The Glasgow Benefit Inventory (GBI) is a measure of patient benefit developed especially for otorhinolaryngological (ORL) interventions. Patient benefit is the change in health status resulting from health care intervention. The GBI was developed to be patient-oriented, to be maximally sensitive to ORL interventions, and to provide a common metric to compare benefit across different interventions. The GBI is an 18-item, postintervention questionnaire intended to be given to patients to fill in at home or in the outpatient clinic. In the first part of the paper, five different ORL interventions were retrospectively studied: middle ear surgery to improve hearing, provision of a cochlear implant, middle ear surgery to eradicate ear activity, rhinoplasty, and tonsillectomy. A criterion that was specific to the intervention was selected for each study, so that the patient outcome could be classified as above and below criterion. In all five interventions, the GBI was found to discriminate between above- and below-criterion outcomes. The second part of the paper reports on the results and implications of a factor analysis of patient responses. The factor structure was robust across the study, and so led to the construction of subscales. These subscales yield a profile score that provides information on the different types of patient benefit resulting from ORL interventions. The GBI is sensitive to the different ORL interventions, yet is sufficiently general to enable comparison between each pair of interventions. It provides a profile score, which enables further breakdown of results. As it provides a patient-oriented common metric, it is anticipated that the GBI will assist audit, research, and health policy planning.

No abstract

The UK National Study of Hearing set out to ascertain the prevalence of hearing impairments of various magnitudes, the prevalence of ear disease and the associated risk factors, and to estimate the percentage of individuals requiring some form of management. A stratified sample of 2708 British adults, aged 18-80 years, was chosen from a sample of 48,313 adults, randomly selected from the electoral roll, for a full otological and audiological assessment. This paper deals primarily with the middle ear results. Otoscopically, 2.6% of British adults had inactive and 1.5% had active chronic otitis media. This condition was more common in older individuals and in those in manual occupations. For this purpose, presumptive otosclerosis was defined as a conductive component to the impairment (average air bone gap over 0.5, 1 and 2 kHz of 15 dB or greater) and with an intact tympanic membrane. The population prevalence for presumptive otosclerosis was 2.1%, for healed OM 1.7% and for Eustachian tube dysfunction 0.9%. This prevalence of otosclerosis was higher in those over 40 years, but only in those with air bone gaps of 30 dB or greater were women more likely to have the condition than men, by a factor of three. At most, 20% of individuals with any of the above middle ear conditions will have had ear surgery.

BackgroundThe Glasgow Benefit Inventory (GBI) is a validated, generic patient-recorded outcome measure widely used in otolaryngology to report change in quality of life post-intervention.Objectives of reviewTo date, no systematic review has made (i) a quality assessment of reporting of Glasgow Benefit Inventory outcomes; (ii) a comparison between Glasgow Benefit Inventory outcomes for different interventions and objectives; (iii) an evaluation of subscales in describing the area of benefit; (iv) commented on its value in clinical practice and research.Type of reviewSystematic review.Search strategy‘Glasgow Benefit Inventory’ and ‘GBI’ were used as keywords to search for published, unpublished and ongoing trials in PubMed, EMBASE, CINAHL and Google in addition to an ISI citation search for the original validating Glasgow Benefit Inventory paper between 1996 and January 2015.Evaluation methodPapers were assessed for study type and quality graded by a predesigned scale, by two authors independently. Papers with sufficient quality Glasgow Benefit Inventory data were identified for statistical comparisons. Papers with <50% follow-up were excluded.ResultsA total of 118 eligible papers were identified for inclusion. A national audit paper (n = 4325) showed that the Glasgow Benefit Inventory gave a range of scores across the specialty, being greater for surgical intervention than medical intervention or ‘reassurance’. Fourteen papers compared one form of surgery versus another form of surgery. In all but one study, there was no difference between the Glasgow Benefit Inventory scores (or of any other outcome). The most likely reason was lack of power. Two papers took an epidemiological approach and used the Glasgow Benefit Inventory scores to predict benefit. One was for tonsillectomy where duration of sore throat episodes and days with fever were identified on multivariate analysis to predict benefit albeit the precision was low. However, the traditional factor of number of episodes of sore throat was not predictive. The other was surgery for chronic rhinosinusitis where those with polyps on univariate analysis had greater benefit than those without. Forty-three papers had a response rate of >50% and gave sufficient Glasgow Benefit Inventory total and subscales for meta-analysis. For five of the 11 operation categories (vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery) that were most likely to have a single clear clinical objective, score data had low-to-moderate heterogeneity. The value in the Glasgow Benefit Inventory having both positive and negative scores was shown by an overall negative score for the management of vestibular schwannoma. The other six operations gave considerable heterogeneity with rhinoplasty and septoplasty giving the greatest percentages (98% and 99%) most likely because of the considerable variations in patient selection. The data from these operations should not be used for comparative purposes. Five papers also reported the number of patients that h...

No abstract

No abstract

One-and-a-half per cent of adults have active chronic otitis media and its management to prevent complications is a considerable workload. The risks of developing these complications is relatively unknown but because of its mortality, intracranial abscess is the most relevant.A 10-year review of all otogenic intracranial abscesses in Scotland was carried out. A 15 per cent allowance was made for missing records. The annual risk in an adult with active chronic otitis media of developing an abscess is about one in 10,000 but its development is three times more likely in males. This risk might appear low but the lifetime expectancy of an individual aged 30 years with active chronic otitis media developing an abscess is one in 200. However, as yet, there is no evidence that surgery reduces this risk. Unfortunately, because of the duration of follow-up needed and the size of the sample required, scientific evidence would be difficult to obtain. However, 5 per cent of abscesses currently occur in the immediate post-operative period following mastoid surgery.

No abstract