National trends in otolaryngology intern curricula following Accreditation Council for Graduate Medical Education changes

Objectives/Hypothesis

In 2016, Accreditation Council for Graduate Medical Education (ACGME) requirements for curriculum and resident experiences were modified to require entering postgraduate year (PGY)-1 residents to spend 6 months of structured education on otolaryngology–head and neck surgery (ORL-HNS) rotations. We aimed to determine how ORL-HNS training programs have adapted curricula in response to 2016 ACGME curriculum requirement changes.

Study Design

Survey study.

Methods

A national survey of ACGME-accredited ORL-HNS programs was distributed via the Otolaryngology Program Directors Organization.

Results

Thirty-seven program directors responded (34.9%). Most common ORL-HNS rotations included general otolaryngology (80.6% of programs, up to 6 months) and head and neck oncology (67.7%, up to 4 months), though more months are also spent on other subspecialty rotations (laryngology, otology, rhinology, and pediatrics) than previously. All programs continue at least 1 month of anesthesiology, intensive care unit, and general surgery. Programs have preferentially eliminated rotations in emergency medicine (77% decrease) and additional months on general surgery (48% decrease). Curricula have incorporated supplemental teaching modalities including didactic lectures (96.3% of programs), simulation (66.7%), dissection courses (63.0%), and observed patient encounters (55.5%), to a greater degree following ACGME changes. More interns are involved in shared call responsibilities than in previous years (70.4% vs. 51.8%). A stable minority of interns take the Otolaryngology Training Examination (approximately 20%).

Conclusions

New ACGME requirements have challenged ORL-HNS training programs to develop effective 6-month rotation schedules for PGY-1 residents. Significant variation exists between programs, and evaluation of first-year curricula and readiness for PGY-2 year is warranted.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2yRzuie

Clinical characteristics and outcomes of major salivary gland malignancies in children

Objectives/Hypothesis

Determine demographics, clinical characteristics, and survival rates for children with primary salivary gland malignancies.

Study Design

Retrospective, population-based cohort study.

Methods

All cases of primary salivary gland malignancies diagnosed between the years of 2002 and 2013 in patients ages 0 to 19 years were extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Additional variables collected included age, gender, ethnicity, tumor histological subtype, tumor size, treatment modality, vitality status, and follow-up time. Kaplan-Meier survival curves were generated.

Results

Two hundred forty-five primary salivary gland malignancies were identified (220 parotid, 25 submandibular). Median age at diagnosis was 15 years. Most patients were female (59%), white (74%), and non–Spanish/Hispanic/Latino (81%). Among parotid tumors, mean tumor size was 2.3 cm, and there were 109 (50%) mucoepidermoid carcinomas and 86 (39%) acinic cell carcinomas. Most patients underwent surgery (n = 212, 96%) and 64 (29%) received adjuvant radiation. At a mean follow-up of 62.4 months, 10 patients (5%) were deceased. Kaplan-Meier survival curves illustrated that black children exhibited higher mortality rates than white children (15.8% vs. 4.6%, log-rank = 0.0260) as did those who underwent adjuvant radiation (15.73% vs. 3.2%, log-rank = 0.0209). Among submandibular tumors, mean tumor size was 3.1 cm, and there were 11 (44%) mucoepidermoid carcinomas. All patients underwent surgery and most received adjuvant radiation (n = 15, 60%). At a mean follow-up of 51.25 months, one patient was deceased.

Conclusions

Salivary gland malignancies in children and adolescents are rare. Overall survival for both parotid and submandibular tumors in children is good.

Level of Evidence

4 Laryngoscope, 2017

http://ift.tt/2kwF8Us

The futility of intraoperative frozen section in the evaluation of follicular thyroid lesions

Objective

Investigate the utility of intraoperative frozen section (iFS) in patients with follicular thyroid lesions following publication of the 2015 American Thyroid Association (ATA) guidelines.

Study Design

Retrospective chart review.

Methods

Patient demographics, preoperative cytology, frozen pathology, and final pathology were reviewed on patients undergoing thyroid surgery at a tertiary care hospital in which iFS was utilized over a 5-year period. The test performance of iFS and the frequency of indicated completion/total thyroidectomies pre- and postpublication of the 2015 ATA guidelines were calculated.

Results

One hundred and one patients met inclusion criteria: 54 patients with follicular lesions of undetermined significance (FLUS) and 47 patients with a cytologic diagnosis of suspicious for follicular neoplasm/follicular neoplasm. The malignancy rate was 36%, but only 14% of malignancies were identified on iFS. A definitive benign or malignant diagnosis was given on iFS in only 21% of cases, and operative management was altered in two cases as a result of iFS. There was a statistically significant reduction in the frequency of indicated total/completion thyroidectomies based on high-risk features as a result of the 2015 ATA guidelines compared to prior recommendations (20.8% vs. 5.0%, P = < 0.001). None of these patients had findings on iFS that would have altered management intraoperatively.

Conclusion

Intraoperative frozen section offers minimal diagnostic utility in the evaluation of follicular thyroid lesions. Updates in the 2015 ATA guidelines further diminish its potential to impact management intraoperatively. Significant improvements in its ability to identify malignancies would be needed to justify its use.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2yShnIZ

Hormone receptors analysis in idiopathic progressive subglottic stenosis

Objective

Idiopathic subglottic stenosis predominantly affects fertile and perimenopausal women. Estrogens and/or progesterone have been proposed as mediators of its pathogenesis by stimulating collagen deposition within the upper airway. We evaluated the presence and expression of estrogen-alpha (ER-α), estrogen-beta (ER-β), and progesterone receptors (PR) in idiopathic stenotic patients.

Study Design

A retrospective analysis on 42 surgical specimens from idiopathic stenosis female patients (mean age, 52.4; age range, 31–79) and 28 gender- and age-matched controls.

Methods

Immunoreactivity of ER-α, ER-β, and PR was calculated as the product of intensity (1 = weak, 2 = moderate, 3 = strong) and positive cell percentage (1–4, for < 10/10–50/50–80/ > 80%). This score was calculated on the stenotic and peristenotic tissues. Influence of menopausal status on hormonal expression and stenotic grade was tested.

Results

Stenosis showed ER-α overexpression versus peristenotic tissue and controls (score 6.6 ± 4.4, 0.3 ± 0.5, and 2.2 ± 1.5, respectively; P < 0.001). Overexpression was even more marked for progesterone receptors (score 8.3 ± 3.6, 0.8 ± 0.6, and 1.0 ± 0.7, respectively; P < 0.001). There was no expression of ER-β in stenosis (score 0), whereas it was normally expressed in peristenotic tissue and controls (score 0.7 ± 0.5 and 0.5 ± 0.5; P < 0.001 vs. stenosis). Expression of ER-α was higher in postmenopausal stenotic patients (P < 0.01). This subgroup included a higher proportion of Cotton-Myer grade III stenosis than in premenopausal subjects (P < 0.001).

Conclusion

An imbalance between ER-α, ER-β, and PR is present in idiopathic stenosis patients. The hormonal background may be involved in inappropriate inflammation and increased stenosis susceptibility. Menopausal changes seem to play a role in both stenosis grade and receptor patterns.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2kxK7Eq

The saline challenge-A test of injection laryngoplasty outcome

http://ift.tt/2ySrfSW

The radioanatomy of endonasal flap coverage of skull base defects: A tool for preoperative planning

Objectives/Hypothesis

To develop a tool for the calculation of surgical skull base defects and endonasal flap dimensions on preoperative computed tomography (CT) to aid surgical planning.

Study Design

Case series.

Methods

A literature search was conducted to identify all endonasal flaps. There were five basic models identified. These are the nasoseptal flap, anterior lateral nasal wall flap, bipedicled anterior septal flap, posterior pedicled inferior turbinate flap, and middle turbinate flap. Publications on the radioanatomy of endonasal flaps and surgical skull base defects were also identified. Using these descriptions as a reference, 38 radioanatomic variables were measured on CT scans obtained from 60 preoperative endonasal skull base surgery patients. These were then used to model endonasal flap coverage of six defects: transfrontal, transcribriform, transplanar, transsellar, transsphenoidal, and transclival.

Results

The nasoseptal provides adequate coverage for most defects. The posteriorly pedicled inferior turbinate flap is a good alternative, and provides better coverage of posterior skull base defects. The anterior lateral nasal wall flap is the best choice for transfrontal defects. The middle turbinate flap and bipedicled anterior septal flaps provide secondary options when larger flaps are not available.

Conclusions

We have developed a simple tool for the calculation of endonasal flap coverage of surgical skull base defects on preoperative CT scans.

Level of Evidence

4 Laryngoscope, 2017

http://ift.tt/2kzqHPB

Adaptation and validation of the Spanish version of the Tonsil and Adenoid Health Status Instrument

Objectives/Hypothesis

The Tonsil and Adenoid Health Status Instrument (TAHSI) is a disease-specific questionnaire, intended for completion by parents, for assessing quality of life related to tonsil and adenoid disease or its treatment in children with throat disorders. The aim of this study was to validate the Spanish adaptation of the TAHSI, thus allowing comparison across studies and international multicenter projects.

Study Design

Multicenter prospective instrument validation study.

Methods

Guidelines for the cross-cultural adaptation process from the original English-language scale into a Spanish-language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version of the TAHSI (s-TAHSI) were assessed in 51 consecutive children undergoing adeno/tonsillectomy (both before and 6 months after surgery) and a separate cohort of 50 unaffected children of comparable age range.

Results

Test-retest reliability (γ = 0.8) and internal consistency reliability (α = 0.95) were adequate. The s-TAHSI demonstrated satisfactory content validity (r > 0.40). The instrument showed excellent between-groups discrimination (P < .0001) and high responsiveness to change (effect size = 2.09).

Conclusions

Psychometric testing of the s-TAHSI yielded satisfactory results, thus allowing assessment of the subjective severity of throat disorders in children.

Level of Evidence

2c Laryngoscope, 2017

http://ift.tt/2ySJVlJ