Associative factors for tracheostomy in patients presenting with stridor or upper airway obstruction

OBJECTIVE

This study aimed to identify associative factors for tracheostomy in patients presenting with airway obstruction.

METHODS

Data from a tertiary hospital were reviewed to identify patients who presented with airway obstruction between 2009 and 2020. Patient demographics, causative pathology and treatments were analysed.

RESULTS

The study identified 297 admitted patients. Of these, 66 underwent a tracheostomy and formed the 'tracheostomy' group and 231 formed the 'other intervention' group. The tracheostomy group had a higher mean age (p = 0.003), and higher percentages of males (p = 0.031) and smokers or ex-smokers (p = 0.020), compared to the other intervention group. The tracheostomy group also had a higher number of patients with a malignancy (p < 0.001) compared to the other intervention group.

CONCLUSION

Being older, male, a previous or current smoker, or developing airway obstruction due to a malignancy were found to be the main associative factors for requiring a tracheostomy.

Melanoma predilection for the lower limbs of women compared with men

The lower limb is a common site for melanoma in women, but the reason for this is not fully understood. To investigate this phenomenon in more detail, we assessed the specific subsites of primary melanoma occurring on the lower limbs of females compared with males across age groups. In a records-based study at an oncology hospital in north-west of England, among an unselected sample of patients with primary invasive melanoma treated between 2002-2015, information was collected on patient age at diagnosis, sex, and co-morbidities, and the tumor thickness and anatomical subsite (thigh, lower leg, foot for lower limb). Of a total sample of 1,522 patients, 316 (227, 72% female) had lower limb melanoma. The most common subsite was lower leg (142 cases with F:M ratio =3.74), followed by thigh (55 cases with F:M = 1.83) and feet (30 cases with F:M = 1.15). At ages <40 years the odds of thigh to foot melanoma was 20 times higher in females than in males (OR 20.0, 95% CI 2.6-152.6) and 7.5 times higher on the lower limb (OR 7.5, 95% CI 1.1-49.2). For ages 40+ years, the odds of females developing thigh melanoma compared to foot melanoma was similar in males versus females (OR 0.8), while the corresponding odds of lower leg melanoma in females versus males remained significantly increased at ages 40-59 and 60+ (OR 4.2 and 2.8 respectively). Our study demonstrates the female predilection for lower limb melanoma persists over most but not all subsites.However, there is heterogeneity in the female to male occurence of lower limb melanoma across subsites and at different ages, which may be linked to relative influence of genetic and environmental risk factors.

762 Completed Cycle Audit on Treatment Escalation Planning Documentation in ENT In-Patients

Aim

Treatment Escalation Planning (TEP) helps ensure treatment foals of patients are developed understood and respected. Treatment Escalation documentation is a communication tool that provides staff immediate and accessible guidance in times of crises. A standardised form was created to improve and standardise TEP documentation in ENT in-patients. This audit aimed to review form completion rates. A further cycle was done to assess whether interventions improved practice.

Method

A retrospective audit of TEP form completion rates and quality of documentation. Paediatric patients and patients from elective surgery discharged on the same day were excluded. Data tabulated included age, co-morbidities, reason for admission, type of admission (emergency/ elective), DNACPR documentation (community and in-hospital), TEP form completion.

Results

The median age for patients included in the study was 73.5 years old. 83% were emergency admissions. Patients were multi-morbid (Malignancy, cardio and cerebro vascular disease, COPD etc.) In the first cycle 23% had in hospital DNACPR forms, 0% had community DNACPR and 0% had TEP forms completed. Intervention included staff education and physical reminders on handover documentation. Second cycle showed improvement, 40% of TEP forms were completed however 1 patient had community DNACPR in place but no in-hospital DNACPR.

Conclusions

Our intervention showed improvement in treatment escalation plan documentation. This audit also picked up a problem i.e., community DNACPR not converted to inpatient DNACPR whilst patient is an inpatient. Next steps include further intervention to improve completion rates and further audit to ensure longlasting improvement.

1031 Survival Outcomes for Larynx-Preserving Therapy Compared to Total Laryngectomy in Advanced Laryngeal Tumour: A North-East of Scotland Cohort

Aim

Advanced laryngeal tumours (stage III and IV) management remains uncertain. This study aims to investigate whether choice of organ-preservation treatment (radiotherapy or radiochemotherapy) or surgical intervention (total laryngectomy with/without adjuvant therapy) affects survival in the North-east of Scotland cohort.

Method

Laryngeal cancer data was prospectively collected and maintained at a tertiary care centre at NHS Grampian Scotland. This data was retrospectively analysed for overall and disease specific survival. Death from laryngeal cancer was recorded from death certificates. Statistical analysis with Cox regression was used to estimate hazard ratios for sex, smoking status, age, staging, tumour site, and treatment choice in the advanced laryngeal cancer cohort.

Results

A total of 311 laryngeal cancer patients were identified. 49 patients were stage III and of which 35 (71%) received organ-preserving treatment and 14(29%) underwent total laryngectomy. The corresponding numbers for 65 stage IV patients were 13 (20%) and 52 (80%) respectively. On cox regression for overall survival, reduced survival was associated (p&lt;0.05) with choice of organ preservation and stage IV disease, fully adjusted HRs (95%CI) were 2.57 (1.42–4.66) and 3.00(1.08–8.34) respectively. For disease specific survival, no variables were found to be significant. Median follow up time from date of diagnosis to death was 1.56 years.

Conclusions

Organ preserving intervention was associated with a worsened overall survival in the advanced laryngeal cancer cohort. This study suggests that primary surgical intervention remains a key element in the treatment of advanced laryngeal cancer and future bigger cohort studies may be needed to evaluate this relationship.

A multicentric multimodal in vivo microscopy MRI study of bipolar disorder reveals axonal loss and demyelination

Introduction

Bipolar disorder has been repeatedly associated with abnormalities of white matter. However, DTI is intrinsically limited and the precise cellular mechanisms that underlie these alterations remains unknown.

Objectives

Our aim was to investigate microscopical characteristics of white matter using MRI in patients with bipolar and healthy controls.

Methods

77 patients and 71 controls from 3 sites had a T1 structural MRI, a multi-shell HARDI MRI and at one site with a T1-weighted VFA-SPGR acquisition, and a T2 MSME acquisition. The volume fraction and the orientation dispersion was extracted using NODDI from DW images in each site. Myelin Water Fraction was extracted in 33 patients and 36 controls to probe myelin characteristics. White matter bundles were reconstructed using deterministic tractography. Statistical analyses were performed after harmonization by the ComBat algorithm and controlled for age, gender and handedness.

Results

We found significant lower axonal density in patients along the short fibers of the left cingulum, the left anterior arcuate and the left inferior fronto-occipital fasciculus. We found lower mean MWF in patients along the short fibers of the right cingulum, the left inferior fronto-occipital fasciculus, the left anterior arcuate and the splenium of the corpus callosum. We found higher mean orientation dispersion in patients only along the left uncinate fasciculus.

Conclusions

We report alterations of limbic and inter-hemispheric white matter tracts in patients with bipolar disorder reflecting axonal loss, demyelination and architecture alterations. These results contribute to better capture the plurality of the mechanisms involved in bipolar disorder that cannot be deciphered with classical diffusion MRI.

Disclosure

No significant relationships.

Efficacy of Citrullus colocynthis seed extract on Earias vittella, Fabricius, (Lepidoptera: Noctuidae): environment sustainable approach

Abstract Earias vittellaFabricius, 1794 (Noctuidae: Lepidoptera) is deliberated to be one of the most destructive pests of cotton and okra vegetation in the world including Asia. The pest has established resistance to various synthetic insecticides. The use of bio-pesticide is one of the unconventional approaches to develop a vigorous ecosystem without harming non- target pests and beneficial natural insect fauna. In the present study, the toxicity levels of Citrullus colocynthis seed extract have been evaluated against the populations of E. vittellaunder standardized laboratory conditions. The toxic effects of C. colocynthis on development periods, protein contents and esterase activity of the life stages of E. vittella were also evaluated. The toxicity levels of methanol, ethanol, hexane, water and profenofos were evaluated on the 1st instar larvae of E. vittella. LC30 and LC80 concentrations exhibited the effectiveness of methanol-based C. colocynthis seed extract against 1st instar larvae of E. vitella. The enhanced larval and pupal periods were revealed in treated samples during the comparison with untreated samples. The intrinsic rate of increase, net reproductive rate in the LC30 and LC80 concentrations exposed larvae remained less than the control treatment. Fecundity, the esterase activity and protein contents were declined in LC30 and LC80 treated samples as compared to the control. The present findings suggest that C. colosynthis extracts based botanical insecticides are beneficial, ecosystem sustainable and can be integrated with insect management programs from environment safety perspective.

1402 Impact of COVID-19 on Nasal Fracture Presentation and Epidemiology: A Retrospective Comparative Case-series Study

Aim

Nasal fractures (NF) are the most common ENT presentation and commonly managed in the clinic or A&E. With the recent COVID pandemic, this study aims to assess the difference in demographics, incidence and aetiology in NF since the start of the first lockdown (16/03/2020) as well as management of nasal fractures.

Method

Retrospectively, data collection on demographics, history and management over 5 years (2015-2020) for all patients presenting with symptoms of nasal fracture. Data was collected on password-protected Excel spreadsheet and subsequent statistical analysis performed using IBM SPSS Statistics.

Results

A total of 346 patients were identified of which 36 were diagnosed during the lockdown. Seventy-one percent were ≤40 years old and common aetiology recorded was assault (n = 85), sports (n = 85) and falls (n = 77). Mechanical fall was the common aetiology in older patients. Across gender, falls was the most common aetiology in females (37/94) and assault for males (72/246). Epistaxis (57%) and nasal congestion (31.8%) were most commonly reported symptoms. Before lockdown, Fifty-six percent of the cohort underwent manipulation of NF under local anaesthetic and no intervention needed in 39% while 58% underwent no intervention during the lockdown. No patients were readmitted in 30 days who were treated conservatively or with local anaesthetic during the lockdown.

Conclusions

This study showed that the most common cause of NF was sports and assault while during the lockdown, falls was the leading cause. More patients were managed conservatively during the lockdown with no 30-readmission showing that conservative management was as effective as management under local anaesthetic.

Electrochemical investigations of DNA-Intercalation potency of bisnitrophenoxy compounds with different alkyl chain lengths

In this study, the binding tendency of bisnitrophenoxy compounds (BN) having different methylene (-CH₂-)_n spacer groups (n = 8-11) with fish sperm double stranded deoxyribonucleic acid (dsDNA) was explored. Cyclic voltammetry (CV) was used to evaluate various kinetic and binding parameters (K_s,h, D_o, K _b and binding site sizes). Performed electrochemical studies designated strong contact of these symmetric molecules with dsDNA in threading intercalation mode of binding. The number (n) of methylene spacer group in the molecular structure of bisnitrophenoxy compounds, e.g., BN-8 (1-nitro-4-(8-(4-nitrophenoxy)octyloxy)benzene, was observed to have a strong influence on their binding affinity. Decreased peak current values and positively shifted peak potentials recorded via cyclic voltammetry clearly depicted that bisnitrophenoxy compounds can intercalate with dsDNA. Results demonstrated the following order of binding constants; K _b (M^-1): BN-8 (2.32 × 10⁴) < BN-9 (5.73 × 10⁴) < BN-10 (8.97 × 10⁴) < BN-11 (17.34 × 10⁴). The order of increasing binding sites from BN-8 (0.13) to BN-11 (1.38), revealed the maximum threading intercalation strength by bisnitrophenoxy compound having the longest methylene spacer (n = 11). Thermodynamic studies augmented the strong binding of BN-11 with dsDNA as compared to BN-8 because of the long-chain, -CH₂- spacer in its structure. The spontaneity of dsDNA-binding was revealed by the negative ΔG values for interaction of all the compounds. Moreover, binding parameters from thermodynamic and kinetic studies also corresponded to the threading intercalation mode of interaction, which itself points to the potency of the envisioned drug-like molecules.

Outcome Of Use Of Nasal Continuous Positive Airway Pressure Through Infant Flow Drivers In Neonates With Respiratory Distress In A Tertiary Care Hospital In Pakistan

BACKGROUND

Nasal continuous positive pressure has been used for management of respiratory distress in neonates in various conditions as a primary modality. Objective of the study is to evaluate the frequency of improved outcome and complications of use of nasal CPAP through infant flow drivers in neonates with respiratory distress. The study was conducted from 2nd April 2017 to 2nd October 2017 in neonatal intensive care unit of Allama Iqbal Memorial Teaching Hospital Sialkot.

METHODS

All neonates with respiratory distress fulfilling the clinical criteria (Neonates with gestational age 28 weeks to 40 weeks having clinical signs of respiratory distress classified according to down score (tachypnea, grunting, decreased air entry, cyanosis, recessions), neonates having pc02 <60 mmhg, neonates having x-ray findings consistent with respiratory distress syndrome (RDS), Transient tachypnea of newborn (TTN) and pneumonia) were included in the study. Nasal CPAP was used at variable settings. Outcome, complications, indications, associated diseases and hospital stay along with other baseline characteristics were assessed. Success was defined as improvement of the respiratory distress as assessed by down score, maintenance of SPO2 above 90% in room air after weaning from CPAP for about consecutive 4 hours and normalization of blood gases while the failure as need for mechanical ventilation.

RESULTS

Total 60 neonates were included in the study. Mean weight was 2113.3±580.32 g while mean gestational age was 33.35±2.59 weeks. Total 52 (86.7%) babies were successfully weaned off from nCPAP while only 8 (13.3%) neonates required mechanical ventilation. Main indication of use of CPAP was RDS (65%). No complications were observed in 73.3% babies while 26.7% had complications of which nasal deformities accounted for 20% and abdominal distension for 6.37%.

CONCLUSIONS

Nasal CPAP can be safely and easily used as primary support for neonates with respiratory distress even in resource limited developing countries. It reduces the need for mechanical ventilation and thus hospital stay.

Induced interval-valued Pythagorean trapezoidal fuzzy aggregation operators based on Einstein operations and their application in group decision making

The aim of this paper is to investigate the information aggregation methods under induced interval-valued Pythagorean trapezoidal fuzzy environment. Some Einstein operational laws on Pythagorean trapezoidal fuzzy numbers are defined based on Einstein sum and Einstein product. In this paper, we introduce the idea of induced interval-valued Pythagorean trapezoidal fuzzy Einstein ordered weighted geometric (I-IVPTFEOWG) operator and induced interval-valued Pythagorean trapezoidal fuzzy Einstein hybrid geometric (I-IVPTFEHG) operator. We discuss some basic properties of the proposed operator, including idempotency, commutativity and monotonicity. We construct an algorithm for multiple attribute group decision making problem, and apply the proposed aggregation operator to deal with multiple attribute group decision making. Finally we construct a numerical example for multiple attribute group decision making and compare the result with existing methods.

Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing?

Setting: Ten hospitals managing drug-resistant tuberculosis (TB) in Pakistan. Objective: To assess the implementation of TB infection control (IC) practices and reasons for non-adherence to guidelines. Design: This was a descriptive study conducted between April and October 2016 with three components: 1) non-participant observation of service delivery areas (SDAs) (n = 82) in hospitals (n = 10) using structured checklists; 2) exit interviews with 100 patients (10 per hospital); and 3) interviews with 100 health-care workers (HCWs, 10/hospital). Results: Of the 82 SDAs, posters were displayed in 34 (41%), mechanical ventilation was implemented in 79% and functional ultraviolet germicidal irradiation (UVGI) was available in only 26%. Patient interviews showed 50-65% adherence to triage and use of personal protective measures. Key reasons for non-adherence were lack of adequate supplies, discomfort using N-95 masks, a lack of knowledge or training, perceived non-cooperation by patients, poor maintenance of mechanical ventilators and UVGI due to unstable electricity supply, a lack of clarity in roles (no-one designated in charge) and staff shortages and subsequent workloads. Adherence to natural ventilation usage was poor for reasons related to climate and privacy. Conclusion: Implementation of TBIC measures in hospitals was suboptimal. Urgent measures need to be put in place, including retraining of HCWs, addressing weaknesses in mask and poster supplies and constant supervision and monitoring.

Intra-parotid dermoid cyst: excision through a face lift incision

Intra-parotid dermoid cysts are extremely rare. Clinically, they present like any other parotid lump and pre-operative diagnosis is rarely possible. A 62 years old Caucasian man presented with a painless lump in his right parotid region. The Magnetic Resonance Imaging (MRI) scan revealed a 3 x 3 cm mass in the parotid tail. Cytological examination was unhelpful. The patient underwent successful excision of the cyst through a small face lift incision. No drain was inserted and the patient was discharged home the same day. The patient made an uneventful recovery and was highly satisfied with the aesthetic outcome. The definite histopathological diagnosis was an intra-parotid dermoid cyst.

Neck abscess and vocal cord paresis: delayed complications of a self-extruded long fishbone stuck in throat

A 57-year-old Caucasian man, otherwise fit and well, presented with a 2-week history of dysphagia, odynophagia. Two weeks prior to the presentation, he had felt a fishbone stuck in his throat which was self-extruded after 3 days. Subsequently he developed a right anterior neck swelling and hoarseness. Transnasal endoscopic examination of larynx revealed an injected and oedematous right hemilarynx with right vocal cord paresis. An ultrasound examination of the neck confirmed a collection in the neck on the right side, and frank pus was aspirated from the neck abscess and he responded well to conservative management. Subsequent examination in follow-up had shown complete recovery of vocal cord movement. The patient did not seek medical attention immediately after getting a 5 cm fishbone extruded from the throat which resulted in significant morbidity. All patients should be alerted to the possibility of delayed complications and they should be encouraged to seek urgent medical attention.

Long-term results of endonasal dacryocystorhinostomy with and without stenting

INTRODUCTION

This study aimed to evaluate the short and long-term results of endoscopic dacryocystorhinostomy (DCR) with and without silicone stenting in chronic dacrocystorhinitis due to postsaccal blockage.

METHODS

The study involved a case series of consecutive 89 patients (128 eyes) who underwent endoscopic DCR. All patients were operated on by the senior author. The stent group comprised 63 eyes (44 patients), for which the DCR was performed between September 2002 and September 2005. The non-stent group with 65 eyes (45 patients) underwent the DCR between October 2005 and December 2006. The follow-up duration was up to 33 months after surgery. The statistical significance (p-value) was calculated using the chi-squared test.

RESULTS

The short-term success rate at six months' follow-up was 70% in the stent group and 97% in the non-stent group (p=0.0005) while the long-term success rate at 33 months was only 57% in stent group compared with 89% in the non-stent group (p=0.0003).

CONCLUSIONS

In this study, the non-stent group showed a higher success rate than the stent group on both short and long-term follow-up. Our study suggests that postoperative stents are not necessary for primary DCR and may be associated with a worse outcome.

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.

Pitfalls in neuroimaging of headache: a case report and review of the literature

Headache is a common symptom, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. Neuroimaging is indicated in patients with red flag features for secondary headaches. The guidelines recommend CT or MRI scan to identify any intracranial pathology. We present a unique case where the initial noncontrast CT scan failed to identify a potential treatable cause for headache. A middle aged man presented with headache and underwent a CT scan without contrast enhancement. The scan was reported as normal. The headache persisted for years and the patient underwent a staging CT scan to investigate an oropharyngeal cancer. This repeat CT scan utilized contrast enhancement and revealed a meningioma. Along with other symptoms, headache is an established presenting complaint in patients with meningioma. The contrast enhanced CT brain proved superior to a nonenhanced CT scan in identifying the meningioma. In a patient with persistent headache where other causes are excluded and a scan is to be requested, perhaps contrast enhanced CT is a better option than a plain CT scan of brain.

Unilateral blindness secondary to acute sphenoid sinusitis

OBJECTIVES

To highlight a rare scenario where a delay in diagnosis caused unilateral blindness.

CASE REPORT

A 45-year-old Aboriginal woman with a history of non-Hodgkin's lymphoma presented with a severe left-sided headache, pyrexia and positive blood cultures. Following admission, the patient rapidly developed unilateral blindness, but did not inform her physician until 21 hours after onset. High-resolution CT scanning of the sinuses showed erosion of the bony covering of the optic nerve. Sinus surgery was performed.

RESULTS

Despite the discovery of pus under considerable pressure, and clearing the sphenoid sinus of pus and debris, vision was not restored, even at 2-month follow-up.

CONCLUSIONS

Two pathological processes are postulated here: that erosion of the bony optic canal allowed the optic nerve to be exposed, allowing the ensuing sinusitis to cause irreversible nerve ischemia, and immunosuppression meant the patient's immune response was inadequate to cope with the sinusitis, with devastating effects.

The evidence-based management of bilateral ethmoid osteomas: diagnosis, endoscopic resection and review of the literature

A 56-year old woman presented with headaches and nasal congestion secondary to bilateral ethmoid osteomas and she made a full recovery following endoscopic resection. Paranasal osteomas are common, benign, encapsulated tumours that are often asymptomatic, but may present similarly to rhinosinusitis and occasionally cause complications depending on their anatomical location. Bilateral ethmoidal osteomas, however are a rare occurrence and have not been previously reported in the English literature as far as the authors are aware. Ethmoidal and fronto-ethmoidal osteomas, like other paranasal osteomas, are easily diagnosed using computed tomography and are increasingly amenable to endoscopic resection. An evidence-based management plan is presented.

Diurnal periodicity of adult eclosion mating and oviposition of the european leafminer Scaptomyza flava (Falln) (Diptera Drosophilidae)

The European leafminer Scaptomyza flava is an important pest of brassicas peas and gypsophila in New Zealand The patterns of S flava adult eclosion mating and oviposition were determined in the laboratory Most adults (97) emerged in the photophase with maximum adult eclosion occurring between 2 and 3 h into the photophase Mating took place exclusively in the photophase and peaked about 30 min after lights on Both male and female S flava mated more than once Females started oviposition 3 days after emergence and the fecundity (number of eggs laid) and fertility (number of eggs hatched) peaked between 5 and 10 days after emergence The mean lifetime fecundity was 133541 eggs with the fertility rate being 57 during the 40day oviposition period

Patients' satisfaction with the nurse-led aural care clinic

BACKGROUND

The necessity of decreasing costs while maintaining a high standard of clinical care has led to the expansion of the role of nurses in recent years. To this end, nurse-led clinics are becoming increasingly common in otolaryngology. The aims of this cross sectional survey were to assess patients' satisfaction with this nurse-led aural care clinic.

METHOD

Patients attending this clinic were requested to fill in an anonymous questionnaire. Data was collected for 12 weeks between January and April, 2007.

RESULTS

Forty-four questionnaires were completed satisfactorily (44/50 = 88%). In response to the presenting complaint, the nurse gave verbal advice (25), discussed with a doctor (10) or arranged a doctor review (9). Forty patients were very satisfied and 4 patients were satisfied with the overall care in the clinic.

CONCLUSION

Combining medical and nursing efforts can provide efficient use of limited time resource in NHS. Nurse-led clinics are cost effective and help reduce the waiting time, for outpatient clinics.

Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK

OBJECTIVE

Little data is available on complementary and alternative medicine (CAM) use in children attending otolaryngology services. We investigated the prevalence and pattern of CAM use among children attending the pediatric otolaryngology department in a tertiary pediatric teaching hospital in Scotland.

DESIGN

A cross-sectional survey conducted by administering an anonymous questionnaire to the parents accompanying patients attending the pediatric otolaryngology department. Elective admissions and clinic attendees were included over a 3-month period in 2005/2006.

SETTING

Academic tertiary care referral centre in North-East Scotland.

PATIENTS

Five hundred and fifty-four consecutive patients aged less than 16 years were eligible. The response rate was 59% (n=327).

MAIN OUTCOME MEASURES

Prevalence of CAM use in children. Secondary measures include types of CAM used, indications for use and communication with family physicians.

RESULTS

Based on 327 responses, 93 patients (29%) had ever used CAM, 20% within the last year. Commonly used CAM preparations were cod-liver oil, echinacea, aloe vera, cranberry, primrose oil and herbal vitamin supplements. The popular non-herbal CAM included homeopathy, massage, aromatherapy, chiropractic, yoga and reiki. Nineteen percent used CAM for their admission illness. Sixty-one percent of parents thought that CAM was effective and 65% would recommend it to others. Fifty-one percent of parents stated that the family physician was unaware of CAM use by the child.

CONCLUSIONS

Despite concerns regarding the efficacy, safety and cost effectiveness of complementary and alternative medicine, its use among the pediatric otolaryngology population is more common than many providers may realize. This has implications for all healthcare workers involved in their care.

Evaluation of endoscopic sinus surgery by Glasgow benefit inventory

INTRODUCTION

Functional endoscopic sinus surgery is a common adjunct to medical therapy in cases of chronic rhinosinusitis and nasal polyposis.

AIM

The objective of this study was to assess patients' quality of life up to two years after endoscopic sinus surgery.

METHOD

Fifty consecutive patients attending a rhinology clinic filled in the Glasgow benefit inventory. The patients were divided into three groups according to the time period elapsed since surgery (i.e. six months, 12 months or up to two years).

RESULTS

The results showed that, generally, the Glasgow benefit inventory scores indicated a benefit from the procedure. Overall, surgery led to statistically significant improvements in both total and general scores (p < 0.05). Comparison of endoscopic sinus surgery with nasal polypectomy (plus endoscopic sinus surgery) indicated a greater benefit for polyp disease. No statistical difference was observed between the scores for females vs males or for various post-operative follow-up periods.