An Update on the Epidemiology and Clinicodemographic Features of Meniere's Disease.

OBJECTIVE: To characterize the estimated prevalence and clinicodemographic features of Ménière's disease (MD) using current diagnostic criteria. METHODS: A cross-sectional study was undertaken at our tertiary academic referral center. All patients seen in Otolaryngology clinic with ICD-10 diagnoses of MD, from January 1, 2013 to July 31, 2022 were identified. Chart review was undertaken to determine the estimated prevalence of MD meeting AAO-HNS diagnostic criteria. Clinicodemographic features were evaluated against a comparator group without MD seen in our health system. RESULTS: Of 806 ICD-10 diagnoses of MD, we identified 480 MD cases meeting diagnostic criteria (168 definite). Mean age at presentation for MD cases was 49 years. Forty-seven percent of cases were male. A significantly higher proportion of MD cases than comparators were white (76% vs. 66%, p < 0.001). Mean time since MD symptom onset was 6.7 years, with a mean attack duration of 4.6 h; 7.5% of MD cases reported a positive family history, and 7% had bilateral disease. The odds of reporting migraine were significantly greater among MD patients than comparators (OR 1.74 [1.26-2.42]); the odds of having autoimmune conditions were lower (OR 0.45 [0.28-0.74]); and the odds of reporting allergies were no different (OR 0.96 [0.74-1.25]) versus comparator patients after controlling for demographic characteristics. CONCLUSIONS: Among MD diagnoses, there is a low estimated prevalence of MD meeting diagnostic criteria, and an even lower prevalence of definite MD. Compared to a comparator group of patients seen for any disorder, patients with MD are more likely to be white, male, and have a history of migraine. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Long-Term Hearing Outcomes After Hybrid Cochlear Implantation.

OBJECTIVE: To examine long-term (>5 yr) low-frequency hearing preservation after hybrid cochlear implantation. STUDY DESIGN: Retrospective cross-sectional study. SETTING: Tertiary care center outpatient clinic. PATIENTS: All patients older than 21 years implanted with a Cochlear Hybrid L24 device from 2014 to 2021. MAIN OUTCOME MEASURE: Changes in low-frequency pure-tone average (LFPTA) were calculated at each of several time points relative to the date of implantation. The proportion of patients with preserved LFPTA at last follow-up and Kaplan-Meier estimates for loss of residual hearing were calculated in addition to hazard ratios for hearing loss according to patient- and surgery-specific factors. RESULTS: Thirty ears in 29 patients underwent hybrid cochlear implantation and were eligible for inclusion (mean age, 59 yr; 65% female). Mean preoperative LFPTA was 31.7 dB. Mean LFPTA across all implanted ears at first follow-up was 45.1 dB; no patient had experienced loss of residual hearing at first follow-up. Six patients had loss of residual hearing during the follow-up period, with Kaplan-Meier probability estimates of preserved hearing of 100% at 1 month, 90% at 12 months, 87% at 24 months, and 80% at 48 months. There was no association between loss of residual hearing and patient age, preoperative LFPTA, surgeon, or use of topical steroids intraoperatively (hazard ratios, 1.05 [0.96-1.15], 0.97 [0.88-1.05], 1.39 [0.20-9.46], 0.93 [0.09-9.74], respectively). CONCLUSIONS: Long-term (>5 yr) outcomes after hybrid cochlear implantation demonstrate good preservation of low-frequency hearing, with only modest decline in the long-term postimplantation, and a low proportion of loss of residual low-frequency hearing.

Three-dimensional Printing in Pediatric Otolaryngology.

Three-dimensional printing (3Dp) is a technology with widespread commercial and medical applications. Adoption of 3Dp has occurred in trainee education, along with specific preoperative and perioperative use. This article explores the application of 3Dp within Otolaryngology, with the pediatric population at the forefront. This article will also discuss specific clinical applications, limitations, and potential future applications of this technology.

Casting Into The Future: Effectiveness of a 3D-Printed Fishhook Removal Task Trainer.

While participation in both recreational and commercial fisheries is common, it is not risk-free. Puncture wounds caused by fishhooks are commonly incurred by people who fish recreationally and commercially. Despite literature that details the challenges of treating fishhook injuries and specific techniques for fishhook removal, only a single publication focuses on teaching fishhook removal techniques to medical trainees and staff physicians. The aim of this technical report is to investigate the efficacy of using a 3D-printed task trainer for simulating and teaching fishhook removal techniques. To facilitate this, the 3D-printed Fishhook Emergency Removal Simulator (FISH-ER 3D) was designed by the Memorial University of Newfoundland (MUN) MED 3D Network and satellite research partner, Carbonear Institute for Rural Reach and Innovation by the Sea (CIRRIS). A sample of 22 medical residents and staff physicians were asked to evaluate the task trainer by way of a practical session, which was then followed by an evaluation survey. The overall realism of the 3D-printed task trainer components was ranked as "realistic" or "very realistic" by 86% of the evaluators. The majority of evaluators rated acquiring and performing various fishhook removal techniques using the simulator as "easy" or "somewhat easy". Most evaluators found that using the task trainer increased user competence and confidence with fishhook removal techniques, and 100% of the evaluators rated the task trainer as a "very valuable" or "valuable" training tool. The results of this report demonstrate support for the FISH-ER 3D as an efficacious simulator for building competence in fishhook removal techniques.

Systematic review and meta-analysis of 3D-printing in otolaryngology education.

INTRODUCTION: Three-dimensional (3D) printing has received increased attention in recent years and has many applications. In the field of otolaryngology surgery, 3D-printed models have shown potential educational value and a high fidelity to actual tissues. This provides an opportunity for trainees to gain additional exposure, especially as conventional educational tools, such as cadavers, are expensive and in limited supply. The purpose of this study was to perform a meta-analysis of the uses of 3D-printing in otolaryngology education. The primary outcomes of investigation were surgical utility, anatomical similarity, and educational value of 3D-printed models. Secondary outcomes of interest included country of implementation, 3D-printer materials and costs, types of surgical simulators, and the levels of training of participants. METHODS: MEDLINE, Embase, Web of Science, Google Scholar and previous reviews were searched from inception until June 2021 for eligible articles. Title, abstract, and data extraction were performed in duplicate. Data were analyzed using random-effects models. The National Institute of Health Quality Assessment Tool was used to rate the quality of the evidence. RESULTS: A total of 570 abstracts were identified and screened by 2 independent reviewers. Of the 274 articles reviewed in full text, 46 articles met the study criteria and were included in the meta-analysis. Surgical skill utility was reported in 42 studies (563 participants) and had a high degree of acceptance (84.8%, 95% CI: 81.1%-88.4%). The anatomical similarity was reported in 39 studies (484 participants) and was received positively at 80.6% (95% CI: 77.0%-84.2%). Educational value was described in 36 studies (93 participants) and had the highest approval rating by participants at 90.04% (87.20%-92.88%). A subgroup analysis by year of publication demonstrated that studies published after 2015 had higher ratings across all outcomes compared to those published prior to 2015. CONCLUSION: This study found that 3D-printing interventions in otolaryngology demonstrated surgical, anatomical, and educational value. In addition, the approval ratings of 3D-printed models indicate a positive trend over time. Future educational programs may consider implementing 3D-printing on a larger scale within the medical curriculum to enhance exposure to otolaryngology.

Use of three-dimensional printing for adapting and optimizing smartphone ophthalmoscopy to existing SD-OCT instrumentation for rodent and teleost ocular research.

Use of animal models for human vision research is now pervasive. To address a range of technical challenges, laboratories either modify existing equipment or purchase products that are purpose designed. Three-dimensional (3D) printing technology now allows the do-it-yourself capability to invent, innovate, and manufacture for a specific purpose. Ophthalmic imaging is often used with a range of other sophisticated experimental retinal imaging techniques, such as spectral domain optical coherence tomography (SD-OCT). The handheld smartphone camera and cost-effective, readily available professional-quality apps now allow accessible high-definition video ophthalmic image recording. However, to our knowledge, there are few reports of adapting smartphone ophthalmic imaging to existing experimental SD-OCT imaging instrumentation. This would offer better accuracy, reproducibility, and most importantly, precision. The objective of the present study was to use 3D printing to enhance the functionality and precision of existing SD-OCT instrumentation and smartphone-based ophthalmic imaging through construction of a custom 3D-printed assembly. The assembly can be controlled either manually or by the highly precise rodent stage of the SD-OCT instrument. Using this technical approach, 3D printing facilitated a novel methodology for high-quality ophthalmic imaging with low cost and ease of production either manually or by enhancing existing SD-OCT instrumentation.

Three-dimensional printing for assessment of paravalvular leak in transcatheter aortic valve implantation.

BACKGROUND: Three-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may therefore provide clinical benefit. Transcatheter aortic valve implantation (TAVI) currently relies on preoperative imaging for accurate valve sizing, type of valve used, and avoidance of complications. Three-dimensional (3D) modelling may provide benefit for optimal preoperative TAVI planning. The goal of this study is to assess the utility of 3D modelling in the prediction of paravalvular leak (PVL) post TAVI. METHODS: Retrospective analysis of five patients who underwent TAVI at our center. Pre-operative cardiac gated CT images were utilized to create a 3D printed model with true size aortic root dimensions, including the coronary artery ostium location and left ventricular outflow tract. Deployment of the corresponding model and size TAVI valve into the created 3D model at a similar depth of implantation via fluoroscopy was performed for each patient. Degree of PVL was assessed using a closed system with water infusion under pressure over a duration of 5 s. Correlation was made between the volume obtained in the closed loop model during the pressurized period and the degree of PVL reported on the patients post TAVI placement on transthoracic echocardiogram. RESULTS: One female, and four males (age in years ranged from 68 to 87) underwent successful TAVI (0% 30-day mortality). PVL on post procedure TTE ranged from none to trivial. Successful deployment of TAVI valves inside the 3D model occurred in all cases. The average volume of water collected on three trials over 5 s ranged between 19.1-24.1 ml A multivariate linear regression showed significant association between the degree of PVL reported on post-operative transthoracic echocardiogram and the amount of volume detected in the 3D model (difference: -3.9657, 95% CI: (- 4.6761,-3.2554), p < 0.001). CONCLUSIONS: Our experiments show that replicated 3D models have potential clinical utilization in predicting PVL in the TAVI population. Future research into the role of 3D modelling in the field of TAVI should continue to be explored.

The Use of 3D Printed Vasculature for Simulation-based Medical Education Within Interventional Radiology.

Three-dimensional (3D) printing has become a useful tool within the field of medicine as a way to produce custom anatomical models for teaching, surgical planning, and patient education. This technology is quickly becoming a key component in simulation-based medical education (SBME) to teach hands-on spatial perception and tactile feedback. Within fields such as interventional radiology (IR), this approach to SBME is also thought to be an ideal instructional method, providing an accurate and economical means to study human anatomy and vasculature. Such anatomical details can be extracted from patient-specific and anonymized CT or MRI scans for the purpose of teaching or analyzing patient-specific anatomy. There is evidence that 3D printing in IR can also optimize procedural training, so learners can rehearse procedures under fluoroscopy while receiving immediate supervisory feedback. Such training advancements in IR hold the potential to reduce procedural operating time, thus reducing the amount of time a patient is exposed to radiation and anaesthetia. Using a program evaluation approach, the purpose of this technical report is to describe the development and application of 3D-printed vasculature models within a radiology interest group to determine their efficacy as supplementary learning tools to traditional, lecture-based teaching. The study involved 30 medical students of varying years in their education, involved in the interest group at Memorial University of Newfoundland (MUN). The session was one hour in length and began with a Powerpoint presentation demonstrating the insertion of guide wires and stents using 3D-printed vasculature models. Participants had the opportunity to use the models to attempt several procedures demonstrated during the lecture. These attempts were supervised by an educational expert/facilitator. A survey was completed by all 30 undergraduate medical students and returned to the facilitators, who compiled the quantitative data to evaluate the efficacy of the 3D-printed models as an adjunct to the traditional didactic teaching within IR. The majority of feedback was positive, supporting the use of 3D=printed vasculature as an additional tactile training method for medical students within an IR academic setting. The hands-on experience provides a valuable training approach, with more opportunities for the rehearsal of high-acuity, low-occurrence (HALO) procedures performed in IR.

Development, Evaluation, and Implementation of a New 3D Printed Tongue Depressor Dispenser.

The purpose of this technical report was two-fold. First was to describe the concept, development and initial implementation of a three-dimensional (3D) printing network focussed on manufacturing simulators and simple devices necessary to the functioning of rural hospital and clinics. Second was to describe the design, fabrication and user-based evaluation of a cost-effective tongue depressor dispenser. The initial successful setup and implementation of the 3D printing network were modelled using four of the five implementation constructs derived from the Consolidated Framework for Implementation Research (CFIR). The 3D printing of the tongue depressor dispenser was found to be an effective and economic initiative. Without considering the initial design costs, the materials costs were estimated at $6 Canadian per dispenser. After installation of the dispenser in a busy emergency department, hospital leadership and staff viewed it as a safer option to the current dispense, and more affordable.

Three-Dimensional Printing: A Novel Approach to the Creation of Obturator Prostheses Following Palatal Resection for Malignant Palate Tumors.

BACKGROUND: A subgroup of patients who have an oronasal fistula live in areas that have limited access to oral prosthetics. For these individuals, a temporary prosthesis, such as a palatal obturator, may be necessary in order to speak, eat, and breath properly. The creation of an obturator, which requires a highly trained prosthodontist, can take time and can be expensive. Through the current proof-of-concept study, there is an attempt to create a patient-specific palatal obturator through use of free and publicly available software, and a low-cost desktop 3-dimensional printer. The ascribed study may provide a means to increase global access to oral prosthetics if suitable biomaterials are developed. METHODS: Computerized tomography data were acquired from a patient who had an oronasal fistula. Through use of free software, these data were converted into a 3-dimensional image. The image was manipulated in order to isolate the patient's maxilla and was subsequently printed. The palatal obturator models were designed, and reformed, in correspondence with the maxilla model design. A final suitable obturator was determined and printed with 2 differing materials in order to better simulate a patient obturator. RESULTS: Creating a suitable palatal obturator for the specified patient model was possible with a low-cost printer and free software. CONCLUSIONS: With further development in biomaterials, it may be possible to design and create an oral prosthesis through use of low-cost 3-dimensional printing technology and freeware. This can empower individuals to attain good healthcare, even if they live in rural, developing, or underserviced areas.

Modelling and Manufacturing of a 3D Printed Trachea for Cricothyroidotomy Simulation.

Cricothyroidotomy is a life-saving medical procedure that allows for tracheal intubation. Most current cricothyroidotomy simulation models are either expensive or not anatomically accurate and provide the learner with an unrealistic simulation experience. The goal of this project is to improve current simulation techniques by utilizing rapid prototyping using 3D printing technology and expert opinions to develop inexpensive and anatomically accurate trachea simulators. In doing so, emergency cricothyroidotomy simulation can be made accessible, accurate, cost-effective and reproducible. Three-dimensional modelling software was used in conjunction with a desktop three-dimensional (3D) printer to design and manufacture an anatomically accurate model of the cartilage within the trachea (thyroid cartilage, cricoid cartilage, and the tracheal rings). The initial design was based on dimensions found in studies of tracheal anatomical configuration. This ensured that the landmarking necessary for emergency cricothyroidotomies was designed appropriately. Several revisions of the original model were made based on informal opinion from medical professionals to establish appropriate anatomical accuracy of the model for use in rural/remote cricothyroidotomy simulation. Using an entry-level desktop 3D printer, a low cost tracheal model was successfully designed that can be printed in less than three hours for only $1.70 Canadian dollars (CAD). Due to its anatomical accuracy, flexibility and durability, this model is great for use in emergency medicine simulation training. Additionally, the model can be assembled in conjunction with a membrane to simulate tracheal ligaments. Skin has been simulated as well to enhance the realism of the model. The result is an accurate simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically landmarking, incision and intubation. This design is a novel and easy to manufacture and reproduce, high fidelity trachea model that can be used by educators with limited resources.

Three-Dimensional Printing of a Hemorrhagic Cervical Cancer Model for Postgraduate Gynecological Training.

INTRODUCTION: A realistic hemorrhagic cervical cancer model was three-dimensionally (3D) printed and used in a postgraduate medical simulation training session. MATERIALS AND METHODS: Computer-assisted design (CAD) software was the platform of choice to create and refine the cervical model. Once the prototype was finalized, another software allowed for the addition of a neoplastic mass, which included openings for bleeding from the neoplasm and cervical os. 3D printing was done using two desktop printers and three different materials. An emergency medicine simulation case was presented to obstetrics and gynecology residents who were at varying stages of their training. The scenario included history taking and physical examination of a standardized patient. This was a hybrid simulation; a synthetic pelvic task trainer that allowed the placement of the cervical model was connected to the standardized patient. The task trainer was placed under a drape and appeared to extend from the standardized patient's body. At various points in the simulation, the standardized patient controlled the cervical bleeding through a peripheral venous line. Feedback forms were completed, and the models were discussed and evaluated with staff. RESULTS: A final cervical model was created and successfully printed. Overall, the models were reported to be similar to a real cervix. The models bled well. Most models were not sutured during the scenarios, but overall, the value of the printed cervical models was reported to be high. DISCUSSION: The models were well received, but it was suggested that more colors be integrated into the cervix in order to better emphasize the intended pathology. The model design requires further improvement, such as the addition of a locking mechanism, in order to ensure that the cervix stays inside the task trainer throughout the simulation. Adjustments to the simulated blood product would allow the bleeding to flow more vigorously. Additionally, a different simulation scenario might be more suitable to explore the residents' ability to suture the cervical models, as cervical suturing of a neoplasm is not a common emergency department procedure. CONCLUSION: 3D-printed cervical models are an economical and anatomically accurate option for simulation training and other educational purposes.