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Fine-needle aspiration cytology in the parotid lesions
Program Oral Presentations
OBJECTIVES: 1) Explore the temporal relationship between discrete acid reflux events and symptom onset in activitytriggered paradoxical vocal fold motion (PVFM). 2) Present a potential role for wireless pH monitoring in selected children with PVFM. METHODS: Case review of five patients with clinical paradoxical vocal fold motion, who were implanted with a wireless pH monitoring device in the lower esophagus between November 2006 and March 2008. Timing and duration of decreases in lower esophageal pH were recorded for 48 hours. During the monitoring period, patients were asked to perform the usually inciting sport and record onset of symptoms. RESULTS: Four girls and one boy, ranging in age from 11 to 18 years old, with clinical PVFM, were implanted with wireless pH monitoring devices as part of an evaluation for airway symptoms. All patients cited a particular sport as the activity that triggered PVFM symptoms. Each patient demonstrated multiple decreases in lower esophageal pH to less than 4, and onset of PVFM symptoms within minutes of pH decreases during the activity. One patient was a competitive swimmer, and wireless pH monitoring allowed correlation of acid reflux events and PVFM symptoms during a swimming meet. CONCLUSIONS: Paradoxical vocal fold motion symptoms occurred minutes after reflux events in these children. Although PVFM is often a multifactorial disease, wireless pH monitoring may allow demonstration of the role of reflux in activity specific PVFM.
Practice Management Fine-needle aspiration cytology in the parotid lesions Lucia O Piccioni, MD (presenter); Mario Bussi; Fabiano Beatrice; Marco Gemma, MD; Daniela Sarandria OBJECTIVES: In the present study we assess the diagnostic accuracy of fine-needle aspiration cytology (FNAC) on parotid gland swellings. The histological diagnosis of the correspondent surgical specimens is taken as the gold standard for diagnosis. The aim is to determine the usefulness of FNAC in the planning of parotid gland surgery. METHODS: All the parotid lesions removed surgically in our Unit of Otolaryngology, Head and Neck Department were reviewed. Both FNAC and histological diagnosis were registered in 176 cases. On these cases sensitivity, specificity, accuracy, predictive values, likelihood ratios, and Kappa statistics were calculated for FNAC vs. histological diagnosis.
RESULTS: FNAC sensitivity and specificity were 81% and 99% respectively. Accuracy for malignancy was 97%, accuracy for benignity was 83%. Positive and negative predictive values were 93% and 98% respectively. Likelihood ratio of positive an negative test results were 100.3 and 0.19 respectively. Prevalence of malignancy was 0.1143 and that for benignity was 0.8857. Kappa statistic for the degree of agreement between FNAC and histological results was 0.85 (95% CI⫽0.71-0.99). CONCLUSIONS: FNAC is a simple method to obtain accurate diagnosis. Preoperative FNA diagnosis improves surgical treatment of parotid masses.
Quality Improvement/Patient Safety Construct validity of a simulator for myringotomy with ventilation tube insertion Peter Volsky, MD (presenter); Bradley W Kesser, MD; Shayn Peirce-Cottler, PhD; Brian Hughley, MD OBJECTIVES: 1) Establish construct validity of an anatomic model as a simulator for myringotomy with ventilation tube insertion. 2) Assess the model’s subjective appeal. METHODS: Prospective comparative validation study conducted June–August 2008. Using an anatomic model of the human auricle, ear canal, eardrum, and middle ear space, 18 otolaryngologists of various levels of training performed 10 timed myringotomy with ventilation tube procedures. Errors were recorded, and subjects reported the quality of their experience. RESULTS: Both time-to-completion and errors per trial discriminated novices (MS-IV and PGY-1) from non-novice (PGY-2 to PGY-6⫹) subjects; novices were 3.4 times slower (P⬍0.05) and 6.5 times more error-prone (P⬍0.05). Errors were strongly correlated with prior surgical experience. All subjects required more time to complete the first trial (P⬍0.05), and their performance stabilized therafter. Overall, the simulation was perceived as a valuable experience. CONCLUSIONS: Our model is a valid platform for simulating myringotomy with ventilation tube insertion. It discriminates novices from non-novices, has a learning curve, and is perceived to be a valuable and realistic teaching tool by users. Cost implications of intubation-related tracheal damage Nasir Islam Bhatti, MD (presenter); Kulsoom Laeeq; Vinciya Pandian; Nancy Reaven; Susan Funk; Marek Mirski; David Feller-Kopman OBJECTIVES: 1) Perform risk analysis of tracheal damage caused by endotracheal intubation during surgery, manifested in extended length of stay (LOS) and hospital readmissions. 2) Estimate the cost to hospitals of these sequelae in adults. METHODS: We searched Medline, Cochrane, International
Words and degrees that may be missing from abstracts in this program are due to limitations in the submission process. Continuing improvements in that database are still in process, and a serious attempt has been made to correct missing content. For the latest information about the annual meeting, and to access the new Itinerary Planner for your visit, please go to: www.entnet.org/annual_meeting.
ORALS
Wireless pH monitoring in paradoxical vocal fold motion Alicia Quesnel, MD (presenter); Christopher Hartnick, MD; Stephen Hardy, MD; Kenan Haver, MD
P105
OBJECTIVES: 1) Explore the temporal relationship between discrete acid reflux events and symptom onset in activitytriggered paradoxical vocal fold motion (PVFM). 2) Present a potential role for wireless pH monitoring in selected children with PVFM. METHODS: Case review of five patients with clinical paradoxical vocal fold motion, who were implanted with a wireless pH monitoring device in the lower esophagus between November 2006 and March 2008. Timing and duration of decreases in lower esophageal pH were recorded for 48 hours. During the monitoring period, patients were asked to perform the usually inciting sport and record onset of symptoms. RESULTS: Four girls and one boy, ranging in age from 11 to 18 years old, with clinical PVFM, were implanted with wireless pH monitoring devices as part of an evaluation for airway symptoms. All patients cited a particular sport as the activity that triggered PVFM symptoms. Each patient demonstrated multiple decreases in lower esophageal pH to less than 4, and onset of PVFM symptoms within minutes of pH decreases during the activity. One patient was a competitive swimmer, and wireless pH monitoring allowed correlation of acid reflux events and PVFM symptoms during a swimming meet. CONCLUSIONS: Paradoxical vocal fold motion symptoms occurred minutes after reflux events in these children. Although PVFM is often a multifactorial disease, wireless pH monitoring may allow demonstration of the role of reflux in activity specific PVFM.
Practice Management Fine-needle aspiration cytology in the parotid lesions Lucia O Piccioni, MD (presenter); Mario Bussi; Fabiano Beatrice; Marco Gemma, MD; Daniela Sarandria OBJECTIVES: In the present study we assess the diagnostic accuracy of fine-needle aspiration cytology (FNAC) on parotid gland swellings. The histological diagnosis of the correspondent surgical specimens is taken as the gold standard for diagnosis. The aim is to determine the usefulness of FNAC in the planning of parotid gland surgery. METHODS: All the parotid lesions removed surgically in our Unit of Otolaryngology, Head and Neck Department were reviewed. Both FNAC and histological diagnosis were registered in 176 cases. On these cases sensitivity, specificity, accuracy, predictive values, likelihood ratios, and Kappa statistics were calculated for FNAC vs. histological diagnosis.
RESULTS: FNAC sensitivity and specificity were 81% and 99% respectively. Accuracy for malignancy was 97%, accuracy for benignity was 83%. Positive and negative predictive values were 93% and 98% respectively. Likelihood ratio of positive an negative test results were 100.3 and 0.19 respectively. Prevalence of malignancy was 0.1143 and that for benignity was 0.8857. Kappa statistic for the degree of agreement between FNAC and histological results was 0.85 (95% CI⫽0.71-0.99). CONCLUSIONS: FNAC is a simple method to obtain accurate diagnosis. Preoperative FNA diagnosis improves surgical treatment of parotid masses.
Quality Improvement/Patient Safety Construct validity of a simulator for myringotomy with ventilation tube insertion Peter Volsky, MD (presenter); Bradley W Kesser, MD; Shayn Peirce-Cottler, PhD; Brian Hughley, MD OBJECTIVES: 1) Establish construct validity of an anatomic model as a simulator for myringotomy with ventilation tube insertion. 2) Assess the model’s subjective appeal. METHODS: Prospective comparative validation study conducted June–August 2008. Using an anatomic model of the human auricle, ear canal, eardrum, and middle ear space, 18 otolaryngologists of various levels of training performed 10 timed myringotomy with ventilation tube procedures. Errors were recorded, and subjects reported the quality of their experience. RESULTS: Both time-to-completion and errors per trial discriminated novices (MS-IV and PGY-1) from non-novice (PGY-2 to PGY-6⫹) subjects; novices were 3.4 times slower (P⬍0.05) and 6.5 times more error-prone (P⬍0.05). Errors were strongly correlated with prior surgical experience. All subjects required more time to complete the first trial (P⬍0.05), and their performance stabilized therafter. Overall, the simulation was perceived as a valuable experience. CONCLUSIONS: Our model is a valid platform for simulating myringotomy with ventilation tube insertion. It discriminates novices from non-novices, has a learning curve, and is perceived to be a valuable and realistic teaching tool by users. Cost implications of intubation-related tracheal damage Nasir Islam Bhatti, MD (presenter); Kulsoom Laeeq; Vinciya Pandian; Nancy Reaven; Susan Funk; Marek Mirski; David Feller-Kopman OBJECTIVES: 1) Perform risk analysis of tracheal damage caused by endotracheal intubation during surgery, manifested in extended length of stay (LOS) and hospital readmissions. 2) Estimate the cost to hospitals of these sequelae in adults. METHODS: We searched Medline, Cochrane, International
Words and degrees that may be missing from abstracts in this program are due to limitations in the submission process. Continuing improvements in that database are still in process, and a serious attempt has been made to correct missing content. For the latest information about the annual meeting, and to access the new Itinerary Planner for your visit, please go to: www.entnet.org/annual_meeting.
ORALS
Wireless pH monitoring in paradoxical vocal fold motion Alicia Quesnel, MD (presenter); Christopher Hartnick, MD; Stephen Hardy, MD; Kenan Haver, MD
P105