In-office insertion tympanostomy tubes in children using single-pass device.

OBJECTIVES: Insertion of tympanostomy tubes (TT) is generally accomplished in children in the operating room under general anesthesia. We report on 229 children treated in-office with a novel device. METHODS: Investigators participated in an IRB-approved, prospective, single arm, multisite investigation of in-office TT placement in awake children. Topical anesthetic was applied, and protective restraint was used. TT placement was performed with a single-pass TT insertion device. Safety was assessed by monitoring procedural events. RESULTS: Four hundred and forty-four ears were treated in 229 children at 10 sites. Children were in age groups 6-24 months (n = 211, mean = 13 months) and 5-12 years (n = 18, mean = 8.3 years). Two hundred and fifteen children received bilateral TT placement, and 14 received unilateral placement. Overall, 226/229 (98.7%) children had successful TT placement in the office (209/211 in 6-24 months and 17/18 in 5-12 years). Three children were rescheduled for the operating room due to anatomical challenges or patient movement. Median procedure time for bilateral cases in both age groups was 4:53. Two minor adverse events (AEs) were reported in one patient. Per independent assessment of 30 procedure videos by clinicians, TT placement was tolerated acceptably by all children. CONCLUSION: In-office TT placement in awake young children using topical anesthetic, enabled by a single pass delivery device, was safe, successful and well tolerated. The American Academy of Otolaryngology (AAO) recently released a Position Statement supporting in-office TT placement in appropriate children. These results affirm an in-office alternative for clinicians and parents who have concerns with the risk, inconvenience and cost of surgery in an operating room under general anesthesia.Level of Evidence: 2c.Clinical Trials Registration Number: NCT03544138.

A novel supermicrosurgery training model: the chicken thigh.

BACKGROUND: Supermicrosurgery is an increasingly important technique in reconstructive surgery. It requires a more technically refined skill set compared with standard microsurgery. All currently available biologic training models involve the use of live rats. A nonliving model would be more accessible and cost-effective for practice. We have developed such a model using chicken thighs purchased from a local grocery store. METHODS: The ischiatic neurovascular bundle was identified in 20 chicken thighs and dissected distally to the end of the specimen. The vessel diameters were measured at several points along the artery, vein, and their respective branches. Vessels with diameters in the 0.3-0.8-mm range were then divided and supermicrosurgical anastomoses were attempted. RESULTS: The branching pattern of the ischiatic artery and vein were anatomically consistent with intermediate and terminal secondary and tertiary branches consistently in the range of 0.3-0.8 mm. In all specimens, at least one 0.3-mm vessel could be identified, though additional intramuscular dissection was sometimes required. It was demonstrated that supermicrosurgical anastomoses could be successfully performed using these branches. CONCLUSIONS: This study introduces a novel, convenient, and economical model for supermicrosurgery utilizing easily obtained chicken thighs. The chicken thighs have an anatomically consistent vascular branching pattern, and vessels of appropriate sizes for training can be easily identified and isolated. Surgeons looking to develop or refine supermicrosurgical skills may find this nonliving, biologic model very useful.

Urinary iodine excretion after contrast computed tomography scan: implications for radioactive iodine use.

IMPORTANCE: Patients who undergo radiographic studies with contrast receive an enormous bolus of iodine. This can delay subsequent use of radioactive iodine (RAI) therapy because the iodine can compete for uptake. There is a paucity of literature on the minimum interval between contrast administration and RAI therapy. OBJECTIVE: To better characterize how long it takes for the iodine load from an intravenous contrast bolus to clear from the body. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 21 adults undergoing intravenous contrast CT studies at a tertiary academic medical center; exclusion criteria included history of thyroid disease or thyroidectomy, history of renal insufficiency, pregnancy, and other contrast administration within 1 year. INTERVENTION: Morning urine samples were taken before the scan for analysis and then every 2 weeks thereafter for 12 weeks. RESULTS The median baseline iodine level was 135 µg/L (range, 29-1680 µg/L), and median peak level was 552 µg/L (range, 62-6172 µg/L). Median time for urinary iodine level to normalize was 43 days, with 75% of subjects returning to baseline within 60 days, and 90% of subjects within 75 days. Baseline iodine level was a significant predictor of postcontrast iodine levels. Age, sex, weight, and estimated glomerular filtration rate were not significant. CONCLUSIONS AND RELEVANCE: These results may be used for guidance on the timing of RAI use following contrast exposure. The practice at our institution is to wait 2 months and then check a 24-hour urinary iodine level. This alleviates concerns about contrast use in patients with thyroid carcinoma interfering with adjuvant radioiodine therapy.

Validation of a task-specific scoring system for a microvascular surgery simulation model.

OBJECTIVE/HYPOTHESIS: Simulation models can help develop procedural skills outside the clinical setting while also providing a means for evaluation of trainees. Objective Structured Assessment of Technical Skills (OSATS) have been developed for several procedures. The purpose of this study was to demonstrate the construct validity of an OSATS for microvascular anastomosis performed on a simulation model using chicken thigh vessels. STUDY DESIGN: Validation study. METHODS: An expert panel constructed a task-specific checklist for an OSATS for microvascular anastomosis. Twenty surgical staff and trainees performed a microvascular anastomosis of a chicken ischiatic artery. Training level and microsurgical experience were assessed by questionnaire. The performances were recorded and scored by two experts using the task-specific and global scales of the OSATS. RESULTS: Analysis of variance revealed a significant effect of training and microvascular experience for both the task-specific score and global rating scale score (P < .005). Interrater reliability was 0.7. Experience level demonstrated a logarithmic relationship with task time. CONCLUSIONS: The microvascular OSATS applied to the chicken thigh simulator model differentiated between levels of microvascular experience. It demonstrated construct validity and reliability for the assessment of procedural competence using a cost-effective and easily accessible model.

Clinical assessment of music perception in cochlear implant listeners.

OBJECTIVE: Cochlear implants (CI) have provided tremendous benefit for speech recognition in quiet for patients with severe and profound hearing impairment, but implant users still have great difficulty perceiving music. The purpose of this study was to develop a test to quantify music perception by CI listeners in a clinically practical manner that could be standardized for administration at any implant center. STUDY DESIGN: Prospective convenience sample. SETTING: Hearing research center at an academic hospital. PATIENTS: Eight CI listeners, including 5 men and 3 women with implant experience ranging from 0.5 to 6 years, participated in this study. They represented a variety of implant devices and strategies. INTERVENTION: Administration of the Clinical Assessment of Music Perception test in a standardized sound field. MAIN OUTCOME MEASURES: Music perception was assessed using a computerized test comprising pitch direction discrimination, melody identification, and timbre identification. The pitch subtest used a 2-alternative forced-choice adaptive procedure to determine a threshold interval for discrimination of complex pitch direction change. The melody and timbre subtests assessed recognition of 12 isochronous melodies and 8 musical instruments, respectively. RESULTS: Testing demonstrated a broad range of perceptual accuracy on all 3 subtests. Test duration averaged less than 45 minutes. CONCLUSION: Clinical Assessment of Music Perception is an efficient computerized test that may be used to measure 3 different aspects of music perception in CI users in a standardized and clinically practical manner.