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Kiesow CW, Mount GR, Bunin J, McMains KC, McFate T, Hartzell J, Servey JT. A Common Trajectory Toward a Professional Identity as a Faculty Developer. Fam Med 2024; 56:108-114. [PMID: 38335938 DOI: 10.22454/fammed.2024.953164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Professional identity formation is a complex construct that continually evolves in relation to an individual's experiences. The literature on educators identifying as faculty developers is limited and incompletely addresses how that identify affects other identities, careers, and influences on teaching. Twenty-six health professionals were trained to serve as faculty developers within our educational system. We sought to examine the factors that influence the professional identity of these faculty developers and to determine whether a common trajectory existed. METHODS We employed a constructivist thematic analysis methodology using an inductive approach to understand the experiences of faculty developers. We conducted semistructured recorded interviews. Coding and thematic analysis were completed iteratively. RESULTS We identified eight primary themes: (1) initial invitation, (2) discovery of faculty development as a professional activity, (3) discovery of educational theory, skills, and need for more education, (4) process of time and experience, (5) fostering relationships and community, (6) transfer of skills to professional and personal roles, (7) experiences that lead to credibility, and (8) sense of greater impact. CONCLUSIONS An individual's journey to a faculty developer identity is variable, with several shared pivotal experiences that help foster the emergence of this identity. Consideration of specific programmatic elements to support the themes identified might allow for a strategic approach to faculty development efforts in health professions education.
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Affiliation(s)
- Caleb W Kiesow
- Department of Family Medicine, 375th Medical Group, Scott Air Force Base, IL
| | - George R Mount
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jessica Bunin
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Kevin C McMains
- Department of Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
| | - Thomas McFate
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Joshua Hartzell
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jessica T Servey
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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McMains KC, Durning SJ, Norton C, Meyer HS. The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory. J Contin Educ Health Prof 2023; 43:254-260. [PMID: 37201556 DOI: 10.1097/ceh.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators? METHODS The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators. RESULTS Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct. DISCUSSION The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.
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Affiliation(s)
- Kevin C McMains
- Dr. McMains : Professor, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Durning : Director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, and Professor, Department of Medicine. Norton : Instruction Librarian, Division of Library Services, National Institutes of Health Library, Bethesda, MD. Dr. Meyer : Assistant Professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD
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McMains KC, Konopasky A, Durning SJ, Meyer HS. Do All Roads Lead to Full Participation? Examining Trajectories of Clinical Educators in Graduate Medical Education through Situated Learning Theory. Teach Learn Med 2023:1-11. [PMID: 37547996 DOI: 10.1080/10401334.2023.2230188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 05/23/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023]
Abstract
Phenomenon: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. Approach: Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. Findings: Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only engagement with educator roles but disengagement with other roles; imagination of future roles with the support of mentors; and fluid alignment with multiple mutually reinforcing identities. Participants identified boundary objects like resumes and formal roles that helped them negotiate across Community of Practice boundaries. Insights: Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.
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Affiliation(s)
- Kevin C McMains
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Abigail Konopasky
- Department of Medical Education, Dartmouth School of Medicine, Hannover, New Hampshire, USA
| | - Steven J Durning
- Department of Medical Education, Dartmouth School of Medicine, Hannover, New Hampshire, USA
| | - Holly S Meyer
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Krysinski MR, Walters BK, Aden JK, Mack D, Weitzel EK, Willson T, McMains KC, Chen PG. Ergonomic analysis of hand dysfunction in endoscopic sinus surgery. Int Forum Allergy Rhinol 2023; 13:172-174. [PMID: 35899765 DOI: 10.1002/alr.23066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Mason R Krysinski
- Department of Otolaryngology- Head & Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Benjamin K Walters
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - James K Aden
- Graduate Medical Education, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Douglas Mack
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Erik Kent Weitzel
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Thomas Willson
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA.,Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, Texas, USA
| | - Kevin C McMains
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA.,Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, Texas, USA
| | - Philip G Chen
- Department of Otolaryngology- Head & Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
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- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Chen PG, Clampitt MR, Chorath KT, Lin RP, Weitzel EK, McMains KC, Bunegin L. Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model. Am J Rhinol Allergy 2019; 33:757-762. [DOI: 10.1177/1945892419866310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Large skull base defects can be challenging to repair. This study uses a controlled ex vivo model to examine the failure pressures of various dural repairs of large skull base defects using mucosa with fibrin glue under 3 conditions: No Additional Support of the repair, support with a Foley catheter (Direct Support), and with Foley catheter contact over a rigid acrylic plate (Diffuse Support). Methods Failure pressures of dural repairs with and without support were determined in a porcine model using an ex vivo closed testing apparatus. In addition, 20 mm × 15 mm dural defects were created. Skull base repairs were performed using porcine dura as an underlay graft followed by a septal mucosa overlay. Saline was infused at 30 mL/h, applying even force to the underside of the graft until repair failure occurred for each condition (none, direct, and diffuse support). Five trials were performed per repair type for a total of 15 repairs. Results The mean failure pressures were as follows: No Additional Support, 6.494 ± 2.553 mm Hg; Direct Support, 5.103 ± 3.913 mm Hg; and Diffuse Support, 15.649 ± 2.638 mm Hg. A post hoc Bonferroni-Holm test demonstrated significant difference between No Additional Support and Diffuse Support ( P = .001), as well as Direct Support and Diffuse Support ( P = .002). Conclusion Support of dural repairs in this model withstood higher pressures when the Foley catheter’s support is distributed evenly using a flat acrylic plate. Use of this plate is the only repair tested in this model that tolerated normal adult supine intracranial pressures.
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Affiliation(s)
- Philip G. Chen
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Michael R. Clampitt
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kevin T. Chorath
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Ryan P. Lin
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Erik K. Weitzel
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
| | - Kevin C. McMains
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
| | - Leonid Bunegin
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
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Yoshiyasu Y, Chang DR, Bunegin L, Lin RP, Aden JK, Prihoda TJ, Weitzel EK, McMains KC, Malekzadeh S, Bowe SN, Chen PG. Construct validity of a low-cost medium-fidelity endoscopic sinus surgery simulation model. Laryngoscope 2018; 129:1505-1509. [PMID: 30578541 DOI: 10.1002/lary.27748] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Assess construct validity of a low-cost medium-fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training. METHODS Fellowship-trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist. RESULTS Thirty-two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task-specific checklist. CONCLUSIONS This study demonstrated the construct validity of the low-cost medium-fidelity ESS model. LEVEL OF EVIDENCE NA Laryngoscope, 129:1505-1509, 2019.
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Affiliation(s)
- Yuki Yoshiyasu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Daniel R Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Leon Bunegin
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Ryan P Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - James K Aden
- San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, San Antonio, Texas, U.S.A
| | - Thomas J Prihoda
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Erik K Weitzel
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, U.S.A
| | - Kevin C McMains
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, U.S.A
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, MedStar Health, Washington, District of Columbia, U.S.A
| | - Sarah N Bowe
- Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft Sam Houston, Texas, U.S.A
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
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McMains KC, Rodriguez RG, Peel J, Yun HC, True MW, Jones WS. Assessing Mentorship Experiences of Faculty at a Military Academic Center: Challenge and Opportunity. South Med J 2018; 111:262-267. [PMID: 29767217 DOI: 10.14423/smj.0000000000000799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Mentor relationships are a key component of professional development within academic medicine. To date, there are no investigations into the prevalence and effects of mentor relationships within military academic medicine. This quality improvement initiative aimed to establish the prevalence and effects of mentorship, including whether sex differences exist among faculty at a military academic center, the San Antonio Uniformed Services Health Education Consortium, and identify opportunities to improve faculty development efforts for mentorship to benefit faculty at this institution. METHODS A 17-item survey was developed using an iterative process. Using the SurveyMonkey platform, the survey was distributed to each faculty member within the 33 Accreditation Council for Graduate Medical Education-accredited programs. RESULTS A total of 104 responses (26%) were received from 393 total faculty members, including 48 Air Force, 45 Army, 3 Navy, and 8 Contractor/Government Service respondents. Thirty-four respondents were women (33%) and 70 were men (67%). Only 42% of faculty reported currently having a mentor. Thirty-nine respondents (38%; 44% men and 27% women) received formal mentorship at their first staff physician position after residency training. Mentorship helped respondents the most in the areas of clinical skills, understanding departmental/institutional culture, professionalism/officership, academic promotion/advancement, and clarification of priorities/goals. When asked whether more effective mentorship would affect their own decision to remain on active-duty military service, 14% responded "yes" and 28% responded "possibly." CONCLUSIONS Increased mentorship has the potential to positively affect career development in military academic military medicine. Results from this study affirm previous reports that effective mentorship potentially represents a powerful tool for faculty retention. Future study should include other military medical academic centers to assess the generalizability of these results across US military medicine.
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Affiliation(s)
- Kevin C McMains
- From the Uniformed Services University of the Health Sciences, Bethesda, Maryland, the San Antonio VA Health Care System, the University of Texas Health Science Center at San Antonio, and the San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Rechell G Rodriguez
- From the Uniformed Services University of the Health Sciences, Bethesda, Maryland, the San Antonio VA Health Care System, the University of Texas Health Science Center at San Antonio, and the San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Jennifer Peel
- From the Uniformed Services University of the Health Sciences, Bethesda, Maryland, the San Antonio VA Health Care System, the University of Texas Health Science Center at San Antonio, and the San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Heather C Yun
- From the Uniformed Services University of the Health Sciences, Bethesda, Maryland, the San Antonio VA Health Care System, the University of Texas Health Science Center at San Antonio, and the San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Mark W True
- From the Uniformed Services University of the Health Sciences, Bethesda, Maryland, the San Antonio VA Health Care System, the University of Texas Health Science Center at San Antonio, and the San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Woodson S Jones
- From the Uniformed Services University of the Health Sciences, Bethesda, Maryland, the San Antonio VA Health Care System, the University of Texas Health Science Center at San Antonio, and the San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
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Laury AM, Chen PG, McMains KC. Randomized Controlled Trial Examining the Effects of Balloon Catheter Dilation on "Sinus Pressure" / Barometric Headaches. Otolaryngol Head Neck Surg 2018; 159:178-184. [PMID: 29688826 DOI: 10.1177/0194599818772818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective To determine if balloon catheter dilation of sinus ostia affects the severity or frequency of headache among patients who have barometric pressure-related "sinus" headache. Study Design Prospective single-blinded randomized controlled trial. Setting Tertiary care medical center. Subjects and Methods Subjects with a diagnosis of sinus pressure headache without evidence of mucosal thickening on computed tomography were recruited. Subjects were blinded and randomized to undergo balloon dilation of affected sinus ostia (active treatment) or balloon dilation in the nasal cavity (placebo). Two balloon devices were utilized (Acclarent and Entellus) and outcomes compared. Subjects were followed with pre- and postprocedure SNOT-22 scores (Sinonasal Outcome Test-22), HIT-6 scores (Headache Impact Test-6), and medication utilization logs for 6 months. Results There was no statistically significant difference in SNOT-22 or HIT-6 scores between the arms at any time point. However, both arms experienced statistically and clinically significant decreases in SNOT-22 and HIT-6 scores from preprocedure to 6 months postprocedure. There was no statistically significant difference in SNOT-22 or HIT-6 score reductions between the Entellus and Acclarent devices. There was no statistically significant difference in medication utilization between the groups at any time point. Conclusions Subjects with sinus pressure headache without evidence of mucosal thickening on computed tomography had no significant difference in outcomes between active treatment (balloon dilation of sinus ostia) and placebo (nasal dilation). Further study on the etiology and effective treatment of barometric pressure / "sinus" headache is needed.
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Affiliation(s)
- Adrienne M Laury
- 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Philip G Chen
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Kevin C McMains
- 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
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Azimuddin AF, Weitzel EK, McMains KC, Chen PG. An ergonomic assessment of operating table and surgical stool heights for seated otolaryngology procedures. Allergy Rhinol (Providence) 2017; 8:182-188. [PMID: 29070277 PMCID: PMC5662545 DOI: 10.2500/ar.2017.8.0215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Musculoskeletal injuries, such as neck and back pain, during a surgeon's career are common. However, studies on ergonomics are limited with regard to seated otolaryngologic procedures. Key elements of an ergonomic operating environment include the height of operating tables and surgical chairs. Surgeons benefit from proper support and positioning to prevent musculoskeletal injuries and reduce occupational risk. Objective: The purpose of this study was to evaluate operating table and surgical seat heights, and determine whether adjustments can be made for various surgeon physiques. Methods: Operating tables and surgical seat dimensions were measured at local hospitals, and the information was complemented by an online search of other models. Results: Five unique operating tables and five unique surgical stools were identified, both in the local hospital and in a search on the Internet. Of available tables, the greatest range was 63.5–124.5 cm, which reaches above the maximum suggested working height of 76.2 cm. The surgical stool with the widest range was adjustable from heights of 50.8–72.4 cm. This combination of operative table and surgical stool provided the greatest range of heights. Conclusion: Of the available tables and stools measured, the combination of surgical table with a range of 63.5–125.7 cm and surgical stool with a range of 50.8–72.4 cm provided the greatest versatility for diverse physician heights. In ergonomic terms, this combination may reduce physical fatigue and create a potentially safer working environment for seated surgeons.
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Affiliation(s)
- Anam F Azimuddin
- From the Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Erik K Weitzel
- Department of Surgery, San Antonio Uniformed Services Health Educational Consortium, Joint Base San Antonio, San Antonio, Texas
| | - Kevin C McMains
- Department of Surgery, San Antonio Uniformed Services Health Educational Consortium, Joint Base San Antonio, San Antonio, Texas
| | - Philip G Chen
- From the Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. 过敏和鼻科学国际共识声明 : 鼻窦炎. Int Forum Allergy Rhinol 2017. [DOI: 10.1002/alr.21695_c] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chang DR, Lin RP, Bowe S, Bunegin L, Weitzel EK, McMains KC, Willson T, Chen PG. Fabrication and validation of a low-cost, medium-fidelity silicone injection molded endoscopic sinus surgery simulation model. Laryngoscope 2016; 127:781-786. [PMID: 28000224 DOI: 10.1002/lary.26370] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/07/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS Develop a low-cost, medium-fidelity model for education in endoscopic sinus surgery techniques. Establish face and content validity of the model based on the feedback of otolaryngology faculty including fellowship-trained rhinologists. STUDY DESIGN Survey. METHODS A novel silicone injection molded sinus model was constructed. Three fellowship-trained rhinologists and four general otolaryngologists were recruited to perform seven tasks and provide feedback of the model's performance via a 22-question Likert survey. RESULTS Those surveyed strongly agreed the sinus model is useful for basic endoscopic skill acquisition such as camera skills (86%), hand-eye coordination (100%), nasal endoscopy skills (100%). Ratings of the model for training the specific tasks were consistently high. Neutral or lower were received for inferior turbinoplasty (14%), frontal balloon task (14%), understanding the ethmoid bulla (29%), and advanced sinus techniques (57%). All faculty strongly agreed they would be interested in using the model to train residents. CONCLUSIONS Simulation models have proven efficacy in endoscopic skill and procedural training. The group developed a novel low-cost, medium-fidelity sinus training model utilizing three-dimensional modeling and printing. Testing of this model revealed high ratings for both face and construct validity for a range of endoscopic procedures. Strong interest in using this model for resident training was unanimous among all survey participants. LEVEL OF EVIDENCE NA Laryngoscope, 127:781-786, 2017.
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Affiliation(s)
- Daniel R Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A
| | - Ryan P Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A
| | - Sarah Bowe
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Leon Bunegin
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A
| | - Erik K Weitzel
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, U.S.A
| | - Kevin C McMains
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, U.S.A
| | - Thomas Willson
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, U.S.A
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A
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Laury AM, Bowe SN, Stramiello J, McMains KC. Balloon dilation of sinus ostia in the Department of Defense: Diagnoses, actual indications, and outcomes. Laryngoscope 2016; 127:544-549. [PMID: 27659163 DOI: 10.1002/lary.26315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/21/2016] [Accepted: 08/15/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the primary diagnoses for which balloon catheter dilation (BCD) of sinus ostia is being employed in a profit-blind health care system, the Department of Defense. STUDY DESIGN Retrospective chart review. METHODS From January 1, 2011 to December 31, 2013, 319 consecutive patient charts were reviewed for International Classification of Diseases, Ninth Edition (ICD-9) diagnoses, presence of chronic rhinosinusitis (CRS) defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), preoperative Lund-Mackay scores, nasal endoscopy findings, sinuses dilated, postoperative outcomes, and complications. RESULTS Of the 319 patients identified, 217 had sufficient documentation to be included. A CRS ICD-9 code was applied in 182 of 217 (83.9%) and recurrent acute rhinosinusitis in 12 of 217 (5.6%). Only 50.5% of CRS patient charts met criteria using EPOS guidelines. In contrast, 39.6% met the ICD-9 criteria for atypical facial pain. Patients with Lund-Mackay scores ≤ 4 were reviewed for number of sinuses dilated. Eighty-eight of 123 patients (71.5%) had sinuses dilated that were free from opacification/mucosal edema on preoperative imaging. CONCLUSIONS Balloon dilation of sinus ostia has an expanding role in treating sinus disease. In the studied population, BCD is often utilized for alternate indications for which there is currently no evidence of efficacy. Future studies are needed to evaluate the efficacy of this technology in treating these alternate indications. LEVEL OF EVIDENCE 4. Laryngoscope, 127:544-549, 2017.
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Affiliation(s)
- Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft. Sam Houston, Texas, U.S.A
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft. Sam Houston, Texas, U.S.A
| | - Joshua Stramiello
- University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
| | - Kevin C McMains
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft. Sam Houston, Texas, U.S.A
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Sarber KM, O'Connor PD, Doellman MS, Dagucon MJ, Chen PG, McMains KC, Weitzel EK. Surgical relationship of the nasolacrimal system to the maxillary line: Performing safe mega antrostomy. Allergy Rhinol (Providence) 2015; 6:158-61. [PMID: 26686206 PMCID: PMC5391483 DOI: 10.2500/ar.2015.6.0138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic extended maxillary mega-antrostomy (EMMA) is a mucosal sparing technique that allows maxillary drainage by gravity, with a reported symptomatic nasolacrimal duct injury incidence of 0-4%, based on history alone. Injury to the nasolacrimal duct is known to cause epiphora, a complication that is rare but more often seen in this revision surgery. OBJECTIVE The goal of this study was to determine the incidence of nasolacrimal system penetration during EMMA. We, in addition, sought to determine the minimal safe distance from the midpoint of the maxillary line (the "M" point) to the nasolacrimal system to avoid this injury. METHODS Six cadaveric heads underwent bilateral Jones II test followed by EMMA. Measurements from the M point to the antrostomy were recorded. The Jones II test was then repeated to assess for penetration and/or injury of the nasolacrimal system. If no penetration occurred at the surgical limit of EMMA, then dissection was continued incrementally until penetration occurred. This measurement was recorded. RESULTS Lacrimal duct violation was identified in 5 of 12 procedures (42%). Lacrimal duct penetration occurred at an average of 3.7 mm (range, 2-7 mm) posterior to the M point. CONCLUSION Subclinical lacrimal system injury is likely to occur during EMMA. These findings would indicate that maintaining a distance of >7 mm from the maxillary line could avoid this injury.
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Affiliation(s)
- Kathleen M Sarber
- Otolaryngology Department, San Antonio Military Medical Center, San Antonio, Texas, USA
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Willson TJ, Lospinoso J, Weitzel EK, McMains KC. Effect of environmental factors on Internet searches related to sinusitis. Laryngoscope 2015; 125:2447-50. [DOI: 10.1002/lary.25420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas J. Willson
- Department of Otolaryngology-Head and Neck Surgery; San Antonio Military Medical Center; San Antonio Texas
| | | | - Erik K. Weitzel
- Department of Otolaryngology-Head and Neck Surgery; San Antonio Military Medical Center; San Antonio Texas
| | - Kevin C. McMains
- Department of Otolaryngology-Head and Neck Surgery; South Texas Veterans Medical Center; San Antonio Texas U.S.A
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Kelts GI, McMains KC, Chen PG, Weitzel EK. Monitor height ergonomics: A comparison of operating room video display terminals. Allergy Rhinol (Providence) 2015; 6:28-32. [PMID: 25860168 PMCID: PMC4388873 DOI: 10.2500/ar.2015.6.0119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A surgeon's eyes should be positioned 1 meter (m) distant and no more than 15° below the top of an operating monitor (0.27 m). We sought to determine which operating room video display terminal can best accommodate ergonomically optimized gaze during surgery. Floor to eye height was measured for surgeons in seated, perched, and standing positions. These ranges were then compared to vertical displacement ranges for monitors measured from floor to top of the screen. Eye height was measured for standing (1.56-1.80 m), perched (1.40-1.65 m), and seated (1.10-1.32 m) positions. The minimum distance (min) between the floor and the top of the monitor and the vertical mobility range (VR) of the monitor were measured throughout a tertiary medical center including towers with boom arms (TcB) (min: 1.58 m, VR: 0.37 m), towers without booms (TsB) (min: 1.82 m, VR: 0.025 m), ceiling mounted booms (CMB) (min: 1.34 m:, VR: 1.04 m), and portable monitors (PM) (min: 1.73 m, VR: 0.04 m). The tangent of 15° declination was used to calculate a correction factor to determine the minimum optimal ergonomic display height. The correction factor was subtracted from the eye height at each position to determine the lowest target height and the highest target floor to eye distance for each position. Analysis of variance with least significant difference post hoc testing identified all minimum distances and vertical ranges to be statistically different (p < 0.001). Monitor vertical displacement varied between styles of carts. CMB video display terminal systems can accommodate standing, perched and the tallest seated surgeons. TcB, TsB and PM systems cannot adequately accommodate all standing, perched or seated surgeons.
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Affiliation(s)
- Gregory I Kelts
- San Antonio Uniformed Services Health Education Consortium, Department of Otolaryngology, San Antonio, Texas, USA
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18
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Doellman M, Chen PG, McMains KC, Sarber KM, Weitzel EK. Sinus penetration of saline solution irrigation and atomizer in a cadaveric polyp and allergic fungal sinusitis model. Allergy Rhinol (Providence) 2015; 6:8-11. [PMID: 25860165 PMCID: PMC4388882 DOI: 10.2500/ar.2015.6.0115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Allergic fungal sinusitis (AFS) is a stubborn disease requiring surgical and medical management. Delivery of topical medication is paramount in these patients, but the most difficult to accomplish. We investigated heavy irrigation (nasal douche) and atomized medication delivery potential in a cadaveric sinus model of polypoid AFS disease. Three disease models were created: a control that involved unoperated sinuses and no simulated disease; an unoperated AFS with type II polyposis mode; and an operated model with recurrent allergic fungal sinusitis with type II polyposis. The maxillary sinus showed the best irrigation and overall the heavy irrigator was more efficient than the atomizer.
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Affiliation(s)
- Mary Doellman
- Department of Otolaryngology - Head and Neck Surgery, San Antonio Military Medical Center, Fort Sam, Houston, Texas, USA
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McMains KC, Isaacson GC, Netterville JL, Wagner R. Avoiding the Deadly Sins of Humanitarian Missions: How to Do Good Better. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Program Description: Humanitarian surgical trips provide an opportunity to deliver care that would otherwise be unavailable. However, there is significant variability among humanitarian missions. This variability has contributed to some unfortunate patient outcomes. This miniseminar will explore “deadly sins” common to medical humanitarian efforts and issues that are unique to surgical humanitarian missions. Panelists with extensive humanitarian experience will discuss available data and areas with a lack of data concerning humanitarian efforts. Best practices will be discussed with respect to appropriate standard of care, duration, follow-up, research, role of the media, and integration with local care systems. Educational Objectives: (1) Critically evaluate the existing literature and identify gaps in knowledge regarding humanitarian efforts in otolaryngology. (2) Recognize “best practices” including appropriate standard of care, duration, follow-up, conduct of research, role of the media, and integration with local care systems. (3) Critically evaluate and devise methods to improve existing humanitarian efforts in otolaryngology.
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McMains KC, Peel J. Dedicated training in adult education among otolaryngology faculty. Laryngoscope 2014; 124:2693-5. [PMID: 24756911 DOI: 10.1002/lary.24731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/27/2014] [Accepted: 04/21/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Most faculty members undergo ad hoc training in education. This survey was developed to assess the prevalence and type of dedicated training in education received by academic otolaryngology-head and neck surgery (OTO-HNS) faculty in the United States. STUDY DESIGN Survey. METHODS An 11-item survey was developed to assess the prevalence of dedicated instruction in education theory and practice, the types of instruction received, and the barriers to receiving instruction. The survey was sent to all OTO-HNS program directors for distribution among their respective faculty. RESULTS A total of 216 responses were received. Seventy respondents (32.7%) serve as program director, associate program director, or assistant program director in their respective programs. Forty-six respondents (21.8%) had received dedicated training in education. Of the respondents who described the type of education training received, 48.7% participated in didactics/seminar, 35.9% in degree/certificate programs, 10.3% in multimodality training, and 5.1% online training. Among the barriers encountered to participation in instruction in education, time/productivity pressures was the most commonly cited reason (60.2%), followed by not knowing about the opportunity to receive training (36.4%), lack of departmental support (26.2%), lack of available training (22.3%), and the perception that such training would not be useful (7.8%). CONCLUSION Presently, only a minority of surveyed academic otolaryngologists in the United States have received any dedicated instruction in the theory and practice of education. Personal, departmental, and institutional barriers exist in many practice environments that hinder otolaryngology faculty from participating in education training. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Kevin C McMains
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland
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Rohrer JW, Dion GR, Brenner PS, Abadie WM, McMains KC, Thomas RF, Weitzel EK. Surfactant improves irrigant penetration into unoperated sinuses. Am J Rhinol Allergy 2012; 26:197-200. [PMID: 22643945 DOI: 10.2500/ajra.2012.26.3761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Saline irrigations are proving to be a valuable intervention in the treatment of chronic sinusitis. The use of surfactants is a well established additive to topical treatments known to reduce surface tension and may prove to be a simple, nonoperative intervention to improve intrasinus douching penetration. METHODS Six 30-mL, flat-bottomed medicine cups with circular holes cut through the bottom center and varying in diameter from 1 to 6 mm were created with punch biopsies. Water, saline, saline/dye, and saline/dye/surfactant were compared for maximum holding pressure via these modeled ostia. Holding pressures also were determined for cups with septal mucosa fused to the bottom with holes ranging from 1 to 6 mm. In addition, analysis was carried out with blood and blood/surfactant. Finally, five thawed, fresh-frozen cadaver heads were evaluated before any sinus surgery with water/dye and water/dye/surfactant for intrasinus penetration. RESULTS Surfactant significantly improved the ability of all solutions to penetrate ostia in both the plastic cup and fused septal mucosa model. All nonsurfactant-containing solutions were not statistically different from one another, nor did surfactant change the ostial penetration of blood. Surfactant significantly improved the ability of sinus irrigant to penetrate unoperated sinus cavities (3.12 vs 3.5, p = .021). CONCLUSIONS The addition of surfactant to saline irrigation improves ostial penetration in undissected and undiseased cadavers. This has practical implications for unoperated patients seeking care for sinus-related symptoms in that we have now described a method for improving topical treatment of target sinus mucosa prior to surgical intervention.
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Affiliation(s)
- Joseph W Rohrer
- Department of Otolaryngology Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236, USA
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McMains KC, Boston ME, Holt GR, Discolo C, Cordes SR, Westerberg BD. Avoiding the “Deadly Sins” of Humanitarian Missions: How to “Do Good” Better. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415818a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Program Description: Over the past several decades, the numbers of North American physicians and surgeons engaged in international humanitarian missions has increased dramatically. Such trips often provide an opportunity for needy individuals and communities to receive care that would otherwise be unavailable to them. They also provide the opportunity for participants to “give back” through providing direct patient care and teaching in an environment of extreme need. Personal motivations, level of ability of the individual practitioner, sophistication of the mission organization, as well as level of connectedness to “in country” providers varies dramatically among mission groups. This variability has contributed to some unfortunate patient outcomes. Accusations that “surgical safaris” represent a “form of Neo-colonialism” have cast doubt on the motivations of participants and brought significant scrutiny to the true benefits arising from these efforts. This interactive miniseminar will explore “deadly sins” which are common to medical humanitarian efforts as well as issues which are unique to surgical humanitarian missions. Panelists will discuss available data and areas in which there is a lack of data concerning humanitarian efforts. Finally, “best practices” for humanitarian missions will be discussed. Issues to be discussed include appropriate standard of care, duration, follow-up, conduct of research, resident trainee participation in surgical procedures, role of the media, and integration with local care systems. Educational Objectives: 1) Identify common problems encountered during medical and surgical humanitarian mission trips. 2) Understand ethical concerns arising during international humanitarian efforts. 3) Apply best practices for conduct of humanitarian mission trips in which they are involved.
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Brenner PS, Abadie WM, Weitzel EK, Thomas RF, McMains KC. Unexpected consequences of transnasal balloon dilation of the maxillary ostium. Int Forum Allergy Rhinol 2011; 1:466-70. [PMID: 22144056 DOI: 10.1002/alr.20085] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/21/2011] [Accepted: 06/28/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nasal irrigations and topical sprays have been demonstrated to have benefit in chronic sinusitis. Increasingly, it is evident that delivery system, patient anatomy, and inflammatory process have significant impacts on irrigant distribution. METHODS Intrasinus endoscopy was performed during sinus irrigation of 5 thawed fresh frozen cadavers (10 sides) before and after transnasal dilation of the maxillary, frontal, and sphenoid ostia with a 5-mm balloon. RESULTS Guidewire insertion created false passages through maxillary fontanelle on all of 10 attempts; 1 of 10 frontal insertions entered the ostia in a submucosal plane, while all 10 sphenoid attempts were successful without complication (p < 0.0001). Average minimum ostial dimension increased from 1.73 mm to 3.6 mm (p < 0.0001) after dilation. Obtaining an ostial size of 5 mm was associated with significantly improved irrigation penetration relative to a minimum dimension of 4 mm or less (p = 0.019). After balloon dilation of the true ostia, irrigation of the sphenoid increased, irrigations into the frontal sinuses were unchanged, and irrigation into the maxillary sinuses decreased. CONCLUSION Guidewire insertion in this study was noted to frequently create a false passage during maxillary sinus ostial dilation. After balloon dilation, irrigant penetration was increased into the sphenoid sinus for heavy and mist irrigators whereas the maxillary sinus had diminished irrigant penetration for heavy and NetiPot irrigators.
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Affiliation(s)
- Pryor S Brenner
- Department of Otolaryngology Head and Neck Surgery, Wilford Hall Medical Center, Lackland AFB, TX 78236, USA
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Boone JL, Feldt BA, McMains KC, Weitzel EK. Improved function of prototype 4.3-mm Medtronic Quadcut microdebrider blade over standard 4.0-mm Medtronic Tricut microdebrider blade. Int Forum Allergy Rhinol 2011; 1:198-200. [PMID: 22287373 DOI: 10.1002/alr.20034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/31/2010] [Accepted: 11/09/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Test performance of a new prototype microdebrider blade. The commercially-available, standard 4.0-mm Medtronic straight Tricut blade was tested against the new, prototype 4.3-mm Medtronic straight Quadcut blade in experimental surgical conditions utilizing both a nasal polyp (NP) analog (raw oysters) and an allergic fungal sinusitis (AFS) analog (minced beef cat food). METHODS Both sides of 5 thawed, fresh-frozen cadaver heads were utilized for NP analog removal. AFS analog was removed out of specimen containers. A total of 10 paired data points were collected for time of surgical removal and number of clogs comparing the 2 blades. RESULTS For simulated AFS debris, the prototype clogged less than the standard blade (0 vs 4.5, p < 0.0001). There were no clogs noted for either blade with the NP analog. Time for debris eradication was significantly improved for both AFS analog (147.4 vs 262.0 seconds, p < 0.0001) and NP analog (43.7 vs 112.1 seconds, p < 0.0001). CONCLUSION The prototype blade offers faster debris and polyp removal and clogs less in the setting of allergic fungal debris. As the new blade is faster and more aggressive, introduction into a surgical setting should be guarded with an appropriate degree of caution.
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Affiliation(s)
- John L Boone
- Department of Otolaryngology, University of Texas Health Science Center at San Antonio, TX, USA
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Abstract
PROBLEM This study explores contribution of the orbital floor to mechanical outcomes of orbital decompressions. METHOD OF STUDY Endoscopic medial wall orbital decompressions with and without extensive medial orbital floor removal (OFR) were performed on opposite sides of ten thawed fresh-frozen cadaver heads Bone removal was compared on pre- and post-dissection CT scans and after orbital exenteration. RESULTS Bony removal in the anterior orbital apex was significantly better after OFR (117 vs 66, p < 0.0001). An average of 10.3% (range 0 - 45.5%) of the orbital floor directly under the globe was removed with the OFR technique. The orbital floor preservation (OFP) technique resulted in average bone removal of 3.6 cm2, whereas OFR decompression resulted in average of 5.7 cm2 (p = 0.0003). Post-operative recession of the globe was significant in both arms of the study relative to the unoperated state (OFP averaged 2.99 mm decompression, p = 0.001 and OFR averaged 4.25 mm decompression, p = 0.02). CONCLUSIONS Endoscopic removal of the medial orbital floor when performed in addition to medial wall decompression removes > 60% more orbital bone and an additional 51 of orbital apex bone. Extensive endoscopic removal of the mid-portion of the medial orbital floor results in bone loss beneath the globe itself.
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Affiliation(s)
- J M Swartz
- DO San Antonio Military Medical Center, Lackland AFB, TX 78236, USA
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Abadie WM, McMains KC, Weitzel EK. Irrigation penetration of nasal delivery systems: a cadaver study. Int Forum Allergy Rhinol 2010; 1:46-9. [PMID: 22287307 DOI: 10.1002/alr.20002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 06/23/2010] [Accepted: 07/13/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND To determine the sinus penetration potential of several commercially available irrigation systems in maximally operated sinus cavities; cadaveric study in a tertiary care center. METHODS Seven fresh cadaver heads with brains removed were maximally dissected to include a Draf III frontal sinusotomy, wide maxillary antrostomy, and complete sphenoethmoidectomy. Drill-holes (4 mm) were created to allow visualization of the irrigations from within the respective sinus cavity. Seven commercially available irrigation systems were then tested according to manufacturer recommendation, and the data recorded using an ordinal scale for comparison. RESULTS Among the 3 atomized particle delivery systems tested, the squeeze atomizer took 1.15 attempts, the pump atomizer took 1.85 attempts, and the mechanized atomizer required 30 seconds of continuous application for intrasinus delivery of aerosol (p = 0.009). Penetration with 4 heavy irrigators showed significant variability depending on the sinus cavity being tested. The NeilMed irrigator showed more consistent penetration than any other tested device (p < 0.01). The other systems tested had varying degrees of efficacy, dependent on sinus cavity irrigated. CONCLUSION Delivery of irrigant to maximally operated sinus cavities is variable and highly dependent on the method of nasal delivery. Use of these systems should be tailored appropriately for the desired effect.
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Affiliation(s)
- Wesley M Abadie
- Wilford Hall Medical Center, Department of Otolaryngology-Head and Neck Surgery, Lackland Air Force Base, TX, USA
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27
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Abstract
PURPOSE Most anterior skull base defects causing cerebrospinal fluid (CSF) rhinorrhea can be readily approached using endoscopic techniques when surgical repair is necessary. We present our data from endoscopic repair of CSF rhinorrhea with long-term follow-up. METHODS Retrospective data analysis of patients that were diagnosed with anterior skull base CSF rhinorrhea and underwent endoscopic repair at a tertiary institution. Data were analyzed to determine the etiology and location of CSF leaks. Diagnostic techniques, surgical techniques, and surgical outcomes were reviewed. RESULTS Ninety-two patients were diagnosed with CSF rhinorrhea and underwent endoscopic repair over a 12-year period. Forty-eight were males, and 44 were females. The average age was 49 (range 6-81) years. Average follow-up was 25 months, with a range of 12 to 82 months. The etiology of CSF leak was prior endoscopic sinus surgery in 23 patients (25%), idiopathic in 19 (21%), neurosurgery in 17 (18%), trauma in 18 (20%), and the presence of meningocele/encephalocele in 11 patients (12%). The most common location of the defect was the sphenoid sinus (n = 36, 39%), followed by ethmoid roof (n-27, 29%), and cribriform plate (n = 24, 26%). Endoscopic repair was initially successful in 78 (85%) patients. Seven additional patients underwent successful revision endoscopic repair for an overall success rate of 92% (n = 85). Five (6%) large skull base defects were eventually repaired by neurosurgery using open intracranial techniques. No major complications were encountered. CONCLUSION The intranasal endoscopic approach is an effective and safe technique in the surgical management of anterior skull base CSF rhinorrhea. Long-term success rate in our patient population was 92%.
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Affiliation(s)
- Kevin C McMains
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 Fifteenth Street, Augusta, GA 30912, U.S.A
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28
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Tritt S, McMains KC, Kountakis SE. Unilateral nasal polyposis: clinical presentation and pathology. Am J Otolaryngol 2008; 29:230-2. [PMID: 18598832 DOI: 10.1016/j.amjoto.2007.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 06/22/2007] [Accepted: 07/06/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study is to determine the clinical presentation and pathology of unilateral nasal polyposis (UNP). STUDY DESIGN Retrospective chart review. METHODS A retrospective analysis was completed on 301 consecutive patients with nasal polyposis that underwent functional endoscopic sinus surgery from 1995 to 2004. Of the charts reviewed, 46 patients were identified with UNP. In this group, there were 28 males and 18 females with a mean age at presentation of 34.85 years. Pathologic diagnosis was not available for 2 patients, so there were 44 UNP patient records for analysis. Presenting symptoms, surgical findings, and pathology were analyzed. RESULTS All 44 patients underwent surgical management for their symptoms, and specimens were sent for pathologic evaluation. There were 17 cases of chronic rhinosinusitis, 15 of allergic fungal sinusitis, 7 of inverting papilloma, 2 of squamous cell carcinoma, 1 of esthesioneuroblastoma, 1 of mucocele, and 1 of human papilloma virus polyp-type papilloma. The only presenting symptom that correlated with the presence of inverted papilloma or neoplastic process in our patients with UNP was epistaxis. CONCLUSIONS Chronic rhinosinusitis, allergic fungal sinusitis, inverting papilloma, and other neoplasms account for most UNP cases and must be considered when a patient presents with symptoms of unilateral polyps. A careful history and endoscopic examination play a key role in identifying possible disease processes and proper management.
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Affiliation(s)
- Shawn Tritt
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA 30912, USA
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29
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Seybt MW, McMains KC, Kountakis SE. The prevalence and effect of asthma on adults with chronic rhinosinusitis. Ear Nose Throat J 2007; 86:409-11. [PMID: 17702323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
We conducted a retrospective review of 145 consecutively presenting adults treated for chronic rhinosinusitis (CRS) in a tertiary care institution. Our goals were to determine (1) the prevalence of asthma in these patients, (2) the prevalence of specific CRS symptoms in both asthmatic and nonasthmatic patients, and (3) the frequency of surgical treatmentfor CRS in patients with and without asthma. We found that asthma was present in 23.4% of CRS patients, a much higher rate than the 5% prevalence of asthma in the general adult population. Patients with asthma had a significantly higher prevalence of nasal polyps (47 vs. 22%; p = 0.004), olfactory dysfunction (26 vs. 6%; p = 0.001), and nasal congestion (85 vs. 60%; p = 0.027) than did those without asthma. Patients without asthma had a significantly higher prevalence of headache (72 vs. 53%; p = 0.037) and rhinorrhea (58 vs. 38%; p = 0.047). The prevalence ofpostnasal drip and environmental allergies in the two groups was similar Although the difference between the proportions of patients with and without asthma who required primary sinus surgery was not statistically significant (76 vs. 64%; p = 0.175), patients with asthma did require significantly more revision sinus procedures overall (mean: 2.9 vs. 1.5; p = 0.003).
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Affiliation(s)
- Melanie W Seybt
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta 30912, USA
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30
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Abstract
We conducted a retrospective review of 145 consecutively presenting adults treated for chronic rhinosinusitis (CRS) in a tertiary care institution. Our goals were to determine (1) the prevalence of asthma in these patients, (2) the prevalence of specific CRS symptoms in both asthmatic and nonasthmatic patients, and (3) the frequency of surgical treatment for CRS in patients with and without asthma. We found that asthma was present in 23.4% of CRS patients, a much higher rate than the 5% prevalence of asthma in the general adult population. Patients with asthma had a significantly higher prevalence of nasal polyps (47 vs. 22%; p = 0.004), olfactory dysfunction (26 vs. 6%; p = 0.001), and nasal congestion (85 vs. 60%; p = 0.027) than did those without asthma. Patients without asthma had a significantly higher prevalence of headache (72 vs. 53%; p = 0.037) and rhinorrhea (58 vs. 38%; p = 0.047). The prevalence of postnasal drip and environmental allergies in the two groups was similar. Although the difference between the proportions of patients with and without asthma who required primary sinus surgery was not statistically significant (76 vs. 64%; p = 0.175), patients with asthma did require significantly more revision sinus procedures overall (mean: 2.9 vs. 1.5; p = 0.003).
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Affiliation(s)
- Melanie W. Seybt
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta
| | - Kevin C. McMains
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta
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Abstract
Nasal dermoid sinus cysts (NDSCs) are uncommon occurrences that require intervention usually because of complications with cyst expansion such as chemical meningitis, infection, and sequelae of mass effect such as new-onset seizures. Although many cysts are removed in childhood, some are not detected until adulthood. They become symptomatic and further evaluations illuminate an NDSC that has progressed. Most present as extracranial lesions in childhood and are effectively removed via open rhinoplasty with no recurrence; however, occasionally, they extend intracranially. This case report presents a unique (unusual) extension of the NDSC into the frontal sinus requiring an osteoplastic flap to access the frontal sinus floor combined with a local midline nasal incision at the sinus tract origin. A discussion of various clinical presentations and surgical approaches and a case report of a 35-year-old man are presented. This case adds to the growing amount of literature on NDSCs and demonstrates an unusual presentation, which has thus far not been documented.
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Affiliation(s)
- Garrett Post
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA, USA
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