Otolaryngology Research Articles

Chronic rhinosinusitis with nasal polyposis and biological agents: the ARIA-ITALY Survey.

Background. Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses. CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. Methods. As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immuno-allergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results. Two hundred and fifty-five experts and specialists participated in the survey. Conclusions. The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn. The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated. Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.

Assessing unknown potential—quality and limitations of different large language models in the field of otorhinolaryngology

Background Large Language Models (LLMs) might offer a solution for the lack of trained health personnel, particularly in low- and middle-income countries. However, their strengths and weaknesses remain unclear. Aims/objectives Here we benchmark different LLMs (Bard 2023.07.13, Claude 2, ChatGPT 4) against six consultants in otorhinolaryngology (ORL). Material and methods Case-based questions were extracted from literature and German state examinations. Answers from Bard 2023.07.13, Claude 2, ChatGPT 4, and six ORL consultants were rated blindly on a 6-point Likert-scale for medical adequacy, comprehensibility, coherence, and conciseness. Given answers were compared to validated answers and evaluated for hazards. A modified Turing test was performed and character counts were compared. Results LLMs answers ranked inferior to consultants in all categories. Yet, the difference between consultants and LLMs was marginal, with the clearest disparity in conciseness and the smallest in comprehensibility. Among LLMs Claude 2 was rated best in medical adequacy and conciseness. Consultants’ answers matched the validated solution in 93% (228/246), ChatGPT 4 in 85% (35/41), Claude 2 in 78% (32/41), and Bard 2023.07.13 in 59% (24/41). Answers were rated as potentially hazardous in 10% (24/246) for ChatGPT 4, 14% (34/246) for Claude 2, 19% (46/264) for Bard 2023.07.13, and 6% (71/1230) for consultants. Conclusions and significance Despite consultants superior performance, LLMs show potential for clinical application in ORL. Future studies should assess their performance on larger scale.

Update on asthma 2024 - what the ENT specialist needs to know

The lifetime prevalence of 8.6% of asthma in Germany reflects the high medical and socioeconomic impact of the disease. Asthma treatment goals have changed during the last decades: from symptom control to symptom prevention, with highly effective, disease-modifying anti-asthmatic drugs (DMAADs) aiming at asthma remission. In order to achieve this goal, phenotyping of patients (including an evaluation of allergies and type 2 biomarkers) is crucial for personalized treatment. The identification and effective treatment of concomitant diseases, such as allergic rhinitis or chronic rhinosinusitis with nasal polyps (CRSwNP), plays a major role for successful treatment. This underlines the importance of interdisciplinary collaboration of otolaryngologists and respiratory physicians in the management of patients with asthma. This CME article informs the reader about current guidelines on the diagnosis and treatment of asthma, focusing on clinically relevant recommendations for ENT physicians.

UK national survey on surgical gowning for tonsillectomy.

Tonsillectomy is a common procedure performed nationally. The personal protective equipment and surgical gowning practices used during this procedure vary widely. We compiled a survey of ENT specialists to gain a national opinion about gowning in tonsillectomy with the aim of determining whether we could make it more environmentally friendly whilst maintaining the highest safety standards. We developed a nine-question survey that was piloted prior to final implementation. The questionnaire was sent to senior registrars and consultant otolaryngologists in the UK. The survey was completed by a total of 63 ENT specialists. It was found that 82.54 per cent of clinicians would consider wearing a reusable gown that would be sterilised between each procedure. Our survey suggests most ENT clinicians would consider using a more environmentally friendly surgical gown and some may even consider wearing no gown at all, although many are understandably concerned about the transmission of infection or blood splatter.

Epistaxis and its management: A prospective study in a Teritiary Care Centre

Background: Epistaxis ( nose bleed) is one of the most common ear, nose and throat (ENT) emergencies that present to the tertiary care center. Management of Epistaxis is challenging and most are managed conservatively and some by surgical intervention. There is always a need to find the prevalence of Epistaxis and to identify the etiological factors in management of Epistaxis, by different methods such as medical treatment, anterior and posterior nasal packing, and surgical intervention that includes endoscopic cauterization, endoscopic arterial ligation, SMR and Nasal bone reduction. In our study we will determine the various etiologies of epistaxis and its management options. Methodology: A prospective study was done in the Department of ENT, for duration of 18 months, total of 70 patients of both genders in age group of 18 - 60 years with clinical features of nasal bleed were enrolled in the study, and were subjected to clinical examination and history regarding onset and predisposing factors. Patients who are willing to undergo investigations to identify the cause and treatment are enrolled for the study after obtaining the written informed consent. Results: A total of 70 patients were examined in this study. Males were affected more than females. The patients distribution across different age groups shows maximum at age of 46-60 years followed by 36-45 years. The most common cause was found to be trauma followed by hypertension, rhinosinusitis, deviated nasal septum and idiopathic. In most cases, anterior nasal bleeding was observed.Majority of the cases managed conservatively 71.5% while 28.5% patients required surgical intervention. Conclusion: The study on epistaxis and its management provides valuable insights into effective strategies for addressing this common medical condition. This study emphasizes the importance of a medical and surgical approaches based on the severity and underlying causes of epistaxis. Anterior epistaxis is more common than posterior bleeds. Majority of cases of epistaxis are manageable by conservative measures and only few require surgical intervention. Overall, this study contributes to the ongoing efforts to enhance our understanding of epistaxis and refine therapeutic approaches for better patient outcomes.

Uitbouw van vestibulaire revalidatie in een centrum voor ambulante revalidatie: behandelmethoden en resultaten bij patiënten met een unilaterale vestibulaire hypofunctie

Development of vestibular rehabilitation in an ambulatory care centre: treatment protocol and results in a group of 12 patients with a unilateral vestibular hypofunction Vestibular rehabilitation (VR) is recommended in patients with a unilateral vestibular hypofunction (UVH) or areflexia resulting from inflammatory, traumatic or other aetiologies. In this study, the authors describe the treatment protocol and discuss the results of individually delivered VR in combination with a home exercise programme in patients initiating therapy 2 months or more post-onset of a UVH. Retrospectively, the data were analysed of patients presenting with > 25% hypofunction on caloric irrigation who were referred by an ear, nose and throat (ENT) specialist in the period of January 2021 until January 2023. The patients received individualized therapy sessions of 45 minutes in combination with a home exercise programme. The following outcome measures were used: Dizziness Handicap Inventory (DHI), Functional Gait Assessment (FGA), Foam Stance Eyes Closed (FSEC), Dynamic Visual Acuity Test-Non Instrumented (DVAT-NI) and comfortable gait speed. Twelve patients (9 men and 3 women) with a mean percentual hypofunction of 81% were included (6 right- and 6 left-sided). The study found clinically relevant improvements for DHI and FGA, based on the minimally clinically important difference (MCID) of these tests. The mean DVAT-NI and FSEC scores normalized towards an age-appropriate level. VR leads to clinically relevant changes on different outcome measures in UVH patients. A centre for ambulatory rehabilitation (CAR) where multidisciplinary rehabilitation for people with hearing loss is provided, is a suitable setting to offer VR because of the longstanding cooperation between ENT specialists and physiotherapists. Nevertheless, there are challenges that need consideration when implementing VR into a CAR.

Imposter Phenomenon and Its Predictors in Saudi ENT Specialists: A Cross-Sectional Study.

Background Impostor syndrome (IS) is characterized by an ongoing disbelief in the authenticity of one's accomplishments, attributing success to luck rather than to one's own ability or hard work. The syndrome has detrimental consequences in both personal and career aspects and is closely linked to emotional exhaustion, stress, and depressive symptoms. This study aimed to determine the prevalence of IS among otolaryngologists practicing in Saudi Arabia. Methods We performed a cross-sectional survey from August to October 2022 that targeted both practicing otolaryngologists and those still in their training phase in Saudi Arabia. The survey, delivered via email, tapped into the Saudi Commission for Health Specialties (SCFHS) database to reach all registered otolaryngologists. The survey tool comprised questions on demographic details and employed the Clance Impostor Phenomenon (IP) Scale to evaluate the presence of IS. Results Out of 80 respondents, males (n = 46) were 57.5%, and 18.8% were consultants (n =15). The study found a 27.5% prevalence rate of IS among the surveyed otolaryngologists (n =80), with a mean score of 56.79 ± 12.98. In terms of severity, 62.5% (n = 50) had a moderate level of IS, 25.0% (n = 20) had high IS, and 5.0% (n = 4) had intense IS. It was significantly more common with resident otolaryngologists as compared to consultants (X2 = 7.476, df= 3; p = 0.048), but there was no significant association in terms of gender (X2=3.418, df =1; p = 0.064), type of hospital (X2= 6.351, df = 3; p = 0.096), or fellowship subspecialty (X2= 2.291, df = 4; p = 0.681). Conclusions The study detected that 36.9% of otolaryngologists (n = 17) experienced IS, with trainees being more susceptible than consultants and fellows. Further investigations to explore the scope and underlying reasons are recommended.

Evaluation of antibiotic prescription patterns using WHO AWaRe classification.

Antimicrobial resistance is a rising problem worldwide and it poses a serious risk to public health. In Pakistan, about 70.0% of the Acinetobacter group of bacteria were resistant to all antibiotics and were responsible for high mortality among neonates within the first week of life. To evaluate the pattern of antibiotic prescription in the Ear, Nose and Throat (ENT) Department of Shalamar Hospital, Lahore, Pakistan, using the WHO AWaRe 2021 classification. We collected prescription data from the ENT outpatient department of Shalamar Hospital from October to December 2021. We compared the quantitative analysis of antibiotics with the WHO AWaRe classification. We analysed the data using SPSS version 26 and discussed the results with the ENT Department for possible improvements. Some 862 (12.1%) of the total 7126 entries were assessed. Others were excluded because they had some missing data or had no antibiotic prescription. Of all the antibiotics prescribed, around 54.9% belonged to the access category. The WHO 13th General Programme of Work 2019-2023 recommends a country-level target of at least 60% of the total antibiotic consumption in the access group antibiotics. The outpatient department of the ENT did not prescribe any reserve or not recommended antibiotics. The use of watch antibiotics was higher than recommended by the WHO AWaRe classification. More efforts should be made to increase prescriptions from the AWaRe access group to achieve the 60% minimum target recommended by WHO for the country.

Vestibular rehabilitation in complex therapy of vestibular vertigo (consensus of experts)

Experts discussed the problem of comprehensive medical treatment of vertigo through vestibular rehabilitation. Peripheral vestibular vertigo is most commonly caused by benign paroxysmal positional vertigo, Meniere's disease and vestibular neuronitis, while central vestibular vertigo is caused by vestibular migraine and stroke. Vestibular rehabilitation is one of the most effective areas of treatment for patients with various disorders of the vestibular system characterized by chronic dizziness. Vestibular rehabilitation improves patients' walking and stability and can lead to an improvement in patients' daily activities and quality of life. Currently, in our country medical rehabilitation centres are being established where patients with various causes of vestibular vertigo can receive complex therapy, including vestibular rehabilitation. The Expert Council recommends the comprehensive personalised use of vestibular rehabilitation in the complex treatment of various diseases manifested by dizziness. An educational program is needed for neurologists, ENT specialists and rehabilitation specialists in treatment of patients with different types of vestibular dizziness.

Post-COVID patients with persistent chemosensory symptoms are rare in the general population

The prevalence of long-/post-COVID-associated chemosensory symptoms is reported in the literature to be significantly higher than clinical reality reflects. 1. N= 4062 adults acutely infected with SARS-CoV-2 and their symptoms transmitted by the Jena health office to the Robert Koch Institute between March 2020 and September 2021 were evaluated. 2. Part of the same cohort (N = 909 of 4062) answered an extensive questionnaire at least 3 months after the start of the infection, including existing chemosensory post-COVID-associated complaints. 3. Fourteen post-COVID Jena patients with chemosensory symptoms who had become acutely infected during the same period were diagnosed, treated and advised in our ENT specialist outpatient clinic. The prevalence of chemosensory symptoms at the onset of infection was 19% (600/3187). About every second written respondent of the formerly acutely infected (441/890) remembered chemosensory symptoms during their COVID-19 infection. Of these, around 38% (167/441) complained of persistent chemosensory post-COVID symptoms after an average of 14.5 months. Only 2.3% (14/600) of the previously acutely infected patients with chemosensory symptoms sought medical help in a special consultation. Quantitative chemosensory damage could only be objectified in half, i.e. 1.2% (7/600) of the total cohort. Despite a high prevalence of subjective chemosensory symptoms in acutely and formerly SARS-CoV-2 infected people, there is only a low need for specialized treatment, so that, unlike other post-COVID-associated complaints, the healthcare system as a whole appears to be less significantly burdened.

Impact of obstructive sleep apnea on patients'’ quality of life

Abstract Obstructive sleep apnea (OSA) is a very commonly spread disease, not only in Bulgaria, but all over the world. One of the reasons for this is that patients suffering from OSA find it difficult to share their problem with their treating doctor (sleep doctor or ENT specialist). Doctor-patient communication is extremely important when gaining the patient'’s trust, for the early detection and diagnosis of obstructive sleep apnea. Sleep disorders lead to a decrease in the quality of life, due to frequent anxiety, fatigue, depressive states, reduced cognitive and motor functions, lack of energy, headaches and sleepiness throughout the day. Improving the quality of life of patients is a primary goal of the health care system, which is conveyed in patient care aimed at reducing or eliminating the effects of diseases and their associated negative psychological and social effects. Prevention, screening and effective communication with the patient are extremely important for a successful diagnosis and treatment of sleep disorders.

Epidemiological Profiles of Acute Otitis Media at the Commune II Referral Health Center in the Bamako District

Acute otitis media is a very common condition in children under the age of 7, most of whom suffer their first episode before the first three years of life. Despite scientific advances in its therapeutic and preventive management, this condition remains frequent and cosmopolitan, particularly in otolaryngology (ENT) and pediatric wards. In view of the possibility of disabling complications, we set out to study the epidemiological and clinical profile of this condition for the first time in the ENT department of the Commune II Reference Health Centre in the District of Bamako, Mali. This is a descriptive, retrospective study, using routine consultation data from January to December 2022. Based on exhaustive sampling, we collected 568 cases of confirmed AOM, representing an incidence of 20.63%. Patient age ranged from 3 months to 83 years, with an average of 12.49 years. Overall, the 3-7 age groups predominated, with 30.63% of cases. However, patients under 2 years of age predominate in progressive forms of the various stages. This study shows that AOM is a frequent occurrence in our department, and highlights the need for good interdisciplinary networking between pediatricians and ENT specialists in the management of AOM, in order to avoid possible recurrences and functional sequelae.

Chronic rhinosinusitis in people with cystic fibrosis-an up-to-date review from the perspective of otorhinolaryngology

Cystic fibrosis (CF) is acomplex systemic disease involving numerous organ systems. With improved treatment options and increasing life expectancy of persons with CF (PwCF), extrapulmonary manifestations are coming increasingly into the focus. From birth, almost all PwCF have radiologically detectable pathologies in the upper airways attributable to CF-associated chronic rhinosinusitis (CF-CRS). The aim of this work is to provide an up-to-date overview of CF-CRS from the otorhinolaryngology perspective and to provide the reader with background knowledge and current developments. The cystic fibrosis transmembrane conductance regulator (CFTR) gene defect leads to increased viscosity of sinonasal secretions and reduced mucociliary clearance, causing chronic infection and inflammation in the upper airway segment and, consequently, to CF-CRS. The clinical picture of CF-CRS comprises awide spectrum from asymptomatic to symptomatic courses. CF-CRS is diagnosed clinically and radiologically. Sinonasal saline irrigation is recommended as aconservative treatment measure. Topical corticosteroids are also commonly used. Surgical therapy is reserved for highly symptomatic treatment-refractory patients without asufficient response to conservative treatment including CFTR modulator (CFTRm) therapies. Depending on the CFTR mutation, CFTRm therapies are the treatment of choice. They not only improve the pulmonary and gastrointestinal manifestations in PwCF, but also have positive effects on CF-CRS. The ENT specialist is part of the interdisciplinary team caring for PwCF. Depending on symptom burden and treatment responsiveness, CF-CRS should be treated conservatively and/or surgically. Modern CFTRm have apositive effect on the clinical course of CF-CRS.

'Best paper' prize winners for 2023 and in the current issue: entry to UK ENT specialist training.

'Best paper' prize winners for 2023 and in the current issue: entry to UK ENT specialist training.

Examining Diagnostic Errors in the Field of Otorhinolaryngology within the Challenging Landscape of Limited-Resource Healthcare.

Diagnostic accuracy is vital in otorhinolaryngology for effective patient care, yet diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists can occur. However, studies investigating such mismatches in low-resource healthcare environments are limited. This study aims to analyze diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. A publicly available dataset assessing diagnostic outcomes from non-otorhinolaryngology clinicians and ENT specialists was analyzed. The dataset included demographic characteristics, referral diagnoses, and final ENT specialist diagnoses. Descriptive statistics and appropriate statistical tests were employed to assess the prevalence of diagnostic mismatches and associated factors. The analysis comprised 1544 cases. The prevalence of diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists was 67.4%. Certain specific ENT diseases demonstrated higher frequencies of diagnostic mismatches. Factors such as mismatch in the diagnosis and compliance of patient were found to influence the occurrence of diagnostic mismatches. This study highlights the presence of diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. The prevalence of these mismatches underscores the need for improved diagnostic practices in such settings. Factors contributing to diagnostic mismatches should be further explored to develop strategies for enhancing diagnostic accuracy and reducing diagnostic errors in otorhinolaryngology.

Diagnostic journey for individuals with fibrous dysplasia / McCune albright syndrome (FD/MAS)

BackgroundReducing delayed diagnosis is a significant healthcare priority for individuals with rare diseases. Fibrous Dysplasia/ McCune Albright Syndrome (FD/MAS) is a rare bone disease caused by somatic activation mutations of NASA. FD/MAS has a broad clinical phenotype reflecting variable involvement of bone, endocrine and other tissues, distribution and severity. The variable phenotype is likely to prolong the diagnostic journey for patients further.AimTo describe the time from symptom onset to final diagnosis in individuals living with FDMAS.MethodsWe used the UK-based RUDY research database (www.rudystudy.org), where patients self-report their diagnosis of FD/MAS. Participants are invited to complete the diagnostic journey based on the EPIRARE criteria.Results51 individuals diagnosed with FD/MAS were included in this analysis. Among them, 70% were female, and the median age was 51.0 years (IQR 34.5–57.5]. 12 (35%) individuals reported McCune Albright Syndrome, 11 (21.6%) craniofacial and 11(21.6%) for each of poly- and mono-ostotic FD and 6 (11.8%) did not know their type of FD/MAS. Pain was the commonest first symptom (58.8%), and 47.1% received another diagnosis before the diagnosis of FD/MAS. The median time to final diagnosis from the first symptom was two years with a wide IQR (1,18) and range (0–59 years). Only 12 (23.5%) of individuals were diagnosed within 12 months of their first symptoms. The type of FD/MAS was not associated with the reported time to diagnosis. Significant independent predictors of longer time to final diagnosis included older current age, younger age at first symptom and diagnosis after 2010.ConclusionIndividuals with FDMAS have a variable time to diagnosis that can span decades. This study highlights the need for further research on how to improve diagnostic pathways within Orthopaedic and Ear, Nose and Throat (ENT)/Maxillofacial services. Our data provides a baseline to assess the impact of novel NHS diagnostic networks on reducing the diagnostic odyssey.

Intratympanic Gels for Inner Ear Disorders: A Scoping Review of Clinical Trials.

Intratympanic injections are a safe, well tolerated procedure routinely performed by ENT's specialists. Intratympanic injections of gels have the potential to deliver therapeutics into the cochlea through the round window membrane prolonging the release of drugs in the inner ear compartment. Aim of the present review is to summarize clinical trials testing pharmacological treatments for inner ear pathologies through intratympanic gel formulations. Online databases (Google scholar and PubMed) and registers (Clinicaltrials.gov and Euclinicaltrial) were used to identify clinical trials performed between 1990 and 2022. PRISMA criteria have been followed. Clinical trials testing gel formulations administered through local intratympanic injections and targeting inner ear disorders were included. All the reports were identified by the authors working in pairs sequentially selecting only studies respecting the inclusion criteria. A total of 45 clinical studies have been noticed; the gels for intratympanic injection are in the form of poloxamers or hyaluronic acid combinations; the trials found target different kind of inner ear disorders: acquired-stable SNHL, tinnitus, acute sudden SNHL, Meniere disease, cisplatin induced ototoxicity and hearing preservation in patients undergoing cochlear implant surgery. Few studies listed do not provide the specific kind of gel formulation used but only report the intratympanic delivery vehicle as "gel" or "thermogel". Multiple clinical studies have been targeting several forms of inner ear disorders by injecting different compounds through poloxamer and hyaluronic acid formulations. Larger and more advanced clinical stages are necessary to confirm the efficacy of these chemical compounds.

ChatGPT Generated Otorhinolaryngology Multiple-Choice Questions: Quality, Psychometric Properties, and Suitability for Assessments.

To explore Chat Generative Pretrained Transformer's (ChatGPT's) capability to create multiple-choice questions about otorhinolaryngology (ORL). Experimental question generation and exam simulation. Tertiary academic center. ChatGPT 3.5 was prompted: "Can you please create a challenging 20-question multiple-choice questionnaire about clinical cases in otolaryngology, offering five answer options?." The generated questionnaire was sent to medical students, residents, and consultants. Questions were investigated regarding quality criteria. Answers were anonymized and the resulting data was analyzed in terms of difficulty and internal consistency. ChatGPT 3.5 generated 20 exam questions of which 1 question was considered off-topic, 3 questions had a false answer, and 3 questions had multiple correct answers. Subspecialty theme repartition was as follows: 5 questions were on otology, 5 about rhinology, and 10 questions addressed head and neck. The qualities of focus and relevance were good while the vignette and distractor qualities were low. The level of difficulty was suitable for undergraduate medical students (n = 24), but too easy for residents (n = 30) or consultants (n = 10) in ORL. Cronbach's α was highest (.69) with 15 selected questions using students' results. ChatGPT 3.5 is able to generate grammatically correct simple ORL multiple choice questions for a medical student level. However, the overall quality of the questions was average, needing thorough review and revision by a medical expert to ensure suitability in future exams.

A hospital-based asynchronous ENT telehealth service for children with otitis media: Cost-minimisation and improved access.

The purpose of this study is to explore the effectiveness of a hospital-based asynchronous ear, nose, and throat (ENT) telehealth service (the Ear Portal) in reducing cost and improving access for children with otitis media. Participants were recruited to the Ear Portal from a tertiary hospital ENT waiting list. Ear and hearing assessments were conducted during appointments by the Ear Portal research assistant, and data was stored for an asynchronous review by the Ear Portal multidisciplinary team. A cost-minimisation analysis was conducted for the Ear Portal and the standard care pathways. Waiting times to provide care for both pathways were calculated for children with semi-urgent (i.e. Category 2) and non-urgent (i.e. Category 3) referrals. The running cost for the Ear Portal was $67.70 for initial appointments and $37.34 for follow-up appointments. Conversely, the running cost for the standard care pathway was $154.65 for initial appointments and $86.10 for follow-up appointments. A total of 223 appointments were required to offset the initial Ear Portal investment of $19,384.00. The median waiting time for the Ear Portal from initial contact to care plan delivery was <30 days, whereas the median waiting times for children in the standard care pathway were 291 days (interquartile range (IQR) = 117) for Category 2 and 371 days (IQR = 311) for Category 3 referrals. Under the current circumstances, the Ear Portal service can reduce costs for the health care system by reducing marginal costs per patient in addition to providing ENT specialist care within the clinically recommended timeframes.

Bridging the gap: a simulation-based education programme to improve the management of postoperative neck haematomas

Postoperative neck haematomas have a reported incidence of 3.4%. They result in a longer length of hospital stay, higher costs and a higher mortality rate. Consensus guidelines provide an algorithm for the management of a suspected neck haematoma and recommend that staff are trained to recognise the symptoms and signs of a neck haematoma. They also suggest the introduction of a post thyroid surgery emergency box. Our aims were to provide education in the form of simulation scenarios and to introduce a neck haematoma evacuation box. This quality improvement project was carried out in a large tertiary referral hospital, with over 1000 beds. It is the major head and neck surgical centre in Ireland. Ethical approval was granted by the hospital. Four simulation training sessions were carried out with Ear, Nose and Throat (ENT) nurses and interns. Voluntary surveys were conducted before and after the sessions. A sample neck haematoma evacuation box was used for the simulation scenarios. 50 staff participated in simulation training. 7% of staff had seen a neck being evacuated on the ward. 37% had received prior teaching on the management of neck haematomas. Significantly more participants reported to know the symptoms and signs of a neck haematoma and the required management of a neck haematoma after completion of the simulation sessions. All participants agreed neck haematoma evacuation boxes were necessary and would improve patient outcomes. The pre-simulation survey demonstrated that an unacceptably low amount of staff had previous training on this topic. Simulation training resulted in more participants being able to identify the signs and symptoms of a neck haematoma and more participants feeling confident regarding the necessary actions. The results show the positive impact of simulation training and provide a basis for advocating for this training to continue on a regular basis. Simulation works to increase participants confidence and familiarity with a given situation. Simulation training also improves technical skills and teamwork. There was unanimous support for the introduction of the post neck surgery haematoma evacuation boxes, which suggests that these would be a valuable introduction in our hospital.