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See detailUse of Vandenberg and Kuse mental rotation test to predict practical performance of rhinosinus endoscopy
Pottier, Laurence ULiege; El Haddadi, Ilyas; Defaweux, Valérie ULiege et al

Poster (2021, March 06)

Introduction and Aim: The aim of this work is to assess the predictive value of the Vandenberg and Kuse Mental Rotation Test (MRT) on performance of novice medical student for manipulation of a nasal ... [more ▼]

Introduction and Aim: The aim of this work is to assess the predictive value of the Vandenberg and Kuse Mental Rotation Test (MRT) on performance of novice medical student for manipulation of a nasal endoscope on a cadaveric model. Material and Methods: We randomly selected 39 medical students who had never handled a nasal endoscope and subjected them to the MRT. They were then asked to perform series of cadaveric model exercises using a nasal endoscope. Two judges, using the Lindquist’s scale, evaluated their performance on cadavers. They were also asked to fill in a questionnaire aimed at defining their general profile (personal experience with manual activities and medical manual activities, surgical tropism, etc.) and an anatomic test in order to exclude possible confounding factors. Results: We found that medical students with higher mental rotation skills had significantly increased endoscopic sinus performance (p=0.0251 using univariate regression, and p=0.0002 using multivariate regression adjusted for specialty choice, previous surgical exposure and anatomy knowledge). Higher anatomy knowledge was also associated with better endoscopic sinus performance (p=0.0141). Other parameters had no impact on endoscopic sinus performance measured by the endoscopic scale (p>0.005). Conclusion: The score obtained on the MRT is correlated to the practical performance of manipulating the nasal endoscope in surgery. It could therefore be a useful spatial ability tool for educational purposes for candidates specializing in rhinology. [less ▲]

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See detailInfluence of storage temperature for respiratory epithelial samples on ciliary functional analysis
Benchimol, Lionel ULiege; Bricmont, Noémie ULiege; BOBOLI, Hedwige ULiege et al

Poster (2021, March 06)

Introduction and Aim: Primary ciliary dyskinesia is characterized by inherited stationary or dyskinetic respiratory cilia. Digital high speed videomicroscopy is highly sensitive and specific for diagnosis ... [more ▼]

Introduction and Aim: Primary ciliary dyskinesia is characterized by inherited stationary or dyskinetic respiratory cilia. Digital high speed videomicroscopy is highly sensitive and specific for diagnosis but lacks standardization. Particularly, the temperature for samples conservation has never been studied. The study goal was to compare ciliary analysis after samples storage at 4°C or 22°C. Agreement between two independent observers was sought as secondary goal. Material and Methods: Ciliated epithelial samples were obtained by inferior turbinate brushing from 13 healthy subjects, divided equally and conserved at 4°C or at 22°C. Digital high speed videomicroscopy assessed ciliary beat frequency (CBF) and percentage of normal ciliary beat pattern (CBP) nine hours after sampling. Results: There was no significant difference when samples were stored at 4°C or 22°C. Median CBF was 13.37 (12,23 –15,37) Hz and 15.24 (12,89 –16,06) Hz at 4°C and 22°C respectively (p = 0.210). Percentage of normal CBP was 81,80% (63,75 – 90,65) and 80,00% (71,70 – 87,30) at 4°C and 22°C respectively (p = 0.910). Moreover, inter observer analysis showed high agreement rate with 93,4% for the CBF and 90.0% for the CBP. Conclusion: This pilot study suggested with a high inter observer agreement rate that the temperature for respiratory ciliated samples conservation had no effect on ciliary function analysis. Larger studies are needed to confirm these preliminary results, notably in pathological conditions. [less ▲]

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See detailUse of Vandenberg and Kuse Mental Rotation Test to Predict Practical Performance of Sinus Endoscopy
ROGISTER, Florence ULiege; Pottier, Laurence ULiege; EL HADDADI, Ilyas et al

in Ear, Nose & Throat Journal (2021)

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See detailENT Service during the COVID-19 pandemic: a cross-sectional study in 572 patients.
Peigneux, Nicolas ULiege; Benchimol, Lionel ULiege; BENDAVID, Guillaume ULiege et al

in B-ENT (2021), 16(4),

Objective: To provide objective data on the impact of COVID-19 crisis on our ENT practice. Methods: 572 consecutive patients presenting to the ENT clinic and ENT operating theatre from March 16, 2020 to ... [more ▼]

Objective: To provide objective data on the impact of COVID-19 crisis on our ENT practice. Methods: 572 consecutive patients presenting to the ENT clinic and ENT operating theatre from March 16, 2020 to May 3, 2020 were prospectively included. Demographic and clinical data, admission time, paraclinic testing, management, outcome and follow’up were recorded. Retrospective search for comparison to past year over the same period of time was carried out. Results: Coronavirus crisis and the strict lockdown rules led to a severe disruption of the ENT service. A drop in overall activity of 91.1% was observed ; compared to the 6,454 patients who had been treated in 2019 over the same period, appointments and procedures were restricted to 572 patients in this study. Mortality rates increased from 0.82% to 4.55%. While some patients in real need may not have been able to be seen, others presented without ground. More than a quarter of admissions (n=157, 27.6%) resulted in no specific ENT treatment. Patient selection improved when patients had a recent ENT history (OR=2.39 [1.50-3.81], p=0.0003) or were referred by a physician (OR=5.30 [3.69-7.61], p<0.0001). Conclusions: Our data suggested impaired healthcare of all ENT patients. Special attention should be paid to non-Covid otolaryngology patients. [less ▲]

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See detailNasal Brushing Sampling and Processing using Digital High Speed Ciliary Videomicroscopy - Adaptation for the COVID-19 Pandemic.
Bricmont, Noémie ULiege; Benchimol, Lionel ULiege; POIRRIER, Anne-Lise ULiege et al

in Journal of visualized experiments : JoVE (2020), (165),

Primary Ciliary Dyskinesia (PCD) is a genetic motile ciliopathy, leading to significant otosinopulmonary disease. PCD diagnosis is often missed or delayed due to challenges with different diagnostic ... [more ▼]

Primary Ciliary Dyskinesia (PCD) is a genetic motile ciliopathy, leading to significant otosinopulmonary disease. PCD diagnosis is often missed or delayed due to challenges with different diagnostic modalities. Ciliary videomicroscopy, using Digital High-Speed Videomicroscopy (DHSV), one of the diagnostic tools for PCD, is considered the optimal method to perform ciliary functional analysis (CFA), comprising of ciliary beat frequency (CBF) and beat pattern (CBP) analysis. However, DHSV lacks standardized, published operating procedure for processing and analyzing samples. It also uses living respiratory epithelium, a significant infection control issue during the COVID-19 pandemic. To continue providing a diagnostic service during this health crisis, the ciliary videomicroscopy protocol has been adapted to include adequate infection control measures. Here, we describe a revised protocol for sampling and laboratory processing of ciliated respiratory samples, highlighting adaptations made to comply with COVID-19 infection control measures. Representative results of CFA from nasal brushing samples obtained from 16 healthy subjects, processed and analyzed according to this protocol, are described. We also illustrate the importance of obtaining and processing optimal quality epithelial ciliated strips, as samples not meeting quality selection criteria do now allow for CFA, potentially decreasing the diagnostic reliability and the efficiency of this technique. [less ▲]

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See detailIs baseline SNOT-22 able to predict outcome and localize pathology? A prospective multicentre study
Pottier, Laurence ULiege; de Dorlodot, Clotilde; Ansari, Edward et al

in B-ENT (2020)

Objective: To optimize the use of SNOT-22 by predicting the diagnosis of patients and healthy volunteers solely based on the pattern of the baseline SNOT-22. Study Design: Cross-sectional multi-center ... [more ▼]

Objective: To optimize the use of SNOT-22 by predicting the diagnosis of patients and healthy volunteers solely based on the pattern of the baseline SNOT-22. Study Design: Cross-sectional multi-center study. Settings: ENT departments of 3 tertiary referral hospitals. Methods: Baseline SNOT-22 from 66 healthy volunteers and 383 rhinology patients were collected blindly prior to diagnosis. Participants were then categorized in 4 groups according to their diagnosis: control, medical rhinologic condition, functional nose surgery, sinus surgery. Difference between groups was assessed by a multinomial logistic regression adjusted for age, gender, history of nose surgery and trauma. Results: The 22 items of SNOT differed significantly among the 4 groups (p <0.05). Control subjects showed the lowest SNOT-22 scores for all items. Patients requiring sinus surgery and those listed for nose surgery exhibited a specific pattern of SNOT-22 score. Nasal and extranasal rhinology symptoms were more specific to the diagnosis than psychological or sleep dysfunction domains. Conclusion: Distinct SNOT-22 patterns were associated to subjects diagnosis. SNOT-22 was not only able to score severity, but could also localize the disease, orientate the diagnosis and predict the need for surgical treatment. In the era of pandemic risk, SNOT-22 may be the easy telemedicine tool the primary care needs for a better referral pattern. [less ▲]

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See detailThe influence of the conservation of respiratory epithelial samples on ciliary functional analysis
Bricmont, Noémie ULiege; Benchimol, Lionel ULiege; POIRRIER, Anne-Lise ULiege et al

Conference (2020)

Background: Primary ciliary dyskinesia(PCD) is an inherited otosinopulmonary ciliopathy in which respiratory cilia are stationary, or beat in a dyskinetic manner. Digital high speed videomicroscopy(DHSV ... [more ▼]

Background: Primary ciliary dyskinesia(PCD) is an inherited otosinopulmonary ciliopathy in which respiratory cilia are stationary, or beat in a dyskinetic manner. Digital high speed videomicroscopy(DHSV) allows ciliary functional analysis(CFA), including beat frequency(CBF) and pattern(CBP). DHSV is highly sensitive and specific for PCD diagnosis, but lacks standardization and evidence-based data. The technical process of ciliated epithelial samples before CFA varies among studies. Of importance, delay after sampling and temperature for samples conservation may impact CFA. However, these parameters have never been compared. Aims: To evaluate the stability of ciliary function over time when nasal brushing samples are conserved either in the fridge, or at room temperature. Methods: Ciliated epithelial samples were obtained by brushing the inferior nasal turbinate from 5 non-smoking healthy subjects. The samples were divided equally, and conserved either at 4°C or at 22°C. Beating cilia were recorded using DHSV at 37°C immediately(T0, then 9 hours after sampling(T9). CFA was assessed by CBF and the percentage of normal CBP. Results: There was no significant difference between CFA performed immediately or 9 hours after sampling, regardless of the sample storage temperature. Conclusion: This pilot study suggested that the stability of CFA may be preserved for 9 hours at 22°C and at 4°C. Larger studies are needed to confirm these preliminary results, notably in pathological conditions. [less ▲]

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See detailTranscutaneous Ultrasound for Maxillary Disease Screening in Intensive Care Unit: a Preliminary Study
Benchimol, Lionel ULiege; PIAZZA, Justine ULiege; ROGISTER, Florence ULiege et al

Conference (2020)

Introduction and Aim: Nosocomial airway infections are common and associated with high morbidity and mortality in Intensive Care Unit. Endotracheal intubation duration is an independent risk factor for ... [more ▼]

Introduction and Aim: Nosocomial airway infections are common and associated with high morbidity and mortality in Intensive Care Unit. Endotracheal intubation duration is an independent risk factor for maxillary sinusitis, which is a frequent gateway for pneumoniae, meningitis or sepsis. Diagnosis remains challenging, as CT imaging is not easily repeated in the daily assessment of unstable patients. Our aim was to evaluate the efficiency of transcutaneous ultrasound to screen maxillary sinus infection. Material and Methods: Patients presenting to our ENT department with a same-day sinus CT scan were prospectively included in this pilot study. Maxillary transcutaneous ultrasounds were performed by two independent examiners and scored in supine and sitting positions, blindly to the CT imaging, the clinical and endoscopic evaluations. Ability to diagnose sinusitis, repeatability in different positions and inter-examiners comparison were studied. Ultrasound scores were compared to Lund-Mackay-derived CT scores. Results: 7 patients (5 men and 2 women, median age 60 [56-64]) were enrolled in this experiment. In total, 14 left and right maxillary sinus were studied by same-day sinus CT scan and ultrasound in prone and sitting positions by 2 blind and independent examiners. Ultrasound was able to detect maxillary pathology the majority of the cases, with a sensitivity of 71.4% and a specificity of 87.5% in sitting position. However, sensitivity dropped to 46.8% in prone position, with a preserved specificity of 84.4%. Agreement between examiners was observed in 85.7% cases. Conclusion: Transcutaneous ultrasound was capable of screening for maxillary sinus disease compared with conventional sinus CT scan. A special attention should be paid to patient position, as sitting position improved the screening accuracy. Agreement between examiners could be improved. Moreover, despite its limitations, it is an attractive method for the screening of maxillary disease, allowing the ability to screen and/or monitor infection in unstable patients. [less ▲]

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See detailAuditory function and dysfunction:estrogen makes a difference
DELHEZ, Amandine ULiege; LEFEBVRE, Philippe ULiege; Pequeux, Christel ULiege et al

in Cellular and Molecular Life Sciences (2020), 77

Estrogen is the major female hormone involved in reproductive functions, but it also exerts a variety of additional roles in non-reproductive organs. In this review, we highlight the preclinical and ... [more ▼]

Estrogen is the major female hormone involved in reproductive functions, but it also exerts a variety of additional roles in non-reproductive organs. In this review, we highlight the preclinical and clinical studies that have pointed out sex differences and estrogenic influence on audition. We also describe the experimental evidences supporting a protective role of estrogen towards acquired forms of hearing loss. Although a high level of endogenous estrogen is associated with a better hearing function, hormonal treatments at menopause have provided contradictory outcomes. The various factors that are likely to explain these discrepancies include the treatment regimen as well as the hormonal status and responsiveness of the patients. The complexity of estrogen signaling is being untangled and many downstream effectors of its genomic and non-genomic actions have been identified in other systems. Based on these advances and on the common physio-pathological events that underlie age-related, drug or noise-induced hearing loss, we discuss potential mechanisms for their protective actions in the cochlea. [less ▲]

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See detailImpact of the European Union directive on driving licences on a Multidisciplinary Sleep Clinic: a Cohort Study
POIRRIER, Anne-Lise ULiege; VERMEIRE, Pierre ULiege; BRUWIER, Annick ULiege et al

Poster (2019, June 29)

Introduction: The threat of Obstructive Sleep Apnea (OSA) for motor vehicle accident has led to a revision of annex III of the European Union directive on driving licences that was implemented in all ... [more ▼]

Introduction: The threat of Obstructive Sleep Apnea (OSA) for motor vehicle accident has led to a revision of annex III of the European Union directive on driving licences that was implemented in all member states from December 31, 2015. In Belgium, it was followed by a shift in funding for OSA from January 1, 2017. Funding was allowed for moderate to severe OSA and the rules shifted for treatments delivery and monitoring by authorised medical opinion. Multidisciplinary Sleep Clinics have long existed, bringing together sleep specialists, dentists, orthodontists and surgeons. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Material and Methods: Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann-Whitney U tests and descriptive statistics were produced. Results: There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline OSA severity was significantly lower (mean apnea-hypopnea index and mean oxygen desaturation index lowered respectively with p = 0.0189 and p = 0.0466) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. Conclusion: Sleep multidisciplinary team meeting changed patient selection and management after the implementation of the new funding rules for OSA. The shift in funding often resulted in treatment options change, reaching more people and offering more options. [less ▲]

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See detailBaseline SNOT-22 as Outcome Predictor: a Powerful Tool just at Hand
POIRRIER, Anne-Lise ULiege; DE DORLODOT, Clotilde; ANSARI, Edward et al

Poster (2019, June 29)

Introduction: SNOT-22 was initially designed for rhinosinusitis, but was recently validated in various nose conditions. We sought to optimize the use of SNOT-22 by predicting the outcome of patients and ... [more ▼]

Introduction: SNOT-22 was initially designed for rhinosinusitis, but was recently validated in various nose conditions. We sought to optimize the use of SNOT-22 by predicting the outcome of patients and healthy volunteers solely based on the pattern of the baseline SNOT-22. Material and Methods: Sixty-six healthy volunteers and 383 patients presenting to the rhinology clinic of 3 ENT academic departments participated in this prospective cross-sectional multi-centre study. SNOT-22 from all participants were collected blindly prior to diagnosis. Participants were then categorized in 4 groups according to their outcome: control, medical rhinologic condition, functional nose surgery, sinus surgery. Difference between groups was assessed by a multinomial logistic regression adjusted for age, gender, history of nose surgery and trauma. Results: The 22 items of SNOT differed significantly among the 4 groups (p <0.05). Control subjects showed the lowest SNOT-22 scores for all items. Patients requiring sinus surgery and those listed for nose surgery exhibited a specific pattern of SNOT-22 score. Nasal and extranasal rhinology symptoms were more specific to the diagnosis than psychological or sleep dysfunction domains. Conclusion: Distinct SNOT-22 patterns were associated to subjects outcome. SNOT-22 was able to differentiate patients from controls, to score severity, and could further provide an accurate description of pathology. Baseline SNOT-22 could help localize pathology in the sinus or in the nose and predict the need for surgical treatment. [less ▲]

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See detailA prospective audit of acute ENT activity in a university teaching hospital
Atta, Lucas; Delrez, Sophie ULiege; Asimakopoulos, Asimakis et al

in B-ENT (2019), 15

Introduction and aim: Acute ENT coverage is available out-of-hours in most hospitals. However, increasing pressure to reduce healthcare cost threatens this 24-hour availability. Our goal was to audit the ... [more ▼]

Introduction and aim: Acute ENT coverage is available out-of-hours in most hospitals. However, increasing pressure to reduce healthcare cost threatens this 24-hour availability. Our goal was to audit the emergency ENT activity in our institution. Methods: A prospective audit of all ENT emergency referrals was carried out over a one-month period in an academic hospital. Descriptive statistics were produced for age, sex, origin, admission time, diagnosis, management, and patient outcome. Results: A total of 190 patients (109 men and 81 women) were referred to the ENT emergency service over the study period (mean, 6.1 cases/day). Mean age was 47.9 (SD ±23.6) years. Most admissions (76.4%) occurred during normal working hours, and 62.0% of patients were self-referred. The mean complaint duration before admission was 7.6 (±13.7) days. One third (33.2% patients) required ambulatory treatment, a quarter (24.7% patients) had a minor ENT procedure, 18 (9.5%) required admission to the ward, and 8 (4.2%) required surgical treatment. Severity of diagnosis or management between patients did not differ with referral by a physician (GP or specialist) and self-referral. At 30 days, 3 (1.6%) patients died, 106 (55.8%) benefitted from an ENT follow-up, 65 (34.2%) were referred to another physician (GP or specialist), and 16 (8.4%) were lost to follow-up. Conclusions: The results of this workload audit suggest that emergency ENT activity is justified in our hospital. Restricting emergency ENT cover to patients referred by a GP or another physician would not improve patient selection. [less ▲]

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See detailENT Surgical Training in 2018: National Cross-sectional Study
ROGISTER, Florence ULiege; CAMBY, Séverine ULiege; ANSARI, Edward et al

in B-ENT (2019), 15

Objectives: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential tools to ... [more ▼]

Objectives: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential tools to be developed. Methodology: We conducted a broad national survey among ENT Belgian trainees from all universities of the country. The questions included self-assessment, training objectives, training quality and training tools. Results: There were 94 trainees contacted and the overall response rate was 59.5% ; 35.7% of trainees evaluated their level of overall surgical competence at 3/5 compared to an ideal mastery. More than a half (55%) of trainees did not know the training objectives and 73% did not know the basic surgical procedures that a qualified ENT surgeon should be able to perform. The main mode of learning (41%) was the observation of a senior and repetition under supervision (companionship). The results showed mainly logistical and economic drawbacks, on which it seems possible to act using learning methods based on the implementation of organized training sessions, associated with different learning tools such as surgical and procedural simulation. Some of these are already available in our country but remain difficult to access or to develop. Conclusion: This study revealed a real demand and motivation from trainees and could serve as a basis to sketch a teaching scheme improving skills and confidence of future surgeons. Additional studies are needed to identify the most effective ways for implementing this type of teaching within the constraints of the surgical curriculum and teaching hospitals resources. [less ▲]

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See detailEvaluation of Surgical Simulation in Temporal Bone Surgical Radio-Anatomy Learning
ROGISTER, Florence ULiege; SALMON, Caroline ULiege; GHUYSEN, Alexandre ULiege et al

Conference (2019, March 28)

Background Lack of data regarding efficiency of simulation-based teaching, in particular high-fidelity virtual reality, constitutes a major drawback for its implementation in the medical training. However ... [more ▼]

Background Lack of data regarding efficiency of simulation-based teaching, in particular high-fidelity virtual reality, constitutes a major drawback for its implementation in the medical training. However, it provides a structured, safe and supportive environment to familiarize with complex anatomy and practice surgical skills. We aimed to evaluate high-fidelity virtual reality simulation in learning of temporal bone radio-anatomy during ENT residency. Materials and Methods 15 Belgian otorhinolaryngology residents completed 5 sessions of simulation in antro-mastoidectomy using VOXEL-MAN Tempo® surgical simulator. Technical mistakes and surgical parameters were recorded. Before and after training period, residents completed a temporal bone radiological anatomy test available online (http://www.radioanatomie.com). Pre- and post-simulation scores were compared as primary endpoint by non-parametric Wilcoxon test using RCmdr (https://www.r-project.org). As secondary endpoint, residents’ surgical skills following simulation training were blindly assessed on cadaveric human temporal bones using a reproducible scale by seniors otologist surgeons of our department. Correlation between radiological testing and dissection scale were evaluated by Spearman regression. Finally, trainees completed a survey on the device itself. Results Performance on radiological testing significantly increased with a mean improvement of 28 ± 12.12 (Wilcoxon p = 0.0011). Surgical results on cadaveric specimens were not correlated to surgical simulation parameters. Higher results on radiological testing were associated with higher scores on dissection scale, suggesting that subjects who succeeded better at dissection were those who knew best anatomy. Among residents, 80% felt this tool suitable for early surgical education, and 84.6% queried further information on simulation techniques. 100% of trainees would integrate this tool within their learning of temporal bone's radiological and surgical anatomy. Conclusions High-fidelity virtual reality simulator improved temporal bone anatomy teaching and specifically increased knowledge of temporal bone radiological anatomy. Acknowledgement No conflict of interest. [less ▲]

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See detailSurgical Simulation in Temporal Bone Surgical Radio-Anatomy Learning
ROGISTER, Florence ULiege; SALMON, Caroline ULiege; GHUYSEN, Alexandre ULiege et al

in B-ENT (2019, February 23)

Introduction and Aim: We aimed to evaluate high-fidelity virtual reality simulation in learning of temporal bone radio-anatomy during ENT residency. Methods: Fifteen ENT residents completed a radiological ... [more ▼]

Introduction and Aim: We aimed to evaluate high-fidelity virtual reality simulation in learning of temporal bone radio-anatomy during ENT residency. Methods: Fifteen ENT residents completed a radiological temporal bone anatomical testing before and after five training sessions on the VOXEL-MAN Tempo® surgical simulator. Secondary investigation: residents also completed a personal subjective assessment after these training session and residents’ technical skills were assessed on cadaveric temporal bones. Results: Primary outcome: Residents significantly improved their performance on the temporal bone radiological anatomy test after completing virtual training on the simulator. Secondary outcomes: The personal assessment survey indicated that 100% of the residents would integrate this virtual tool within the learning methods. No significant correlation was found between virtual simulator performances and surgical performances on cadaveric model, but a significant correlation was shown between the anatomical testing result and the performances on cadaveric model. Conclusions: This study suggested that a high-fidelity virtual reality simulator, the VOXEL-MAN Tempo® device, improved teaching of temporal bone anatomy and specifically increased trainees’ practical knowledge regarding radiological anatomy of temporal bone. [less ▲]

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See detailCarotid blowout syndrome in patients with nasopharyngeal carcinoma: three cases
Detroux, Valentine; Goffart, Yves; Maris, Dana et al

in B-ENT (2019), 15

Carotid blowout syndrome (CBS) is a rare complication of radiation therapy for nasopharyngeal carcinoma (NPC), for which angiography is the gold standard for diagnosis and treatment. We report three NPC ... [more ▼]

Carotid blowout syndrome (CBS) is a rare complication of radiation therapy for nasopharyngeal carcinoma (NPC), for which angiography is the gold standard for diagnosis and treatment. We report three NPC cases treated with irradiation and complicated by bleeding from the internal carotid artery. The first case presented with multiple episodes of limited nosebleeding followed by massive bleeding. Bleeding was initially stopped by internal carotid artery embolisation. A few months later, meningitis related to skull base osteoradionecrosis occurred and the patient died from sceptic shock. The second case was admitted to the hospital with severe repetitive epistaxis and despite several attempts to manage the bleeding, the patient passed away. The third case presented with a massive epistaxis that resolved itself without any treatment. Spontaneous occlusion of the internal carotid artery occurred without any neurological defects. A nasopharyngeal muscle flap was constructed to prevent meningitis. CBS is a rare but life-threatening complication that requires emergency treatment. Re-irradiation and skull base radioosteonecrosis are strong predisposing factors. [less ▲]

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See detailResponsiveness of acoustic rhinometry to septorhinoplasty by comparison to rhinomanometry and subjective instruments.
ANSARI, Edward; ROGISTER, Florence ULiege; LEFEBVRE, Philippe ULiege et al

in Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2019)

OBJECTIVES: Nose patency measures and instruments assessing subjective health are increasingly being used in rhinology. However, there is very little evidence of comparing existing methods' responsiveness ... [more ▼]

OBJECTIVES: Nose patency measures and instruments assessing subjective health are increasingly being used in rhinology. However, there is very little evidence of comparing existing methods' responsiveness to change. We evaluated the responsiveness of acoustic rhinometry to nasal valve surgery by comparison to rhinomanometry and patient-reported outcome instruments. DESIGN: Prospective case-control study Setting: Tertiary referral University Hospital Participants: Sixty consecutive patients with internal nasal valve dysfunction and 20 healthy volunteers as control group were enrolled. Prospectively collected data included acoustic rhinometry, rhinomanometry, NOSE scale, SNOT-23 questionnaire, visual analogue scale and demographics. MAIN OUTCOME MEASURES: Primary endpoint was the responsiveness of acoustic rhinometry to functionnal septorhinoplasty surgery at 3 months. Secondary endpoints were ability of acoustic rhinometry to reflect "known group" differences and correlation to subjective symptoms. RESULTS: Acoustic rhinometry was highly responsive to septorhinoplasty (p<0.0001) while anterior rhinomanometry was not (p=0.08). Based on the quartiles of the post-operative change in NOSE score, patients were classified as respectively non responders, mild, moderate and good responders to surgery. Logistic regression model showed that acoustic rhinometry was able to discriminate non responders to responders to surgery (p=0.019), while anterior rhinomanometry failed (p=0.611). Sensitivity and specificity of acoustic rhinometry were significantly higher (ROC area=0.76) than rhinomanometry (ROC area =0.48). Acoustic rhinometry was also superior than rhinomanometry to discriminate patients from control subjects, and agreed better with patients-based subjective questionnaires. CONCLUSIONS: Our study confirms and quantifies the responsiveness of acoustic rhinometry to nasal valve surgery, with a higher sensitivity and specificity than rhinomanometry. This article is protected by copyright. All rights reserved. [less ▲]

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See detailImpact of a Shift in Treatment Funding on a Multidisciplinary Sleep Clinic: a Cohort Study
VERMEIRE, Pierre ULiege; FANIELLE, Julien ULiege; BRUWIER, Annick ULiege et al

in B-ENT (2019)

Introduction and Aim: A shift in Obstructive Sleep Apnea (OSA) funding was implemented in Belgium on January 1, 2017. Funding was allowed for moderate to severe OSA and the rules shifted for treatments ... [more ▼]

Introduction and Aim: A shift in Obstructive Sleep Apnea (OSA) funding was implemented in Belgium on January 1, 2017. Funding was allowed for moderate to severe OSA and the rules shifted for treatments delivery and monitoring by authorised medical opinion. Multidisciplinary Sleep Clinics have long existed, bringing together sleep specialists, dentists, orthodontists and surgeons. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Material and Methods: Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann-Whitney U tests and descriptive statistics were produced. Results: There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline OSA severity was significantly lower (mean apnea-hypopnea index and mean oxygen desaturation index lowered respectively with p = 0.0189 and p = 0.0466) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. Conclusion: Sleep multidisciplinary team meeting changed patient selection and management after the implementation of the new funding rules for OSA. The shift in funding often resulted in treatment options change, reaching more people and offering more options. [less ▲]

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See detailENT Surgical Training in 2018: National Cross-sectional Study
ROGISTER, Florence ULiege; CAMBY, Séverine ULiege; LEFEBVRE, Philippe ULiege et al

in B-ENT (2019)

Introduction and Aim: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential ... [more ▼]

Introduction and Aim: This study aimed to draw up an inventory of the current practical training from the surgical trainees’ point of view, identifying strengths and gaps of current training and potential tools to be developed. Material and Methods: We conducted a broad national survey among Belgian population within the North-part and South-part universities of the country. The questions included self-assessment, training objectives, training quality and training tools. Results: 35.7% of trainees evaluated their level of overall surgical competence at 3/5 compared to an ideal mastery. More than a half (55%) of trainees did not know the training objectives and 73% did not know the basic surgical procedures that a qualified ENT surgeon should be able to perform. The main mode of learning (41%) was the observation of a senior and repetition under supervision (companionship). The results showed mainly logistical and economic drawbacks, on which it seems possible to act using learning methods based on the implementation of organized training sessions, associated with different learning tools such as surgical and procedural simulation. Some of these are already available in our country but remain difficult to access or to develop. Conclusion: This study revealed a real demand and motivation from trainees and could serve as a basis to sketch a teaching scheme improving skills and confidence of future surgeons. Additional studies are needed to identify the most effective ways for implementing this type of teaching within the constraints of the surgical curriculum and teaching hospitals resources. [less ▲]

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