The good lecture.

Postgraduate medical education often relies on the traditional lecture model with low knowledge retention rates of 5-20%. Cognitive overload from excessive information during lectures diminishes learning efficacy. To optimise learning, evidence suggests prioritising active engagement, streamlining visual aids, introducing clinical scenarios, and incorporating audience response systems may further enhance retention and comprehension. In conclusion, the traditional lecture must evolve into more interactive and engaging modalities to facilitate increased participant long-term learning as summarised in this review.

Gathering validity evidence for a 3D-printed simulator for training of myringotomy and ventilation tube insertion.

Objectives: This study aimed to gather validity evidence according to Messick's framework for a novel 3D-printed simulator for myringotomy with ventilation tube insertion for use in technical skills training of otorhinolaryngology (ORL) residents. Methods: The study included 15 junior ORL residents (trainees) and 13 experienced teaching otolaryngologists (experts). Experts and trainees first received an identically structured introduction to the procedure, simulator, and simulation setup. Five procedures performed by each participant were video-recorded and ordered randomly for blinded rating by two independent raters. The rating tools used were a global rating scale (GBRS) and a task-specific checklist. Validity evidence was collected according to Messick's framework. Differences in time consumption and performance scores were analyzed. Finally, a pass/fail standard was established using the contrasting groups' method. Results: Trainees used significantly more time per procedure (109 s, 95% CI: 99-120) than experts (82 s, 95% CI: 71-93; p < .001). Adjusted for repetition and rater leniency, experts achieved an average GBRS score of 18.8 (95% CI: 18.3-19.2) out of 20 points, whereas trainees achieved an average of 17.1 points (95% CI: 16.6-17.5; p < .001). In contrast to the task-specific checklist, the GBRS score discriminated between repetition number and participant experience. The pass/fail standard for the GBRS was established at 18.4 points. Conclusion: We established educational validity evidence for a novel 3D-printed model for simulation-based training of ventilation tube insertion and established a reliable pass/fail standard. Level of Evidence: 1b.

Parent-reported infant and maternal symptom relief following frenotomy in infants with tongue-tie.

INTRODUCTION: A tightening of the lingual frenulum may cause breastfeeding difficulties. Surgical release of the restricted frenulum is accomplished by a frenotomy. Between 2015 and 2019, frenotomy procedures in Danish primary healthcare doubled. Causality has not previously been established. The primary aim of this study was to investigate infant/maternal symptom relief and parent satisfaction following frenotomy and discuss potential causes for the increasing frenotomy frequency in Danish infants. METHODS: Between April 2019 and April 2020, 230 breastfed infants less-than 12 months had a frenotomy performed in three private ENT clinics. Parents of 163 infants participated in a phone interview. RESULTS: A moderate to high degree of symptom relief was reported in 138 (85%) infants and 127 (78%) mothers. If more than one preoperative symptom was reported, post-operative infant/maternal symptom relief increased significantly, and maternal symptom alleviation occurred more quickly. Also, infant and maternal symptom relief increased significantly when "infant breastfeeding difficulty" or "maternal nibble/breast pain during breastfeeding" was reported preoperatively. Most parents (95%) would have a frenotomy performed on their child again under similar circumstances. CONCLUSIONS: Most parents reported a moderate to high degree of infant and maternal symptom relief following frenotomy. Parent satisfaction was compelling. A uniform assessment tool may sharpen diagnostic criteria and eventually stabilise the frenotomy frequency in Danish infants. FUNDING: none. TRIAL REGISTRATION: not relevant.

Simulation-based surgical training needs in otorhinolaryngology.

INTRODUCTION: This study aimed to conduct a targeted needs assessment to identify and prioritise technical skills and procedures suited for simulation-based training (SBT) in private otorhinolaryngology (ORL) practice in Denmark, including mapping the learning environment related to implementation of SBT. METHODS: A panel of trainers and trainees in private ORL practice was recruited. Using the Delphi method, three rounds of surveys were conducted. Round one consisted of a survey of the learning environment and a brainstorming phase. Round two quantified the frequency of procedures, ranked the importance of procedural competency, impact on patient safety and feasibility for SBT. In round three, panelists eliminated and ranked procedures for final prioritisation. RESULTS: A total of 26 of 57 invited trainers and trainees accepted participation. The educational environment was described and 136 skills were suggested in the brainstorming phase. "Non-technical" skills were removed, and the remaining 46 technical skills were grouped for appraisal in round two. In round three, panelists reduced these to eight technical skills and procedures which were maintained for final prioritisation for SBT with myringotomy with ventilation tube insertion ranking highest. Trainees and trainers indicated that close supervision and dedicated time for training were major strengths of the learning environment. CONCLUSIONS: Our findings extend the results obtained in a previous general needs assessment and may inform curricular implementation of SBT in private ORL practice. A structured "package" with SBT and assessment for the identified procedures are desired by trainers. This work is already in progress and implementation is facilitated by a positive attitude towards SBT among trainers and trainees alike. FUNDING: none. TRIAL REGISTRATION: not relevant.

Diagnosis of possible nasopharyngeal malignancy in adults with isolated serous otitis media; a systematic review and proposal of a management algorithm.

PURPOSE: The objective of this study was (1) to systematically review the evidence of routine post-nasal space blind biopsies and/or imaging of adults with isolated serous otitis media (SOM) of unknown cause for detection nasopharyngeal malignancy (NPM), and (2) to design a clinical management algorithm for these patients. METHODS: A systematic search was conducted in the databases PubMed, Embase and Cochrane Library guided by the study question "Should adults with isolated SOM of unknown cause undergo routine biopsies of the post-nasal space and/or diagnostic imaging for detection of NPM?". All retrieved studies were reviewed and quantitatively analyzed. RESULTS: The systematic literature search identified 552 publications accessible for title-abstract screening. This yielded 23 studies for full text assessment, of which 6 were found eligible for inclusion. All six studies dealt with nasopharyngeal blind biopsies, whereas no studies on cross-sectional imaging were identified. The derived summarized results of the included studies showed that 5.5% (31/568) of patients with isolated SOM of unknown cause were diagnosed with NPM. Of these, 6.5% (2/31) had normal nasopharyngeal endoscopy (i.e., malignancy was discovered by blind biopsies). Finally, 0.35% (2/568) of patients with isolated SOM of unknown cause diagnosed with NPM had normal nasopharyngeal endoscopy findings (i.e., nasopharyngeal endoscopy ruled-out malignancy in 99.65% of patients). CONCLUSIONS: We found no evidence supporting routine use of blind biopsies or cross-sectional imaging in adults with isolated serous otitis media of unknown cause. We propose a pragmatic management algorithm for workup of adults with persistent secretory otitis media.

Specialists' adherence to guidelines on tympanostomy tube insertion.

INTRODUCTION: Tympanostomy tube insertion is very frequent in Denmark. Using electronic patient-reported outcome (ePRO) data, we investigated Danish ear, nose og throat (ENT) specialists' adherence to the 2015 national clinical guideline (NCG) on first-time tympanostomy tube (TT) insertion in children aged 0-5 years with otitis media (OM). METHODS: Data on children aged 0-5 years with OM undergoing first-time TT insertion were extracted from the Danish ENT Specialists Organisation (DØNHO) database. Pre-operative questionnaires were used to obtain information on symptom duration, and the number of acute OM (AOM) episodes was analysed. The following criteria were established to define NCG adherence: 1) A symptom duration of three months or longer, 2) three or more AOM episodes within six months and 3) four or more AOM episodes within 12 months. These criteria are in accordance with the NCG definition of chronic OM with effusion (COME) and recurrent AOM (RAOM). RESULTS: A total of 1,495 children were included in the study. In total, 91.0% of the parents reported a symptom duration of three months or more and/or RAOM within 6-12 months prior to TT insertion in accordance with the adherence criteria; 4.6% reported a symptom duration of less than three months with few or no episodes of AOM and did not meet the recommended TT insertion criteria. Finally, 4.4% of the parents were undecided with respect to symptom duration, number of AOM episodes or both at 6-12 months prior to TT insertion. CONCLUSIONS: Using solely ePRO data, we found that Danish practicing ENT specialists adhere to the 2015 NCG in regard to OM symptom duration and RAOM. FUNDING: none. TRIAL REGISTRATION: not relevant.

Parent satisfaction and symptom relief in children with otitis media undergoing tympanostomy tube insertion.

INTRODUCTION: The objective of this study was to investigate parent satisfaction and symptom relief in children younger than 12 years undergoing tympanostomy tube (TT) insertion for otitis media (OM) using electronic patient-reported outcome (ePRO) data in private ear, nose and throat (ENT) practice settings. METHODS: A total of 3,553 children aged 0-11 years and registered in the Danish ENT Specialists Organisation (DØNHO) database were included. Following parental consent to participate, we e-mailed a pre-surgical questionnaire two days prior to surgery. Follow-up questionnaires were sent one, three, six, nine and 12 months after surgery. The pre-operative questionnaire collected information on symptom duration, number of acute OM (AOM) episodes within one year before TT insertion and ear-related symptoms. The post-operative questionnaires collected information on symptom relief, number of AOM episodes and parental satisfaction. RESULTS: Pre- and post-operative questionnaires from 2,462 children were eligible for complete analysis. Before surgery, 89.8% of parents reported a symptom duration of three months or longer and/or recurrent AOM (RAOM). Complete symptom regression was reported in more than half of the children post-operatively. For the rest, significant symptom relief was reported 1-12 months following TT insertion. Parent satisfaction rose from 94.8% to 97.2% in the course of the observation period. CONCLUSIONS: We report a consistent, high rate of symptom relief 1-12 months following TT insertion in children < 12 years of age. Furthermore, parental satisfaction throughout the 12-month observation period was compelling. FUNDING: none. TRIAL REGISTRATION: The database was approved by the Danish Data Protection Agency as a private, clinical database (no. 2016-42-3152). According to Danish law, approval by the Danish Research Ethics Committee system was not necessary.

Validation of the Danish National Tympanostomy Tube Insertion Questionnaires.

INTRODUCTION: The objective of the present study was to validate two questionnaires (the Danish National Tympanostomy Tube Insertion Questionnaires (DANTIQ)) intended for use by the DØNHO database in the investigation of the effect of tympanic tube (TT) insertion on ear-related symptoms and the adherence of ear, nose and throat (ENT) specialists in Danish private practice to the Danish National Clinical Guideline on treatment of otitis media (OM) with TT insertion using electronic patient-reported outcome (ePRO) data. METHODS: The content validity of the questionnaires was assessed through discussion in a group of four active ENT specialists. Face and content validity analyses were conducted using data from semi-structured, single-person interviews with nine subjects. Reliability analysis was conducted as a three-day test/re-test study involving two groups of 117 individuals receiving and answering the same questionnaire twice. RESULTS: The overall face validity of both questionnaires was satisfactory. The reliability of the answers for both questionnaires was considered acceptable with a proportion of agreement ranging from 1.00 to 0.77. The correlation between first and second scores of the total number of symptoms reported in the test/re-test setup was acceptable with results ranging from 0.93 to 0.84. CONCLUSIONS: The DANTIQ are valid and reliable for measuring ear-related symptoms in children with OM undergoing TT insertion and for investigating Danish private ENT specialists' adherence to guidelines concerning TT insertion by use of ePRO data. FUNDING: non. TRIAL REGISTRATION: not relevant.

[Benign paroxysmal positional vertigo in children after head trauma]. / Benign paroksysmal positionel vertigo kan opstå efter hovedtraumer hos børn.

We present an eight-year-old boy with benign paroxysmal positional vertigo (BPPV) after a head trauma, successfully treated with Epley's manoeuvre. BPPV is a common cause of vestibular vertigo in adults, but it is rarely seen in children. Diagnostic work-up is challenging as children often lack the ability to describe their symptoms accurately and to cooperate in clinical examination. The diagnosis should be suspected in children with a relevant medical history and verified by positional testing. BPPV of childhood is treated with otolith repositioning manoeuvres, and the prognosis is good.