Curtis's cephaloscope: deafness and the making of surgical authority in London, 1816-1845.

Aural surgery is a branch of nineteenth-century medicine and surgery providing specialized treatment for ear diseases. During the 1830s, faced with a "popular prejudice" against the curability of deafness as well as intraprofessional rivalries and continuous accusations of quackery, aurists found their surgical authority questioned and their field's value threatened. In an attempt to bolster aural surgery's reputation, in 1841, the aurist John Harrison Curtis (1778-1856) introduced his new diagnostic instrument, the cephaloscope, which could not only improve diagnosis but also provide approaches for regulating aural knowledge, thus strengthening aural surgery's authority. This article examines the motives underlying Curtis's introduction of the cephaloscope and the meanings it held for the occupational group at large.

Use and teaching of pneumatic otoscopy in a family medicine residency program.

OBJECTIVE: To determine to what extent FPs teach and use pneumatic otoscopy and to identify the chief influences on this behaviour. DESIGN: Mixed-methods descriptive study conducted between March and May 2011. SETTING: The family medicine residency program at Laval University in Quebec city, Que. PARTICIPANTS: Directors of the family medicine teaching units (FMTUs), teachers, and residents. METHODS: We used questionnaires to assess the availability of pneumatic otoscopy equipment in 12 FMTUs, current behaviour and behavioural intention among physicians (residents and teachers) to use or teach pneumatic otoscopy, and facilitators and barriers to these practices. We also conducted 2 focus groups to further explore the facilitators of and barriers to using pneumatic otoscopy. We used descriptive statistics for quantitative data, transcribed the qualitative material, and performed content analysis. MAIN FINDINGS: Eight of the 12 FMTUs reported having pneumatic otoscopy equipment. Four had it in all of their consulting rooms, and 2 formally taught it. Nine (4%) of 211 physicians reported regular use of pneumatic otoscopy. Mean (SD) intention to teach or use pneumatic otoscopy during the next year was low (2.4 [1.0] out of 5). Teachers identified improved diagnostic accuracy as the main facilitator both for use and for teaching, while residents identified recommendation by practice guidelines as the main facilitator for use. All physicians reported lack of availability of equipment as the main barrier to use. The main barrier to teaching pneumatic otoscopy reported by teachers was that they did not use it themselves. In focus groups, themes of consequences, capabilities, and socioprofessional influences were most dominant. Residents clearly identified role modeling by teachers as facilitating the use of pneumatic otoscopy. CONCLUSION: Pneumatic otoscopy is minimally used and taught in the family medicine residency program studied. Interventions to increase its use should target identified underlying beliefs and facilitators of and barriers to its use and teaching.

Holographic otoscope for nanodisplacement measurements of surfaces under dynamic excitation.

We describe a novel holographic otoscope system for measuring nanodisplacements of objects subjected to dynamic excitation. Such measurements are necessary to quantify the mechanical deformation of surfaces in mechanics, acoustics, electronics, biology, and many other fields. In particular, we are interested in measuring the sound-induced motion of biological samples, such as an eardrum. Our holographic otoscope system consists of laser illumination delivery (IS), optical head (OH), and image processing computer (IP) systems. The IS delivers the object beam (OB) and the reference beam (RB) to the OH. The backscattered light coming from the object illuminated by the OB interferes with the RB at the camera sensor plane to be digitally recorded as a hologram. The hologram is processed by the IP using the Fresnel numerical reconstruction algorithm, where the focal plane can be selected freely. Our holographic otoscope system is currently deployed in a clinic, and is packaged in a custom design. It is mounted in a mechatronic positioning system to increase its maneuverability degrees to be conveniently positioned in front of the object to be measured. We present representative results highlighting the versatility of our system to measure deformations of complex elastic surfaces in the wavelength scale including a copper foil membrane and postmortem tympanic membrane. SCANNING 33: 342-352, 2011. © 2011 Wiley Periodicals, Inc.

Assessment of pediatric residents' otoscopic interpretive skills by videotaped examinations.

BACKGROUND: Accurate diagnosis of otitis media is essential to facilitate appropriate management. Few residency programs assess formally their residents' competency in diagnosing middle ear disease. OBJECTIVE: To evaluate the performance of pediatric residents' otoscopic interpretive skills by level of training, with a videotaped otoendoscopic examination (VOE). METHODS: A VOE was used to assess and compare the performance of a cross-sectional sample of 141 residents with one another by level of training as well as with novice and expert groups. Total score, sensitivity, specificity, and kappa coefficients were calculated for each subject by comparing the subject's answers on the 50-ear test with the VOE's expert panel-derived answers, and averages were determined for each training level. RESULTS: Each pediatric resident training group had moderate agreement (mean kappa coefficient range: .45-.56) with the VOE answers, compared with the novice group (mean kappa: .31, fair) and expert group (mean kappa: .80, substantial). Twenty-eight residents (20%) had fair or less agreement (kappa<.41) with the VOE answers. The mean total scores of all pediatric resident training levels were significantly (P<.05) lower than the expert group and significantly (P<.05) higher than the novice group (with exception of the early postgraduate year-1 group). Subjects with more training had higher kappa levels (r=.33,<.001, Spearman) when results were compared among novice, residents, and experts. CONCLUSIONS: We found the VOE to be a feasible and reliable instrument to accurately distinguish novice, resident, and expert level skills in the determination of middle ear effusion status.

Pediatric residents' clinical diagnostic accuracy of otitis media.

OBJECTIVE: Pediatric resident physicians' clinical diagnostic accuracy of otitis media is unknown. We attempted to correlate the clinical examination of pediatric house staff with pediatric otolaryngologists and tympanometry. METHODS: Pediatric residents evaluated patients who were scheduled in the pediatric acute care clinic and completed a provider examination form detailing their otoscopic findings, interpretation, and treatment plan. Patients were then immediately reevaluated by a pediatric otolaryngologist using an identical form. Tympanometry was also performed by a pediatric audiologist. We used kappa statistics to calculate correlation of clinical findings and interpretation. RESULTS: A total of 103 patients consented for the study; 70 patients were examined by 27 different pediatric residents with 43 patients (86 ears) examined by all 3 providers. Correlation of clinical findings between all pediatric residents and the pediatric otolaryngologists was a kappa statistic of 0.30 (fair agreement). The individual diagnostic finding with the greatest correlation was tympanic membrane erythema (kappa statistic: 0.40 [fair agreement]), and the worst correlate was tympanic membrane position (kappa statistic: 0.16 [slight agreement]). Resident interpretation and tympanometry yielded a kappa statistic of 0.20 (slight agreement), and the otolaryngologist interpretation and tympanometry yielded a kappa statistic of 0.32 (fair agreement). CONCLUSIONS: Otitis media is the most common disease seen by practicing general pediatricians, but there is a paucity of formalized resident education. We demonstrated only a slight to moderate correlation between the clinical diagnostic examinations of pediatric residents and pediatric otolaryngologists and tympanometry.

Frecuencia de otitis media aguda en menores de 5 años bajo control / Frequency of acute medium otitis in controlled children under 5 years old

Con el objeto de determinar la magnitud y algunas características del comportamiento de la otitis media aguda (OMA), se analiza el seguimiento de 246 niños nacidos sanos y controlados en un consultorio del Área Norte de Santiago, desde el nacimiento hasta los 5 años; éstos son parte de un estudio sobre afecciones respiratorias. El diagnóstico se realiza bajo las normas del Ministerio de Salud el que se basa en la historia clínica y examen físico que es realizado por médico, que incluye ostocopía. Se calculó tasas de incidencia anual que variaron entre 16,3 por ciento en los menores de un año a 9 por ciento en los cuatros años. En el periodo de seguimiento el 33,3 por ciento los niños presento OMA. No se encontró diferencias por sexo. El 48,6 por ciento de los primeros episodios se presento antes de dos años de edad y en este periodo se registro el 53,6 por ciento de todos los episodios. Las tasas no difieren estadísticamente según existencia de hermanos ni consumo de cigarrillo en el hogar: La duración de la lactancia materna (LM) influyo significativamente en la tasa de OMA en los dos primeros años (37,9 por ciento en niños con menos de 4 meses de LM, 22,9 por ciento en los con 4 meses o mas). En los niños con OMA el promedio anual episodios aumentan de 1,3 en el primer año a 4,5 en el cuarto años. Se observo un máximo de 4 episodios en un año solo en un niño. El 37,9 por ciento de los episodios acompañaron IRA (Infección Respiratoria Alta) y el 35,7 por ciento IRA baja, en su mayoría bronquitis. Se concluye que la OMA afecta a un tercio de los menores de cinco años, especialmente lactantes