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Research Square Dec 2023There is a notable lack of low-cost OHNS simulation models that are relevant for early medical trainees and students. By conducting this study, we will understand the...
IMPORTANCE
There is a notable lack of low-cost OHNS simulation models that are relevant for early medical trainees and students. By conducting this study, we will understand the current landscape of low-cost otolaryngology-head and neck surgery simulation for early medical trainees and students.
OBJECTIVES
Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in otolaryngology-head and neck surgery (OHNS), while simulation training is often focused on senior residents and specialists, there is a critical need to target general practitioners who carry a significant load of OHNS care in countries with limited OHNS providers. This scoping review aims to describe affordable, effective OHNS simulation models for early-stage trainees and non-OHNS specialists in resource-limited settings and discuss gaps in the literature.
EVIDENCE REVIEW
This scoping review followed the five stages of Arksey and O'Malley's Scoping Review Methodology. Seven databases were used to search for articles. Included articles discussed physical models of the ear, nose, or throat described as "low-cost," "cost-effective," or defined as <$150 if explicitly stated; related to the management of common and emergent OHNS conditions; and geared towards undergraduate students, medical, dental, or nursing students, and/or early-level residents.
FINDINGS
Of the 1706 studies screened, 17 met the inclusion criteria. Most studies were conducted in HICs. Most models were low fidelity (less anatomically realistic) models. The most common simulated skills were peritonsillar abscess aspiration and cricothyrotomy. Information on cost was limited, and locally sourced materials were infrequently mentioned. Simulations were evaluated using questionnaires and direct observation.
CONCLUSION AND RELEVANCE
Low-cost simulation models can be beneficial for early medical trainees and students in LMICs, addressing resource constraints and improving skill acquisition. However, there is a notable lack of contextually relevant, locally developed, and cost-effective models. This study summarizes existing low-cost OHNS simulation models for early-stage trainees and highlights the need for additional locally sourced models. Further research is needed to assess the effectiveness and sustainability of these models.
PubMed: 38106212
DOI: 10.21203/rs.3.rs-3673832/v1 -
IDCases 2024Helicobacter cinaedi, a gram-negative spiral bacterium, has historically been associated with infections primarily in immunocompromised patients. Recently, however, its...
Helicobacter cinaedi, a gram-negative spiral bacterium, has historically been associated with infections primarily in immunocompromised patients. Recently, however, its potential to cause infections in immunocompetent individuals has been recognized. We report a unique case of a man in his 20 s who reported having sex with men. He presented with symptoms of fever and throat discomfort and was diagnosed with a peritonsillar abscess. While the rapid antigen test for Group A Streptococcus was positive and antibiotics were administered, a puncture fluid from the peritonsillar abscess taken the day after antibiotic treatment revealed the presence of Group C Streptococcus. By the fifth day, the blood culture taken on the first day detected a gram-negative spirochete, which was subsequently identified H. cinaedi. The patient had engaged in oral sex with his male partner, suggesting a potential transmission route. This is significant as H. cinaedi was initially identified from rectal cultures in men who have sex with men (MSM), raising the possibility of pharyngeal transmission through oral sex. In our patient, although H. cinaedi was not isolated from the aspirate of the peritonsillar abscess, its presence in the blood culture and lack of other potential sources of bacteremia make the abscess a likely primary site of infection. This case highlights the importance of considering H. cinaedi as a potential pathogen in immunocompetent patients, particularly in cases of MSM. The potential for H. cinaedi transmission through oral sex and its role in the development of peritonsillar abscesses, a previously unreported association, requires further investigation.
PubMed: 38721054
DOI: 10.1016/j.idcr.2024.e01975 -
BMC Medical Education May 2024Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in... (Review)
Review
BACKGROUND
Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in otolaryngology-head and neck surgery (OHNS), while simulation training is often focused on senior residents and specialists, there is a critical need to target general practitioners who carry a significant load of OHNS care in countries with limited OHNS providers. This scoping review aims to describe affordable, effective OHNS simulation models for early-stage trainees and non-OHNS specialists in resource-limited settings and discuss gaps in the literature.
METHODS
This scoping review followed the five stages of Arksey and O'Malley's Scoping Review Methodology. Seven databases were used to search for articles. Included articles discussed physical models of the ear, nose, or throat described as "low-cost," "cost-effective," or defined as <$150 if explicitly stated; related to the management of common and emergent OHNS conditions; and geared towards undergraduate students, medical, dental, or nursing students, and/or early-level residents.
RESULTS
Of the 1706 studies screened, 17 met inclusion criteria. Most studies were conducted in HICs. Most models were low-fidelity (less anatomically realistic) models. The most common simulated skills were peritonsillar abscess aspiration and cricothyrotomy. Information on cost was limited, and locally sourced materials were infrequently mentioned. Simulations were evaluated using questionnaires and direct observation.
CONCLUSION
Low-cost simulation models can be beneficial for early medical trainees and students in LMICs, addressing resource constraints and improving skill acquisition. However, there is a notable lack of contextually relevant, locally developed, and cost-effective models. This study summarizes existing low-cost OHNS simulation models for early-stage trainees and highlights the need for additional locally sourced models. Further research is needed to assess the effectiveness and sustainability of these models.
Topics: Humans; Otolaryngology; Simulation Training; Clinical Competence; Internship and Residency; Cost-Benefit Analysis; Developing Countries
PubMed: 38693491
DOI: 10.1186/s12909-024-05466-3 -
Cureus Apr 2024A peritonsillar abscess (PTA) is an infection that primarily affects the peritonsillar space. The incidence is estimated to affect 30 per 100,000 individuals annually,...
A peritonsillar abscess (PTA) is an infection that primarily affects the peritonsillar space. The incidence is estimated to affect 30 per 100,000 individuals annually, with a higher prevalence between the 15- and 30-year-old age groups. The pathogenesis of a PTA is a crucial step in effective management and prevention. Typically, a PTA has a polymicrobial etiology, aerobic, and anaerobic bacteria of oral flora. Multiple papers in the literature have studied the incidence of species in PTA cases. However, few studies have isolated in a PTA. We present a case of a 29-year-old patient who was admitted as a case of a PTA. He underwent an incision and drainage of the right PTA in the operation room. A significant amount of purulent fluid was drained with a positive culture of .
PubMed: 38765424
DOI: 10.7759/cureus.58499 -
Archivos Argentinos de Pediatria Feb 2024The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval...
The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.
Topics: Male; Humans; Adolescent; Peritonsillar Abscess; Tonsillectomy; Pharyngitis; Hypertrophy; Edema
PubMed: 37382552
DOI: 10.5546/aap.2023-03034.eng -
Cureus Jan 2024A peritonsillar abscess (PTA) is a frequent reason for a visit to the emergency department. As there are no current published guidelines for medical versus surgical...
INTRODUCTION
A peritonsillar abscess (PTA) is a frequent reason for a visit to the emergency department. As there are no current published guidelines for medical versus surgical management, attending physicians vary among management tendencies, generating uncertainty among resident physicians. This project established a standard of care for managing patients with PTA and provided clear management guidelines to the emergency department, in collaboration with the otolaryngology department, at a community academic hospital.
METHODS
Pre- and post-interventional, anonymous surveys were given to assess resident physician confidence in the management of PTA. A proposed management protocol was developed based on existing literature and approved by both the emergency medicine (EM) and otolaryngology (ENT) departments. The protocol was then disseminated during in-person didactic sessions to EM residents and ENT residents for use over a four-month interventional period.
RESULTS
The mean confidence level for all residents increased significantly after the implementation of the protocol (p<0.001). The increase in confidence level for "antibiotic selection for PTA" (p=0.72) and "inpatient PTA management" (p=0.20) was not statistically significant for the post-graduate year (PGY) 3 and 4 residents. The increase in confidence level was higher overall for PGY 1 and 2 residents (95% CI 2.25 ± 1.09, p<0.001) than for PGY 3 and 4 residents (95% CI 1.73 ± 1.09, p=0.003).
CONCLUSION
The implementation of a standardized protocol for the management of PTA proved to be an effective tool in assisting residents and improving their confidence. This study highlights the importance of establishing guidelines in clinical practice to promote consistent and evidence-based management strategies for PTA. By providing clear guidelines, this protocol enhances communication among healthcare providers and contributes to the delivery of high-quality care to patients with PTA.
PubMed: 38425612
DOI: 10.7759/cureus.53223 -
HNO Jan 2024Peritonsillar abscess (PTA) is often seen as a complication of acute tonsillitis and is defined as pus retention between the tonsillar capsule and the peritonsillar...
BACKGROUND
Peritonsillar abscess (PTA) is often seen as a complication of acute tonsillitis and is defined as pus retention between the tonsillar capsule and the peritonsillar tissue. The etiology and pathogenesis have not yet been fully elucidated. A connection between certain weather conditions and temperature fluctuations and the occurrence of abscesses in the head and neck region has been discussed for years. The question here is whether higher temperature fluctuations are predisposing for the formation of abscesses.
MATERIALS AND METHODS
A retrospective evaluation of all patients hospitalized with peritonsillitis or PTA in the Department of Otorhinolaryngology of the Klinikum Rechts der Isar of the Technical University of Munich during a period of 10 years (2012-2021) was performed. Each patient was individually correlated with daily temperature data from the statistical meteorological office of the City of Munich.
RESULTS
A total of 1450 patients were included, 270 patients (18.62%) with peritonsillitis and 1180 patients (81.38%) with PTA. A correlation between the occurrence of peritonsillitis or PTA and major temperature fluctuations could be excluded in this large patient population. Moreover, a similar frequency of peritonsillitis and PTA was seen throughout the year.
CONCLUSION
The myth of a temperature dependence of the development of peritonsillitis or PTA and a so-called abscess weather could be negated in this study.
Topics: Humans; Peritonsillar Abscess; Retrospective Studies; Palatine Tonsil; Weather; Tonsillitis
PubMed: 37932499
DOI: 10.1007/s00106-023-01384-w -
World Journal of Clinical Cases Aug 2023Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and...
BACKGROUND
Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton-Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.
CASE SUMMARY
A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.
CONCLUSION
Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
PubMed: 37621581
DOI: 10.12998/wjcc.v11.i22.5391 -
Clinical Microbiology and Infection :... Jan 2024We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA).
OBJECTIVES
We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA).
METHODS
We performed a cross-sectional analysis of all patients with PTA and their microbiological findings in the 2 years preceding versus the 2 years following the COVID-19 lockdown in Denmark (11 March 2020), who were admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Age-stratified population data for the catchment area were obtained from Statistics Denmark.
RESULTS
The annual incidence rate was significantly higher in the 2-year period before (21.8 cases/100 000 inhabitants) compared with after (14.9 cases/100 000) the lockdown (p < 0.001). The number of cases with growth of Streptococcus pyogenes was significantly higher in the period before (n = 67) compared with after (n = 28) the lockdown (p < 0.001), whereas the number of cases positive for Fusobacterium necrophorum (n = 60 vs. n = 64) and streptococcus anginosus group (SAG) (n = 37 vs. n = 43) were stabile (p 0.79 and p 0.58, respectively). The relative prevalence of S. pyogenes was significantly higher in the period before (67/246 cultures, 27%) compared with after (28/179, 16%) the lockdown (p 0.007). On the contrary, the relative prevalence of F. necrophorum and SAG is significantly lower before (60/246, 24% and 37/246, 15%) compared with after (64/179, 36% and 43/179, 24%) the lockdown (p 0.013 and p 0.023).
DISCUSSION
Social distancing had a significant impact on the incidence and microbiology of PTA. Our findings suggest that S. pyogenes-positive PTA is highly related to direct social interaction, and represents a contagious pathogen. By contrast, PTA development caused by F. necrophorum and SAG is unrelated to direct social interaction and may be derived from flora imbalance.
Topics: Humans; Peritonsillar Abscess; Incidence; Retrospective Studies; Cross-Sectional Studies; Fusobacterium Infections; Streptococcus pyogenes
PubMed: 37562694
DOI: 10.1016/j.cmi.2023.08.003 -
Journal of Clinical Medicine Apr 2024Odontogenic infection is one of the main etiologies of deep neck infection (DNI). However, the relationship between chronic periodontitis (CP) and the incidence of DNI...
Associations between Peritonsillar Abscess and Deep Neck Infection in Chronic Periodontitis Patients: Two Nested Case-Control Studies Using a National Health Screening Cohort.
Odontogenic infection is one of the main etiologies of deep neck infection (DNI). However, the relationship between chronic periodontitis (CP) and the incidence of DNI has not been examined. This study aimed to evaluate the incidence of DNI and peritonsillar abscess (PTA) after CP. The Korean National Health Insurance Service-National Sample Cohort 2002-2019 was used. In Study I, 4585 PTA patients were matched with 19,340 control I participants. A previous history of CP for 1 year was collected, and the odds ratios (ORs) of CP for PTA were analyzed using conditional logistic regression. In Study II, 46,293 DNI patients and 185,172 control II participants were matched. A previous history of CP for 1 year was collected, and conditional logistic regression was conducted for the ORs of CP for DNI. Secondary analyses were conducted in demographic, socioeconomic, and comorbidity subgroups. In Study I, a history of CP was not related to the incidence of PTA (adjusted OR = 1.28, 95% confidence interval [CI] = 0.91-1.81). In Study II, the incidence of DNI was greater in participants with a history of CP (adjusted OR = 1.55, 95% CI = 1.41-1.71). The relationship between CP history and DNI was greater in groups with young, male, low-income, and rural residents. : A prior history of CP was associated with a high incidence of DNI in the general population of Korea. Patients with CP need to be managed for the potential risk of DNI.
PubMed: 38673440
DOI: 10.3390/jcm13082166