Université de Montréal Objective and Structured Checklist for Assessment of Audiovisual Recordings of Surgeries/ techniques (UM-OSCAARS): a validation study.

Background: Use of videos of surgical and medical techniques for educational purposes has grown over the last years. To our knowledge, there is no validated tool to specifically assess the quality of these types of videos. Our goal was to create an evaluation tool and study its intrarater and interrater reliability and its acceptability. We named our tool UM-OSCAARS (Université de Montréal Objective and Structured Checklist for Assessment of Audiovisual Recordings of Surgeries/techniques). Methods: UM-OSCAARS is a grid containing 10 criteria, each of which is graded on an ordinal Likert-type scale of 1 to 5 points. We tested the grid with the help of 4 voluntary otolaryngology - head and neck surgery specialists who individually viewed 10 preselected videos. The evaluators graded each criterion for each video. To evaluate intrarater reliability, the evaluation took place in 2 different phases separated by 4 weeks. Interrater reliability was assessed by comparing the 4 topranked videos of each evaluator. Results: There was almost-perfect agreement among the evaluators regarding the 4 videos that received the highest scores from the evaluators, demonstrating that the tool has excellent interrater reliability. There was excellent test-retest correlation, demonstrating the tool's intrarater reliability. Conclusion: The UM-OSCAARS has proven to be reliable and acceptable to use, but its validity needs to be more thoroughly assessed. We hope this tool will lead to an improvement in the quality of technical videos used for educational purposes.

Contexte: Au fil des ans, l'utilisation de vidéos pour l'enseignement de techniques chirurgicales et médicales s'est répandue. À notre connaissance, il n'existe aucun outil pour évaluer spécifiquement la qualité de ces types de vidéos. Notre objectif était de créer un outil d'évaluation et d'analyser sa fiabilité interévaluateurs et son acceptabilité. Notre outil a pour nom UM-OSCAARS (Université de Montréal Objective and Structured Checklist for Assessment of Audiovisual Recordings of Surgeries/Techniques). Méthodes: L'outil UM-OSCAARS est une grille qui contient 10 critères; chacun est noté sur une échelle de type Likert de 1 à 5 points. Nous avons testé la grille avec l'aide de 4 volontaires, spécialistes en otorhinolaryngologie/chirurgie de la tête et du cou, qui ont visionné 10 vidéos présélectionnées. Les évaluateurs ont noté chacun des critères pour chaque vidéo. Afin de vérifier la fiabilité interévaluateurs, l'évaluation s'est déroulée en 2 phases, à 4 semaines d'intervalle. La fiabilité interévaluateurs a été mesurée en comparant les 4 vidéos les mieux cotées par chaque évaluateur. Résultats: La concordance a été quasi parfaite entre les évaluateurs pour les 4 vidéos qu'ils ont les mieux cotées, ce qui montre que l'outil a une excellente fiabilité interévaluateurs. La corrélation test­retest a été excellente, ce qui démontre la fiabilité interévaluateurs de l'outil. Conclusion: L'outil UM-OSCAARS et son utilisation se sont révélés fiables et acceptables, mais il faut évaluer davantage sa validité. Nous espérons que cet outil permettra d'améliorer la qualité des vidéos techniques destinées à l'enseignement.

Chronic suppurative otomastoiditis due to nontuberculous mycobacteria: A case series.

INTRODUCTION: Eight new cases of chronic otomastoiditis due to nontuberculous mycobacteria were reported at Center Hospitalier Universitaire Sainte-Justine (CHUSJ) between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This case series aims to define the clinical presentation, infectious pathogens, as well as diagnostic and therapeutic means employed in cases of nontuberculous mycobacteria otitis media encountered in our tertiary pediatric reference center. METHODS: All cases of otitis media caused by nontuberculous mycobacteria diagnosed at Sainte-Justine between 2008 and 2018 were reviewed. Species identification was retrieved from the Laboratoire de Santé Publique du Québec, Quebec's provincial public health and reference laboratory. RESULTS: All 8 cases occurred in immunocompetent children. Clinical features on presentation were chronic tympanostomy tube otorrhea with abundant granulation tissue in 7 cases. CT scan demonstrated coalescent mastoiditis in 3 cases. The median delay between initial presentation and identification of nontuberculous mycobacteria was 81 days. Seven patients had a Mycobacterium (M.) abscessus complex infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. While 3 cases required at least one mastoidectomy, 2 cases were treated only medically. CONCLUSION: Nontuberculous mycobacteria otitis media is a rare clinical entity, for which high clinical suspicion and specific microbiological analyses could minimize diagnostic delay. The use of boric acid as a desiccating agent may allow for a better local control.

Locacorten Vioform Ototoxicity Upon Guinea Pig Middle Ear Application.

BACKGROUND AND OBJECTIVES: Locacorten Vioform (Novartis UK) is frequently prescribed for otomycosis. Its component, Clioquinol, also has anti-bacterial properties. Up to this point, its ototoxic potential has not been evaluated. Our objective aims to evaluate Locacorten Vioform's potential ototoxicity when applied directly to the middle ear cavity. MATERIALS AND METHODS: We performed an experimental prospective animal study in our animal research center with 20 Hartley guinea pigs divided into 2 groups. The first group (experimental) was treated with Locacorten Vioform in one ear and with a physiologic saline solution in the other. The second group (positive control) was treated with concentrated gentamycin in one ear and physiologic saline in the other. Auditory brainstem response measurements were obtained before and after three sets of injections. Statistics were analyzed using a variance analysis with repeated measures. The histological state of cochlear outer hair cells was compared between the two groups using scanning electron microscopy. RESULTS: Average hearing loss in ears treated with Locacorten Vioform was 32.1 dB, compared with a 2.5 dB average loss in the saline-treated ears. Ears treated with gentamycin lost an average of 33.0 dB. There were clinically and statistically significant differences between the two ears of the guinea pigs in both groups (p<0.001). Scanning electron microscopy revealed severe pericochlear and cochlear inflammation and ossification in the Locacorten Vioform-treated ears. Gentamycin caused significant destruction of outer hair cell architecture. CONCLUSIONS: Locacorten Vioform induces a hearing loss similar to that caused by gentamycin when applied directly to the middle ear of a guinea pig model. Electron microscopy indicates a pericochlear and cochlear inflammatory reaction with ossification.

A 3D benign paroxysmal positional vertigo model for study of otolith disease.

OBJECTIVE: To develop a three-dimensional study tool of the membranous labyrinth in order to study the pathophysiology, diagnostic workup and treatment of benign paroxysmal positional vertigo (BPPV). BPPV is the most common cause of peripheral vertigo. Its diagnosis and treatment depend on an understanding of the anatomy of the vestibular labyrinth and its position relative to the head. To date, many illustrations have been made to explain principals of diagnosis and treatment of BPPV, but few have been based on anatomical studies of the membranous labyrinth. METHODS: A cadaveric human membranous labyrinth was axially sectioned at 20 µm resolution, stained and segmented to create a high-resolution digital model. The model was cloned to create an enantiomeric pair of labyrinths. These were associated a 3D model of a human skull, segmented from MRI data, and were oriented according to established anatomic norms. Canal markers representing otoliths were created to mark canalith position during movement of the model within the 3D environment. RESULTS: The model allows visualization of true membranous labyrinth anatomy in both ears simultaneously. The dependent portion of each semicircular duct and of the utricle can easily be visualized in any head position. Moveable markers can mark the expected progress of otolith debris with changes in head position and images can be captured to document simulations. The model can be used to simulate pathology as well as diagnostic maneuvers and treatment procedures used for BPPV. The model has great potential as a teaching tool. CONCLUSION: A simple model based on human anatomy has been created to allow careful study of BPPV pathophysiology and treatment. Going forward, this tool could offer insights that may lead to more accurate diagnosis and treatment of BPPV.

Intraparotid neurofibroma: review of the literature.

OBJECTIVE: To perform a literature review of intra-parotid neurofibromas. These tumours present a challenge because of their risk of malignant transformation and their high probability of operative facial nerve compromise. DESIGN: A description of one case of intraparotid neurofibroma. A systematic MEDLINE review was performed to document all reported cases. SETTING: Pediatric tertiary care centre. METHODS: An 14-month-old boy was referred with a nontender right-sided 4 × 2.5 cm preauricular mass, which was slowly increasing in size for 8 months. No facial nerve compromise was present. MAIN OUTCOME MEASURES: During superficial parotidectomy, the mass was found to involve the facial nerve and complete resection was performed, on which a cerebrospinal fluid (CSF) leak originating from the stylomastoid foramen occurred. Mastoidectomy revealed an intramastoid division of the facial nerve. The leak coming from the facial nerve was successfully controlled with anastomosis of the major division with the distal nerves. RESULTS: Histopathologic analysis revealed a diffuse neurofibroma. Twenty-two previous cases of intraparotid neurofibroma have been described, although this is the first reported case of the diffuse subtype. Preoperative fine-needle aspiration was inconclusive, and incisional biopsy was dangerous. CONCLUSION: It seems prudent to delay surgery for asymptomatic pediatric patients with facial neurofibroma. Surgery with primary facial nerve grafting is an effective option for patients with facial function of grade III or worse or when the tumour is large, disfiguring, and aggressive. Potential complications of treatment vary depending on the location of the tumour. These include disease recurrence, facial nerve compromise, and CSF leak.

Effect of nystatin on Guinea Pigs' inner ear.

Nystatin is a topical antifungal agent. Its wide spectrum of action and low cost make it a treatment of choice. Though it is safe for external ear use, no study has proven its safety in cases of tympanic membrane perforation (TMP). We aim to test the safety of Nystatin when applied directly to the middle ear of a Guinea Pig model. We performed an experimental study with 18 Hartley Guinea Pigs that were divided into two groups. All tympanic membranes were perforated at the beginning of the study. Exposing one group to Nystatin and the other to the ototoxic Neomycin, we compared results of auditory brainstem response testing at three intervals. Each animals' contralateral ear was used as a negative control. At the end, we performed a histological analysis of the animals' cochleae using a scanning electron microscope (SEM). Average hearing loss in the Nystatin group was 13.0 dB which was similar to the results obtained in the negative control group (13.1 dB). Average hearing loss in the Neomycin group was 39.3 dB, which represents a statistically significant difference (P < 0.001). SEM evaluation revealed intact cochlear hair cell architecture in the Nystatin and normal saline groups, whereas significant hair cell losses were noted in the Neomycin group was noted. Nystatin does not cause hearing impairment or cochlear hair cell damage when exposed directly to the middle ear of a Guinea Pig model. It is therefore a safe treatment option for otomycosis with presence of TMP.

Hyaluronic acid fat graft myringoplasty: a minimally invasive technique.

OBJECTIVES: Hyaluronic acid fat graft myringoplasty (HAFGM) is a new technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aim to evaluate the HAFGM on different TMP sizes, to compare the success rate of HAFGM with the underlay and overlay techniques, and to assess the hearing improvement at one year postoperatively. STUDY DESIGN: Prospective study. METHODS: Patients were divided into three groups depending on the patient's choice of technique: HAFGM (group I), underlay technique (group II), and overlay technique (group III). Perforations were classified into four grades. Postoperatively, the status of the eardrum, the improvement of hearing, and the incidence of complications were the main criteria for measuring outcome. RESULTS: Distribution of TMP was 131, 63, and 52 in group I, II, and III, respectively. Global successful rate and successful closure of the grade I, II, III, and IV were the same for the three groups. Postoperatively, no worsening of bone conduction threshold was noted. Air-bone gap (ABG) was statistically similar for the three groups. No complications were noted for group I. The mean duration of the operative procedures was 16, 65, and 74 minutes for group I, II, and III, respectively (P = .02). The mean postoperative follow-up was 18.7, 20.6, and 15.5 months for groups I, II, and III, respectively. CONCLUSIONS: HAFGM success rate is comparable to that of the underlay and overlay techniques. Furthermore, it requires no hospitalization and avoids the difficulty of overlay and underlay tympanoplasty.

BAHA results in children at one year follow-up: a prospective longitudinal study.

OBJECTIVE: To evaluate audiometric and clinical results of children fitted with a bone-anchored hearing aid with specific emphasis on speech discrimination in different sound environments after one year of use. METHODS: We performed a prospective longitudinal study. Seventeen patients between the ages of 5 and 18 years old were included. All patients underwent a complete tonal and vocal evaluation at four pre-determined intervals between the pre-operative period and one-year of bone-anchored hearing aid (BAHA) use. Basic pure-tone average and speech reception threshold were measured in different sound environments. Speech discrimination improvement was tested with the voice originating from the side of the BAHA-fitted ear and with the voice originating from a source directly in front of the patient. These measures were repeated with confounding noise facing the patient then from the side of the affected ear. All tonal and vocal evaluations were performed pre-operatively, the day of processor insertion, 6 months and 12 months after processor insertion. A variance analysis was performed to compare differences in hearing gain with BAHA over time. RESULTS: Hearing gain with BAHA was clinically and statistically significant at all intervals. Conventional tonal evaluation revealed significantly improved hearing gain after BAHA insertion compared with pre-operative testing with BAHA (26.3 dB vs. 17.3 dB), and this improvement was maintained at one year (27.9 dB). Speech discrimination gain at one year was better than immediately post-insertion (21.9% vs. 11.7%). Maximal gain with BAHA was found with the voice originating from the side of the affected ear and with confounding noise facing the patient (27.1% at one year), whereas the least gain was found in a silent room with the voice coming from straight ahead (11.9% at one year). CONCLUSIONS: Pure-tone average gain at one year post-insertion was similar to immediate post-insertion gain. BAHA aids speech discrimination most when the voice originates from the side of the affected ear with confounding noise facing the patient. Speech discrimination gain improves with time, suggesting an underlying learning process. The best BAHA gain in speech discrimination occurred with background noise.

Ossicular reconstruction: incus versus universal titanium prosthesis.

OBJECTIVES: The main purpose of this study is to compare audiological outcomes of incus reconstruction, Xomed Medtronic universal titanium partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP). We also compared results based on surgical technique, history of previous surgery, form of the prosthesis head, pathology and frequency. METHODS: A chart review was performed and included reconstructions performed between June 2003 and December 2006. Results were based on air-bone gap and pure tone average. RESULTS: Postoperative mean air-bone gap and mean pure tone average are significantly lower using incus reconstruction compared with the titanium prosthesis groups. PORP and TORP groups yielded similar outcomes. Closure of ABG is similar in all three groups. Postoperative results were better using an intact canal wall mastoidectomy compared with a canal wall down technique, but ABG closure was similar in both groups. Primary surgeries gave better results than revisions of reconstructions performed by the senior author or elsewhere. CONCLUSION: Though Xomed Medtronic titanium prostheses are effective in ossicular reconstruction, incus reconstruction is at least as effective when feasible. Canal wall down mastoidectomy should be reserved for cases where preservation of the canal wall is contraindicated. Previous same ear surgery is a poor prognostic factor for successful outcome. Preliminary results indicate that round head PORPs may be superior to their oval head counterparts.