Objective: To develop a low-cost 3D-printed Laryngeal Injection Task Trainer (LITT) for simulation of transcutaneous injection laryngoplasty and evaluate its effectiveness among trainees. Methods: Design: Cross-Sectional Time-Motion Study and Post-Training Evaluation Survey Setting: Tertiary University College of Medicine Anatomy Laboratory Participants: Five residents and 2 consultants in Otolaryngology-Head and Neck Surgery were trained using a LITT fabricated through three-dimensional printing of cartilage models and silicone molds through the UP SIBOL Greenhouse and the Philippine General Hospital Craniomaxillofacial Prosthesis Unit. Participants were asked to perform transcutaneous laryngeal injection on the LITT. The duration in performing the procedure from palpation of landmarks to injection of material was measured in seconds and recorded. After the simulation workshop, participants were asked to evaluate the subjective experience with surgical simulation using the modified Michigan Standard Simulation Experience Scale (MiSSES). Results: The mean time in performing transcutaneous laryngeal injection across different training levels for either trans-cricothyroid or trans-thyrohyoid approach was not statistically significant. Mean time in performing transcutaneous laryngeal injection between 2 approaches, the trans-cricothyroid approach (79.32 seconds with SD 34.89) and the trans-thyrohyoid approach (35.16 seconds with SD of 10.88), was statistically significant. Using the MiSSES tool for evaluation of the simulation training, majority of the participants agreed that the LITT allowed self-efficacy in performing the procedure, had adequate fidelity in terms of its characteristics and components, had high educational value in training participants for knowledge and skills on transcutaneous laryngeal injection and that the simulation provided good teaching quality. For the overall rating, all participants concurred, with 83.3% of participants answering strongly agree and 16.7% of participants responding somewhat agree, that the simulation experience was helpful in knowledge and skills development on transcutaneous laryngeal injection. On final evaluation of the LITT, 75% of the participants responded that it can be used in training but should be improved slightly. Conclusion The laryngeal injection task trainer (LITT) had an acceptable fidelity, educational value, teaching quality to improve self-efficacy in performing transcutaneous injection laryngoplasty - with points for improvement in terms of model and set-up stability, color accuracy and consistency of the visual indicator. It is recommended that the LITT be also used for future workshops and possibly further validation studies after applying the points for improvement gathered from this simulation study.

Objective. To determine the diagnostic accuracy of self-collected snorted and spit saliva in detecting COVID-19 using RT-PCR (ssRT-PCR) and lateral flow antigen test (ssLFA) versus nasopharyngeal swab RT-PCR (npRT-PCR). Methods. One hundred ninety-seven symptomatic subjects for COVID-19 testing in a tertiary hospital underwent snort-spit saliva self-collection for RT-PCR and antigen testing and nasopharyngeal swab for RT-PCR as reference. Positivity rates, agreement, sensitivity, specificity, and likelihood ratios were estimated. Results. Estimated prevalence of COVID-19 using npRT-PCR was 9% (exact 95% CI of 5.5% - 14.1%). A higher positivity rate of 13% in the ssRT-PCR assay suggested possible higher viral RNA in the snort-spit samples. There was 92.9% agreement between ssRT-PCR and npRT-PCR (exact 95% CI of 88.4% to 96.1%; Cohen’s Kappa of 0.6435). If npRT-PCR will be assumed as reference standard, the estimated Sensitivity was 83.3% (exact 95% CI of 60.8% to 94.2%), Specificity 93.9% (exact 95% CI of 89.3% to 96.5%), Positive predictive value of 57.7% (exact 95% CI of 38.9% to 74.5%), Negative predictive value of 98.2% (exact 95% CI of 95% to 99.4%), positive likelihood ratio of 3.65 (95% CI of 7.37 to 24.9), negative likelihood ratio of 0.178 (95% CI of 0.063 to 0.499). There was 84.84% agreement (95% exact CI of 79.1% to 89.5%; Cohen’s Kappa of 0.2356) between ssLFAvs npRT-PCR, sensitivity of 38.9% (exact 95% CI of 20.3% to 61.4%), specificity of 89.4% (exact 95% CI of 84.1% to 93.1%), PPV of 26.9% (95% CI of 13.7% to 46.1%), NPV of 93.6% (exact 95% CI of 88.8% to 96.4%), LR+ of 3.67 (95% CI of 1.79 - 7.51), LR – of 0.68 (95% CI of 0.47 - 0.99). Conclusion. Our data showed that snort-spit saliva RT-PCR testing had acceptable diagnostic performance characteristics and can potentially be used as an alternative to the standard nasopharyngeal/oropharyngeal swab RT-PCR test for COVID-19 in certain situations. However, our data also showed that snort-spit saliva antigen testing using lateral flow assay did not offer acceptable performance.
Saliva ; SARS-CoV-2 ; Reverse Transcription ; Reverse Transcriptase Polymerase Chain Reaction