Venkat Reddy

Speech therapy in the treatment of globus pharyngeus: how we do it.

1 Young E.W. (1991) The ethics of non treatment of patients with cancers of the head and neck. Arch. Otolaryngol. Head Neck Surg. 117, 769–773 2 Kowalski L.P. & Carvalho A.L. (2000) Natural history of untreated head and neck cancer. Eur. J. Cancer 36, 1032–1037 3 Sesterhenn A.M., Folz B.J., Bieker M. et al. (2008) End-of-life care for terminal head and neck cancer patients. Cancer Nurs. 31, E40–E46 4 Shedd D.P., Carl A. & Shedd C. (1980) Problems of terminal head and neck cancer patients. Head Neck Surg. 2, 476–482 5 Lyon L., Gleich C., Collins M. et al. (2003) Therapeutic decision making in stages III and IV head and neck squamous cell carcinoma. Arch. Otolaryngol. Head Neck Surg. 129, 26–35

Investigation of the influence of ambient temperature, atmospheric pressure and water vapour pressure on epistaxis admission rate

BACKGROUND To investigate the relationship between weather variables (atmospheric pressure, temperature, water vapour pressure) and epistaxis admission rates at Derriford Hospital, Plymouth, United Kingdom. METHODOLOGY Retrospective observational study using hospital inpatient information databases to identify all patients admitted with epistaxis from April 1999 to March 2009 inclusive. Meteorological data for the same period was retrieved from the University of Plymouth Meteorological Archive. Epistaxis admissions were investigated for correlation with weather variables using Pearson correlation, and stepwise multiple regression analysis was performed. RESULTS During the study period there were 1071 admissions (978 patients) (501 males (mean age 64 years) and 477 females (mean age 72 years)). Less than 10% of the variance in epistaxis admissions is explained by the maximum temperature only. Temperature and water vapour pressure demonstrated statistically significant association with epistaxis admission rates. CONCLUSIONS Though there is statistical significance in the association of some weather variables and epistaxis admission rates, the findings are not practically relevant (<10% variance). The results of this study do not indicate a need for revision of current healthcare resource allocation.

The water penetration of different ventilation tubes

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.

Inter-observer reliability of operative supervision coding by forty three ENT surgeons of twenty eight operations

Surgical trainees are required to record their operative experience in a logbook to provide evidence of progression of competency. They have access to published guidelines regarding minimum requirements in operative experience that must be achieved before a certificate of completion of training (CCT) is issued http:// www.jcst.org/docs/ENT_CCT_submission_guidelines. The level of supervision that the trainee has had during a procedure must be recorded as stipulated in the ‘Pink Book’ published by the Joint Committee on Surgical Training. The levels of operative supervision as can be recorded in the Pan-surgical Electronic Logbook (http://www.elogbook. org) are as follows: ‘Observed’, ‘Assisting’, ‘Supervised – trainer scrubbed’, ‘Supervised – trainer unscrubbed but in theatre’, ‘Performed’ and ‘Training a more junior trainee’. The various levels of supervision recorded are important as that information is used to form judgements on a trainee’s competency progression and suitability to be entered onto the Specialist Register. Given that the logbook is integral to demonstrating training, it stands to reason that this evidence should be robust and valid. As part of its validity, this record should be reproducible and consistent. To investigate this, we set about assessing the reliability of coding the level of operative supervision amongst ENT trainees and trainers. To our knowledge, no previous study has been attempted to answer this question. Method

Does Academic Output Affect Mortality Rates in NHS Trusts

Objective: It has been claimed that institutions engaging in academic activities provide better care. The aim of this study was to establish whether there is an association between academic output and mortality rates for NHS Trusts (NT). Method: Standardized mortality rates for 2010 were obtained from www.drfosterhealth.co.uk. MEDLINE was queried to establish the number of citations credited to NT from 2006 to 2010. Admissions for NT for 2009-2010 were obtained from www.hesonline.nhs.uk. The number of citations per admission was calculated and used as an indicator of academic output. Results: Spearman rank analysis was performed to identify any correlation between citations per admission and the inverse of 4 types of mortality rates: high risk conditions r = 0.20 (P = .01); low risk conditions r = -0.06 (P = .46); deaths after surgery r = 0.193 (P = .019); overall mortality 0.291 (P < .01). Conclusion: The results of this preliminary study demonstrate a statistically significant correlation between academic output and mortality rates. However, it should be noted that the correlation coefficients are small, but the findings of this study encourage further debate.

Retrospective Study of Esophageal Food Bolus Impaction

Objective: Establish the recurrence rate of food bolus impaction (FBI) and identify demographic/pathological features associated with food bolus obstruction recurrence. Method: Retrospective case note review of patients (greater than or equal to 16 years) admitted to the hospital with FBI between 2002 and 2007. Patient demographics, co-morbidities, interventions, radiological investigations, and results were recorded. Statistical analysis was performed using SPSS 13. Results: A total of 99 patients fulfilled the inclusion criteria (65 males and 34 females; median ages 59 and 71.5 years), IQR 47-74, and 53-81 years respectively). A total of 22 patients died between first presentation with FBI and the time of this study being conducted (mean follow up 34 months ±17). A total of two patients had recurrences but died before this study. For all other patients without recurrences the mean follow-up was 68 months ±20. Logistic regression demonstrated that only hiatus hernia demonstrated a statistical significance in its association with FBI recurrence (OR 4.77 95% CI 1.15-19.82, P = .032). All other variables were not statistically significant. Conclusion: The recurrence rate of food bolus impaction of the esophagus was 9%. Hiatus hernia was the only esophageal pathology associated with recurrence of food bolus impaction.

Interobserver Reliability of the “Clockface” Method of Describing the Site and Size of Tympanic Membrane Perforations:

Objective: Analyze the interobserver reliability of a “clockface” method for describing the site and size of tympanic membrane perforations. Method: Six junior doctors (ENT experience 0-3 months) and 6 ENT surgeons (ENT experience 4-26 years) were asked to estimate the position, percentage size, and “clockface” position of perforations in 30 images of tympanic membrane perforations. Four juniors repeated the exercise 2 weeks later to investigate test-retest reliability. Results: Results were analyzed using intraclass correlation coefficients (95% confidence interval in brackets). With junior raters, perforation size percentage estimate gave 0.85 (0.77-0.92), clockhand method site of perforation (CM1) gave 0.91 (0.87-0.94), and clockhand method size of perforation (CM2) gave 0.82 (0.73-0.90). With ENT surgeons, perforation size percentage estimate gave 0.85 (0.77-0.92), CM1 gave 0.96 (0.94-0.99), and CM2 gave 0.88 (0.78-0.94). With all raters, perforation size percentage estimate gave 0.86 (0.78-0.92), CM1 gave 0.93 (0.90-0.95), and CM2 gave 0.84 (0.76-0.91). In test-retest reliability, using Pearson correlation coefficients, perforation size percentage estimate gave 0.94 (P < .001), CM1 gave 0.91(P < .001), and CM2 gave 0.92(P < .001). Conclusion: The clockface method allows quick, detailed, and reliable recording of site and size of perforation at the time of clinical assessment. This may also become a valuable research and audit tool.

Interobserver reliability of the "clock face" method of describing the site and size of tympanic membrane perforations

Results: The OH and non-OH group comprised 40 and 211 patients, respectively. The OH group included 29 patients with OV and 11 patients without OV. The non-OH group included 150 patients with OV and 62 patients without OV. In the OH group, the OV patients exhibited a marked orthostatic decrease in VAFV as compared with those without OV. In the non-OH group, the orthostatic decrease in VAFV was significantly greater in OV patients than in those without OV.