JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Oct 2015
Utility of Inferior Turbinoplasty for the Treatment of Nasal Obstruction in Children: A 10-Year Review.
Inferior turbinoplasty (IT) in pediatric patients is a common procedure used to treat childhood nasal obstruction. Most of the published IT studies in this population did not control for concurrent airway procedures. ⋯ Inferior turbinoplasty showed overall utility and was safe and effective in the treatment of nasal obstruction in children for whom medical management had failed. No differences between surgical techniques were found in patient satisfaction, improvement of nasal patency, and recurrence, likely related to sample size. More than half of the patients continued to use medical therapy postoperatively, suggesting that inferior turbinate hypertrophy should not be considered solely as a surgical disease. Allergic rhinitis was identified as a significant comorbidity.
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JAMA Otolaryngol Head Neck Surg · Oct 2015
Trends in U.S. Pediatric Otolaryngology Fellowship Training.
Interest in pediatric otolaryngology fellowship training is growing. The workforce implications of this growing interest are unclear and understudied. ⋯ The number of pediatric otolaryngology fellowship applicants as well as total number of matched applicants and ACGME-accredited positions has risen in the last 10 years. It appears that a higher proportion of fellows trained in accredited programs work in academic positions in hospital-based practices. The long-term effect on the pediatric otolaryngology workforce of training more fellows in accredited fellowships remains to be seen.
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JAMA Otolaryngol Head Neck Surg · Oct 2015
Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice.
Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal in understanding skills acquisition and best-practice implementation and organization of training. ⋯ Novices can acquire basic mastoidectomy competencies with self-directed VR simulation training. Training should be organized with distributed practice, and simulator-integrated tutoring can be useful to accelerate the initial learning curve. Practice should be deliberate and toward a standard set level of proficiency that remains to be defined rather than toward the mean learning curve plateau.
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JAMA Otolaryngol Head Neck Surg · Oct 2015
Epidemiology, Prognostic Factors, and Treatment of Malignant Submandibular Gland Tumors: A Population-Based Cohort Analysis.
Malignant tumors of the submandibular gland are uncommon, leading to limited information regarding prognostic factors and difficulty in evaluating treatment modalities. ⋯ We report, to our knowledge, the largest study to date focused on correlates of survival in submandibular gland malignant neoplasms. Multivariate analysis found that older age at diagnosis, high tumor grade, and later stage at presentation were correlated with decreased survival whereas female sex and surgical resection were correlated with increased survival. In addition, a 3-cm tumor cutoff size was demonstrated above which was associated with a significantly less favorable prognosis. Radiation therapy had mixed association with survival, dependent on tumor size and subtype.