A force sensor improves trainee technique for rigid endoscopy.

OBJECTIVE: Developing skills in rigid endoscopy poses challenges to the surgical trainee. This study investigates whether a modified manikin can improve the technical skill of junior operators by providing direct quantitative feedback. METHODS: A force-sensing pad was incorporated into the oral cavity of a life support manikin. Junior trainees and senior otolaryngologists were invited to perform rigid endoscopy and received real-time feedback from the force sensor during the procedure. RESULTS: There was a significant inverse correlation between operator seniority and the weight applied to the oral cavity (p < 0.0001). All junior trainee operators applied less weight after five attempts (346 ± 90.95 g) compared to their first attempt (464 ± 85.79 g). This gave a statistically significant decrease of 118 g (standard deviation = 107.27 g, p = 0.007) when quantitative feedback was provided to learning operators. CONCLUSION: This low-cost, simple model allows trainees to rehearse a high-risk procedure in a safe environment and adjust their operative technique.

Diffusion-weighted Magnetic Resonance Imaging as a Novel Imaging Modality in Assessing Treatment Response in Necrotizing Otitis Externa.

OBJECTIVE: To report our initial experience of diffusion-weighted magnetic resonance imaging (DW-MRI) as a novel imaging tool for assessing and monitoring treatment response in necrotizing otitis externa (NOE). PATIENTS: Seven adults with a diagnosis of NOE on both clinical and computed tomography (CT) criteria who were subsequently monitored with at least two echoplanar DW-MRI investigations were included in this retrospective longitudinal observational study. INTERVENTION: Patients underwent magnetic resonance imaging (MRI), including echoplanar diffusion-weighted sequences, within 2 weeks of diagnosis of NOE to determine the extent of infection and to provide a baseline scan for monitoring response to treatment. Repeated imaging was undertaken after the agreed initial course of antimicrobial therapy was completed. MAIN OUTCOME MEASURE: The primary outcome measure for complete treatment response was complete resolution of high inflammatory signal on the DW-MRI apparent diffusion coefficient (ADC) map. This was correlated to clinical, biochemical, and other MRI measures of disease resolution. RESULTS: Baseline DW-MRI was carried out in all but one patient within 2 weeks of the initial diagnostic CT scan. Patients had between one and three further DW-MRI scans, at a mean interval of 4.4 months from the initial scan (range, 2-8 months). The decision to terminate or continue therapy correlated with ADC signal findings on DW-MRI in all cases. In comparison, conventional MRI sequences performed less well, as there was some degree of persistent residual soft tissue changes in all cases.

Auditory deprivation and health in the elderly.

Age-related hearing loss is a common disorder with important consequences for quality of life. We performed a systematic review of the evidence investigating the effect of age-related hearing loss on cognition and quality of life in the elderly, and evaluated the effect of interventions for hearing loss. There is a large body of evidence associating hearing loss with detriment to physical and mental health, cognition, independence, social interaction and quality of life in the elderly. Hearing rehabilitation programmes, hearing aids and cochlear implants show beneficial effects in restoring communicative ability in this group and subsequently improve quality of life. Furthermore, much of the benefit seen is comparable to that in younger adults. However, both identifying those at need of such interventions and implementing them effectively are sub-optimal. Treatment approaches that better address the difficulties within this group need to be developed and the role significant others have to play in hearing rehabilitation should be explored.