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Introduction: Rapid advancements in Next Generation Sequencing (NGS) and bioinformatics tools have allowed physicians to obtain genetic testing results in a more rapid, cost-effective, and comprehensive manner than ever before. Around 50% of pediatric sensorineural hearing loss (SNHL) cases are due to a genetic etiology, thus physicians regularly utilize targeted sequencing panels that identify variants in genes related to SNHL. These panels allow for early detection of pathogenic variants which allows physicians to provide anticipatory guidance to families. Molecular testing does not always reveal a clear etiology due to the presence of multigenic variants with varying classifications, including the presence of Variants of Uncertain Significance (VUS). This study aims to perform a preliminary bioinformatics characterization of patients with variants associated with Type II Usher Syndrome in the presence of other multigenic variants. We also provide an interpretation algorithm for physicians reviewing molecular results with medical geneticists. Methods: Review of records for multigenic and/or VUS results identified several potential subjects of interest. For the purposes of this study, two ADGRV1 compound heterozygotes met inclusion criteria. Sequencing, data processing, and variant calling (the process by which variants are identified from sequence data) was performed at Invitae (San Francisco CA). The preliminary analysis followed the recommendations outlined by the American College of Medical Genetics and Association for Molecular Pathology (ACMG-AMP) in 2015 and 2019. The present study utilizes computational analysis, predictive data, and population data as well as clinical information from chart review and publicly available information in the ClinVar database. Results: Two subjects were identified as compound heterozygotes for variants in the gene ADGRV1. Subject 1's variants were predicted as deleterious, while Subject 2's variants were predicted as non-deleterious. These results were based on known information of the variants from ClinVar, multiple lines of computational data, population databases, as well as the clinical presentation. Discussion: Early molecular diagnosis through NGS is ideal, as families are then able to access a wide range of resources that will ultimately support the child as their condition progresses. We recommend that physicians build strong relationships with medical geneticists and carefully review their interpretation before making recommendations to families, particularly when addressing the VUS. Reclassification efforts of VUS are supported by studies like ours that provide evidence of pathogenic or benign effects of variants.
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OBJECTIVE: To examine the relationship between conferred immunity after standard pneumococcal series and refractory otolaryngologic infections in pediatric patients using post-vaccination antibody titers, and to identify contributory underlying conditions revealed when vaccination/re-vaccination fails to confer protective immunity. STUDY DESIGN: IRB-reviewed and "exempt" retrospective case series with chart review using the Epic® Electronic Medical Record system from 2013 to 2021. SETTING: Dedicated tertiary referral children's hospital. METHODS: Pneumococcal antibody titer results were assessed for children ages 0 to 21 years and: (1) at least 1 of 7 otolaryngologic disease diagnoses and (2) having received the 4-dose schedule of pneumococcal conjugate vaccine (PCV 7 or 13). RESULTS: A total of 241 subjects met inclusion criteria with 356 laboratory tests. Recurrent acute otitis media, chronic rhinitis, and chronic otitis media with effusion were the 3 most frequent diagnoses. At presentation, only 27.0% of subjects had titers conferring immunity from their prior vaccinations with PCV. About 85 subjects had been subsequently revaccinated with Pneumococcal Polysaccharide Vaccine (PPSV), and antibody responses conferring immunity reached 91.8%. Seven subjects never developed adequate responses; 5 of these had recurrent acute otitis media as the primary otolaryngologic diagnosis. Secondary "revealed" diagnoses included Juvenile Rheumatoid Arthritis (n = 1), unresolved specific antibody deficiency (n = 2), and Hypogammaglobulinemia (n = 1). CONCLUSION: In pediatric patients with recurrent infectious otolaryngologic disease refractory to traditional medical and surgical therapy, inadequate responses to pneumococcal vaccination may be revealed. This correlation represents a potential pathway for diagnosis and therapy.
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Otitis Media , Infecciones Neumocócicas , Vacunas Neumococicas , Niño , Humanos , Otitis Media/tratamiento farmacológico , Infecciones Neumocócicas/prevención & control , Infecciones Neumocócicas/tratamiento farmacológico , Vacunas Neumococicas/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Streptococcus pneumoniae , VacunaciónRESUMEN
Auditory neuropathy spectrum disorder (ANSD) is a spectrum of conditions marked by diminished auditory function and believed to be caused by the impaired neural transmission of auditory stimulation in the setting of functional outer hair cells (Rance1). There are reports of "spontaneously resolving" or "transient" ANSD (TAN) in the literature. In this case report of TAN, we demonstrate the resurgence of the ABR waveform morphology over a 3-year period to reveal electrophysiologic testing consistent with the subject's functional hearing level by age 3 years.
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AIM: This commentary presents practical and evidenced based guidelines for the development and delivery of real-time online training workshops aimed at rural health professionals. CONTEXT: Online learning is increasingly being used as an avenue for delivering education, particularly to rural and remote sites where barriers persist in upskilling health workers. Further, online learning has become essential during the coronavirus disease 2019 (COVID-19) pandemic. In response to the Australian 2020 COVID-19 social distancing requirements, our team rapidly transformed face-to-face educational workshops into an online format, to deliver over 20 workshops to more than 150 multidisciplinary staff across our large rural district. APPROACH: There are no published guidelines regarding the conversion of face-to-face education programs into an online format within health care. We conducted a review of the literature regarding the implementation of online education programs. Three broad categories of evidence were identified: participant qualities, content development and content deliverance. CONCLUSION: We present a set of practical and evidenced based recommendations, which will enhance live online workshops for a rural health workforce. These recommendations are derived both from published literature and our experience delivering our workshops. We argue that rural health professionals and organisations need relevant, up-to-date practical guidelines and more institutional support and training focused on creating and implementing live online educational programs in rural Australia.
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COVID-19 , Educación a Distancia , Servicios de Salud Rural , Humanos , Australia , Salud Rural , Fuerza Laboral en SaludAsunto(s)
Linfadenitis , Humanos , Animales , Linfadenitis/diagnóstico , Cuello/diagnóstico por imagenRESUMEN
OBJECTIVES: To assess use of and physician experiences with pediatric otolaryngology telehealth visits as impacted by the COVID-19 pandemic. STUDY DESIGN/SETTING: Cross sectional survey. METHODS: A 15-question survey was electronically distributed to 656 members of the American Society of Pediatric Otolaryngology in August 2021, addressing member demographics, experiential practice elements, and use pre-pandemic, during the initial shutdown period of March-May 2020, and current use at the time of survey inquiry. RESULTS: There were 124 respondents (response rate = 18.9%). Incident use pre-pandemic and during the shutdown were 21.0% (n = 26), and 92.7% (n = 115), respectively. Current use was 83.9% (n = 104) and the percentage of new current users (79.5%, n = 78) was significant (P < .0001,95% CI = 70.6%-86.4%). Estimated median telehealth visit rates pre-pandemic, during shutdown, and currently were 0 to 1, 4 to 5, and 2 to 3 per week, respectively (P < .0001). A difference in post-covid adoption rates was noted only for location (P = .008), with no differences for years out of training or practice type. Compared to in-person visits, physician satisfaction with telehealth visits was rated equivalent (49.0%) or worse/much worse (48.1%). The most common telehealth uses were follow-up visits (83.7%), pre-operative counseling (76.9%), and post-operative evaluation (69.2%). The need for a detailed exam (89.4%) and initial visits (32.7%) were reasons a telehealth visit was not offered. CONCLUSIONS: The COVID-19 pandemic appears to have precipitated a rapid increase in telehealth adoption among surveyed pediatric otolaryngologists, regardless of age or practice type. The most significant limitations remain the need for a detailed exam, perceived low patient technological literacy, and limitations to interpretive services. Technology-based optimization of these barriers could lead to increased use and physician satisfaction.
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COVID-19 , Telemedicina , Humanos , Niño , COVID-19/epidemiología , Pandemias , SARS-CoV-2 , Otorrinolaringólogos , Estudios TransversalesRESUMEN
OBJECTIVES: To characterize the patient population with severe bronchopulmonary dysplasia (BPD) requiring tracheostomy in a large tertiary level 4 neonatal intensive care unit (NICU) and to identify potential targets for improvement in the delivery of high-quality healthcare. METHODS: An IRB-exempt but IRB-registered retrospective review of medical records. Study inclusion criteria: patients treated for severe BPD with tracheostomy under 2 years of age in our tertiary referral center NICU. Control group criteria: 4-year aggregate NICU patient demographics. Basic demographics, maternal history, clinical data points, and outcomes variables were collected. RESULTS: There was a statistically significant difference between the two groups in only one variable: racial identification (p-value = 0.036). All data points were then analyzed against racial identification, and statistically significant differences appeared in 4 categories: 1) illicit drug use, 2) birth head circumference and length, 3) days to readmission, and 4) child opportunity index scores. There was not a statistically significant difference in any other maternal characteristics or medical comorbidities, NICU length of stay, age at tracheostomy, or decannulation status. CONCLUSION: The incidence of our tracheostomy in infants with severe BPD was significantly higher (p = 0.036) in the subjects whose families identified as racially African American or Black, a marked contrast to our general NICU population and our overall tracheostomy population. The timing of the first readmission to the hospital was shorter for Caucasian or White infants compared to African American or Black infants. COI demonstrated statistically significantly poorer resources for African American or Black infants compared to White infants with tracheostomy. All other perinatal and outcome measurements did not differ significantly between the two racial groups. This suggests that this racial disparity is present and needs further investigation to better assess its impact on risk and outcomes as we develop pathways for high-quality healthcare delivery.
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Displasia Broncopulmonar , Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/terapia , Niño , Femenino , Edad Gestacional , Disparidades en Atención de Salud , Humanos , Lactante , Recién Nacido , Embarazo , Grupos Raciales , Estudios Retrospectivos , Factores de Riesgo , TraqueostomíaRESUMEN
The topographic features of surfaces are known to affect bacterial retention on a surface, but the precise mechanisms of this phenomenon are little understood. Four coccal-shaped bacteria, Staphylococcus sciuri, Streptococcus pyogenes, Micrococcus luteus, and Staphylococcus aureus, that organise in different cellular groupings (grape-like clusters, tetrad-arranging clusters, short chains, and diploid arrangement, respectively) were used. These differently grouped cells were used to determine how surface topography affected their distribution, density, dispersion, and clustering when retained on titanium surfaces with defined topographies. Titanium-coated surfaces that were smooth and had grooved features of 1.02 µm-wide, 0.21 µm-deep grooves, and 0.59 µm-wide, 0.17 µm-deep grooves were used. The average contact angle of the surfaces was 91°. All bacterial species were overall of a hydrophobic nature, although M. luteus was the least hydrophobic. It was demonstrated that the 1.02 µm-wide featured surface most affected Strep. pyogenes and S. sciuri, and hence the surfaces with the larger surface features most affected the cells with smaller dimensions. The 0.59 µm featured surface only affected the density of the bacteria, and it may be suggested that the surfaces with the smaller features reduced bacterial retention. These results demonstrate that the size of the topographical surface features affect the distribution, density, dispersion, and clustering of bacteria across surfaces, and this is related to the cellular organisation of the bacterial species. The results from this work inform how surface topographical and bacterial properties affect the distribution, density, dispersion, and clustering of bacterial retention.
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Bacterial retention and organic fouling on meat preparation surfaces can be influenced by several factors. Surfaces with linear topographies and defined chemistries were used to determine how the orientation of the surface features affected cleaning efficacy. Fine polished (irregular linear) stainless steel (FPSS), titanium coated fine polished (irregular linear) stainless steel (TiFP), and topographically regular, linear titanium coated surfaces (RG) were fouled with Escherichia coli mixed with a meat exudate (which was utilised as a conditioning film). Surfaces were cleaned along or perpendicular to the linear features for one, five, or ten wipes. The bacteria were most easily removed from the titanium coated and regular featured surfaces. The direction of cleaning (along or perpendicular to the surface features) did not influence the amount of bacteria retained, but meat extract was more easily removed from the surfaces when cleaned in the direction along the linear surface features. Following ten cleans, there was no significant difference in the amount of cells or meat exudate retained on the surfaces cleaned in either direction. This study demonstrated that for the E. coli cells, the TiFP and RG surfaces were easiest to clean. However, the direction of the clean was important for the removal of the meat exudate from the surfaces.
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Acero Inoxidable , Titanio , Escherichia coli , Exudados y Transudados , Carne , Propiedades de SuperficieRESUMEN
INTRODUCTION: As health outcomes and disparities become more important in national healthcare, physicians must be aware of every patient's health literacy in order to deliver effective care. Our goal was to measure the health literacy rates in the caregivers of our pediatric tracheostomy population. These caregivers specifically have an immense responsibility that requires a certain capacity for understanding and learning complex skills. Thus far there have been no studies or surveys investigating the rates of health literacy in this population or tracheostomy patients in general. Caregivers' literacy rates were measured by administering a Test of Functional Health Literacy in Adults (TOFHLA). This test uses actual materials that patients might encounter in a typical clinic and consists of a reading comprehension and numeracy section. To assess impact of the complex care on caregiver quality of life, we simultaneously administered the Pediatric Tracheostomy Health Status Instrument (PTHSI), a validated caregiver quality of life measurement. METHODS: Caregivers of children with tracheostomies were recruited and surveyed during the Pediatric Tracheostomy Clinic between July 2019-October 2019. Twenty - six caregivers completed the TOFHLA; 24 completed all three parts - the TOFHLA, the demographic survey, and the PTHSI. RESULTS: Health literacy rates among patient families in the out-patient setting with experience with tracheostomy were deemed "adequate" in 85% of caregivers; the remaining 15% of caregivers scored "inadequate". Overall adult literacy rates in the general population in this state are 26% "inadequate." Approximately 80% of our caregivers rely solely on Medicaid for healthcare insurance and nearly half of participants reported an annual household income less than $5000. Ages of caregivers ranged from 20 to 61 years, with no significant correlation to health literacy. The average PTHSI score was 36 (SD 8.6), denoting a moderate level of caregiver burden but no correlation to the caregiver health literacy score was found. When comparing caregiver health literacy scores in relation to education level, caregivers with college and post-graduate education had higher literacy scores than those with a high school education, p = .0086. In addition, when comparing African American to white caregivers, white caregivers were found to have higher health literacy scores, p = .036. Notably, caregiver burden as measured by the PTHSI score did not differ significantly between caregivers in lower income and higher income levels, p = .91. CONCLUSION: Health literacy measurements for caregivers of children with complex medical conditions exceed the health literacy rates of the general population in our state, potentially biased by the intensive training provided to families during their prolonged hospitalization. Healthcare disparities may impact the medically complex child differently from the healthy child. Assumptions about health, wealth and caregiver burden may be inaccurate and warrant further evaluation. Assessing health literacy before institutionalization has occurred may enable us to more accurately design caregiver training programs to further augment literacy and health literacy.
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Cuidadores , Alfabetización en Salud , Adulto , Niño , Estado de Salud , Humanos , Persona de Mediana Edad , Calidad de Vida , Traqueostomía , Adulto JovenRESUMEN
Bronchopulmonary Dysplasia (BPD) is a pulmonary disease affecting newborns, commonly those with prematurity or low birth weight. Its pathogenesis involves underdevelopment of lung tissue with subsequent limitations in ventilation and oxygenation, resulting in impaired postnatal alveolarization. Despite advances in care with improved survival, BPD remains a prevalent comorbidity of prematurity. In severe cases, management may involve mechanical ventilation via tracheostomy. BPD's demand for multidisciplinary care compounds the challenges in management of this condition. Here, we review existing literature: the history of disease, criteria for diagnosis, pathogenesis, and modes of treatment with a focus on the severe subtype: that which is associated with pulmonary hypertension (PAH) for which tracheostomy is often required to facilitate long-term mechanical ventilation. We review the current recommendations for tracheostomy and decannulation.
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Displasia Broncopulmonar , Displasia Broncopulmonar/terapia , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Pulmón , Respiración Artificial , TraqueostomíaRESUMEN
We describe a device engineered for realistic simulation of myringotomy and tympanostomy tube insertion that tracks instrument placement and objectively measures operator proficiency. A 3-dimensional computer model of the external ear and cartilaginous external auditory canal was created from a normal maxillofacial computed tomography scan, and models for the bony external auditory canal and tympanic cavity were created with computer-aided design software. Physical models were 3-dimensionally printed from the computer reconstructions. The external auditory canal and tympanic cavity surfaces were coated with conductive material and wired to a capacitive sensor interface. A programmable microcontroller with custom embedded software completed the system. Construct validation was completed by comparing the run times and total sensor contact times of otolaryngology faculty and residents.
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Instrucción por Computador/métodos , Oído Medio/diagnóstico por imagen , Oído Medio/cirugía , Ventilación del Oído Medio/educación , Ventilación del Oído Medio/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Simulación por Computador , Diseño Asistido por Computadora , Humanos , Modelos Anatómicos , Otolaringología/educación , Otolaringología/instrumentación , Impresión Tridimensional , Programas InformáticosRESUMEN
Type IV laryngotracheo-esophageal cleft (LTEC) extending to the level of the carina presents unique challenges to operative repair, particularly with respect to soft tissue durability. This is the first report of CorMatrix(®) extra-cellular matrix (ECM) material use as an interposition graft in a four-layered LTEC repair. At day seven post-operatively, there was epithelialization along the surface of the trachea. At 3 months, she was stable for tracheotomy. At 6 months, the posterior wall resembled completely native tissue. CorMatrix(®) ECM(®) use intra-operatively and post-operative outcome were both highly satisfactory. No adverse reaction was seen in this case through 12-month follow up.
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Anomalías Múltiples/cirugía , Anomalías Congénitas/cirugía , Esófago/cirugía , Matriz Extracelular , Laringe/anomalías , Tráquea/cirugía , Esófago/anomalías , Femenino , Humanos , Lactante , Recién Nacido , Laringe/cirugía , Tráquea/anomalías , TraqueotomíaRESUMEN
Otitis media is a prominent disease among children. Previous literature indicates that otitis media is a polymicrobial disease, with Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis and Moraxella catarrhalis being the most commonly associated bacterial pathogens. Recent literature suggests that introduction of pneumococcal conjugate vaccines has had an effect on the etiology of otitis media. Using a multiplex PCR procedure, we sought to investigate the presence of the aforementioned bacterial pathogens in middle ear fluid collected from children undergoing routine tympanostomy tube placement at Wake Forest Baptist Medical Center during the period between January 2011 and March 2014. In purulent effusions, one or more bacterial organisms were detected in ~90% of samples. Most often the presence of H. influenzae alone was detected in purulent effusions (32%; 10 of 31). In non-purulent effusions, the most prevalent organism detected was A. otitidis (26%; 63 of 245). Half of the non-purulent effusions had none of these otopathogens detected. In purulent and non-purulent effusions, the overall presence of S. pneumoniae was lower (19%; 6 of 31, and 4%; 9 of 245, respectively) than that of the other pathogens being identified. The ratio of the percentage of each otopathogen identified in purulent vs. non-purulent effusions was >1 for the classic otopathogens but not for A. otitidis.
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Infecciones Bacterianas/microbiología , Carnobacteriaceae/aislamiento & purificación , Haemophilus influenzae/aislamiento & purificación , Ventilación del Oído Medio , Moraxella catarrhalis/aislamiento & purificación , Otitis Media con Derrame/microbiología , Streptococcus pneumoniae/aislamiento & purificación , Infecciones Bacterianas/patología , Infecciones Bacterianas/cirugía , Carnobacteriaceae/crecimiento & desarrollo , Preescolar , Oído Medio/microbiología , Oído Medio/patología , Oído Medio/cirugía , Femenino , Haemophilus influenzae/crecimiento & desarrollo , Humanos , Lactante , Masculino , Moraxella catarrhalis/crecimiento & desarrollo , Otitis Media con Derrame/patología , Otitis Media con Derrame/cirugía , Estudios Retrospectivos , Streptococcus pneumoniae/crecimiento & desarrollo , SupuraciónRESUMEN
OBJECTIVE: To investigate the associations between patient age, sociological factors, and the microbiology of pediatric neck infections. METHODS: Retrospective chart review of children up to 5 years old who underwent surgical management of suppurative cervical lymphadenitis. RESULTS: A total of 76 individuals met inclusion criteria; 93% of culture-positive infections were caused by Staphylococcus aureus in infants, compared with 59% in children between 13 months and 5 years of age (P = .002). Of the S aureus isolates, 51% were methicillin-resistant S aureus (MRSA) and 49% were methicillin-sensitive S aureus. Methicillin resistance was associated with African American race (P = .004); 67% of participants received empirical antibiotics prior to admission. Of these, 73% received antibiotics in the ß-lactam class, and 25% received treatment with clindamycin. CONCLUSIONS: Incidence of MRSA is high in infants with cervical lymphadenitis who fail empirical antibiotic therapy and require surgical management. Empirical coverage for cervical lymphadenitis with ß-lactam antibiotics may provide inadequate coverage for early infection in this population.
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Infecciones Comunitarias Adquiridas/epidemiología , Linfadenitis/epidemiología , Infecciones Estafilocócicas/epidemiología , Factores de Edad , Antibacterianos/uso terapéutico , Causalidad , Preescolar , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/cirugía , Femenino , Humanos , Lactante , Linfadenitis/tratamiento farmacológico , Linfadenitis/cirugía , Masculino , Staphylococcus aureus Resistente a Meticilina , Pruebas de Sensibilidad Microbiana , Grupos Raciales/estadística & datos numéricos , Estudios Retrospectivos , Factores Socioeconómicos , Sociología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/cirugíaRESUMEN
OBJECTIVES: (1) To determine the percentage of otherwise healthy patients achieving "graduation," or postoperative compliance achieving complete problem resolution and discharge from the otolaryngologist's care, after tympanostomy tube placement. (2) To analyze follow-up behaviors and patient characteristics influencing the likelihood of graduation. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care hospital. SUBJECTS AND METHODS: Analysis of details of tympanostomy tube placements performed from 2004 to 2011 by 2 pediatric otolaryngologists for children aged 0 to 18 years. Exclusion criteria were clearly defined craniofacial anomalies, cleft palates, and other ongoing postoperative care. The remaining study subjects were categorized into 3 groups. Graduation (GRAD) subjects achieved discharge from care with "follow-up pro re nata" status. LOST<2Y subjects had not attended scheduled follow-up in <2 years. LOST≥2Y subjects had no follow-up in ≥2 years. RESULTS: A total of 1454 pediatric subjects were included. GRADs constituted only 25.6% of the subject pool; 22.1% were LOST<2Y, and 52.3% were LOST≥2Y. Statistically significant factors in achieving graduation were total number of follow-up visits, total duration of follow-up, compliance with first postoperative visit, patient age, insurance type, and distance between home and practice. CONCLUSION: Rate of graduation, or postoperative compliance achieving complete problem resolution, of otherwise healthy tympanostomy tube patients is low despite perioperative discussions of the importance of proper follow-up. Higher graduation rates are associated with increasing number of follow-up visits and duration, younger patient age, private insurance, and proximity to the practice. Compliance with attending the first postoperative visit may be an early marker for increased likelihood of graduation.
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Continuidad de la Atención al Paciente/normas , Ventilación del Oído Medio/métodos , Otitis Media con Derrame/cirugía , Cooperación del Paciente/estadística & datos numéricos , Adolescente , Factores de Edad , Niño , Preescolar , Estudios de Cohortes , Continuidad de la Atención al Paciente/tendencias , Femenino , Estudios de Seguimiento , Humanos , Lactante , Modelos Logísticos , Masculino , Ventilación del Oído Medio/efectos adversos , Monitoreo Fisiológico/normas , Monitoreo Fisiológico/tendencias , Otitis Media con Derrame/diagnóstico , Cuidados Posoperatorios/normas , Cuidados Posoperatorios/tendencias , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Centros de Atención Terciaria , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
OBJECTIVES: We performed this study to evaluate the competency of health-care providers managing patients with tracheotomies, and assess the need for, and efficacy of, a multidisciplinary educational program incorporating patient simulation. METHODS: The prospective observational study included 87 subjects who manage patients with tracheotomies within a tertiary-care hospital. The subjects completed self-assessment questionnaires and objective multiple-choice tests before and after attending a comprehensive educational course using patient simulation. The outcome measurements included pre-course and post-course questionnaire and test scores, as well as observational data collected during recorded patient simulation sessions. RESULTS: Before the education and simulation, the subjects reported an average comfort level of 3.3 on a 5-point Likert scale across 10 categories in the questionnaire, which improved to 4.4 after the training (p < 0.0001). The subjects' mean scores improved from 56% on the pre-course test to 91% on the post-course test (p < 0.0001). The specific deficiencies observed during patient simulation scenarios included unfamiliarity with different tracheotomy tube types, misunderstanding of speaking valve physiology, and delayed recognition and treatment of a plugged or dislodged tracheotomy tube. CONCLUSIONS: There is a significant need for improved tracheotomy education among primary health-care providers. Incorporating patient simulation into a comprehensive tracheotomy educational program was effective in improving provider confidence, increasing provider knowledge, and teaching the skills necessary for managing patients with a tracheotomy.
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Competencia Clínica , Atención Primaria de Salud , Traqueostomía/educación , Traqueotomía/educación , Conocimientos, Actitudes y Práctica en Salud , Hospitales Universitarios , Humanos , Maniquíes , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
PURPOSE: Prior studies have associated gross inner ear abnormalities with pediatric sensorineural hearing loss (SNHL) using computed tomography (CT). No studies to date have specifically investigated morphologic inner ear abnormalities involving the contralateral unaffected ear in patients with unilateral SNHL. The purpose of this study is to evaluate contralateral inner ear structures of subjects with unilateral SNHL but no grossly abnormal findings on CT. MATERIALS AND METHODS: IRB-approved retrospective analysis of pediatric temporal bone CT scans. 97 temporal bone CT scans, previously interpreted as "normal" based upon previously accepted guidelines by board certified neuroradiologists, were assessed using 12 measurements of the semicircular canals, cochlea and vestibule. The control-group consisted of 72 "normal" temporal bone CTs with underlying SNHL in the subject excluded. The study-group consisted of 25 normal-hearing contralateral temporal bones in subjects with unilateral SNHL. Multivariate analysis of covariance (MANCOVA) was then conducted to evaluate for differences between the study and control group. RESULTS: Cochlea basal turn lumen width was significantly greater in magnitude and central lucency of the lateral semicircular canal bony island was significantly lower in density for audiometrically normal ears of subjects with unilateral SNHL compared to controls. CONCLUSION: Abnormalities of the inner ear were present in the contralateral audiometrically normal ears of subjects with unilateral SNHL. These data suggest that patients with unilateral SNHL may have a more pervasive disease process that results in abnormalities of both ears. The findings of a cochlea basal turn lumen width disparity >5% from "normal" and/or a lateral semicircular canal bony island central lucency disparity of >5% from "normal" may indicate inherent risk to the contralateral unaffected ear in pediatric patients with unilateral sensorineural hearing loss.
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Oído Interno/diagnóstico por imagen , Pérdida Auditiva Sensorineural/diagnóstico por imagen , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Análisis de Varianza , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVE: To investigate whether the effects of sex (male/female) that have been demonstrated in the pathology literature using 0.1 mm histopathologic slices are measurable and statistically significant using high-resolution (0.625 mm slice) computed tomography (CT). METHODS: IRB-approved retrospective analysis of high-resolution "normal" CT temporal bone images in pediatric subjects (0-18 years) using comparative anatomic measurements between males and females obtained from the semicircular canals, cochlea and vestibule as follows: (1) lateral semicircular canal (LSCC) bony island width, (2) superior semicircular canal (SSCC) bony island width, (3) central lucency of the LSCC bony island, (4) coronal cochlear height, (5) axial cochlear height, (6) cochlear length, (7) cochlea basal turn lumen width, (8) cochlear aperture width, (9) cochlear aperture height, (10) vestibular length, (11) vestibular width, and (12) coronal vestibule oblique diameter. RESULTS: Eighteen females (36 ears) and twenty males (36 ears) were included in the study. Independent-samples t-tests revealed statistically significant differences in measurements for females and males as follows (differences reported as a percentage and as an absolute difference (AD) in mm): (1) vestibular width was 4.2% (0.13 mm AD) smaller in females (mean ± SD; 3.0 ± 0.27) compared to males (mean ± SD; 3.2 ± 0.25) [t(70) = 2.083, p = 0.041]; (2) cochlear length was 3.9% (.23 mm AD) smaller in females (mean ± SD; 5.8 ± 0.32) compared to males (mean ± SD; 6.0 ± 0.40) [t(70)=2.660, p = 0.010]; (3) cochlear aperture height was 11.6% (0.13 mm AD) smaller in females (mean ± SD; 1.0 ± 0.18) compared to males (mean ± SD; 1.2 ± 0.22) [t(70)=2.549, p = 0.013]; and (4) coronal cochlear height was 11.4% (0.55 mm AD) smaller in females (mean ± SD; 4.8 ± 0.58) compared to males (mean ± SD; 5.4 ± 0.48) [t(68) = 4.270, p < 0.005]. CONCLUSION: Sexual dimorphism of inner ear structures may contribute to variability in reported normative and pathologic measurements of inner ear structures. This variability must be taken into consideration when designing future research studies to investigate inner ear structures and for drawing accurate conclusions about possible inner ear morphologic abnormalities associated with SNHL compared to controls.