Telephone survey to review patient satisfaction with telephone follow-up consultation in an ENT setting.
Dr. M. Groarke, Miss A. Harrison, Mr. Y. Karagama
Tameside General Hospital, Manchester
Introduction: With increasing pressures on the National Health Service (NHS) to reduce waiting times for operations and outpatient appointments alternative methods of reviewing patients in a safe, timely and suitable manner are necessary. Our hospital was struggling to meet demands and follow-up patients in a timely manner. With a view to resolving such issues, clinics involving an ENT Consultant Surgeon conducting telephone consultations with patients were piloted.
Objective: To review patient satisfaction with a follow-up telephone consultation service and assess the practicalities of telephone consultations as a follow-up method in place of hospital out-patient clinic appointments.
Method: Thirty-eight patients were scheduled for telephone consultations with an ENT Consultant Surgeon in December 2014 and April 2015. Following the telephone consultation they were contacted and asked for feedback regarding the service using a 5 point feedback questionnaire. Patients were encouraged to give comments regarding the process.
Results: Twenty-nine patients responded to the follow-up questions. Of these, 97% expressed their satisfaction with the service and had no concerns regarding being contacted via telephone. Moreover, the vast majority of patients contacted expressed that they preferred this method of follow-up.
Conclusion: Overall, patients’ were satisfied with the follow-up telephone consultation service and it appears, from this study, to be a potentially viable option for certain patient groups. It may be a safe and cost effective alternative to hospital out-patient review.
Evaluating the use of Floseal haemostatic matrix in the treatment of epistaxis: a prospective, control-matched longitudinal study
Lepa Lazarova, Andrew S Lau, Navdeep S Upile,Andrew C Swift
Affiliation: Department of ENT and Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, L9 7AL, United Kingdom
Introduction: Epistaxis is a common cause of emergency admissions in ENT. The use of Floseal haemostatic matrix in the treatment of epistaxis has been investigated in a number of studies in North America. We aimed to report a UK-based experience in the context of the current UK management paradigm.
Methods: The study was designed as a prospective, unrandomised, control-matched longitudinal study. Cases were matched to controls in order to reduce the risk of bias.
Results: The overall treatment success rate for Floseal was 75%, similar to the rates reported by studies based in North America. Nasal packing carried a success rate of 85% and there was no statistically significant difference between the success rates of both treatments.
Anecdotally, Floseal is successful at arresting epistaxis in patients who experience treatment failure with silver nitrate cautery. It can also be used successfully in thrombocyctopenic patients. There was a trend towards a shorter LoS in the Floseal group, but this was not statistically significant. The 7-day readmission rate was 10% for both groups.
Conclusion: This controlled study demonstrates that Floseal has a similar treatment success rate to nasal packing and that there may be a trend towards a shorter length of stay.
Best Supportive Management for Adults Referred with Tonsillopharyngitis – The BeSMART
Project Phase One: A Multicentre Observational Study
Jessica Veitch1, 6, Costas Mamais1, 2, Ewan McChesney1, 3, Navdeep S Upile1, 4, Casey
Vaughan1, 5, Jonathan Abbas1, 7, Anne Markey1, 8, Mark Evans1, 3, Jamie Thomas1, 3, Andrew S
Lau1, 3
Affiliations:
1. Mersey ENT Research Collaborative 2. Aberdeen Royal Infirmary, Aberdeen 3. Aintree
University Hospital, Liverpool 4. Arrowe Park Hospital, Wirral 5. Leighton Hospital, Crewe 6.
Royal Liverpool University Hospital, Liverpool 7. Salford Royal Hospital, Salford 8. Warrington Hospital, Warrington
Introduction:
Tonsillopharyngitis is the most common ENT emergency admission. 74,092 episodes were
recorded in England in 2013-14, representing over £51.5 million in NHS expenditure. Despite
this, there is a surprising paucity of evidence addressing the supportive management of
tonsillopharyngitis in secondary care. We therefore set up a multi-phased project, beginning
with a multicentre retrospective observational study.
Methods:
Work was coordinated through our trainee research collaborative. The project was registered at six institutions and cases were identified. Anonymised data including patient
demographics, length of stay and prescription of supportive medicines was recorded on
consensus spreadsheets, followed by statistical analysis (α=0.05).
Results:
Data from 151 patients has been analysed to date. Female:male ratio was 2:1 and median
age was 26 years. There was no significant association between length of stay (LoS) and age
(p=0.085); gender (p=0.468); seeing an ENT doctor directly (p=0.838) or the seniority of the
doctor initially seen (p=0.174).
Prescription of ‘escalation’ medications was not associated with a shorter LoS, such as
codeine (p=0.153) and corticosteroid (p=0.876). Interestingly, longer LoS was associated with administration of NSAIDs (p=0.002), topical benzydamine (p<0.001) and intravenous fluid (p<0.001). Fluid prescription was significantly associated with tachycardia on admission
(p=0.030), whereas NSAID and benzydamine prescriptions were not (p=0.992 and p=0.797
respectively). This may indicate either prescribers’ response to patient condition.
Conclusion:
The results yield valuable insights into current practice. Often-prescribed therapies such as
corticosteroid may not be as effective as previously believed. Prospective studies are
required to provide robust evidence for the best supportive management of this common ENT emergency.
Incidental findings on MRI scans of patients with audiovestibular symptoms
Htun HM, Mui S L, Hans P
Blackpool Victoria Hospital, Blackpool, Lancashire, UK
Introduction: Magnetic Resonance Imaging (MRI) is considered the gold standard in detecting cerebellopontine angle (CPA) or internal acoustic meatus (IAM) lesions such as vestibular Schwannoma in patients presenting with unilateral audiovestibular symptoms - sensorineural deafness, tinnitus and vertigo. However, vestibular Schwannoma is rare in both patients with audiovestibular symptoms and in the healthy population. It is therefore much more likely for otolaryngologists to encounter the report of an incidental finding in the imaged brain than a vestibular Schwannoma itself.
Aim: To determine the frequency of these incidental findings and to determine the best next steps in counselling and investigations when they arise.
Materials and methods: We retrospectively reviewed all MRI IAM scan reports during a 3 month period at the Radiology department at Blackpool Victoria Hospital, Blackpool, Lancashire, UK, noting relevant IAM and incidental findings.
Results and conclusion: Out of the 109 scans, eight scans were reported to have ‘abnormal’ IAM - one was found to have a small vestibular schwannoma (0.9%) and seven had vascular loops (6.4%). The remaining 101 scans were reported as having ‘normal’ IAM (92.7%). However, two scans needed further action as a deep lobe parotid tumour and an empty sella with benign intracranial hypertension were found (1.8%). 45 of the 101 scans (41.3%) showed various incidental findings such as age related ischaemic changes and small vessel disease, sinonasal disease and benign neurological pathologies. 54 of them (53.5%) were found to be entirely normal.
Our study demonstrated that almost half of the scans were reported with incidental findings albeit only two patients needed further action. Otolaryngologists should have a basic understanding of the significance of the most commonly encountered incidental findings, and be able to appropriately counsel their patients with reassurance or an initial explanation of the implications of the finding and any onward referral.
Prognostic value of the neutrophil to lymphocyte ratio in laryngeal squamous cell carcinoma patients
B.Y.W. Wong, N.D.Stafford, V.L.Green, J.Greenman
Background. The neutrophil to lymphocyte ratio (NLR) has been found to be predictive of survival outcome in a range of tumours. The purpose of this study was to investigate the prognostic value of pre-treatment (NLR) in laryngeal squamous cell carcinoma (LSCC) patients.
Methods. A retrospective analysis of 140 LSCC patients treated between 2005 and 2010 in the Hull and East Yorkshire Hospitals NHS Trust was carried out. Patient records were evaluated and both pretreatment neutrophil and lymphocyte counts were documented together with survival data, gender, smoking status, nodal status and disease staging.
Results. An elevated NLR was significantly associated with advanced disease stage, e.g. node positive and tumours Stage III & IV. In addition a high NLR was significantly associated with poor overall survival but not disease free survival on multivariate analysis, with the greatest significance seen in patients with the highest NLR.
Conclusion. Pretreatment NLR may serve as a useful prognostic marker in LSCC, however a large prospective study is required to determine an optimal NLR cut-off value.
Cohort study comparing the diagnostic potential of computed tomography and magnetic resonance imaging in the management of paranasal sinus disease
Harris R1, Markose G2, Bernstein J3, Bury RW1
Blackpool Victoria Hospital 1
Royal Bolton Hospital 2
Toronto University Health Network 3
Introduction :CT is currently the imaging modality of choice for diagnosis and follow-up of sinus disease and pre-operative planning. Historically, MRI has been considered inferior to CT. Our aim is to compare the diagnostic potential of CT and MRI in paranasal sinus disease.
Methods :40 patients with suspected sinusitis underwent coronal CT followed immediately by T1 and STIR MRI sequences. Scans were reviewed by a single radiologist blinded to the clinical history. Inter-examination agreement was calculated as the kappa statistic using Stata11 software.
Results :CT is superior to MRI in delineating fine bony structures however there is good agreement between MRI and CT over disease extent and soft tissue structures. MRI was only marginally longer (15min) than CT (10min).
Conclusion:MRI should be considered an alternative first line diagnostic tool in: 1) the young 2) dental implants 3) orbital complications 4) assessing therapeutic success. CT should be reserved for pre-operative planning in order to restrict radiation exposure.
Title: Bioplastique (polymethylsiloxane elastomer) in the treatment of Patulous Eustachian Tube Dysfunction.
Authors: Alastair White, Okechukwu Okonkwo, Simon Hargreaves.
Objective: Patulous Eustachian tube is a clinical diagnosis that is poorly understood with no definitive treatment. Patients’ quality of life can be severely affected by their symptoms and there is little evidence surrounding current treatment. Recent studies have suggested a benefit from Bioplastique (polymethylsiloxane elastomer) injections to the Eustachian tube cushions.
Method: We performed a retrospective case series analysis using a modified Cambridge Otology Quality of Life questionnaire. 9 patients clinically diagnosed with PET to assess the impact of the procedure on their perception of their symptoms.
Results: In the major symptoms that describe this condition 44% of patients described an improvement in their symptoms of autophony and 33% described an improvement in their symptoms of aural fullness. 79% of patients experienced some symptom resolution in at least 1 symptom category. One patient claimed complete resolution of all symptoms.
Conclusion: Benefit derived from this procedure is variable but with careful patient selection it can be a useful tool in the management of a difficult cohort of patients.
A Rapidly Resolving Neck Mass
Siau R.T.K., Khan M.M, Kaushik, V.
Stockport NHS Foundation Trust
Introduction: Multidisciplinary correlation of patient history, examination findings, pathology and imaging is necessary in diagnosing a new neck mass. We report an atypical case of an evolving neck mass where examination and pathology findings were limited, and clinical and radiological findings were not consistently in correlation. We use this case to highlight the diagnostic dilemma when managing a patient with these challenges.
Methods: Case report.
Results: An anxious but otherwise healthy 19-year old woman was referred with a three-week history of rapidly enlarging right level II cervical mass. The patient declined fiberoptic laryngoscopy and fine-needle aspiration in clinic, and thus panendoscopy and excision of the mass under general anaesthesia was planned. Ultrasonography was suggestive of a 4.2cm parotid cyst. MRI of the neck reported a 5cm mass of jugulodigastric lymph nodes with cystic development. On the day of surgery, the mass had clinically resolved and a repeat MR scan which was initially reported as normal, demonstrated a much smaller residual lesion in right jugulodigastric region.
Conclusion: Many patients suffer from some degree of medical anxiety, which can contribute to diagnostic difficulties. Lack of pathological diagnosis can lead to over-reliance on radiological reporting, which is operator dependent and can be misleading. We describe an unusual case causing multiple diagnostic and management dilemmas, requiring a multidisciplinary approach to formulate a differential diagnosis of this unusual presentation, and influence onward management.
Customised ENT Clerkings and An Online 'Clerking Collaborative'
Ahmad Hariri, Rachel Edmiston, Navin Mani, Simon Lloyd
Fairfield General Hospital, Bury, UK Manchester Royal Infirmary, Manchester, UK
Introduction: Clerking proformas are frequently used in the acute hospital setting to provide a template for complete assessment. Much variation remains in the format of such proformas and they frequently fail to account for local and speciality specific factors. We develop and pilot a customised ENT clerking proforma and create a national online 'clerking collaborative'.
Methods: Junior doctors were asked to complete mock clerkings for 6 common acute ENT presentations by traditional methods (freehand) followed by annotation of a custom designed diagram of the head and neck. Participants were timed and asked to complete a feedback questionnaire. A senior ENT clinician provided structured feedback for the quality of each clerking.
Results: Nine doctors participated in the exercise. Overall, pre-drawn diagrams provided accurate representations of the clinical scenarios and were easier to complete than free drawings. Pre-drawn diagrams took less time and improved legibility and quality of documentation as assessed by the senior clinician.
A website (www.MyClerking.co.uk) was created to disseminate the clerking proforma and allow other clinicians to contribute ideas and improvements.
Conclusion: Accurate and legible clerkings are essential across all specialities allowing continuity of care and management. This is particularly important in ENT where illustrations are used to demonstrate clinical findings. Our pre-drawn diagrams speed up the clerking process and allow for more accurate depiction of findings.
We have designed an online 'clerking collaborative' where doctors around the world can download our clerking proforma and also amend/upload their own customised proforma for others to use.
The Accuracy of MRI in Predicting Extracapsular Spread in Neck Nodes
Mr Benjamin Wood, Medical Student Professor Kenneth MacLennan, Professor of Histopathology Dr Henry Wood, Senior Research Fellow Professor Pamela Rabbitts, Professor of Experimental Therapeutics Mr Neeraj Sethi, Clinical Research Fellow