RESUMO
Flexible fiberoptic nasopharyngolaryngoscope (FN) examinations are important to the practice of otolaryngology (ENT). We sought to assess whether a portable recording adaptor for the FN can enhance resident learning and improve patient management. The adaptor was used prospectively on consultations by first- and second-year ENT residents, and changes in diagnosis and management were recorded in the patient care workflow. In 43 patients, we found a 23% change in diagnosis, 44% change in management, and 19% change in surgical management after an attending reviewed recorded videos. Residents and attendings reported that discussing the video enhanced learning in 88% and 81% of cases, respectively. A portable FN recording adaptor has the potential to improve resident training and perhaps lead to more prompt health care delivery.
Assuntos
Educação de Pós-Graduação em Medicina , Laringoscopia/instrumentação , Otolaringologia/educação , Gravação em Vídeo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Competência Clínica , Tecnologia de Fibra Óptica , Humanos , Lactente , Internato e Residência , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo de TrabalhoRESUMO
OBJECTIVE: Cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) are commonly used in evaluation of neurotologic disorders. We present a case of sudden bilateral hearing loss immediately after oVEMP and cVEMP testing. The hearing loss did not recover. To our knowledge, no previous case reports discuss sudden hearing loss, especially bilateral, associated with VEMP testing. PATIENT: A single patient with sudden bilateral hearing loss that has persisted after cVEMP and oVEMP. INTERVENTION: The patient had a history of chronic daily dizziness. She underwent vestibular function testing that included cVEMP and oVEMP testing. A significant bilateral sensorineural hearing loss was noted immediately after cVEMP and oVEMP testing and confirmed with audiometric testing. Despite the use of oral steroids, her hearing loss did not recover. MAIN OUTCOME MEASURES: Serial audiograms, calculated maximum total sound energies to each ear. RESULTS: Pre-VEMP versus post-VEMP audiograms show increased thresholds and decreased word recognition scores; total sound energy delivered to each ear shows significant sound exposure. CONCLUSION: Although VEMP testing is thought to be safe and well tolerated, a significant amount of sound can be delivered to the cochlea, and certain individuals may be susceptible to acoustic trauma at these levels. We recommend limits for VEMP stimuli levels and attention to total sound exposure when multiple trials are used.
