Biodegradable Synthetic Polyurethane Foam Nasal Packing After Septoplasty.

OBJECTIVE: To determine the usefulness of biodegradable Synthetic Polyurethane Foam (SPF) nasal packing as an adjunct to day-case septoplasty. STUDY DESIGN: Comparative, observational case series. PLACE AND DURATION OF STUDY: Aberdeen Royal Infirmary, University of Aberdeen, Scotland, UK, in the year 2011. METHODOLOGY: One-hundred consecutive patients who underwent septoplasty and received SPF packing in 2010 were prospectively audited while one-hundred consecutive patients undergoing septoplasty in the year 2000 were studied retrospectively. Data collected include demographics, type of operation and duration of hospital stay. Excel and SPSS were used for data collection and analysis. RESULTS: In the year 2000, the average age of the patients was 40.6 years. There were 37 females and 63 males. One patient returned home the same day, 22 stayed one night, 69 spent two nights and 8 stayed more than two nights in hospital for their operation. The average length of stay was 1.84 nights. In 2010, the average age of patients was 37.86 years, with 31 patients being female and 69 male. All patients in this cohort received SPF packing postoperatively. Seventy-three patients went home the same day, 24 patients stayed one night and 3 patients spent two nights in hospital for their operation. Average length of hospital stay was 0.3 nights. Results were statistically significant (p < 0.001). CONCLUSION: SPF was a useful nasal packing option after septoplasty and inferior turbinate surgery, which enabled the surgeons to carry out this surgery safely as a day-case procedure.

Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure.

OBJECTIVE: Septoplasty is an accepted and common surgical intervention to improve the nasal airway. However, the role of concomitant surgery on the inferior turbinate remains debated. This study aims to investigate if the inferior turbinate surgery at the time of septoplasty would impact on the likelihood of revision nasal surgery - septoplasty or septorhinoplasty. STUDY DESIGN: Retrospective review of consecutive patients undergoing septoplasty with or without inferior turbinate reduction over 12 years (1998 - 2010) at Aberdeen Royal Infirmary. METHODS: Patients were identified from the theatre log books and were excluded if they underwent any other nasal procedure. Data collected include demographics, type of primary surgery, and grade of surgeon along with revision nasal surgery in this cohort. RESULTS: 2168 eligible patients with a mean age of 39 years were investigated. Two groups were identified: Group A, with 788 patients who underwent septoplasty only, and Group B, in which 1380 patients underwent septoplasty with concomitant inferior turbinate reduction. The majority of operations were performed by the surgeons in training. The incidence of revision surgery was 5.1 % (21 revision septoplasties and 19 corrective septorhinoplasties) in Group A compared to 2.2 % (20 revision septoplasties and 10 corrective septorhinoplasties) in Group B. CONCLUSION: Based on this study, it would appear that concomitant inferior turbinate reduction may decrease the likelihood of revision nasal surgery.

Effectiveness of olfactory rehabilitation according to a structured protocol with potential of regaining pre-operative levels in laryngectomy patients using nasal airflow-inducing manoeuvre.

This pilot study aims to evaluate the effectiveness of the Nasal Airflow-Inducing Manoeuvre (NAIM) when employing a structured protocol as well as investigate if early rehabilitation has the potential to return olfaction to pre-operative levels in patients undergoing laryngectomy following laryngeal cancer. Prospective study of cases conducted during 1 year, 2009­2010, at the Department of Ear-, Nose and Throat at Sahlgrenska University Hospital, Gothenburg, Sweden. Ten patients with laryngeal cancer and about to undergo laryngectomy were identified, of which four were included in the study. The remaining six patients were unfit to participate (n = 4) or declined participation (n = 2). Testing was conducted pre- and post-operatively and at each NAIM training session. Patients received three initial NAIM sessions followed by reinforcement training at 3, 6 and 12 months. Measures included Scandinavian Odour-Identification Test (SOIT), a semi-structured interview and questionnaires including European Organisation for Research and Treatment of Cancer, QLQ-C30 and QLQ-H&N35. All patients were normosmic smellers according to SOIT at the study end-point. One patient reported higher SOIT scores at 12 months follow-up compared to pre-operatively. Remaining patients had scores close to that reported pre-operatively. Using subjective measures, olfaction improved in all patients with one patient's final score surpassing pre-operative scores. By implementing a structured protocol consisting of three training sessions early following laryngectomy with additional reinforcement sessions at 3, 6 and 12 months, NAIM is effective in terms of improving smelling ability. There also appears to be potential for restoring olfaction to a patient's pre-operative level as reflected by both olfactory testing and PRO instruments. However, larger studies are needed to further explore the findings highlighted by this study.

Survival outcome depending on different treatment strategies in advanced stages III and IV laryngeal cancers: an audit of data from two European centres.

In light of continued uncertainty regarding efficacy of treatment of Stages III and IV laryngeal tumours, this study aims to evaluate organ-preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy ± adjuvant treatment) by encompassing the long-established practice at two internationally acclaimed tertiary centres not previously presented in published literature. Retrospective review was conducted of non-randomised prospectively maintained Stages III and IV disease patient databases at two tertiary centres: Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Primary outcome measures included 3-year overall, disease-specific survival and local control depending on treatment. A total of 176 patients were identified. Sixty-five patients (37 %) presented with Stage III tumours, of which 51 patients received organ-preserving treatment and 14 underwent total laryngectomy. The corresponding figures for the 111 patients (63 %) presenting with Stage IV disease were 42 and 69. Three-year overall and disease-specific survival for Stage III was 58 and 73 %, respectively. The corresponding figures for Stage IV disease were 42 and 53 %. The choice of treatment did not appear to significantly influence survival for Stage III (p = 0.56) or IV (p = 0.93) disease. The choice of treatment, whether organ preservation or surgery, does not seem to significantly influence the overall or disease-specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate the preferred treatment options, but larger randomised trials are needed.

Revision nasal surgery after septoplasty: trainees versus trainers.

Otolaryngology trainees are expected to be able to successfully perform septoplasty early in their career. An important parameter to assess the success of an operation is to look at the revision surgery rate. This study aimed to investigate the revision nasal surgery rate after septoplasty based on the grade of the primary surgeon. Retrospective review of hospital records of all patients who underwent septoplasty with or without inferior turbinate reduction over 12 years (1998-2010) in a tertiary referral centre in North-East Scotland. Patients were identified from theatre log books and were excluded if they underwent any other simultaneous nasal procedure. Data were collected on demographics, type of primary and revision surgery, grade of surgeon and duration of hospital stay. 2,168 eligible patients (70 % male, 30 % female) with a mean age of 39 years were investigated. Surgeons were divided into four categories: junior trainee (Group A), senior trainee (Group B), staff grade (Group C) and consultant (Group D). There were 753, 644, 298 and 473 patients in Groups A, B, C and D, respectively. The revision rate in Group A was 4.4 % compared to 3.2 % for Group D and this difference was not statistically significant. For their operation, patients in Group A stayed for 1.54 nights compared to 1.47 nights in Group D, the difference being insignificant. Grade of the surgeon does not appear to strongly affect the need for revision nasal surgery and our patients do not appear to be disadvantaged if operated on by trainees.