Outpatient clinic letters in ENT. Is there any margin of improvement?

INTRODUCTION: Outpatient clinic letters are a widely used and effective means of communication between hospital staff and general practitioners. This study audited the letter format used by consultants and specialist registrars (SpRs) at an otolaryngology clinic to assess the readability of different formats. MATERIALS AND METHODS: The two-cycle audit was performed at the Otolaryngology Clinic at Guy's and St Thomas' NHS Foundation Trust in London, England. A readability score (0-4) was assigned to the letters as an indication of how easy it was to extract information from structured or unstructured (paragraph) format letters. RESULTS: In the first cycle, 71.91% of the SpR letters followed a structured format and had an overall mean readability score of 2.87/4; 46.58% of the consultant letters followed a structured format and had an overall mean readability score of 1.25/4. In the second cycle, after the results of the first audit were presented to the participating physicians, 84.72% of the SpR letters followed a structured format and had an overall mean readability score of 3.41/4. Consultants followed a structured format in 52.56% of the letters, which had an overall mean readability score of 2.04/4. CONCLUSIONS: We found that a structured format for outpatient letters was better than unstructured format. This audit helped change the structure and consequently the readability scores of the clinic letters.

Desmoplastic fibroma of the vidian canal in a child: case report.

INTRODUCTION: To present a case of a child with a desmoplastic fibroma of the vidian canal, compressing the vidian nerve. CASE REPORT: A 12-year-old girl with several years' history of right-sided facial pain was referred to our institution. Magnetic resonance imaging and computed tomography scans showed an expansile mass involving the right vidian canal. The patient underwent a complete endoscopic surgical resection aided by the FusionTM ENT navigation system. This was performed through a transnasal, trans-septal, trans-sphenoidal route via the right nostril, and achieved macroscopic clearance with minimal peri-operative morbidity. A biopsy of the lesion showed a fibro-osseous lesion consistent with desmoplastic fibroma. CONCLUSION: Diagnosis and resection of this rare lesion at an earlier stage would have avoided delays in resolving the child's disabling pain. This emphasises the importance of early referral of unusual cases to tertiary centres.

Unilateral choanal atresia in one monozygotic twin: a case report.

Unilateral atresia is an extremely uncommon congenital disorder in monozygotic twins. We present the first case in the literature of premature, monozygotic twins with no other congenital genetic defects other than only one twin with unilateral choanal atresia on the right side, being the other sibling completely normal. Diagnostic examinations performed to both twins consisted of nasal endoscopy, which revealed only one twin with unilateral choanal atresia; axial computed tomography scan; genetic analysis; chromosome analysis; abdominal ultrasound and echocardiography. In our cases the genetic-chromosomal analysis failed to support a possible cause of unilateral choanal atresia in one monozygotic twin, suggesting a multifactorial etiology.