Otolaryngologist-performed head and neck ultrasound: outcomes and challenges in learning the technique

Do dental students need sonography training? A prospective observational study

INTRODUCTION

Sonography is a key diagnostic tool in oral and maxillofacial surgery and complements other imaging methods such as computer tomography or X-rays. While X-ray courses are integral to dentistry students' training, ultrasound diagnostics have not been integrated into undergraduate and postgraduate training. This study investigates whether there is a demand for undergraduate sonography training among dental students.

METHODS

An online questionnaire was developed by a team of experts (dentistry, maxillofacial surgery, otorhinolaryngology, radiology, and didactics) based on the "Checklist for Reporting Results of Internet E-Surveys (Cherries)". Multiple items addressed several topics using dichotomous ("yes"/ "no"), free text, and 7-level Likert answering formats (1 = not at all; 7 = fully and entirely). These included "personal data", "previous experience", "demand for ultrasound diagnostics in an undergraduate degree program", "desired topics of ultrasound training", "teaching methods", and "study materials". Dentistry students completed the questionnaire in the winter semester of 2023/24. The questionnaire's validity was assessed using factor analysis, reliability testing (Cronbach's Alpha, KR-20), and item discrimination.

RESULTS

129 dental students participated (74% female). Many respondents (approx. 90%) were in higher semesters (6-10 semesters) and stated that they had not yet had any contact with ultrasound diagnostics (75%) and had not performed an ultrasound examination as yet (97%). The overall demand for ultrasound training was high (5.8 ± 1.3), particularly for the mandibular joint (6.3 ± 1.1), parotid gland (6.2 ± 1.0), submandibular gland, sublingual gland (6.1 ± 1.1), and floor of the mouth and tongue (5.9 ± 1.4) topics. Concerning the teaching methods and teaching materials, "practical training on a proband" (82%), and the use of "teaching scripts" (85%), "video instructions" (74%), "digital pathological experts" (66%), "e-learning" (62%), and "blended learning" (52%) were most desired. The questionnaire demonstrated high reliability (Cronbach's Alpha 0.93-0.95), strong factor structure (84% and 64% variance explained), and effective item discrimination.

CONCLUSION

The data suggest a demand for undergraduate ultrasound training in dentistry. A practice-oriented, digitally supported training should be developed and implemented.

CLINICAL TRIAL NUMBER

Not applicable.

A comparison of ultrasound-guided aspiration with open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis

OBJECTIVES

Image-guided aspiration has been proposed as an alternative to the traditional open drainage in acute suppurative cervical lymphadenitis, although little evidence comparing these approaches exists. The aim of this study was to compare ultrasound-guided aspiration and open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis.

METHODS

Patients treated for acute suppurative cervical lymphadenitis at a tertiary referral pediatric hospital over a three-year period were retrospectively analyzed.

RESULTS

Of eighteen patients included, 9 (50 %) underwent aspiration and 9 (50 %) underwent open surgical drainage. None required repeat intervention or readmission over a median follow up of 10.5 weeks. Those undergoing aspiration had a shorter post-operative length of stay (1.67 vs 4.33 days, p = 0.001) compared with open surgical drainage.

CONCLUSION

Ultrasound-guided aspiration of pediatric acute suppurative cervical lymphadenitis is a safe and effective alternative to open drainage.

Assessing the Use of Telepresence-Guided Video-Based Head and Neck Ultrasound Training: A Step towards Minimizing Dependence on Human Resources?

The acquisition of ultrasound skills is an essential part of any medical student's education. University access restrictions in the context of the COVID-19 pandemic have highlighted the need for digitization in teaching. However, teaching manual skills in online courses has proven to be challenging, not least in terms of human resources. Therefore, the aim of this study was to set up a hybrid head and neck ultrasound course consisting of a preface of video-based self-study followed by supportive instruction by a tutor in telepresence and to evaluate the quality, effectiveness, and feasibility of this teaching method. Thirty-five students were shown video tutorials on systematic ultrasound of the neck course. Learning outcomes were analyzed using self-assessment questionnaires and external assessment by an experienced ultrasonographer. All participants demonstrated statistically significant learning improvement (p < 0.001) when comparing self-assessment scores before and after training. The mean self-assessment scores increased from 13.8 to 26.6 for the telepresence-guided group, from 16.6 to 27.3 for the web-based group, and from 14.0 to 26.2 for the in-person group. The external observer assessment also showed improvement, with mean scores of 46.7, 48.1, and 46.5, respectively. Overall results did not significantly differ when comparing different instruction modalities. A telepresence-guided video-based ultrasound course is well suited to teaching ultrasound skills similar to in-person courses and allows a more resource-efficient targeting of student needs.

“A Head Start or a Pain in the Neck?”—Establishment and Evaluation of a Video-Based “Hands-On” Head and Neck Ultrasound Course

The COVID-19 pandemic has strongly highlighted the need for more digitalization in healthcare. Teaching ultrasound skills in online courses is a key challenge in this context. The aim of this study was to establish an online video-based head and neck ultrasound course with an evaluation of the quality, effectiveness, and feasibility of this teaching method compared to in-person teaching. Twenty-two medical students were taught head and neck ultrasound in two groups: one group in an in-person course and the other one in a video-based course. Learning success was analyzed using self-evaluation forms and external assessment by an experienced ultrasonographer. Comparing pre- and post-training self-evaluation, all participants showed statistically significant learning progress. In the external assessment, the overall scores in both groups did not differ significantly. The courses themselves were positively evaluated by all participants. Herein, we present the first feasibility study of a web-based head and neck-ultrasound course for medical students. The methodology provides the potential for future changes in telemedical education and sustainable improvements in telemedical teaching and global intra-clinical and interdisciplinary patient care.

Radiologist-patient consultation of imaging findings after neck ultrasonography: An opportunity to practice value-based radiology

OBJECTIVE

To investigate how patients experience a radiologist-patient consultation of imaging findings directly after neck ultrasonography (US), and how much time this consumes.

MATERIALS AND METHODS

This prospective randomized study included 109 consecutive patients who underwent neck US, of whom 44 had a radiologist-patient consultation of US results directly after the examination, and 65 who had not.

RESULTS

The median ratings of all healthcare quality metrics (friendliness of the radiologist, explanation of the radiologist, skill of the radiologist, radiologist's concern for comfort during the examination, radiologist's concern for patient questions/worries, overall rating of the examination, and likelihood of recommending the examination) were either good/high or very good/very high, without any significant differences between both patient groups. Patients who did not discuss the US results with the radiologist, were significantly more worried during the examination (P = 0.040) and had significantly higher anxiety levels after completion of the US examination (P = 0.027) than patients who discussed the US results with the radiologist. Fifty-one out of 55 responding patients (92.7%) indicated a radiologist-patient consultation of US results to be important. The median duration of US examinations that included a radiologist-patient consultation of US results was 7.57 min (range: 5.15-12.10 min), while the median duration of US examinations without a radiologist-patient consultation of US results was 7.34 min (range: 3.45-14.32 min), without any significant difference (P = 0.637).

CONCLUSION

A radiologist-patient consultation of imaging findings after neck US decreases patient anxiety, is desired by most patients, and does not significantly prolong total examination time.

Ultrasound Training for Head and Neck Surgeons in Rural Kenya: A Feasibility Study

OBJECTIVE

To determine the feasibility of training otolaryngologists to perform head and neck ultrasound in low- and middle-income countries over a short timeframe.

DESIGN

Prospective cohort evaluating an ultrasound training course for otolaryngologists in low- and middle-income countries.

SETTING

Surgical training camp for otolaryngologists in semirural Kenya.

METHODS

Participants were prospectively recruited to participate in an ultrasound training course during a 2-week surgical training camp. They performed baseline ultrasound exams (9-item test, 5-point scale) with no assistance, followed by didactic sessions teaching ultrasound techniques. Participating surgeons then performed head and neck ultrasound exams on patients in clinic or in the operating room with direct supervision. Postcourse ultrasounds were performed, and the results of these tests were compared to baseline exams.

RESULTS

Eight surgeons were enrolled out of a total of 13 (62%). Three were attending surgeons (37.5%), 1 enrollee was a head and neck surgery fellow, and 4 were senior residents (50%). Six of 8 surgeons were from Kenya. The mean precourse test score was 25 (range 21-30) compared to a mean postcourse test score of 40 (range 37-45, p < 0.005). All participants significantly improved their scores, with a mean improvement of 16 points (range 10-23).

DISCUSSION

Otolaryngologists are uniquely equipped to learn head and neck ultrasound given their familiarity with the anatomy and pathology in this region. Training physicians without prior experience can be done even over short timeframes. Early training should focus on ultrasound, with later stages of training focusing on pathology.

Using Technology in Global Otolaryngology

Technology is integral to the diverse diagnostics and interventions of Otolaryngology. Historically, major advances in this field derive from advances of associated technologies. Challenges of visualization and surgical access are increasingly overcome by integrating endoscopic, electronic, and robotic instruments. Otolaryngology is often limited to urban areas and large academic centers, making it difficult to allocate care and resources to many underserved populations. The widespread use of technology has important implications in regards to global access to this field as telemedicine is most effectively applied to specialties that are heavily reliant on data and visuals that may be electronically disseminated.