High-Density Otologic Camps in Regions of Sparse Expertise.

Aims/Purpose: When 2 models of otologic surgery instruction in Ethiopia are compared, high-density otologic surgery campaigns are more effective for accelerated skills transfer in areas of sparse expertise than the standard outpatient clinic/OR model. METHODS: A continuously operating otolaryngology/head and neck surgery department in a large public hospital is compared with a nonprofit specialty hospital where outpatients are selected for weeklong surgical campaigns. The number and variety of otologic visits and operations in each setting, presence of expert supervision, and resident-trainees' surgical progress were tallied. RESULTS: The public hospital saw 84 otologic operations in 1 full year. Meanwhile, the ear specialty surgical campaign site saw 185 otologic operations in 6 surgical campaign weeks. All operations at both sites were performed primarily by trainees. Experienced otologists supervised 40% of operations at the public hospital and 100% at the surgical campaign site. At the end of the year, none of the 10 resident-trainees in the public hospital were able to perform a simple underlay tympanoplasty, compared to 6 of 12 resident-trainees in the campaign setting. CONCLUSIONS: Where otologic expertise is sparse, otologic surgical campaigns allow the most effective use of resources-patient pathology, medical facilities, trainee attendance, and imported instructors.

HIV Positivity per se Does Not Affect Tympanoplasty Outcomes.

BACKGROUND: The English language literature finds no clear protocols for otologic surgery for HIV+ patients. OBJECTIVE: To demonstrate that simple tympanoplasty and type III tympanoplasty in HIV+ patients with CD4 >400 cells/cc results in tympanic membrane closures and hearing improvements equivalent to the same procedures in controls. MATERIALS AND METHODS: This retrospective review documents the otologic conditions and operative results of 32 HIV+ patients and 32 controls. The controls were healthy and had no opportunistic infections or other medications. RESULTS: Genders, ages, sizes of tympanic membrane perforations, severity of air bone gaps, and type of operation were equivalent between the HIV+ and the control groups. Thirty of 32 patients in each group had closure of their perforations after 1 operation. Air bone gaps improved significantly for each group ( P = .001): 22 dB (SD = 11 dB) in the HIV+ group and 26 dB (SD = 10 dB) in the control group. And there was no statistically significant difference in change in hearing between the 2 groups. There were no complications of infection, wound dehiscence, worsened sensorineural levels, dizziness, or facial weakness in either group. CONCLUSION: HIV+ patients whose CD4 counts are above 400 cells/cc can undergo simple tympanoplasty or type III tympanoplasty with acceptable outcomes.