bluuebunny/crossref_metadata_2025_split huggingface dataset:
350 Cross Over Septal Flap Technique for Choanal Atresia Surgery: Two Centre Series with Outcomes
Authors: Adegboyega G , Elhassan H A , Karligkiotis A , Searyoh K , Zocchi J , Bozkurt G , Bandi F , Turri-Zanoni M , Battaglia P , Bignami M , Castelnuovo P 
Published: October 2021

Abstract

Introduction
Choanal atresia (CA) is a congenital obstruction of the posterior nasal aperture due to nasal cavity canalisation failure. Endoscopic endonasal surgery has led to successful CA repair and fewer complications compared to open surgery. We describe our surgical technique that uses septal mucosal flaps without need for stenting or subsequent intubation.

Method
A multicentre retrospective review of patients who underwent surgery using the cross over septal technique. Patient demographics and outcomes were recorded. Flap design: bilateral vertical septal mucosa incisions are performed on either side of the posterior third of the septum to form two mucoperiosteal flaps. The posterior vomer and atretic plates are removed. One flap is pedicled superiorly and rotated over the bare sphenoid rostral bone. The contralateral flap is pedicled inferiorly and rotated to cover exposed bone of nasal cavity floor. Lateral nasal wall mucosal integrity is maintained. This technique is used both for unilateral and bilateral atresia.

Results
Twelve patients from 2013 to 2020 were included. Age range was 0.07-50 years, male to female ratio of 1:5. Ten patients had unilateral CA, two had bilateral. Nine had bony CA, the remainder mixed. 5 patients (mean age 2.8 years) underwent second-look endoscopy under sedation an average 36 days following primary surgery.

Conclusions
The cross over technique for CA has low morbidity and 100% success in our multicentre series. Use of mucoperiosteal flaps to cover the exposed bone, removal of vomer and minimal instrumentation to the lateral nasal wall are the best ways to avoid postoperative stenosis.
400 A Comparative Study of Intracapsular & Extracapsular Coblation Paediatric Tonsillectomy in A Tertiary Centre
Authors: Wilson B , Li L , Gomati A , Sharma A 
Published: October 2021

Abstract

Background
Intracapsular tonsillectomy has emerged as a novel alternative to traditional tonsillectomy where the tonsillar capsule is left intact with a small amount of overlying tonsillar tissue. There is growing evidence to suggest that intracapsular tonsillectomy is associated with reduced post-operative pain, haemorrhage and readmission rates. The aim of this study was to assess the reported benefits of intracapsular tonsillectomy within the ENT department at a tertiary paediatric hospital.

Method
Retrospective analysis comparing two cohorts of 72 consecutive paediatric patients undergoing coblation intracapsular and extracapsular tonsillectomy between March-2019 and November-2020. Patient age at procedure, removal of adenoids, indication, surgeon grade, and discharge time were recorded. Post-tonsillectomy bleeding and 30-day readmission rates were used as the main outcome measures.

Results
The median age in both groups was 5 years. The intracapsular cohort demonstrated a lower 30-day readmission rate (8.3% vs. 15.3%), lower primary (&lt;24 hours) post-op bleed rate (0% vs. 2.78%) and lower secondary (&gt;24hours) post-op bleed rate (4.2% vs. 12.5%) when compared to the extracapsular cohort. Eight cases were conducted as day cases in total, all Intracapsular, with none of these patients requiring readmission within 30 days.

Discussion
Coblation Intracapsular tonsillectomy is an effective and low-risk alternative to extracapsular techniques. It is hoped with the reduced associated risks and morbidity associated with the procedure, the department can move towards day case tonsillectomy procedures resulting in a reduction in overall healthcare costs and improved patient experience.
450 Low Dose CT Protocols - The Future for Paediatric Foreign Body Aspiration?
Authors: Ash J , Daya H 
Published: October 2021

Abstract

Aim
Suspected foreign body aspiration is a common attendance at the paediatric emergency department. Low dose Computer tomography (CT) protocols (0.06-2mSv) have been developed to be able to diagnose these patients more effectively.

Method
All paediatric low dose CT protocols for foreign body aspiration from a large tertiary level hospital were identified retrospectively over a year. Data was collected on prior imaging, result, further intervention and subsequent follow up of patients.

Results
Eight patients were identified. Three (37.5%) identified a foreign body on CT. All three had subsequent microlaryngoscopy and all found a foreign body present. Of the five negative scans, none re-presented or had any associated symptoms of a foreign body at follow up. Five had previous Chest X-ray, all of which were inconclusive.

Conclusions
Although need for ongoing research into the area, low dose CT thorax protocols for suspected foreign body aspiration is a promising and effective tool. Its use across the country will likely lead to reduced negative microlaryngoscopy rates with huge associated benefits for both the patient and the ENT department.
512 The Management of Aural Foreign Bodies During the COVID-19 Pandemic - MKUH ENT Department Experience
Authors: Ho G C , Thind R , Yap D , Hunt A 
Published: October 2021

Abstract

Aim
During the initial wave of the COVID-19 pandemic, ENT UK published a clinical guide on surgical prioritisation which suggested that aural foreign bodies can be removed between one and three months from initial presentation. This case series aims to investigate the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications, success rates of subsequent removal attempts and whether foreign bodies can clear themselves without intervention.

Method
Retrospective study of all aural foreign body referrals to the ENT emergency clinic over a 6-month period.

Results
Thirty-four patients were identified. The duration of foreign bodies left in-situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts, however there were no other significant complications. First attempts made by non-ENT specialists (68.8%) all failed and were associated with a high risk of trauma (36.4%). The chances of successful removal on second attempt (28.6%) reduced dramatically when compared to the first attempt (52.9%). Two patients had no foreign body visualised upon second attempt, suggesting it has cleared itself. A total of 7 patients (20.6%) required removal under general anaesthesia.

Conclusions
Due to the unique circumstances of the COVID-19 pandemic, this is the first case series to look specifically at the relationship between duration of aural foreign bodies left in situ for over 30 days from presentation and the risk of complications. Our data suggests that prolonged duration did not increase the incidence of complications.
665 Management of Epistaxis Patients After Nasal Pack Removal - Quality Improvement Project
Authors: Priskorn F , Wong P , Daultrey C 
Published: October 2021

Abstract

Introduction
Epistaxis is a common emergency and treatments include cautery and nasal packing. NICE guidelines recommend Naseptin® (chlorhexidine and neomycin) and routine practice is to perform cautery if bleeding point identified following pack removal.

Method
Retrospective analysis of electronic records over a 9-month period identified 114 patients admitted with epistaxis.

Results
Demographics: 65 male, 49 females (roughly 13:10 ratio), an average age of 72.5 and median age: 76. 8 patients had 2 presentations with epistaxis (3 had SPA ligation on repeat admission). 97 patients were packed, 17 no packing performed. Reasons for admission without packing was observation after cautery (7), observation without cautery (5) and admission under medics for non-epistaxis issue (5). Of patients with discharge summaries, 90% had naseptin prescribed. Of patient admitted under medics, only 60% discharged with naseptin. 70 patients (61.4%) were cauterized, 16 patients (14%) examined, but no cautery required, and 28 patients (24.5%) had no documentation of examination or cautery attempt.

Conclusions
The majority of patients are receiving naseptin on discharge but room for improvement. Although small sample size of 5, greater portion medical patients discharged without naseptin, better handover required. Almost a quarter of patients (24.5%) did not have any documentation of cautery attempts.
686 Evaluating and Modernising the Management of Nasal Trauma in Emergency ENT Clinic
Authors: Rassam J , Blackabey V , Srouji I 
Published: October 2021

Abstract

Aim
1. Optimise and compare management of nasal fractures at a single UK based centre with nationally excepted standards from ENT UK and published literature. 2. To measure the non-attendance (DNA) rate in the emergency ENT clinic for patients with nasal trauma. 3. To assess the ratio of face to face (F2F) appointments to patients listed for a manipulation under anaesthesia MUA. 4. To provide additional insight into the aetiology of nasal trauma

Method
Retrospective analysis of clinical notes for all nasal traumas reviewed in the ENT emergency clinic at a single centre from 1st July 2019 – 1st March 2020. Parameters investigated included – demographics, days from injury, F2F:MUA, DNA rate and aetiology of injury. Implementation of a video-based clinic and local anaesthetic MUA clinic.

Results
At total of 255 patients and 311 appointments notes were reviewed in this period. DNA rate was found to be 28%. F2F:MUA was found to be 4:1. Patients were reviewed on average 9 days post-injury. Most common causes of trauma were assault (39%), fall (31%), sport (13%), accidental hit (10%).

Conclusions
The DNA rate was found to be 20% higher than the national average for outpatient clinics and a F2F:MUA of 4:1 displays a high burden of unnecessary F2F contact. A video-based and local anaesthetic nasal fractures clinic has been implemented to combat these issues which will be re-audited.
918 Nasal Packing Duration in The Management of Epistaxis: A Cohort Study
Authors: Collins R , Addison A , Paul C , Clark A , Philpott C 
Published: October 2021

Abstract

Aim
Nasal packing is one of the mainstays of inpatient treatment for epistaxis. However, no current guidelines exist on optimal duration of nasal packing. This paper seeks to determine the optimal duration of nasal packing in terms of re-bleeding.

Method
A retrospective cohort study was conducted on patients admitted over a two-year period. Data collected included re-bleeding events following pack removal, age, gender, site of epistaxis, hypertension, trauma and anticoagulation medication.

Results
The rate of re-bleeding increased with length of pack duration; over 12 hours was associated with greater re-bleeding rates (p = &lt;0.001) and continued to be statistically significant when controlling for co-founders (p = 0.01). Those packed over 24 hours were over five times more likely to re-bleed than those packed less than 12 hours (p = 0.01. OR 5.34).

Conclusions
A packing duration of less than 12 hours is associated with lower rates of re-bleeding. Admitting teams should therefore aim to ensure that patient pathways involve early pack removal.
974 Improving Safety for Tracheostomy and Laryngectomy Patients Within A Regional Head and Neck Unit
Authors: Simpson L , Watson G 
Published: October 2021

Abstract

Aim
To improve the safety of tracheostomy and laryngectomy patients within a UK-based regional head and neck unit.

Method
This audit was conducted against standards taken from the National Tracheostomy Safety Project (NTSP). Inclusion criteria were all patients with a tracheostomy or laryngectomy on the ward, there were no exclusion criteria. Data was collected per inpatient episode for a one month period pre- and post- implementation of each intervention (1st March to 31st May 2020).

Results
Pre-intervention results showed that none of the 19 neck-breathing inpatients during March 2020 had a bedhead sign or emergency algorithm displayed, however all patients had required bedside equipment and the only unavailable ward equipment was capnography. Laminated bedhead signs and algorithms were implemented and 33% neck-breathing patients had signs displayed during April 2020. Further intervention in May 2020 to educate ward staff led to 90% of patients having a bedhead sign displayed and 80% having an algorithm displayed.

Conclusions
Overall, our unit has very high standards of care for neck-breathing patients. The use of bedhead signs and emergency airway algorithms is an integral part of providing safe care for neck-breathing patients and all members of staff are responsible for their use. The COVID-19 crisis has impacted on the number of elective procedures being performed which has impacted upon the numbers for the post-intervention arms of our audit. Reduced staffing due to sickness during the pandemic may have contributed to the substandard results.
1168 Radiotherapy Dose for HPV Driven Oropharyngeal Cancer: What Is Enough?
Authors: Penny F , Shanmugasundaram R , Patel N 
Published: October 2021

Abstract

Aim
Squamous cell carcinoma of the oropharynx is associated with high-risk Human Papilloma Virus (HPV) infection. HPV positive oropharyngeal cancer is often more radiosensitive and first line treatment includes either radiotherapy or surgical resection. Trials are ongoing to establish situations in which radiation doses can be reduced with the aim of reducing late tissue toxicity (“de-escalation trials”) . We report a case in which a patient failed to complete his prescribed radiotherapy treatment, describe his clinical outcomes and the potential questions this situation raises.

Method
In 2009 a male patient presented with a right T2N0MO P16 positive tonsillar squamous cell carcinoma. He was scheduled to complete a course of chemoradiotherapy. However, he was only able to complete a third of the radiotherapy course. Due to unresolved symptoms, he underwent a right transoral laser extended tonsillectomy, however this showed only fibrous tissue.

Results
Despite not completing the radiotherapy course he has not experienced local recurrence of the tonsillar OPSCC 11 years post initial treatment.

Conclusions
This case illustrates that some patients with HPV driven oropharyngeal cancer can have a clinically significant tumour response to markedly lower doses of radiotherapy than is currently recommended. Further randomized controlled trials are required to establish the optimum dose in the management of HPV driven oropharyngeal squamous cell cancer.
1189 ENT Emergency Clinic: The Introduction of The Online Booking System
Authors: Motter D , Downes S 
Published: October 2021

Abstract

Introduction
The ENT department at the Royal Glamorgan Hospital introduced the use of an online booking system for the emergency clinic. The aim of it was to provide a more organised clinic that can be run efficiently and reduce the waiting time for patients. We aimed to assess the efficiency of the transition between paper-based and online booking system.

Method
We initially carried out a 3-week retrospective data collection on patients booked using the paper-based system, and then collected data during the 3-week transition period, and finally 3 weeks after the use of the online booking system only. We compared the findings for each and analysed the results

Results
Over the 9-week period, 370 appointments were booked into the emergency clinic. We analysed that since the introduction of the online booking system, there has been a reduction in booking errors, number of overlapping and overbooked sessions. Initially, 11 slots were overbooked with the paper-based system, but after the use of the online booking system, only 2 sessions were overbooked.

Conclusions
The transition to the online system has significantly improved the quality of the ENT emergency clinic. Patients were less likely to be waiting in an overfilled waiting room and each patient will have enough time allocated to address their needs. The online booking system allows an MDT approach as it can be accessed by the entire ENT team, this can be an important tool to aid in audits and quality improvement projects.
1199 Attend Anywhere: The Virtual Clinic for Routine ENT Consultations
Authors: Motter D 
Published: October 2021

Abstract

Introduction
During the COVID-19 pandemic, the ENT department at the Royal Glamorgan Hospital introduced the use of “Attend anywhere” which is a virtual platform that is used by medical professionals to carry out clinics remotely. It ensures confidentiality between the physician and the patient, as well as practicing social distancing. We assessed the number of patients seen in the virtual clinic, the conversion rate of virtual to face-to-face appointments and technical issues with Attend Anywhere.

Method
We carried out a 3-month retrospective data collection on patients seen in the Attend Anywhere clinic. We accessed their clinical records using the Welsh Clinical Portal system. The outcome for each patient was documented. We also assessed any technical issues with the platform.

Results
305 patients were scheduled to be seen on the platform. Of the 305, 264 attended their appointment. 4 of the patients required urgent medical attention and were subsequently scheduled for urgent face-to-face appointment within the 24 hours.
19 patients had technical issues with the Attend Anywhere platform, and 14 of them were subsequently converted to telephone consultations. The issues were not specifically documented, but connectivity to webcam was a common recurrence. 70 patients were safely discharged from the ENT department

Conclusions
The introduction of the Attend Anywhere virtual clinic has greatly helped prevent a backlog of patients waiting to be seen by the ENT team. 26% of patients were safely discharged back to the GP. The results with the virtual clinic platform are promising and could be a new practice for the NHS.
1251 Risk Stratification in the Management of Post-Tonsillectomy Haemorrhage
Authors: Holden P , Wilson G , Daniel M , Srivastava R 
Published: October 2021

Abstract

Aim
Tonsillectomy represents 17% of the elective workload in ENT and post-tonsillectomy haemorrhage is the most significant complication of this procedure. Accordingly, the GIRFT (Getting It Right First Time) report for ENT surgery focusses on the prevention of post-tonsillectomy bleeding. However, there is little guidance on the management of post-tonsillectomy haemorrhage. A local guideline for the management of post-tonsillectomy haemorrhage was introduced in 2020 based on expert consensus. This audit examines the management of patients readmitted with post-tonsillectomy haemorrhage in 2019 and compares this to the management suggested in the new guideline.

Method
Patients readmitted with post-tonsillectomy haemorrhage within 30 days of a tonsillectomy performed in 2019 were identified. These were retrospectively stratified into risk categories according to both patient and clinical factors. Management was audited against the new guideline including both the initial patient assessment and the treatment suggested for their respective risk category.

Results
Fifteen patients were identified and stratified into low, medium and high-risk categories. All patients in the “low risk” category were successfully treated conservatively. One patient from the “medium risk” category had a further bleed as an inpatient during the proposed period of observation in the new guideline and was thereafter treated as “high risk”. Within the “high risk” category two patients required return to theatre for arrest of post-tonsillectomy haemorrhage.

Conclusions
These results show that the risk stratification proposed in these guidelines may be useful in the management of post-tonsillectomy haemorrhage. Amendments to the guideline and a re-audit are in progress.
1261 Incidence and Risk of Post Tonsillectomy Bleeds for Tonsillitis And/Or Peritonsillar Abscess (Quinsy) In Adult Patients
Authors: Majhail G , Wise K 
Published: October 2021

Abstract

Aim
Determine the incidence of post tonsillectomy bleeds (PTB) in patients 16 years and over with a background of tonsillitis and/or quinsy. Explore factors that can increase the risk of a haemorrhage. Assess the operation notes for completeness.

Method
A retrospective review was conducted of 30 tonsillectomies for quinsy and recurrent or chronic tonsillitis from the 01/08/20 to 10/12/20. They were followed up for 28 days. Patient notes including operation notes were reviewed.

Results
Following surgery 8 out of the 30 patients (26.7%) had a secondary PTB. There were no primary PTB. 4 out of the 8 patients (50%) had to return to theatre to arrest the haemorrhage. The median time was 6 days post-op. Only 1 PTB (12.5%) occurred following a cold dissection and the other 7 (87.5%) following electro dissection. This equated to 39% of the electro dissections resulting in PTB compared to 8.3% of the cold techniques. There were 6 robot-assisted surgeries with 3 (50%) resulting in a haemorrhage. Just over a third (35%) of patients 25 years of age and over had a PTB vs. 10% of those under 25. Only 1 out of the 30 operation notes was completed fully. Examples of details omitted are estimated bloods loss, power settings, findings, and indications.

Conclusions
A 3.5 times greater rate of PTB is seen in those aged 25 years and over. Hot techniques, in particular those that were robot-assisted, showed a higher incidence of haemorrhages. A pro forma should be utilised to improve the completeness of operation notes.
1262 Audit of MRI IAM (Internal Auditory Meatus) Requests at Darlington Memorial Hospital and Review of The Literature
Authors: Awni S , Zomorodian P , Maw J , Damodara M , Srinivasan R 
Published: October 2021

Abstract

Aim
To assess if the MRI IAM scans are being requested as suggested in NICE guidelines Draft 2017 for consultations. Educate and implement any changes if needed to minimise unnecessary investigations.

Method
Retrospective data collection of 1000 data. Variables included hearing loss (HL), tinnitus (T), dizziness (D) and other lateralized symptoms. Audiograms assessed for asymmetrical HL at decibel level ≥20 Db at a frequency of 0.5 kHz, 1.0 kHz, 2.0 kHz. MRI of IAM assessed if a cerebellar pontine angle (CPA) lesion was presented.

Results
853 (85.3%) met criteria. 16/1000 (1.6%) MRI showed CPA lesion. All 16 cases had unilateral sensorineural hearing loss (SNHL) and met NICE guidelines criteria.

Discussion
Limited value in the scanning of asymptomatic patients, those who do not fit audiometric guidelines, those bilateral symptoms or those with unilateral tinnitus without audiometric asymmetry. Very few studies were found in the literature in relation to symptoms associated with positive findings of CPA lesion. Our results indicate unilateral SNHL were linked with positive findings of MRI and it is similar findings in the literature. We recommend that patients who present with asymmetrical SNHL with this audiometric asymmetrical characteristic of 20Db or more will need an urgent MRI IAM as part of their diagnostic workup.