Social media in otolaryngology-head and neck surgery.

The objective of this study was to assess the current use of social media tools within Canadian otolaryngology-head and neck surgery (OHNS) programs and to assess the interest within these programs to integrate social media for networking, social, and educational programs. A prospective study from September 2013 to February 2014 was performed involving residents and faculty in Canadian OHNS programs. A 26-item questionnaire was created and sent to staff and resident physicians who met the study inclusion criteria using an online survey tool (http://surveymonkey.com). There were 101 respondents for a 10% response rate. More than half (58.4%) of respondents reported use of social media for personal and/or professional matters. Residents and junior faculty physicians 39 years and younger were more likely to have social media accounts and used them more frequently than their older counterparts. Among staff physicians, pediatric otolaryngologists had the highest rate of use, and otologists exhibited the lowest rate. Cellular phones were the most commonly used devices to access social media sites. Fewer than 35% of social media users failed to separate their personal and professional accounts. Although OHNS trainees and practicing physicians identified the potential benefits of social media tools in their specialty, most were unsure how to apply these tools to their practice. Ours is the first study to assess social media use in OHNS. Otolaryngologists are currently using social media; however, their application as a communication and educational tool in otolaryngology remains to be defined.

Thyroglossal duct cysts in children: Sonographic features every radiologist should know and their histopathological correlation.

Distinguishing between thyroglossal duct cysts (TGDC) and dermoid cysts (DC) sonographically can be challenging. We illustrate the three sonographic features in neck masses in children recently identified as being most suggestive of TGDC (septa, irregular wall and solid elements) and their corresponding histopathology. These three variables form a proposed predictive model for TGDC as a guide to surgical intervention. Pediatric radiologists should be familiar with these key imaging features, as compared with other imaging features described in TGDC also illustrated here, which are less discriminating.

Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants.

OBJECTIVES: 1) To determine if bilateral vestibular dysfunction can be predicted by performance on standardized balance tasks in children with sensorineural hearing loss (SNHL) and cochlear implants (CI). 2) To provide clinical recommendations for screening for vestibular impairment in children with SNHL. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care pediatric implant center. PATIENTS: Pediatric patients (4.8-18.6 years) with profound SNHL using CIs. INTERVENTIONS: Vestibular end-organ (horizontal canal and otoliths), and balance assessment. MAIN OUTCOME MEASURES: Comparison of balance skills, measured by the Bruininks Oseretsky Test of Motor Proficiency II (BOT-2), was performed between two groups of children with SNHL and CI: 1) total bilateral vestibular loss (TBVL) (n = 45), and 2) normal bilateral vestibular function (n = 20). Sensitivity, specificity, and suitability of each task as a screening tool for the detection of TBVL were assessed. RESULTS: Balance as measured by the BOT-2 balance subtest was significantly poorer in children with TBVL then those with normal vestibular function (p < 0.0001). "Eyes closed" tasks best identified children with TBVL having the highest sensitivity and specificity. One-foot standing eyes closed was found to have the best performance as a screening tool for TBVL using a timed cutoff of 4 seconds. CONCLUSION: A brief in-office screen of balance function using one of the BOT-2 balance subtest tasks, one-foot standing eyes closed, is able to identify children at risk of TBVL with excellent sensitivity and specificity and should be used to screen for TBVL in all children presenting with SNHL.

Objective Evaluation of Otoscopy Skills Among Family and Community Medicine, Pediatric, and Otolaryngology Residents.

INTRODUCTION: The objective of this study is to evaluate and compare the perceived need for otolaryngology training and otoscopy diagnostic skills in primary care (Family and Community Medicine, Pediatric Medicine), and Otolaryngology Head and Neck Surgery (OTO-HNS) postgraduate trainees. Participant otoscopy skills were evaluated using the OtoSim simulator. METHODS: Family and Community Medicine, Pediatric, and OTO-HNS residents were recruited. Each resident participated in 3 separate otoscopy training and assessment sessions. The ability to correctly identify middle ear pathology was objectively evaluated using OtoSim™. Pretest, posttest, and 3-month retention test results were compared among residents in a paired comparison paradigm. Survey data assessing exposure to OTO-HNS during undergraduate and postgraduate training were also collected. RESULTS: A total of 57 residents participated in the study. All residents reported limited exposure to OTO-HNS during undergraduate medical training. Primary care trainees performed poorly on pretest assessments (30% ± 7.8%; 95% CI). Significant improvement in diagnostic accuracy was demonstrated following a single 1-hour teaching session (30%-62%; p < 0.001). Primary care residents demonstrated a significant decrease in diagnostic accuracy at a 3-month follow-up assessment (62%-52%, p < 0.001). Self-perceived comfort with otology was poorly correlated to pretest performance among primary care trainees (r = 0.26) and showed a stronger positive correlation among OTO-HNS trainees (r = 0.56). CONCLUSIONS: A single teaching session with an otoscopy simulator significantly improved diagnostic accuracy in primary care and OTO-HNS trainees. Improved performance is susceptible to deterioration at 3 months if acquired skills are not frequently used. Self-perceived comfort with otology may not be an accurate predictor of otoscopic diagnostic skill.

Ultrasound to differentiate thyroglossal duct cysts and dermoid cysts in children.

OBJECTIVES/HYPOTHESIS: To determine if ultrasound could differentiate between thyroglossal duct cysts (TGDC) and midline dermoid cysts (DC). STUDY DESIGN: Cohort study. METHODS: A search of pathology reports yielded 91 patients with TGDC or midline DC. Ultrasound images were presented to a radiologist blinded to pathology who evaluated the following: 1) depth of lesion from skin, 2) maximum diameter, 3) dimensions, 4) midline location, 5) distance from base of tongue, 6) tract, 7) wall regularity, 8) wall thickness, 9) margin definition, 10) heterogeneity, 11) internal septae, 12) solid components, 13) intralesional Doppler flow, and 14) posterior enhancement. The predictive power of these variables was evaluated in a multiple logistic regression model. RESULTS: There were 53 TGDC and 38 DC. TGDC were significantly more likely than DC to have the following features: 1) smaller distance from base of tongue, 2) tract, 3) irregular wall, 4) ill-defined margin, 5) internal septae, 6) solid components, and 7) intralesional Doppler flow. Three clinically reliable ultrasound variables were independently able to discriminate between TGDC and DC. A predictive model was fashioned whereby each variable was scored as 0 or 1, with a total score calculated (septae + irregular wall + solid components = TGDC [or SIST] score). We propose a scoring system whereby 0 = suggestive of DC; 1 = suggestive of TGDC; and ≥2 = highly suggestive of TGDC. CONCLUSIONS: It may be possible to differentiate between TGDC and midline DC preoperatively using ultrasound.

Undergraduate otolaryngology education at the University of Toronto: a review using a curriculum mapping system.

BACKGROUND/PURPOSE: The aim of Canadian medical school curricula is to provide educational experiences that satisfy the specific objectives set out by the Medical Council of Canada. However, for specialties such as otolaryngology, there is considerable variability in student exposure to didactic and clinical teaching across Canadian medical schools, making it unclear whether students receive sufficient teaching of core otolaryngology content and clinical skills. The goal of this review was to assess the exposure to otolaryngology instruction in the undergraduate medical curriculum at the University of Toronto. METHOD: Otolaryngology objectives were derived from objectives created by the Medical Council of Canada and the University of Toronto. The University of Toronto's recently developed Curriculum Mapping System (CMap) was used to perform a keyword search of otolaryngology objectives to establish when and to what extent essential topics were being taught. RESULTS: All (10 of 10) major topics and skills identified were covered in the undergraduate medical curriculum. Although no major gaps were identified, an uneven distribution of teaching time exists. The majority (> 90%) of otolaryngology education occurs during year 1 of clerkship. The amount of preclerkship education was extremely limited. DISCUSSION AND CONCLUSIONS: Essential otolaryngology topics and skills are taught within the University of Toronto curriculum. The CMap was an effective tool to assess the otolaryngology curriculum and was able to identify gaps in otolaryngology education during the preclerkship years of medical school. As a result, modifications to the undergraduate curriculum have been implemented to provide additional teaching during the preclerkship years.

Hypertension and a Large pulsatile neck mass: A Case of Malignant Glomus Vagale Tumour.

This teaching case report represents an unusual example of a neck mass in a previously healthy individual. The presence of a new neck mass is a relatively common head and neck problem and requires a full work up including a complete history and physical examination. With respect to our patient, thorough history taking, physical examinations and specific investigations led to the diagnosis of a malignant and functionally active paraganglioma. Vagal paraganglioma themselves are rare tumours and account for only 5-25% of all paragangliomas in the head and neck region. The presence of a malignant, functionally active, catecholamine-secreting paraganglioma is even rarer and accounts for only 1-3% of all reported glomus vagale tumours. This case report illustrates the need to carefully monitor all neck masses for changes in size, for any distortion to surrounding structures, and their given function.