How we do it: evaluation of nurse-led ENT services in the UK: a preliminary descriptive postal questionnaire survey.

There has been a steady growth in the volume and range of nurse led services in ENT practise in the UK. There was very little consistency in the titles of the nurses providing nurse led services but those nurses working in advanced practice roles now require courses, diplomas, degrees and study days related to ENT. Locally or nationally agreed practice guidelines can define nursing practice boundaries and ensure accountability. Monitoring and evaluation of nurse led services also requires attention.

Is buscopan effective in meat bolus obstruction?

OBJECTIVE: To assess the efficacy of hyoscine butyl bromide (buscopan) in relieving oesophageal meat bolus obstruction. DESIGN: Retrospective review of case notes. SETTING: Secondary otorhinolaryngology care. PARTICIPANTS: Twenty-nine patients who presented to the Accidents & Emergency department satisfying, inclusion criteria: (i) >or=16 years old, (ii) patients with only meat bolus obstruction and (iii) had either only buscopan or no medications. Exclusion criteria were: (i) <16 years of age, (ii) patients who received any medications other than or in addition to buscopan, (iii) other foreign body obstructions and (iv) any patient in whom the approximate time of resolution of obstruction was not documented. RESULTS: Twenty-nine patients with 31 episodes of obstruction were analysed. Twenty-two episodes were treated with buscopan and in 18 (82%) the obstruction was relieved. Two had spontaneous relief >24 h later and two had surgical disimpaction. In nine episodes, where no medications were given, seven (78%) cleared spontaneously and two had surgical removal. Fisher's exact test failed to show any significant difference between the two groups. The study groups were too small and power calculation showed that the number required for statistically validated result would be 140 in each group. CONCLUSION: Routine use of buscopan in oesophageal obstruction especially in the upper two-thirds needs to be reviewed because of the possibility of side-effects and lack of objective evidence of its efficacy.

Waiting-list prioritization in the National Health Service.

The aim of this study was to find out whether there is a consensus of opinion among healthcare providers and different sections of the public on the relative prioritization of common otolaryngological conditions for outpatient consultations and inpatient treatment. ENT consultants, general practitioners, administrators, NHS employees, non-ENT patients and members of the general public were given common scenarios of otolaryngological conditions and asked to prioritize them in order of importance. All the groups gave top priority for patients with suspected cancer of the larynx (outpatients) and for surgical treatment of cancer. Children with hearing problems were more commonly ranked in the top three categories than children requiring treatment for sore throats. All groups assigned those requiring rhinoplasty, treatment for snoring or hearing aids to the last three ranks. This study shows that there is a remarkable uniformity of opinion in determining clinical priorities which is similar to the traditional policies practised by UK ENT consultants.

Surgery for snoring: are partners satisfied in the long run?

Patients seek surgery for snoring, essentially for the sake of their partners. Few studies have looked into the long-term results from this angle. We herein report the findings of a study of partner satisfaction, following laser-assisted uvulopalatoplasty (LAUP) and uvulopalatopharyngoplasty (UVPP). This was a questionnaire-based survey, with a minimum follow-up of 1 year. A total of 91 procedures (LAUP = 50 and UVPP = 41) were evaluated. Response rate was 65.93%. Both groups were matched for age, gender and duration of the follow-up. Residual snoring was even more frequently following LAUP than it was following UVPP (Mann-Whitney U = 244, P = 0.012). After UVPP, partners were less likely to have trouble falling asleep (Mann-Whitney U = 255, P = 0.041). There was a highly significant reduction in the disturbance of sleep and need to wake up after both types of surgery (McNemar test, chi2 = 25.037, P < 0.001). Both groups reported improvements in quality of life. We propose a grading system to record partner satisfaction. The long-term results show that surgery for snoring is justified in the National Health Service (NHS) in the new millennium.

Live recordings of sound levels during the use of powered instruments in ENT surgery.

Otolaryngology is one of the surgical specialities employing high-powered instruments and this study was designed in order to establish whether sound levels at work conform to HSE guidelines. No study to date has measured intra-operative noise levels in ENT operation theatres. A prospective observational study was therefore performed. Sound levels were measured during the use of bone drills for mastoid surgery and microdebriders for endoscopic sinus surgery. A SLM/IS Acos Class I sound level meter calibrated to BS 1259 was employed. A spectrum analysis of drill-generated noise was measured using a calibrated B and K precision sound level meter. Sound levels emitted varied as follows: Large burrs- 72.4 dB (A), medium size; 71.2 dB (A), small sized burrs- 68.8 dB (A) (all values for cutting burrs) and 60.8 dB (A) for diamond burs. With microdebriders, the average sound level was 60.1 dBA. Spectrum analysis revealed that the maximum intensity was at 3.15 kHz, followed by 4 kHz, while the least sound was produced at 40 kHz and 31.5 kHz. Essentially sound produced by drills was between 1.6 kHz and 6.3 kHz. Powered instruments used in ENT surgery are safe and pose no occupational hazard.

Tissue augmentation using Bioplastique as a treatment of leakage around a Provox 2 voice prosthesis.

Rehabilitation of voice and speech after laryngectomy with valve prosthesis has become a well-established practice in recent years. The formation of tracheo-oesophageal fistula (TOF) and the subsequent management of the patient with a voice prosthesis can be associated with a number of problems and complications. We report a new technique of the use of injectable Bioplastique in the treatment of persistent leakage around Provox 2 voice prosthesis. Our experience in two cases has shown that it is a relatively simple and effective procedure in stopping the leak around the valve immediately and is without any short-term complications.

Has the internet overtaken other traditional sources of health information? Questionnaire survey of patients attending ENT outpatient clinics.

The aim of this study was to find out whether patients attending ENT clinics obtain health information about their medical condition and to assess satisfaction with the sources of health information, including the internet. Three hundred and thirty patients attending ENT outpatient clinics at District General Hospitals in Wigan and Warrington during June 2001 were asked to complete detailed questionnaires. Fifty-seven per cent of patients attempted to obtain health information before their visit to the specialist clinic. Forty-five per cent of patients had access to the internet, but only 13% used it to obtain health information. General practitioners were the source of health information for 64%, but the NHS-Direct help line was only used by 16%. Patients also trusted the health information provided by their GPs the most. In the twenty-first century, patients turn to their GP as the main source of health information.