1
|
Chan CY, Karmali SA, Arulanandam B, Nguyen LHP, Duval M. Cholesteatoma in Congenital Aural Atresia and External Auditory Canal Stenosis: A Systematic Review. Otolaryngol Head Neck Surg 2023; 169:449-453. [PMID: 35439089 DOI: 10.1177/01945998221094230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with congenital external auditory canal (EAC) abnormalities are at risk of developing cholesteatoma and often undergo surveillance imaging to detect it. The aims of this systematic review are to determine the incidence of cholesteatoma in patients with congenital aural atresia (CAA) and patients with congenital EAC stenosis and to investigate the most common age of cholesteatoma diagnosis. This information will help clinicians decide which patients require surveillance scanning, as well as the timing of imaging. DATA SOURCES Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases. REVIEW METHODS A systematic literature review following the PRISMA guidelines was performed. The data sources were searched by 2 independent reviewers, and articles were included that reported on CAA or congenital EAC stenosis with a confirmed diagnosis of cholesteatoma. The selected articles were screened separately by 3 reviewers before reaching a consensus on the final articles to include. Data collection on the number of patients with cholesteatoma and the age of diagnosis was performed for these articles. RESULTS Eight articles met the inclusion criteria. The incidence of cholesteatoma was 1.7% (4/238) in CAA and 43.0% (203/473) in congenital EAC stenosis. The majority of patients with congenital EAC stenosis that developed cholesteatoma were diagnosed at age <12 years. CONCLUSION CAA is associated with a low risk of cholesteatoma formation, and surveillance imaging is unnecessary in asymptomatic patients. EAC stenosis is strongly associated with cholesteatoma, and a surveillance scan for these patients is recommended prior to 12 years of age with close follow-up into adulthood.
Collapse
Affiliation(s)
- Ching Yee Chan
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal Children's Hospital, Montreal, Canada
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
| | | | - Brandon Arulanandam
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal Children's Hospital, Montreal, Canada
- Institute of Health Sciences Education, McGill University, Montreal, Canada
- Department of Pediatric Surgery, McGill University, Montreal, Canada
| | - Melanie Duval
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal Children's Hospital, Montreal, Canada
- Department of Pediatric Surgery, McGill University, Montreal, Canada
| |
Collapse
|
2
|
Hutchinson KA, Turkdogan S, Nguyen LHP. Aspiration de corps étrangers chez les enfants. CMAJ 2023; 195:E724. [PMID: 37220927 DOI: 10.1503/cmaj.221393-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Kelly Ann Hutchinson
- Faculté de médecine (Hutchinson), Université McGill; Département d'oto-rhino-laryngologie et chirurgie cervico-faciale (Turkdogan), Université McGill; Service d'oto-rhino-laryngologie et chirurgie cervico-faciale (Nguyen), Hôpital de Montréal pour enfants, Montréal, Que
| | - Sena Turkdogan
- Faculté de médecine (Hutchinson), Université McGill; Département d'oto-rhino-laryngologie et chirurgie cervico-faciale (Turkdogan), Université McGill; Service d'oto-rhino-laryngologie et chirurgie cervico-faciale (Nguyen), Hôpital de Montréal pour enfants, Montréal, Que
| | - Lily H P Nguyen
- Faculté de médecine (Hutchinson), Université McGill; Département d'oto-rhino-laryngologie et chirurgie cervico-faciale (Turkdogan), Université McGill; Service d'oto-rhino-laryngologie et chirurgie cervico-faciale (Nguyen), Hôpital de Montréal pour enfants, Montréal, Que.
| |
Collapse
|
3
|
Neocleous P, Strychowsky JE, You P, Husein M, Nguyen LHP, Propst E, Wolter N, Graham ME. In Response to Documentation in Pediatric Microlaryngoscopy/Bronchoscopy. Laryngoscope 2023; 133:E27-E28. [PMID: 36458665 DOI: 10.1002/lary.30502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Penelope Neocleous
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Julie E Strychowsky
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Peng You
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Murad Husein
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Evan Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Elise Graham
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | | |
Collapse
|
4
|
Hutchinson KA, Turkdogan S, Nguyen LHP. Foreign body aspiration in children. CMAJ 2023; 195:E333. [PMID: 36878545 PMCID: PMC9987228 DOI: 10.1503/cmaj.221393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
- Kelly Ann Hutchinson
- Faculty of Medicine (Hutchinson), McGill University; Department of Otolaryngology - Head and Neck Surgery (Turkdogan), McGill University; Department of Otolaryngology - Head and Neck Surgery (Nguyen), Montreal Children's Hospital, Montréal, Que
| | - Sena Turkdogan
- Faculty of Medicine (Hutchinson), McGill University; Department of Otolaryngology - Head and Neck Surgery (Turkdogan), McGill University; Department of Otolaryngology - Head and Neck Surgery (Nguyen), Montreal Children's Hospital, Montréal, Que
| | - Lily H P Nguyen
- Faculty of Medicine (Hutchinson), McGill University; Department of Otolaryngology - Head and Neck Surgery (Turkdogan), McGill University; Department of Otolaryngology - Head and Neck Surgery (Nguyen), Montreal Children's Hospital, Montréal, Que.
| |
Collapse
|
5
|
Roy CF, Turkdogan S, Nguyen LHP, Yeung J. Procedural Sedation in Minor Procedure Rooms for Pediatric Myringotomy and Tympanostomy: A Quality Improvement Initiative. Otolaryngol Head Neck Surg 2022; 167:979-984. [PMID: 33940993 DOI: 10.1177/01945998211011066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. METHODS As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. RESULTS Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. DISCUSSION Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. IMPLICATIONS FOR PRACTICE This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.
Collapse
Affiliation(s)
- Catherine F Roy
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sena Turkdogan
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jeffrey Yeung
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
6
|
St-Onge C, Boileau E, Langevin S, Nguyen LHP, Drescher O, Bergeron L, Thomas A. Stakeholders' perception on the implementation of Developmental Progress Assessment: using the Theoretical Domains Framework to document behavioral determinants. Adv Health Sci Educ Theory Pract 2022; 27:735-759. [PMID: 35624332 DOI: 10.1007/s10459-022-10119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The widespread implementation of longitudinal assessment (LA) to document trainees' progression to independent practice rests more on speculative rather than evidence-based benefits. We aimed to document stakeholders' knowledge of- and attitudes towards LA, and identify how the supports and barriers can help or hinder the uptake and sustainable use of LA. METHODS We interviewed representatives from four stakeholder groups involved in LA. The interview protocols were based on the Theoretical Domains Framework (TDF), which contains a total of 14 behaviour change determinants. Two team members coded the interviews deductively to the TDF, with a third resolving differences in coding. The qualitative data analysis was completed with iterative consultations and discussions with team members until consensus was achieved. Saliency analysis was used to identify dominant domains. RESULTS Forty-one individuals participated in the study. Three dominant domains were identified. Participants perceive that LA has more positive than negative consequences and requires substantial ressources. All the elements and characteristics of LA are present in our data, with differences between stakeholders. CONCLUSION Going forward, we could develop and implement tailored and theory driven interventions to promote a shared understanding of LA, and maintain potential positive outcomes while reducing negative ones. Furthermore, ressources to support LA implementation need to be addressed to facilitate its uptake.
Collapse
Affiliation(s)
- Christina St-Onge
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Elisabeth Boileau
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Serge Langevin
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Linda Bergeron
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | |
Collapse
|
7
|
Wiens I, Ramjiawan A, Wiens J, Fung K, Gooi M, Gooi P, Hu A, Leitao D, Nguyen LHP, Gooi A. Factors Affecting the Use of Medical Articles for Citation and Academic Reference. Adv Med Educ Pract 2022; 13:755-763. [PMID: 35915806 PMCID: PMC9338393 DOI: 10.2147/amep.s355465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Increases in publication quantity and the onset of open access have increased the complexity of conducting a literature search. Bibliometric markers, like impact factor (IF), have traditionally been used to help identify high-quality research. These markers exist amongst a variety of other factors, which poses the following question: what factors are examined when considering articles for clinical and academic research? OBJECTIVE To determine what factors are involved when authors choose citations to include in their publications. METHODS A voluntary and anonymous questionnaire-based survey was distributed to medical students, residents, and faculty from multiple medical schools across Canada during the 2020/2021 academic year. Survey ratings were scored on a 5-point Likert scale and open word response. RESULTS The study collected 156 complete sets of responses including 78 trainees (61 medical students and 17 residents), and 78 faculty. Language of the article (3.93) and availability on PubMed/Medline (3.77) were found more important than country of origin (2.14), institution (2.26), and IF (2.97). Trainees found the following factors more important than faculty: year of publication (3.94 vs 3.47, p = 0.0016), availability on Google/Google Scholar (2.51 vs 1.88, p = 0.0013), Open-access (2.46 vs 1.87, p = 0.0011), and Free access (2.73 vs 2.31, p = 0.049). CONCLUSION Our study identified differences in faculty and trainee literature search preferences, bias towards English language publications, and the movement towards online literature sources. This knowledge provides insight into what biases individuals may be exposed to based on their language and literature search preferences. Future areas of research include how trainees' opinions change over time, identifying trainee ability to recognize predatory journals, and the need for better online journal article translators to mitigate the language bias. We believe this will lead to higher quality evidence and optimal patient care amongst healthcare workers.
Collapse
Affiliation(s)
- Ian Wiens
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Angela Ramjiawan
- Office of Clinical Research, St. Boniface Hospital, Winnipeg, Canada
| | - Julia Wiens
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Kevin Fung
- Department of Otolaryngology, Western University, London, Canada
| | - Malcolm Gooi
- Department of Ophthalmology, University of Calgary, Calgary, Canada
| | - Patrick Gooi
- Department of Ophthalmology, University of Calgary, Calgary, Canada
| | - Amanda Hu
- Department of Otolaryngology, University of British Columbia, Vancouver, Canada
| | - Darren Leitao
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology, McGill University, Montreal, Canada
- Institute of Health Sciences Education – McGill University, Montreal, Canada
| | - Adrian Gooi
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Department of Otolaryngology, University of British Columbia, Vancouver, Canada
| |
Collapse
|
8
|
Silver JA, Yeung JC, Almutawa D, Szwimer R, Nguyen LHP. Evaluating Strength of Evidence of Pediatric Otolaryngology Research Literature: A 20-Year Review. Laryngoscope 2021; 132:1869-1876. [PMID: 34784065 DOI: 10.1002/lary.29945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Quantity and quality of Otolaryngology-Head and Neck Surgery (OTL-HNS) research are increasing, yet patterns within Pediatric OTL-HNS publications are unknown. This study examines trends in the level of evidence of pediatric OTL-HNS articles over a 20-year period to quantify the growth and characterize contributing factors. STUDY DESIGN Review article. METHODS A retrospective review was conducted on 12 peer-reviewed OTL-HNS journals at three time-points: 1996, 2006, and 2016. Pediatric-specific OTL-HNS journals were selected; all were among the top 10 highest impact factor journals, with one pediatric-specific and one Canadian journal. Publication details, author characteristics, and study focus were collected. Papers were classified based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence by two independent reviewers. RESULTS Of the 1,733 articles reviewed, 727 met inclusion criteria. A greater absolute number of pediatric OTL-HNS articles were published over the years studied: from 95 in 1996 to 359 in 2016 (P < .001). As well, the absolute number of high-quality studies has increased over the study period, from 28 articles in 1996 to 100 articles in 2016. However, the relative percentage of high-quality papers remained stable between 27.9% and 32.2% with an average of 29.7% (P = .89). Higher impact factor journals did not tend to publish higher-quality pediatric OTL-HNS articles (P = .48). CONCLUSIONS Over the past 20 years, there is no appreciable improvement in the proportion of high-quality publications in pediatric OTL-HNS; however, there is an overall greater number of high-quality papers within OTL-HNS literature. These findings likely relate to challenges of research within pediatric surgical specialties. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
Collapse
Affiliation(s)
- Jennifer A Silver
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada
| | - Jeffrey C Yeung
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada
| | - Deema Almutawa
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada
| | - Rachel Szwimer
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada
| |
Collapse
|
9
|
McDonough M, Hathi K, Corsten G, Chin CJ, Campisi P, Cavanagh J, Chadha N, Graham ME, Husein M, Johnson LB, Jones J, Korman B, Manoukian J, Nguyen LHP, Sommer DD, Strychowsky J, Uwiera T, Yunker W, Hong P. Choosing Wisely Canada - pediatric otolaryngology recommendations. J Otolaryngol Head Neck Surg 2021; 50:61. [PMID: 34715936 PMCID: PMC8557011 DOI: 10.1186/s40463-021-00533-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
The Choosing Wisely Canada campaign raises awareness amongst physicians and patients regarding unnecessary or inappropriate tests and treatments. Using an online survey, members of the Pediatric Otolaryngology Subspecialty Group within the Canadian Society of Otolaryngology – Head & Neck Surgery developed a list of nine evidence based recommendations to help physicians and patients make treatment decisions regarding common pediatric otolaryngology presentations: (1) Don’t routinely order a plain film x-ray in the evaluation of nasal fractures; (2) Don’t order imaging to distinguish acute bacterial sinusitis from an upper respiratory infection; (3) Don’t place tympanostomy tubes in most children for a single episode of otitis media with effusion of less than 3 months duration; (4) Don’t routinely prescribe intranasal/systemic steroids, antihistamines or decongestants for children with uncomplicated otitis media with effusion; (5) Don’t prescribe oral antibiotics for children with uncomplicated tympanostomy tube otorrhea or uncomplicated acute otitis externa; (6) Don’t prescribe codeine for post-tonsillectomy/adenoidectomy pain relief in children; (7) Don’t administer perioperative antibiotics for elective tonsillectomy in children; (8) Don’t perform tonsillectomy for children with uncomplicated recurrent throat infections if there have been fewer than 7 episodes in the past year, 5 episodes in each of the past 2 years, or 3 episodes in each of the last 3 years; and (9) Don’t perform endoscopic sinus surgery for uncomplicated pediatric chronic rhinosinusitis prior to failure of maximal medical therapy and adenoidectomy.
Collapse
Affiliation(s)
| | - Kalpesh Hathi
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Gerard Corsten
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada
| | - Christopher J Chin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada
| | - Paolo Campisi
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Cavanagh
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Newfoundland, Canada
| | - Neil Chadha
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Elise Graham
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Murad Husein
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Liane B Johnson
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada
| | - Jodi Jones
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bruce Korman
- Department of Surgery, Otolaryngology/Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - John Manoukian
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Doron D Sommer
- Department of Surgery, Otolaryngology/Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - Julie Strychowsky
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Trina Uwiera
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Warren Yunker
- Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Paul Hong
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada.
| |
Collapse
|
10
|
Paradis J, Dzioba A, El-Hakim H, Hong P, Kozak FK, Nguyen LHP, Perera D, Propst EJ, Siu JM, Wojtera M, Husein M. A national study of choanal atresia in tertiary care centers in Canada - part II: clinical management. J Otolaryngol Head Neck Surg 2021; 50:46. [PMID: 34256864 PMCID: PMC8276453 DOI: 10.1186/s40463-021-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the clinical management of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with choanal atresia to a participating center. Results The health charts of 215 patients (59.6% female) with choanal atresia (CA) were reviewed. Mean age of initial surgical repair was 0.8 months for bilateral CA, and 48.6 months for unilateral CA. Approaches of surgical repair consisted of endoscopic transnasal (31.7%), non-endoscopic transnasal (42.6%), and transpalatal (25.2%). Stents were used on 70.7% of patients. Forty-nine percent of patients were brought back to the OR for a planned second look; stent removal being the most common reason (86.4%). Surgical success rate of initial surgeries was 54.1%. Surgical technique was not associated with rate of restenosis [χ2 (2) = 1.6, p = .46]. Conclusions The present study is the first national multi-institutional study exploring the surgical outcomes of CA over a 30-year period. The surgical repair of CA presents a challenge to otolaryngologists, as the rate of surgical failure is high. The optimal surgical approach, age at surgical repair, use of stents, surgical adjuncts, and need for planned second look warrant further investigation. Graphical abstract ![]()
Collapse
Affiliation(s)
- Josee Paradis
- Department of Paediatric Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada. .,Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Agnieszka Dzioba
- Department of Paediatric Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada
| | - Hamdy El-Hakim
- Division of Pediatric Surgery and Otolaryngology Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, AB, Canada
| | - Paul Hong
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Frederick K Kozak
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Institute for Health Science Education, McGill University, Montreal, Canada.,Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada
| | - Demitri Perera
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Evan Jon Propst
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Monika Wojtera
- Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Murad Husein
- Department of Paediatric Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada.,Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | |
Collapse
|
11
|
Paradis J, Dzioba A, El-Hakim H, Hong P, Kozak FK, Nguyen LHP, Perera D, Propst EJ, Siu JM, Wojtera M, Husein M. A national study of choanal atresia in tertiary care centers in Canada - part I: clinical presentation. J Otolaryngol Head Neck Surg 2021; 50:45. [PMID: 34253250 PMCID: PMC8274042 DOI: 10.1186/s40463-021-00517-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center. Results The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome. Conclusions The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted. Graphical abstract ![]()
Collapse
Affiliation(s)
- Josee Paradis
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada. .,Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Agnieszka Dzioba
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada
| | - Hamdy El-Hakim
- Division of Pediatric Surgery and Otolaryngology Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, AB, Canada
| | - Paul Hong
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Frederick K Kozak
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada.,Institute for Health Science Education, McGill University, Montreal, Canada.,Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada
| | - Demitri Perera
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Evan Jon Propst
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Monika Wojtera
- Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Murad Husein
- Department of Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada.,Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | |
Collapse
|
12
|
Gabrysz-Forget F, Young M, Zahabi S, Nepomnayshy D, Nguyen LHP. Surgical Errors Happen, but Are Learners Trained to Recover from Them? A Survey of North American Surgical Residents and Fellows. J Surg Educ 2020; 77:1552-1561. [PMID: 32694084 DOI: 10.1016/j.jsurg.2020.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Surgical training necessitates graded supervision and supported independence in order to reach competence. In developing surgical skills, trainees can, and will, make mistakes. A key skill required for independent practice is the ability to recover from an error or unexpected complication. Error recovery includes recognizing and managing a technical error in order to ensure patient safety and may be underrepresented in current educational approaches. OBJECTIVE The purpose of this study is to explore residents' experiences and perceptions of error recovery training in surgical procedures. METHOD An online survey was sent to surgical program directors in the United States and Canada using the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada distribution lists. Participating programs distributed the survey to their residents and fellows. The survey was composed of Likert-scale items, yes/no questions as well as open-ended questions focused on perceptions, experiences, and factors that influence to error recovery training in the operating room. RESULTS A total of 206 surveys were completed. Overall, 99% (n = 203) agreed or strongly agreed that error recovery is an important competency for future practice. This was reflected in free-text response: "Errors can be minimized but they are inevitable, so certainly believe a surgical curriculum that addresses error recovery is of paramount importance." While 83% (n = 170) feel confident recovering from minor errors, only 34% (n = 68) feel confident that they could recover from major errors that are likely to have serious consequences on patient safety. Overall, residents do not consider that they have adequate training in error recovery, with only 37% (n = 72) felt they were adequately trained to recover from major errors. It was also mentioned "The quality of learning regarding error recovery depends entirely on the attending." CONCLUSIONS Opportunities to learn to recover from technical errors in the operating room are valued by surgical trainees, but they perceive their training to be both inadequate and variable. This contributes to a lack of confidence in error recovery skills throughout their surgical training. There is a need to explore how best to integrate error recovery into more formal surgical curricula in order to better support learners and, ultimately, contribute to increased surgical safety.
Collapse
Affiliation(s)
- Fanny Gabrysz-Forget
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Meredith Young
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah Zahabi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts; Department of Surgery, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Lily H P Nguyen
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
13
|
Faucett EA, Wolter NE, Balakrishnan K, Ishman SL, Mehta D, Parikh S, Nguyen LHP, Preciado D, Rutter MJ, Prager JD, Green GE, Pransky SM, Elluru R, Husein M, Roy S, Johnson KE, Friedberg J, Johnson RF, Bauman NM, Myer CM, Deutsch ES, Gantwerker EA, Willging JP, Hart CK, Chun RH, Lam DJ, Ida JB, Manoukian JJ, White DR, Sidell DR, Wootten CT, Inglis AF, Derkay CS, Zalzal G, Molter DW, Ludemann JP, Choi S, Schraff S, Myer CM, Cotton RT, Vijayasekaran S, Zdanski CJ, El-Hakim H, Shah UK, Soma MA, Smith ME, Thompson DM, Javia LR, Zur KB, Sobol SE, Hartnick CJ, Rahbar R, Vaccani JP, Hartley B, Daniel SJ, Jacobs IN, Richter GT, de Alarcon A, Bromwich MA, Propst EJ. Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus. Laryngoscope 2020; 131:1168-1174. [PMID: 33034397 DOI: 10.1002/lary.29126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN Blinded modified Delphi consensus process. SETTING Tertiary care center. METHODS A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE 5. Laryngoscope, 131:1168-1174, 2021.
Collapse
Affiliation(s)
- Erynne A Faucett
- Division of Otolaryngology, Head and Neck Surgery, Phoenix Children's Hospital, Department of Child Health, University of Arizona, Tucson, Arizona, U.S.A.,College of Medicine, Department of Otolaryngology, Mayo College of Medicine and Science, Phoenix, Arizona, U.S.A
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Karthik Balakrishnan
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Stacey L Ishman
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Deepak Mehta
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Sanjay Parikh
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Diego Preciado
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - Michael J Rutter
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Glenn E Green
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - Seth M Pransky
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, U.S.A
| | - Ravi Elluru
- Division of Otolaryngology, Dayton Children's Hospital, Dayton, Ohio, U.S.A
| | - Murad Husein
- Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Soham Roy
- Department of Otorhinolaryngology, University of Texas at Houston McGovern Medical School, Houston, Texas, U.S.A
| | - Kaalan E Johnson
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jacob Friedberg
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Romaine F Johnson
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - Charles M Myer
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Eric A Gantwerker
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - J Paul Willging
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin-Milwaukee Campus, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Derek J Lam
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A
| | - Jonathan B Ida
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - John J Manoukian
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - David R White
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Christopher T Wootten
- Division of Otolaryngology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, U.S.A
| | - Andrew F Inglis
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Craig S Derkay
- Department of Otolaryngology - Head and Neck Surgery Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - David W Molter
- Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, U.S.A
| | - Jeffrey P Ludemann
- Pediatric Otolaryngology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A
| | - Charles M Myer
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Robin T Cotton
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Head and Neck Surgery, Perth Children's Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Hamdy El-Hakim
- Division of Pediatric Surgery and Otolaryngology - Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Udayan K Shah
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A
| | - Marlene A Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Marshall E Smith
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Dana M Thompson
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Luv Ram Javia
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Karen B Zur
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Steven E Sobol
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston, Boston, Massachusetts, U.S.A
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jean-Philippe Vaccani
- Division of Otolaryngology, Department of Surgery, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hartley
- Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom
| | - Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Gresham T Richter
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | - Alessandro de Alarcon
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Matthew A Bromwich
- Division of Otolaryngology, Department of Surgery, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| |
Collapse
|
14
|
Labbé M, Young M, Mascarella M, Husein M, Doyle PC, Nguyen LHP. How Consistent Is Competent? Examining Variance in Psychomotor Skills Assessment. Acad Med 2020; 95:771-776. [PMID: 31517685 DOI: 10.1097/acm.0000000000002985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Direct assessment of trainee performance across time is a core tenet of competency-based medical education. Unlike variability of psychomotor skills across levels of expertise, performance variability exhibited by a particular trainee across time remains unexplored. The goal of this study was to document the consistency of individual surgeons' technical skill performance. METHOD A secondary analysis of assessment data (collected in 2010-2012, originally published in 2015) generated by a prospective cohort of participants at Montreal Children's Hospital with differing levels of expertise was conducted in 2017. Trained raters scored blinded recordings of a myringotomy and tube insertion performed 4 times by junior and senior residents and attending surgeons over a 6-month period using a previously reported assessment tool. Descriptive exploratory analyses and univariate comparison of standard deviations (SDs) were conducted to document variability within individuals across time and across training levels. RESULTS Thirty-six assessments from 9 participants were analyzed. The SD of scores for junior residents was highly variable (5.8 out of a scale of 30 compared with 1.8 for both senior residents and attendings [F(2,19) = 5.68, P < 0.05]). For a given individual, the range of scores was twice as large for junior residents than for senior residents and attendings. CONCLUSIONS Surgical residents may display highly variable performances across time, and individual variability appears to decrease with increasing expertise. Operative skill variability could be underrepresented in direct observation assessment; emphasis on an adequate amount of repetitive evaluations for junior residents may be needed to support judgments of competence or entrustment.
Collapse
Affiliation(s)
- Mathilde Labbé
- M. Labbé is a resident, Department of Family Medicine, McGill University, Montreal, Quebec, Canada. M. Young is associate professor, Faculty of Medicine, McGill University, and research scientist, Centre for Medical Education, McGill University, Montreal, Quebec, Canada. M. Mascarella is a resident, Department of Otolaryngology-Head and Neck Surgery, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. M. Husein is associate professor, Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada. P.C. Doyle is professor, Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada. L.H.P. Nguyen is associate professor, Department of Otolaryngology-Head and Neck Surgery, McGill University, and member, Centre for Medical Education, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | | |
Collapse
|
15
|
Propst EJ, Wolter NE, Ishman SL, Balakrishnan K, Deonarain AR, Mehta D, Zalzal G, Pransky SM, Roy S, Myer CM, Torre M, Johnson RF, Ludemann JP, Derkay CS, Chun RH, Hong P, Molter DW, Prager JD, Nguyen LHP, Rutter MJ, Myer CM, Zur KB, Sidell DR, Johnson LB, Cotton RT, Hart CK, Willging JP, Zdanski CJ, Manoukian JJ, Lam DJ, Bauman NM, Gantwerker EA, Husein M, Inglis AF, Green GE, Javia LR, Schraff S, Soma MA, Deutsch ES, Sobol SE, Ida JB, Choi S, Uwiera TC, Shah UK, White DR, Wootten CT, El-Hakim H, Bromwich MA, Richter GT, Vijayasekaran S, Smith ME, Vaccani JP, Hartnick CJ, Faucett EA. Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus. Laryngoscope 2019; 130:2700-2707. [PMID: 31821571 DOI: 10.1002/lary.28461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 11/21/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Create a competency-based assessment tool for pediatric tracheotomy. STUDY DESIGN Blinded, modified, Delphi consensus process. METHODS Using the REDCap database, a list of 31 potential items was circulated to 65 expert surgeons who perform pediatric tracheotomy. In the first round, items were rated as "keep" or "remove," and comments were incorporated. In the second round, experts were asked to rate the importance of each item on a seven-point Likert scale. Consensus criteria were determined a priori with a goal of 7 to 25 final items. RESULTS The first round achieved a response rate of 39/65 (60.0%), and returned questionnaires were 99.5% complete. All items were rated as "keep," and 137 comments were incorporated. In the second round, 30 task-specific and seven previously validated global rating items were distributed, and the response rate was 44/65 (67.7%), with returned questionnaires being 99.3% complete. Of the Task-Specific Items, 13 reached consensus, 10 were near consensus, and 7 did not achieve consensus. For the 7 previously validated global rating items, 5 reached consensus and two were near consensus. CONCLUSIONS It is feasible to reach consensus on the important steps involved in pediatric tracheotomy using a modified Delphi consensus process. These items can now be considered to create a competency-based assessment tool for pediatric tracheotomy. Such a tool will hopefully allow trainees to focus on the important aspects of this procedure and help teaching programs standardize how they evaluate trainees during this procedure. LEVEL OF EVIDENCE 5 Laryngoscope, 130:2700-2707, 2020.
Collapse
Affiliation(s)
- Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology and Mayo Children's Center, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, U.S.A
| | - Ashley R Deonarain
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Deepak Mehta
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, DC, U.S.A
| | - Seth M Pransky
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, U.S.A
| | - Soham Roy
- Department of Otorhinolaryngology, University of Texas at Houston McGovern Medical School, Houston, Texas, U.S.A
| | - Charles M Myer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Michele Torre
- Airway Unit, Scientific Institute for Research and Healthcare, Giannina Gaslini Institute, Genoa, Italy
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jeffrey P Ludemann
- Pediatric Otolaryngology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin-Milwaukee Campus, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Paul Hong
- Division of Otolaryngology, Dalhousie University, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - David W Molter
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Charles M Myer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Karen B Zur
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Liane B Johnson
- Division of Otolaryngology, Dalhousie University, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - Robin T Cotton
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - J Paul Willging
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - John J Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, DC, U.S.A
| | - Eric A Gantwerker
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Murad Husein
- Department of Otolaryngology-Head and Neck Surgery, Victoria Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew F Inglis
- Division of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Glenn E Green
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - Luv Ram Javia
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A
| | - Marlene A Soma
- Department of Pediatric Otolaryngology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Steven E Sobol
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Jonathan B Ida
- Division of Pediatric Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Trina C Uwiera
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Udayan K Shah
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A
| | - David R White
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Hamdy El-Hakim
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Matthew A Bromwich
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Gresham T Richter
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | - Shyan Vijayasekaran
- Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, University of Western Australia, Nedlands, Western Australia, Australia
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Jean-Philippe Vaccani
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Erynne A Faucett
- Department of Pediatric Otolaryngology, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| |
Collapse
|
16
|
Torgerson T, Johnson AL, Jellison S, Tanghetti M, Langley J, Nguyen LHP, Vassar M. Reporting of Clinical Trial Interventions Published in Leading Otolaryngology–Head and Neck Surgery Journals. Laryngoscope 2019; 130:E507-E514. [DOI: 10.1002/lary.28404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
| | - Austin L. Johnson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
| | - Sam Jellison
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
| | - Margo Tanghetti
- Department of OtolaryngologyOklahoma State University Medical Center Tulsa Oklahoma U.S.A
| | - Jean‐Maria Langley
- Department of OtolaryngologyOklahoma State University Medical Center Tulsa Oklahoma U.S.A
| | - Lily H. P. Nguyen
- Department of Otolaryngology–Head and Neck SurgeryMcGill University Montreal Quebec Canada
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
| |
Collapse
|
17
|
Hong X, Khalife S, Bouhabel S, Bernard C, Daniel SJ, Manoukian JJ, Nguyen LHP. Rhinologic manifestations of Burkitt Lymphoma in a pediatric population: Case series and systematic review. Int J Pediatr Otorhinolaryngol 2019; 121:127-136. [PMID: 30897372 DOI: 10.1016/j.ijporl.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Burkitt lymphoma (BL), an aggressive form of B-cell non-Hodgkin's lymphoma, arising from the nose and paranasal sinuses is relatively rare. It can present with various symptoms leading to potential misdiagnosis and delayed treatment. BL is fatal if left untreated, while early identification and treatment can improve prognosis. OBJECTIVES 1) To review clinical presentations and sites of involvement of six cases of pediatric BL with rhinologic manifestations and compare these with the current literature. 2) To raise awareness on the variety of presentations of BL in this particular anatomic location. METHODS A series of six cases of pediatric (0-18 years) BL with rhinologic manifestations is presented. Age, sex, ethnicity, symptoms, imaging, staging, treatment and outcome were recorded. A systematic review of literature was also conducted using PRISMA guidelines. The search strategy used keywords related to rhinologic manifestations of BL (nasal cavity, nasopharynx, paranasal sinus etc.; Burkitt etc.) and included studies published in English and French describing patients 0-18 years of age. RESULTS 42 patients were included (six from case series and 36 from current literature). Most common presenting symptoms were: nasal obstruction (29%), facial swelling (24%), headache (21%) and proptosis (19%). Most frequent sites of presentation were: nasopharynx (40%), maxilla (40%) and sphenoid (33%). More than half (60%) had systemic involvement, of which the most common locations were: kidney (19%), pancreas (17%) and liver (17%). Mortality from BL in children from this study population was correlated with a longer duration of symptoms prior to presentation, as well as a misdiagnosis preceding the final diagnosis of BL. CONCLUSIONS This study brings understanding to the numerous presentations of the same aggressive disease, promotes high clinical suspicion when evaluating common otolaryngologic symptoms and can guide healthcare providers in diagnosing pediatric BL with rhinologic manifestations.
Collapse
Affiliation(s)
- Xinyuan Hong
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Sarah Khalife
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - Sarah Bouhabel
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - Chantal Bernard
- Department of Pathology, McGill University, Montreal, Canada
| | - Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - John J Manoukian
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.
| |
Collapse
|
18
|
Nguyen LHP, Bank I, Fisher R, Mascarella M, Young M. Managing the airway catastrophe: longitudinal simulation-based curriculum to teach airway management. J Otolaryngol Head Neck Surg 2019; 48:10. [PMID: 30782200 PMCID: PMC6381681 DOI: 10.1186/s40463-019-0332-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background A longitudinal curriculum was developed in conjunction with anesthesiologists, otolaryngologists, emergency physicians and experts in medical simulation and education. Methods Residents participated in four different simulation-based training modules using animal models, cadavers, task trainers, and crisis scenarios using high fidelity manikins. Scenarios were based on various clinical settings (i.e. emergency room, operating room) and were followed by video-assisted structured debriefings. Participants completed both a self-assessment questionnaire and an exit survey using five-point Likert scales. Results 31 otolaryngology residents participated in the curriculum. Residents reported simulation training significantly improved technical skills such as tracheostomy, cricothyroidotomy and pediatric intubation (p < 0.05 for all). Non-technical skills, including communication, delegation and management were significantly improved on post-test surveys in simulated crisis scenarios (p < 0.05 for all). 90 (28/31) of participants found simulations to be very realistic. Junior residents placed increased value on didactic teaching and procedural skills, while senior residents on crisis scenarios. Survey results indicated that > 90% (28/31) of participants found the modules of the curriculum to be useful and would recommend them to others. Conclusion A longitudinal simulation-based medical curriculum can be an effective method to teach airway management and teamwork skills to otolaryngology residents.
Collapse
Affiliation(s)
- Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada. .,Centre for Medical Education, McGill University, Montreal, Canada. .,Department of OTL-HNS, Montreal Children's Hospital, 1001 Blvd. Decarie, Room A02-3015, Montreal, Canada.
| | - Ilana Bank
- Centre for Medical Education, McGill University, Montreal, Canada.,Department of Emergency Medicine, McGill University, Montreal, Canada
| | - Rachel Fisher
- Centre for Medical Education, McGill University, Montreal, Canada.,Department of Anesthesia, McGill University, Montreal, Canada
| | - Marco Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - Meredith Young
- Centre for Medical Education, McGill University, Montreal, Canada
| |
Collapse
|
19
|
Beaudoin PL, Labbé M, Fanous A, Young M, Rappaport J, Park YS, Manoukian J, Nguyen LHP. Teaching communication skills to OTL-HNS residents: multisource feedback and simulated scenarios. J Otolaryngol Head Neck Surg 2019; 48:8. [PMID: 30691537 PMCID: PMC6350291 DOI: 10.1186/s40463-019-0329-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Effective communication has been linked to a reduction in adverse events and improved patient compliance. Currently in Otolaryngology - Head and Neck Surgery (OTL-HNS) residency programs, there is limited explicit teaching of communication skills. Our objective was to implement an educational program on communication skills for residents using multisource assessment in several simulation-based contexts throughout residency. METHODS For three consecutive years, OTL-HNS residents were recruited to participate in a total of nine simulation-based clinical scenarios in which communication skills could be honed. This educational program was designed to provide instruction and practice of challenging ethics scenarios, with communication efficacy as a secondary goal. To facilitate this goal, a multisource assessment was paired with a debriefing process that involved attending staff, observing and participating residents, standardized patients, and invited content experts. RESULTS Seventeen residents completed the curriculum for at least two consecutive years from 2009 to 2011. The internal-consistency reliability of the scenarios ranged from 0.88 to 0.96. The intraclass correlation was 0.19, as expected in this context. There was no statistical difference in the mean ratings of performance across post-graduate year (PGY) level (p = 0.201). Results from the random-intercept regression indicated that, on average, a learner's mean rating at baseline was 3.6/5 and increased significantly by 0.25 points per year (p < 0.05) as assessed by OTL-HNS staff members and peers. No significant improvement across time was found for ratings by non-medical assessors. CONCLUSION Implementing an educational program focused on communication skills using a multisource assessment in various contexts has shown to be potentially effective at our institution, and resulted for yearly improvement and consolidation of performance of OTL-HNS residents as judged by faculty and residents. The inclusion of a multisource assessment in the simulation curriculum is key to allow for the representation of different perspectives on communication skills, for both the assessment and the debriefing process. Future studies are needed to explore the possibility of fully integrating this educational program into residence training in order to support deliberate communication skills teaching.
Collapse
Affiliation(s)
| | - Mathilde Labbé
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Amanda Fanous
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada
| | - Meredith Young
- Center for Medical Education, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jamie Rappaport
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois, Chicago, Illinois, USA
| | - John Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada. .,Center for Medical Education, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
20
|
Bhindi A, Carpineta L, Al Qassabi B, Waissbluth S, Ywakim R, Manoukian JJ, Nguyen LHP. Hearing loss in pediatric temporal bone fractures: Evaluating two radiographic classification systems as prognosticators. Int J Pediatr Otorhinolaryngol 2018; 109:158-163. [PMID: 29728172 DOI: 10.1016/j.ijporl.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Temporal bone fractures (TBF) are traditionally classified by their angle of fracture relative to the petrous ridge, and more recently by whether or not they violate the otic-capsule. This study compared rates of hearing loss (HL) and signs of otologic dysfunction among fracture types of both classification systems, within the pediatric population. METHODS Pediatric patients were retrospectively characterized from a previously identified cohort of TBF patients, diagnosed from 2000 to 2014. CT scans were reviewed and TBFs were classified first as longitudinal (L), transverse (T) or mixed (M), and then as otic-capsule sparing (OCS) or otic-capsule violating (OCV). Medical records were reviewed, and rates of HL and presenting signs were compared among L, T and M fractures, and OCS and OCV fractures. RESULTS Forty-three patients with 47 TBFs met the inclusion criteria. Eighteen, 4 and 25 TBFs were classified as L, T and M fractures, respectively. Thirty-three and 9 were classified as OCS, and OCV, respectively. Among 24 cases of HL: 20, 3, and 1 were conductive HL (CHL), sensorineural HL (SNHL) and mixed HL, respectively. Two cases of SNHL were found among OCV fractures, with none in OCS fractures (estimated difference 0.22; 95% confidence interval 0.01-0.60). Similar rates of CHL were found across L, T and M fractures (range 36-50%), and across OCV and OCS fractures (range 42-44%). Hemotympanum was the most common presenting sign, found in 68% of TBFs and 80% of CHL cases. There were no significant differences in the incidence of signs or symptoms between fracture types. CONCLUSIONS In our cohort, both the traditional and otic-capsule radiographic classification systems failed to predict the incidence of CHL and other otologic signs in the pediatric population. Though OCV fractures conferred an increased risk for developing SNHL, we found a lower incidence than anticipated given violation to the bony labyrinth.
Collapse
Affiliation(s)
- A Bhindi
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - L Carpineta
- Department of Pediatric Medical Imaging, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - B Al Qassabi
- Department of Pediatric Medical Imaging, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - S Waissbluth
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - R Ywakim
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - J J Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - L H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Center for Medical Education, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
21
|
Huang YQ, Traore K, Ibrahim B, Sewitch MJ, Nguyen LHP. Reporting quality of randomized controlled trials in otolaryngology: review of adherence to the CONSORT statement. J Otolaryngol Head Neck Surg 2018; 47:34. [PMID: 29764496 PMCID: PMC5952888 DOI: 10.1186/s40463-018-0277-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/29/2018] [Indexed: 11/30/2022] Open
Abstract
Background Randomized controlled trials are the gold standard in medical and surgical research to assess the efficacy of therapeutic interventions. The reporting of these trials should be of high quality to allow readers’ appropriate interpretation and application. Methods The objectives of our study were to assess the extent to which the recent Otolaryngology – Head and Neck Surgery (ORL-HNS) randomized control trials in the top nine journals and in the top Canadian journal comply with the Consolidated Standards of Reporting Trials (CONSORT) statement, and to identify the CONSORT items most in need of improvement. Based on the impact factor and circulation number of 2014, the top nine Otolaryngology journals and the top Canadian Otolaryngology journal were selected and were searched to identify RCTs published in English and between 2010 and 2014. Two authors independently reviewed and extracted data using a standardized data extraction form constructed with the help of a medical librarian. Our outcome was to assess the adherence of articles reporting to the CONSORT items. Descriptive statistics were used. Results One hundred and eighty-two Otolaryngologic RCTs were identified in the top nine international journals and in the top Canadian journal. The inter-rater reliability between two raters was 0.32. The extent of adherence to CONSORT Statement ranged from 25 to 93.5% with a mean of 59.0% and a median of 59.4%. Only 6.5% of RCTs described the individual responsible for enrolling and assigning subjects and method of randomization; 32.4% reported the estimated effect size and precision; 40.6% reported a sample size calculation and 32.4% mentioned external validity or implications of the findings. Conclusion Findings revealed that the reporting of RCTs in the top nine ORL-HNS journals and in the top Canadian ORL-HNS journal is suboptimal. The quality of reporting can be improved by addressing the three CONSORT items found most deficient in this study namely, sample size calculations, estimated effect size and precision, and external validity.
Collapse
Affiliation(s)
- Yu Qing Huang
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Badr Ibrahim
- Department of Otolaryngology - Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Maida J Sewitch
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada. .,Center for Medical Education, McGill University, Montreal, Quebec, Canada. .,Department of ORL-HNS, Montreal Children's Hospital, 1001 Boulevard Décarie, Montréal, Quebec, H4A 3J1, Canada.
| |
Collapse
|
22
|
Nhan C, Young M, Bank I, Nugus P, Fisher R, Azzam M, Nguyen LHP. Interdisciplinary Crisis Resource Management Training: How Do Otolaryngology Residents Compare? A Survey Study. OTO Open 2018; 2:2473974X18770409. [PMID: 30480212 PMCID: PMC6239147 DOI: 10.1177/2473974x18770409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/04/2017] [Accepted: 03/22/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Emergent medical crises, such as acute airway obstruction, are often managed by interdisciplinary teams. However, resident training in crisis resource management traditionally occurs in silos. Our objective was to compare the current state of interdisciplinary crisis resource management (IDCRM) training of otolaryngology residents with other disciplines. Methods A survey study examining (1) the frequency with which residents are involved in interdisciplinary crises, (2) the current state of interdisciplinary training, and (3) the desired training was conducted targeting Canadian residents in the following disciplines: otolaryngology, anesthesiology, emergency medicine, general surgery, obstetrics and gynecology, internal medicine, pediatric emergency medicine, and pediatric/neonatal intensive care. Results A total of 474 surveys were completed (response rate, 12%). On average, residents were involved in 13 interdisciplinary crises per year. Only 8% of otolaryngology residents had access to IDCRM training, as opposed to 66% of anesthesiology residents. Otolaryngology residents reported receiving an average of 0.3 hours per year of interdisciplinary training, as compared with 5.4 hours per year for pediatric emergency medicine residents. Ninety-six percent of residents desired more IDCRM training, with 95% reporting a preference for simulation-based training. Discussion Residents reported participating in crises managed by interdisciplinary teams. There is strong interest in IDCRM and crisis resource management training; however, it is not uniformly available across Canadian residency programs. Despite their pivotal role in managing critical emergencies such as acute airway obstruction, otolaryngology residents received the least training. Implication IDCRM should be explicitly taught since it reflects reality and may positively affect patient outcomes.
Collapse
Affiliation(s)
- Carol Nhan
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Québec, Canada
| | - Meredith Young
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ilana Bank
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Pediatric Emergency Medicine, McGill University, Montréal, Québec, Canada
| | - Peter Nugus
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Rachel Fisher
- Department of Anesthesiology, McGill University, Montréal, Québec, Canada
| | - Milène Azzam
- Department of Anesthesiology, McGill University, Montréal, Québec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Québec, Canada.,Center for Medical Education, McGill University, Montréal, Québec, Canada
| |
Collapse
|
23
|
Abstract
BACKGROUND/PURPOSE Intrathyroidal thymic tissue may be misinterpreted as a thyroid lesion in children, leading to invasive tests or resection. We sought to describe the characteristic imaging features of these lesions and to evaluate the safety of non-operative management. METHODS A retrospective review of all patients less than 18years old with intrathyroidal thymic tissue from 2000 to 2016 was performed. Data collection included patient demographics, imaging results, interventions, and outcomes. RESULTS Eleven patients were identified using institutional radiology and pathology databases. Median patient age and lesion size at presentation were 5years old (range 2 to 8years old) and 0.9cm (range 0.4 to 9.2cm), respectively. Six lesions were incidentally identified, six were left-sided, and the most common location was the lower pole. Ultrasonographic features were reproducible and included well demarcated (10/11), hypoechoic lesions (11/11), containing punctate/linear internal echoes (11/11), and occasional mild hypervascularity (6/11). All cases demonstrated interval size and echotexture stability over a median surveillance period of 3years (range 1 to 8years). While 9 patients were simply observed, the first patient in this series underwent excision, while another had a fine needle aspiration to confirm pathology. LEVEL OF EVIDENCE Study of diagnostic test, Level IV. CONCLUSION Intrathyroidal thymic tissue has typical clinical and sonographic characteristics which allow for appropriate diagnosis and avoids thyroid resection.
Collapse
Affiliation(s)
- Emily Kay-Rivest
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco A Mascarella
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pramod Puligandla
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- Division of Pediatric Radiology, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sam J Daniel
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
24
|
Abstract
Purpose Complex clinical situations, involving multiple medical specialists, create potential for tension or lack of clarity over leadership roles and may result in miscommunication, errors and poor patient outcomes. Even though copresence has been shown to overcome some differences among team members, the coordination literature provides little guidance on the relationship between coordination and leadership in highly specialized health settings. The purpose of this paper is to determine how different specialties involved in critical medical situations perceive the role of a leader and its contribution to effective crisis management, to better define leadership and improve interdisciplinary leadership and education. Design/methodology/approach A qualitative study was conducted featuring purposively sampled, semi-structured interviews with 27 physicians, from three different specialties involved in crisis resource management in pediatric centers across Canada: Pediatric Emergency Medicine, Otolaryngology and Anesthesia. A total of three researchers independently organized participant responses into categories. The categories were further refined into conceptual themes through iterative negotiation among the researchers. Findings Relatively "structured" (predictable) cases were amenable to concrete distributed leadership - the performance by micro-teams of specialized tasks with relative independence from each other. In contrast, relatively "unstructured" (unpredictable) cases required higher-level coordinative leadership - the overall management of the context and allocations of priorities by a designated individual. Originality/value Crisis medicine relies on designated leadership over highly differentiated personnel and unpredictable events. This challenges the notion of organic coordination and upholds the validity of a concept of leadership for crisis medicine that is not reducible to simple coordination. The intersection of predictability of cases with types of leadership can be incorporated into medical simulation training to develop non-technical skills crisis management and adaptive leaderships skills.
Collapse
Affiliation(s)
- Hugo Paquin
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, University of Montreal , Montréal, Canada
| | - Ilana Bank
- Department of Pediatric Emergency Medicine, Montreal Children's Hospital, Centre for Medical Education, McGill University , Montréal, Canada
| | - Meredith Young
- Department of Medicine, Centre for Medical Education, McGill University , Montréal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Centre for Medical Education, Montreal Children's Hospital, McGill University , Montréal, Canada
| | - Rachel Fisher
- Department of Anesthesiology, Montreal Children's Hospital, McGill University , Montréal, Canada
| | - Peter Nugus
- Department of Family Medicine, Centre for Medical Education, McGill University , Montreal, Canada
| |
Collapse
|
25
|
Labbé M, Young M, Nguyen LHP. Toolbox of assessment tools of technical skills in otolaryngology-head and neck surgery: A systematic review. Laryngoscope 2017; 128:1571-1575. [DOI: 10.1002/lary.26943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/25/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Mathilde Labbé
- Faculty of Medicine; McGill University; Montreal Quebec Canada
| | - Meredith Young
- Center for Medical Education; McGill University; Montreal Quebec Canada
- Department of Medicine; McGill University; Montreal Quebec Canada
| | - Lily H. P. Nguyen
- Center for Medical Education; McGill University; Montreal Quebec Canada
- Department of Otolaryngology; McGill University; Montreal Quebec Canada
| |
Collapse
|
26
|
Smith MM, Huang A, Labbé M, Lubov J, Nguyen LHP. Clinical presentation and airway management of tracheal atresia: A systematic review. Int J Pediatr Otorhinolaryngol 2017; 101:57-64. [PMID: 28964311 DOI: 10.1016/j.ijporl.2017.07.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Tracheal atresia (TA) is a rare congenital condition that typically requires an unexpected and emergent resuscitation in the delivery room. The mortality rate associated is very high, with only a few long-term survival cases reported. We describe the findings of a systematic review on the clinical presentation and airway management of TA. METHODS Using the keywords "tracheal atresia", "tracheal agenesis" and "tracheal hypoplasia" a search through Embase and Pubmed databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles published from 1950 to 2015 in English, French, Italian, Portuguese and Spanish were included. Exclusion criteria were cases of stillborn, and unclear diagnosis or outcome. RESULTS 149 cases of TA were identified after reviewing 1125 initial references. There was a male preponderance (65%), and associated malformations were described in 94.2% of patients. Prenatal ultrasound was abnormal in 56.3% of cases, with polyhydramnios being the most common finding. The most frequent type of TA was Faro Type C. 94 (41.3%) patients did not survive beyond the first 24 h of life. Only 13 (8.4%) patients survived more than three months of life, after undergoing a variety of surgical approaches. CONCLUSION This review, which to our knowledge is the largest one to date, confirms that TA is a rare malformation, occurs more frequently in males, and has a very high mortality rate. Depending on the presence and type of concomitant malformation, as well of the length of the remaining trachea, different surgical management options are described.
Collapse
Affiliation(s)
- Mariana M Smith
- Department of Otolaryngology- Head & Neck Surgery, McGill University, Montreal, Canada
| | - Amy Huang
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Mathilde Labbé
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Joshua Lubov
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology- Head & Neck Surgery, McGill University, Montreal, Canada.
| |
Collapse
|
27
|
Chorfi S, Schwartz JS, Verma N, Young M, Joseph L, Nguyen LHP. Evolution of gender representation among Canadian OTL-HNS residents: a 27-year analysis. J Otolaryngol Head Neck Surg 2017; 46:55. [PMID: 28851430 PMCID: PMC5576270 DOI: 10.1186/s40463-017-0232-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background The proportion of females enrolling into medical schools has been growing steadily. However, the representation of female residents among individual specialties has shown considerable variation. The purpose of this study was to compare the trends of gender representation in Otolaryngology – Head and Neck Surgery (OTL-HNS) residency programs with other specialty training programs in Canada. In order to contextualize these findings, a second phase of analysis examined the success rate of applicants of different genders to OTL-HNS residency programs. Method Anonymized data were obtained from the Canadian Residency Matching Service (CaRMS) and from the Canadian Post-M.D. Education Registry (CAPER) from 1988 to 2014. The differences in gender growth rates were compared to other subspecialty programs of varying size. Descriptive analysis was used to examine gender representation among OTL-HNS residents across years, and to compare these trends with other specialties. Bayesian hierarchical models were fit to analyze the growth in program rates in OTL-HNS based on gender. Results CaRMS and CAPER data over a 27 year period demonstrated that OTL-HNS has doubled its female representation from 20% to 40% between 1990 and 1994 and 2010-2014. The difference in annual growth rate of female representation versus male representation in OTL-HNS over this time period was 2.7%, which was similar to other large specialty programs and surgical subspecialties. There was parity in success rates of female and male candidates ranking OTL-HNS as their first choice specialty for most years. Conclusions Female representation in Canadian OTL-HNS residency programs is steadily increasing over the last 27 years. Large variation in female applicant acceptance rates was observed across Canadian universities, possibly attributable to differences in student body or applicant demographics. Factors influencing female medical student career selection to OTL-HNS require further study to mitigate disparities in gender representation and identify barriers to prospective female OTL-HNS applicants.
Collapse
Affiliation(s)
- Sarah Chorfi
- Faculty of Medicine, McGill University Health Centre, Montreal Children's Hospital, McGill University, Room A02.3015, 1001 Boulevard Decarie, Montreal, QC, H4A 3J1, Canada
| | - Joseph S Schwartz
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
| | - Neil Verma
- Faculty of Medicine, McGill University Health Centre, Montreal Children's Hospital, McGill University, Room A02.3015, 1001 Boulevard Decarie, Montreal, QC, H4A 3J1, Canada.
| | - Meredith Young
- Centre for Medical Education, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada.,Centre for Medical Education, McGill University, Montreal, Canada
| |
Collapse
|
28
|
Fanous A, Rappaport J, Young M, Park YS, Manoukian J, Nguyen LHP. A longitudinal simulation-based ethical-legal curriculum for otolaryngology residents. Laryngoscope 2017; 127:2501-2509. [DOI: 10.1002/lary.26551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/30/2016] [Accepted: 01/30/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Amanda Fanous
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Jamie Rappaport
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Meredith Young
- Center for Medical Education; McGill University; Montreal Quebec Canada
- Department of Medicine; McGill University; Montreal Quebec Canada
| | - Yoon Soo Park
- Department of Medical Education; University of Illinois, Chicago; Chicago Illinois U.S.A
| | - John Manoukian
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Lily H. P. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Center for Medical Education; McGill University; Montreal Quebec Canada
| |
Collapse
|
29
|
Alrasheed AS, Nguyen LHP, Mongeau L, Funnell WRJ, Tewfik MA. Development and validation of a 3D-printed model of the ostiomeatal complex and frontal sinus for endoscopic sinus surgery training. Int Forum Allergy Rhinol 2017; 7:837-841. [PMID: 28614638 DOI: 10.1002/alr.21960] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 04/10/2017] [Accepted: 04/25/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endoscopic sinus surgery poses unique training challenges due to complex and variable anatomy, and the risk of major complications. We sought to create and provide validity evidence for a novel 3D-printed simulator of the nose and paranasal sinuses. METHODS Sinonasal computed tomography (CT) images of a patient were imported into 3D visualization software. Segmentation of bony and soft tissue structures was then performed. The model was printed using simulated bone and soft tissue materials. Rhinologists and otolaryngology residents completed 6 prespecified tasks including maxillary antrostomy and frontal recess dissection on the simulator. Participants evaluated the model using survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated. Descriptive analysis was used to evaluate ratings, and thematic analysis was done for qualitative questions. RESULTS A total of 20 participants (10 rhinologists and 10 otolaryngology residents) tested the model and answered the survey. Overall the participants felt that the simulator would be useful as a training/educational tool (4.6/5), and that it should be integrated as part of the rhinology training curriculum (4.5/5). The following responses were obtained: visual appearance 4.25/5; realism of materials 3.8/5; and surgical experience 3.9/5. The average time to complete each task was lower for the rhinologist group than for the residents. CONCLUSION We describe the development and validation of a novel 3D-printed model for the training of endoscopic sinus surgery skills. Although participants found the simulator to be a useful training and educational tool, further model development could improve the outcome.
Collapse
Affiliation(s)
- Abdulaziz S Alrasheed
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada
| | - Luc Mongeau
- Department of Mechanical Engineering, McGill University, Montréal, QC, Canada
| | - W Robert J Funnell
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada.,Department of BioMedical Engineering, McGill University, Montréal, QC, Canada
| | - Marc A Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada
| |
Collapse
|
30
|
Kay-Rivest E, Varma N, Scott GM, Manoukian JJ, Desrosiers M, Vaccani JP, Nguyen LHP. Securing an OTL-HNS residency: how competitive is it? Comparing medical student perceptions to actual Canadian statistics. J Otolaryngol Head Neck Surg 2017; 46:16. [PMID: 28241867 PMCID: PMC5327531 DOI: 10.1186/s40463-017-0192-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/18/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The residency match is an important event in an aspiring physician's career. Otolaryngology - Head and Neck Surgery (OTL-HNS) is a surgical specialty that has enjoyed high numbers of applicants to its residency programs. However, recent trends in Canada show a decline in first-choice applicants to several surgical fields. Factors thought to influence a medical student's choice include role models, career opportunities and work-life balance. The notion of perceived competitiveness is a factor that has not yet been explored. This study sought to compare competitiveness of OTL-HNS, as perceived by Canadian medical students to residency match statistics published yearly by CaRMS (Canadian Residency Matching Service), with the hope of informing future decisions of surgical residency programs. METHODS An electronic survey was created and distributed to all medical students enrolled in the 17 Canadian medical schools. After gathering demographic information, students were asked to rank what they perceived to be the five most competitive disciplines offered by CaRMS. They were also asked to rank surgical specialties from most to least competitive. Publically available data from CaRMS was then collected and analyzed to determine actual competitiveness of admissions to Canadian OTL-HNS residency programs. RESULTS 1194 students, from first to fourth year of medical school, completed the survey. CaRMS statistics over the period from 2008 to 2014 demonstrated that the five most competitive specialties were Plastic Surgery, Dermatology, Ophthalmology, Emergency Medicine and OTL-HNS. Among surgical disciplines, OTL-HNS was third most competitive, where on average 72% of students match to their first-choice discipline. When students were questioned, 35% ranked OTL-HNS amongst the top five most competitive. On the other hand 72%, 74% and 80% recognized Opthalmology, Dermatology and Plastic Surgery as being among the five most competitive, respectively. We found that fourth-year medical students were significantly more knowledgeable about the competitiveness of both OTL-HNS and Plastic Surgery compared to first-year students (p < 0.01). CONCLUSION Overall, Canadian medical students may underestimate the competitiveness of OTL-HNS. Furthermore, competitiveness would appear to be a concept that resonates with medical students during the match process.
Collapse
Affiliation(s)
- E Kay-Rivest
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.
| | - N Varma
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - G M Scott
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
| | - J J Manoukian
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - M Desrosiers
- Department of Otolaryngology - Head and Neck Surgery, Université de Montréal, Montréal, Canada
| | - J P Vaccani
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada
| | - L H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
- Center for Medical Education, McGill University, Montreal, Canada
| |
Collapse
|
31
|
AlReefi MA, Nguyen LHP, Mongeau LG, Haq BU, Boyanapalli S, Hafeez N, Cegarra-Escolano F, Tewfik MA. Development and validation of a septoplasty training model using 3-dimensional printing technology. Int Forum Allergy Rhinol 2016; 7:399-404. [PMID: 27897397 DOI: 10.1002/alr.21887] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/29/2016] [Accepted: 10/25/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Providing alternative training modalities may improve trainees' ability to perform septoplasty. Three-dimensional printing has been shown to be a powerful tool in surgical training. The objectives of this study were to explain the development of our 3-dimensional (3D) printed septoplasty training model, to assess its face and content validity, and to present evidence supporting its ability to distinguish between levels of surgical proficiency. METHODS Imaging data of a patient with a nasal septal deviation was selected for printing. Printing materials reproducing the mechanical properties of human tissues were selected based on literature review and prototype testing. Eight expert rhinologists, 6 senior residents, and 6 junior residents performed endoscopic septoplasties on the model and completed a postsimulation survey. Performance metrics in quality (final product analysis), efficiency (time), and safety (eg, perforation length, nares damage) were recorded and analyzed in a study-blind manner. RESULTS The model was judged to be anatomically correct and the steps performed realistic, with scores of 4.05 ± 0.82 and 4.2 ± 1, respectively, on a 5-point Likert scale. Ninety-two percent of residents desired the simulator to be integrated into their teaching curriculum. There was a significant difference (p < 0.05) between the expert, intermediate, and novice groups in time taken and nares cuts, whereas other performance metrics showed no significant difference. CONCLUSION To our knowledge, there are no other simulator training models for septoplasty. Our model incorporates 2 different materials mixed into the 3 relevant consistencies necessary to simulate septoplasty. Our findings provide evidence supporting the validity of the model.
Collapse
Affiliation(s)
- Mahmoud A AlReefi
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Center for Medical Education, McGill University, Montreal, QC, Canada
| | - Luc G Mongeau
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Bassam Ul Haq
- Department of Mechanical Engineering, McGill University, Montreal, QC, Canada
| | | | - Nauman Hafeez
- Department of Mechanical Engineering, McGill University, Montreal, QC, Canada
| | | | - Marc A Tewfik
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC, Canada
| |
Collapse
|
32
|
Waissbluth S, Ywakim R, Al Qassabi B, Torabi B, Carpineta L, Manoukian J, Nguyen LHP. Pediatric temporal bone fractures: A case series. Int J Pediatr Otorhinolaryngol 2016; 84:106-9. [PMID: 27063763 DOI: 10.1016/j.ijporl.2016.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Temporal bone fractures are relatively common findings in patients with head trauma. The aim of this study was to evaluate the characteristics of temporal bone fractures in the pediatric population. STUDY DESIGN Retrospective case series. Tertiary care pediatric academic medical center. METHODS The medical records of patients aged 18 years or less diagnosed with a temporal bone fracture at the Montreal Children's Hospital from January 2000 to August 2014 were reviewed. Patient demographics, clinical presentation, mechanism of injury and complications were analyzed. Imaging studies and audiograms were also evaluated. RESULTS Out of 323 patients presenting to the emergency department with a skull fracture, 61 presented with a temporal bone fracture. Of these, 5 presented with bilateral fractures. 47 patients had associated fractures, and 3 patients deceased. We observed a male to female ratio of 2.8:1, and the average age was 9.5 years. Motor vehicle accidents were the primary mechanism of injury (53%), followed by falls (21%) and bicycle or skateboard accidents (10%). The most common presenting signs included hemotympanum, decreased or loss of consciousness, facial swelling and nausea and vomiting. 8 patients had otic involvement on computed tomography scans, and 30 patients had documented hearing loss near the time of accident with a majority being conductive hearing loss. 17 patients underwent surgical management of intracranial pressure. CONCLUSION In children, fractures of the temporal bone were most often caused by motor vehicle accidents and falls. It is common for these patients to have associated fractures.
Collapse
Affiliation(s)
- S Waissbluth
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - R Ywakim
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - B Al Qassabi
- Department of Radiology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - B Torabi
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Carpineta
- Department of Radiology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - J Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - L H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
33
|
Schwartz J, Costescu A, Mascarella MA, Young ME, Husein M, Agrawal S, Roth K, Doyle PC, Nguyen LHP. Objective assessment of Myringotomy and tympanostomy tube insertion: A prospective single-blinded validation study. Laryngoscope 2015; 126:2140-6. [DOI: 10.1002/lary.25746] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Joseph Schwartz
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Adrian Costescu
- Faculty of Medicine; McGill University; Montreal Quebec Canada
| | - Marco A. Mascarella
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Meredith E. Young
- Center for Medical Education; McGill University; Montreal Quebec Canada
- Department of Medicine; McGill University; Montreal Quebec Canada
| | - Murad Husein
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Sumit Agrawal
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Kathryn Roth
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Philip C. Doyle
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Lily H. P. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Center for Medical Education; McGill University; Montreal Quebec Canada
| |
Collapse
|
34
|
Do BA, Lands LC, Mascarella MA, Fanous A, Saint-Martin C, Manoukian JJ, Nguyen LHP. Lund-Mackay and modified Lund-Mackay score for sinus surgery in children with cystic fibrosis. Int J Pediatr Otorhinolaryngol 2015; 79:1341-5. [PMID: 26115934 DOI: 10.1016/j.ijporl.2015.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund-Mackay (LM) and modified Lund-Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. METHODS We performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver-operator characteristics curves (ROC) were used to analyze the radiological scoring systems. RESULTS A total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (±3.1) compared to 11.5 (±6.2) for those treated medically (p<0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (±3.5) and 13.5 (±7.3) for those medically treated (p<0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72-98) and specificity of 69.2% (95% CI of 39-91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48-84) and specificity of 84.6% (95% CI of 55-98). CONCLUSION The modified Lund-Mackay score provides a high specificity while the Lund-Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population.
Collapse
Affiliation(s)
- Bao Anh Do
- McGill University, Faculty of Medicine, Montreal, QC, Canada
| | - Larry C Lands
- Division of Peadiatric Respiratory Medicine, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada.
| | - Amanda Fanous
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - John J Manoukian
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada.
| |
Collapse
|
35
|
Varshney R, Frenkiel S, Nguyen LHP, Young M, Del Maestro R, Zeitouni A, Tewfik MA. Development of the McGill simulator for endoscopic sinus surgery: a new high-fidelity virtual reality simulator for endoscopic sinus surgery. Am J Rhinol Allergy 2015; 28:330-4. [PMID: 25197920 DOI: 10.2500/ajra.2014.28.4046] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The technical challenges of endoscopic sinus surgery (ESS) and the high risk of complications support the development of alternative modalities to train residents in these procedures. Virtual reality simulation is becoming a useful tool for training the skills necessary for minimally invasive surgery; however, there are currently no ESS virtual reality simulators available with valid evidence supporting their use in resident education. Our aim was to develop a new rhinology simulator, as well as to define potential performance metrics for trainee assessment. METHODS The McGill simulator for endoscopic sinus surgery (MSESS), a new sinus surgery virtual reality simulator with haptic feedback, was developed (a collaboration between the McGill University Department of Otolaryngology-Head and Neck Surgery, the Montreal Neurologic Institute Simulation Lab, and the National Research Council of Canada). A panel of experts in education, performance assessment, rhinology, and skull base surgery convened to identify core technical abilities that would need to be taught by the simulator, as well as performance metrics to be developed and captured. RESULTS The MSESS allows the user to perform basic sinus surgery skills, such as an ethmoidectomy and sphenoidotomy, through the use of endoscopic tools in a virtual nasal model. The performance metrics were developed by an expert panel and include measurements of safety, quality, and efficiency of the procedure. CONCLUSION The MSESS incorporates novel technological advancements to create a realistic platform for trainees. To our knowledge, this is the first simulator to combine novel tools such as the endonasal wash and elaborate anatomic deformity with advanced performance metrics for ESS.
Collapse
Affiliation(s)
- Rickul Varshney
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Sater L, Schwartz JS, Coupland S, Young M, Nguyen LHP. Nationwide study of publication misrepresentation in applicants to residency. Med Educ 2015; 49:601-11. [PMID: 25989408 DOI: 10.1111/medu.12729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/21/2015] [Accepted: 02/04/2015] [Indexed: 05/27/2023]
Abstract
OBJECTIVES This study was conducted to assess the prevalence of research publication misrepresentation amongst Canadian Resident Matching Service (CaRMS) applicants to a single surgical subspecialty residency as a potential means of assessing professional behaviour. METHODS The authors reviewed CaRMS application forms to Canadian otolaryngology residency programmes over a 3-year period (2006-2008) for peer-reviewed publications reported as 'published', 'accepted' and 'in press'. Citations were verified by searching PubMed, Google Scholar and electronic journals. Misrepresentation was defined as any of: (i) falsely claimed authorship of an existing article; (ii) claimed authorship of a non-existing article, and (iii) improper ordering of authorship. Outcomes included descriptive statistics, as well as sub-analyses pertaining to age, gender, affiliated medical school and academic degree, and number of publications per applicant. RESULTS A total of 427 peer-reviewed publications were reported by 124 of 182 applicants (68% of applicants reported at least one publication). Of the 385 verifiable publications, 47 (12% of articles) were misrepresented by 29 applicants (23% of applicants claiming publication) self-reporting at least one publication. Age, gender, location of medical training, prior academic degree and number of citations per applicant did not relate to likelihood of misrepresentation (p > 0.05). CONCLUSIONS This study documents the nationwide prevalence of publication misrepresentation amongst applicants to Canadian otolaryngology residency programmes. The high rate of misrepresentation aligns with data reported in the literature and highlights the need to institute measures to dissuade graduates from this form of unprofessional behaviour.
Collapse
Affiliation(s)
- Lara Sater
- Department of Family Medicine, University of Ottawa Health Services, Ottawa, Ontario, Canada
| | - Joseph S Schwartz
- Division of Head and Neck Surgery, Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Sarah Coupland
- Department of Psychology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Meredith Young
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Center for Medical Education, McGill University, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Division of Head and Neck Surgery, Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
- Center for Medical Education, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
37
|
Ho-Wo-Cheong D, Mijovic T, Manoukian JJ, Bergeron M, Nguyen LHP. Synchronous airway lesions in children: an analysis of characteristics and comorbidities. Int J Pediatr Otorhinolaryngol 2014; 78:1586-91. [PMID: 25074344 DOI: 10.1016/j.ijporl.2014.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To analyze the characteristics and the associated medical co-morbidities in children with synchronous airway lesions (SALs) found during rigid bronchoscopy. METHODS Retrospective case series and chart review of patients who were found to have more than one airway lesion after undergoing airway evaluation via rigid endoscopy at a tertiary care pediatric hospital between 2001 and 2011. Patient demographics, presence of associated non-airway pathologies, and the number and types of airway lesions were collected. For analysis, airway lesions were classified based on the anatomical subsites involved (supraglottic, glottic, subglottic, tracheal and bronchial). RESULTS Out of 592 rigid bronchoscopies performed, there were 73 cases with SALs (12.3%). Of these, only 20% of patients were term infants without associated congenital anomalies. Over 70% of patients with SALs have combinations of lesions involving the trachea, subglottis and supraglottis. Neurological anomalies and GERD were both independently associated with a three-time increase in the odds of having synchronous involvement of these three anatomical subsites (OR 3.15, 95% CI 1.06-9.41; OR 3.0, 95% CI 1.05-8.50, respectively). Glottic lesions were present in 28.7% of patients. Prematurity and cardiac anomalies were both associated with tendency of doubling the odds of glottic lesions (OR 2.34, 95% CI 0.84-6.52; OR 2.0, 95% CI 0.76-5.60, respectively). Overall, almost 10% of newly diagnosed lesions in context of SALs required an additional intervention. CONCLUSIONS The majority of patients with SALs are either born prematurely or have associated congenital anomalies. In SAL patients with associated neurological anomalies or GERD, the lesions are more likely to be localized to the supraglottis, subglottis and trachea whereas prematurity and cardiac anomalies could both be increasing the odds of a glottic lesion. High suspicious index should be kept in mind when rigid bronchoscopy is performed to not miss an associated lesion.
Collapse
Affiliation(s)
| | - Tamara Mijovic
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - John J Manoukian
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Mathieu Bergeron
- Department of Otolaryngology-Head and Neck Surgery, Laval University, Quebec City, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada; Center for Medical Education, McGill University, Montreal, QC, Canada.
| |
Collapse
|
38
|
Campagna-Vaillancourt M, Manoukian J, Razack S, Nguyen LHP. Acceptability and reliability of multiple mini interviews for admission to otolaryngology residency. Laryngoscope 2013; 124:91-6. [PMID: 24122744 DOI: 10.1002/lary.24122] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/26/2013] [Accepted: 03/04/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the acceptability and reliability of the Multiple Mini Interview (MMI) for the selection of applicants to an Otolaryngology-Head and Neck (OTL-HNS) residency program. STUDY DESIGN Prospective observational study. METHODS Canadian medical graduates applying to the OTL-HNS residency program at McGill University in 2011 and 2012 underwent a 7-station MMI. Upon completion, the major stakeholders commented on and rated various aspects of the MMI using a 7-point Likert scale. Descriptive statistics were used to analyze the quantitative portion of the exit survey, while content analysis and thematic description was applied to qualitative data. Interrater reliability was examined with intraclass correlation coefficients. RESULTS Data was collected from 45 applicants and 18 evaluators. The majority of applicants (>80%) felt that the MMI helped them present their strengths and was free of any gender, cultural, or age bias. Assessors (>85%) agreed the MMI evaluated a valid range of competencies, and that it tested more aspects of an applicant than did traditional interviews. Both applicants and assessors (>70%) agreed that the MMI was a fair process, and both preferred it over the traditional interview. Overall, interrater reliability of the MMI was good. CONCLUSION This is the first study to examine how the MMI interview process can be adapted for admission to an OTL-HNS residency program, while showing both good acceptability for all major stakeholders and good reliability.
Collapse
|
39
|
Sirisopana M, Saint-Martin C, Wang NN, Manoukian J, Nguyen LHP, Brown KA. Novel Measurements of the Length of the Subglottic Airway in Infants and Young Children. Anesth Analg 2013; 117:462-70. [DOI: 10.1213/ane.0b013e3182991d42] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
40
|
Abstract
OBJECTIVE To examine the evolution of racial, ethnic, and gender diversity in US otolaryngology-head and neck surgery residency programs and compare these figures with other residency programs. DESIGN Retrospective database review. SETTING US residency programs. METHODS Information concerning minority and female representation in US residency programs was obtained from annually published graduate medical education reports by the Journal of the American Medical Association from 1975 to 2010. Minority representation among US population and university students was obtained from the US Census Bureau. The racial, ethnic, and gender diversity of otolaryngology residents was then compared with other medical fields (general surgery, family medicine, and internal medicine). RESULTS Underrepresentation in otolaryngology-head and neck surgery is particularly disconcerting for African Americans (-2.3%/y, P = .09) and Native Americans (1.5%/y, P = .11) given their nonsignificant annual growth rates. Hispanic representation (17.3%/y, P < .0001) is growing in otolaryngology but is half the rate of growth of the Hispanic American population (32.8%/y, P < .0001). There is nonetheless promise for women (70.6%/y, P < .0001) and Asian Americans (63.0%/y, P < .0001), who demonstrated statistically significant growth trends. CONCLUSION To our knowledge, this is the first study to describe the evolution of female and minority representation among US otolaryngology residents. Despite increasing gender, ethnic, and racial diversity among medical residents in general, female and certain minority group representation in US otolaryngology residency programs is lagging. These findings are in contrast to rising trends of diversity within other residency programs including general surgery.
Collapse
Affiliation(s)
- Joseph S Schwartz
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Canada.
| | | | | | | |
Collapse
|
41
|
Horwood L, Nguyen LHP, Brown K, Paci P, Constantin E. African American Ethnicity as a Risk Factor for Respiratory Complications Following Adenotonsillectomy. JAMA Otolaryngol Head Neck Surg 2013; 139:147-52. [DOI: 10.1001/jamaoto.2013.1321] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
42
|
Abstract
Objective: Racial and ethnic minorities constitute a growing portion of the US population including the medical profession. The purpose of this study was to examine the evolution of racial and ethnic diversity in US otolaryngology residency programs and to compare it to minority representation in other surgical and non-surgical residency programs. Method: Information concerning minority representation in US residency programs was obtained from annually published Graduate Medical Education reports by the Journal of the American Medical Association from 1980 to 2010. The diversity of otolaryngology residents was then compared to other medical fields (general surgery, family medicine, and internal medicine). Results: Overall, minority representation among US medical residents increased dramatically from 1980 to 2010 (20% to 43.9%). However, otolaryngology residents remain a less diverse group with only 29% minority representation in 2010. In contrast to other residency programs compared, African American (AA) and Hispanic (H) representation were consistently underrepresented among otolaryngology residents (AA = 3.1%, H = 4.3%) relative to all residents (AA = 5.7%, H = 6.4%) in recent years. Conclusion: Despite rising racial and ethnic diversity among medical residents in general, minority representation in US otolaryngology residency programs is lagging. This finding is in contrast to rising trends of diversity within other residency programs including general surgery.
Collapse
|
43
|
Campagna-Vaillancourt M, Nguyen LHP, Manoukian JJ, Razack S. Multiple Mini Interview for Selection into OTL Residency. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451438a39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: 1) To determine the reliability of the Multiple Mini Interview (MMI) for resident selection into an otolaryngology–head and neck surgery (OTL-HNS) program. 2) To assess the degree of acceptance by major stakeholders (interviewers and applicants) towards the MMI when compared to traditional interviews. Method: Canadian medical graduates applying to OTL-HNS residency programs underwent MMI in 2011 and 2012. MMI had 7 stations evaluating unique candidate attributes. Stations include surgical skills assessment and 2 simulation scenarios with standardized actors for noncognitive traits. Reliability was determined, and upon completion, stakeholders rated aspects MMI using 7-point Likert scale. Results: Data were collected from a total of 45 applicants and 19 evaluators. Overall interrater reliability of the MMI was good. The majority of applicants (>80%) felt that MMI helped them present their strengths and that it did not have any gender, cultural, or age bias. Assessors (>85%) felt that the MMI evaluated a valid range of competencies and that it tested more aspects of an applicant than traditional interviews. Both applicants and assessors (>70%) agreed that the MMI was a fair process, and both preferred the MMI over the traditional interview. Conclusion: The MMI is a reliable tool for the selection of applicants to an OTL-HNS residency program. It is well accepted by both applicants and assessors, with the majority of stakeholders preferring the MMI over traditional interviews.
Collapse
|
44
|
Saliba J, Mijovic T, Daniel S, Nguyen LHP, Manoukian J. Asthma: the great imitator in foreign body aspiration? J Otolaryngol Head Neck Surg 2012; 41:200-206. [PMID: 22762702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE To determine the prevalence of underlying lower airway inflammatory conditions in children who underwent rigid bronchoscopy (RB) for a suspected foreign body aspiration (FBA) in the tracheobronchial tree and to identify the characteristics of patients who could benefit from a trial of antiasthma treatment prior to undergoing a diagnostic bronchoscopy. DESIGN Retrospective chart review. SETTING Children with suspected FBA in the tracheobronchial tree who underwent RB at the Montreal Children's Hospital (2001-2009). METHODS Patient characteristics such as clinical, radiologic, and bronchoscopic findings on presentation, as well as prior use of inhaled bronchodilators or corticosteroids, were analyzed. A p value < .05 was considered significant. MAIN OUTCOME MEASURES Use of inhaled bronchodilators or corticosteroids, signs, symptoms, and radiologic and bronchoscopic findings on presentation. RESULTS Fifty-five children underwent an RB for suspected FBA. Foreign bodies were found in 36 subjects. Asthmatics were significantly more likely to have a negative bronchoscopy than nonasthmatics (80.0% vs 30.0%, p < .05). Otherwise, clinical and radiologic findings were not significantly different in these two groups. The median time between the suspected choking event and the first otolaryngology evaluation was 14 days in asthmatics (range 5 hours-90 days), whereas it was 16 hours in nonasthmatics (range 0.5 hours-120 days). CONCLUSION A conservative approach cannot be justified in suspected asthmatic children with possible FBA, in whom the indications for diagnostic bronchoscopy must be tailored to each patient to ensure a timely diagnosis.
Collapse
Affiliation(s)
- Joe Saliba
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, QC, Canada
| | | | | | | | | |
Collapse
|
45
|
Sudarshan M, Hanna WC, Jamal MH, Nguyen LHP, Fraser SA. Are Canadian general surgery residents ready for the 80-hour work week? A nationwide survey. Can J Surg 2012; 55:53-7. [PMID: 22269303 DOI: 10.1503/cjs.019110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe Canadian general surgery residents' perceptions regarding potential implementation of work-hour restrictions. METHODS An ethics review board-approved, Web-based survey was submitted to all Canadian general surgery residency programs between April and July 2009. Questions evaluated the perceived effects of an 80-hour work week on length of training, operative exposure, learning and lifestyle. We used the Fisher exact test to compare senior and junior residents' responses. RESULTS Of 360 residents, 158 responded (70 seniors and 88 juniors). Among them, 79% reported working 75-100 hours per week. About 74% of seniors believed that limiting their work hours would decrease their operative exposure; 43% of juniors agreed (p < 0.001). Both seniors and juniors thought limiting their work hours would improve their lifestyle (86% v. 96%, p = 0.12). Overall, 60% of residents did not believe limiting work hours would extend the length of their training. Regarding 24-hour call, 60% of juniors thought it was hazardous to their health; 30% of seniors agreed (p = 0.001). Both senior and junior residents thought abolishing 24-hour call would decrease their operative exposure (84% v. 70%, p = 0.21). Overall, 31% of residents supported abolishing 24-hour call. About 47% of residents (41% seniors, 51%juniors, p = 0.26) agreed with the adoption of the 80-hour work week. CONCLUSION There is a training-level based dichotomy of opinion among general surgery residents in Canada regarding the perceived effects of work hour restrictions. Both groups have voted against abolishing 24-hour call, and neither group strongly supports the implementation of the 80-hour work week.
Collapse
|
46
|
AlRomaih SR, Alrajhi Y, Nguyen LHP. Sharp Foreign Body Aspiration Patients: Are They Different? Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415823a362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Compare and contrast patients with sharp foreign body aspiration (FBA) in the airways to other non-sharp FBA in terms of age, social background, presentation, and nature of foreign body. Method: Case series of patients with FBA in airways and the upper digestive tract in multi-centers, between Jan 2004 to Dec 2009. Results: Around 10 percent of patients had sharp FBA in the airway. We noticed that they are overall older. They mostly have the same social background. Most of them gave clear history of sharp FBA. Imaging was useful in the majority of patients. Most sharp FBA happened with the same object. Conclusion: Patients with sharp FBA are different in terms of age, social background, presentation, and nature of FBA when compared to other non-sharp FBA.
Collapse
|
47
|
Al-Khatib T, Fanous A, Al-Saab F, Sewitch M, Razack S, Nguyen LHP. Pneumatic video-otoscopy teaching improves the diagnostic accuracy of otitis media with effusion: results of a randomized controlled trial. J Otolaryngol Head Neck Surg 2010; 39:631-634. [PMID: 21144356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND the diagnostic accuracy of otitis media with effusion (OME) has been shown to be poor among medical students, residents, and practicing physicians. OBJECTIVE to determine if the use of pneumatic video-otoendoscopic examination (VOE) improves the diagnostic accuracy of OME among residents. METHODS pediatric residents were randomized into a "pneumatic" examination group (intervention) and a "still" examination group (control). The control group viewed a set of 25 still VOE images of the tympanic membranes of both normal and OME ears. The intervention group viewed the same still images but with the addition of pneumatic VOE assessments. Each resident documented each of his or her diagnoses as normal or OME. The accuracy of assessment for both the static and the pneumatic methods was compared. RESULTS twenty-nine pediatric residents participated in this study: 15 in the intervention group and 14 in the control group. The overall diagnostic accuracy was 91% for the intervention group versus 78% for the control group (p = .0003). CONCLUSION pneumatic video-otoscopy teaching improves the diagnostic accuracy of OME among residents.
Collapse
Affiliation(s)
- Talal Al-Khatib
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC
| | | | | | | | | | | |
Collapse
|
48
|
Nayan S, Nguyen LHP, Nguyen VH, Daniel SJ, Emil S. Cervical esophageal duplication cyst: case report and review of the literature. J Pediatr Surg 2010; 45:e1-5. [PMID: 20850608 DOI: 10.1016/j.jpedsurg.2010.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 05/28/2010] [Accepted: 05/29/2010] [Indexed: 11/29/2022]
Abstract
Cervical esophageal duplication cysts are rare congenital anomalies that can be successfully managed surgically. These anomalies are rare causes of upper airway obstruction. We present here a case of a cervical esophageal duplication cyst in an infant, along with a review of the literature concerning this anomaly.
Collapse
Affiliation(s)
- Smriti Nayan
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Canada
| | | | | | | | | |
Collapse
|
49
|
Al-Saab F, Manoukian JJ, Al-Sabah B, Almot S, Nguyen LHP, Tewfik TL, Daniel SJ, Schloss MD, Hamid QA. Linking laryngopharyngeal reflux to otitis media with effusion: pepsinogen study of adenoid tissue and middle ear fluid. J Otolaryngol Head Neck Surg 2008; 37:565-571. [PMID: 19128594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
HYPOTHESIS/OBJECTIVES Laryngopharyngeal reflux (LPR) was recently implicated in the etiology of otitis media with effusion (OME). To study the hypothesis that gastric juice reaches the middle ear through the nasopharynx and eustachian tube, we evaluated the presence of pepsinogen in the adenoid tissues of children with otitis media with effusion (OME) and compared them with the tissues of a control group of children without OME. METHODS In the study group, middle ear effusions (MEEs) and adenoidal tissue biopsies were obtained from patients undergoing simultaneous tympanostomy tube placement and adenoidectomy. In the control group, adenoid specimens were taken during adenoidectomy (+/- tonsillectomy) from children with no history of OME. The adenoid tissues were analyzed immunohistochemically to confirm the presence of pepsinogen. Normal gastric tissue was used as a positive control and lymphatic tissue as a negative control. Total pepsinogen levels of MEE were measured with enzyme-linked immunosorbent assay. RESULTS Adenoid tissue of the OME group (n = 25) demonstrated significantly higher pepsinogen immunoreactivity when compared with the adenoid tissue of the control group (n = 29), specifically in staining of both the epithelia (p < .0001) and the subepithelia, (p < .001). The presence of pepsinogen was detected in 84% of MEEs from the OME group, at concentrations 1.86 to 12.5 times higher than that of serum. Pepsinogen messenger ribonucleic acid was not demonstrated in any of the adenoid tissues of the OME group. CONCLUSION LPR plays an important role in the pathogenesis of OME as gastric reflux reaches the middle ear through the nasopharynx and eustachian tube to cause OME.
Collapse
Affiliation(s)
- Fahad Al-Saab
- Department of Otolaryngology, Meakins-Christie Laboratory, McGill University, Montreal, Quebec
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Nguyen LHP, Allegro J, Low A, Papsin B, Campisi P. Effect of cochlear implantation on nasality in children. Ear Nose Throat J 2008; 87:138-143. [PMID: 18404908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Hypernasality is a commonly perceived characteristic of speech in deaf adults and children, but the mechanism of this abnormal nasal resonance is poorly understood. The impact of cochlear implantation on nasalance measures in children with severe auditory deprivation has not been previously reported. We conducted a study of nasality in 6 deaf children who had undergone cochlear implantation. Voice recordings were obtained before surgery and 6 months after activation of the implants. The MacKay-Kummer SNAP Test--which consists of a syllable-repetition subtest and a picture-cued subtest--was used to obtain nasalance scores for oral (bilabial, alveolar, velar, and sibilant) and nasal phonemes. Before cochlear implantation, mean nasalance scores were significantly higher than normal during the production of oral phonemes for both subtests (p < or = 0.05). Six months after activation, the nasalance measures for all components of the syllable-repetition subtest had been restored to within 1 standard deviation of normal. For all oral phonemes of the picture-cued subtest, the elevated nasalance scores were consistently lower after cochlear implant activation, although the difference was statistically significant only for velar tasks. Nasalance scores for nasal phonemes were within 1 standard deviation of normal both before and after implant activation. Our study showed that cochlear implantation partially corrects elevated nasalance measures. Disturbances in nasal resonance may be caused in part by the inability of deaf speakers to monitor velopharyngeal valving with auditory feedback. The trend toward improved nasalance scores after implantation highlights the role of auditory feedback in monitoring velopharyngeal function. Visual biofeedback may be required to further normalize hypernasal speech in profoundly deaf children.
Collapse
Affiliation(s)
- Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Canada
| | | | | | | | | |
Collapse
|