar comfort levels when compared with immediately after the teaching session for the ear, oral cavity, and neck examinations., Conclusion: The initial teaching session persistently improved medical students' comfort levels in performing the H&NPE, with some attrition in comfort levels with performing the nasal examination and complete H&NPE. An otolaryngologist-directed, practical educational intervention may permanently reinforce the acquisition of complex skills such as the H&NPE., (Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Similar to conventional cryogen spray cooling, carbon dioxide (CO2) spray may be used in combination with laser cartilage reshaping (LCR) to produce cartilage shape change while minimizing cutaneous thermal injury. Recent ex vivo evaluation of LCR with CO2 cooling in a rabbit model has identified a promising initial parameter space for in vivo safety and efficacy evaluation. This pilot study aimed to evaluate shape change and cutaneous injury following LCR with CO2 cooling in 5 live rabbits., Study Design/materials and Methods: The midportion of live rabbit ears were irradiated with a 1.45 µm wavelength diode laser (12 J/cm(2)) with simultaneous CO2 spray cooling (85 millisecond duration, 4 alternating heating/cooling cycles per site, 5 to 6 irradiation sites per row for 3 rows per ear). Experimental and control ears (no LCR) were splinted in the flexed position for 30 days following exposure. A total of 5 ears each were allocated to the experimental and control groups., Results: Shape change was observed in all irradiated ears (mean 70 ± 3°), which was statistically different from control (mean 37 ± 11°, P = 0.009). No significant thermal cutaneous injury was observed, with preservation of the full thickness of skin, microvasculature, and adnexal structures. Confocal microscopy and histology demonstrated an intact and viable chondrocyte population surrounding irradiated sites., Conclusions: LCR with CO2 spray cooling can produce clinically significant shape change in the rabbit auricle while minimizing thermal cutaneous and cartilaginous injury and frostbite. This pilot study lends support for the potential use of CO2 spray as an adjunct to existing thermal-based cartilage reshaping modalities. An in vivo systematic evaluation of optimal laser dosimetry and cooling parameters is required., (© 2014 Wiley Periodicals, Inc.)

Objectives/hypothesis: Electromechanical reshaping (EMR) involves reshaping cartilage by mechanical deformation and delivering electric current to the area around the bend axis, causing local stress relaxation and permanent shape change. The mechanism of EMR is currently unclear, although preliminary studies suggest that voltage and application time are directly related to the concentration and diffusion of acid-base products within the treated tissue with little heat generation. This study aims to characterize local tissue pH changes following EMR and to demonstrate that local tissue pH changes are correlated with tissue damage and shape change., Study Design: Ex vivo animal study involving EMR of rabbit nasal septal cartilage and biochemical estimation of tissue pH changes., Methods: The magnitude and diffusion of acid-base chemical products in control (0V, 2 minutes), shape change (4V, 4 minutes; 6V, 1, 2, 4 minutes; 8V, 1, 2 minutes), and tissue damage (8V, 4, 5 minutes; 10V, 4, 5 minutes) parameters following EMR are approximated by analyzing local pH changes after pH indicator application., Results: There is a direct relationship between total charge transfer and extent of acid-base product diffusion (P <0.05). A "pH transition zone" is seen surrounding the bend apex above 8V, 2 minutes. Colorimetric analysis suggests that small local pH changes (10(-8) hydrogen ions) are at least partly implicated in clinically efficacious EMR., Conclusions: These results provide additional insight into the translational applications of EMR, particularly the relationship among pH changes, shape change, and tissue injury, and are integral in optimizing this promising technology for clinical use., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)