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1.
BMC Med Educ ; 21(1): 510, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579717

RESUMO

BACKGROUND: Emerging research indicates that video otoscopy can be used as a teaching tool to enhance students' ability to identify outer and middle ear pathologies. However, there is little research on the perceptions of audiology students regarding their competence and confidence following video otoscopic training, and how they view the use of video otoscopy as a teaching tool. Therefore, this study aimed to determine undergraduate (UG) audiology students' perceived competence and confidence in conducting otoscopy following training by video otoscopic examination. METHODS: A survey methodology with a cross sectional design was employed. An electronic questionnaire was distributed to all third and fourth year (senior) (N = 79) UG audiology students using Survey Monkey. Ethical approval and permission from relevant stakeholders were obtained. Data were analysed using both descriptive and inferential statistics. RESULTS: 60 % of the students felt competent in performing otoscopy, while 63.3 % felt less competent in interpreting otoscopic examination findings. 43.3 % felt they can confidently and competently identify outer ear pathologies. There was no association between the number of video otoscopic examinations performed and perceived competence or/and confidence. There was also no statistically significant relationship between year of study (e.g., third year versus fourth year) and perceived competence or/and confident (p = 0.7131). Almost all (97 %) students felt that video otoscopic training should continue to be part of the clinical training as it helped them enhance their skills in performing otoscopy. CONCLUSIONS: Current findings highlight the need to improve students' practical training, incorporating pathologic ears into the curriculum. These findings also highlight the importance of supplementing practical training methodologies with changing technological advancements, particularly where tele-audiology opportunities may exist.


Assuntos
Audiologia , Otopatias , Estudantes de Medicina , Audiologia/educação , Competência Clínica , Estudos Transversais , Humanos , Otoscopia
2.
Vestn Otorinolaringol ; 86(4): 13-16, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499441

RESUMO

THE AIM: Of the investigation was to establish the standard and improve the treatment of otitis media with effusion (OME) in children. 361 children at age from 11 months to 18 years were inspected after tympanostomy during 2013-2018 years. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, CT. MATERIAL AND METHODS: Treatment takes into consideration the reveal of OME: surgical initially. The tympanostomy preferable place is anterior-inferior quadrant. RESULTS: In cases with cleft palate or reccurence OME long-term tubes and balloonisation of ET are preferable. CONCLUSION: Authors received normalization of the hearing thresholds in 97.6% cases, but after surgery the patients have to be followed-up during 12-24 months.


Assuntos
Fissura Palatina , Otite Média com Derrame , Testes de Impedância Acústica , Criança , Humanos , Ventilação da Orelha Média , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/cirurgia , Otoscopia
3.
Int J Pediatr Otorhinolaryngol ; 149: 110865, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34385040

RESUMO

BACKGROUND: The highest prevalence of chronic suppurative otitis media is seen among children in Greenland. The purpose of this study was to investigate the prevalence of hearing loss among school children in Sisimiut, the second-largest city in Greenland. MATERIAL AND METHOD: All 423 children from 5th to 10th grade from the two schools in Sisimiut and the nearby settlements were invited to participate. Participants filled out a questionnaire at home with their parents before ear-examination and audiometry. Risk factors for hearing loss and otitis media (OM) related otoscopy findings were analyzed by binomial logistic regression. RESULTS: A total of 185 children between 9 and 15 years of age (median: 11 years, IQR: 10-13) were included; 60% (n = 111) were girls. Fifty-four children (29%) were found to have hearing impairment using a PTA of 15 dB for either low or high frequencies or both as threshold. When using 25 dB as threshold, the number of children with hearing impairment was 18 (10%). None of the children had hearing aids. Of 355 otoscopies available for evaluation, the majority were normal (n = 249, 70.1%). Perforation of the tympanic membrane was found in six ears (1.7%), of which all were unilateral. Other sequelae related to OM (i.e., circular atrophy and myringosclerosis) were found in 37 ears (10.4%). Children with OM-related otoscopy findings had significantly lower hearing tresholds compared to children without. CONCLUSION: A high prevalence of untreated hearing loss was found among examined school children in Sisimiut. Children with otoscopy findings indicating prior OM had significantly lower hearing tresholds compared to children without.


Assuntos
Perda Auditiva , Otite Média , Adolescente , Criança , Feminino , Groenlândia/epidemiologia , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Humanos , Otoscopia , Instituições Acadêmicas
4.
Lang Speech Hear Serv Sch ; 52(3): 856-867, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098724

RESUMO

Purpose The purpose of this study is to describe and assess a hearing screening program of first-grade children in Poland. The program aimed to detect hearing disorders and increase awareness among parents of hearing problems. Method A hearing screening program was conducted in all elementary schools of the biggest region in Poland. A total of 34,618 first-graders were screened. The hearing screening protocol included video otoscopy and pure-tone audiometry. The program also included an information campaign directed to the local community and educational meetings between parents and medical staff. Results The estimated prevalence of hearing loss was 11%. Unilateral hearing loss was more common than bilateral hearing loss. Mild hearing loss was more frequent than moderate (or worse) hearing loss. In otoscopy, the most common positive result was otitis media with effusion. Parents and medical staff took part in 1,608 educational meetings, broadening the parents' knowledge of how to care for hearing. Conclusions A hearing screening program not only provides data on the prevalence of childhood hearing problems but is also an avenue for providing the local community with valuable knowledge about how to care for hearing. This study demonstrated the importance for systematic monitoring of children's hearing status and of increasing awareness among parents and teachers of the significance of hearing loss. The hearing screening of children starting school should become a standard part of school health care programs.


Assuntos
Perda Auditiva , Audiometria de Tons Puros , Criança , Audição , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Humanos , Otoscopia , Polônia/epidemiologia
5.
Otol Neurotol ; 42(9): e1382-e1388, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34191783

RESUMO

OBJECTIVES: To develop a multiclass-classifier deep learning model and website for distinguishing tympanic membrane (TM) pathologies based on otoscopic images. METHODS: An otoscopic image database developed by utilizing publicly available online images and open databases was assessed by convolutional neural network (CNN) models including ResNet-50, Inception-V3, Inception-Resnet-V2, and MobileNetV2. Training and testing were conducted with a 75:25 breakdown. Area under the curve of receiver operating characteristics (AUC-ROC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to compare different CNN models' performances in classifying TM images. RESULTS: Our database included 400 images, organized into normal (n = 196) and abnormal classes (n = 204), including acute otitis media (n = 116), otitis externa (n = 44), chronic suppurative otitis media (n = 23), and cerumen impaction (n = 21). For binary classification between normal versus abnormal TM, the best performing model had average AUC-ROC of 0.902 (MobileNetV2), followed by 0.745 (Inception-Resnet-V2), 0.731 (ResNet-50), and 0.636 (Inception-V3). Accuracy ranged between 0.73-0.77, sensitivity 0.72-0.88, specificity 0.58-0.84, PPV 0.68-0.81, and NPV 0.73-0.83. Macro-AUC-ROC for MobileNetV2 based multiclass-classifier was 0.91, with accuracy of 66%. Binary and multiclass-classifier models based on MobileNetV2 were loaded onto a publicly accessible and user-friendly website (https://headneckml.com/tympanic). This allows the readership to upload TM images for real-time predictions using the developed algorithms. CONCLUSIONS: Novel CNN algorithms were developed with high AUC-ROCs for differentiating between various TM pathologies. This was further deployed as a proof-of-concept publicly accessible website for real-time predictions.


Assuntos
Aprendizado Profundo , Algoritmos , Humanos , Internet , Redes Neurais de Computação , Otoscopia
6.
Am J Emerg Med ; 46: 150-155, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33945977

RESUMO

BACKGROUND: Acute otitis media is often misdiagnosed. Pediatric trainees learn otoscopy from supervisors who cannot concurrently view the eardrum. Digital, smartphone otoscopes show promise to improve the visibility and learning due to a concurrent view by trainees and supervisors. We aimed to determine whether use of digital otoscopes improved accuracy of the ear exams between medical trainees and their supervisors, compared to using traditional otoscopes. Secondarily, we evaluated whether the use of digital otoscopes reduced the number of repeat ear examinations by supervisors, changed the trainee's confidence in their exam findings, and led to differences in the rate of antibiotics prescribed. METHODS: This study was a randomized controlled trial comparing use of a digital otoscope to a traditional otoscope, in a pediatric emergency department and primary care clinic in an academic tertiary care children's center. We used a modified validated image-based grading scale to compare accuracy of the ear exam between trainees and supervisors. Surveys documented modified OMgrade scores, frequency of supervisor exams, trainee confidence on a 5-point Likert scale, and antibiotic prescriptions. Inter-rater agreement of trainees and supervisors, the number of supervisor confirmatory examinations performed, trainee confidence, and antibiotic prescription rates were evaluated. RESULTS: Amongst 188 children, 375 ears were examined by 85 trainees and 22 supervisors. The digital otoscope was utilized in 92 (48.9%) exams and 96 (51.1%) used the traditional otoscope. Accuracy of ear exam findings between trainees and supervisors improved by 11.2% (95% CI: 1.5, 21.8%, p = 0.033) using the Cellscope Oto (74.8%, 95% CI: 67.3, 82.1%) compared to the traditional otoscope (63.5%, 95% CI: 56.7, 70.4%). Fewer repeat supervisor exams were performed in the digital otoscope group (27.2%) vs. the traditional otoscope group (97.9%) (p < 0.001). There was no difference in mean trainee confidence in their examination (p = 0.955) or antibiotic prescription rates when using digital versus traditional otoscopes (p = 0.071). CONCLUSIONS: Utilization of a digital otoscope resulted in increased accuracy of the ear exam between trainees and supervisors, and fewer total number of examinations performed on a given child. Compared to a traditional otoscope, a digital otoscope may be a more efficient and effective diagnostic tool.


Assuntos
Competência Clínica , Otite Média/diagnóstico , Otoscopia/métodos , Smartphone , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Adulto Jovem
8.
Eur Rev Med Pharmacol Sci ; 25(8): 3386-3394, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33928627

RESUMO

COVID-19 pandemic has forced the emergency deployment of digital health technology (DHT) to provide remote care. DHT is a promising option to enable telehealth, and, by the same token, it contributes to the implementation of social distance measures. The objective of this scoping review is to investigate existing DHT solutions that have been put in place to enable remote care in response to the COVID-19 pandemic. Structured literature searches were performed in Medline (Ovid), Scopus and CINAHL with Full Text (EBSCOhost), with a mix of keywords and controlled vocabulary unique to each database. The librarian utilized the search strategy on respiratory pandemics created in April 2020 for Medline (Ovid) by Canadian Agency for Drugs and Technology in Health (CADTH). An additional search for grey literature was performed including pre-prints and reports in Google Advanced, LitCovid and MedRx. Two independent reviewers assessed the articles retrieved from the databases (n=131) based on pre-established inclusion criteria and included six articles. Analysis of the results revealed six different types of DHT, including 5 dedicated to telemedicine and one used to track activity of people who were confined to their homes. The results showed positive health-related outcomes and user behavior outcomes. This review revealed that there is limited literature on the use of DHT to enable remote care in response to a pandemic and therefore calls for more documentation of the ongoing deployment of DHTs to support patient safety and the delivery of quality care during the COVID-19 pandemic and beyond.


Assuntos
Tecnologia Biomédica , COVID-19/prevenção & controle , Tecnologia Digital , Aplicativos Móveis , Telemedicina , Dispositivos Eletrônicos Vestíveis , Acelerometria , Atenção à Saúde , Humanos , Otoscopia , Cooperação do Paciente , Quarentena , SARS-CoV-2
9.
BMJ Case Rep ; 14(4)2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846192

RESUMO

High-riding jugular bulb (HRJB), although rare, may pose a challenge as it may be mistaken for other non-alarming condition, such as middle ear effusion. Patients with HRJB classically present with pulsatile tinnitus. We report a unique case of a 26-year-old patient with underlying beta thalassaemia who presented with a 2-month history of intermittent epistaxis and rhinorrhoea. Otoscopic examinations revealed a pulsatile bluish mass behind the right tympanic membrane and a dull left tympanic membrane. Imaging performed revealed a finding of dual retrotympanic pathology, which consisted of a right dehiscent HRJB and left cholesterol granuloma. We highlight a rare case of dual retrotympanic mass as well as its management.


Assuntos
Otite Média com Derrame , Zumbido , Adulto , Humanos , Veias Jugulares , Otoscopia , Zumbido/etiologia , Membrana Timpânica/diagnóstico por imagem
10.
Med Image Anal ; 71: 102034, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33848961

RESUMO

In this study, we propose an automatic diagnostic algorithm for detecting otitis media based on otoscopy images of the tympanic membrane. A total of 1336 images were assessed by a medical specialist into three diagnostic groups: acute otitis media, otitis media with effusion, and no effusion. To provide proper treatment and care and limit the use of unnecessary antibiotics, it is crucial to correctly detect tympanic membrane abnormalities, and to distinguish between acute otitis media and otitis media with effusion. The proposed approach for this classification task is based on deep metric learning, and this study compares the performance of different distance-based metric loss functions. Contrastive loss, triplet loss and multi-class N-pair loss are employed, and compared with the performance of standard cross-entropy and class-weighted cross-entropy classification networks. Triplet loss achieves high precision on a highly imbalanced data set, and the deep metric methods provide useful insight into the decision making of a neural network. The results are comparable to the best clinical experts and paves the way for more accurate and operator-independent diagnosis of otitis media.


Assuntos
Otite Média com Derrame , Otite Média , Humanos , Redes Neurais de Computação , Otite Média/diagnóstico por imagem , Otite Média com Derrame/diagnóstico por imagem , Otoscopia , Membrana Timpânica
11.
Vestn Otorinolaringol ; 86(2): 4-9, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33929144

RESUMO

PURPOSE OF THE STUDY: To evaluate the effectiveness of the application of the web application "Automated system of primary hearing assessment" created by us for the diagnosis of hearing impairment in different age groups. MATERIAL AND METHODS: With the help of this web application, 712 patients were examined in 3 age groups: group 1 - patients aged 18 to 44 years, 196 people (average age 25.6±2.7 years), group 2 - patients aged 45 to 59 years, 265 people (mean age 46.3±3.6 years), 3rd group - patients 60 years old and older, 251 people (mean age 75.4±1.1 years). RESULTS: It was revealed that 61.8% of patients had risk factors for the development of hearing loss. In the 1st age group, one risk factor for hearing loss prevailed, in the 2nd and 3rd groups, up to 5-9 factors were simultaneously combined. Clinically significant hearing loss was found in 24.3% of patients. Hearing studies at frequencies of 10 and 12 kHz revealed latent hearing loss in 31.3% of patients, 57% of them had risk factors for the development of hearing loss. Comparative analysis in the groups showed that hearing impairment at high frequencies was found in 47.4% of patients in older age groups and in 15.8% of young people. The possibility of performing otoscopy images made it possible to identify changes in the tympanic membrane in 17.1% of patients, to give a correct conclusion about the state of their hearing and to propose an algorithm for further examination. It was found that the sensitivity of the study in the web application was 98%, the specificity - 99.9%. FINDINGS: The use of the web application allows assessing the risk factors for the development of hearing loss, identifying patients with latent hearing loss, objectifying the study with otoscopy images, and remotely obtaining a conclusion about the state of hearing from a specialist doctor.


Assuntos
Perda Auditiva , Adolescente , Adulto , Idoso , Audição , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Testes Auditivos , Humanos , Pessoa de Meia-Idade , Otoscopia , Membrana Timpânica , Adulto Jovem
13.
Pediatrics ; 147(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33731369

RESUMO

OBJECTIVES: Misdiagnosis of acute and chronic otitis media in children can result in significant consequences from either undertreatment or overtreatment. Our objective was to develop and train an artificial intelligence algorithm to accurately predict the presence of middle ear effusion in pediatric patients presenting to the operating room for myringotomy and tube placement. METHODS: We trained a neural network to classify images as " normal" (no effusion) or "abnormal" (effusion present) using tympanic membrane images from children taken to the operating room with the intent of performing myringotomy and possible tube placement for recurrent acute otitis media or otitis media with effusion. Model performance was tested on held-out cases and fivefold cross-validation. RESULTS: The mean training time for the neural network model was 76.0 (SD ± 0.01) seconds. Our model approach achieved a mean image classification accuracy of 83.8% (95% confidence interval [CI]: 82.7-84.8). In support of this classification accuracy, the model produced an area under the receiver operating characteristic curve performance of 0.93 (95% CI: 0.91-0.94) and F1-score of 0.80 (95% CI: 0.77-0.82). CONCLUSIONS: Artificial intelligence-assisted diagnosis of acute or chronic otitis media in children may generate value for patients, families, and the health care system by improving point-of-care diagnostic accuracy. With a small training data set composed of intraoperative images obtained at time of tympanostomy tube insertion, our neural network was accurate in predicting the presence of a middle ear effusion in pediatric ear cases. This diagnostic accuracy performance is considerably higher than human-expert otoscopy-based diagnostic performance reported in previous studies.


Assuntos
Aprendizado de Máquina , Otite Média com Derrame/diagnóstico , Algoritmos , Humanos , Período Intraoperatório , Ventilação da Orelha Média , Redes Neurais de Computação , Otite Média com Derrame/cirurgia , Otoscopia
14.
BMJ Open ; 11(2): e042363, 2021 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-33597137

RESUMO

INTRODUCTION: A cohort of 12 000 children in the Philippines who had enrolled in a 2000-2004 (current ages 16 to 20 years) Phase 3 11-valent pneumococcal conjugate vaccine for the prevention of radiographically confirmed pneumonia are now being asked to participate in a separate study (expected completion date September 2021) to assess the cohort's current long-term audiometric and otologic status. This new study would allow assessments of the utility of the pneumococcal vaccine in conferring its protective effects on the long-term sequelae of otitis media (OM), if any. Lack of trained local healthcare providers in otolaryngology/audiology and testing equipment in Bohol, Philippines, necessitates the development of a distinct methodology that would lead to meaningful data analysis. METHODS AND ANALYSIS: Reliable data collection and transfer are achieved by a US otolaryngologist/audiologist team training local nurses on all procedures in a didactic and hands-on process. An assortment of portable otolaryngologic and audiologic equipment suitable for field testing has been acquired, including an operating otoscope (Welch-Allyn), a video-otoscope (JedMed), a tympanometer with distortion product otoacoustic emission measurements (Path Sentiero) and a screening audiometer (HearScreen). Data will then be uploaded to a Research Electronic Data Capture database in the USA.Tympanometric and audiologic data will be codified through separate conventional algorithms. A team of paediatric otolaryngology advanced practice providers (APPs) have been trained and validated in interpreting video otoscopy. The protocol for classification of diagnostic outcome variables based on video otoscopy and tympanometry has been developed and is being used by APPs to evaluate all otoscopy data. ETHICS AND DISSEMINATION: The study was approved by the Research Institute of Tropical Medicine, Alabang, Manila, Philippines, and the institutional review board and the Colorado Multiple Institutional Review Board of the University of Colorado School of Medicine, Aurora, Colorado, USA.Research results will be made available to children and their caregivers with abnormal audiologic outcomes, the funders and other researchers. TRIAL REGISTRATION NUMBER: ISRCTN 62323832; Post-results.


Assuntos
Otoscópios , Vacinas Pneumocócicas , Adolescente , Adulto , Criança , Colorado , Humanos , Otoscopia , Filipinas , Adulto Jovem
15.
Ann Otol Rhinol Laryngol ; 130(10): 1190-1197, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33629599

RESUMO

OBJECTIVE: Otoscopy is a frequently performed procedure and competency in this skill is important across many specialties. We aim to systematically review current medical educational evidence for training of handheld otoscopy skills. METHODS: Following the PRISMA guideline, studies reporting on training and/or assessment of handheld otoscopy were identified searching the following databases: PubMed, Embase, OVID, the Cochrane Library, PloS Medicine, Directory of Open Access Journal (DOAJ), and Web of Science. Two reviewers extracted data on study design, training intervention, educational outcomes, and results. Quality of educational evidence was assessed along with classification according to Kirkpatrick's model of educational outcomes. RESULTS: The searches yielded a total of 6064 studies with a final inclusion of 33 studies for the qualitative synthesis. Handheld otoscopy training could be divided into workshops, physical simulators, web-based training/e-learning, and smartphone-enabled otoscopy. Workshops were the most commonly described educational intervention and typically consisted of lectures, hands-on demonstrations, and training on peers. Almost all studies reported a favorable effect on either learner attitude, knowledge, or skills. The educational quality of the studies was reasonable but the educational outcomes were mostly evaluated on the lower Kirkpatrick levels with only a single study determining the effects of training on actual change in the learner behavior. CONCLUSION: Overall, it seems that any systematic approach to training of handheld otoscopy is beneficial in training regardless of learner level, but the heterogeneity of the studies makes comparisons between studies difficult and the relative effect sizes of the interventions could not be determined.


Assuntos
Competência Clínica/normas , Educação de Pós-Graduação em Medicina/métodos , Otolaringologia/educação , Otoscopia/normas , Humanos
16.
Ugeskr Laeger ; 183(4)2021 01 25.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33491630

RESUMO

Middle-ear cholesteatoma is a serious illness of the ear, which untreated can often lead to serious complications. The treatment is always surgical. The operation focuses on removing the cholesteatoma and repairing damaged structures like the ossicular chain. It is of utmost importance, that primary care physicians maintain a high suspicion for the presence of cholesteatoma. The most accessible tool is otoscopy. This review gives an overview of symptoms, signs in otoscopy and treatment modalities of cholesteatoma patients in Denmark.


Assuntos
Colesteatoma da Orelha Média , Colesteatoma da Orelha Média/diagnóstico , Colesteatoma da Orelha Média/cirurgia , Humanos , Otoscopia , Atenção Primária à Saúde , Estudos Retrospectivos
17.
Otolaryngol Head Neck Surg ; 164(1): 188-190, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32660342

RESUMO

Aural discomfort may be the result of obstructive eustachian tube (ET) dysfunction, temporomandibular joint dysfunction, or other causes. The infratemporal fossa (ITF) sign, in which a patient points to a characteristic location below the auricle, is proposed as an indicator of nonobstructive eustachian salpingitis. A preliminary study included patients with a complaint of aural discomfort who were prompted to localize symptoms using a single finger. Group 1 localized by using the ITF sign; group 2 localized deep within the external ear canal (suggesting ET dysfunction); and group 3 localized to the preauricular region (suggesting temporomandibular joint dysfunction). Findings of ET inflammation recorded during nasal endoscopy were greater in groups 1 and 2. Tympanometry and otoscopy were uniformly abnormal for group 2 and uniformly normal for groups 1 and 3. The ITF sign may help to identify eustachian salpingitis as a phenotype of ET disease characterized by symptomatic inflammation without abnormal middle ear pressure.


Assuntos
Otopatias/diagnóstico , Otopatias/fisiopatologia , Tuba Auditiva/fisiopatologia , Fossa Infratemporal/anatomia & histologia , Testes de Impedância Acústica , Adulto , Endoscopia , Tuba Auditiva/diagnóstico por imagem , Feminino , Humanos , Fossa Infratemporal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Otoscopia , Fenótipo , Exame Físico , Projetos Piloto , Salpingite , Inquéritos e Questionários , Telemedicina , Tomografia Computadorizada por Raios X
18.
Otolaryngol Head Neck Surg ; 164(2): 381-390, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32662734

RESUMO

OBJECTIVE: To evaluate the efficacy of acellular collagen scaffold (ACS) in combination with basic fibroblast growth factor (bFGF) for the repair of traumatic tympanic membrane (TM) perforation in a rat model. STUDY DESIGN: A prospective controlled animal study in a rat model of traumatic TM perforation. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Sprague-Dawley rats (N = 84) with unilateral traumatic perforation of the right TMs were randomized to receive ACS, bFGF, ACS in combination with bFGF (ACS/bFGF), or nothing (spontaneous healing without any interventions as a control group). The healing outcomes were evaluated by otoscopy, optical coherence tomography, histology, and transmission electron microscopy at 1, 2, and 4 weeks postoperatively. The hearing outcomes were assessed with auditory brainstem response testing. RESULTS: ACS/bFGF resulted in higher perforation closure rates at an earlier stage than spontaneous healing, ACS, and bFGF. Based on histology, optical coherence tomography, and transmission electron microscopy, a trilaminar structure and uniform thickness with mature, densely packed collagen fibers were seen in the ACS/bFGF group. Auditory brainstem response evaluation also showed that ACS/bFGF treatment promoted faster functional hearing recovery as compared with the control group. CONCLUSIONS: ACS is an effective TM scaffold and a carrier for bFGF. ACS/bFGF improves the TM closure rate, results in better-reconstructed TMs, and improves hearing. ACS/bFGF serves as a potential substitute for TM perforations in clinical settings.


Assuntos
Audição/fisiologia , Recuperação de Função Fisiológica , Tecidos Suporte , Perfuração da Membrana Timpânica/cirurgia , Membrana Timpânica/cirurgia , Cicatrização/efeitos dos fármacos , Animais , Colágeno/farmacologia , Modelos Animais de Doenças , Fator 2 de Crescimento de Fibroblastos/farmacologia , Otoscopia/métodos , Estudos Prospectivos , Ratos , Ratos Sprague-Dawley , Perfuração da Membrana Timpânica/fisiopatologia
19.
Eur Arch Otorhinolaryngol ; 278(6): 1799-1804, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32960350

RESUMO

PURPOSE: Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate's confidence to perform otoscopy is reported as low. Smartphone otoscopes have been suggested to improve undergraduates learning of normal eardrum anatomy because unlike the traditional otoscope, the learner and educator share the same image. This study aimed to evaluate whether a smartphone otoscope could enhance medical undergraduates recognition of common ear pathology. METHODS: 52 medical students were randomised into a standard group that used a traditional otoscope and an intervention group that used a smartphone otoscope. Both groups received a short didactic presentation on the recognition of common ear pathologies and were asked to diagnose four simulated pathologies. Both groups received feedback and guidance on how to better visualise the tympanic membrane. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope. RESULTS: The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs. 39%, p = < 0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs. 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone otoscope was preferential for their learning. The same number expressed that they want to use it in future learning. The remainder were indifferent. CONCLUSIONS: The smartphone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.


Assuntos
Otolaringologia , Otoscópios , Humanos , Otoscopia , Smartphone , Membrana Timpânica
20.
Eur Arch Otorhinolaryngol ; 278(7): 2313-2320, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32909062

RESUMO

PURPOSE: At graduation from medical school, competency in otoscopy is often insufficient. Simulation-based training can be used to improve technical skills, but the suitability of the training model and assessment must be supported by validity evidence. The purpose of this study was to collect content validity evidence for a simulation-based test of handheld otoscopy skills. METHODS: First, a three-round Delphi study was conducted with a panel of nine clinical teachers in otorhinolaryngology (ORL) to determine the content requirements in our educational context. Next, the authenticity of relevant cases in a commercially available technology-enhanced simulator (Earsi, VR Magic, Germany) was evaluated by specialists in ORL. Finally, an integrated course was developed for the simulator based on these results. RESULTS: The Delphi study resulted in nine essential diagnoses of normal variations and pathologies that all junior doctors should be able to diagnose with a handheld otoscope. Twelve out of 15 tested simulator cases were correctly recognized by at least one ORL specialist. Fifteen cases from the simulator case library matched the essential diagnoses determined by the Delphi study and were integrated into the course. CONCLUSION: Content validity evidence for a simulation-based test of handheld otoscopy skills was collected. This informed a simulation-based course that can be used for undergraduate training. The course needs to be further investigated in relation to other aspects of validity and for future self-directed training.


Assuntos
Competência Clínica , Treinamento por Simulação , Simulação por Computador , Alemanha , Humanos , Otoscopia
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