Laryngomalacia in the older child: clinical presentations and management.

PURPOSE OF REVIEW: To review the literature on laryngomalacia that manifests in older children and contrast this with congenital laryngomalacia seen more prevalently in infants. In doing so, we hope to offer relevant diagnostic and management options to treat late-onset laryngomalacia based from our experience and the current literature. RECENT FINDINGS: Laryngomalacia in older children can present differently than congenital laryngomalacia, and the most common and best understood consequence of late-onset laryngomalacia is obstructive sleep apnea syndrome. Other manifestations include exercise-induced stridor and possibly even dysphagia. When the diagnosis is properly made and the etiology is isolated to the larynx, supraglottoplasty can be an effective treatment option. SUMMARY: Compared with congenital laryngomalacia, the diagnosis and management of late-onset laryngomalacia is not as well defined. Few articles have addressed this condition directly, and more research is needed to better delineate how it presents and how it should be diagnosed. Finally, its treatment options, including the role of supraglottoplasty, need to be better understood.

The validation of an endoscopic sinus surgery skills training model: a pilot study.

BACKGROUND: Performing functional endoscopic sinus surgery (FESS) requires a trainee surgeon to develop both thorough anatomic understanding and new manual dexterity skills. Traditionally, these skills were learned in the operating room setting. In an era of available surgical simulation, this practice introduces ethical concerns about exposing patients to unnecessary risks during surgical skills development. Additionally, cost-effective rhinologic training has become increasingly important. To address these problems, a low-cost, intermediate-fidelity FESS training model was developed, and both speed and accuracy of task completion were measured to assess both immediate and intermediate-term skills retention. METHODS: Preliminary data were collected on 12 medical students and 10 resident-level (PGY1, -2, and -3) learners. Distinct tasks were performed five times on the initial day of testing and repeated after 2 weeks. RESULTS: Both groups attained statistically significant improvement in time to complete both tasks by the second iteration of each task and retained this effect after 2 weeks. Similarly, statistically significant improvement was seen for accuracy relative to the initial attempt by the fifth iteration for residents. This effect was also seen by the third through fifth iterations and after 2 weeks for students. Additionally, when the 2-week follow-up testing was compared with the fifth attempt, the only skills that deteriorated significantly were the resident group with the complex task times and the students with measures of accuracy. However, in both cases a highly significant improvement from initial attempts was maintained (p = 0.02 and p = 0.005, respectively). Residents were significantly faster than medical students at both simple and complex tasks for attempts 1 through 4, but this difference was not significant for attempt 5 and after 2 weeks. Residents had significantly fewer errors for all but the 2-week data point. CONCLUSION: The data from this pilot study support improved FESS skills for both medical students and residents using this low-cost, intermediate-fidelity model.