Although rare, vallecular cysts can have catastrophic consequences in an anaesthetised patient if airway management is inappropriate. We report a case of difficult intubation in a 46-year-old man with a vallecular cyst, and detail the methods and strategies for successful endotracheal tube insertion. Following a review of the current literature, we also discuss airway management options in adult patients with vallecular cysts.
Airway Management ; Airway Obstruction ; diagnosis ; surgery ; Anesthesiology ; methods ; Cysts ; diagnosis ; surgery ; Humans ; Intubation, Intratracheal ; methods ; Laryngeal Diseases ; diagnosis ; surgery ; Laryngoscopy ; Male ; Middle Aged

INTRODUCTIONThis study evaluated the efficacy of tinnitus retraining therapy (TRT) in habituating patients with tinnitus.

MATERIALS AND METHODSThis is a retrospective review of patients who underwent TRT in a tertiary referral Otorhinolaryngology unit. Patients were followed up with structured interviews with the aid of questionnaire forms. Habituation following TRT was evaluated.

RESULTSA total of 702 patients were included (55% male, 45% female). Habituation of reaction to tinnitus and habituation of perception were analysed. Average duration of follow up was 33 months. In total, 68% of patients described improvement in annoyance following TRT. Of these patients, 80% of them described habituation of perception as well. There was no statistical difference in gender and age between patients who did and did not respond to TRT. However, duration of treatment was significantly longer in patients who habituated (P <0.05). Patients who adopted treatment strategies recommended based on Jastreboff's TRT categories were also found to have higher success rates compared to those who refused.

CONCLUSIONThe goal of TRT is to achieve habituation of reaction to tinnitus. Habituation of perception is often a secondary result of sufficiently habituated response. From our study, more than two thirds of patients with tinnitus achieved habituation of reaction and of these, the majority also habituated to awareness of the tinnitus.

Female ; Habituation, Psychophysiologic ; Humans ; Male ; Medical Audit ; Qualitative Research ; Retrospective Studies ; Tinnitus ; psychology ; therapy ; Treatment Outcome

Introduction: A compulsory research component is becoming increasingly common for clinical residents. However, integrating research into a busy clinical training schedule can be challenging. This study aimed to explore barriers to research supervision in specialist training programmes from the perspectives of clinical supervisors and trainees at a Malaysian university hospital. Methods: Qualitative interviews and focus group discussions were conducted (December 2016 to July 2017) with clinical supervisors (n=11) and clinical trainees (n=26) utilising a topic guide exploring institutional guidelines, research culture and supervisor-student roles. Interviews were transcribed verbatim and analysed thematically to identify barriers to research supervision. Results: Supervisors and trainees from 11 out of 18 departments participated. Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. Among the reasons identified included a lack of supervisory access due to the nature of clinical rotations and placements, clashing training priorities (clinical vs research) that discouraged trainees and supervisors from engaging in research, poor research expertise and experience among clinical supervisors hampering high-quality supervision, and a frustrating lack of clear standards between the various parties involved in research guidance and examination. Conclusion: Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. This was not only an issue of resource limitation since questions regarding clinical priorities and unclear research standards emerged. Thus, institutional coordinators need to set clear standards and provide adequate training to make research meaningful and achievable for busy clinical supervisors and trainees.