ENT Services Research Articles

Is It Safe to Cauterise Both Sides of the Nasal Septum at the Same Time in Children With Nosebleeds?

It is often recommended that, in children with bilateral epistaxis, only one side of the nasal septum should be cauterised at a time in order to reduce the risk of septal perforation. This advice may have been reasonable when hot wire electrocautery was in common use. The risk of septal perforation after silver nitrate cautery is unknown but probably low. Retrospective case note review of children attending the nurse-led epistaxis clinic between 2019 and 2022. Nine hundred and twenty children were seen in the nurse-led clinic between January 2019 and December 2022. Six hundred and one children (79%) underwent nasal cautery. Simultaneous bilateral nasal cautery was carried out in 176 (29%) children. Our follow up period ranged between 303 and 1744 days, with a median of 809.5 days. No child presented to emergency or ENT services with septal perforation or any other complication of simultaneous bilateral nasal cautery. To the author's knowledge, this is the largest study assessing the safety of simultaneous bilateral nasal cautery with silver nitrate in children. No adverse results have been found after cauterising both sides of the septum at the same sitting, and doing so potentially saves time and money for patients and the health service.

Epidemiological pattern and clinical indications for tracheostomy at Bugando Medical Centre Mwanza Tanzania

Background: Tracheostomy is among the first surgical procedures done by man and is performed from generation to generation with the major reason of saving lives. In Tanzania this procedure is commonly done and in the medical universities is taught as one of the procedures that all doctors should know. Tracheostomy is a common emergency lifesaving procedure performed between 21 to 25 patients per year among all patients receiving ENT services (13, 14). Though there is a scarcity in recent data and literature on the magnitude of tracheostomies performed in the lake zone. The most common indication for tracheostomy varies in studies from upper airway obstruction due to trauma, neoplasm, or prolonged intubation (13, 14). The pattern of tracheostomy indications may have changed with time due to advancement in medical practice. However, we lack current data in our setting highlighting indications for tracheostomies performed Methodology: This study aims at finding the epidemiological pattern and clinical indications for tracheostomy patients attending at Bugando medical centre. The engagement was done in a zonal referral hospital serving 6 regions of the country. This is a descriptive cross-sectional study which spanned from September 2023 to May 2024. Results: The total number of patients was 35 whereby males were 51.4%(18) and females 48.6% (17).Number of males was slightly higher compared to females by 1.1%.The median age for the patient was 23 years, with the mean age of 20 years. The leading age group with the largest number of patients was 50 to 59 years. Most patients came from rural areas 74 %(26). Among clinical indications for tracheostomy the leading was upper airway obstruction by 65.7%, within which malignancy predominated other conditions by 65.2%, followed by trauma 26.1%, then prolonged intubation. Females showed a significant predominant distribution of malignancies of head and Neck by 60% which were evenly distributed in varying head and neck sites with p value of 0.039 which is statistical significant; with exception of laryngeal malignancies which were observed in males alone accounting for 26.7% in the whole study period. In conclusion this study shows the prevalence of tracheostomy in our environment, which is 1.8% and the clinical indication pattern has changed from trauma in previous studies to upper airway obstruction secondary to neoplastic conditions. It also shows the significance of site of malignancy to its relation to gender and this findings are not found in other studies. Recommendation: Molecular studies are needed to analyze further the differences in subsite in terms of gender.

804 Exploring the Characteristics of ENT Senior House Officers: Insights for Workforce Planning

Abstract Aim The current healthcare climate has adversely impacted the recruitment and retention of healthcare professionals, particularly Senior House Officers (SHOs), who play an important role in the provision of ENT services. Consequently, there has been a shift in the characteristics of applicants for SHO positions. We examined applicant characteristics for a Trust Grade ENT SHO position at The Royal London Hospital. Method Data was collected from all applications made for the position, evaluating qualifications, experience, academic achievements, skills, and fitness to practice. Essential characteristics included a medical degree, surgical experience, <2 years' ENT experience, foundation program completion, and English proficiency. Desirable features encompassed MRCS exam success, NHS experience, peer-reviewed publications, teaching and research qualifications, and participation in audits and quality improvement projects. Results There were 110 applicants; 94% qualified outside the UK. Whilst 74% met all essential criteria, significantly fewer satisfied desirable criteria such as passing surgical membership examinations (0-5%) and prior NHS experience (7%). 2% to 4% reported experience of performing basic ENT procedures under supervision, and only 4% reported previously assisting in theatre. 1 applicant satisfied all desirable characteristics. Conclusions The current healthcare climate has significantly impacted the characteristics of the ENT SHO workforce. A lack of NHS experience and limited ENT exposure necessitates intensive support for new SHOs. Departments must consider how to balance the provision of support, for example with the implementation of registrar hot weeks or funding for additional staffing, with key economic and educational interests.

Awareness of Diabetic Retinopathy among Patients with Diabetes Mellitus Attending the Tertiary Eye Hospital in Nepal: A Descriptive Cross-sectional Study

Abstract Introduction: Lack of knowledge of the need for regular diabetic retinopathy screening (DRS) has turned many patients in the advanced stage of DR before first eye check-ups. Unfortunately, data on the knowledge, attitude, and behaviour of diabetic patients with DR are not satisfactory in Nepal. Here, we aim to assess the factors predisposing to awareness levels in the Nepalese context. Methods: This was an observational cross-sectional study enrolling 369 diabetic patients visiting the Hospital for Children, Eye, ENT and Rehabilitation Services between March 2020 and February 2021 after obtaining ethical clearance from the Nepal Health Research Council. A convenience sampling technique was used. The questionnaire was utilized to assess basic demographic profiles, awareness about diabetic retinopathy, and sources of information on the need for diabetic eye check-ups. Results: The mean (standard deviation) age of diabetes mellitus (DM) patients was 56.26 (11.13) years. The age group of 40–59 years comprised more than half of the total patients. Awareness of DR was 86.7% in this study. Education level and the duration of DM were directly proportional to the awareness level. Healthcare workers or physicians were the primary sources of information on awareness. Conclusions: Awareness of poor visual consequences of DR among patients with diabetes in Nepal is relatively satisfactory. However, patients’ willingness to undergo retinopathy check-ups was not up to the mark. Therefore, we recommend finding out the barrier to poor compliance with diabetic retinopathy in the future. The consumer-focussed health educational interventions and physician-based skills and the DRS facility would improve the awareness level in Nepal.

Evaluating the Appropriateness of ENT Emergency Clinic Referrals to Enhance the Quality of Healthcare Provision in the NHS

Background: Ear, Nose, and Throat (ENT) services in the National Health Service (NHS) face escalating pressure, exacerbated by the COVID-19 pandemic, resulting in prolonged waiting times and increased referrals. Understanding the factors driving pressure on ENT services is crucial for enhancing patient care and resource allocation.

Long COVID Symptoms in the ENT: Coordinating Community and Hospital Services in the United Kingdom

The COVID-19 pandemic has had a catastrophic effect on the entire world, and the WHO has described it as the worst global health emergency it has ever faced. A highly significant positive development was the relatively quick creation of safe and effective vaccines, but persistent problems like the appearance of variants that are highly contagious have complicated the plans for ending the pandemic. It is now a widely acknowledged fact that a sizable number of people who are infected will suffer for a long time from a complicated and potentially crippling chronic sickness, the so-called “Long COVID”. A significant portion of COVID-19 patients who experience ENT symptoms do not entirely recover from these symptoms. This article will discuss the ENT manifestations of COVID-19 along with their prevalence, pathogenesis, natural course, persistence in some individuals, and contribution to Long COVID-19. Also, it will go over broad guidelines and principles for treating patients with Long COVID as a whole, followed by a more detailed discussion of how ENT services in the UK could be set up in a way that is safe, efficient, and ensures that the workforce is utilised as effectively as possible.

Organization of children's otorhinolaryngological care in conditions of biological risks: international experience

The COVID-19 pandemic has spurred the introduction of new devices and technologies into the organization of otorhinolaryngological care, the development of safety measures and clinical work protocols in order to increase the safety of doctors and patients. Virtual outpatient clinics have been integrated into the pediatric and basic outpatient services, the potential of which for pediatric otolaryngology is considered quite significant. In otorhinolaryngological practice, the transition to the expanded use of telemedicine technologies (individual gadgets for examining ENT patients, including a direct access otoscope connected to an otolaryngologist's computer) was especially significant. The practice of pediatric ENT services tends to combine virtual and face-to-face visits, even after the acute phase of the COVID-19 pandemic. When organizing otorhinolaryngological care, it is necessary to pay special attention to dialogic consensus - an inclusive and reflective dialogue between a doctor and a patient.

A narrative review of the management of pars flaccida tympanic membrane retractions without cholesteatoma.

Review the effectiveness of surgical and non-surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. Narrative review. ENT and otology services worldwide. Patients with non-cholesteatoma tympanic membrane retractions. Changes in retraction (progression or resolution, or development of a known sequela such as perforation). Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. Few high-quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence.

Incidence and Management of Acute Otitis Externa in a UK Centre Before and During the COVID-19 Pandemic

Objective: Patients with otitis externa (OE) are commonly referred to acute ENT services after failed treatment in community. This case series analyses the prevalence and management of OE in a UK ENT rapid access clinic (RAC) prior to and following the national lockdown imposed in March 2020. Materials and Methods: Retrospective case review of all patients referred with OE to the RAC between January 2019 and March 2021 with comparison of the cohorts before and after 1st March 2020. Data anaylsed included demographics, treatment methods, rates of admission, microbiological swab and CT results and rates of necrotising otitis externa (NOE). Results: There were 239 new referrals over the total study period. The rate of referral dropped from 12.1/month to 5.8/month following the March 2020 lockdown. There were no significant differences in rates of severe infection or NOE before and after the lockdown. The most common organisms grown were Pseudomonas aeruginosa, Candida, and Staphylococcus aureus. Conclusions: There was a considerable reduction in acute referrals for OE to this centre in the year following the March 2020 lockdown. There was no significant change in disease severity or management trends.

Management of otogene extracranial complications in children and adolescents: report of 35 cases over 10 years.

Medical management of exocranial otogenic complications represents a challenge for a medical system of a country in general, especially for ENT services. The goal of this study is to find some answers on demographic data, clinical symptoms and signs, diagnostics, and especially therapy for these complications in young patients. The study is retrospective, performed in the ENT clinic of the University Clinical Center of Kosova in Prishtina and covers 10years (from 01.06.2000 to 01.06.2010) and includes all young aged patients (1-18years) hospitalized because of exocranial otogenic complications. From a total of 35 patients, male were 22 (63%) and females 13 (37%). The commonest complications were: mastoiditis in 18 (51.4%) and subperiosteal mastoidal abscess in 12 cases (34%) than rarest complications were: Bezold's abscess in 2 cases, facial nerve paresis, labyrinthitis, and combined complication one case each. Diagnostics of these cases were based on the clinical appearance, laboratory analyses, and clinical imaging. Treatment of these patients was surgical, medical, and combined: 3 of the medical therapy only (intravenous antibiotics), and 32 others were treated surgically: cortical mastoidectomy in 16 (45%) of cases, mastoidectomy and aeration tube insertion in 6 (17%) and antrotomy in 3 (8.5%) of cases. None of these series of patients died and none of them had permanent sequels. Timely diagnostics and adequate treatment of exocranial otogenic complications made it possible that our results can be comparable with the results of other referent centers cited in the recent literature.

1010 Audit of Acute Management of Sudden Onset Sensorineural Hearing Loss and Streamlining of Local Management Pathway

Abstract Aim Sudden onset sensorineural hearing loss (SSNHL) presents infrequently to ENT services in Aberdeen Royal Infirmary. Although ENT UK guidelines are in place for the management of SSNHL, the practicalities of organising these cases within our department can be challenging to junior staff leading to variation in time to review and timings of intervention. We Aimed to assessed current local practice in comparison compare it to national ENT UK guidelines Method Retrospective audit of 6 months data set recording management pathway of patients presenting with SSNHL to Rapid Access Clinic of Royal Aberdeen Infirmary Hospital. Electronic patient records were searched for: time of referral, duration of symptoms, times to first ENT review, intervention and audiogram, and timings and management during subsequent reviews. Results Seven patients meeting the inclusion criteria were identified and included in the audit. Average times from referral were calculated including time from referral to intervention (1.47 days), from referral to first ENT review (3.82 days), from referral to first audiogram (4.43 says). Average time from presentation to starting oral steroids was very efficient of just 0.33 days and average time from symptom onset to oral steroids initiation was 7.5 days suggesting late patient presentation. Conclusions The data gather helped our department to reinforce management pathway of SSNHL as per ENT UK guidelines and improved the way urgent audiograms are organised in the hospital. It also emphasised the importance of performing tuning fork test to determine the nature of hearing loss when audiogram is not immediately available.

Evaluation of health service outcomes for an audiology first point of contact retrocochlear clinic: a 6-year retrospective cohort study

Objective Although existing studies of audiology first point of contact clinics which screen for retrocochlear pathology have demonstrated positive clinical outcomes, they have provided limited information regarding service impacts. Thus, this study aimed to evaluate both the clinical and health service outcomes of an audiology first point of contact (FPOC) clinic for adults referred to ENT services with suspected retrocochlear pathology. Design Retrospective cohort study. Study sample All 1123 patients referred to the clinic over a 6-year period (2013–2019). Results Most (73.7%) of the 1123 patients referred to the Retrocochlear Clinic were managed and discharged by the audiologist and did not require ENT appointment. Almost half (43.1%) were directly referred for MRI imaging, of which 4 (1.1%) were diagnosed with Vestibular Schwannoma. Waiting times for first appointments significantly (p < 0.001) reduced from a median of 748 days to 63.5 days over the 6-year period. Attendance rates also significantly (p < 0.001) improved over this time (from 52.2% to 90%). There were no adverse events reported. Of those discharged without attending an ENT appointment, 1.8% were rereferred to ENT within 12 months of discharge. Conclusions This audiology FPOC Retrocochlear Clinic was shown to be a safe and effective alternative service model.

Pediatric Ent Pathology Cases in Hospitals

Very few studies have been conducted in the ENT profession that did not include the use of an ENT expert. For this cross-sectional study, we sought to determine the level of activity in the pediatric ear, nose, and throat department. This was a prospective, cross-sectional research including ENT functional unit patients who had been observed for a period of time. A patient's age ranged from 7 months to 180 months during a consultation. A sex ratio of 1.2 (61/51) was recorded. With 33.5 percent of the patients, pharyngolaryngeal disease was followed by otological, rhinological, and other pathologies with 30 percent and 26.88 percent, respectively. Pediatric ENT has a significant role in the field of ENT. As a result of our research, we were able to demonstrate the wide range of services available in pediatric ENT pathology in remote areas. It is clear that these findings support the idea of distributing specialist services more widely. As a result of these findings, it is recommended that ENT services be decentralized in order to better serve this vital segment of the population.

Creating A Protocol for the Management of Epistaxis in A Tertiary Care Centre-A Practical Application of the British Rhinological Society Multidisciplinary Consensus Recommendations on the Hospital Management of Epistaxis

Epistaxis is the most common acute presentation to ENT services in the UK. The recent British Rhinological Society multidisciplinary consensus recommendations [1] provide new guidance for its management. To better align with these, we reviewed current practice in our tertiary referral centre. We noted practice variation both within and between departments, particularly concerning the timing and utilisation of nasal packing, accounting for inpatient stay.

Otologic Surgery in a Tropical Environment: About 56 Cases were Operated on at the Yaounde General Hospital-Cameroon

Introduction and Aims : Ear surgery is a separate entity in the surgical activity of ENT department. In ENT services in developed countries, this activity has become routine. Several data on the activity of otologic surgery in Western teams are available. This surgery is performed in our tropical environment, characterized by under-equipment and poor access to care. But few data from the sub-Saharan African series are reported. To contribute to the understanding of this entity, we conducted this study in the ENT service of the Yaounde General Hospital (YGH), Cameroon. The general objective was to study the practice of ear surgery in our setting. Patients and Methods: This was a cross-sectional, descriptive, retrospective study. The study took place from June 2016 to June 2021, i.e. 5 years. The study was conducted in the ENT and Head and Neck Surgery service of the YGH. The sampling was consecutive. We included in this study all patients with an otological disease, treated surgically during the study period. Sociodemographic, clinical, paraclinical, therapeutic, and evolutionary data were collected. Results: Our sample consisted of 56 operated patients, out of a total of 330 surgeries performed during the study period. This represents a frequency of 16.96%. The distribution of patients according to sex was 33 women and 23 men, i.e. a sex ratio of 0.69 in favor of women. The distribution of the patients in the sample according to age showed an average age of 36.98 years, with extremes ranging from 3 years to 92 years. 55 patients, i.e. 98.2%, were undergoing their first otological surgery, and only one patient had already undergone a previous operation. 49 patients (87.5%) had a symptomatology that had been evolving for more than three months. And 7 (12.5%) had acute or sub-acute symptoms. The main pathologies found and operated on were: open non cholesteatoma chronic otitis with 19 patients (33.92%), otomastoiditis with 9 cases (16.01%), cholesteatoma chronic otitis with 8 cases (14.28%), followed by other pathologies such as otoscléroses, osteomas of the external auditory canal, etc. with 7 cases (12.5%). The most common surgical procedure was tympanoplasty with 19 cases (33.9%), mastoidectomy with 9 cases (16.1%), petro-mastoidectomy with 8 cases (14.3%), extraction of foreign bodies from the auditory canal with 5 cases (8.9%) and cochlear implantation with 4 cases (7.1%). 4 patients, i.e. 7.2%, presentedcomplications (4 infectious, 1 complaining of tinnitus). 55 patients, i.e. 98.2%, saw an improvement in their symptoms with a favorable evolution. Conclusion: The non-negligible frequency found in our practice at the YGH reflects the definite evolution of this surgery in our environement. The patients are young, chronic open otitis media without cholesteatoma are the main indication, and tympanoplasty is the most practiced surgical modality.

1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice

Abstract Aim The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals. Method An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020. Results In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November. Conclusions Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.

909 ENT Telephone Clinic During COVID-19 Pandemic

Abstract Introduction In response to the COVID-19 pandemic, ENT services in NHS hospitals have fundamentally changed the way they function. Focus is narrowed on emergency care and cancer care, with cancellation of most elective procedures. In response to this, 2 week wait (2ww) ENT telephone clinics were set up. This project reviewed the effectiveness of ENT telephone clinic appointments in managing 2ww referrals and to determine whether the introduction of 2ww telephone clinics improves patient waiting times and appropriates of referrals. Method Retrospective review of ENT telephone clinic 2ww referral outcomes at Eastbourne District General Hospital and the effectiveness of managing these patients. Results A total of 58 ENT Telephone Clinic 2ww referrals from the GP were reviewed. After a telephone consultation 63% of patients were referred to 2ww imaging, from which 70% were discharged following imaging. 83% of patient offered face to face appointment following imaging, required further investigation or treatment, again reducing delay in diagnosis. Conclusions Telephone clinic is an effective way of managing 2ww referral patients. In the ongoing pandemic, telephone clinics will be used to manage cancer pathways. This study shows that a large number of patients are discharged after imaging following a telephone clinic. Further study is required to determine whether low scoring patients on symptom-based risk calculators for cancer referrals could be directly referred to imaging to avoid delay in diagnosis, reduce anxiety as well as allow appropriate resource allocation.

Anxiety, Depression and Functional Impairment among Health Care Workers during COVID-19 Pandemic: A Crosssectional Online Survey

Background COVID-19 is an infectious disease caused by a newly discovered coronavirus. The number of cases and dramatic loss of human life worldwide created psychological problems among general public, including health care workers.&#x0D; Objective To determine the burden of anxiety, depression, and functional impairment among health care workers in the early days of lockdown during the first wave of COVID-19 outbreak in Nepal.&#x0D; Method A hospital-based cross-sectional study was carried out among all the employees of Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur during the COVID-19 pandemic lockdown from April 3, 2020 to May 2, 2020 using an online questionnaire. The tools used were adopted from Nepali version of Hospital Anxiety and Depression scale (HADS) and Nepali version of WHO Disability Assessment Schedule (WHODAS 2.0).&#x0D; Result The mean age (SD) of the participants (n=86) was 32.53 (7.92) years. Male and female participants were equal in number. The point prevalence of anxiety and depression was 25.6% and 14.0%, respectively. Females had a higher prevalence of both anxiety (39.5% vs 11.6%, p &lt; 0.01) and depression (18.6% vs 9.3%, p=0.351). Clinical and nonclinical staff both had a higher prevalence of both anxiety (31.0% and 20.5%, p=0.265) and depression (16.7% and 11.4%, p=0.478). The mean functional impairment score (WHODAS 2.0) among all participants and participants with anxiety and depression was 19.47 (95% CI: 18.13-20.80), 21.27 (95% CI: 18.08-24.46), and 19.92 (95% CI: 15.28- 24.56), respectively.&#x0D; Conclusion Anxiety and depression during the first lockdown due to COVID-19 pandemic were highly prevalent in clinical and non-clinical employees. Besides controlling the outbreak, special consideration should be given to mental health.

One year on: assessing the impact of coronavirus disease 2019 on demand for semi-urgent ENT services.

This study investigated how the coronavirus disease 2019 pandemic has impacted on presentations to ENT first-on-call services. All appointments to a rapid access triage clinic from 1 June to 31 August in 2019 and 2020 were reviewed retrospectively and their reasons for consultation classified. A binomial proportion test was used to determine whether the proportions of consultations per presentation differed significantly between years. This analysis was repeated with the number of unique patients per presenting complaint. The proportions of nine reasons for consultation differed significantly between 2019 and 2020, including an increase in otitis media and nasal trauma presentations, and a decrease in otitis externa and tonsillitis presentations. Reattendances caused some variation in the frequency of certain diagnoses. Our data suggest a shift in the presentations to first-on-call services, which may be a result of changes in patient behaviour and access to healthcare services.

How we do it: impacted oesophageal foreign body removal using a dilatation balloon.

Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means. After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction. This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.