Validation of a 3D-Printed Percutaneous Injection Laryngoplasty Simulator: A Randomized Controlled Trial.

OBJECTIVE: Simulation may be a valuable tool in training laryngology office procedures on unsedated patients. However, no studies have examined whether existing awake procedure simulators improve trainee performance in laryngology. Our objective was to evaluate the transfer validity of a previously published 3D-printed laryngeal simulator in improving percutaneous injection laryngoplasty (PIL) competency compared with conventional educational materials with a single-blinded randomized controlled trial. METHODS: Otolaryngology residents with fewer than 10 PIL procedures in their case logs were recruited. A pretraining survey was administered to participants to evaluate baseline procedure-specific knowledge and confidence. The participants underwent block randomization by postgraduate year to receive conventional educational materials either with or without additional training with a 3D-printed laryngeal simulator. Participants performed PIL on an anatomically distinct laryngeal model via trans-thyrohyoid and trans-cricothyroid approaches. Endoscopic and external performance recordings were de-identified and evaluated by two blinded laryngologists using an objective structured assessment of technical skill scale and PIL-specific checklist. RESULTS: Twenty residents completed testing. Baseline characteristics demonstrate no significant differences in confidence level or PIL experience between groups. Senior residents receiving simulator training had significantly better respect for tissue during the trans-thyrohyoid approach compared with control (p < 0.0005). There were no significant differences in performance for junior residents. CONCLUSIONS: In this first transfer validity study of a simulator for office awake procedure in laryngology, we found that a previously described low-cost, high-fidelity 3D-printed PIL simulator improved performance of PIL amongst senior otolaryngology residents, suggesting this accessible model may be a valuable educational adjunct for advanced trainees to practice PIL. LEVEL OF EVIDENCE: NA Laryngoscope, 134:318-323, 2024.

"The Pedagogical Legacy of Dr. Chevalier Jackson: An Archival Visit to the John Q. Adams History Center at the American Academy of Otolaryngology-Head and Neck Surgery".

This article explores the historic records of the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) John Q. Adams Center for the History of Otolaryngology-Head and Neck Surgery, with particular attention paid to the Dr. Chevalier Jackson Collection. The library houses diverse materials that would be of interest to medical historians seeking to understand the early innovations in our specialty. With a repository of over 2200 items chronicling over 200-years of otolaryngological history, the library contains special collections dedicated to Drs. Maurice H. Cottle, Samuel Rosen, Adam Politzer, and Chevalier Jackson. An original aim of this visit sought to understand Dr. Jackson's early contributions to the fields of laryngology, bronchology, and esophagology; yet, an intimate review of his works, including autobiographical material, reveals a fascinating pedagogical legacy.

The Nasogenital Reflex: Imprudence of the Past as a Lesson for a Wiser Future.

The history of the nasogenital reflex, a theory that purports a bidirectional pathway between the nose and genitalia, reveals a complex and diverse record spanning back to antiquity and across the Eurasian continent. This article examines how an antiquated medical theory made its way into early contemporary medicine, and the lesson this account serves as otolaryngology-head and neck surgery continues to work toward making all its interventions based on a hierarchy of evidence.

Tonsil Riots and Vaccine Hesitancy: A 100-Year Legacy of Medical Mistrust.

The "tonsil riots" of 1906 were panics that developed at several public schools in historically immigrant-dominated neighborhoods of New York City (NYC). Per archived newspaper articles, several NYC public schools asked for parental consent to have Board of Health physicians come and perform tonsillectomy and adenoidectomy on their students. When children subsequently returned home from school "drooling mouthfuls of blood and barely able to speak," mothers reacted with panic and flocked to the schools demanding the safe return of their children. Police, ultimately, had to be called in to manage the crowds, and the events of 1906 largely faded from the public eye. However, these events can offer important lessons in communication and cultural humility as the United States continues its mass vaccination against coronavirus disease 2019.

A Rare Case of Invasive Mucormycosis in a Diabetic Patient Treated with a Short Course of Dexamethasone.

BACKGROUND Invasive mucormycosis is a rare, life-threatening infection that requires urgent medical management. Here we describe a patient who developed invasive mucormycosis after receiving only a short course of dexamethasone. The purpose is to highlight this atypical presentation of a rare disease. CASE REPORT A 74-year-old woman with a medical history of diabetes mellitus (DM), hypertension, hyperlipidemia, and small cell lung cancer with metastasis to the brain presented to the Emergency Department with altered mental status and a hyperosmolar hyperglycemic state. Three weeks before, she had been diagnosed with DM (hemoglobin A1c [HbA1c] 6.5%) and was started on dexamethasone to treat cerebral edema. On admission, her HbA1c was 10.8%, although she had received only a short course of dexamethasone. Her physical exam was concerning for left eyelid swelling and ophthalmoplegia. Computed tomography of the head and neck revealed signs of left ocular proptosis and invasive rhinomaxillary fungal disease. The patient underwent urgent surgical debridement; subsequent magnetic resonance imaging revealed extensive fungal disease extending into her left inferior frontal lobe. A surgical pathology report was positive for Rhizopus oryzae and Stenotrophomonas maltophilia. Her blood cultures were positive for methicillin-susceptible Staphylococcus aureus. She was treated with antibiotics and amphotericin B. Her clinical course was complicated by hypokalemia. She eventually recovered and was discharged from the hospital. CONCLUSIONS This case highlights an atypical presentation of mucormycosis. Clinicians should remain vigilant for this rare complication of dexamethasone use even when the therapy is given for a short time.

Dysphagia in the elderly population: A Videofluoroscopic study.

OBJECTIVE: To examine the impact of age and underlying comorbid conditions on swallowing in elderly patients with dysphagia. METHODS: Charts of consecutive patients aged >64 studied by Videofluoroscopic swallowing study (VFSS) between 2010 and 2018 at our institution were reviewed (n = 731). Patients were categorized based on age into young old (aged 65-74), older old (aged 75-84) and oldest old (aged 85+). The underlying comorbidities and VFSS results were compared between different age groups. RESULTS: Dysphagia was more likely to be caused by presbyphagia (p < 0.01) and dementia (p < 0.0001) in the oldest old, whereas, head and neck cancers (p < 0.0001) were more common in the young old cohort. In the absence of organic disease (e.g. cancer, stroke, dementia), aging was associated with prolonged oral transit time (OTT) (p < 0.05) and aspiration after swallow (p < 0.05). Compared to those with presbyphagia, patients with organic disease were more likely to have delayed pharyngeal swallow response (p < 0.05) and aspiration during swallow (p < 0.005). CONCLUSION: There are significant differences in the etiology of dysphagia between different age cohorts amongst the dysphagic elderly population. In addition, organic diseases affect swallowing differently than does mere aging. The rate of prolonged OTT and post-swallow aspiration increase with aging in patients with presbyphagia, likely due to age-related sarcopenia of the swallowing muscles. Whereas, those with organic diseases have a higher rate of delayed pharyngeal swallow response and aspiration during swallow, likely due to sensorineural impairment. Thus, it is important to view the elderly as a heterogeneous group when evaluating patients with dysphagia.

Technology Can Augment, but Not Replace, Critical Human Skills Needed for Patient Care.

The practice of medicine is changing rapidly as a consequence of electronic health record adoption, new technologies for patient care, disruptive innovations that breakdown professional hierarchies, and evolving societal norms. Collectively, these have resulted in the modification of the physician's role as the gatekeeper for health care, increased shift-based care, and amplified interprofessional team-based care. Technological innovations present opportunities as well as challenges. Artificial intelligence, which has great potential, has already transformed some tasks, particularly those involving image interpretation. Ubiquitous access to information via the Internet by physicians and patients alike presents benefits as well as drawbacks: patients and providers have ready access to virtually all of human knowledge, but some websites are contaminated with misinformation and many people have difficulty differentiating between solid, evidence-based data and untruths. The role of the future physician will shift as complexity in health care increases and as artificial intelligence and other technologies advance. These technological advances demand new skills of physicians; memory and knowledge accumulation will diminish in importance while information management skills will become more important. In parallel, medical educators must enhance their teaching and assessment of critical human skills (e.g., clear communication, empathy) in the delivery of patient care. The authors emphasize the enduring role of critical human skills in safe and effective patient care even as medical practice is increasingly guided by artificial intelligence and related technology, and they suggest new and longitudinal ways of assessing essential noncognitive skills to meet the demands of the future. The authors envision practical and achievable benefits accruing to patients and providers if practitioners leverage technological advancements to facilitate the development of their critical human skills.

Laryngopharyngeal reflux: Comparing improvements in reflux symptom index with reflux finding score.

PURPOSE: The objective of this study was to determine the correlation of reported symptom improvement in laryngopharyngeal reflux (LPR) with physical findings on laryngoscopic examination following medical therapy. MATERIALS AND METHODS: This IRB-approved, retrospective, single-institution study included all patients who were diagnosed and medically treated for LPR from Jan. 1, 2015-October 21st, 2019. Only patients who received at least six weeks of treatment with a proton pump inhibitor and those with pre- and post-treatment Reflux Symptom Index; RSI (n = 91) and Reflux Finding Score; RFS (n = 33) were included in the study. RESULTS: A total of 91 patients were included in the analysis (61.54% female). There was a 19.99% improvement in total RSI (p = 0.0034) and a 25.20% improvement in total RFS (p = 0.0011) following at least six weeks of treatment (average = 253 ± 213 SD days). RSI symptoms were significantly decreased between pre- and post-treatment for hoarseness (p = 0.0005), clearing of the throat (p = 0.0066), excess throat mucus or postnasal drip (p = 0.0004), troublesome cough (p = 0.0231), and heartburn/chest pain (p = 0.0053). RFS demonstrated a statistically significant decrease in only subglottic edema (p < 0.0001) and ventricular obliteration (p = 0.0295). Pearson's correlation test did not demonstrate a relationship between RSI and RFS in the pre- and post-treatment analyses alone, but did demonstrate a statistically significant relationship when analyzed across all captured pre and post data (r = 0.265, p = 0.006). CONCLUSIONS: RSI and RFS are complimentary to one another when assessing for treatment response, but improvement in RSI does not correlate with that in RFS.

Jigsaw Group-Based Learning in Difficult Airway Management: An Alternative Way to Teach Surgical Didactics.

OBJECTIVE: We describe the effectiveness of the Jigsaw method in the instruction of residents in difficulty airway management. DESIGN: The residents were given a pre-Jigsaw instruction test and a self-assessment of their skills for bag-mask ventilation, Intubation, cricothyrotomy, and tracheostomy. After the completing the pre-test, they were randomly assigned tasks from A-D, with each letter corresponding to a section of reading from Cumming's Otolaryngology and related questions. The residents were given ten minutes to read their portion of the article, and then another ten minutes to discuss their section with others assigned the same responsibilities, thereby becoming "experts." Then, the "experts" were assigned to a second group where they had ten minutes to teach their peers their designated material and learned from their peers the other designated material. A skill simulation lab was then performed involving intubation, cricothyrotomy, and tracheotomy. The residents were then given a post-Jigsaw instruction test and post simulation lab selfassessment of their skills for bag-mask ventilation, intubation, cricothyrotomy and tracheotomy. SETTING: Renaissance School of Medicine at Stony Brook University. PARTICIPANTS: General surgery, otolaryngology, plastic surgery, and oral and maxillofacial surgery residents. RESULTS: Post-Jigsaw tests scores a statistically significant increase in the number of correctly answered questions (P< 0.001) and residents reported a statistically significant increase in confidence in performing difficult airway skills. CONCLUSIONS: The Jigsaw method of learning is an effective alternative to tradition lecture-based methods.