Search

Personally, I know of no other field so fraught with controversy as education of the hearing impaired. Staunch advocates of oralism, of total communication, and of cued speech alternately inspire and terrify parents with various tales of triumph and tragedy. 1 —Sheila L. Doctors, Supervisor, Auditory Programs, Montgomery County, Maryland

The changes and modifications that occur in the practice of medicine are often recognized in retrospect, rather than being appreciated as they develop. As we review the past century of medical education, we can see clearly that medical education and medical practice have been improved dramatically by three "tidal waves" of change. The first of these major shifts occurred asspecialtiesbegan to evolve more clearly out of the general practice of medicine; the second tidal wave occurred in parallel with the evolution of national mechanisms foraccreditingtraining programs andcertifyingindividuals; and the third tidal wave (the one we are experiencing now) is the dramatic proliferation ofsubspecialistsandsubspecialty trainingprograms.

First, let me say that it has been an extremely high honor to serve as President of this prestigious society this year, and allow me to express sincere thanks for the hard work and the productive efforts of the Executive Council, the committee chairs, and so many others who make this society work. Because of the Third International Conference on Head and Neck Cancer that took place in San Francisco, Calif, at the end of July last year, this year has been short and has gone by rapidly. In spite of its brevity, we have put the time to good use by stepping back and sharpening our focus through the process of strategic and long-range planning. Before we get into the details of that process, I want to offer some personal views on the significance of the American Society for Head and Neck Surgery. This organization has always been a

For the past 12 years as chief editor of the American Medical Association's (AMA) Archives of Otolaryngology—Head and Neck Surgery I have been provided with a wonderful opportunity to learn more about our specialty and its subspecialties. Interaction with fellow chief editors of the other AMA specialty journals and the JAMA editorial board has allowed me to explore medicine in a broader sense and to gain an understanding of the complex and dynamic world of medical publishing. Foremost in my memory of these years, however, are the recollections that I will always carry and cherish of the people who have made the success of ourArchivespossible. Literally dozens of individuals have made important contributions, have debated complicated issues and learned from each other, have planned wisely, and have pursued the high ground continuing the proud record of accomplishments begun by Doctors George Shambaugh, Sr, George Coates, George Shambaugh, Jr

• This study was undertaken to characterize the objective information available about applicants to otolaryngology—head and neck surgery residency positions, and to determine the influence of these factors on obtaining a residency position. Applicants to the otolaryngology—head and neck surgery programs at University of Utah, Salt Lake City, University of Texas Medical Branch, Galveston, and University of Louisville (Ky) were studied. Thirty-one variables were examined, representing demographic and academic factors. Excellent academic performance in medical school (as represented by [1] medical school grade-point average greater than 3.4, [2] National Board part I score greater than 650, [3] class percentile rank greater than 85th percentile, [4] honors grades in both junior medicine and surgery clinical clerkships, or [5] election to Alpha Omega Alpha) was significantly correlated with success in obtaining an otolaryngology-head and neck surgery residency position. ( Arch Otolaryngol Head Neck Surg . 1990;116:1041-1043)

Endoscopic sinus surgery (ESS) is now taught in most otolaryngology residency programs in the United States. However, this is technically challenging surgery and concerns exist regarding patient safety early in the surgeon's learning curve. The authors reviewed 193 cases of ESS performed by residents, under faculty supervision at our program, between 1987 and 1992. Sixty-seven percent of patients underwent bilateral anterior ethmoidectomy, 40% had bilateral total ethmoidectomy, and 44% had bilateral middle turbinate reduction. The overall complication rate was 22% and included one major complication. Synechiae accounted for 50% of minor complications. There was no correlation between middle or inferior turbinate reduction and the formation of synechiae. Posterior ethmoidectomy was not associated with a significant increase in complications. We conclude that ESS can be safely performed by otolaryngology residents in carefully structured and supervised training programs.

In a 1990 study we investigated resident applicant characteristics associated with successful matching into otolaryngology. 1 Of the 175 applicants studied, 87 matched, for a 49.7% success rate. Successful matching was much more likely for applicants with a history of excellent academic achievement in medical school. Of the 88 applicants who did not match during the year that was originally studied, 30 matched to otolaryngology in subsequent years. Of the 58 who never matched in otolaryngology, there is no evidence of board certification for 30. Of the other 28, 12 are board certified in anesthesia; 3 in radiology; 2 each in family medicine, internal medicine, general surgery, psychiatry, and physical medicine, and rehabilitation; and 1 each in pathology, emergency medicine, and dermatology. Of the total of 117 who matched in otolaryngology, 109 began residency training, and 107 finished otolaryngology training. Program directors answered questionnaires about 100 of 107 of these residents, detailing aspects of residency performance. The only correlation found between a highly satisfactory residency performance and characteristics that could be evaluated at the time of interviewing for residency positions was with excellent academic performance in medical school.

Educational objectives: To understand the concepts behind conservation surgery, the methods of preoperative evaluation, and the methods of sophisticated reconstruction of the larynx after conservation surgical procedures.

About two centuries ago, our specialty of otolaryngology—head and neck surgery began to emerge from general medicine and surgery as a group of physicians who cared for patients with a wide variety of disorders in the region of the head and neck. During the second half of the 19th century, otolaryngology evolved further through the phenomenon of subspecialization . Some individuals became laryngologists and others became otologists, known more commonly in that day as aurists. During the 20th century, subspecialization has moved ahead rapidly, reflecting the dramatic advances in the fields of bronchoesophagology, endoscopy, otology/neurotology, pediatric otolaryngology, facial plastic and reconstructive surgery, head and neck oncologic surgery, and otolaryngic allergy. Postresidency fellowship programs ranging from 12 to 24 months in length have proliferated during the last two decades, and there are now in the United States more than 100 fellowship programs (some having more than one fellow) in these various subspecialties

The KTP-532 laser has decreased the technical difficulty involved in teaching and performing a stapedectomy in our residency program. Use of this laser has resulted in improved hearing and a decreased number of major and minor complications compared to an equal number of large fenestra stapedectomies performed with hand-held instruments. The major disadvantages of the KTP-532 laser are its cost and limited availability, and the inconvenience of a micromanipulator. The laser should not be relied upon entirely in performing a stapedotomy on a thick footplate. The University of Texas Medical Branch experience in training residents in both large and small fenestra stapedectomy is reported.

Nasal airway resistances were measured bilaterally on subjects at 30-minute intervals over 6 hours using anterior rhinomanometry. The first 10 subjects found to exhibit alternating congestion and decongestion of the nasal mucosa (i.e., the nasal cycle) were included in the study. Using the saccharin method, nasal mucociliary clearance was determined for each subject in both the congested and decongested phases of the cycle. The results were statistically significant at the P less than .09 level, highly suggestive of a difference in nasal mucociliary clearance between the two phases of the cycle, with the congested phase having the more rapid clearance. However, when compared to the mucociliary clearance times in disease states, the difference in transport times between the two phases is probably not clinically significant.