A. Narula

Improving tracheostomy care: a prospective study of the multidisciplinary approach

Clin. Otolaryngol. 2011, 36, 482–488

Improving tracheostomy management through design, implementation and prospective audit of a care bundle: how we do it

1 Hoffman H.T. & McCulloch T.M. (1996) Anatomic considerations in the surgical treatment of unilateral laryngeal paralysis. Head Neck 18, 174–187 2 Remacle M. & Lawson G. (2007) Results with collagen injection into the vocal folds for medialization. Curr. Opinion. Otolaryngol. Head Neck Surg. 15, 148–152 3 Isshiki N., Morita H., Okamura H. et al. (1974) Thyroplasty as a new phonosurgical technique. Acta Otolaryngol. (Stockh) 78, 451–457 4 Laccourreye O., El Sharkawy L., Holsinger F.C. et al. (2005) Thyroplasty type-I with Montgomery implant among native French language speakers with unilateral laryngeal nerve paralysis. Laryngoscope 115, 1411–1417 5 Schneider B., Denk D.M. & Bigenzahn W. (2003) Acoustic assessment of the voice quality before and after medialization thyroplasty using the titanium vocal fold medialization implant (TVFM). Otolaryngol. Head Neck Surg. 128, 815–822 6 McCulloch T.M. & Hoffman H.T. (1998) Medialization laryngoplasty with expanded polytetrafluooethylene: surgical techniques and preliminary results. Annals Otolo. Rhinol. Laryngol. 107, 427–432 7 Zeitels S.M., Mauri M. & Daily S. (2003) Medialisation laryngoplasty with Gore-tex for voice restoration secondary to glottal incompetence: indications and observations. Ann. Otol. Rhinol. Laryngol. 112, 180–184 8 Giovani A., Vallicioni J., Gras R. et al. (1999) Clinical experience with Gore-tex for vocal fold medialization. Laryngoscope 109, 284–288 9 Robinson K., Gatehouse S. & Browning G. (1996) Measuring patient benefits from Otolaryngological surgery and therapy. Ann Otol. Rhinol. Laryngol. 105, 415–422

Driving standards in tracheostomy care: a preliminary communication of the St Mary’s ENT-led multi disciplinary team approach

Objectives:  To assess tracheostomy care and improve standards following the introduction of an ENT‐led multidisciplinary tracheostomy ward round service.

Estimation of tracheostomy tube cuff pressure by pilot balloon palpation

Two methods can be used to assess the intra-cuff pressure of tracheostomy tubes: digital palpation of the pilot balloon and use of a hand-held manometer. We conducted a telephone survey to determine the prevalence of both methods in intensive care units within 21 teaching hospitals across the United Kingdom. Forty-two per cent of the intensive care units surveyed used a protocol for monitoring cuff pressure with a manometer.A study to compare these two methods, using the manometer as the reference standard, was then carried out. The cuff pressure was correctly estimated in pre-inflated tracheostomy tubes, in a tracheal model, by 61 per cent of a cross-section of intensive care unit and otolaryngology staff.Using pilot balloon palpation is inaccurate and leaves a significant proportion of patients at risk of tracheal injury. We advocate the wider availability of hand-held pressure manometers in intensive care units and the institution of protocols for monitoring cuff pressure for any patient with a tracheostomy tube with an inflated cuff in situ.

Health outcome measurements in children with sleep disordered breathing.

Objective:  To validate the Child Health Questionnaire, measure quality of life in children with obstructive sleep apnoea and assess the impact of surgery.

Long-term quality-of-life outcomes in children undergoing adenotonsillectomy for obstructive sleep apnoea: a longitudinal study

Clin. Otolaryngol. 2011, 36, 475–481

Global Tracheostomy Collaborative: The Future of Quality Improvement Strategies

Patients who undergo tracheostomy are an extremely heterogeneous, often critically ill group, who can often experience significant morbidity and mortality. The challenge of measuring and improving the quality of care for this diverse patient population has remained. There have been several publications within the last year highlighting advances in both quality monitoring and risk prevention strategies in tracheostomy care. This article reviews those recent key developments and introduces a model to facilitate the development and dissemination of good-practice in tracheostomy management. The majority of literature focuses on single-institution interventions with a paucity of widely generalizable evidence available. Other fields of medicine have faced similar challenges and have used quality improvement collaboratives to good effect. This article describes the innovative model for improving tracheostomy related outcomes called the Global Tracheostomy Collaborative (GTC). The GTC aims to provide the foundation necessary to translate data and knowledge into local quality change by opening lines of communication, disseminating high quality information and sharing best practices, supported by clinical data. A quality improvement collaborative may provide a new tool to link exemplar institutions, share clinical data, conduct research, develop metrics and—ultimately—improve the care and quality of life for all tracheostomy patients.

An “Uncrimped” SMart Stapes Prosthesis: A Cause of Late Hearing Deterioration in Otosclerosis

Statement of Problem. Stapedotomy is the treatment of choice for otosclerosis. Numerous techniques and prosthesis are available to perform this procedure. Success rates of surgery vary from 17% to 80%, and revision surgery carries an increased risk of complications as well as poorer hearing outcomes. Method of Study. Case report. Results. We report the first case of uncrimping of a SMart stapes prosthesis with no lateral displacement as a cause of late failure despite successful crimping and improvement in audiological outcomes after initial surgery. Conclusion. The SMart stapes prosthesis is widely used and has been shown to be safe and provide good hearing outcomes. Displacement of a stapes prosthesis is the commonest cause of failure. Our case shows that deterioration of hearing thresholds can occur from uncrimping of the prosthesis with no displacement. It is important to improve our understanding of stapedotomy failure as revision procedures are associated with poorer outcomes.

How we do it: An audit of Action on ENT baseline standards in otolaryngology departments in England, UK

• An internet‐based audit was conducted to determine how well English otolaryngology departments apply Action on ENT baseline clinical and administrative standards.

Paediatric ENT Standards in London: are we delivering a first class service?: A Repeat Audit

were treated conservatively (31%). • The average time to reduction was 5.6 days after the injury. However, delay up to one month for closed reduction had no correspondence to the number of reoperations or corrective surgery. • Almost all (95%) primary nasal fracture reductions in adults were performed under local anaesthesia. • Three-quarters (75%) of the closed reductions were performed by a resident and one-quarter (25%) by a senior doctor – with no difference in the long-term outcome.