Proton therapy for adult medulloblastoma: Acute toxicity and disease control outcomes.

PURPOSE: We report disease control, survival outcomes, and treatment-related toxicity among adult medulloblastoma patients who received proton craniospinal irradiation (CSI) as part of multimodality therapy. METHODS: We reviewed 20 adults with medulloblastoma (≥ 22 years old) who received postoperative proton CSI ± chemotherapy between 2008 and 2020. Patient, disease, and treatment details and prospectively obtained patient-reported acute CSI toxicities were collected. Acute hematologic data were analyzed. RESULTS: Median age at diagnosis was 27 years; 45% of patients had high-risk disease; 75% received chemotherapy, most (65%) after CSI. Eight (40%) patients received concurrent vincristine with radiotherapy. Median CSI dose was 36GyE with a median tumor bed boost of 54GyE. Median duration of radiotherapy was 44 days. No acute ≥ grade 3 gastrointestinal or hematologic toxicities attributable to CSI occurred. Grade 2 nausea and vomiting affected 25% and 5% of patients, respectively, while 36% developed acute grade 2 hematologic toxicity (36% grade 2 leukopenia and 7% grade 2 neutropenia). Those receiving concurrent chemotherapy with CSI had a 38% rate of grade 2 hematologic toxicity compared to 33% among those not receiving concurrent chemotherapy. Among patients receiving adjuvant chemotherapy (n = 13), 100% completed ≥ 4 cycles and 85% completed all planned cycles. With a median follow-up of 3.1 years, 4-year actuarial local control, disease-free survival, and overall survival rates were 90%, 90%, and 95%, respectively. CONCLUSIONS: Proton CSI in adult medulloblastoma patients is very well tolerated and shows promising disease control and survival outcomes. These data support the standard use of proton CSI for adult medulloblastoma.

Gender Dysphoria and Chronic Pain in Youth.

Chronic pain in youth with gender dysphoria (GD) is poorly understood. The aim of our study was to review the clinical presentation of 8 youth with GD in a multidisciplinary chronic pain clinic. A single center retrospective chart review was conducted to obtain information on demographics, clinical care, previous diagnoses, and validated clinical measures. We present the trajectory of pain in this population with treatment of GD. Recognition and treatment of GD in youth with pain may improve pain outcomes.

A retrospective review of Paparella Type 1 tympanostomy tubes.

OBJECTIVE: This study aims to provide data on ear tube extrusion and complication rates for patients who have Paparella Type 1 tympanostomy tube (TT) placement. METHODS: Retrospective chart review of patients 6 months to 12 years old who underwent insertion of Paparella Type 1 TT by a single surgeon. RESULTS: Of 197 tubes evaluated, 3% were plugged between 1 and 3 months after surgery. Of the 144 tubes evaluated long-term, all tubes extruded within 4 years. There were no tympanic membrane perforations. CONCLUSIONS: This chart review showed expected rate of initial ear tube plugging. The rate of tympanic membrane perforation was lower than expected.

Mindfulness Education for Otolaryngology Residents: A Pilot Study.

This pilot project was designed to (1) implement a mindfulness-based wellness curriculum for otolaryngology residents, (2) determine the impact of a mindfulness-based curriculum on resident mood, and (3) examine the use of mindfulness among otolaryngology residents. Otolaryngology residents participated in a 6-week course guided by the Headspace mindfulness mobile application. Resident use of mindfulness was measured by the validated Mindful Attention Awareness Scale (MAAS). Changes in mood before and after each session were assessed using the validated Positive and Negative Affect Schedule (PNAS). Residents reported a statistically significant decrease in postsession negative affect scores (P < .001). A moderate positive correlation was noted between mindfulness scores and presession positive mood (Pearson r = 0.597, P < .001). This pilot study supports the feasibility and impact of including mindfulness training as part of a resident wellness curriculum.

A Multidisciplinary Basic Airway Skills Boot Camp for Novice Trainees.

INTRODUCTION: Otolaryngology and anesthesiology residents may be the first responders to airway emergencies, even in the first weeks of training. These residents may be unfamiliar with the armamentarium of airway maneuvers, the most basic of which may be lifesaving. Boot camp education has been demonstrated to be effective in multiple disciplines. In this study, we examine whether an immersive, multidisciplinary boot camp style simulation course leads to an improvement in novice airway provider confidence. METHODS: Novice otolaryngology and anesthesiology residents participated in an annual (2013-2018) multidisciplinary boot camp simulation course. Residents completed an anonymous pre- and post-test self-assessment tool reporting their confidence for airway skills and concepts from the curriculum. Responses were on a Likert scale from 1 to 5 (1=no familiarity, 5=extremely comfortable). We analyzed pre- and post-course participant self-reported comfort level with the airway management skills and concepts addressed in the course. Frequencies and percentages were reported. Fisher's exact test was used to assess statistical significance at level 0.05. RESULTS: A total of 62 residents, including 50 anesthesiology residents and 12 otolaryngology residents, completed a post-test self-assessment tool. For all topics covered in the course, there was a statistically significant change in the percentage of residents who reported familiarity with the topic (p<0.001). This corresponded to an increase in self-reported comfort level and a decrease in non-familiarity or discomfort with the airway topics covered in the course. The greatest increase in percentage of residents reporting feeling comfortable or extremely comfortable with the task after completion of the simulation boot camp were all moderately advanced airway maneuvers (laryngeal mask airway [LMA] placement, flexible fiberoptic intubation, glidescope intubation, endotracheal intubation, and two-person mask ventilation). The greatest decrease in non-familiarity or discomfort was seen in moderately complex to advanced airway topics (fiberoptic intubation, glidescope intubation, intubating LMA, rigid bronchoscopy, cricothyroidotomy, tracheostomy, and laryngectomy). CONCLUSIONS: Our data support the use of immersive surgical boot camp experiences to enhance resident familiarity and comfort and decrease unfamiliarity and discomfort with a wide variety of airway topics and maneuvers.

Taking a Systematic Approach to Resident Wellness: A Pilot Study.

Resident wellness is increasingly recognized as critically important in otolaryngology education, and well-being education is now a requirement for all residencies. The objectives of this pilot study are to (1) perform a needs assessment to determine the wellness topics most important to the residents, (2) determine systemic barriers to wellness through a structured focus group, and (3) describe a new method to approach resident well-being. An anonymous survey needs assessment, adapted from a published wellness curriculum, was administered to otolaryngology residents. Residents underwent a structured, anonymous focus group applying Maslow's hierarchy of needs. The focus group highlighted resident priorities and defined an action plan for the program. This method allows for an individual and systems approach to resident wellness. Involving residents may increase engagement, and this approach can identify barriers to wellness and provide the groundwork for a formal resident wellness curriculum.