Validation of a new ENT emergencies course for first-on-call doctors.

BACKGROUND: First-on-call ENT cover is often provided by junior doctors with limited ENT experience; yet, they may have to manage life-threatening emergencies. An intensive 1-day simulation course was developed to teach required skills to junior doctors. METHODS: A prospective, single-blinded design was used. Thirty-seven participants rated their confidence before the course, immediately following the course and after a two-month interval. Blinded assessors scored participant performance in two video-recorded simulated scenarios before and after the course. RESULTS: Participant self-rated confidence was increased in the end-of-course survey (score of 27.5 vs 53.0; p < 0.0001), and this was maintained two to four months after the course (score of 50.5; p < 0.0001). Patient assessment and management in video-recorded emergency scenarios was significantly improved following course completion (score of 9.75 vs 18.75; p = 0.0093). CONCLUSION: This course represents an effective method of teaching ENT emergency management to junior doctors. ENT induction programmes benefit from the incorporation of a simulation component.

A break-even analysis of major ear surgery.

OBJECTIVES: To determine variables which affect cost and profit for major ear surgery and perform a break-even analysis. DESIGN: Retrospective financial analysis. SETTING: UK teaching hospital. PARTICIPANTS: Patients who underwent major ear surgery under general anaesthesia performed by the senior author in main theatre over a 2-year period between dates of 07 September 2010 and 07 September 2012. MAIN OUTCOME MEASURES: Income, cost and profit for each major ear patient spell. Variables that affect major ear surgery profitability. RESULTS: Seventy-six patients met inclusion criteria. Wide variation in earnings, with a median net loss of £-1345.50 was observed. Income was relatively uniform across all patient spells; however, theatre time of major ear surgery at a cost of £953.24 per hour varied between patients and was the main determinant of cost and profit for the patient spell. Bivariate linear regression of earnings on theatre time identified 94% of variation in earnings was due to variation in theatre time (r = -0.969; P < 0.0001) and derived a break-even time for major ear surgery of 110.6 min. Theatre time was dependent on complexity of procedure and number of OPCS4 procedures performed, with a significant increase in theatre time when three or more procedures were performed during major ear surgery (P = 0.015). CONCLUSION: For major ear surgery to either break-even or return a profit, total theatre time should not exceed 110 min and 36 s.

Evidence-based management of otitis media: a 5S model approach.

OBJECTIVE: The 5S model proposes five hierarchical levels (systems, summaries, synopses, syntheses and studies) of pre-appraised evidence to guide evidence-based practice. This review aimed to identify and summarise pre-appraised evidence at the highest available 5S level for the management of different subsets of otitis media: acute otitis media, otitis media with effusion, chronic suppurative otitis media and cholesteatoma in both adults and children. METHOD: Data sources were pre-appraised evidence resources. Evidence freely available from sources at the highest available level of the 5S model were summarised for this review. RESULTS: System level evidence exists for acute otitis media and otitis media with effusion. Summary level evidence exists for recurrent acute otitis media and medical management of chronic suppurative otitis media. There is an absence of randomised controlled trials to prove the efficacy of surgical management of chronic suppurative otitis media and cholesteatoma. CONCLUSION: Until randomised controlled trial data are generated, consensus publications on the surgical management of chronic suppurative otitis media and cholesteatoma should be used to guide best practice.

Myringoplasty: impact of perforation size on closure and audiological improvement.

OBJECTIVES: To investigate the impact of perforation size and other variables on the success of myringoplasty, and also to determine audiological gain following successful closure of tympanic membrane perforations of various sizes. STUDY DESIGN: Retrospective analysis of 130 case notes. MAIN OUTCOME MEASURES: (1) Successful closure of tympanic membrane following myringoplasty, in relation to recorded variables (i.e. perforation size, grade of surgeon, surgical technique, graft material, previous myringoplasty and smoking history). (2) Mean, four-frequency, air conduction audiometric gain following successful myringoplasty for various, pre-operatively categorised tympanic membrane perforation sizes. RESULTS AND CONCLUSION: The collective myringoplasty success rate was 80.8 per cent (105/130); for successful patients, the mean air conduction audiometric gain was -6.8 dB (t = 5.29, p < 0.0001). Neither perforation size nor any other assessed variable was a statistically significant determinant factor for successful myringoplasty. Air conduction audiometric gains following successful myringoplasty were directly correlated with pre-operative perforation size (-4.0 dB for 0-20 per cent perforations, -5.0 dB for 21-40 per cent, -9.1 dB for 41-60 per cent, -10.8 dB for 61-80 per cent and -13.3 dB for 81-100 per cent).

How we do it: diagrammatic recording of tympanomastoid procedures.

Accurate documentation of the operative findings of tympanomastoid procedures is essential for effective patient management and to satisfy the growing demands of clinical audit. Due to the three-dimensional complexity of the middle ear, it is difficult to represent graphically. Consequently, most surgeons only describe subjectively their operative, otological findings. We present for the first time a simple middle ear template which provides an objective tool to improve the recording of tympanomastoid procedures.