Utility of a smartphone-enabled otoscope in the instruction of otoscopy and middle ear anatomy Abstract Purpose To present the utility of a smartphone-enabled otoscope as a teaching adjunct in pre-clinical otoscopy training. Methods 60 pre-clinical medical students were randomized into either a control group using a conventional otoscope or an experimental group using a smartphone-enabled otoscope. Participants in each group were trained to use their assigned device and were given time to practice on a colleague’s ear. Participants then completed a questionnaire indicating their ability to visualize anatomical landmarks of the middle ear as well as their confidence in performing a middle ear examination using their device. Results Compared to participants using the conventional otoscope, significantly more students using the smartphone-enabled otoscope identified the umbo (93% versus 63%, P = 0.005), the short process of the malleus (67% versus 33%, P = 0.008), the cone of light (100% versus 70%, P = 0.001), and the pars flaccida (60% versus 33%, P = 0.03). Furthermore, participants who used the smartphone-enabled otoscope reported significantly increased confidence in performing otoscopy compared to those who used a conventional otoscope (4.1 ± 0.7 versus 2.8 ± 0.9, P < 0.001). Finally, participants rated the smartphone-enabled otoscope as an excellent teaching aid for otoscopy training. Conclusion The smartphone-enabled otoscope serves as a valuable teaching tool for pre-clinical otoscopy education. After using the device, pre-clinical students were more confident in performing a middle ear examination and in identifying important anatomical landmarks of the middle ear.

Otorhinolaryngology litigations in Japan Abstract Purpose The purpose of this study was to examine the malpractice litigations pertaining to otorhinolaryngology in Japan. Methods A retrospective review was undertaken of cases tried in the Japanese civil court system during the 26-year period from 1990 to 2015 as identified in a computerized legal database. Data including patient demographics, disease, chief allegations, court’s decisions, and the year decision was made were collected and analyzed. Patients’ chief allegations were assigned to one of the five categories: delayed diagnosis, complication during diagnostic procedure, inappropriate treatment, complication during treatment procedure, or lack of informed consent. Results Thirty-one malpractice litigations were identified. Eight (26%) malpractice litigations pertained to tumors, 1 (3%) to a tumor-like lesion, 14 (45%) to inflammation, and 8 (26%) to others. Among the patients’ chief allegations, inappropriate treatment and complication during treatment procedure were the most frequent [11 (36%) for each], followed by delayed diagnosis [6 (19%)], complication during diagnostic procedure [2 (6%)], and lack of informed consent [1 (3%)]. Conclusion These data may aid in the design of risk-prevention strategies to be used by otorhinolaryngologists.

Endoscopic butterfly inlay myringoplasty for large perforations Abstract Purpose Nowadays, the use of otoendoscopy is becoming increasingly popular in ear surgery. Data on endoscopic tympanoplasty are quite current but not yet sufficient. This study aims to present the anatomical and functional results of endoscopic butterfly inlay myringoplasty in large perforations. Methods The graft success rates and audiological outcomes of 26 ears of 23 patients who underwent endoscopic cartilage inlay myringoplasty due to large perforation (more than two-thirds of the area of tympanic membrane) from March 2016 to August 2018 were evaluated. Results The mean follow-up period was 13.3 ± 7.1 (6–32) months. Graft success rate was 96% (25/26 ears). The preoperative mean air–bone gap (ABG) was 21.4 dB and postoperative mean was 14.4 dB. Significant improvement was observed in postoperative air–bone gap values compared to preoperative period (p 0.005). Conclusions Endoscopic inlay butterfly myringoplasty is a safe surgical technique and has satisfactory anatomic and audiological outcomes in large tympanic perforations.

Influence of olfactory dysfunction on the perception of food Abstract Purpose Eating-related problems are among the most frequent issues in olfactory impairment, causing a noticeable loss of quality of life for some of the affected persons. To what extent olfactory dysfunction impacts on the sensory perception of food is less explored. The aim of the present study was to examine the impact of olfactory dysfunction on the perception of food aromas, as well as the perception of the “basic tastes” salty, sour, sweet, and bitter. Methods Eighty-nine participants were recruited for the prospective study. Group 1 consisted of thoroughly examined patients with olfactory dysfunction (n = 48, mean age = 60.0 years), group 2 consisted of people with normal olfactory function (n = 41, mean age = 50.4 years). First, olfactory and gustatory functions were assessed for all participants with the help of the “Sniffin’Sticks” battery and the “taste strips” test. Second, food odors were rated for their pleasantness, intensity, familiarity and desirability. Last, real food items were tasted orally and the intensity for basic taste qualities (sweet, bitter, salty, and sour) and pleasantness was rated. In addition, salivation was measured following exposure to the food odors. Results In comparison to controls, patients rated orthonasal food odors as less pleasant, intense, familiar, and less appetizing. “Taste strip” scores were significantly lower in patients (M = 9.56, SD = 2.76) as compared to controls (M = 10.88, SD = 1.89). In addition, ratings of food liking for chocolate and peanut were lower in patients compared to controls (chocolate: patients—M = 6.85, SD = 2.09, controls—M = 7.90, SD = 1.53; peanut: patients—M = 4.88, SD = 2.20, controls—M = 6.80, SD = 2.33). No significant differences were found regarding the comparison of the salivary flow rate in controls (M = 0.52 g/min, SD = 0.19) and patients (M = 0.50 SD = 0.17). Conclusions Changes in the perception of odors may change the perception of food with specific effects on food liking. Olfactory dysfunction affects gustatory function, indicating the central-nervous interaction between taste and smell. Still, olfactory dysfunction did not appear to affect patients’ salivary flow.

Lymph node yield and lymph node density for elective level II–IV neck dissections in laryngeal squamous cell carcinoma patients Abstract Purpose To determine the minimum lymph node yield (LNY) in patients with laryngeal squamous cell carcinoma (LSCCs). Methods This retrospective study was performed in a tertiary care hospital setting and included 42 LSCC patients aged 39–81 years (females, n = 2; males, n = 40) who underwent a total or partial laryngectomy and elective bilateral level II–IV neck dissections (unilateral neck dissections: n = 84). Results The average LNY in the unilateral level II–IV lymph node dissections was 25.9 ± 10, and the average metastatic LNY was 0.9 ± 1.9. The unilateral neck dissections were grouped according to the number of lymph nodes. There was no significant difference between the groups in terms of the metastatic LNY (p = 0.5). The metastatic lymph node density (LND) (metastatic lymph node yield/LNY) was 0.043 for unilateral neck level II–IV neck dissections. A Cox regression analysis revealed no significant relationship between survival and the LNY and LND in bilateral neck dissections (p = 0.4 and p = 0.8, respectively). Conclusions The results revealed no minimum number of lymph nodes that could reliably detect metastatic lymph nodes in LSCC patients.

Decentralized virtual reality mastoidectomy simulation training: a prospective, mixed-methods study Abstract Purpose Virtual reality (VR) training of mastoidectomy is effective in surgical training—particularly if organized as distributed practice. However, centralization of practice facilities is a barrier to implementation of distributed simulation training. Decentralized training could be a potential solution. Here, we aim to assess the feasibility, use, and barriers to decentralized VR mastoidectomy training using a freeware, high-fidelity temporal bone simulator. Methods In a prospective, mixed-methods study, 20 otorhinolaryngology residents were given three months of local access to a VR mastoidectomy simulator. Additionally, trainees were provided a range of learning supports for directed, self-regulated learning. Questionnaire data were collected and focus group interviews conducted. The interviews were analyzed using thematic analysis and compared with quantitative findings. Results Participants trained 48.5 h combined and mainly towards the end of the trial. Most participants used between two and four different learning supports. Qualitative analysis revealed five main themes regarding implementation of decentralized simulation training: convenience, time for training, ease of use, evidence for training, and testing. Conclusions Decentralized VR training using a freeware, high-fidelity mastoidectomy simulator is feasible but did not lead to a high training volume or truly distributed practice. Evidence for training was found motivational. Access to training, educational designs, and the role of testing are important for participant motivation and require further evaluation.

Evaluation of wireless Bluetooth devices to improve recognition of speech and sentences when using a mobile phone in bone conduction device recipients Abstract Objective To evaluate the effect of a wireless Bluetooth device (WBD) in word and sentence recognition in patients with bone conduction devices (BCDs) while using mobile phones. Methods We performed a prospective study evaluating speech and sentence recognition in both quiet and noised conditions. A total of nine patients, audiologically eligible for BCDs, were included. Based on their hearing impairment type and severity, subjects were divided into “BCD only” and “BCD with HA” groups. The speech and sentence recognition scores of each condition were compared by nonparametric methods. Results Both the “BCD only” and “BCD with HA” groups had higher scores in the quiet condition than in the noised condition in word and sentence recognition tests, irrespective of whether the WBD was used. The benefit from using a WBD was greater in the noised condition. There were significant differences in the word recognition test results before and after using the WBD in the “BCD only” group, and in both the word and sentence recognition tests results before and after using the WBD bimodally in the noised condition in the “BCD with HA” group. Conclusion WBDs improve word and sentence recognition in adult BCD bone recipients when they use mobile phones. WBD use provides additional benefits in “BCD with HA” patients in a bimodal situation.

Oral lesion as the primary diagnosis of non-Hodgkin’s lymphoma: a 20-year experience from an oral pathology service and review of the literature Abstract Purpose We aimed to investigate the frequency and clinicopathological features of oral NHL in our institution as well as to compare the data gathered from other oral pathology and general pathology services published in the literature. Methods Clinical records of patients diagnosed with NHL exclusively affecting the oral cavity were reviewed from 1997 to 2017. Additionally, a review of the literature over a 20-year period was conducted aiming to examine articles on oral NHLs. Results Oral NHLs represented 0.1% (n = 98) of the total number of biopsies (68,229) received during the period evaluated (1997–2017). The mean age at the diagnosis was 47 years. Most patients were white (67.3%). A nodular lesion was the most frequent presentation (54.9%) and pain was described in 47.1% of the cases. The most common diagnosis was diffuse large B cell lymphoma (42%) followed by plasmablastic lymphoma (24%). Only 19 articles were included in the review of the literature. Conclusions Although NHLs are rare in the oral cavity, clinicians and surgeons have an important role in promptly diagnosing lymphomatous lesions to refer the patient to a proper treatment.

Differing characteristics of cartilaginous lesions of the larynx Abstract Introduction The tissues of the laryngeal region only rarely harbor primary cartilaginous lesions, and squamous cell carcinoma remains the most frequently encountered malignant tumor in this area. Materials and Methods We reviewed the salient histological features of cartilaginous laryngeal lesions to provide differential diagnostics and guidelines for distinguishing the benign from the malignant ones. Results Cartilaginous neoplasms of the larynx include chondroma and chondrosarcoma. Among the overarching group of all forms of laryngeal sarcoma, chondrosarcoma forms the most common entity in the larynx, followed by rhabdomyosarcoma. Cartilaginous tumors comprise about 0.1%–1% of all laryngeal neoplasms with chondrosarcomas being more frequently encountered than chondromas. Several neoplasms earlier reported as giant-cell tumors of the larynx would most likely, using current terminology, be classified as cases of undifferentiated pleomorphic sarcoma (previously known as malignant fibrous histiocytoma, giant-cell variant) or aneurysmal bone cyst. Conclusion When true laryngeal sarcomas do exist, they may prove to be challenging lesions both for the pathologist and the treating clinician. The diagnostic problems are mainly a result of the infrequent exposure of clinicians and diagnosticians to these lesions.

Classification and volumetric study of the sphenoid sinus on MDCT images Abstract Purpose We aimed to determine the position and size of the sphenoid sinus (SS) in our study and compare the results of the measurements relative to age, gender, and the presence of pituitary adenoma using multidetector computerized tomography (MDCT). Methods We retrospectively evaluated the paranasal sinus computerized tomography (CT) images of 200 individuals (age range of all the individuals 4–84 years; 101 females, 99 males; age range of individuals with pituitary adenoma 15–63 years; 15 females, 9 males) with 24 pituitary adenomas. The shape of SS were identified and classified, volume were measured by MDCT also for individuals with pituitary adenoma. Results It was determined that the volume averages were significantly affected by the type of SS. Among all the individuals studied, the sellar type of SS was most frequently observed (41.5%), followed by the postsellar type (38.5%), and the least observed was the presellar type (9%). The volume of the SS is bigger in males than females although the volume is not affected by the presence of pituitary adenomas. The development of the SS continues until the age of nine. Conclusion The morphology and morphometry of the SS show individual differences. These anatomic variations are important for decision making and application for surgical interventions (especially transsphenoidal surgery).