Background
The direct to audiology via ENT referral pathway was designed to enhance patient access to audiology services. The pathway is recommended in the Otolaryngology Head & Neck Surgery: a model of care for Ireland report, published in 2019.
Aims
This study aimed to review the outcomes of all patients that attended our institution over the last seven years.
Methods
A retrospective review of the direct to audiology referral service from March 2014 to December 2021 was conducted. Outcomes were defined by the pathway each patient took following attendance at the audiology clinic. Patients were either (i) discharged, (ii) referred for hearing aid(s) or (iii) identified as candidates for further diagnostic assessments, including a follow-up at the ENT outpatient clinic.
Results
During the time frame, 419 patients were triaged to the pathway. The average wait time was 13 days. The average age was 53 years (range 16–96 years, SD = 6.1). Approximately 34% (
n
= 143) of all patients referred were discharged back to the GP by the audiologist, but 66% (
n
= 276) presented with ‘red flags’ and needed further investigation in the ENT clinic, with 30% (
n
= 73) ultimately requiring imaging studies. Over half (
n
= 254, 61%) were referred for hearing aids.
Conclusion
The direct to audiology initiative has proven effective at reducing waiting times for ENT patients solely in need of audiological intervention. Approximately one-third of these referrals to the ENT service can be assessed comprehensively in the audiology clinic, thereby reducing the demand for ENT clinics, enhancing service provision and expediting onwards referral for amplification.
Cranial nerve palsy is a rare but recognised complication of epidural anaesthesia, most commonly presenting as diplopia secondary to abducens nerve palsy. While upper cranial nerve palsies have been documented on numerous occasions, lower cranial nerve palsies, including recurrent laryngeal nerve palsy, are exceedingly rare. This case describes a 37-year-old female who, following epidural anaesthesia for spontaneous vaginal delivery of her first child, presented with dysphonia. Flexible laryngoscopy confirmed a left vocal cord palsy, and computed tomography ruled out any mass lesions along the course of the recurrent laryngeal nerve. Here, we discuss a case of vocal cord palsy secondary to epidural anaesthesia, an extremely rare complication. We also discuss the proposed etiology, treatment, and outcomes in patients with this condition. Cranial nerve palsy should be an important differential in patients presenting with dysphonia following spinal or epidural anaesthesia.
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