Volume 9 Issue 1 - 2016

 

Welcome to the first issue of 2016, I hope you had a good break over the Christmas period and New Year. It is always tough getting back to work and dealing with the increasing challenges in the NHS, I encourage you to read the guest Editorial from David Strachan (my colleague), which illustrates nicely the benefits of taking a sabbatical. I would suggest that for those consultants who are feeling a bit ‘burnt out’ it is something certainly to consider strongly.

We have some great articles for you to enjoy and Francis Vaz and I try to ensure that each issue has something of interest to all Otorhinolaryngologists. Please let Francis or I know if you have any suggestions for the journal. The on line access for the CPD part of the journal continues to have software improvements from the publishing team and I encourage you to try it out.

With best wishes for 2016.

Sanjai Sood
Editor in Chief

‘Sounds great but there is no way I can do that!’ is the usual reaction from colleagues to talk of taking a sabbatical. You may think the same but perhaps, by the time you’ve read this, the seeds may have been sown ….!

Abstract

Introduction: Functions of the normal human balance system include postural control and gaze stabilisation. The latter requires accurate lateral and torsional eye movement. We recently acquired cVEMP and videonystagmography recording equipment and reassessed patients diagnosed with bilateral vestibular hypofunction in order to optimise their customised vestibular rehabilitation.

Methods: Patients with caloric confirmed bilateral vestibular hypofunction were identified. Each was invited to undergo cVEMP testing in order to assess their inferior vestibular nerve function. Eye movements were also recorded during active and passive head movements.

Results: Twenty-eight patients with bilateral vestibular hypofunction attended in order to assess their inferior vestibular nerve function. Of these 25 demonstrated normal cVEMP responses and normal ocular torsion on active and passive head tilt. Three subjects failed to elicit normal cVEMP responses. In each case pendular ocular torsion was demonstrated on active and passive head tilt.

Discussion: This observation suggests that assessing ocular torsion may provide a simple alternative to cVEMP testing and merits further research.

Abstract

Introduction: We aimed to assess whether MRI scans for screening of vestibular schwannoma (VS) are a cost effective tool and how best to maximise their positive yield.

Materials and Methods: We undertook a retrospective analysis of 1000 scans to assess the diagnostic yield and the sensitivity and specificity of four published protocols

Results: Of 756 patients included 8 patients were positively identified with a VS. If only patients who had either a 15dB or 20dB hearing loss at any single frequency underwent screening the number of negative scans would have been reduced by over 50%. No patients with unilateral tinnitus alone and normal hearing (8.6%) were diagnosed with VS.

Discussion: To reduce the burden of MRI scans all departments should scan in accordance with a published protocol.

Abstract

Antibiotics are the most commonly prescribed drug class for patients with chronic rhinosinusistis (CRS) even through the causative role of bacteria remains unclear.

However, recent concern has been raised regarding the potential association of macrolide antibiotics and cardiotoxic side effects. This article reviews the evidence and safety of the role of macrolides in the management of patients with CRS.

Abstract

Introduction: This review seeks to highlight high-risk areas to individuals performing rhinological procedures within the NHS. By recognising such areas we look to establish guidance for surgeons at every stage of training to help decrease this risk.

Methods: The NHS Litigation Authority (NHSLA) were contacted and provided anonymous data on all claims against NHS ENT Surgeons related to the practice of rhinology for the five-year period between 2005-2010.

Results: Ninety-six cases were identified. 59% of claims related to ‘injuries’ occurring in the operating theatre. Surgical complications accounted for 55% of claims.

Conclusions: The operating theatre was highlighted as an area of high-risk. Surgical complications were the most common perceived cause of malpractice. Streamlining the consent process may help curb this risk.

Abstract

Historically, there appears to be continuing shift in opinion regarding the ideal modality of treatment of oropharyngeal cancer. This review focuses specifically on the swallowing and speech outcomes during the march in progress through the years of both oncology and surgery disciplines in treating this cancer.

This article illustrates a case of delayed vocal cord paralysis after blunt neck trauma. Delayed nerve palsy has been frequently described in relation to some nerves such the median nerve but not the recurrent laryngeal nerve.

A 69 year old man presented with a minimally displaced fracture of the thyroid cartilage which was managed conservatively. No airway intervention was required. Both vocal cords were mobile during three days of observation. At 14 days there was a palsy of the right vocal cord.

Fractures of the larynx may need surgical intervention. Surgery may be complicated by a recurrent laryngeal nerve injury. Postoperative detection of a vocal cord palsy can be a complication of either the surgery or initial trauma.

Abstract

Background: Nurse-led pre-admission clinics were established by the need for delivering a cost-effective service that would improve management of waiting-lists. These have been shown to have high patient satisfaction. A nurse-led ‘one stop’ rapid access clinic for elective tonsillectomy referrals was introduced in 2006 in the ENT department of Lincoln County hospital.

Aim: The aim of this audit was to determine patient satisfaction of these clinics following their implementation.

Methodology: All patients referred for and offered tonsillectomy at this clinic in August 2007 were included in the audit. They were asked to participate in a telephone questionnaire survey on their satisfaction with the procedure and consultation.

Results: Most patients (78.3%) were happy to be seen by a nurse rather than the doctor with the remaining 22.7% having reservations. Our findings showed a 100% patient satisfaction with this service.

Conclusion: Nurse-led rapid access rapid access tonsillectomy clinics deliver an effective, resourceful and safe service provision which is regarded to be most satisfactory to patients.

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