Balloon sinuplasty has been licensed for the treatment of chronic rhinosinusitis since 2006. Balloon dilation enlarges the sinus ostium by effecting tiny fractures of the surrounding bone and compressing soft tissue such that no mucosa is removed. We believe this to be the ideal technique for achieving drainage of an acutely infected frontal sinus when surgical intervention is required. We report the application of this new technique in a 32-year-old female with acute frontal sinusitis. The frontal sinus was successfully cannulated and drained. Post-operative irrigation was achieved using a modified Vortex catheter.
Chronic rhinosinusitis has a significant impact on health-related and generic quality-of-life, has a high cost burden to both society and patients, and may be associated with absenteeism, loss of productivity and poor respiratory function. Though there is a paucity of level 1 evidence, endoscopic sinus surgery may be considered in medically refractory patients and a variety of objective and subjective outcome measures exist to assess the effectiveness of intervention. We outline the outcome measurements available and review in-depth the published outcomes to date. Furthermore we discuss the literature that indicates that endoscopic sinus surgery can have a positive effect on respiratory function in asthma. How patient selection, timing and extent of surgery, and post-operative care interventions may optimise surgical outcomes is explored.
We believe that balloon sinuplasty has a place in routine rhinology practice but that its applications are limited, and that its additional costs must be considered. We present advantages and possible limitations of the technique.
Summary-In the United Kingdom (UK) T-and Z-scores are usually calculated using reference ranges derived from United States (US) populations. In the UK arm of a recent randomised trial (IBIS-II) substantially fewer women than expected were recruited into the osteopenic (-2.5 < Tscore < −1.0) and osteoporotic (T-score < −2.5) arms of the study. Comparison with data from two independent studies showed that UK women aged > 45 years with a typical body mass index of 28 kg m −2 have spine and hip BMD 0.6 SD higher than their US counterparts.Introduction-Dual energy X-ray absorptiometry (DXA) is widely used for the diagnosis of osteoporosis and to investigate the effect of pharmacological treatments on bone mineral density (BMD). In both routine and research settings it is important that DXA results are correctly interpreted.
Objective
This study sought to assess the impact of simulation training in influencing trainees’ initial surgical participation as perceived by experienced surgeon trainers.
Methods
Twenty ENT surgeons assessed how much of a given procedure they would expect to allow a trainee to perform for their first time. Responses were provided for trainees who had undergone a relevant simulation course and those who had not, and scored according to the eLogbook levels of involvement in surgery. This was completed for simulated procedures with validated models, across four grades of junior doctors.
Results
A total of 1120 judgements on the trainees’ intended level of involvement were made. The median involvement score was higher in the simulation group versus the non-simulation group (Mann–Whitney U, p = 0.0001), corresponding to a translation in surgical opportunity from a primarily assisting role to an active role.
Conclusion
Trainer perception of a relevant ENT simulation course appears to positively impact on the initial surgical opportunities afforded to the trainee.
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