Using Computer-Assisted Instruction to Increase Otolaryngology Education During Medical School.

Introduction: A quarter of all complaints seen in adult primary care and half of all complaints seen in pediatric primary care are otolaryngology related. Even though half of all medical students enter primary care fields, there is no standardized curriculum for otolaryngology during medical school. Due to increasing limitations on specialty teaching during general medical education, computer-assisted instruction has been suggested as a format for increasing exposure to otolaryngology. Methods: We designed a computer-based learning module for teaching high-yield otolaryngology topics for third- and fourth-year medical students during their primary care clerkship at our institution from 2016-2018. We evaluated students' prior otolaryngology knowledge with 11 case-based, multiple-choice questions and then evaluated the efficacy of the module by a similar posttest. Results: Three-hundred and sixty-five students completed the module. The average pre- and posttest scores were 44% (SD = 21%) and 70% (SD = 17%), respectively, showing that the module resulted in significantly increased scores (p < .01). Discussion: The improvement of test scores indicates that this module was an effective educational intervention at our institution for increasing exposure and improving otolaryngology knowledge in third- and fourth-year medical students. As medical schools shift toward adult learning principles such as independent and self-directed learning, computer-assisted instruction is an alternative to classroom-based didactics. Creating resources for independent study will allow more time for otolaryngology faculty and residents to teach clinical exam skills and interactive case-based discussions, which are less suitable to teach via computer-assisted instruction.

Outpatient Parotidectomy: A Retrospective Series.

OBJECTIVES: Recent literature suggests that outpatient head and neck surgery is safe and may decrease costs. This study assesses whether outpatient parotidectomy differs in complication type and rate from inpatient surgery. METHODS: Patients who underwent parotidectomy at our institution from 2011 to 2019 were retrospectively reviewed and divided by inpatient or outpatient status. Complications including infection, seroma, salivary fistula, hematoma, and flap necrosis, as well as readmission rates were tabulated. Drain placement, related to tumor size, was also analyzed using a receiver operating curve. RESULTS: 144 patients had available data for analysis. Nine of the 144 patients had complications. Seven of 98 outpatients and two of 46 inpatients had complications. There was no statistically significant difference in complication rate between the two groups (P = .518). Tumor size ≥4.62 cm3 was associated with drain placement (P = .044). CONCLUSION: Outpatient parotidectomy is a safe and viable alternative for carefully selected patients.

Minimum fascia tumor distance for selection of extracapsular dissection for benign parotid tumors: A preliminary study.

OBJECTIVE: There is increasing literature supporting the use of extracapsular dissection (ECD) for the treatment of select superficial lobe parotid tumors, though no objective criteria for selection has been proposed. Prior studies have suggested the minimum distance between the parotideomasseteric fascia and the tumor edge or minimum fascia-tumor distance (MFTD) as a useful measurement for the identification of superficial parotid tumors. The objective of this study is to demonstrate the utility of the minimum fascia-tumor distance in selecting candidates for extracapsular dissection of benign parotid tumors. METHODS: This is a retrospective case-control study at a tertiary academic otolaryngology clinic. Twenty-three patients with prior surgical excision of benign parotid tumors that underwent surgeon-performed ultrasonography prior to excision of tumor were identified. Ultrasound images were reviewed and the minimum fascia-tumor distance was recorded and categorized by less than 3 mm or as 3 mm or greater. The primary outcome was successful completion of extracapsular dissection versus more extensive resection. RESULTS: Thirteen patients had a minimum fascia-tumor distance less than 3 mm; eleven of thirteen (84.6%) successfully underwent extracapsular dissection. Ten patients had a minimum fascia-tumor distance of 3 mm or greater; one of ten (10%) successfully underwent extracapsular dissection. A minimum fascia-tumor distance less than 3 mm was sensitive, specific, and accurate in predicting successful ECD at 91.7%, 81.8%, and 87.0% respectively (OR 49.5, 95% CI 3.4-573.2). CONCLUSION: Minimum fascia-tumor distance may be a useful measurement in identifying candidates for removal of benign parotid tumors with extracapsular dissection.

A cost effective custom dental guard for transoral robotic surgery.

There has been an increasing use of transoral robotic surgery (TORS) as studies have demonstrated its effectiveness for treating a variety of conditions. Postoperative complications of TORS include hemorrhage, tooth injury, dehydration, aspiration pneumonia, and prolonged percutaneous endoscopic gastrostomy (PEG) tube dependency. Dental injury has not been adequately discussed although it has been reported to be a common complication in multiple studies, with repair costs ranging from $700 to $3000 and average time spent to address the injury estimated to be 2.6 h. The incidence of this injury is likely due to the standard dental guard, which is not customizable to the patient's teeth, therefore, not optimal for dental protection. Many alternative dental guards have been proposed to reduce the rate of dental injury. However, the previously presented alternatives are high cost, not time efficient, or have the potential for molding error rendering them less effective. We propose a guard that is cheap, time efficient, and effective in preventing dental injury. A retrospective study of 124 patients who underwent TORS over a period of 6 years with the proposed dental guard was conducted. No dental complications were observed in any of these cases. A cost analysis showed that this guard saved $4526.64 for our relatively small patient cohort. This guard can save money, time, and stress for both the patient and the surgeon, as well as reduce the number and severity of medico-legal claims related to perioperative dental injury.