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Purpose: Epistaxis is a common condition that affects about 60% of the population in their lifetime, with 6% needing medical attention. Little is known about the epidemiology and risk factors of epistaxis outside the health care system. This study aimed to investigate the prevalence and risk factors of epistaxis in a rural Danish population using data from the Lolland-Falster Health Study (LOFUS)., Methods: We conducted a cross-sectional survey based on data from LOFUS, a household-based, prospective cohort study in the rural provincial area of Lolland-Falster, Denmark. We enrolled 10,065 participants (≥ 50 years) and collected data on demographics, comorbidities, medication, lifestyle factors, and laboratory parameters. Logistic regressions were used to test for correlations between epistaxis and different risk factors., Results: In total 5.3% of the participants had experienced epistaxis within the past 30 days, and 7.9% had sought medical attention for epistaxis at some point in their lives. We identified several factors that were significantly correlated with increased odds of epistaxis, such as male gender, age group 50-59 years, high BMI (> 25), allergy, diabetes, hypertension, atherosclerosis, angina, and anticoagulant treatment. Excellent or good self-reported health was correlated to significantly lower odds of epistaxis., Conclusion: This study provides a comprehensive overview of the prevalence and risk factors of epistaxis outside the health care system. Our study suggests that preventive measures targeting these risk factors may reduce the incidence and severity of epistaxis in this population., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Subglottic stenosis (SGS) is a rare condition. The aetiology of SGS can be congenital, iatrogenic, idiopathic or caused by infectious and vascular diseases. In this case report, a 49-year-old woman was admitted to the hospital due to acute respiratory insufficiency. During intubation attempt SGS was found, and acute tracheotomy was performed. Biopsies from SGS and serology did not support an underlying vascular disease and the patient was diagnosed with an idiopathic SGS. SGS is a rare cause of acute respiratory insufficiency but is important to consider as a differential diagnosis.

Proper specimen collection is the most important step to ensure accurate testing for the coronavirus disease 2019 (COVID-19) and other infectious diseases. Assessment of healthcare workers' upper respiratory tract specimen collection skills is needed to ensure samples of high-quality clinical specimens for COVID-19 testing. This study explored the validity evidence for a theoretical MCQ-test and checklists developed for nasopharyngeal (NPS) and oropharyngeal (OPS) specimen collection skills assessment. We found good inter-item reliability (Cronbach's alpha = 0.76) for the items of the MCQ-test and high inter-rater reliability using the checklist for the assessment of OPS and NPS skills on 0.86 and 0.87, respectively. The MCQ scores were significantly different between experts (mean 98%) and novices (mean 66%), p < 0.001, and a pass/fail score of 91% was established. We found a significant discrimination between checklist scores of experts (mean 95% score for OPS and 89% for NPS) and novices (mean 50% score for OPS and 36% for NPS), p < 0.001, and a pass/fail score was established of 76% for OPS and 61% for NPS. Further, the results also demonstrated that a group of non-healthcare educated workers can perform upper respiratory tract specimen collection comparably to experts after a short and focused simulation-based training session. This study, therefore, provides validity evidence for the use of a theoretical and practical test for upper respiratory specimens' collection skills that can be used for competency-based training of the workers in the COVID-19 test centers.

Objective: Myringotomy and ventilation tube insertion (MT) is a key procedure in otorhinolaryngology and can be trained using simulation models. We aimed to systematically review the literature on models for simulation-based training and assessment of MT and supporting educational evidence., Databases Reviewed: PubMed, Embase, Cochrane Library, Web of Science, Directory of Open Access Journals., Methods: Inclusion criteria were MT training and/or skills assessment using all types of training modalities and learners. Studies were divided into 1) descriptive and 2) educational interventional/observational in the analysis. For descriptive studies, we provide an overview of available models including materials and cost. Educational studies were appraised using Kirkpatrick's level of educational outcomes, Messick's framework of validity, and a structured quality assessment tool., Results: Forty-six studies were included consisting of 21 descriptive studies and 25 educational studies. Thirty-one unique physical and three virtual reality simulation models were identified. The studies report moderate to high realism of the different simulators and trainees and educators perceive them beneficial in training MT skills. Overall, simulation-based training is found to reduce procedure time and errors, and increase performance as measured using different assessment tools. None of the studies used a contemporary validity framework and the current educational evidence is limited., Conclusion: Numerous simulation models and assessment tools have been described in the literature but educational evidence and systematic implementation into training curricula is scarce. There is especially a need to establish the effect of simulation-based training of MT in transfer to the operating room and on patient outcomes., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Millions of people are tested for COVID-19 daily during the pandemic, and a lack of evidence to guide optimal nasal swab testing can increase the risk of false-negative test results. This study aimed to determine the optimal insertion depth for nasal mid-turbinate and nasopharyngeal swabs. The measurements were made with a flexible endoscope during the collection of clinical specimens with a nasopharyngeal swab at a public COVID-19 test center in Copenhagen, Denmark. Participants were volunteer adults undergoing a nasopharyngeal SARS-CoV-2 rapid antigen test. All 109 participants (100%) completed the endoscopic measurements; 52 (48%) women; 103 (94%) white; mean age 34.39 (SD, 13.2) years; and mean height 176.7 (SD, 9.29) cm. The mean swab length to the posterior nasopharyngeal wall was 9.40 (SD, 0.64) cm. The mean endoscopic distance to the anterior and posterior end of the inferior turbinate was 1.95 (SD, 0.61) cm and 6.39 (SD, 0.62) cm, respectively. The mean depth to nasal mid-turbinate was calculated as 4.17 (SD, 0.48) cm. The optimal depths of insertion for nasal mid-turbinate swabs are underestimated in current guidelines compared with our findings. This study provides clinical evidence to guide the performance of anatomically correct nasal and nasopharyngeal swab specimen collection for virus testing.

Background: The use of robotic surgery for minimally invasive procedures has increased considerably over the last decade. Robotic surgery has potential advantages compared to laparoscopic surgery but also requires new skills. Using virtual reality (VR) simulation to facilitate the acquisition of these new skills could potentially benefit training of robotic surgical skills and also be a crucial step in developing a robotic surgical training curriculum. The study's objective was to establish validity evidence for a simulation-based test for procedural competency for the vaginal cuff closure procedure that can be used in a future simulation-based, mastery learning training curriculum., Methods: Eleven novice gynaecological surgeons without prior robotic experience and 11 experienced gynaecological robotic surgeons (> 30 robotic procedures) were recruited. After familiarization with the VR simulator, participants completed the module 'Guided Vaginal Cuff Closure' six times. Validity evidence was investigated for 18 preselected simulator metrics. The internal consistency was assessed using Cronbach's alpha and a composite score was calculated based on metrics with significant discriminative ability between the two groups. Finally, a pass/fail standard was established using the contrasting groups' method., Results: The experienced surgeons significantly outperformed the novice surgeons on 6 of the 18 metrics. The internal consistency was 0.58 (Cronbach's alpha). The experienced surgeons' mean composite score for all six repetitions were significantly better than the novice surgeons' (76.1 vs. 63.0, respectively, p < 0.001). A pass/fail standard of 75/100 was established. Four novice surgeons passed this standard (false positives) and three experienced surgeons failed (false negatives)., Conclusion: Our study has gathered validity evidence for a simulation-based test for procedural robotic surgical competency in the vaginal cuff closure procedure and established a credible pass/fail standard for future proficiency-based training.

A 10-year-old girl presented with episodes of migraine. A nasal mass was found randomly during work-up. Interpreted as an osteoma, the mass was removed during endoscopic surgery. However, the histopathological examination turned out to be a pyomucocele in the right middle turbinate, which is an extremely rare yet benign condition in children., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Clinical differentiation between pain mechanisms of temporomandibular joint (TMJ) arthralgia and osteoarthritis (OA) is challenging. The aims were to compare somatosensory function at the TMJs and conditioned pain modulation (CPM) effects between TMJ arthralgia and OA patients diagnosed clinically and based on different imaging techniques and age- and gender-matched healthy controls (n = 41)., Methods: Patients (n = 58) underwent standard clinical examination and three different TMJ imaging modalities. After each examination, they were classified into arthralgia or OA based on the findings. TMJ region somatosensory testing was performed in all participants. Z-scores were calculated for patients based on healthy reference data. CPM was tested by comparing pressure pain thresholds (PPTs) at TMJ and thenar (control) before, during and after the application of painful and nonpainful cold stimuli. Data were analyzed using analyses of variance., Results: Somatosensory abnormalities were commonly detected in both patient groups. Assessment of somatosensory function at the TMJ revealed that arthralgia patients were less sensitive to warmth, cold and tactile stimuli than OA patients (P < 0.048). OA patients showed pressure hyperalgesia compared with arthralgia patients (P = 0.025). There was a significant CPM effect at both test sites during painful cold application in all groups (P < 0.001). There was no significant difference in the relative CPM effect between groups except for clinically diagnosed arthralgia patients showing reduced CPM effect compared with controls (P = 0.047)., Conclusions: Pain profiles including somatosensory function differed between TMJ arthralgia and OA patients although CPM effects were similar in patients and controls. Thus, different TMJ pain conditions may share common pain mechanisms but the present study for the first time also indicated that differential pain mechanisms could be involved.