Reintroduction of elective paediatric otolaryngology procedures in South Africa during the COVID-19 pandemic

Cancelling elective clinical consultations and surgical procedures was instrumental in assisting hospitals prepare for the COVID-19 crisis. Essential bed space was made available, and it allowed mobilisation of health workers and enforced social distancing. A shift in patient-centred ethics to public health ethics was required to provide a utilitarian approach to the crisis. However, at some point, clinicians need to start becoming patient centred again, and this needs to happen within the utilitarian framework. Children only account for 1 - 5% of confirmed COVID-19 cases, and they present with a much milder disease spectrum than adults. Consequently, paediatric units may be at the forefront of implementing reintroduction of patient-centred elective clinical and surgical procedures. The following recommendations provide a framework to do this in a way that minimises risk to patients and clinicians. They are the first paediatric guidelines in the literature to propose a strategy to reintroduce elective surgical procedures

Tonsillectomy Rates in the South Africa Private Healthcare Sector

Background. Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this; there exists considerable international (190 - 850/100 000 people =19 years of age) and regional variation in rates. This cannot be accounted for by differences in clinical need or regional morbidity. Objectives. To describe the adeno-/tonsillectomy rate in the South African (SA) private healthcare sector and regional variations thereof. To compare local rates with international rates and assess trends in adeno-/tonsillectomy practice. Methods. Analysis of 2012 and 2013 adeno-/tonsillectomy data provided by the largest SA private healthcare funder; accounting for 30% of the medical scheme market. Rates are expressed per 100 000 people =19 years of age. Results. The tonsillectomy rate in the SA private healthcare sector was 1 888/100 000 people =19 years of age in 2012. In 2013; the rate dropped significantly (p0.001) to 1 755/100 000. This is more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in this rate within SA. Discussion. The SA tonsillectomy rate is very high when compared with international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather; it is differences in training and clinical practice of clinicians; as well as social and family factors; that have been implicated.Conclusion. The adeno-/tonsillectomy rate in the SA private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration

Is Total Glossectomy for Advanced Caricinoma of the Tongue Justified?

Total glossectomy (with or without total laryngectomy) followed by postoperative radiotherapy remains the principal treatment method for advanced base of tongue carcinoma. The procedure remains controversial owing to poor cure rates and the inevitable functional deficits associated with it. However; even though total glossectomy is a major surgical procedure that impacts on speech; deglutition and quality of life; it may offer patients the best chance of cure in many centres; especially in the developing world.METHODS. We did a retrospective chart review of all patients at Groote Schuur Hospital; Cape Town; who had undergone total glossectomy; with or without total laryngectomy; for stage IV squamous cell carcinoma (SCC) of the tongue between 1998 and 2004. RESULTS. Eight patients had a total glossectomy performed during the study period. At 2; 3 and 5 years 63; 38and 25of patients respectively were alive without disease. No patient required permanent nasogastric or gastrostomy feeding; and all returned to a full oral diet. Three of 5 patients who had laryngeal preservation and could be assessed for speech had intelligible speech. All but 1 patient (88) reported pain relief following surgical excision. Perineural invasion was present in 75; and 38had positive resection margins. Five patients had recurrence; 2 cervical; 1 local; and 2 local and cervical. Conclusion. Advanced SCC of the tongue is a devastating disease causing severe pain and disorders of speech and swallowing. Total glossectomy (with or without total laryngectomy) and postoperative radiotherapy is a reasonable treatment option; particularly in the developing world setting. It has cure rates superior to primary radiotherapy; and provides motivated patients with excellent pain relief and a reasonable quality of life

Adult tonsillectomy - are long waiting lists putting patients at risk? : otolaryngology

There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more; only 55 were contactable. This low yield (15.7) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy); it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis