ABSTRACT
OBJECTIVE: To develop a simulator of the external auditory canal and tympanic membrane that enables surgical trainees to practise their otomicroscopy skills, which is particularly valuable at a time where there is limited patient contact because of the coronavirus disease 2019 lockdown. METHODS: A simulator of the external auditory canal and tympanic membrane was made using a cardboard bowl, a 2 ml syringe and a latex glove. The simulator was used to practise otomicroscopy skills, including microsuction, foreign body removal, myringotomy and grommet insertion. Five doctors in the ENT department participated, ranging from core surgical training year two doctor to specialty doctor. RESULTS: The simulator provides an effective tool on which surgical trainees can practise, develop and maintain a variety of otomicroscopy skills. CONCLUSION: This inexpensive, easy and quick-to-make simulator enables trainees to practise their otomicroscopy skills on an approximately accurate model during a time when there is minimal clinical opportunity to develop these skills, particularly because of the coronavirus disease 2019 pandemic.
Subject(s)
Anti-Infective Agents/administration & dosage , Bandages , Bismuth/administration & dosage , Catheterization , Gramicidin/administration & dosage , Hydrocarbons, Iodinated/administration & dosage , Myringoplasty/instrumentation , Neomycin/administration & dosage , Nystatin/administration & dosage , Postoperative Care/instrumentation , Triamcinolone Acetonide/administration & dosage , Administration, Topical , Drug Combinations , Equipment Design , Humans , OintmentsABSTRACT
OBJECTIVE: To compare the nasal valsalva with the trumpet manoeuvre and anterior neck skin traction as aids to nasendoscopic examination of the hypopharynx. DESIGN: Randomised, controlled comparison of examination techniques. SETTING: Single tertiary referral centre. PARTICIPANTS: Twenty-six adult patients requiring hypopharyngeal nasendoscopic examination were recruited. Patients were examined with both techniques in a randomised order that was recorded to video cassette. MAIN OUTCOME MEASURES: Blinded assessment of the percentage visualisation of the pyriform fossae, post-cricoid and upper oesophageal sphincter was carried out by three consultant otolaryngologists independently. RESULTS: Mean percentage scores (and 95% confidence intervals) for nasal valsalva versus trumpet manoeuvre for the three consultants, respectively, were as follows: right pyriform fossa: 77(68, 87) versus 80(71, 91), 61(55, 66) versus 60(54, 66), 46(38, 54) versus 45(37, 54); left pyriform fossa: 76(65, 87) versus 80(69, 91), 59(53, 64) versus 55(49, 61), 42(35, 49) versus 42(35, 50); post-cricoid: 55(44, 67) versus 59(47, 71), 53(46, 60) versus 53(46, 60), 32(25, 39) versus 32(25, 39); upper oesophageal sphincter: 11(1, 21) versus 21(11, 31), 15(9, 21) versus 20(14, 26), 4(0, 8) versus 7(3, 11). No significant difference was found between the two techniques at any subsite. Individual differences were noted in a minority of patients where one or other technique gave a clearly improved view. CONCLUSIONS: The nasal valsalva and the trumpet manoeuvre with anterior neck skin traction are complementary techniques for improving the view of the hypopharynx.
Subject(s)
Hypopharynx , Laryngoscopy , Valsalva Maneuver , Adult , Analysis of Variance , Female , Humans , Male , Nose , Treatment OutcomeABSTRACT
Two patients who had undergone emergency tracheal intubation developed signs of aspiration of ingested food. Nasendoscopy demonstrated supraglottic anaesthesia which recovered from the laryngeal margins in towards the vocal cords. It is assumed that this was caused by a neuropraxia of the internal branch of the superior laryngeal nerve, presumably as a result of trauma related to intubation.
