Paediatric grommet insertions are a common ENT procedure which is typically carried out as a daycase procedure. National guidelines exist (NICE CG60) outlining the criteria for grommet insertions. At our institution it was noted that children were experiencing long waits for their grommet surgery with 78% breaching the national 18 week RTT target by time of surgery in the preceding 6 months. 38% of children were attending for surgery with out of date audiograms and as a consequence, due to children no longer meeting the NICE criteria for grommet insertions, 8% of children were being cancelled on the day of surgery.To improve our waiting times and reduce on the day cancellations we introduced a pilot scheme of “rapid turnover” paediatric day case theatre lists. These lists were accompanied by a pre-operative consent clinic, enabling children not requiring surgery to be cancelled. The theatre lists were run by a senior ENT registrar and had two anaesthetic “pods” i.e. two anaesthetists and two ODPs. This enabled faster turnover of patients and consequently more patients could be operated on per theatre list.Following our pilot there are no longer any children on the grommet waiting list in breach of the 18 week RTT time. Furthermore, there were no on the day cancellations due to surgery not being indicated. All staff and patients involved were satisfied with the “rapid turnover” lists and subsequently the idea is to be introduced on a regular, 2 monthly basis, to keep waiting times down.
Further ENT training is required for doctors in general practitioner training schemes to aid improvement of patient care. The most logical way to enhance ENT training in a post-graduate setting is through up-to-date courses held locally with a faculty made up of experts working within the specialty.
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Objectives To investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED). Design Prospective cohort study. Setting A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period. Participants Patients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs. Main outcome measures The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology. Results A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4‐3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1‐3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2‐3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4‐4.2). Conclusions The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non‐dissolvable intranasal packs to improve patient experience in epistaxis.
The insertion of middle ear ventilation tubes remains one of the most common procedures for ENT surgeons. A common concern amongst patients undergoing such procedures is the effect on their ability to partake in swimming and other water sports. Currently there is little evidence comparing the penetration ability of different water solutions encountered by swimmers. This study compares the water penetration of four different water solutions for Shah, mini-Shah, T tube and titanium bobbin ventilation tubes. A model was constructed to replicate a grommet inserted through a tympanic membrane using a syringe barrel, latex membrane and one of the ventilation tubes. Four solutions (sea water, chlorinated water, freshwater and soapy water) were then pipetted down the barrel until penetration of the tube occurred. The volume required for penetration was recorded. For all tubes soapy water was the most penetrating, followed by seawater. Titanium bobbins required significantly less of each solution for penetration. Mini-Shah grommets required significantly more of all solutions except soapy water for penetration to occur. Shah grommets were more resistant to chlorinated and sea water than T tubes. Mini-Shah grommets appear to protect against water penetration into the middle ear cleft and their use should be considered in patients who are keen water-sport enthusiasts. Furthermore, swimmers in sea or chlorinated water seem to be at higher risk than freshwater swimmers. Titanium bobbins were relatively easily penetrated by all four solutions and should be avoided in keen swimmers.
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