ABSTRACT
A tracheotomy is a basic operation for the otorhinolaryngologist. According to reports from the United States and from our experience, there has been a steady decline in the number of tracheostomies performed by young resident doctors. Due to concerns for inadequate training of young residents, we developed a tracheotomy course consisting of a lecture, a live animal model, and questionnaires. The aim of this study was to evaluate the effectiveness of this training model. Twelve volunteer resident doctors joined the training course and, following a lecture by a senior surgeon, practiced tracheostomies with a 4-month-old female swine weighing 32 kg. We recorded the procedure time, blood loss, and complications. The doctors' procedural competence was recorded using questionnaires before and after the training. All operations were completed within 30 minutes, and the blood loss was less than 5 ml. There were no serious acute complications. After the training, young residents had improved scores on surgical landmark recognition, overall procedural competence, confidence in performing the procedure, and understanding of the surgical procedures and equipment (P < .05). Our findings reveal that an animal model-based tracheotomy course is an effective training model for young resident doctors.
Subject(s)
Internship and Residency/methods , Medical Staff, Hospital/education , Tracheotomy/education , Animals , Clinical Competence , Female , Humans , Models, Animal , Surveys and Questionnaires , Swine , United StatesABSTRACT
OBJECTIVE/HYPOTHESIS: The beneficial effect of intensity-modulated radiotherapy (IMRT) on reducing the prevalence of postirradiated sudden deafness (PISD) in nasopharyngeal carcinoma (NPC) survivors has never been mentioned. This study investigated the evolution of PISD in NPC survivors during the past two decades. STUDY DESIGN: Retrospective study. METHODS: Of the 3,206 NPC patients who underwent radiotherapy during the past two decades, 32 patients (34 ears) had PISD. Twenty-nine patients (30 ears) received two-dimensional radiotherapy (2DRT) and were assigned to group A, whereas three patients (4 ears) undergoing IMRT were assigned to group B. An inner ear test battery including audiometry, vestibular-evoked myogenic potential (VEMP) test, and caloric test was performed for comparison between the two groups. RESULTS: Group B (0.2%) showed significantly lower prevalence of PISD than group A (2%). Percentages of abnormal pursuit, saccade, and optokinetic nystagmus test results revealed nonsignificant difference between groups A and B. Likewise, both groups did not differ significantly in the percentages of abnormal pure tone average, cervical VEMP test, and caloric test. However, significant hearing improvement after treatment was identified in group B (P < 0.01) but not in group A (P > 0.05), probably because mean radiation dosage to the cochela of group B (35.0 ± 0.4 gray units [Gy]) was less than group A (50 ± 3 Gy). CONCLUSION: Compared to 2DRT, both radiation dosages to the cochlea and radiation damage to tissues surrounding the inner ear are lessened by IMRT. Therefore, NPC survivors who received IMRT have a low prevalence of PISD, with significant hearing improvement after treatment. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2016-2021, 2016.
Subject(s)
Carcinoma/radiotherapy , Hearing Loss, Sudden/etiology , Nasopharyngeal Neoplasms/radiotherapy , Radiation Injuries/etiology , Radiotherapy, Intensity-Modulated/adverse effects , Adult , Ear, Inner , Female , Hearing Loss, Sudden/diagnosis , Hearing Tests , Humans , Male , Middle Aged , Nasopharyngeal Carcinoma , Radiation Injuries/diagnosis , Retrospective Studies , Survivors , Time FactorsABSTRACT
CONCLUSION: Patients with sudden deafness who had abnormal ocular vestibular-evoked myogenic potential (oVEMP)/cervical VEMP (cVEMP) responses but retained caloric function may subsequently develop secondary hydrops with a mean interval of 8 years. OBJECTIVE: This study applied the inner ear test battery in patients who had sudden deafness previously to elucidate how secondary endolymphatic hydrops occurs years after sudden deafness. METHODS: Twenty patients who had experienced recent vertiginous attacks several years after sudden deafness (group A) and 20 patients without rotational vertiginous episode for at least 5 years following sudden deafness (group B) were enrolled. All patients underwent an inner ear test battery comprising audiometry, caloric test, and oVEMP and cVEMP tests. RESULTS: The mean interval from initial sudden deafness to vertiginous attack in group A was 8 years, with a mean hearing level of 66 ± 20 dB, which did not significantly differ from 61 ± 20 dB in group B. For the vestibular test results, the percentages of abnormal cVEMP, oVEMP, and caloric tests in group A were 65%, 70%, and 25%, respectively. Compared to the respective 70%, 60%, and 75% abnormalities in group B, only the caloric test differed significantly.
