przyssawka t1_j20bd9t wrote

Polyphasic as a necessity more like. Jokes aside not really, the work is structured in a way that wouldn’t allow for the polyphasic sleep cycle outside of on-calls (and even then ER can wake you up at any moment). Not to mention I have yet to see research that proves that it’s a valid and sustainable alternative to regular cycle.


przyssawka t1_j1z731i wrote

Yes but as you mentioned for stuff like anterior or lateral approach skull base surgery or large tumor dissections we do take turns. it’s usually a combined effort by neuro, maxfac and ENT. Compare it to stuff like transplantology where one team usually handles the entirety of the procedure.


przyssawka t1_j1z3ra4 wrote

We eat and drink coffee during shifts, nothing different compared to an office job. Part of resilience is definitely adaptation though, residency is exploitative. My speciality doesn’t have those 20-ish hour procedures (at least none that would be all-HNS team) so no surgeon rotation, if it’s 4-5h in the OT you’re stuck there for 4-5h. Then again, hunger or sore legs is the last thing you’re concerned with assuming you’re actively participating, even more so if you’re the primary surgeon.


przyssawka t1_j1z1sdu wrote

Head and neck surgeon here. 24h shifts are the norm, it’s something you just get used to. It sucks but that’s the reality of it. 36 hours of nonstop work does happen, especially in residency. It’s definitely taxing and impacts your productivity especially during low stake work like charting. I had instances of my prechart notes being absolute gibberish due to sleep deprivation. But when it comes to procedures your body runs on adrenaline, tired or not it feels like a reset button was pressed, even during longer procedures like laryngectomies. Getting distracted doesn’t really happen unless you are a med student holding the retractor then all you have left is praying for mercy and sweet release


przyssawka t1_j1l46ow wrote

>what is a cold receptor?

Aδ and C nerve fibers have a protein that responds to heat dissipation and triggers the “gentle cooling” effect. That protein is TRPM8 and on top of being activated by cold (due to part of the protein changing shape) it can also be activated by menthol and eucalyptol.

More on that here


przyssawka t1_j1jgskg wrote

The confusion may be due to poorly written wikipedia entry on conchae, which is extremely inconsistent:

>Conchae (/ˈkɒnkiː/), also called a nasal turbinate or turbinal,[1][2] is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose

followed immediately by:

>Conchae are composed of pseudostratified columnar, ciliated respiratory epithelium with a thick, vascular, and erectile glandular tissue layer.

I'm a head and neck surgeon and I've never heard anyone in the field make a distinction between the mucosa covering the concha and the bony part, mostly because it's the mucosal part that's important for things like FESS procedure (outside of cases of Concha Bullosa).

It's similar to the labyrinth of the inner ear. Can mean the petrous part alone but it's commonly used to refer to what it contains as well. Anatomically the whole structure is called a concha and that includes the mucosa.


przyssawka t1_j1jfngc wrote

Conchae are more than just the scrolls of bone in anatomy. A popular outpatient procedure conchoplasty (also called turbinoplasty) removes (or simply destroys) the mucosal part of conchae usually without touching the bone itself (though "breaking" the conchae is sometime a part of the procedure)


przyssawka t1_j1izih5 wrote

yes. For the first question at least. Never skydived in winter.

*Subjective* nasal patency (the perception of airflow) and nasal airflow are two completely different things. The study I posted compares effects of different air conditions on the perception of airflow. Cold air (or rather "heat loss by mucosa") was consistently the best way to evoke the feeling of decongestion. None of the conditions improved the actual flow.

This direpacy between the flow and perception can also cause the adverse effect for patients who underwent concha reduction surgery (conchoplasty) or Endoscopic Sinus Surgery, to suffer from "empty nose syndrome", which is the subjective feeling of low nasal patency with optimal airflow.


przyssawka t1_j1hezwm wrote

I'd like to add to this with: subjective feeling of decongestion is related to perception of airflow, and substances OP mentioned provide an additional "cooling effect" by chemically stimulating the cold receptors. This is interpreted as increased airflow - similarly to how after using a cooling spray on your skin it's suddenly way easier to feel even a slight breeze. There was even a study done on that effect, that proved that menthol alone can increase the subjective feeling of decongestion on par with some actual decongestant with zero increase in nasal flow.

Drugs such as xylometazoline and adrenaline delivered topically will actually affect the size of nasal conchae (turbinates) - with mid concha hanging directly over the maxilary sinus entrance.


przyssawka t1_j1hc7uw wrote

This is incorrect, and a common misconception. BBPV is indeed a disorder caused by otoconia displacement but that displacement won't be commonly caused by a spinning manouvre, but usually by sharp accelerated unidirectional head movements, or changes in the endolymph. Completely unrelated to what we experience after spinning lets say on a merry-go-round.

Animal vision relies on the image on the retina being somewhat stable. Similarly to how a head of a chicken is stablised by neck muscles to prevent "retinal slip" human vision relies on Vestibulo-ocular reflex (VOR). Generally speaking oculomotor muscles adjust for movements of the head to stabilise the image by rapidly shifting the eye it in the other direction. Spining movement is a special situation in which (A) - VOR is continuuos and unidirectional and (B) - unable to fully compensate for movement. That causes a level of overcompensation persisting after the movement ends, causing nystagmus, and producing motion sickness symptoms.

EDIT: I don't want to sound hostile but it feels like the response you provided was written by a bot.