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A man in his mid 70s was referred to head and neck outpatients with bulky tissue in the left tonsillar fossa. He had previously been treated for oligometastatic renal clear cell carcinoma (diagnosed over 15 years prior to disease recurrence) by tonsillectomy and adjuvant radiotherapy (years from primary treatment), followed by trans-oral laser surgery to his oropharyngeal recurrence 3 years later. Examination under anaesthetic and biopsy confirmed further recurrence of disease in the left tonsillar fossa, with parapharyngeal extension, which has not been previously reported in the literature. After discussion in the head and neck and urology multi-disciplinary teams meeting, the patient was offered trans-oral robotic-assisted surgery (TORS) for local control and prevention of progression of a fungating oropharyngeal mass. TORS partial pharyngectomy and left buccal artery myomucosal flap reconstruction were successfully carried out, with preservation of some swallow function.

Purpose Fluorodeoxyglucose (FDG) positron emission tomography (PET) is increasingly used to diagnose and stage malignancy. The aim of this article is to investigate the significance of incidental FDG uptake in the Waldeyer’s ring and to assess its value in predicting clinically occult oropharyngeal malignancy. Methods All FDG-PET/CT scans performed in Imperial College NHS Foundation Trust, UK between January 2012 and November 2018 were included. Patients with known or suspected oropharyngeal malignancy or lymphoma were excluded. Minimum follow-up was 12 months. Results A total of 724 scans revealed oropharyngeal uptake of FDG. Of these, 102 were included in the study. Most patients (62.1%) were scanned as part of staging for other malignancies. Oropharyngeal FDG uptake was asymmetrical in 57.3% of the cases. Uptake was more common in the tonsils (56.3%), followed by the tongue base (31.1%) and both sites (12.6%). In 41.7% of reports, appearance was described as likely physiological; however, 52.4% of reports advised direct visualisation, clinical correlation or ENT opinion. Only 24.3% (25/102) of patients were referred and seen by ENT, 14.6% (15/102) of which had an interval PET scan and 8.7% (9/102) proceeded to tissue diagnosis. There was one oropharyngeal cancer identified and one unexpected metastasis from esophageal cancer. Conclusion Incidental uptake on PET/CT in the oropharynx is common. However, malignancy is rare (1.9%) and, when present, is associated with high SUVmax and asymmetrical uptake. Imaging results must be correlated clinically. These patients should be seen by an ENT specialist yet most may not require further investigations.

Trauma to the cervical region may result in critical injury to the airway, the neck vasculature, and the pharynx or oesophagus. These three systems should be systematically assessed, alongside ATLS protocols, in all patients presenting with blunt or penetrating trauma to the head and neck region. The majority of trauma centres now have a policy of selective neck exploration based on clinical and radiological findings. It is therefore essential to be aware of the symptoms and clinical signs of injury of key neck structures, so that neck exploration can be performed promptly in patients who require it.

Cricopharyngeal spasm and pharyngeal pouch can result in severe dysphagia symptoms that can have a significant impact on a patient’s quality of life. Several surgical interventions have been demonstrated including balloon dilatation, botox injection, and open and endoscopic cricopharyngeal myotomy. The aim of this case series is to describe our technique for endoscopic cricopharyngeal myotomy and compare pre- and postoperative swallowing outcomes using objective swallowing questionnaires in a small series of patients. Seven patients diagnosed with cricopharyngeal spasm or grade 1 pharyngeal pouch on barium swallow were prospectively observed. MD Anderson Dysphagia inventory (MDADI) and Dysphagia handicap index (DHI) were given to patients before and after their operation. All patients underwent the same surgical technique with the cricopharyngeal bar divided and the defect closed with dissolvable sutures. Mean inpatient stay was 7 days (range 1-8) and mean time to resumption of soft diet was 4 (range 1-7) days. All patients resumed oral diet before discharge. MDADI scores showed improvement across all domains, however only the emotional score achieved statistical significance ( P = .04). Dysphagia handicap index scores showed a statistically significant improvement across functional, emotional, and total domains. Postoperative chest infection treated with oral antibiotics occurred in 3 patients (43%) and no other complications were documented. In conclusion, endoscopic cricopharyngeal myotomy with primary sutured endoscopic closure can result in a significant benefit to patient’s swallowing symptoms, emotional well-being, and quality of life.

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.

The advent of trans-oral robotic surgery (TORS) has facilitated removal of tumors previously deemed unresectable, by providing access to the deep structures of the head and neck. Despite this, the wider dissemination of TORS has been restricted due to issues with line of access, as the da Vinci robot was never designed with head and neck surgery in mind. Flexible instruments and novel energy delivery devices offer great potential in overcoming some of the existing challenges surrounding TORS. This review aimed to summarize the existing literature surrounding energy delivery in TORS and highlight areas of future innovation. MEDLINE was searched for studies relating to energy delivery in TORS in November 2019. The existing literature surrounding monopolar and bipolar electrocautery, LASER (CO2, Tm:YAG and blue LASER), Ligasure and Harmonic was reviewed. Additionally, the latest iteration of the da Vinci; the SP, and the FLEX robot were evaluated as novel methods of energy delivery in TORS. Overall, these novel energy devices and robotic systems are predicted to further improve energy delivery to the head and neck. The use of flexible LASER in particular is well substantiated in the literature. This has the potential to achieve treatment de-escalation, based on the excellent outcomes demonstrated for disease-free margins and post-operative morbidity.

Purpose of Review Simulation-based training is an integral component of surgical training. It allows practice of technical skills within a safe environment without compromising patient safety. This article seeks to review current virtual and non-virtual reality simulation models within the literature and review their validation status. Recent Findings Many simulation models exist within otolaryngology and are currently being used for education. New models are also continuously being developed; however, validity should be proven for the models before incorporating their use for educational purposes. Validity should be determined by experts and trainees themselves. Summary A validated simulation curriculum should be incorporated within the otolaryngology training programme. A curriculum based on the current training programme at our institution serves as an exemplar for local adoption.

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 We hypothesize that poor consideration of specialist surgery is due to a lack of exposure to information about careers and practice itself. Ear, Nose, and Throat (ENT) surgery is given little weight in medical school curricula, despite ENT problems being extremely common. Our objective is to assess whether a specialty showcase day was sufficient to boost informed consideration of this career. Design We designed a half-day course involving an interactive careers workshop exploring ENT as a specialty choice, alongside simulation stations of commonly presenting ENT problems led by ENT doctors. We used pre- and post-course evaluation sheets to explore factors that encourage and discourage students from surgical careers and perceptions of ENT. Setting A large proportion of UK medical schools do not offer ENT placements, and of those that do, nearly half are not compulsory. This leaves students unaware of ENT as a career option and unclear about what an ENT career comprises. Our half-day course took place in the simulation suite at St Mary's Hospital, London. Participants Medical students were mainly in their third year of study and had aspirations towards a variety of surgical and non-surgical careers, with a minority aspiring towards ENT before the course. Results Our results demonstrate that all students found the session useful and had a much better understanding of ENT practice, with almost all students leaving more likely to consider a career in ENT. Conclusion We would like to repeat this session in different student year groups and compare their perceptions with our results. We find our results a good case for including informative careers workshops as part of medical school teaching. We pose that interactive workshops exploring specialist surgical careers are a valid way to enable students in making informed career decisions - particularly in specialties that are under-represented at medical school.

Introduction: Human papilloma virus (HPV)–positive oropharyngeal cancer carries a good prognosis when managed with primary chemoradiotherapy. However, the dramatically increasing rate of this disease means more patients are now developing recurrence, with surgery remaining the mainstay of treatment. Despite this, there is no agreed technique for excision of recurrent oropharyngeal cancer. Objective: We describe the transoral robotic technique employed by our head and neck multidisciplinary team (MDT) in the management of patients with recurrent HPV positive oropharyngeal cancer and assess their symptom severity using quality of life and swallowing questionnaires. Method: Three (2 males:1 female, mean age 60.7 years) patients with recurrent or residual p16 positive oropharyngeal cancer following radical chemoradiotherapy were identified. All patients underwent selective neck dissection, tracheostomy, and transoral robotic surgery (TORS)–assisted partial oropharyngeal resection with the resultant defect closed with a robotic assisted radial forearm free flap (RFFF). Patient quality of life, symptom severity, and swallowing were assessed pre- and postoperatively using the University of Washington Quality of Life score and MD Anderson Dysphagia Index (MDADI). Results: Histopathological examination revealed complete clearance of the primary lesion in all cases. Two patients made uneventful recoveries, while one patient developed a chest infection and tracheocutaneous fistula managed conservatively. Mean inpatient stay was 15 days (range 8-27). University of Washington Quality of Life and MDADI scores showed a mild improvement in symptoms following surgery. Conclusion: Surgical management of recurrent oropharyngeal cancer remains a technical challenge; however, MDT discussion and judicious use of TORS oropharyngeal resection and RFFF can result in good oncological and quality of life outcomes with acceptable postoperative complications and symptoms.

The improved survival in patients with HPV-positive (human papilloma virus) oropharyngeal squamous cell carcinoma as compared with HPV-negative disease calls for treatment that preserves quality of life, particularly a functional swallow. There are several trials currently assessing treatment de-escalation in terms of less invasive transoral robotic surgery, reduced-dose radiotherapy, and omission of chemotherapy in this disease cohort. It is important for head and neck oncology surgeons to stay abreast of developments in this area to offer their patients the most up-to-date treatment and consider recruiting patients to trials at their institutions. For this purpose, we provide a summary of current trials and associated challenges in managing a disease with fast-evolving treatment algorithms.

Objectives To test a novel, low‐cost, home‐made model for needle aspiration of PTA. To ascertain whether simulation‐based teaching using this model was superior to lecture‐based teaching in increasing confidence and reducing anxiety relating to PTA aspiration. To assess whether there was an improvement in outcomes for PTA patients at one hospital following the delivery of a simulation‐based training session using our model. Methods We designed two teaching sessions for junior doctors starting work in ENT: a simulation‐based teaching session using a low‐cost home‐made simulation model and a lecture‐based teaching session covering the same content. We asked the participants to complete pre‐ and post‐session surveys regarding confidence and anxiety levels and analyzed this data. We also retrospectively collected data over 3 months for patients referred to ENT with suspected PTA and assessed their outcomes. We assessed patient outcomes before and after the delivery of a simulation‐based training course using our model. Results Simulation‐based teaching using our model was shown to be associated with a statistically significant increase in junior doctors' confidence levels. Reaccumulation and reattendance rates for PTA following aspiration were 16.67% and 22.7% respectively preintervention and 0% and 7.14% respectively postintervention. Conclusion A regular simulation‐based teaching session should be introduced using a PTA aspiration model for junior doctors as it leads to increased confidence levels, and reduced reaccumulation and recurrence rates of PTA. Level of evidence Level 4.

ObjectiveTo ascertain whether simulation-based teaching is superior to lecture-based teaching for an induction programme using a home-made induction model.MethodsA simulation-based induction programme was designed and separate lecture-based teaching covering the same content was organised for junior doctors. The junior doctors were asked to complete pre- and post-induction surveys regarding confidence and anxiety levels. The skills taught included microsuction, flexible nasendoscopy, and anterior and posterior nasal packing. Structured interviews were conducted after the programme to gain qualitative data for analysis. The trainees’ knowledge retention was compared using a standardised written assessment one month after the session.ResultsSimulation-based teaching using the induction model was associated with a statistically significant increase in confidence levels and reduction in anxiety levels, and was associated with greater knowledge retention.ConclusionA regular simulation induction programme should be introduced using the induction model, as it leads to better knowledge retention and increased confidence levels.

Background: The knowledge and attitude of school teachers can affect significantly the academic achievement, social development and the quality of life of epileptic students. Objective: To assess the knowledge and attitude of school teachers towards students with epilepsy in Hail, KSA. Methods: This cross-sectional study used a pretested, self-administered, 5-item questionnaire to evaluate the basic knowledge and attitude of Elementary, intermediate, and secondary schools? teachers as regards epilepsy. Schools were chosen at random and included private and public schools for male and female students. Results: The study included 342 teachers. 98.8% of the respondents heard about the disease, with no significant association with age (p = 0.205) or gender (p = 0.593). The common reported causes for epilepsy included mental disease (62.6%), spiritual possession (11.1%), electric charges in the brain (9.9%) and disturbed nerves (5.3%). 71.3% of respondents were willing to provide first aid during fits and objected to prevent epileptic students from studying (97.7%). Age was significantly associated with knowledge about causes of epilepsy (p = 0.008) and readiness to provide first aid (p = 0.012). Gender was not significantly associated with neither knowledge nor attitude of the respondents. Conclusion: Knowledge of teachers about causes of epilepsy was not adequate. Also, most of them would treat epileptic students differently from their peers. Educational programs should be provided to school teachers to correct wrong beliefs about epilepsy and to train them on first aid measures during epileptic fits.

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.

Metastatic disease to the parotid lymph nodes typically occurs secondary to head and neck and cutaneous squamous cell carcinomas (SCC). Nasal septal SCC is an exceedingly rare primary cancer that rarely spreads to regional lymph nodes. A 39-year-old man presented with left-sided cervical lymphadenopathy and nasal polyposis. Initial assessment suggested that he may have a head and neck SCC of unknown origin with nodal deposits in close proximity to the parotid gland. Cross-sectional imaging did not reveal the primary source. After further review of imaging and examination under anaesthetic, the primary SCC was found on the left nasal septum. The patient ultimately required a type 1 craniofacial resection and adjuvant chemoradiotherapy to treat the disease. Thorough investigation of the ‘unknown primary’ SCC including cross-sectional imaging and endoscopic examination is essential for the diagnosis of rare and unusual primary SCCs. Nasal septal SCC can be successfully managed with combined modality treatment in the form of surgical resection and chemoradiotherapy.

ObjectiveTo assess the feasibility of using cumulative sum analysis to show trainees’ performance curves and highlight concerns in tonsillectomy surgery.MethodsIn this prospective study, the performance of eight otolaryngology trainees (in their first 6–12 months in the specialty) was compared to that of experts (over 150 tonsillectomies performed) in terms of operative time and post-operative complications. Cumulative sum analysis curves were generated to highlight trainees’ performance, and were updated after each performance.ResultsThe average operative time was 23 minutes (standard deviation = 11) for experts and 38 minutes (standard deviation = 16) for trainees (p < 0.0001). Cumulative sum analysis charts for trainees’ operative time initially rose and then started to plateau after a number of cases (range, 25–30), while that of experts remained low. Cumulative sum analysis charts for complications can be used to monitor performance. In this study, complications were combined (because of low incidence) to allow use of this outcome measure.ConclusionThe flexibility of the cumulative sum analysis makes it adaptable to any outcome. It is a strong adjunct in surgical training to monitor progress and competence. Its sensitivity also allows early detection of poor performance, to instigate intervention.

A 28-year-old Caucasian man was referred to the head and neck clinic with a 2-year history of a right-sided neck lump, which had started to cause discomfort. Physical examination revealed two discrete non-tender neck masses in the region of the right sternocleidomastoid muscle, with no bruit or palpable pulse. CT demonstrated multiple right-sided thin-walled cystic lesions within the upper to lower jugular chain and posterior triangle (levels II–V) forming a multiloculated cystic lesion measuring 10 cm in craniocaudal dimension. Ultrasound assessment suggested a multiloculated cystic mass with thin walls and no intralesional flow, extending along the posterior margin of the right sternocleidomastoid muscle, posterolateral to the right internal jugular vein. The thyroid and major salivary glands appeared unremarkable. Fine-needle aspiration cytology (FNAC) proved inconclusive. The abnormality was presumed to be a slow-flow lymphatic malformation; however, injection sclerotherapy …

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

Background:This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools.Methods:A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics.Results:Poor body image was associated with poor scar perception (ρ = 0.178,p= 0.05). Poor life quality correlated with poor scar perception (ρ = −0.292,p= 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates.Conclusion:Negative body image and life quality impact negatively upon scar perception.

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

To investigate the impact of mixing surgical subspecialty patients on post-operative wound infections. A retrospective analysis of post-operative 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. 1,381 patients underwent head and neck surgery at our institution in the two periods; 705 in the first and 676 in the second. Excluding MRSA positive swabs, the rate of positive swabs or "episodes" was 4% in the first group (2005) and 10% in the second group (2006). The monthly breakdown showed a significant increase in the second group (2006) (p = 0.024). Uro-genital 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). It is recommend that head and neck surgery patients are better managed on separate wards. Clinicians should have a low threshold of suspecting a broader range of microorganisms when other specialty patients are on the same ward.

Objective To determine the construct validity of cadaveric temporal bones in mastoidectomy training. Study Design A prospective observational study. Methods Trainees from the North London otolaryngology training program performed step-wise modified radical mastoidectomy on cadaveric temporal bones under faculty supervision. Performance was assessed using a validated mastoidectomy assessment tool. A longitudinal assessment of nine trainees was also carried out over two sessions separated by 12 months. The main outcomes measures were task-specific (TS) and global skills (GS). Results Twenty-six intermediate and eight novice trainees participated and were assessed by a minimum of two assessors each. Intermediate trainees performed significantly better than novices in TS and GS (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 To assess the reliability, validity and outcomes of Case-based Discussion (CBD) in otolaryngology training. Design Retrospective database analysis. Setting National electronic database. Participants North London otolaryngology trainees. Main outcome measures We tested the tool's reliability along with its capacity to denote trainee progress. A score was calculated (cS) and compared across core (CT) and specialty trainees (ST) at all levels. The number of items rated as “development required” (D) was also examined. Results One thousand four hundred and fifty-six CBDs were submitted by 46 trainees from 2007 to 2013, averaging 13.6 per trainee per year. Items relating to knowledge, management and judgement were more popular (98% usage), and better predictors of cS compared to other parameters (rs: +0.74, +0.70 and +0.72, respectively). CBD was found to be reliable (Cronbach's α = 0.848) and highly sensitive (99%), yet not specific. cS was significantly higher in ST than CT (95.3% ± 0.6 versus 88.7% ± 1.3). pS showed a similar pattern (3.15 ± 0.4 versus 2.0 ± 0.05) (P

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.

OBJECTIVE To investigate the face, content, and concurrent validity of the synthetic Pettigrew temporal bone (PTB) for mastoidectomy training as compared with cadaveric temporal bone (CTB). STUDY DESIGN A prospective evaluation study. METHODS Participants were invited to perform a step-by-step modified radical mastoidectomy using both bones and complete a 22-item, 5-point Likert scale questionnaire. The questionnaire is divided into 4 domains: face validity (FV), global content (GC), task-specific content (TSC), and curriculum recommendation (CR). RESULTS Thirty-six experts and 89 trainees completed all tasks, 63 using CTB and 62 using PTB. The PTB median FV was 4 (IQR: 4-5), GC of 4 (IQR: 4-5), TSC of 4 (IQR: 3-4), and CR of 4 (IQR: 4-5). The CTB was rated significantly higher than PTB by both groups in all domains; CTB FV: 5 (IQR: 4-5), GC: 5 (IQR: 4-5), TSC: 5 (IQR: 4-5), and CR: 5 (IQR: 5-5), p < 0.001 for each. Trainees rated PTB significantly higher than experts in all domains. There was no statistically significant difference between experts and trainees in rating the CTB in all domains. PTB gives similar haptic feedback to CTB, allows the use of suction and irrigation, has the important landmarks painted for identification, and contains articulating ossicles. The facial nerve anatomy was found to be inaccurate around the region of the second genu. CONCLUSION Participants found PTB to be valid for teaching some, yet not all, aspects of mastoid surgery, and experts agreed that it could improve global transferrable otologic skills. It is essential that the facial nerve anatomy is addressed before recommending this model.

To demonstrate construct validity of the ovine model as a tool for training in endoscopic sinus surgery (ESS).Prospective, cross-sectional evaluation study.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).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 .001). Experience of the intermediate group was variable, and the number of ESS procedures performed under supervision had the highest impact on performance.This study describes an alternative model for ESS training and assessment. It is also the first to demonstrate construct validity of the sheep-head model for ESS training.

To investigate the reliability and construct validity of procedure-based assessment (PBA) in assessing performance and progress in otolaryngology training.Retrospective database analysis using a national electronic database.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.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 .001). cS and pS increased from CT1 to ST8 showing construct validity (rs : +0.348 and +0.354, respectively; P .001). The technical skill domain had the highest utilization (98% of PBAs) and was the best predictor of cS and pS (rs : +0.96 and +0.66, respectively).PBA is reliable and valid for assessing otolaryngology trainees' performance and progress at all levels. It is highly sensitive in identifying competent trainees. The tool is used in a formative and feedback capacity. The technical domain is the best predictor and should be given close attention.NA.

Background UK surgical trainees are required to undertake work-based assessments each year in order to progress in their training. Direct Observation of Procedural Skills (DOPS) is one of these assessments. We aim to investigate the validity of DOPS in assessing otolaryngology trainees at all levels. Methods A retrospective search of the portfolios of all otolaryngology trainees in North Thames was carried out to identify otolaryngology-specific DOPS. A score (Cs) was calculated for each DOPS based on the percentage of satisfactorily-rated items. The overall performance rating (Ps) was analysed as a separate variable and compared with Cs. The Ps and Cs results were then compared across trainee grades and levels within each grade: Core trainees (CT1-CT2) and specialty trainees (ST3-ST8). Results Seven hundred and sixty-seven otolaryngology DOPS were completed between August 2008 and September 2013. The tool was found to be reliable and internally consistent. Trainees in ST grade had higher Cs and Ps scores than CT grade (P

The objective of this study was to assess the face and content validity of the sheep head model in endoscopic rhinology training.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 20-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).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).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.