Evaluation of surgical skill among otology residents during cadaveric temporal bone dissection using an objective assessment tool.

Background: The acquisition and refinement of technical skills by the surgical residents are central to surgical teaching; hence, there is increasing interest in the objective assessment of surgical competence. In the field of otology, as of now, there are limited studies for the assessment of surgical competence, also, various subjective methods are being used to assess this vital aspect of training. This study aimed to validate and use an objective assessment tool for the valuation of surgical skills in a tertiary care teaching institute in the Indian subcontinent. Methods: Surgical competence of the residents in temporal bone dissection was assessed on a Likert scale by using a grading scale developed by Wan et al., after obtaining necessary permissions. Results: Junior residents in ENT who had completed one year of residency in otolaryngology were asked to perform temporal bone surgery (cortical mastoidectomy) and were marked according to the proforma by two senior experienced otologists. The Cronbach's alpha value was .86 which is an indicator of good technical validity. Conclusions: In our study, we have validated a grading scoring scale used by Wan et al. to objectively assess the ability of an otology resident to perform temporal bone surgery. It is recommended for use in Indian scenario due to its good technical validity. The use of a Likert scale to individually rate each competency makes the evaluation precise and simple.

Cough RIB Fracture: An Uncommon Upper Respiratory Cause.

Cough is a whole-sole dynamic housekeeper of the airways. Although a run-of-the-mill symptom, chronic cough frequently forces the patient to seek medical help. It can persist for years end on, and not only makes the patient anxious about underlying illness, but may cause vomiting, exhaustion, impaired sleep, urinary incontinence, and social embarrassment. The propulsive effort made by the patient to clear the noxious stimuli irritating the airways can at times disrupt the integrity of the chest wall and result in rib fractures. We present a case who was detected to have cough fracture during the evaluation of symptoms of chronic cough with pleuritic chest pain. He was evaluated for the aetiology of chronic cough and was diagnosed to have laryngopharyngeal reflux which even though a common aetiology for chronic cough is a very uncommon cause of cough rib fracture. The importance of small innocuous diseases causing severe debility, even in patients with no comorbid illness or contributing risk factors is emphasized by this case report.

Laryngeal Trauma Managed with Titanium Mesh Fixation: A Rare Case Report.

Laryngeal fractures are though uncommon they can be potentially life threatening. Comminuted laryngeal cartilage fractures are difficult to manage and various fixation techniques have been described in literature. Outcome results of fixation with different materials can be varied. We report a case of 27 years old male who sustained laryngeal cartilage fracture following accidental fall. Patient underwent emergency tracheostomy and early surgical repair of fractured laryngeal thyroid cartilage with one of the newest techniques "titanium mesh fixation". After a month of surgery tracheostomy tube was removed and patient recovered with good laryngeal function. Titanium mesh fixation gave immediate effective fixation and stability to laryngeal fracture leading to good surgical outcome.