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1.
J Laryngol Otol ; 133(8): 700-703, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31317846

RESUMO

OBJECTIVE: The completion of a laser safety course remains a core surgical curriculum requirement for otolaryngologists training in the UK. This project aimed to develop a comprehensive laser safety course utilising both technical and non-technical skills simulation. METHODS: Otolaryngology trainees and consultants from the West of Scotland Deanery attended a 1-day course comprising lectures, two high-fidelity simulation scenarios and a technical simulation of safe laser use in practice. RESULTS: The course, and in particular the use of simulation training, received excellent feedback from otolaryngology trainees and consultants who participated. Both simulation scenarios were validated for future use in laser simulation. CONCLUSION: The course has been recognised as a laser safety course sufficient for the otolaryngology Certificate of Completion of Training. To the authors' knowledge, this article represents the first description of using in situ non-technical skills simulation training for teaching laser use in otolaryngology.


Assuntos
Lasers/efeitos adversos , Otolaringologia/educação , Treinamento por Simulação/métodos , Competência Clínica , Simulação por Computador , Educação Médica Continuada , Humanos , Internato e Residência , Reino Unido
2.
J Laryngol Otol ; 131(8): 714-718, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28683847

RESUMO

OBJECTIVE: To assess if there is an association between sinonasal anatomical variants and the risk of developing orbital cellulitis and associated complications, in children. METHODS: A retrospective case-control series was conducted, examining computed tomography confirmed sinonasal anatomical variants of septal deviation and concha bullosa in children who presented with periorbital cellulitis who went on to develop orbital cellulitis and abscesses. RESULTS: Thirty children had a Chandler score of 2 or greater on computed tomography. Mean age was seven years and there was relatively equal sex distribution. There was no association between presence of concha bullosa and side of disease (odds ratio = 1), and no statistically significant difference between septal deviation and ipsilateral orbital infection (p = 0.125). CONCLUSION: There was no statistical correlation between any sinonasal bony or cartilaginous anatomical variants on computed tomography and orbital complications of acute rhinosinusitis in our paediatric cohort. The findings do not support the theory that these anatomical variants predispose to orbital cellulitis occurring in these children, nor complications thereof.


Assuntos
Celulite Orbitária/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagem , Rinite/complicações , Sinusite/complicações , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Septo Nasal/anormalidades , Septo Nasal/diagnóstico por imagem , Celulite Orbitária/etiologia , Seios Paranasais/anormalidades , Estudos Retrospectivos , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem
3.
Clin Otolaryngol ; 41(5): 472-80, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26441199

RESUMO

OBJECTIVES: Comparison of pinnaplasty techniques is difficult due to variation in the reporting of outcomes. We aimed to develop a family-centred outcome questionnaire for use after pinnaplasty and assess it for reliability and validity. DESIGN: Cross-sectional study. SETTING: Tertiary referral paediatric otolaryngology centre. PARTICIPANTS: 20 prospective and 71 retrospective pinnaplasty patients and their parent(s). METHODS: The Post-Operative Pinnaplasty Questionnaire (POPQ) was developed after semi-structured interview with families of children undergoing pinnaplasty. Children aged 4-16 were recruited. Three different ear measurements (auriculocephalic angle, helix-mastoid distance and Walker's ratio) were performed pre-operatively. Children were reviewed 3 months post-operatively and asked to complete a POPQ and Glasgow Children's Benefit Inventory with their parent(s). Ear measurements were repeated and data collected on surgical technique and complications. 200 retrospective pinnaplasty patients were posted a POPQ and Glasgow Children's Benefit Inventory and data collected on surgical technique, complication rate and Walker's angle. MAIN OUTCOMES MEASURES: Validity and reliability of the POPQ. RESULTS: Age range was 4-16 (median 12). POPQ correlated well with Glasgow Children's Benefit Inventory (Spearman's rho = 0.776, P < 0.001). There was no correlation of POPQ scores with age, sex, complication or surgical technique. POPQ score was not associated with severe prominence pre-op nor change or degree of prominence post-op. POPQ displayed good internal consistency (Cronbach's alpha 0.850) and ease-of-use scores. CONCLUSIONS: We have developed a family-focused outcome tool for pinnaplasty that displays good face validity, internal consistency and correlation with health-related quality of life and that is simple and easy to use. No correlation was seen with more traditional measures of outcome such as complications or ear measurements. Further refinement and testing of validity and reliability on a larger sample is planned.


Assuntos
Orelha Externa/anormalidades , Orelha Externa/cirurgia , Família , Avaliação de Resultados da Assistência ao Paciente , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Projetos Piloto , Estudos Retrospectivos , Escócia , Inquéritos e Questionários
5.
J Laryngol Otol ; 129(9): 882-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26314322

RESUMO

OBJECTIVE: This paper presents our experience of managing children with a tracheostomy in a multidisciplinary team clinic consisting of an ENT consultant, paediatric respiratory consultant, a nurse specialist, and speech and language therapist. METHOD: A retrospective case note review was conducted of all children seen in the multidisciplinary team tracheostomy clinic (at a tertiary paediatric hospital) between February 2009 and September 2014. RESULTS: Ninety-seven patients were examined. The most common indications for tracheostomy were: lower airway and respiratory problems (66 per cent), upper airway obstruction (64 per cent), and neurodevelopmental problems (60.8 per cent). CONCLUSION: Children with a tracheostomy are a diverse group of patients. The most common indications for paediatric tracheostomy have changed from infective causes to airway obstruction and anomalies, long-term ventilation requirement, and underlying neuromuscular or respiratory problems. Our unified approach empowers the carers and patient, as a home management plan, long-term plan and goals are generated at the end of each appointment.


Assuntos
Comportamento Cooperativo , Comunicação Interdisciplinar , Otorrinolaringopatias/cirurgia , Traqueostomia/métodos , Adolescente , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Masculino
6.
J Laryngol Otol ; 129(8): 795-800, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26244423

RESUMO

BACKGROUND: Congenital airway obstruction is rare but potentially fatal. We developed a complex airways interventional delivery team to manage such cases. Antenatal imaging detects airway compromise at an early stage and facilitates the planning of delivery procedures ('ex utero intrapartum treatment' and 'operation on placental support') which maintain feto-placental circulation whilst an airway is secured. METHOD: A retrospective review was performed of cases in which ENT input was required at birth for airway obstruction. RESULTS: Four neonates were delivered before implementation of the service: two were intubated and another two underwent tracheostomy but died in the peri-natal period. Seven neonates were delivered after implementation of the service: six were intubated and one underwent immediate tracheostomy. Five subsequently underwent tracheostomy (three have since been decannulated). One child with multiple congenital anomalies died due to respiratory failure. Airway obstruction was caused by lymphatic malformation, teratoma, costo-craniomandibular syndrome and choristoma. CONCLUSION: In the absence of other anomalies, interventional airway delivery led to reduced mortality and improved outcomes.


Assuntos
Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/terapia , Comportamento Cooperativo , Parto Obstétrico/métodos , Comunicação Interdisciplinar , Intubação Intratraqueal , Imagem por Ressonância Magnética , Equipe de Assistência ao Paciente , Diagnóstico Pré-Natal , Traqueostomia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/mortalidade , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Escócia , Taxa de Sobrevida , Resultado do Tratamento
7.
Int J Pediatr Otorhinolaryngol ; 79(10): 1673-6, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26255606

RESUMO

AIMS: The aim of this paper was to review the indications, complications and outcomes for tracheostomy at a Scottish paediatric tertiary referral hospital. METHODS: All patients undergoing tracheostomy between January 2001 and September 2012 were identified. A retrospective case note analysis was performed. RESULTS: 111 tracheostomies were done in the study period. The mean number per year was 11 (3-12). Full data was available for 95 patients. There were 56 (59%) males and 39 (41%) females. Age at time of tracheostomy ranged from one day to 15 years, the mean age of tracheostomy insertion was 69 weeks. The majority of patients, 75 (79%), were under one year old when they had their tracheostomy. The most common indication was long-term ventilation (20%), followed by craniofacial abnormality causing airway obstruction (18%), followed by subglottic stenosis (14%). 37% of patients were decannulated. CONCLUSIONS: This series reflects current trends in the indications for paediatric tracheostomy, with chronic lung disease of prematurity being the most common indication.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Traqueostomia/tendências , Adolescente , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria , Estudos Retrospectivos , Escócia , Centros de Atenção Terciária , Traqueostomia/efeitos adversos
8.
J Laryngol Otol ; 129(5): 494-5, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25994383

RESUMO

OBJECTIVE: This paper, a report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society, presents a consensus view of the minimal requirements for ENT clinics in National Health Service hospitals. RESULTS AND CONCLUSION: The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting.


Assuntos
Instituições de Assistência Ambulatorial/normas , Hospitais Municipais/normas , Otolaringologia/normas , Equipamentos e Provisões Hospitalares/normas , Humanos , Escócia , Medicina Estatal
9.
Int J Pediatr Otorhinolaryngol ; 78(9): 1485-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25005226

RESUMO

OBJECTIVES: To assess for identifiable risk factors for failed surgical intervention in children with laryngomalacia. METHODS: Retrospective case note review between September 2007 and March 2012. Case notes were reviewed for demographic data, symptoms, co-morbidities, operative technique, postoperative recovery, complications, length of hospital stay including intensive care unit (ICU) care, and resolution of symptoms. RESULTS: 148 children underwent supraglottoplasty. Case notes were available for 115 (78%) patients. 35% (41/115) of cases were females and 65% (74/115) were male. A bimodal age distribution was observed with peaks at 3 months and 3.5 years. Those over one year of age were more likely to have complications (p = 0.035). There was no significant difference in outcomes for age (p > 0.05). In patients less than one year, reflux symptoms were significantly associated with a higher likelihood of failure of the operation (p = 0.013). Patients under one year with pre-operatively identified comorbid conditions were less likely to have an improvement in breathing (p = 0.002). Cold steel was used in 55% (63/115) of cases, laser only in 17% (20/115) cases and a combination of the two techniques in 28%, (32/115). There was no association between the surgical technique used and complications (p = 0.558). There was no association between improvement in symptoms and surgical technique used (p = 0.560). There was a significant association between delayed post-operative neurological diagnosis and failure of the operation (p < 0.001). 21 (18%) patients required a second procedure. CONCLUSIONS: Pre-operative predictors of failure were patients with reflux symptoms (p = 0.013). Patients that required a second procedure were 37 times more likely to have a delayed diagnosis of an underlying neurological condition. Failure of symptoms to improve after supraglottoplasty should alert the clinician to the possibility of an underlying neurological disorder.


Assuntos
Glote/cirurgia , Laringomalácia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Otorrinolaringológicos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
10.
Scott Med J ; 58(3): e22-7, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23960066

RESUMO

BACKGROUND AND AIMS: Dog bites represent an important public health issue, causing injuries from trivial to fatal. The true incidence is unknown due to the lack of national and local reporting system. School children, mostly male, are more commonly affected with the majority of injuries occurring in the head and neck area, followed by the limbs and trunk. METHODS: The conservative management of a 6-year-old girl who sustained a fracture of her laryngeal structure from an attack by her neighbours' dog is described. Only a 1 cm visible puncture wound in the midline of her neck with air escaping through the wound was seen at presentation. RESULTS: Ten days were spent in hospital including the first four in intubated Paediatric Intensive Care Unit. Initial microlaryngoscopy and bronchoscopy (MLB) showed a swelling in the right anterior subglottis not reducible by manipulation. She was re-intubated with progressively larger naso-tracheal tube until the fracture was fully reduced on her 3rd MLB. Three months post-injury, there is no evidence of airway narrowing. CONCLUSION: The literature advocates early surgical management of laryngeal trauma including dog bites. Conservative management of laryngeal fracture from a dog bite is feasible and associated with a good outcome and no long-term sequela.


Assuntos
Antibacterianos/uso terapêutico , Mordeduras e Picadas/cirurgia , Glote/lesões , Laringe/lesões , Lesões do Pescoço/cirurgia , Ferimentos Penetrantes/cirurgia , Animais , Mordeduras e Picadas/fisiopatologia , Broncoscopia , Criança , Cuidados Críticos , Cães , Feminino , Humanos , Intubação Intratraqueal , Laringoscopia , Lesões do Pescoço/patologia , Resultado do Tratamento , Cicatrização , Ferimentos Penetrantes/patologia
11.
J Laryngol Otol ; 127(5): 494-500, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23544702

RESUMO

OBJECTIVE: To review the aetiology, investigation, diagnosis, treatment and clinical outcome of children with recurrent croup. METHOD: Retrospective case note review of all children with recurrent croup referred to the otolaryngology service at our hospital from November 2002 to March 2011. RESULTS: Ninety children with recurrent croup were identified. Twenty-five children (28 per cent) had anatomical airway abnormalities, of which 16 (18 per cent) demonstrated degrees of subglottic stenosis. Twenty-three children (26 per cent) had positive microlaryngobronchoscopy findings suggestive of reflux. Eleven children were treated for gastroesophageal reflux disease, 10 (91 per cent) of whom responded well to anti-reflux medication (p = 0.006). No cause was identified for 41 (45 per cent) of the children; this was the group most likely to continue having episodes of croup at follow up. One death occurred in this group. CONCLUSION: Airway anomalies are common in children that present with recurrent croup. Laryngobronchoscopy allows identification of the cause of croup and enables a more accurate prognosis. In the current study, laryngobronchoscopy findings that indicated reflux were predictive of benefit from anti-reflux medications, whereas the clinical presentation of reflux was not. Routine measurement of immunoglobulin E and complement proteins did not appear to be helpful.


Assuntos
Crupe/diagnóstico , Crupe/terapia , Criança , Pré-Escolar , Crupe/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Recidiva , Estudos Retrospectivos
13.
J Laryngol Otol ; 127(4): 392-8, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23458071

RESUMO

OBJECTIVE: To determine the number of children undergoing tonsillectomy that could have this performed as a day surgery procedure. METHODS: This paper reports a prospective cohort study, which entailed a comparison of children's eligibility for day-case surgery between 2001 and 2011 and an assessment of the Scottish Index of Multiple Deprivation scores. RESULTS: In total, 148 children were enrolled. In 2011, 60 children (42 per cent) were eligible for surgery with same day discharge compared with 27 per cent in 2001. The percentage of children undergoing tonsillectomy for sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome increased from 26 per cent to 55 per cent. CONCLUSION: Eligibility for tonsillectomy with same day discharge has increased. This appears to be related to an increase in the number of children who are able to fulfil the social criteria for same day discharge. The results indicate an association between deprivation and tonsillectomy, particularly surgery carried out for the symptoms of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. There has been a significant increase in the percentage of children undergoing tonsillectomy for the indication of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Tonsilectomia/tendências , Adenoidectomia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Escócia/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Fatores Socioeconômicos
14.
Cochrane Database Syst Rev ; 12: CD005607, 2012 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-23235625

RESUMO

BACKGROUND: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2008 and previously updated in 2010.Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES: To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 20 March 2012. SELECTION CRITERIA: All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS: Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total (any documented) haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, we generated summary measures using random-effects models. MAIN RESULTS: Ten trials, comprising a pooled total of 1035 participants, met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were mostly not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (risk ratio (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.90, 95% CI 0.56 to 1.44, P = 0.66). With regard to secondary outcomes, antibiotics reduced the proportion of patients with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS: The present systematic review, including meta-analyses for select outcomes, suggests that although individual studies vary in their findings, there is no evidence to support a consistent, clinically important impact of antibiotics in reducing the main morbid outcomes following tonsillectomy (i.e. pain, need for analgesia and secondary haemorrhage rates). The limited benefit apparent with antibiotics may be a result of positive bias introduced by several important methodological shortcomings in the included trials. Based on existing evidence, therefore, we would advocate against the routine prescription of antibiotics to patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.


Assuntos
Antibacterianos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/tratamento farmacológico , Tonsilectomia/efeitos adversos , Adulto , Analgésicos/administração & dosagem , Antibacterianos/efeitos adversos , Antibioticoprofilaxia , Infecções Bacterianas/tratamento farmacológico , Criança , Convalescença , Febre/tratamento farmacológico , Humanos , Dor Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Scott Med J ; 57(4): 247, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23138584

RESUMO

The objective of this study was to assess if any changes have occurred in the utilization of neonatal services with referral for neonatal airway assessment and how this is related to the establishment of a National Complex Airway Service. A retrospective case-note review was performed for neonates referred for airway assessment from 2004-2010 inclusive. Seventy-nine neonates were referred from throughout Scotland; 10 in 2004-2006, 24 in 2007-2008 and 45 in 2009-2010. The mean gestational age was 35 weeks; 39% were preterm. Stridor was the most common reason for referral (46%). The most common diagnosis was airway malacia (38%). Fifty-three procedures were performed on the ward. In total, 64 microlaryngobronchoscopies were performed; 45 diagnostic and 19 interventional. The most common intervention was supraglottoplasty for airway malacia. Thirty-five separate airway procedures were undertaken. Additional investigations were frequently requested and co-morbidities were common. Since the establishment of the Scottish National Complex Airway Service in 2006, referrals for neonatal airway assessment have increased significantly. The reasons for this include a greater awareness of the service, improved treatment options and increased preterm survival. These neonates frequently have associated co-morbidities and require a repertoire of specialist input. This increase has significant implications for further service provision.


Assuntos
Manuseio das Vias Aéreas/tendências , Unidades Hospitalares/tendências , Hospitais Pediátricos/tendências , Carga de Trabalho/estatística & dados numéricos , Manuseio das Vias Aéreas/estatística & dados numéricos , Broncoscopia , Atresia das Cóanas/diagnóstico , Atresia das Cóanas/terapia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/terapia , Unidades Hospitalares/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Recém-Nascido , Laringoscopia , Laringoestenose/congênito , Laringoestenose/diagnóstico , Laringoestenose/terapia , Laringe/anormalidades , Obstrução Nasal/congênito , Obstrução Nasal/diagnóstico , Obstrução Nasal/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Sons Respiratórios/diagnóstico , Estudos Retrospectivos , Escócia , Estenose Traqueal/diagnóstico , Estenose Traqueal/terapia
16.
Int J Pediatr Otorhinolaryngol ; 76(7): 1017-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22537842

RESUMO

OBJECTIVES: To describe our experience of cricoid split in the older child for acquired subglottic stenosis secondary to chemical or thermal burns. METHODS: A retrospective case series. RESULTS: We describe two patients, both two years old, who benefitted from the procedure and had a return to a normal-sized airway. Neither child required a tracheostomy or further airway intervention after the cricoid split. CONCLUSIONS: Laryngotracheal reconstruction (LTR) is the standard treatment for subglottic injuries with associated subglottic stenosis in children, infants and (where possible) neonates. We have found the cricoid split a useful technique in carefully selected older children with acute subglottic injury and associated early subglottic stenosis, where LTR or ballooning is not feasible, where there is limited experience of ballooning, and/or ballooning has failed in the early stages of treatment. Cricoid split is a technique that is part of the airway surgeon's open operative repertoire and therefore should be remembered as a management option.


Assuntos
Queimaduras/complicações , Cáusticos/toxicidade , Cartilagem Cricoide/cirurgia , Glote/lesões , Glote/cirurgia , Estenose Traqueal/cirurgia , Queimaduras Químicas/complicações , Humanos , Estudos Retrospectivos , Estenose Traqueal/etiologia
17.
Scott Med J ; 57(1): 4-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22194401

RESUMO

The aim of this study was to assess the impact of the recommendations and interventions of the 2003 audit of 'readability and content of postoperative tonsillectomy instructions, given to patients in Scotland'. A two-cycle audit of readability and content of postoperative tonsillectomy instructions was undertaken. All National Health Service (NHS) hospital wards and associated Otolaryngology Departments in Scotland where tonsillectomies were being performed were contacted. Interventions following the first cycle included the mailing copies of original audit results and conclusions to all ear, nose and throat wards in Scotland, presentation at a National Meeting and publication of results in a peer reviewed journal. While changes had occurred in 61% of the information sheets, and with six of the 31 (19%) postoperative information sheets now being written at or below the recommended reading level, the average reading grade/age required to understand these information sheets still remains above those recommended by patient education experts. In conclusion, the majority of postoperative tonsillectomy information sheets in Scotland remain written at a level above those recommended by patient education experts. The interventions undertaken in this audit were of limited success. The ENT-UK Tonsillectomy Information sheets (2006) are written at reasonable reading levels, have good content levels and we continue to recommend these information sheets.


Assuntos
Compreensão , Auditoria Médica , Folhetos , Alta do Paciente , Educação de Pacientes como Assunto , Cuidados Pós-Operatórios/métodos , Tonsilectomia , Adulto , Escolaridade , Feminino , Humanos , Masculino , Programas Nacionais de Saúde , Período Pós-Operatório , Escócia
19.
Cochrane Database Syst Rev ; (7): CD005607, 2010 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-20614441

RESUMO

BACKGROUND: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2008.Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES: To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH STRATEGY: We searched the Cochrane ENT Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to 2009) and EMBASE (1974 to 2009). The date of the last search was 30 October 2009. SELECTION CRITERIA: All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS: Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total (any documented) haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, we generated summary measures using random-effects models. MAIN RESULTS: Ten trials, comprising a pooled total of 1035 participants, met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were mostly not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (relative risk (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.90, 95% CI 0.56 to 1.44, P = 0.66). With regard to secondary outcomes, antibiotics reduced the proportion of subjects with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS: The present systematic review, including meta-analyses for select outcomes, suggests that although individual studies vary in their findings, there is no evidence to support a consistent, clinically important impact of antibiotics in reducing the main morbid outcomes following tonsillectomy (i.e. pain, need for analgesia and secondary haemorrhage rates). Limited benefit apparent with antibiotics may be a result of positive bias introduced by several important methodological shortcomings in the included trials. Based on existing evidence therefore, we would advocate against the routine prescription of antibiotics to patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.


Assuntos
Antibacterianos/uso terapêutico , Tonsilectomia/efeitos adversos , Adulto , Analgésicos , Antibioticoprofilaxia , Infecções Bacterianas/tratamento farmacológico , Criança , Convalescença , Febre/tratamento farmacológico , Humanos , Dor Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
J Laryngol Otol ; 123(6): 642-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19216835

RESUMO

BACKGROUND: Dysphonia is common in children, but practice varies considerably regarding what, if any, investigations are performed and how the condition is managed. Although childhood dysphonia is mostly due to non-serious causes such as voice misuse, very serious pathology such as papillomatosis or malignancy needs occasionally to be excluded, and treatable congenital anomalies such as webs and cysts can be missed. Voice clinics and voice therapy services are now well established in most adult health services in the developed world, but equivalent services for children are less common, at least in the UK. METHODS: We retrospectively reviewed the records of all children presenting to our large children's hospital with a primary complaint of dysphonia between January 2001 and October 2007, in order to determine their management, investigations and final diagnosis. RESULTS: We identified 142 children. Case records were found for 137 (97 per cent). Eight-three children were male (61 per cent) and 54 female (39 per cent). Ages ranged from two months to 15 years (median 5.3 years). In 10 children (7 per cent), hoarseness was congenital, presenting as a hoarse, weak cry at birth. In 15 children (11 per cent), onset of hoarseness was related to a specific surgical procedure. The larynx was visualised by mirror alone in 23 children (17 per cent), by awake fibre-optic laryngoscopy in 27 (20 per cent) and by microlaryngoscopy-bronchoscopy under anaesthesia in 42 (31 per cent). Forty children (29 per cent) did not undergo laryngeal visualisation at any time and were diagnosed based on history alone. A further five (4 per cent) were scheduled for direct laryngoscopy but this was not performed due to resolution of symptoms. Voice abuse accounted for 62 (45 per cent) of all diagnoses. CONCLUSIONS: Childhood dysphonia accounts for a large number of referrals. There is considerable variation in how these children are managed. A more structured approach to diagnosis and investigation would be beneficial, perhaps within the setting of a dedicated paediatric voice clinic.


Assuntos
Disfonia/diagnóstico , Treinamento da Voz , Adolescente , Criança , Pré-Escolar , Disfonia/etiologia , Disfonia/terapia , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Laringoscopia/métodos , Masculino , Estudos Retrospectivos
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