Head and neck ultrasound training improves the diagnostic performance of otolaryngology residents.

Objective: Surgeon-performed head and neck ultrasound (US) is increasingly used among otolaryngologists in office-based and surgical settings. However, it is unknown how formal US training affects otolaryngology residents' diagnostic workup of patients with cervical pathology. This study examined how a formal US course for residents affected their outpatient clinic US performance and diagnostic accuracy. Methods: We conducted a randomized cross-over trial, where 13 otolaryngology residents participated in a 6-h formal US course. Participants were randomized to perform head and neck US on four patient cases before and after completing the course. Eight patients with and without neck pathology were invited to participate as test cases. The ultrasound examinations were video recorded and anonymized before two consultants rated the US performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. Otolaryngology residents wrote an ultrasound report with a diagnosis based on their US examination, which was used to calculate the specificity and sensitivity. Results: We found a statistically significant difference in the OSAUS score before compared to after the hands-on training (p = .035). The diagnostic accuracy also increased from 62% before the course to 75% after the course (p = .02). Specificity increased from 54% prior to the course to 62% following the course, and sensitivity increased from 64% prior to the course to 79% following the course. The intraclass correlation coefficient with "absolute agreement" was 0.63. Conclusion: This study demonstrates that short, formal ultrasound training can improve otolaryngology residents' ultrasound skills and diagnostic accuracy in an outpatient clinic setting. Lay summary: This study looks at the change of otolaryngology residents' diagnostic workup of patients after they take a formal ultrasound course and shows that they get better at using ultrasound and make more accurate diagnoses if they take a formal course. Level of Evidence: Level 2.

[Ischaemic necrosis of the tongue due to temporal arteritis].

An 85-year-old woman was admitted to hospital due to newly onset of atrial flutter and fever. Biochemical workup showed elevated infection parameters. Empirical antibiotic treatment was initiated without convincing effect. The patient complained of tongue pain and decreased unilateral vision. Inspection showed white discolouration and necrosis of the left tongue margin. The patient was treated with high-dose steroid, and a temporal artery biopsy was performed. Histology showed giant cell arteritis. The patient responded to steroid treatment and was in progress at outpatient assessment.

Hearing Results After Tympanoplasty Are Stable Short-term: A Prospective Database Study.

OBJECTIVE: To evaluate the short-term stability of postoperative hearing results after tympanoplasty. STUDY DESIGN: Prospective database study. SETTING: Tertiary referral center. PATIENTS: 1,367 cases of tympanoplasty I-IV were registered in the OTOKIR database between February 2004 and November 2013. INTERVENTION: The authors included the 553 cases attending postoperative follow-ups at both 3 and 12 months. MAIN OUTCOME MEASURE: Analysis of the changes in pure-tone average of air conduction (AC), air-bone gap, and speech reception threshold and Word Recognition Score between follow-ups were performed. RESULTS: The overall mean change between follow-ups was 0.7, 0.5, and 0.3 dB for the AC, air-bone gap, and speech reception threshold, respectively. A majority of cases (87.7%) had a change in AC of 10 dB or less, and only 7.6% of the tympanoplasty type I cases had a decrease in AC of more than 10 dB. Of the 1,367 cases registered, 47.5% of cases were lost to follow-up at 12 months. CONCLUSION: The changes in hearing results after tympanoplasty are minimal during 3 to 12 months after surgery. This suggests that 3-month results are as valid for reporting as 12-month results. In addition, a possible bias that compromises the validity of reported results is introduced at 12 months because half of the cases are lost to follow-up. Including results from 3-month postoperative follow-up when reporting on tympanoplasty could reduce bias in reporting and enable more centers to contribute valid results.

[A rare metastasis from a rare brain tumour].

This case report presents the story of a patient with an oligodendroglioma metastasizing to the bone marrow and to lymph nodes of the neck. The patient had undergone primary brain surgery 13 years prior to the discovery of metastases and radiotherapy directed at the brain tumour two months prior. Oligodendroglioma are rare primary brain tumours of which extraneural metastasis is even more rare. The incidence of cases like this may be increasing because of better treatment and thus longer survival of patients with oligodendroglioma.

Graft take-rates after tympanoplasty: results from a prospective ear surgery database.

OBJECTIVE: To present a prospective ear surgery database and investigate the graft take-rate and prognostic factors for graft take-rate in tympanoplasty using the database. STUDY DESIGN: Prospective database study. SETTING: Tertiary referral center. PATIENTS: A total of 1606 cases undergoing tympanoplasty types I to IV were registered in the database in the period from February 2004 to November 2013. INTERVENTION: A total of 837 cases underwent myringoplasty/tympanoplasty type I. MAIN OUTCOME MEASURE: Graft take-rate and prognostic factors (age, discharge at time of surgery, tuba function, technique, graft material, and revision surgery) for tympanoplasty type I were studied. A comparison with the graft take-rates for tympanoplasty types II to IV and/or cholesteatoma was made. RESULTS: A user-friendly ear surgery database with fast data entry and direct import of audiometric data was developed. The graft take-rate was found to be 93.0% at 2 to 6 months and 86.6% at more than 12 months. Except for a discharging ear at the time of surgery, no significant differences using χ² test of association were found when comparing graft take-rates for different prognostic factors or more advanced tympanoplasty with or without cholesteatoma. A long-term graft take-rate overestimation of 6% was found if cases with defaulted follow-up because of early reperforation were not included. CONCLUSION: A prospective database can be used to study prognostic factors and reduce bias in reporting the graft take-rate. Prospective databases are needed for high-quality longitudinal studies but require a continuous and daily effort of involved surgeons and therefore need to be convenient and fast to use.