Erynne A. Faucett

A Fresh Cadaver Model for the Instruction of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules

Objective The aim of our study is to determine if a fresh cadaver model (FCM) for the instruction of ultrasound (US)–guided fine-needle aspiration (FNA) of thyroid nodules is a practical method for instruction. Study Design Pre- and postinstruction assessment of medical students’ ability to perform US-guided FNA of artificially created thyroid nodules placed adjacent to the thyroid gland of a fresh cadaver. Setting University-based fresh cadaver laboratory. Subjects and Methods Study participants included a total of 17 first- and second-year medical students with minimal US training. Technical skills were assessed using a 10-item checklist. In addition, a cognitive assessment regarding the indications, contraindications, and complications of the procedure was completed. A postinstruction assessment was provided for participants 5 weeks after their initial assessment. Differences between pre- and postinstruction assessment scores of technical skills were analyzed using McNemar’s test. The mean cognitive knowledge gain was analyzed using a paired 2-sample t test. Results Eight of 10 items on the skills checklist were statistically significant between pre- and postinstruction skills assessment (P < .05). There was a statistically significant change in cognitive knowledge gain regarding the contraindications of the procedure (P = .001), but not for indications or complications (P = .104 and P = .111, respectively). Conclusion US-guided FNA continues to be an important diagnostic procedure in the workup of thyroid nodules, making it an essential skill to integrate into surgical skills lab. Our FCM for the instruction of US-guided FNA is the first of its kind, and this pilot study shows this is a viable method for instruction.

Medicinal honey as treatment for skin reactions associated with bone-anchored hearing implant surgery.

1. Majtan J, Majtan V. Is manuka honey the best type of honey for wound care? Journal of Hospital Infection. 2010 Mar; 74(3): 305-306 2. Robson V, Dodd S, Thomas S. Standardized antibacterial honey (Medihoney) with standard therapy in wound care: randomized clinical trial. J Adv Nurs. 2009 Mar; 65(3): 565-75 3. Thamboo A, Philpott C et al. Single-blind study of manuka honey in allergic fungal rhinosinusitis. J Otolaryngol Head Neck Surg. 2011 Jun; 40(3):238-43 4. Biswal BM, Zakaria A & Ahmad NM. Topical application of honey in the management of radiation mucositis: a preliminary study. Support Care Cancer. 2003; 11:242-248 5. Thamboo A, Philpott C et al. Single-blind study of manuka honey in allergic fungal rhinosinusitis. J Otolaryngol Head Neck Surg. 2011 Jun; 40(3):238-43 6. Butler,G., Al Ghamdi, A., Salom, K., Al-Waili. Honey and microbial infections: a review supporting the use of honey for microbial control. J Med Food. 2011;14(10): 1079-1096 7. Robson V, Cooper RA & Ehsan ME. Honey in wound management following ENT surgery. Primary Intention. 2007 Nov; 15(4): 176-180 8. Flynn M, Breitholtz F, Halvarsson G, Rosengren A, Sadeghi A. (2008, Dec). Classifying skin reactions at the BAHA® implant site. Acknowledgements: The authors would like to thank the members of the University of Arizona Department of Otolaryngology and the University of Arizona School of Medicine for their opinions and suggestions for this work. Author Contact: eafaucett@oto.arizona.edu Table 1. Skin Reaction Characteristics Figure 1. Medihoney ®

Diversity in Otolaryngology Residency Programs: A Survey of Otolaryngology Program Directors

Objective As the population of the United States becomes increasingly racially and ethnically diverse, it is important that the medical profession reflect these changes. Otolaryngology has previously been identified as one of the surgical subspecialties with the smallest presence of those underrepresented in medicine. In the context of this study, the term underrepresented in medicine is defined as blacks, Latinos, Native American, and Native Hawaiians. The purpose of this study was to describe the current state of otolaryngology residency programs in terms of diversity of resident and faculty cohort, explore general interviewing practices, and investigate recruitment of underrepresented in medicine applicants. Study Design Survey via electronic questionnaire. Setting Academic otolaryngology residency programs. Subjects and Methods A 14-item survey was distributed to 105 program directors asking them to consider their program’s past 15 years of existence. Results With a response rate of roughly 30%, we found that over one-third of responding programs had matriculated 1 or fewer underrepresented in medicine residents. There was a statistically significant association between the number of underrepresented in medicine faculty and the number of underrepresented in medicine residents matriculated (P = .02). Conclusion The authors stress the importance of underrepresented in medicine faculty mentorship. Although not statistically significant in this study, increasing the number of underrepresented in medicine applicants interviewed, as well as recommending outreach programs, may help to improve underrepresented minority matriculation into residency programs as demonstrated in the literature.

Otolaryngology Resident Education and the Accreditation Council for Graduate Medical Education Core Competencies: A Systematic Review

Importance To date, there have been no reports in the current literature regarding the use of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in otolaryngology residency training. An evaluation may help educators address these core competencies in the training curriculum. Objectives To examine the quantity and nature of otolaryngology residency training literature through a systematic review and to evaluate whether this literature aligns with the 6 core competencies. Evidence Review A medical librarian assisted in a search of all indexed years of the PubMed, Embase, Education Resources Information Center (via EBSCOhost), Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register), Thomson Reuters Web of Science (Science Citation Index Expanded, Social Sciences Citation Index Expanded, Conference Proceedings Citation Index–Science, and Conference Proceedings Citation Index–Social Science and Humanities), Elsevier Scopus, and ClinicalTrials.gov databases to identify relevant English-language studies. Included studies contained original human data and focused on otolaryngology resident education. Data regarding study design, setting, and ACGME core competencies addressed were extracted from each article. Initial searches were performed on May 20, 2015, and updated on October 4, 2016. Findings In this systematic review of 104 unique studies, interpersonal communication skills were reported 15 times; medical knowledge, 48 times; patient care, 44 times; practice-based learning and improvement, 31 times; professionalism, 15 times; and systems-based practices, 10 times. Multiple studies addressed more than 1 core competency at once, and 6 addressed all 6 core competencies. Conclusions and Relevance Increased emphasis on nonclinical core competencies is needed, including professionalism, interpersonal and communication skills, and systems-based practices in the otolaryngology residency training curriculum. A formal curriculum addressing nonclinical core competencies should be integrated into otolaryngology residency training.

A Diagnostic Dilemma: Multiple Primary Intracranial Tumors Without Vestibular Schwannomas.

Sinonasal schwannomas with intracranial extension are exceedingly rare, with only 7 cases reported in the literature. Schwannomas can be isolated or multiple and are commonly associated with familial disorders such as neurofibromatosis 2 (NF 2) or familial schwannomatosis or in sporadic cases seen in sporadic schwannomatosis. Nearly all people with NF2 older than 30 years of age will have the hallmark of bilateral vestibular schwannomas (VS). This case highlights a reported case of an adult with separate primary intracranial tumors. We review the diagnostic criteria of NF2 and schwannomatosis, a recently described third variant of neurofibromatosis. In this case, we incorporate family history, histopathology, and the pathophysiology of both disorders to help determine a diagnosis for this patient.

Metastatic Prostate Cancer to the Left Temporal Bone: A Case Report and Review of the Literature

Breast, lung, and prostate cancers are the three most common malignancies to metastasize to the temporal bone. Still, metastatic prostate cancer of the temporal bone is a rare finding, with approximately 21 cases reported in the literature and only 2 cases discovered more than 10 years after initial treatment of the primary. This disease may be asymptomatic and discovered incidentally; however, hearing loss, otalgia, cranial nerve palsies, and visual changes can all be presenting symptoms. We present the case of a 95-year-old man with history of primary prostate cancer treated 12 years earlier that was seen for new-onset asymmetric hearing loss and otalgia. The tympanic membranes and middle ears were normal; however, based on radiologic findings and eventual biopsy, the patient was diagnosed with extensive metastatic prostate cancer to the left temporal bone. This case (1) demonstrates that a high index of suspicion for unusual etiologies of seemingly benign symptoms must be maintained in elderly patients having prior history of cancer and (2) substantiates the value of temporal bone imaging when diagnosis may be unclear from history and physical exam.

High-Quality Feedback Regarding Professionalism and Communication Skills in Otolaryngology Resident Education

Objective The Accreditation Council for Graduate Medical Education (ACGME) requires competency-based education for residents and recommends 5 basic features of high-quality feedback. Our aim was to examine the incorporation of feedback in articles regarding professionalism and interpersonal/communication skills for otolaryngology residency training curriculum. Data Sources PubMed, Embase, ERIC, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov. Methods We used studies identified during a systematic review of all indexed years through October 4, 2016. Results Eighteen studies were included in this review. Professionalism was discussed in 16, of which 15 (94%) examined aspects of feedback. Interpersonal/communication skills were the focus of 16 articles, of which 14 16 (88%) discussed aspects of feedback. Our assessment demonstrated that timeliness was addressed in 8 (44%) articles, specificity in 4 (22%), learner reaction and reflection in 4 (22%), action plans in 3 (20%), and balancing reinforcing/corrective feedback in 2 (13%). Two articles did not address feedback, and 6 did not address aspects of high-quality feedback. The ACGME-recommended feedback systems of ADAPT (ask, discuss, ask, plan together) and R2C2 (relationship, reactions, content, and coach) were not reported in any of the studies. Conclusion Feedback is an essential component of graduate medical education and is required by the ACGME milestones assessment system. However, the core feedback components recommended by the ACGME are rarely included in the otolaryngology resident education literature.

The first reported case of recurrent carcinoid tumor in the external auditory canal

OBJECTIVE Cutaneous neuroendocrine lesions of the external auditory canal (EAC) are exceptionally rare, with only five cases reported in the literature. In this case report, we present a patient with a recurrent carcinoid tumor in the EAC, which has yet to be described. PATIENTS A 38-year-old woman presenting with otalgia, aural fullness, and decreased hearing was found to have a recurrent EAC carcinoid tumor, 8-years after initial resection at an outside facility. INTERVENTIONS The recurrent tumor involved much of the proximal, anterior bony ear canal and was trans-tympanic, extending to the middle ear and epitympanum; therefore, a lateral temporal bone resection was performed to ensure complete resection. MAIN OUTCOME MEASURES Surgical pathology confirmed the presence a recurrent carcinoid tumor in the EAC, with immunohistochemistry positive for pancytokeratin (MAK6), CD56, and synaptophysin, with chromogranin showing rare cells positive for cytoplasmic granules. There was no evidence of metastasis. RESULTS Lateral temporal bone resection was successful and the patient is being followed with annual imaging. The patient is considering future hearing rehabilitation with a bone anchored hearing device. CONCLUSION This case report highlights the first known case of recurrent carcinoid tumor in the EAC, treated with lateral temporal bone resection. Clinical presentation, imaging, treatment, and pathology are reviewed along with a review of the literature.

Immunoglobulin G4–related sclerosing disease Mimicking sjogren's syndrome: A case report

Immunoglobulin G4–related sclerosing disease (IgG4‐RSD) is a fibroinflammatory condition that has the potential to affect nearly every organ system. Classic histological findings include storiform fibrosis and lymphoplasmacytic infiltrates of immunoglobulin G4 (IgG4)–positive plasma cells. The clinical features of IgG4‐RSD may be an under‐recognized disease process that can mimic other autoimmune disorders, including Sjogrens syndrome. We describe a rare case of IgG4‐RSD involving the salivary glands, initially misdiagnosed as Sjogrens syndrome. Clinical features of IgG4‐RSD can mimic those of other autoimmune disorders affecting the head and neck. Therefore, otolaryngologists should have IgG4‐RSD on their differential when evaluating patients with diffuse salivary gland swelling. Laryngoscope, 126:2242–2245, 2016