Survey of otolaryngology services in Ukraine and neighbouring Central and Eastern European countries.

OBJECTIVE: The present humanitarian crisis in Ukraine is putting strains on its healthcare system. This study aimed to assess services and training in otolaryngology, audiology and speech therapy in Ukraine and its geographical neighbours. METHOD: Survey study of 327 otolaryngologists from 19 countries. RESULTS: Fifty-six otolaryngologists (17 per cent) from 15 countries responded. Numbers of otolaryngologists varied from 3.6 to 12.3 per 100 000 population (Ukraine = 7.8). Numbers of audiologists varied from 0, in Ukraine, to 2.8 per 100 000, in Slovakia, and numbers of speech therapists varied from 0, in Bulgaria, to 4.0 per 100 000, in Slovenia (Ukraine = 0.1). Ukraine lacks newborn and school hearing screening, good availability of otological drills and microscopes, and a cochlear implant programme. CONCLUSION: There is wide variation in otolaryngology services in Central and Eastern Europe. All countries surveyed had more otolaryngologists per capita than the UK, but availability of audiology and speech and language therapy is poor. Further research on otolaryngology health outcomes in the region will guide service improvement.

Chronic rhinosinusitis: patient experiences of primary and secondary care - a qualitative study.

OBJECTIVES: To explore the experience of CRS and its management from the perspective of patients with CRS. To our knowledge, this is the first qualitative study exploring sinus disease. DESIGN: Semi-structured qualitative interviews. SETTING: ENT outpatient clinic. PARTICIPANTS: Twenty-one adult patients with CRS: 11 male, 10 female. Patients suffered from a range of types of CRS (including polyps and fungal disease) and differing durations of symptoms (1.5-47 years). Participants were purposively selected. Thematic analysis was used. OUTCOME MEASURES: Patient experience of CRS and its management. RESULTS: Patients had concerns regarding management of their symptoms by both healthcare professionals and themselves, including delays to referral and repeated medications. They reported reduced quality of life and high financial and psychosocial costs associated with living with CRS. CONCLUSIONS: Despite guidelines for CRS treatment, outcomes remain variable leading to dissatisfaction with treatment. Adherence to existing guidelines may result in fewer repeated consultations in primary care and earlier referrals to secondary care.

Silent threat? A retrospective study of screening practices for pulmonary arteriovenous malformations in patients with hereditary haemorrhagic telangiectasia.

BACKGROUND: Patients with hereditary haemorrhagic telangiectasia (HHT) are at risk of pulmonary arteriovenous malformations (PAVMs) that may be complicated by stroke and brain abscess. ENT surgeons are well placed to direct patients to screening, which was recommended for all HHT patients in recently published international guidelines. METHODOLOGY/PRINCIPAL: A retrospective study of patients with known HHT was performed based on responses to a telephone questionnaire. Epistaxis was assessed using a validated epistaxis severity scoring system. RESULTS: 123 patients responded, with ages ranging from 14-86 years (mean 57 years). 80% of patients experienced their first symptom of HHT by 30 years old. Epistaxis was assessed at time of questionnaire as mild (26 patients), moderate (52 patients) or severe (45 patients). 71 patients (57.7% of total) underwent screening for PAVMs. 30 patients (42.2% of screened individuals) reported PAVMs detected by screening. 18 patients received treatment and 12 patients were found to have PAVMs too small for treatment. The modal screening method was computed tomography (CT, 58 patients) and the majority of patients with treatable PAVMs received trans-catheter embolisation (15 patients). Only 9 patients reported being under long term follow up for PAVMs. Shortness of breath (70.0% vs 41.5%, p<0.05) and migraine (43.3% vs 24.4%, p<0.05) were more common amongst patients found to have PAVMs than those without PAVMs. There was no difference in age of onset of HHT symptoms or epistaxis severity between patients with PAVMs and those without. CONCLUSIONS: PAVMs are common in HHT patients and carry a risk of morbidity and mortality. Safe and effective treatment exists for PAVMs although a significant minority of patients has received no screening to date. Clinicians should refer all patients for screening regardless of symptoms.