Journal of basic and clinical physiology and pharmacology, Jul 20, 2021
Objectives Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encounter... more Objectives Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological entity, of various types and severity, with an array of associated symptoms including vertigo. This is a devastating life-changing condition with a blurry prognosis. The objective of this study was to determine the clinical association of vestibular impairment by electronystagmography (ENG) and caloric tests, and their ability to predict prognosis. Methods An observational, crossectional study was carried out amongst patients admitted with SSNHL. Each consenting patient had an audiometry test performed on admission as well as ENG and caloric tests. Treatment included oral steroids and carbogen with intratympanic steroids used only as salvage treatment. Follow-up was completed after 6 months when hearing gains were evaluated. Finally, an association was sought between the rate of recovery and ENG and caloric test results. Results Of 35 patients included, marked recovery was seen in patients without vertigo when compared to those with vertigo (p=0.003). A statistically significant association was found between the presence of vertigo and hearing deterioration (p=0.008). More so, normal electronystagmography results were associated with marked recovery (p=0.04). Conclusions The vestibular end organs are both subjectively and objectively affected in SSNHL as demonstrated by the abnormal ENG and caloric tests in our study despite the small sample size. Concomitant vestibular involvement carries poorer prognosis and routine identification may help foresee the recovery of patients with SSNHL and as such, aid in patient counseling. ENG and caloric tests are easily available and may be recommended for all patients with SSNHL.
INTRODUCTION The Israeli Scientific Council is responsible for the physician's training proce... more INTRODUCTION The Israeli Scientific Council is responsible for the physician's training process and the residency exams. These are performed in two phases: Stage A (written examination) and Stage B (the final Board oral examination). The COVID-19 pandemic started in Israel a few weeks before the scheduled spring 2020 Stage B exams and had a major impact, not only on the health and economic systems in Israel, but also on the residency exams. AIMS To describe the efforts of the Israeli Scientific Council to execute the spring 2020 Stage B exams during the COVID-19 pandemic in comparison to the worldwide data, and to deduce the appropriate management during potential future crises. METHODS We present a description of the activity of the Israeli Scientific Council since the start of the COVID-19 pandemic according to documents and other sources, An internet search was conducted on the destiny of residency examinations throughout the world, and a comparison between them. RESULTS Due to rapid worsening in the restrictions enforced in Israel, the spring 2020 oral board exams were cancelled. However, a decision was made to execute them in the summer. This new schedule dictated a delay in the schedule of other residency examinations and forced condensation of 5 periods into 10 months instead of 14. The examination team prepared the new summer exams period under the assumption that heavy restrictions will still be implemented. Indeed, COVID-19 was still around and the restrictions were still enforced. Despite that, all oral Board examinations were perfectly executed. This contrasts with the rest of the world, in which most residency exams were cancelled, even without a solution or an alternative date. CONCLUSIONS Recruitment of all involved and preparation for the worst-case scenario enabled the perfect execution of the previously cancelled exams, and will enable the execution of future residency exams under conditions of potential health or war crises. DISCUSSION To the best of our knowledge, the Israeli Scientific Council is the only communal body in the world which organized an alternative period for the cancelled oral exams, only 4 months after the cancelled dates. Due to an enormous effort and rigorous preparations, Israel is also the only place in which oral exams were successfully executed, physically, under an active disease and very heavy restrictions.
Annals of Otology, Rhinology, and Laryngology, Dec 1, 1999
A patient with acute vertigo, and normal findings on neurologic examination, was found to have ve... more A patient with acute vertigo, and normal findings on neurologic examination, was found to have vertebral artery dissection (VAD). This case shows that the clinical picture of VAD can mimic vertigo of labyrinthine (ie, peripheral) origin.
Background Temporal bone fractures are divided into otic capsule sparing and otic capsule involvi... more Background Temporal bone fractures are divided into otic capsule sparing and otic capsule involving fractures. In the latter, hearing loss, facial nerve paralysis, cerebrospinal fluid leak and meningitis have been reported to occur. The impact of hearing loss can be devastating, especially when occurring in children, with significant risk to speech development and sound localization. In the event of hearing loss, early rehabilitation is therefore of paramount importance. Identification of an intra-operative fracture line with available images and the outcome of such cases has not been reported. Case presentation We present the case of a 31-month-old male with an otic capsule involving temporal bone fracture, who presented with ipsilateral profound hearing loss. After all required work-up had been performed, he was admitted for a cochlear implant insertion. Per-operatively, a clear fracture line was seen at the round window niche, but a normal insertion was performed despite the anticipated potential ossification at the fracture line. The dreaded complications of cerebrospinal fluid otorrhea or non-auditory stimulation post-implant did not occur. The peculiarity of this case was its rarity, which was demonstrated by clear images that showed the fracture line on preoperative imaging and intraoperatively. Conclusion Cochlear implantation in the presence of a visible fracture line is feasible and the surgical procedure must not be aborted at its discovery. In these cases, post-operative bacterial meningitis can occur and should be treated aggressively with systemic antibiotics to avoid contralateral ossification of the labyrinth due to labyrinthitis.
Examinations are an integral part of the process of medical specialization in the State of Israel... more Examinations are an integral part of the process of medical specialization in the State of Israel and a resident cannot receive an expert degree without passing the exams. The Scientific Council is the body responsible for the physician's training process, and the Higher Examinations Committee for the exams. Professional examinations committees are subject to the professional guidance by the Higher Examinations Committee. The residency exams are performed in two phases: Stage A (written examination) and Stage B (oral examination). Changes in Stage A exams, Stage B exams, and in the process of appeals to the exam results, are conducted after thorough thinking and testing procedures and under the guidance of professionals. During the course of the current Higher Examinations Committee, a number of significant changes were made in Stage A exams, including: 1. Reducing the number of questions in the surgical fields exams; 2. Consolidating the two parts of the exam in General Surgery, Urology, Vascular Surgery, Plastic Surgery, and Pediatric Surgery. 3. Exposing the questions and answers after the examination and altering the appeals process. There have also been changes in some specialties in Stage B exams according to the following rules: 1. Aspiration for multi-test stations; 2. Two examiners in each station; 3. Structured and unified content on all exam stations; 4. Structured evaluation forms; 5. Filling out the evaluation form by the examiners without consulting between them; 6. Automatic calculation of scores based on the percentage of accumulated points that the examinees accumulated from the maximum possible points; 7. An upfront decision on the passing score. The Higher Examinations Committee of the Scientific Council works, and will act constantly, for the construction of professional, fair, reliable and valid residency examinations.
We report the case ofan adult who develop ed an isolatedsolitary papilloma on the margin of the s... more We report the case ofan adult who develop ed an isolatedsolitary papilloma on the margin of the soft palate 1 month af te r he had undergon e a uvulop alat opharyngoplasty. We describe the clinica l and cellular characteristics of this common lesion.
Journal of basic and clinical physiology and pharmacology, Jul 20, 2021
Objectives Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encounter... more Objectives Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological entity, of various types and severity, with an array of associated symptoms including vertigo. This is a devastating life-changing condition with a blurry prognosis. The objective of this study was to determine the clinical association of vestibular impairment by electronystagmography (ENG) and caloric tests, and their ability to predict prognosis. Methods An observational, crossectional study was carried out amongst patients admitted with SSNHL. Each consenting patient had an audiometry test performed on admission as well as ENG and caloric tests. Treatment included oral steroids and carbogen with intratympanic steroids used only as salvage treatment. Follow-up was completed after 6 months when hearing gains were evaluated. Finally, an association was sought between the rate of recovery and ENG and caloric test results. Results Of 35 patients included, marked recovery was seen in patients without vertigo when compared to those with vertigo (p=0.003). A statistically significant association was found between the presence of vertigo and hearing deterioration (p=0.008). More so, normal electronystagmography results were associated with marked recovery (p=0.04). Conclusions The vestibular end organs are both subjectively and objectively affected in SSNHL as demonstrated by the abnormal ENG and caloric tests in our study despite the small sample size. Concomitant vestibular involvement carries poorer prognosis and routine identification may help foresee the recovery of patients with SSNHL and as such, aid in patient counseling. ENG and caloric tests are easily available and may be recommended for all patients with SSNHL.
INTRODUCTION The Israeli Scientific Council is responsible for the physician's training proce... more INTRODUCTION The Israeli Scientific Council is responsible for the physician's training process and the residency exams. These are performed in two phases: Stage A (written examination) and Stage B (the final Board oral examination). The COVID-19 pandemic started in Israel a few weeks before the scheduled spring 2020 Stage B exams and had a major impact, not only on the health and economic systems in Israel, but also on the residency exams. AIMS To describe the efforts of the Israeli Scientific Council to execute the spring 2020 Stage B exams during the COVID-19 pandemic in comparison to the worldwide data, and to deduce the appropriate management during potential future crises. METHODS We present a description of the activity of the Israeli Scientific Council since the start of the COVID-19 pandemic according to documents and other sources, An internet search was conducted on the destiny of residency examinations throughout the world, and a comparison between them. RESULTS Due to rapid worsening in the restrictions enforced in Israel, the spring 2020 oral board exams were cancelled. However, a decision was made to execute them in the summer. This new schedule dictated a delay in the schedule of other residency examinations and forced condensation of 5 periods into 10 months instead of 14. The examination team prepared the new summer exams period under the assumption that heavy restrictions will still be implemented. Indeed, COVID-19 was still around and the restrictions were still enforced. Despite that, all oral Board examinations were perfectly executed. This contrasts with the rest of the world, in which most residency exams were cancelled, even without a solution or an alternative date. CONCLUSIONS Recruitment of all involved and preparation for the worst-case scenario enabled the perfect execution of the previously cancelled exams, and will enable the execution of future residency exams under conditions of potential health or war crises. DISCUSSION To the best of our knowledge, the Israeli Scientific Council is the only communal body in the world which organized an alternative period for the cancelled oral exams, only 4 months after the cancelled dates. Due to an enormous effort and rigorous preparations, Israel is also the only place in which oral exams were successfully executed, physically, under an active disease and very heavy restrictions.
Annals of Otology, Rhinology, and Laryngology, Dec 1, 1999
A patient with acute vertigo, and normal findings on neurologic examination, was found to have ve... more A patient with acute vertigo, and normal findings on neurologic examination, was found to have vertebral artery dissection (VAD). This case shows that the clinical picture of VAD can mimic vertigo of labyrinthine (ie, peripheral) origin.
Background Temporal bone fractures are divided into otic capsule sparing and otic capsule involvi... more Background Temporal bone fractures are divided into otic capsule sparing and otic capsule involving fractures. In the latter, hearing loss, facial nerve paralysis, cerebrospinal fluid leak and meningitis have been reported to occur. The impact of hearing loss can be devastating, especially when occurring in children, with significant risk to speech development and sound localization. In the event of hearing loss, early rehabilitation is therefore of paramount importance. Identification of an intra-operative fracture line with available images and the outcome of such cases has not been reported. Case presentation We present the case of a 31-month-old male with an otic capsule involving temporal bone fracture, who presented with ipsilateral profound hearing loss. After all required work-up had been performed, he was admitted for a cochlear implant insertion. Per-operatively, a clear fracture line was seen at the round window niche, but a normal insertion was performed despite the anticipated potential ossification at the fracture line. The dreaded complications of cerebrospinal fluid otorrhea or non-auditory stimulation post-implant did not occur. The peculiarity of this case was its rarity, which was demonstrated by clear images that showed the fracture line on preoperative imaging and intraoperatively. Conclusion Cochlear implantation in the presence of a visible fracture line is feasible and the surgical procedure must not be aborted at its discovery. In these cases, post-operative bacterial meningitis can occur and should be treated aggressively with systemic antibiotics to avoid contralateral ossification of the labyrinth due to labyrinthitis.
Examinations are an integral part of the process of medical specialization in the State of Israel... more Examinations are an integral part of the process of medical specialization in the State of Israel and a resident cannot receive an expert degree without passing the exams. The Scientific Council is the body responsible for the physician's training process, and the Higher Examinations Committee for the exams. Professional examinations committees are subject to the professional guidance by the Higher Examinations Committee. The residency exams are performed in two phases: Stage A (written examination) and Stage B (oral examination). Changes in Stage A exams, Stage B exams, and in the process of appeals to the exam results, are conducted after thorough thinking and testing procedures and under the guidance of professionals. During the course of the current Higher Examinations Committee, a number of significant changes were made in Stage A exams, including: 1. Reducing the number of questions in the surgical fields exams; 2. Consolidating the two parts of the exam in General Surgery, Urology, Vascular Surgery, Plastic Surgery, and Pediatric Surgery. 3. Exposing the questions and answers after the examination and altering the appeals process. There have also been changes in some specialties in Stage B exams according to the following rules: 1. Aspiration for multi-test stations; 2. Two examiners in each station; 3. Structured and unified content on all exam stations; 4. Structured evaluation forms; 5. Filling out the evaluation form by the examiners without consulting between them; 6. Automatic calculation of scores based on the percentage of accumulated points that the examinees accumulated from the maximum possible points; 7. An upfront decision on the passing score. The Higher Examinations Committee of the Scientific Council works, and will act constantly, for the construction of professional, fair, reliable and valid residency examinations.
We report the case ofan adult who develop ed an isolatedsolitary papilloma on the margin of the s... more We report the case ofan adult who develop ed an isolatedsolitary papilloma on the margin of the soft palate 1 month af te r he had undergon e a uvulop alat opharyngoplasty. We describe the clinica l and cellular characteristics of this common lesion.
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