Journal of Laryngology and Otology最新文献

Objectives: To create a simple simulated tonsil-tying model to help trainees gain surgical skills during limited training opportunities.

Methods: A tonsil-tying trainer was constructed using basic hospital items that are easily attainable in a basic hospital setting. Feedback was obtained from consultants, registrars and senior house officers.

Results: A simple, low-cost and effective low-fidelity model for deep knot tying in tonsillectomy is presented. The model is modifiable for the progressing trainee and allows a degree of objective feedback with the potential for subjective feedback from a trainer. The model is easy to prepare using typical basic hospital ward equipment.

Conclusion: This model provides practice of placing a Boyle-Davis gag, and the use of tools and a head light. It is adjustable for tonsil-tying practice at a variety of depths with different vessel sizes and conditions (e.g. bleeding). Lastly, basic objective feedback without significant technical challenges is possible.

Objectives: To address the challenge of observing the round window niche during exoscopic cochlear implantation, an assisted endoscopic underwater drilling technique was developed.

Methods: To improve visibility, we introduced an endoscopic underwater technique after posterior tympanotomy for enhanced visualization of round window area. The procedure transitions between the exoscope and endoscope, with saline irrigation clearing bone dust and blood.

Results: Operation times were slight longer, but it offered enhanced safety and ergonomic advantages.

Conclusion: This technique enhances clarity for safe manipulation of the round window area, improving cochlear implantation outcomes by optimizing surgical precision and reducing complications.

Objective: To show our experience in performing endoscopic-assisted maxillectomy (EAM), with the aim of facilitating delineation of tumour resection and improve the achievement of free tumour resection margins.

Methods: Patients undergoing EAM between 2021 and 2024 were reviewed. During the endoscopic approach, the medial and lateral plates of the pterygoid were drilled, taking as reference the superior margin of the inferior turbinate.

Results: Six patients underwent an EAM surgery. The maxillectomy was completed with an external transfacial approach in four patients and with a transoral approach in two. No intraoperative complications were observed. Five patients had postoperative flap dehiscence; two cases healed spontaneously and three cases required surgery.

Conclusion: EAM allows delimitation of the posterior limit of tumour resection in total or subtotal maxillectomies. This endoscopic approach facilitates the drilling of the pterygoid process to complete the posterior osteotomy, which is a complex manoeuvre during the exclusive external approach.

Objectives: To evaluate the indications, outcomes, and recurrence rates of elective paediatric functional endoscopic sinus surgery at a tertiary centre, and to highlight the continued importance of multidisciplinary management.

Methods: A retrospective review included 65 patients (age range 5-17 years) undergoing elective paediatric functional endoscopic sinus surgery from January 2017 to December 2024. Data on demographics, surgical details, additional procedures, and revision rates were collected. Logistic regression identified predictors of revision.

Results: Chronic rhinosinusitis was the most common indication (45/65), with 62 per cent requiring polypectomy and 84 per cent undergoing middle meatal antrostomy. Fifteen percent had cystic fibrosis; cystic fibrosis status significantly predicted revision (odds ratio 8.5, p = 0.007). A multidisciplinary approach was crucial for the 20 per cent needing additional procedures. No major complications were reported.

Conclusion: Paediatric functional endoscopic sinus surgery is safe and effective for paediatric sinonasal disease, particularly where balloon sinuplasty is insufficient for polyposis. Multicentre collaborations will help refine selection criteria and enhance long-term outcomes.

Objectives: This study aimed to evaluate the quality of information provided by artificial intelligence (AI) applications regarding ENT surgeries and usability for patients.

Methods: ChatGPT 4.0, GEMINI 1.5 Flash, Copilot, Claude 3.5 Sonnet and DeepSeek-R1 were asked to provide detailed responses to patient-oriented questions about 15 ENT surgeries. Each AI application was queried three times, with a 3-day interval between each session. Two ENT specialists evaluated all responses using the Quality Analysis of Medical Artificial Intelligence (QAMAI) tool.

Results: Average QAMAI scores for each AI application were as follows: ChatGPT 4.0 (27.56 ± 1.20), GEMINI 1.5 Flash (26.24 ± 1.26), Copilot (26.84 ± 1.35), Claude 3.5 Sonnet (28.24 ± 0.77) and DeepSeek-R1 (28.13 ± 0.84). A statistically significant difference was found among the applications (p < 0.001). ICC analysis indicated high stability across evaluations conducted for all five AI applications (p < 0.001).

Conclusion: AI has the potential to provide patients with accurate and consistent information about ENT surgeries, yet differences in QAMAI scores show that information quality varies between platforms.

Objective: Efficacy of gastric inlet patch (GIP) ablation using argon plasma coagulation (APC) for patients presenting with persistent throat symptoms was evaluated.

Methods: Retrospective observational study from a single university hospital. Consecutive patients who had GIP ablation for persistent throat symptoms between 01/10/2018-31/10/2023 were reviewed and patients who met all of the set inclusion and exclusion criteria were included in this study for analysis.

Results: 50% (n = 18/36) of patients responded to APC ablation (median follow-up 3 months) with their post-ablation GETS score decreasing by 30-100%. Long-term follow-up results could be obtained from 22 patients (n = 22/36) and 75% (n = 9/12) had their clinical effects maintained (median follow-up 4.5 years; range 2.7-5.8 years).

Conclusion: GIP ablation can be a very effective treatment for patients with persistent throat symptoms with its therapeutic effects long-lasting. Future studies should focus on evaluating the optimal patient selection process for GIP ablation for persistent throat symptoms.

Objectives: Confidence among surgeons is required for complex decision-making and surgical ability. However, surgical trainees' confidence is decreasing. This systematic review aims to explore factors that affect the confidence of surgical trainees.

Methods: A systematic review was performed following the PRISMA guidelines. Pubmed®, Embase™, Scopus, ClinicalTrials.gov and grey literature were searched for primary research on factors affecting surgical trainee confidence.

Results: Eleven studies were included. Key factors positively impacting trainee confidence were receiving regular positive feedback, working with a supportive trainer and having a calm working environment and effective team dynamic. The main factors negatively impacting trainee confidence were experiencing undermining behaviour from trainers and stressful, time-pressured environments. Female gender was also associated with reduced confidence. Greater confidence was associated with higher perceived performance.

Conclusion: This work assimilates the factors impacting surgical trainees' confidence, which could guide training programmes to improve trainee self-confidence and therefore patient care.

Objectives: To evaluate early postoperative complaints using the Palate postoperative Problems Score in patients undergoing modified barbed reposition pharyngoplasty with tonsillectomy and tonsillectomy alone.

Methods: The study included 40 patients who underwent modified barbed reposition pharyngoplasty with tonsillectomy and 18 patients who had tonsillectomy alone. Patients completed the Palate Postoperative Problems Score questionnaire at the first, third and sixth months post-operatively, and changes in their complaints were observed. Additional data included the Epworth Sleepiness Scale and sleep parameters (apnea-hypopnea Index, body mass index and oxygen saturation).

Results: In the modified barbed reposition pharyngoplasty group, Palate Postoperative Problems Scores decreased significantly from 8.85 (month 1) to 4.07 (month 6). The tonsillectomy group also showed significant improvement (from 5.28 to 2.61 by month 3).

Conclusion: The Palate Postoperative Problems Score questionnaire is an effective tool for assessing post-operative symptoms after palate surgery. Repeated use enables monitoring of patient recovery and the impact of tonsillectomy should be considered in Palate Postoperative Problems Score-based evaluations.

Objectives: This study compares outcomes of open versus percutaneous tracheostomies in coronavirus disease 2019 patients to guide clinical decision-making based on disease severity.

Methods: A retrospective cohort study using the 2020 National Readmissions Database identified 4810 coronavirus disease 2019 patients (International Statistical Classification of Diseases and Related Health Problems 10th Revision code U071) who underwent tracheostomy. Of these, 2061 had open and 2749 had percutaneous tracheostomies. Patient demographics, severity (All Patient Refined-Diagnosis Related Groups) and outcomes (mortality, readmission, complications) were analysed using chi-squared tests, both overall and by severity.

Results: Mortality was higher in the percutaneous group (29.25 per cent) compared to the open group (26.35 per cent) (p = 0.0265). For severe cases (All Patient Refined-Diagnosis Related Groups 3-4), open tracheostomies had significantly lower mortality, readmission and complication rates (p < 0.05).

Conclusion: Open tracheostomies are associated with better outcomes in severe coronavirus disease 2019 cases. Percutaneous tracheostomies are effective in mild cases, but patient selection and procedural planning should consider disease severity. Future research should validate these findings.

Introduction: Ear arteriovenous malformation is a complex problem with a lack of data and a clear consensus on its management. This paper aims to develop an algorithm for protocol-based ear arteriovenous malformation management.

Method: All patients underwent pre-operative discussions at a multi-disciplinary team meeting to plan excision and pre-operative embolisation.

Results: Nineteen patients were included in this study. Following excision, 26.3 per cent of cases had flap cover, 10.5 per cent needed a skin graft, 15.3 per cent had total amputation of the ear, and the rest underwent excision of the arteriovenous malformation with or without cartilage excision and primary closure. Recurrence was observed in 10.5 per cent of cases.

Conclusion: Surgical excision is the treatment of choice for ear arteriovenous malformations. Cartilage should be preserved whenever possible. The wound cover should be either a primary closure or a flap cover. A protocol-based guide facilitates decision-making of this complex problem.