The Advantages of a Rural Resident Rotation in Otolaryngology Training: Comparing Surgical Case Volumes of a Rural Rotation with a University Rotation

Objective: Rural residency rotations have played a significant role in encouraging surgical residents to pursue a career in a rural community. This study reviews the resident caseload of an otolaryngology residency rural rotation in comparison with a traditional primary university-based urban location. Methods: The Accreditation Council for Graduate Medical Education (ACGME) case log system was used to review cases logged by residents during their rural rotations from July 2017 to December 2018. Case log data were compared with a matched resident of similar training experience on the university service during the same time period. Results: Rural residents reported more cases than their urban-based counterparts (1143 vs 690 cases). Junior residents had over double the number of cases in rural practice (400) compared to junior residents on the university service (168). The university service was much stronger on H&N Neck (54 vs. 28 cases), Larynx (39 vs 8) and Endoscopy (92 vs 42). In contrast, the rural rotation provided substantially more Endocrine cases (103 vs 47) and comparable Salivary cases (23 vs 21) compared to the university service. Discussion: This study defines a surgically robust rotation in rural medicine and highlights the possibility of obtaining exposure to a surgical practice unique to a rural setting. By participating in high volume surgical rural residency rotations, trainees may better understand the otolaryngologic needs of a rura

Endoscopic removal of Fractured 3D-Printed Nasopharyngeal Swabs from the Olfactory Cleft During COVID-19

The severe acute respiratory syndrome SARS-CoV-2 pandemic has posed significant challenges to hospital and public health systems in the United States. In response to a shortage in nasopharyngeal swabs, our institution developed, tested, and deployed 3D-printed swabs to obtain a specimen for testing. A patient was tested in preparation for a scheduled Esophagogastrodeuodenoscopy. During the procedure the swab broke and a portion remained in the superior meatus and olfactory cleft. This case study describes the process of locating and removing the broken sections of the 3D-printed swab. In response to this incident, 3D-printing teams test swabs for sample collection and rheology with an elongation test. Additionally, we have implemented just-in-time training for staff including point-of-care durability testing, model simulation with feedback to ensure accurate trajectory, and suggestions on how to address anatomic and other challenges

Rural–Urban Otolaryngologic Observational Workforce Analysis: The State of Nebraska

Objective To analyze the rural–urban access to otolaryngology (OHNS) care within the state of Nebraska. Design Cross-sectional study. Methods Counties in Nebraska were categorized into rural versus urban status based upon the 2013 National Center for Health Statistics urban–rural classification scheme with I indicating most urban and VI indicating most rural. The information on otolaryngologists was gathered utilizing the Health Professions Tracking System. Otolaryngologists were categorized based on the county of their primary and outreach clinic location(s). Travel burden was estimated using census tract centroid distance to the nearest clinic location, aggregated to county using weighted population means to determine the average county distance to the nearest otolaryngologist. Results Nebraska is a state with a population of 1.8 million people unequally distributed across 76,824 square miles, with rural counties covering 2/3 of the land area. Nebraska has 78 primary OHNS clinics and 70 outreach OHNS clinics distributed across 93 counties. More than half (54.8%) of the counties in Nebraska lacked any OHNS clinic. Overall, a statistically significant difference was found when comparing mean primary OHNS per 100,000 population and mean miles to a primary OHNS clinic with Level III counties being 5.17 linear miles from primary OHNS compared to Level V counties being 29.94 linear miles. Conclusion Overall, a clear discrepancy between rural and urban primary OHNS clinics in Nebraska can be seen visually and statistically with rural Nebraskans having to travel at least 5.5 times farther to primary OHNS clinics when compared to urban Nebraskans

A Case of Radiation-Induced Multifocal Laryngeal Angiosarcoma Presenting as a Diagnostic Dilemma

Head and neck sarcomas are relatively rare tumors, with angiosarcomas representing a small subset. Angiosarcoma is a malignant endothelial neoplasm characterized by atypical, multilayered, or solid endothelial proliferation with vasoformative architecture. The global incidence of irradiation-associated sarcoma is estimated as between 0.03% and 0.08%. Here we reported the case of an elderly woman previously treated with radiation more than 20 years ago for an unknown primary of head and neck. This interesting case presented as a diagnostic challenge, and multiple biopsies were required to eventually establish the diagnosis of laryngeal angiosarcoma. We additionally have confirmation from our prior radiation records that the patient did, in fact, receive a substantial dose of radiation to the site previously. To our knowledge, this case represents the first report of a documented radiation-induced multifocal laryngeal angiosarcoma

Costs Associated with Recurrent Epistaxis in a Patient with a Ventricular Assist Device

Mucosal bleeding is a well-known complication of having a ventricular assist device and commonly presents with epistaxis. Although the frequency of epistaxis as a complication in patients with a ventricular assist device has been documented in the literature, to our knowledge the cost of this complication has not been reported. This case report examines the financial burden of ventricular assist device-associated epistaxis in a single patient from September 2018 to December 2019 using ICD 10 diagnostic codes. The patient was found to have accumulated $138,020 in costs over 38 encounters. This case report not only highlights the recurrent nature and potential high cost of epistaxis in this patient population, but also identifies a target to reduce healthcare spending. Further research is needed to assess whether cheap and simple preventative measures such as nasal hygiene regimen can decrease the frequency and/or severity of epistaxis in the patients with a ventricular assist device