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International Journal of Otolaryngology publishes original research articles, review articles, and clinical studies in all areas of otolaryngology-head and neck surgery.
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Treatment Principle Based on the Clinical Staging of Pharyngocutaneous Fistula
Objective. Studies on factors affecting pharyngocutaneous fistulas (PCFs) and PCF repair methods have been widely reported. However, the healing phases of PCF are unclear, and their elucidation could guide clinical treatment. Methods. Clinical stages of the PCF healing process were identified by a retrospective study of 39 patients with head and neck cancer who developed a PCF. Results. Different conservative treatments were performed in turn according to three defined stages of the PCF healing process: stage I (drainage and debriding period), stage II (pressure dressing period), and stage III (healing period). A 7-day course of antibiotic therapy was only performed in stage I in 23 patients. The PCF was cured in 30 (76.9%) of 39 patients; the remaining 9 patients underwent subsequent surgical interventions for PCF healing. Conclusion. The three stages of PCF healing have a certain reference value in guiding clinical treatments. Moreover, antibiotics should be used in stage I when signs of infection are present, but they should not be used in all three phases of conservative treatment.
A Historical Review of Indian Perspectives on Techniques of Tympanoplasty
Reconstructive surgery of the conductive hearing mechanism is collectively called as tympanoplasty, which has gradually evolved over time with the contributions from all over the word. The aim of the present historical review is to summarize the Indian contributions in the development of the technique of tympanoplasty. The literature review was conducted using only the “Medline” search using keywords “tympanoplasty” and “ossiculoplasty” in “India” on 15th June 2016. A total of 195 articles and abstracts were found dated from the year 1998 onwards. Articles describing work on technique were included, and those describing only experimentation with graft material were excluded. All articles were fully read and analysed. It was found that there had been experiments regarding the choice of anaesthesia and the use of combinations of different chemical agents for this purpose. There were suggestions in favour of monitored anaesthesia care for the surgery in select patients. Surgeons expressed their perspectives on the time and conditions for the surgery, laterality of surgery, different types of incisions, use of endoscopes, graft placement techniques, ossicular replacements with autologous or allogenic grafts, and the timing of prophylactic antibiotic therapy given after or during the surgery. The range of work is wide and covers most of the aspects of surgery; however, the incorporation of a uniform methodology and standards reporting results were lacking in the articles reviewed.
The Effect of Endoscopic Olfactory Cleft Opening on Obstructed Olfactory Cleft Disease
Purpose. This study was conducted to evaluate the effect of endoscopic olfactory cleft (OC) opening on olfaction in patients with obstructed OC disease. Materials and Methods. Patients with obstructed OC disease who underwent endoscopic OC opening for treatment were enrolled. The endoscopic olfactory cleft opening was performed under local anesthesia. Under an endoscopy, the middle and superior turbinates were gently lateralized to open the OC using an elevator. The phenyl ethyl alcohol threshold test was performed to evaluate the olfactory function both before and after surgery. Results. An endoscopic OC opening was performed on 42 patients. Amongst them, the etiology of OC obstruction revealed anatomic anomalies in 14 patients, inflammatory process in 14, and anatomic anomalies as well as inflammatory process in 14. The phenyl ethyl alcohol threshold levels improved in 32 (76.2%) of the patients after surgery. The olfactory function was better improved in patients experiencing OC obstructed by inflammatory process than those by anatomic anomalies. Conclusions. This study showed that endoscopic OC opening seemed to be effective in treating olfactory dysfunction in patients with obstructed OC disease caused by inflammatory process.
An Analysis of Complaints in Two Large Tertiary University Teaching Hospital ENT Departments: A Two-Year Retrospective Review
Introduction. Complaints relating to patient care are known to correlate with surgical complication rates and malpractice lawsuits. In a continually evolving health service and on-going financial pressures, identifying current complaint themes could drive future improvements in healthcare delivery. Objective. The aim of this paper is to review and analyse complaints received by the ENT department of two large teaching hospitals in London in order to determine current trends and mitigate future challenges. Method. All complaints registered with the Patient Advice and Liaison Service (PALS) from the ENT Department at our institution were collected between June 2016 and August 2018. Demographic information was collated and complaints were analysed and interpreted as per a standardised coding taxonomy. Results. A total of 242 complaints were collected. Most (91.7%) were logged by patients themselves with a mean age of 48.3 (range 3–98 years). The majority were directed at the administrative team (52%) followed by management (23.5%) and then clinicians (16.9%). Administrative issues were the most common (50.1%) followed by clinical (25.1%) and relationship/communication (24.7%). The bulk of complaints focused on delays in access to services and treatment in the form of cancellations and long appointment waiting times (37%). Conclusion. There has been a significant shift in complaints themes from clinical issues to administrative issues. This may reflect increasing financial and staffing pressures in the NHS. Complaints analysis is key in quality improvement and a cross-specialty integrated filing system in concordance with the recently proposed taxonomy would ease future collection and analysis of data.
Merocel Surgicel Wrap Technique to Manage Diffuse Epistaxis in Patients with Comorbidities
Epistaxis, or nasal bleeding, occurs in over half of the general population. It is caused by various etiological factors and affects both sexes and all age groups. The simplest treatment for a nosebleed is pinching of the ala nasi, referred to as the Hippocratic technique. In this study, we adopted different treatment protocols dependent on the severity of bleeding and assessed the etiology and efficacy of these modalities. This was a prospective study. We recruited 25 patients (24 adults and 1 child) who presented with epistaxis in the ENT departments of two tertiary care hospitals. We evaluated the cause of epistaxis and efficacy of the treatments used. All patients had experienced several episodes of epistaxis and were managed using anterior nasal packing with gauze and ointment or with Merocel packs alone. The incidence of epistaxis was more common in males than in females. It was effectively managed by anterior nasal packing with Surgicel-wrapped Merocel. Patients did not experience further episodes of bleeding following the removal of Merocel and retention of Surgicel in place.
Friedman Score in Relation to Compliance and Treatment Response in Nonsevere Obstructive Sleep Apnea
Nonsevere obstructive sleep apnea (OSA) is most often treated with a continuous positive airway pressure (CPAP) device or a mandibular advancement splint (MAS). However, patient compliance with these treatments is difficult to predict. Improvement in apnea-hypopnea index (AHI) is also somewhat unpredictable in MAS treatment. In this study, we investigated the association between Friedman tongue position score (Friedman score) and both treatment compliance and AHI improvement in patients with nonsevere OSA receiving CPAP or MAS treatment. 104 patients with nonsevere OSA were randomly allocated to CPAP or MAS treatment and followed for 12 months. Data were collected through a medical examination, questionnaires, sleep recordings from ambulatory type 3 polygraphic sleep recording devices, and CPAP recordings. Associations between Friedman score, treatment compliance, and AHI improvement were analysed with logistic regression analyses. Friedman score was not associated with treatment compliance (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.59–1.23), or AHI improvement (OR: 1.05, 95% CI: 0.62–1.76) in the overall study sample, the CPAP treatment group, or the MAS treatment group. Adjustment for socioeconomic factors, body mass index, and tonsil size did not significantly impact the results. Although Friedman score may predict OSA severity and contribute to the prediction of success in uvulopalatopharyngoplasty, we found no association between Friedman score and treatment compliance in patients with nonsevere OSA receiving CPAP or MAS treatment, nor did we find any association between Friedman score and AHI improvement. Factors other than Friedman score should be considered when deciding whether a patient with nonsevere OSA should be treated with CPAP or MAS.