Murad Husein

Interactive computer-based simulator for training in blade navigation and targeting in myringotomy

A virtual-reality simulator was developed for the training of Otolaryngology (Ear-Nose-Throat) surgical residents to perform myringotomy, a relatively common surgical procedure in which an incision is made in the eardrum mainly to treat middle-ear infections. The simulator presents the trainee with a three-dimensional (3D) virtual model of the ear that can be viewed through a mock surgical microscope consisting of a stereo visor mounted on a custom-designed stand. The trainee interacts with the virtual ear using a real myringotomy blade, the movements of which are tracked in real time using a stereo optical tracker. Interactions of the blade with virtual tissues are calculated and rendered on the visor using freely available physics and graphics software engines. Six experienced surgical residents and surgeons assessed the effectiveness of the simulator as a viable training tool by completing a questionnaire designed specifically for this study after using the simulator. Surgeons and residents were positively impressed by the simulator as a training tool and would recommend its use as part of training.

A general review of the otolaryngologic manifestations of Down Syndrome

OBJECTIVEnDown Syndrome (DS) is the most common chromosome abnormality in liveborn children. Otolaryngologists frequently encounter these patients in their practice; in one survey, 50% of DS patients had been seen by Otolaryngology at least once. As such, it is essential that the practicing Otolaryngologist is aware of the otologic, rhinologic, and laryngologic manifestations of this complex disease and comfortable in the management and treatment of these unique patients. Our goal was to provide this information in a concise and definitive document.nnnMETHODSnA comprehensive literature review using PubMed was completed. The terms Otolaryngology, Head and neck, Ear, nose, throat, Down Syndrome, and Trisomy 21 were searched in various combinations. Applicable articles that discussed the Otolaryngologic manifestations of Down Syndrome were included.nnnRESULTSnIn total, fifty articles were included for review. The Down Syndrome child tends to have smaller external ear canals, have higher rates of chronic ear disease, and may present with conductive, sensorineural, or mixed hearing loss. As such, DS patients should receive behaviouralaudiological testing every 6 monthsand annually after the age of three in addition to closer follow-up by an Otolaryngologist if tympanic membranes cannot be visualized or if the external auditory canals are significantly stenosed. Management should involve close follow-up and a low threshold for PE tube placement to reduce the risks for speech and language delay. Chronic rhinitis in the Down Syndrome patient is common. Retrognathia, hypotonia, and macroglossia can all cause obstructive sleep apnea (OSA) in this population and therefore each DS patient should get an overnight polysomnograph. Subglottic stenosis, vocal cord paralysis and laryngomalacia are not infrequently seen in the Down Syndrome patient. To reduce acquired subglottic stenosis, endotracheal tubes that are at least two sizes smaller than what is appropriate for the patients age should be used.nnnCONCLUSIONnDown Syndrome is common and there are many Otolaryngologic manifestations. We recommend that this patient population visit an Otolaryngologist on a regular basis and that the practicing Otolaryngologist is comfortable with the management and treatment of the unique challenges faced with these children.

The epidemiology, antibiotic resistance and post-discharge course of peritonsillar abscesses in London, Ontario

BackgroundPeritonsillar abscesses (PTA) are a common complication of tonsillitis. Recent global epidemiological data regarding PTAs have demonstrated increasing antimicrobial resistance patterns. No similar studies have been conducted in Canada and no Canadian study has examined the post-discharge course of treated patients.MethodsA prospective observational study of the epidemiology, antibiotic resistance and post-discharge course of patients presenting with a peritonsillar abscess to the Emergency Department in London, Ontario over one year. A follow-up telephone survey was conducted 2–3 weeks after abscess drainage.Results60 patients were diagnosed with an abscess, giving an incidence of 12/100,000. 46 patients were enrolled in the study; the average duration of symptoms prior to presentation was 6 days, with 51% treated with antibiotics prior to presentation. Streptococcus pyogenes and Streptococcus anginosus were present in 56% of isolates and of those, 7/23 (32%) of specimens demonstrated resistance to clindamycin. Eight patients were treated with clindamycin and had a culture that was resistant, yet only one had recurrence. Telephone follow-up was possible for 38 patients: 51% of patients reported a return to solid food within 2 days, and 75% reported no pain by 5 days. Resolution of trismus took a week or longer for 51%.InterpretationClindamycin resistance was identified in a third of Streptococcus isolates, which should be taken into account when prescribing antibiotics. Routine culture appears unnecessary as patients recover quickly from outpatient drainage and empiric therapy, with less pain than expected, but trismus takes time to resolve.

Objective assessment of Myringotomy and tympanostomy tube insertion: A prospective single-blinded validation study.

Despite the transition to competency‐based education in surgery, few standardized assessment tools exist in otolaryngology training. In particular, myringotomy and tympanostomy tube insertion (M+T) is a common surgical procedure with few validated assessment tools available. Our objectives were to develop an objective structured assessment of operative skills in M+T and to provide validity evidence for the developed assessment tool within otolaryngology training.

Face and content validity of a novel, web-based otoscopy simulator for medical education.

BackgroundDespite the fact that otoscopy is a widely used and taught diagnostic tool during medical training, errors in diagnosis are common. Physical otoscopy simulators have high fidelity, but they can be expensive and only a limited number of students can use them at a given time.Objectives1) To develop a purely web-based otoscopy simulator that can easily be distributed to students over the internet. 2) To assess face and content validity of the simulator by surveying experts in otoscopy.MethodsAn otoscopy simulator, OtoTrain™, was developed at Western University using web-based programming and Unity 3D. Eleven experts from academic institutions in North America were recruited to test the simulator and respond to an online questionnaire. A 7-point Likert scale was used to answer questions related to face validity (realism of the simulator), content validity (expert evaluation of subject matter and test items), and applicability to medical training.ResultsThe mean responses for the face validity, content validity, and applicability to medical training portions of the questionnaire were all ≤3, falling between the “Agree”, “Mostly Agree”, and “Strongly Agree” categories. The responses suggest good face and content validity of the simulator. Open-ended questions revealed that the primary drawbacks of the simulator were the lack of a haptic arm for force feedback, a need for increased focus on pneumatic otoscopy, and few rare disorders shown on otoscopy.ConclusionOtoTrain™ is a novel, web-based otoscopy simulator that can be easily distributed and used by students on a variety of platforms. Initial face and content validity was encouraging, and a skills transference study is planned following further modifications and improvements to the simulator.

Incidence and Risk Factors of Velopharyngeal Insufficiency Postadenotonsillectomy.

Objectives To evaluate the incidence and risk factors of velopharyngeal insufficiency (VPI) postadenoidectomy, posttonsillectomy, and postadenotonsillectomy. Study Design Retrospective chart review. Setting Academic tertiary care center (2007-2014). Subjects and Methods Retrospective review of patients who underwent adenoidectomies, tonsillectomies, or adenotonsillectomies by 1 pediatric otolaryngologist. Patient’s age, sex, type of surgery, indication for surgery, medical syndromes, tonsil grade, adenoid size, and pre- and postoperative nasal air emissions were obtained. Results The VPI risk at 3 weeks postoperatively was 13.6% (95% CI: 9.0%, 18.2%) for adenotonsillectomies, 3.2% (95% CI: 1.2%, 7.6%) for adenoidectomies, and 2.2% (95% CI: 2.1%, 6.5%) for tonsillectomies. There was a significantly higher risk of VPI with combined procedures in comparison with adenoidectomies (P = .02) or tonsillectomies alone (P = .03). There was no significant difference in risk of VPI between adenoidectomies and tonsillectomies (P = .78); between surgical indication groups (sleep-disordered breathing vs other; P = .15); or in terms of sex (P = .80), age (P = .11), tonsil grade (P = .96), or adenoid size (P = .15). There was no qualitative difference in postoperative nasal air emissions between patients with and without medical syndromes. Conclusion Our data are consistent with the literature that most VPI after adenotonsillectomy is temporary in nature and resolves by 5 months postoperatively. Combined procedures were shown to have a significantly higher risk of VPI. Our rates of VPI were much higher than that previously cited and may be indicative of subclinical cases of VPI, which were accounted for due to this study’s unique methodology.

Blinded randomized controlled study of a web‐based otoscopy simulator in undergraduate medical education

OtoTrain is a Web‐based otoscopy simulator that has previously been shown to have face and content validity. The objective of this study was to evaluate the effectiveness of this Web‐based otoscopy simulator in teaching diagnostic otoscopy to novice learners

An evaluation of communication apprehension in adolescents with velopharyngeal inadequacy.

Objective This investigation evaluated the construct of communication apprehension (CA) in adolescents with velopharyngeal inadequacy (VPI). Design Prospective comparative study. Settings The investigation was conducted in a hospital-based clinic, voice laboratory, and the homes of participants. Participants Two groups of children participated in this study. The first group was composed of 14 children between the ages of 8 and 14 years who attended the velopharyngeal inadequacy (VPI) clinic at our institution, and the second group was composed of 14 age-matched children from the community with no history of speech or voice disorders. Interventions The study involved completion of the Measure of Elementary Communication Apprehension (MECA) by all 28 participants (14 experimental and 14 control subjects). Reliability of the subjects’ responses to the MECA was also evaluated. Outcome Measures Communication apprehension scores obtained from the MECA were the main focus of the study. Results Children with VPI experienced significantly higher levels of CA than did those in the control group. Moderate-to-good reliability of the MECA was found. Conclusions Based on these data, children with VPI may be experiencing increased levels of CA. Consequently, the experience of high CA has the potential to affect the communication performance and social functioning of children with VPI.

Surgical Distance to the Sphenoid Ostium: A Comparison of Healthy Patients and Patients With Cystic Fibrosis

OBJECTIVESnTo establish and compare the distance and angle from the limen nasi to the sphenoid ostium in pediatric patients with normal sinonasal anatomy vs pediatric patients with cystic fibrosis (CF).nnnDESIGNnRetrospective review of computed tomographic images.nnnSETTINGnTertiary university-based medical center.nnnPARTICIPANTSnPatients (newborn to age 20 years) with normal sinonasal anatomy (n = 117) or CF (n = 15).nnnMAIN OUTCOME MEASURESnWe used a fourth-degree polynomial to curve-fit the distance to the sphenoid ostium vs age for patients with normal sinonasal anatomy, producing a coefficient of determination (R(2)) of 82%. With this regression curve, we produced a normative distance equation and a normative distance graph using age to predict the distance (95% confidence interval). We validated the normative distance curve fit among 30 new pediatric patients.nnnRESULTSnNo significant difference in the distance to the sphenoid ostium was found between healthy patients and patients with CF. There was no correlation between age and angle in either patient group. The mean (SD) angle was statistically different between healthy patients (37.5 degrees [7.5 degrees]) and patients with CF (41.4 degrees [7.4 degrees]).nnnCONCLUSIONSnUsing a normative distance graph and the mean angle, surgeons performing pediatric endoscopic sinus surgery can predict the distance to the sphenoid ostium for healthy patients and for patients with CF. These findings may decrease complications of endoscopic sinus surgery among the pediatric population.

Velopharyngeal dysfunction from intranasal substance abuse: Case series and review of literature: VPD and Intranasal Substance Abuse

Intranasal substance abuse with cocaine or opioids can result in complications involving the midline nasal and oral structures. When the defect involves the velopharyngeal musculature, this leads to velopharyngeal dysfunction (VPD). This article aims to illustrate this clinical entity through a series of four patients and a review of the literature.