Eustachian Tube dysfunction in chronic rhinosinusitis: pre and post-operative results following endoscopic sinus surgery, a prospective study.

BACKGROUND: Prospective study investigating the incidence of concurrent Eustachian Tube dysfunction (ETD) in patients with CRS refractory to medical therapy, and the effect of Endoscopic Sinus Surgery (ESS) on ETD in this patient group. METHODS: Prospective study of 57 CRS patients. Outcome measures were SNOT-22 and ETDQ-7 questionnaires, tympanometry and Valsalva manoeuvre recorded pre-operatively and at 3 and 9 months post ESS. RESULTS: There was a moderate positive correlation between pre-operative ETDQ-7 and SNOT 22 scores (r equals 0.5715, p less than 0.0001). 68% of patients recorded positive ETDQ-7 scores pre-operatively, mean equals 20.6 (SD plus or minus 10.34). Mean ETDQ-7 scores were significantly lower at 3 months; mean equals 11.4 (SD plus or minus 5.65) (P less than 0.0001) and 9 months mean equals 11.4 (SD plus or minus 6.15) (P less than 0.0001) following ESS. Type A tympanograms increased form 76.6% pre-operatively, to 94.5% at 3 months and 96% at 9 months. Reported positive Valsalva increased from 38% pre-operatively to 96% at 3 and 9 months. Mean ETDQ-7 scores were higher in the CRSwNP group; 24.34 (SD plus or minus 9.2) compared to the CRSsNP group; 18.11 (SD plus or minus 10.3), (p equals 0.6101). 16 patients in the cohort had existing diagnoses of asthma, of which 4 had documented aspirin sensitivity. The mean pre-operative SNOT-22 score in this overall subgroup was 64.81 (SD equals plus or mins 20.13) compared with 49.07 (SD equals plus or minus 21.37) in non-asthmatic patients (p equals 0.0168). CONCLUSIONS: We found a high incidence of concurrent ETD symptoms in patients with severe CRS, which improve following ESS. Further research is required to better understand the association between CRS and ETD in order to provide effective treatments.

Is training in endoscopic sinus surgery detrimental to patient outcome?

OBJECTIVE: To identify whether training in endoscopic sinus surgery (ESS) is detrimental to patient outcome. MATERIALS AND METHODS: Prospective evaluation of SinoNasal Outcome Test 22 (SNOT-22) scores for all patients undergoing ESS. Comparison between the outcome scores of patients operated on by the established endoscopic sinus surgeon with outcome scores of patient operated on by the supervised trainee. RESULTS: Patients operated on by the supervised trainee did not have poorer outcome scores than patients operated on by the established endoscopic surgeon. CONCLUSIONS: Training in endoscopic sinus surgery is not detrimental to patient outcome when assessing symptom resolution, assuming that the training is closely supervised and that the trainee complies with a structured training program.

Change in health status after rhinoplasty.

OBJECTIVE: To assess the change in health status of patients undergoing rhinoplasty. DESIGN: Retrospective mail-based questionnaire study using a validated post-intervention questionnaire specifically designed for otolaryngology surgery. SETTING: District general hospital otolaryngology department. PATIENTS: All patients (78 in total) undergoing rhinoplasty surgery between October 1998 and November 2003 were included in the study. MAIN OUTCOME MEASURE: Glasgow Benefit Inventory, a validated post-intervention questionnaire specifically designed for otolaryngologic surgery. RESULTS: The mean total Glasgow Benefit Inventory score was +20.0 (95% confidence interval [CI] 14.2-25.9), and the mean general, social, and physical subscale scores were +25.0 (95% CI 17.3-32.7), +10.2 (95% CI 4.4-16.0), and +9.9 (95% CI 2.7-17.0), respectively. CONCLUSIONS: Our results show that the health status of patients undergoing rhinoplasty improved overall and according to each of the subscales used.

The facial skin lesions "see and treat" clinic: A prospective study.

Facial lesions are commonly referred to ear, nose and throat surgeons. Almost all are amenable to excision under local anaesthetic as a day case. However, in the UK, there is still a significant delay between referral by the general practitioner (GP) and final surgery. To address this delay, a one stop see and treat consultant led clinic was set up in the community. The aim of this study was to assess the impact of the one stop clinic on waiting times and to ascertain the satisfaction of patients with the treatment they received in this clinic. Patients with facial skin lesions were referred by the GPs to the ENT department in the usual manner. The referral letters were screened by two consultants, the appointments were booked by telephone and the patients were seen and treated in a single visit. The clinics were held in a minor surgery unit of a centrally located GP practice. Patients were seen, assessed and if the facial lesion was considered amenable to excision under local anaesthetic, the patient was consented and the procedures carried out immediately. The clinic was audited over a 1 year period. Waiting times were compared before and after the start of the project. Patients were asked to fill in a questionnaire immediately after surgery. The attendance rate was 96%. The waiting time was reduced from 121 to 47 days. Patients rated the clinic experience as excellent (88%) or good (12%) indicating a very high satisfaction rate. During the study period, 160 lesions were excised of which 22% were malignant. Patients with malignant lesions did not show any sign of recurrence at a follow up of 9 months, except in one case with basal cell carcinoma. This was operated on and removed completely. Our project shows that the aims of reducing waiting times and improving patient care were achieved with this community model of a one stop facial lesions clinic. This clinic is now an integral part of the service provided by the ear, nose and throat department at Ipswich hospital, UK.