From Inpatient Notes to Outpatient Followup: Enhancing the Rhinology Service in a Tertiary Centre through Student Led Projects.

Introduction. Medical students can use systems to help improve the quality of care in a unit. Following the review of care within the ENT department at a tertiary centre a number of quality improvement projects were put in place. Methods. The following interventions were established: (1) creation of an outpatient telephone enquiry clinic, (2) development of a rhinology database, (3) introduction of operative note templates, and (4) construction of electronic discharge summary templates (eDSTs). Discussion and Outcomes. (1) Consultant telephone inquiry clinics were successfully organised and showed high levels of patient satisfaction. (2) A database to collect patient reported outcome measures was piloted within rhinology outpatients; the results suggest that such a database would be simple to introduce and yield benefits for patients and the department. (3) Operative note templates for FESS procedures were implemented with a view to improving the continuity of care onto the ward; these have become well established and further steps to integrate these into routine care are being taken. (4) eDSTs specific to FESS and septorhinoplasty procedures were introduced with a view to increasing completion speed of templates and adherence to Royal College of Physician Guidance.

Objective evaluation of tongue base snoring after the use of an oral appliance: a prospective case series.

UNLABELLED: Oral appliances have become increasingly popular for treatment of obstructive sleep apnoea especially for patients who are not able to tolerate continuous positive airway pressure devices. For simple snoring, oral appliances have become one of the treatments of choice despite a relative lack of scientific evidence of their efficiency. OBJECTIVES: This study was designed to objectively evaluate the clinical effectiveness of oral appliance in the treatment of simple snoring. DESIGN: Prospective case series. PARTICIPANTS: Fifteen patients with confirmed simple tongue base snoring had pre- and post-oral appliance objective assessment of their snoring loudness and duration at home. MAIN OUTCOME MEASURES: The Snore Index was calculated as the number of snores per hour slept. Patients bed partners were asked to rate the snoring severity on a Spouse Dissatisfaction Scale. RESULTS: Overall there was no significant difference in the Snore Index in the pre- and post-oral appliance recordings. Subjectively, there was a statistically significant decrease in the Spouse Dissatisfaction Scale following the use of oral appliance. CONCLUSION: Tongue base snorers had no significant reduction in their snoring with the oral appliances. There is a subjective benefit which may be due to the placebo effect.

Use of a rectal snare to remove a hypopharyngeal haemangioma.

We describe in this case report a new technique for treatment of hypopharyngeal haemangioma, using the surgical diathermy snare. The snare was easily introduced through the direct laryngoscope, without any difficulties. The procedure was simple, rapid and involved minimal bleeding. We also discuss the histological types of haemangioma, clinical picture, radiological findings and other modalities of treatment.

Palatal surgery for snoring: objective long-term evaluation.

Snoring surgery has mainly been assessed in the literature using subjective outcome measures with some evidence to indicate that the benefits of surgery are short lived. There is remarkably little published on the objective outcome of snoring surgery. We reported previously short-term (2-11 months) objective results on 38 patients who had palatal surgery. All the patients had preoperative and postoperative objective assessment of their snoring loudness and duration in the home. The current study presents the long-term objective results of 24 patients from the same cohort. All patients who were included in our study had palatal snoring confirmed on sleep nasendoscopy. and none of them had significant obstructive sleep apnoea. The median follow-up period was 45 months (range 29-56 months). Overall, the mean snore index (SI) at long-term follow-up was significantly less than the preoperative SI (P < 0.0001). There was no significant difference between the short-term and the long-term results regarding the fall in the SI. This study is the first to use postoperative objective assessment in the home and to demonstrate that snoring reduction is maintained for several years after snoring surgery.