Inadvertent, Self-Induced Pneumoparotitis Provoking Pneumomediastinum.

Pneumoparotid refers to the presence of air within the parotid gland and pneumoparotitis indicates overlying inflammation or infection. Several physiologic mechanisms exist to prevent the reflux of air and oral contents into the parotid gland, however, these safeguards can be overcome by high intraoral pressures, thus provoking pneumoparotid. Whereas the relationship between pneumomediastinum and air dissecting up into cervical tissues is well understood, the relationship between pneumoparotitis and free air traveling downwards through contiguous structures within the mediastinum is less defined. We present a case of a gentleman who experienced the sudden onset of facial swelling and crepitus in the context of inflating an air mattress with his mouth, who was ultimately found to have pneumoparotid with consequent pneumomediastinum. Discussion of this unusual presentation is important to facilitate recognition and treatment of this uncommon pathology.

Social Media Use by Residents and Faculty in Otolaryngology Training Programs.

OBJECTIVES: Despite the growth of social media in healthcare, the appropriateness of online friendships between otolaryngological residents and attendings is poorly defined in the current literature. This issue is of growing importance, particularly as residency programs increasingly utilize social media as a means of connecting with and evaluating applicants due to limited in-person experiences during the COVID-19 pandemic. Our objective was to better understand the prevalence of and concerns surrounding social media use between residents and faculty. METHODS: This study sent out 2 surveys in 2017 to all United States Otolaryngology residency program directors to disperse to their residents and attendings, respectively. RESULTS: We received a response from 72 residents and 98 attendings. Our findings show that social media is commonly used by both residents and attendings, and most residents have at least 1 online friendship with an attending. Resident and attending opinions diverge on topics such as appropriateness of use, privacy settings, and professionalism. CONCLUSIONS: We call on residency programs to delineate a transparent social media policy so applicant expectations on social media are clear.

Virtual Residency Interviews during the COVID-19 Pandemic: The Applicant's Perspective.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on medical education at all levels, particularly on applicants applying to residency programs. The objective of the study was to gain a comprehensive understanding of applicants' perspectives on virtual interviews in the setting of the COVID-19 pandemic. METHODS: We conducted a quantitative survey and a qualitative study between March and April 2021. The link to an anonymous online survey was emailed to fourth-year medical students from one allopathic medical school. The survey link also was posted on the social media page of one allopathic medical school and one osteopathic medical school. Participants were then invited to participate in a follow-up 15- to 45-minute qualitative virtual interview. RESULTS: A total of 46 participants completed the survey, with a response rate of approximately 29.1%. The most beneficial aspect of the virtual interview was saving money on travel (31, 78.39%). In contrast, the least beneficial aspect of the virtual interview was the inability to personally explore the culture of the program (16, 34.78%), followed by the inability to explore the city and surrounding area (11, 23.91%). Thematic saturation was reached after interviewing 14 participants over Zoom. Four major themes of the virtual residency interview experience were discussed: virtual interviews offered many advantages, virtual interviews posed unique challenges, residency programs need more organizational improvements, and virtual specific preparations are needed. CONCLUSIONS: Despite the challenges associated with the virtual interview process, applicants rated the overall virtual interview experience positively. Given the continued impact of COVID-19 on medical education, the majority of residency programs will elect to continue virtual interviews for the 2022 Electronic Residency Application Services cycle. We hope that our findings may provide insight into the applicant's perspective on the virtual interview experience and help optimize virtual interviews for future cycles.

Complications associated with PEAK PlasmaBlade from 2010 to 2020 from MAUDE.

The pulse-electron avalanche knife (PEAK) PlasmaBlade 3.0 and 4.0 (Medtronic, Minneapolis, MN) is an electrosurgical technology that is widely used in surgery. Our study aimed to summarize device malfunctions, patient injuries, and interventions related to PEAK PlasmaBlade 3.0 and 4.0. The US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports of PlasmaBlade adverse events from June 6, 2010, to August 30, 2020. Data were extracted from reports pertaining to PlasmaBlade 3.0 and 4.0. A total of 384 medical device reports were identified, from which 424 adverse events were extracted. Of those, 348 (82.1%) were device malfunctions, 53 (12.5%) were patient injuries, and 23 (5.4%) were operator injuries. Device malfunctions were most frequently caused by delaminated coating (110, 25.9%), followed by ignition or fire (56, 13.2%). Operator injury was most frequently caused by thermal injury (19, 4.5%), followed by laceration (4, 0.9%). Pacemakers (22, 57.9%) were the most common devices causing interference. PEAK PlasmaBlade 3.0 and 4.0 have demonstrated utility during surgeries but are associated with adverse events. Interventions that aim to educate physicians on potential risks may help reduce the incidence of complications. Future studies with standardized reporting protocols are warranted.

Intraoperative stretching microbreaks reduce surgery-related musculoskeletal pain in otolaryngologists.

OBJECTIVE: The purpose of this study was to examine the role intraoperative otolaryngology stretching microbreak (OSMB) has on musculoskeletal (MSK) pain and discomfort in otolaryngologists. BACKGROUND: Otolaryngology procedures subject surgeons to significant amounts of pain and strain over their years of training. MSK pain is a serious concern for otolaryngologists' career longevity as well as their general wellbeing. METHODS: Participants from two different hospitals and one private practice were recruited to participate in this study. An initial ergonomic survey was obtained to assess baseline MSK pain, and its subjective impact on operative performance. The participants then completed three control days without OSMB exercises, followed by three intervention days with OSMB exercises which were completed at 20-40 minute intervals. Preoperative and postoperative pain rating surveys were completed before and after each procedure and at the end of the day to determine changes in pain and/or discomfort. RESULTS: Ten otolaryngologists (50 % men, 50 % women; mean age 35.6 years) participated in this study. Half of the participants indicated that they were concerned their pain would limit their ability to operate in the future. 70 % of participants indicated that they have not attempted to treat this pain and 60 % did not try any stretching exercises outside the operating room (OR) to mitigate their symptoms. Participants reported neck, upper back, and lower back to be the primary MSK discomfort. OSMB improved participants' pain scores in neck, shoulders, hands, and lower back pain (p < 0.05). CONCLUSION: MSK pain has shown to be a serious concern for the ability of otolaryngologists to continue performing surgery in the future. OSMB may be an effective strategy that can be implemented by otolaryngologists intraoperatively to improve MSK pain and overall well being.

Did More Otolaryngology Residency Applicants Match at Their Home Institutions in 2021? Investigating the Impact of the COVID-19 Pandemic.

OBJECTIVE: To compare the proportion of applicants who matched to their home otolaryngology program during the COVID-19 pandemic compared to the previous 5 years. METHODS: A "home program match" status was identified for residents in each PGY level and in incoming interns. The "home match proportion" (HMP) was then calculated for each program for each year from 2016 to 2021. The difference in the distribution of home matches between PGY0 and PGY 1, 2, 3, 4, and 5 were analyzed using the chi-square independence test and Fisher's exact test. Statistical significance was declared at P < .05. RESULTS: A total of 1885 residents were identified from 101 otolaryngology residency programs. The distribution of PGY0s who home matched was statistically higher when separately compared to PGY1-5s. (PGY0 vs PGY 1, 2, 3, 4, 5: 96 [30.1%] vs 63 [19.3%] P = .002, 73 [22.9%] P = .048, 50 [16.3%] P < 0.0005, 59 [19.2%] P = .002, 52 [16.9%] P < .0005). There was no statistical difference in any binary combination within PGY1 through PGY5. CONCLUSION: Nearly a third of applicants matched to their home institution for otolaryngology during the 2021 application cycle, a statistically significant increase compared to an average of the previous 5 years. While there are likely many reasons for this increase, we believe that the severely limited nature of away rotations due to the COVID-19 pandemic played a significant role in this outcome.

Head and Neck Cancer Screening Events Are a Mixed Bag, in Response to: "Follow-Up Phone Interviews and Attendance Motivation From A Free Head and Neck Cancer Screening".

We read with great interest, "Follow-Up Phone Interviews and Attendance Motivation From A Free Head and Neck Cancer Screening." Having recently hosted a community head and neck cancer screening event and shared these findings with the otolaryngology community, we greatly appreciate this most recent contribution to the ongoing discussion. Identifying the motivational factors for being screened is a valuable addition to the literature, as these are important considerations for institutions seeking to hold their own head and neck cancer screening events.

Perceived Impact of USMLE Step 1 Score Reporting to Pass/Fail on Otolaryngology Applicant Selection.

OBJECTIVES: Recently, the decision was made to transition the United States Medical Licensing Examination (USMLE) Step 1 score from a three-digit numerical score to a pass/fail system. Historically, Step 1 scores have been important for otolaryngology resident applicant selection. The purpose of this study was to understand and evaluate otolaryngology residency program directors' (OPDs) opinions on the impact following the change in Step 1 score reporting. METHODS: A 22-question survey administered through Qualtrics was sent to 113 academic otolaryngology residency program directors in April 2020. Information about demographics, impressions on the new Step 1 score format, anticipated changes in applicant selection, impact on mental health, and importance of various other factors in selecting applicants were queried. Descriptive statistics were used to analyze survey results. RESULTS: A total of 41 out of 113 (36.3%) OPDs completed this survey. A majority of surveyed OPDs (80.5%) do not support the decision to change Step 1 to a pass/fail system. In the absence of a three digit numeric USMLE Step 1 score, OPDs indicated prioritization of away rotations, letters of recommendation (LORs), personal prior knowledge of the applicant, grades in required clerkship, and class ranking or quartile. 53.7% of OPDs anticipate requiring USMLE Step 2 Clinical Knowledge for interview consideration following this change. CONCLUSION: OPDs believe a pass/fail Step 1 score will decrease the importance of this exam and that this change will lead to the implementation and evaluation of additional metrics such as a required Step 2 CK score.

I'm All Ears: A Population-Based Analysis of Consumer Product Foreign Bodies of the Ear.

OBJECTIVES: The purpose of this study was to assess the nationwide incidence of ear foreign body (FB) presentations to the emergency department (ED) and analyze the most common FB consumer products encountered. METHODS: The National Electronic Injury Surveillance System (NEISS) was evaluated for ED visits that included "ear foreign bodies" from 2010 through 2019. The most frequent foreign bodies were identified and organized by demographics. RESULTS: A total of 20,545 ear FB cases were found, with an estimated 608,860 ED visits nationwide. Female patients (56%) were more likely to have jewelry and first aid equipment FBs. Males between the ages of 5 and 15 years were significantly (P < 0.05) more likely to have paper products, pens/pencils, and desk supplies in their ears. CONCLUSION: Ear FBs represent a substantial proportion of healthcare expenditures. Although children are the most commonly affected individuals, all ages require further education and preventive measures.

Temporomandibular disorder treatment algorithm for otolaryngologists.

OBJECTIVE: To review current literature describing the management of temporomandibular disorder (TMD) and to propose an evidence-based algorithm for otolaryngologists. DATA SOURCES: A literature review using PubMed and Scopus was conducted to identify manuscripts that describe TMJ disorder etiology, diagnostic methods, and management across the fields of otolaryngology, general practice medicine, physical therapy, dentistry, and maxillofacial surgery. REVIEW METHODS: Two reviewers subjectively evaluated the studies based on the inclusion criteria, incorporating them into a comprehensive algorithm. CONCLUSIONS: TMD is one of the most common conditions presenting to otolaryngology outpatient clinics. Etiologies of TMD vary widely, including myofascial, intraarticular, neurologic, traumatic, or psychiatric in origin. When conservative measures fail to produce symptom relief, alternative treatments and referral to outside specialists including psychiatry, physical therapy, dentistry, and maxillofacial surgery may be indicated. Premature or inappropriate referrals may lead to patients suffering TMD for extended periods of time, with alternating referrals between various specialists. Thus, we present a TMD treatment algorithm for otolaryngologists to aid in the decision-making process in managing TMD. IMPLICATIONS FOR PRACTICE: Patients frequently present to otolaryngology outpatient clinics for symptoms of TMD. Multidisciplinary practice may be necessary to effectively treat TMD of varying etiology and severity. Following conservative treatment, appropriate referrals and treatment plans will reduce ineffective use of resources, deferral of treatment, and patient suffering. For this reason, a comprehensive algorithm for otolaryngologists will improve resource utilization and efficiency of treatment to ultimately provide improved treatment outcomes for patients.

Human Papillomavirus-Associated Head and Neck Cancer.

Oropharyngeal squamous cell carcinoma (OPSCC) has historically been attributable to tobacco and alcohol exposure and saw a decline in incidence after societal norms shifted away from smoking. In recent decades, this disease has had a re-emergence due to human papillomavirus (HPV) infection, now surpassing cervical cancer as the number 1 cause of HPV-related cancer in the United States. HPV-positive OPSCC differs from HPV-negative disease in epidemiology, prognosis, treatment, and prevention. Additionally, there is a deficit in awareness of the causal relationship between HPV and OPSCC. This, coupled with low vaccination rates, puts primary care providers in a unique position to play a vital role in prevention and early diagnosis. In this review, we highlight the epidemiology, screening, patient presentation, diagnosis, prognosis, and prevention of HPV-positive OPSCC, with a focus on the primary care provider's role.

Feel the Burn! Fireworks-related Otolaryngologic Trauma.

OBJECTIVES: Fireworks are used commonly for celebrations in the United States, but can lead to severe injury to the head and neck. We aim to assess the incidence, types, and mechanisms of head and neck injuries associated with fireworks use from 2010 to 2019. METHODS: A retrospective cross-sectional study, using data from the National Electronic Injury Surveillance System, of individuals presenting to United States Emergency Departments with head and neck injuries caused by fireworks and flares from 2010 to 2019. Incidence, types, and mechanisms of injury related to fireworks use in the US population were assessed. RESULTS: A total of 541 patients (349 [64.5%] male, and 294 [54%] under 18 years of age) presented to emergency departments with fireworks-related head and neck injuries; the estimated national total was 20 584 patients (13 279 male, 9170 white, and 11 186 under 18 years of age). The most common injury diagnoses were burns (44.7% of injuries), laceration/avulsion/penetrating trauma (21.1%), and otologic injury (15.2%), which included hearing loss, otalgia, tinnitus, unspecified acoustic trauma, and tympanic membrane perforation. The remaining 19% of injuries were a mix, including contusion, abrasion, hematoma, fracture, and closed head injury. Associations between fireworks type and injury diagnosis (chi-square P < .001), as well as fireworks type by age group (chi-square P < .001) were found. Similarly, associations were found between age groups and injury diagnoses (chi-square P < .001); these included children 5 years and younger and adults older than 30 years. CONCLUSIONS: Fireworks-related head and neck injuries are more likely to occur in young, white, and male individuals. Burns are the most common injury, while otologic injury is a significant contributor. Annual rates of fireworks-related head and neck injuries have not changed or improved significantly in the United States in the past decade, suggesting efforts to identify and prevent these injuries are insufficient.

The Virtual Mock Oral Examination: A Multi-institutional Study of Resident and Faculty Receptiveness.

Due to the coronavirus disease 2019 (COVID-19) pandemic, several American Board of Medical Specialties members have implemented board exams in an online format. In response, we decided to evaluate the efficacy and receptiveness of otolaryngology faculty and residents to a web-based virtual mock oral examination (MOE). Faculty and residents from DC-metropolitan institutions were recruited for decentralized virtual MOE in early 2020. A total of 28 faculty and 20 residents signed up. Follow-up included a survey study consisting of Likert scale and free-text questions to evaluate receptiveness. Helpfulness of the exercise was rated as an average of 8.8 and 9.06, respectively, by faculty and residents on a 10-point Likert scale. Likelihood to recommend a similar exercise to others was 9.2 and 9.3, respectively, for faculty and residents. All survey respondents said they would participate again if given the opportunity. We conclude that existing videoconferencing technologies can be effective tools for conducting virtual MOE by otolaryngology residency programs.

A Qualitative Study of Developing Competency in Thyroid Surgery: A Resident's Perspective With 5 Year Follow Up.

OBJECTIVES: The Accreditation Council for Graduate Medical Education has guidelines on assessing surgical qualifications based on experience. Attending surgeons have various assumptions on how their trainees learn and acquire surgical skills. This study primarily investigates the resident's perspective on gaining experience and achieving competency in thyroid surgical procedures. METHODS: A qualitative study using semi-structured interviews was designed to derive themes that discuss the acquisition of competency in thyroid surgery. After IRB approval, data was collected from 2012 to 2014 at 4 academic centers in the Washington, DC area. Fourteen chief residents specializing in either general surgery or otolaryngology were interviewed until saturation was achieved. These semi-structured interviews were transcribed and broken up into codes utilizing Moustakas' analysis. A comprehensive list of master themes in regards to achieving competency in thyroid surgery was developed. A follow up survey of the surgeons was undertaken at 5 years to determine if the perceptions during residency persisted in practice. RESULTS: Surgical specialty residents experience and learn thyroid surgery in 5 learning themes:1. Self-directed learning is significant during residency.2. Repetition with graduated autonomy is key.3. Effective mentors are competent surgeons who challenge residents and use positive teaching techniques.4. Residents employ active learning through the "see one, do one, teach one" philosophy.5. Learning from complexity is of importance to residency training.After several years in practice, the most important theme in learning after residency was repetition of cases. CONCLUSIONS: This study demonstrates how residents progress in approaching competency in thyroid surgery. Adult learning strategies are preferred, and programs should incorporate tailored techniques to meet the individual needs of the residents. Perceptions of what is most important shifted in long-term follow up. Further study is needed to assure competency in residency and in practice.

Using Computer-Assisted Instruction to Increase Otolaryngology Education During Medical School.

Introduction: A quarter of all complaints seen in adult primary care and half of all complaints seen in pediatric primary care are otolaryngology related. Even though half of all medical students enter primary care fields, there is no standardized curriculum for otolaryngology during medical school. Due to increasing limitations on specialty teaching during general medical education, computer-assisted instruction has been suggested as a format for increasing exposure to otolaryngology. Methods: We designed a computer-based learning module for teaching high-yield otolaryngology topics for third- and fourth-year medical students during their primary care clerkship at our institution from 2016-2018. We evaluated students' prior otolaryngology knowledge with 11 case-based, multiple-choice questions and then evaluated the efficacy of the module by a similar posttest. Results: Three-hundred and sixty-five students completed the module. The average pre- and posttest scores were 44% (SD = 21%) and 70% (SD = 17%), respectively, showing that the module resulted in significantly increased scores (p < .01). Discussion: The improvement of test scores indicates that this module was an effective educational intervention at our institution for increasing exposure and improving otolaryngology knowledge in third- and fourth-year medical students. As medical schools shift toward adult learning principles such as independent and self-directed learning, computer-assisted instruction is an alternative to classroom-based didactics. Creating resources for independent study will allow more time for otolaryngology faculty and residents to teach clinical exam skills and interactive case-based discussions, which are less suitable to teach via computer-assisted instruction.

Optimization of COVID-19 testing accuracy with nasal anatomy education.

IMPORTANCE: Adequate sampling of the nasopharynx is crucial to performing accurate SARS-CoV-2 (COVID) testing. Formalized education of nasal anatomy may improve provider testing technique and reduce false-negative test results. OBJECTIVE: To assess the effect of nasal anatomy education on medical providers' comfort level and knowledge base in performing accurate SARS-CoV-2 (COVID) testing. STUDY DESIGN: Pre-post survey. SETTINGS: Tertiary care academic hospital. PARTICIPANTS: 17 nurses performing COVID testing were enrolled. INTERVENTION: An educational session on COVID nasopharyngeal testing technique and nasal anatomy was presented by an otolaryngologist. MAIN OUTCOMES AND MEASURES: A pre-session survey assessed providers' prior nasal testing training and COVID testing challenges. Provider comfort level with COVID testing was surveyed pre-and post-session. A 6-question nasal anatomy test was administered pre- and post-session. RESULTS: 16 out of 17 nurses performed fewer than 10 COVID tests prior to the educational session (94%). Reported challenges with COVID testing included patient discomfort (79.6%), inability to pass the test swab (23.5%) and nasal bleeding (11.8%). The number of providers comfortable with independently performing COVID testing increased from pre- to post-session (5 and 14, p = 0.013). The average number of correct responses to the 6-question nasal anatomy test increased following the session (3.2 ± 1.2 to 5.1 ± 1.1, p = 0.003). Specifically, the number of providers able to localize the nasopharynx increased from 8 providers pre-session to 14 providers post-session (p = 0.04). CONCLUSION: Early implementation of nasal anatomy and nasopharyngeal swab technique education can help improve provider comfort and knowledge in performing accurate COVID testing.

Adverse events associated with the Inspire implantable hypoglossal nerve stimulator: A MAUDE database review.

BACKGROUND: Implantable hypoglossal nerve stimulation (HNS) has been found to be a safe and effective therapy for patients with obstructive sleep apnea, and patient adherence to treatment has been found to be as high as 86% after 12 months of therapy. OBJECTIVE: The purpose of this study is to review the medical device reports (MDRs) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events related to HNS therapy that could hinder compliance. METHODS: A search of the FDA MAUDE database was conducted using the product code "MNQ" for "Inspire stimulator for sleep apnea." Reports of adverse events associated with Inspire for sleep apnea from January 2000 to May 2020 were included for analysis. From these included reports, event variables were collected, including event setting, adverse event to patient, iatrogenic injury, device malfunction, interventions, and root causes. Results were compiled and reviewed. RESULTS: The search query yielded 180 reports that met inclusion criteria, containing a total of 196 adverse events. The most commonly reported adverse events to patients were infection (n = 50, 34.2%), neuropraxia (n = 22, 15.1%) and hematoma/seroma (n = 17, 11.6%). A total of 83 adverse events (42.3%) required reoperation. The most common reoperations performed for adverse events to patients were explantation (n = 30, 46.2%) and device repositioning/lead revision (n = 24, 36.9%), while the most common reoperation performed for device malfunctions was device replacement (n = 10, 55.6%). CONCLUSION: In attempting to further improve patient compliance, understanding these device malfunctions and adverse events related to HNS implantation or usage is crucial for the identification of potential causes of patient non-adherence.

Building Community Relations and Promoting Cancer Prevention: An Oral Cancer Screening Event.

Communities often call upon their university hospitals to help with health screening events. Otolaryngologists can play an important role in prevention and education. We recently evaluated 285 community members at an oral cancer screening event at a community health "expo." An intake form and oral exam identified 67 with conditions that warranted further evaluation: 16 for dental follow-up; 25 for further ear, nose, and throat (ENT) evaluation; and 26 for primary care follow-up. One patient was identified with laryngeal cancer after referral for dysphonia. The event served to increase awareness of oral cancer among high-risk patients via educational materials and podium presentations. There was a positive effect on our university's credibility and reputation in the local community. Medical students interested in ENT received valuable supervised hands-on experience. This screening event identified opportunities for collaboration with local dental societies and primary care physicians for prevention and early detection of oral cancer.