RESUMO
INTRODUCTION: The T-14 questionnaire is a validated outcome measurement tool to assess the value of paediatric tonsillectomy from a parent's perspective. There is a paucity of data regarding the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. Our previous study assessed T-14 scores up to year 2 postoperatively, with this study extending follow-up to 5 years. MATERIALS AND METHODS: We undertook a prospective uncontrolled observational study examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children undergoing surgery were invited to complete a T-14 questionnaire preoperatively, as well as at 3 months, 6 months, 1 year, 2 years and now 5 years postoperatively. RESULTS: In total, 44 of 54 patients completed questionnaires preoperatively and at all postoperative time points, with 46 being completed at 5 years. There was a highly significant (P < 0.001) difference between the preoperative scores and all other measured T-14 scores postoperatively. The mean score preoperatively was 33.3 compared with 1.0 at 5 years. CONCLUSIONS: This is the first study to assess long-term quality of life following paediatric tonsillectomy using the T-14 questionnaire. The benefits of tonsillectomy on long-term quality of life further confirms its value within the paediatric population.
Assuntos
Adenoidectomia , Doenças Faríngeas/cirurgia , Tonsilectomia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pais , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: The T-14 questionnaire is a validated patient reported outcome measure used to assess the value of paediatric tonsillectomy from the patient's perspective. There are currently limited data revealing the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. A previously published study was therefore extended to provide additional data at 12 and 24 months following surgery. METHODS: A prospective uncontrolled observational study was undertaken examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children having surgery were invited to complete a T-14 questionnaire preoperatively as well as at 3, 6 (previously published), 12 and 24 months postoperatively. RESULTS: The questionnaire was completed for 50 of the 54 patients preoperatively as well as at 3, 6 and 12 months postoperatively, with 44 being completed at 24 months. The mean difference between the preoperative T-14 scores and the scores at 3, 6, 12 and 24 months following surgery were highly statistically significant (p<0.001). CONCLUSIONS: This is the first study published in the literature to assess the T-14 questionnaire at 12 and 24 months following paediatric tonsillectomy, providing evidence of the ongoing benefit of patient reported outcome measures. This further confirms the value of tonsillectomy in the paediatric population and demonstrates its ongoing positive effects on quality of life.
Assuntos
Adenoidectomia/estatística & dados numéricos , Doenças Faríngeas/cirurgia , Tonsilectomia/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Inquéritos e Questionários , Resultado do TratamentoRESUMO
INTRODUCTION: It is important that patients have a good understanding of surgery-related risks, particularly for mastoid surgery, which exposes patients to the risk of very serious complications, despite addressing conditions which often have only minor symptoms. MATERIALS AND METHODS: A patient information leaflet describing the risks of mastoid surgery was prepared. However, the Hospital Patient Advice and Liaison Services team thought it was too long and complicated. It was introduced unchanged. Fifty-four consecutive mastoidectomy patients were given a questionnaire asking for their opinion of the leaflet. The leaflet was also assessed with readability formulae and the Ensuring Quality Information for Patients tool. RESULTS AND ANALYSIS: Ninety-eight per cent of respondents thought the leaflet's writing style was easy to understand. The majority (96 per cent) thought the length was 'just right'. The 7 readability formulae used established readability at a grade 9 level (i.e. appropriate for a reading age of 13-15 years). The Ensuring Quality Information for Patients score was 87.5 per cent. DISCUSSION: Despite the drive to simplify patient information leaflets, quite detailed information is sometimes required. A style which is too simple may be perceived as patronising and may encourage patients to underestimate potential risks. It is important to ask patients their opinion.
Assuntos
Processo Mastoide/cirurgia , Folhetos , Educação de Pacientes como Assunto/normas , Compreensão , Humanos , Consentimento Livre e Esclarecido , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente , Inquéritos e QuestionáriosRESUMO
We present a case of an oesophageal foreign body (approximately 2x2 cm) which was not seen on the initial lateral soft tissue neck X-ray but was detected following manipulation of the X-ray using the Picture Archiving and Communication System of X-ray viewing. This system gives the user much greater flexibility, including a choice of magnification and contrast.
Assuntos
Esôfago/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Sistemas de Informação em Radiologia , Adulto , Esôfago/cirurgia , Feminino , Corpos Estranhos/cirurgia , Humanos , Radiografia , Resultado do TratamentoRESUMO
There is continued encouragement to increase the use of day surgery. Recent publications have suggested that day-case tonsillectomy is a safe procedure due to the low primary haemorrhage rates (0.14-3.5%). One of the suggested benefits of day surgery is that patients want it. They prefer to recover at home after an operation. With tonsillectomy, personal experience suggested that this was not the case. A review of 117 patients having tonsillectomy was undertaken. All patients stayed in for at least one post-operative night. No patients or parents thought that the post-operative stay was too long (80% 'just right', 20% 'too short') and only 7% would have been happy to go home on the day of operation. 'Safety' does not automatically make an operation suitable for day-case surgery. Pain, nausea, vomiting, drowsiness and anxiety about the operation and post-operative course were all reasons given for not wanting to go home on the day of surgery. The justification for the increased use of day surgery is that it increases efficiency by reducing costs per case while maintaining the quality of care. One aspect of quality of care is patient acceptability and before day-case tonsillectomy is acceptable to patients the factors responsible for the post-operative morbidity need to be addressed.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Tonsilectomia , Adulto , Criança , Análise Custo-Benefício , Custos e Análise de Custo , Humanos , Tempo de Internação , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Qualidade da Assistência à SaúdeRESUMO
It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the 'gold standard', but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis. A newer technique to reduce snoring caused by palatal flutter by using a neodymnium:yttrium aluminum garnet laser to stiffen the soft palate has been introduced recently by another unit. We show that this procedure can be carried out using a CO2 laser, and present the initial results of the first 29 patients operated on at The Royal National Throat, Nose and Ear Hospital.
Assuntos
Terapia a Laser , Palato/cirurgia , Síndromes da Apneia do Sono/cirurgia , Ronco/cirurgia , Dióxido de Carbono , Feminino , Humanos , Masculino , Projetos Piloto , Resultado do Tratamento , Úvula/cirurgiaRESUMO
Over the period of a year, Merocel nasal packs were used routinely as the primary form of packing in patients referred to the hospital with epistaxis that had not resolved with simple measures, and in whom packing was thought to be required. Their effectiveness was assessed. The packing was usually performed by inexperienced senior house officers. The Merocel packs successfully controlled bleeding in 91.5 per cent of the patients in whom they were used. Use of the correct insertion technique is very important but is very easy to learn and perform. The actual insertion takes only a couple of seconds. Discomfort during insertion, whilst in situ and on removal was assessed. Merocel nasal packing is an effective form of first line treatment in patients with epistaxis.
Assuntos
Epistaxe/terapia , Formaldeído , Hemostáticos , Álcool de Polivinil , Tampões Cirúrgicos , Humanos , Satisfação do PacienteRESUMO
This case report illustrates the value of intravenous digital subtraction angiography (DSA) in cases of penetrating neck injury. The debate continues between a policy of mandatory exploration of all penetrating neck wounds versus one of selective exploration with observation of the remainder. The argument for the former policy is that vascular trauma can occur without clinical signs. Whichever policy is followed a DSA provides invaluable information in strengthening the decision either not to operate or if operating which operation to perform and which approach to use. DSA is a quick, simple and safe investigation that can be carried out at any time of day or night.
Assuntos
Angiografia Digital , Lesões do Pescoço , Ferimentos Perfurantes/diagnóstico por imagem , Adulto , Humanos , Masculino , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Ferimentos Perfurantes/cirurgiaRESUMO
Twenty-five children (mean age six years) with de novo bilateral ear effusions received a 'trimmed' high grade silicone (HGS) Shah permavent ventilation tube in one ear and a conventional polyethylene Shah grommet in the other. The extrusion rate and the degree of tympanosclerosis formation was examined. At 29 months the conventional grommet had extruded in 90 per cent of children and a recurrent middle ear effusion was found in over 50 per cent of these ears. The average length of stay for the conventional grommet was 12.5 months. Five permavent tubes had extruded, one was extruding but the remainder were all in place and patent. Comparing ears on each side the amount of tympanosclerosis was worse in the ear with the conventional grommet in 47 per cent of children and worse on the permanent side in 11 per cent of the children. The 'trimmed permavent' appears to act as a medium to long-term grommet which self extrudes without serious complications. Its use at the primary operation in young children may save repeated insertions of conventional grommets.
Assuntos
Ventilação da Orelha Média/instrumentação , Otite Média com Derrame/cirurgia , Criança , Pré-Escolar , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Ventilação da Orelha Média/efeitos adversos , Otite Média com Derrame/patologia , Membrana Timpânica/patologiaRESUMO
The case records and histology of 34 patients with vocal process granulomata were reviewed. The five patients presenting most recently with idiopathic vocal process granulomata were investigated by axial computerized tomography (CT). Increased density of the arytenoid cartilage on the side of the lesion was found in all five cases. It is suggested that this indicates cartilage ossification, secondary to perichondritis. This perichondritis, playing either a primary or a secondary role in granuloma development, may explain the annoying tendency of vocal fold granulomata to recur after excision.
Assuntos
Granuloma Laríngeo/etiologia , Prega Vocal , Adulto , Fatores Etários , Cartilagem Aritenoide/diagnóstico por imagem , Feminino , Granuloma Laríngeo/patologia , Granuloma Laríngeo/terapia , Humanos , Laringe/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Tomografia Computadorizada por Raios X , Prega Vocal/patologiaRESUMO
One of the most important parts of the management of patients with the obstructive sleep apnoea syndrome is the assessment of the level of obstruction in order to allow the appropriate choice of treatment. We have recently developed the technique of sleep nasendoscopy which allows direct visualization of the site of obstruction in the sleeping patient. Having performed over a hundred of these investigations we are able to suggest a grading system for these patients dividing them into five grades. Grade 1 = simple palatal level snoring; grade 2 = single palatal level obstruction; grade 3 = palatal level obstruction with intermittent orohypopharyngeal involvement; grade 4 = sustained multi-segment involvement; grade 5 = tongue-base level obstruction. We feel that this grading system will help in deciding which patients are suitable for surgery and which are not; hence avoiding unnecessary operations and allowing a more logical decision on the appropriate form of treatment. Results of the first 90 patients to have sleep nasendoscopy are presented.
Assuntos
Endoscopia/métodos , Síndromes da Apneia do Sono/diagnóstico , Humanos , Palato Mole/fisiopatologia , Palato Mole/cirurgia , Faringe/cirurgia , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/cirurgia , Ronco , Resultado do Tratamento , Úvula/cirurgiaRESUMO
Metastases to the temporal bone are a recognized, if rare, cause of otological symptoms including sudden sensorineural hearing loss. Carcinoma of the prostate is a common cancer which frequently metastasizes to bone but is only rarely reported in the temporal bone. We report a case of sudden sensorineural hearing loss due to metastatic prostatic carcinoma in the temporal bone.
Assuntos
Perda Auditiva Neurossensorial/etiologia , Neoplasias da Próstata/complicações , Neoplasias Cranianas/secundário , Osso Temporal , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Perda Auditiva Neurossensorial/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias Cranianas/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Speech audiometry was performed on 15 children with secretory otitis media pre- and post-operatively and the findings compared with the pre- and post-operative pure tone audiograms. The results showed that in 30 per cent of cases pre-operatively the speech audiogram suggested a significantly worse hearing ability than that suggested by the pure tone audiogram (PTA). Where a PTA gives a borderline threshold disproportionate parental concern should be taken seriously as the hearing ability may well be worse than the PTA suggests.
Assuntos
Audiometria de Tons Puros , Audiometria da Fala , Otite Média com Derrame/fisiopatologia , Criança , Pré-Escolar , Audição/fisiologia , Humanos , Ventilação da Orelha Média , Otite Média com Derrame/cirurgia , Fatores de TempoRESUMO
Ever since Armstrong reintroduced the concept of grommet insertion parents have been asking 'may my child swim?', yet there is still no consensus as to the correct answer. This paper reviews the work that has been done on this subject in the last 25 years. A review of the rates of otorrhoea following grommet insertion, irrespective of swimming, shows a variation from 12 to 64 per cent. Evidence suggests that pressures of 12-23 cm H2O are needed to push water through a grommet and that it is unlikely that water will enter the middle ear during surface swimming. Only bath water seems to cause significant inflammatory changes to middle ear mucosa. Not a single paper comparing swimmers with non-swimmers shows an increased rate of otorrhoea in those patients who swam; to the contrary, rates of otorrhoea were repeatedly higher in those patients who did not swim. The evidence suggests that swimming without ear protection can be safely permitted for children with grommets.
Assuntos
Ventilação da Orelha Média , Otite Média com Derrame/cirurgia , Otite Média Supurativa/etiologia , Complicações Pós-Operatórias , Natação , Adolescente , Banhos , Criança , Pré-Escolar , Humanos , Otite Média Supurativa/epidemiologia , Complicações Pós-Operatórias/epidemiologia , ÁguaRESUMO
A questionnaire was sent to all United Kingdom consultants enquiring about their use of intra-nasal splints. 301 (70%) consultants replied. The commonest reason given for use of nasal splints was to try to prevent the formation of adhesions. Flat, pre-shaped silicone rubber splints were by far the most frequently used type. 64% used splints routinely for operations involving both walls of the nasal cavity. Just over one-third of respondents never or 'rarely' (less than 1 in 50 cases) used splints for procedures involving both walls of the nasal cavity. They reported an adhesion rate of 5.2% which was only 1.3% greater than that reported by those who always or 'sometimes' (at least 1 in 10 cases) used splints. Comments from some respondents and review of the literature suggests that early out-patient review with the use of nasal toilet is an effective alternative to using nasal splints in the prevention of intranasal adhesions.
Assuntos
Consultores , Doenças Nasais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Contenções/estatística & dados numéricos , Humanos , Inquéritos e Questionários , Aderências Teciduais/prevenção & controleRESUMO
Much attention has been focused on the risks of inoculation with the human immune deficiency virus in the operating theatre. However, less emphasis has been placed on infection resulting from outpatient exposure to this pathogen. A survey of current protective measures undertaken by ENT consultants in the outpatient clinic in the United Kingdom is presented. The precautions employed by the majority of these subjects are inadequate and non-universal. A review of the risk factors and subsequent safety recommendations is detailed.
Assuntos
Infecções por HIV/prevenção & controle , Doenças Profissionais/prevenção & controle , Otolaringologia , Dispositivos de Proteção dos Olhos , Luvas Cirúrgicas , Humanos , Máscaras , Ambulatório Hospitalar , Fatores de Risco , Reino UnidoRESUMO
Knowledge of the level of pharyngeal obstruction during sleep is an important factor in deciding whether or not a patient suffering from obstructive sleep apnoea syndrome (OSAS) will benefit from uvulopalatopharyngoplasty. The Muller manoeuvre has been advocated as a method of obtaining this information. We compared the findings from the technique of sleep nasendoscopy, which actually allows visualization of the level of obstruction in the sleeping patient, with the results of the Muller manoeuvre performed in the same patients while awake. We found the Muller manoeuvre to be less accurate than previously believed.