Mastoidectomy audit: results of the Royal College of Surgeons of England comparative audit of ENT surgery

This paper presents the results of a national comparative audit of mastoid surgery, retrospectively analysing 611 operations by 55 consultants. Confidentiality for both patient and surgeon was assured. For cholesteatoma 80% of mastoidectomies performed were open cavity procedures and for other middle ear disease 58% used an intact canal wall technique. Thirty-two surgeons used only an open cavity mastoidectomy for cholesteatoma during the period of the audit. There was a statistically significantly greater number of wet ears with open cavities than with closed cavities, but the frequency of the operator did not correlate with the dry ear rate. Ten serious complications (facial palsy and dead ear) were recorded. All occurred in open cavity mastoidectomies. The post-operative hearing status was unknown in 40% of patients.     

Royal College of Surgeons comparative ENT audit 1990

The Royal College of Surgeons Comparative Audit Service was set up in 1990 so that surgeons could pool their audit data, to provide ‘standards’ with which to compare their own figures. A total of 405 consultant otolaryngologists were circularized in December 1991 inviting them to return data about their resources, workload, case-mix and complications, and about two specific audit topics—Myringoplasty and Carcinoma of the Larynx—for the calendar year 1990. A total of 65 consultants returned proformas with data on 52208 admissions and 31240 surgical procedures. The ‘average’ respondent admitted 829 patients in the year (19% of these day cases and 14% emergencies) and performed 744 surgical procedures with a mean complication rate of 1.39% using three theatre sessions per week. Cancelled theatre sessions per annum per consultant ranged from 0 to 71. The mean known success rate after myringoplasty was 65%, with hearing improvement in 53%. The ‘average’ ENT surgeon saw 3.5 new cases of invasive carcinoma of the larynx and treated 69% of these with radiotherapy alone, compared with 14% surgery alone. As well as allowing a profile to be drawn up of the ‘average’ ENT surgeon saw 3.5 new cases of invasive carcinoma of the larynx and treated 69% of these with radiotherapy alone, compared with 14% surgery alone. As well as allowing a profile to be drawn up of the ‘average’ respondent, this audit allowed individual consultants returning data to compare their own figures in detail with the pooled data, which were presented graphically at a meeting in April 1992.     

Informed consent in endoscopic sinus surgery: the patient perspective

OBJECTIVES: To understand patient expectations during the informed consent process for functional endoscopic sinus surgery (FESS). STUDY DESIGN: Multi-institutional, cross-sectional survey design. METHODS: Anonymous surveys were administered to patients in two tertiary academic centers with a chief complaint relating to "allergy and sinus" problems. Patients completed an eight-item questionnaire that assessed both the nature and the level of risks that they wished to be informed of prior to FESS. RESULTS: Three hundred eighty-nine surveys were returned. Sixty-nine percent of patients wished to be informed of complications that occur as infrequently as 1 in 100 cases, regardless of severity. Ninety percent of patients wanted to know of a risk that occurred as frequently as 1 in 10 cases. Patients also reported whether or not they wished to be told in detail about specific complications during the informed consent process, regardless of their infrequency. Affirmative responses were as follows: 83% for cerebrospinal fluid leak and orbital injury, 81% for infection, 76% for revision surgery, 74% for impairment of smell, 73% for bleeding and myocardial infarction, 72% for cerebrovascular accident, and 58% for scarring. CONCLUSIONS: Patients wanted to be informed about severe FESS complications at a higher rate than physicians previously surveyed, even if the incidence is low. This study, combined with our previous examination of the physicians' perspective, highlights that there may be a discrepancy between what the physician and the patient believe are priority topics during the informed consent process.     

Informed consent in sinus surgery: link between demographics and patient desires

OBJECTIVE: To evaluate and understand differences in expectations according to patient demographics during the informed consent process for functional endoscopic sinus surgery (FESS). STUDY DESIGN: Multi-institutional, cross-sectional survey design. METHODS: Anonymous surveys were administered to patients in two tertiary academic centers with a chief complaints relating to "allergy and sinus" problems. Patients completed and eight-item questionnaire that assessed demographics and the nature and level of risks that patients wished to be informed of before FESS. Univariate and multivariate analyses were performed to assess for differences in patient desires related to FESS risks according to demographics. RESULTS: Three hundred eighty-nine completed surveys were analyzed. Younger patients (P = .049), white patients (P = .0026), and more educated patients (P = .0033) wished to know about complications at the lowest risks levels (lowest incidence), regardless of severity. With regards to specific complications, black patients and patients with less formal education were less interested in being informed about the potential risks of orbital complications, cerebrospinal fluid leak, or possible need for revision surgery. Multivariate analysis confirmed that race, education, age were independently significant factors in determining response. CONCLUSION: Demographic-related differences exist in patient's desires and expectations in the informed consent process for a sinus procedure. Physicians should be aware of these differences when counseling patients about sinus surgery. More research is needed to elucidate the factors that underlie the observed differences.     

The application of endoscopic sinus surgery to the treatment of recurrent sinus barotrauma

Recurrent sinus barotrauma is an uncommon condition but it may terminate the career of an aviator. Sinus barotrauma occurs almost exclusively on descent and probably results from occlusion of the sinus ostia through a combination of mucosal disease and anatomical abnormalities. Traditional methods of treating sinus barotrauma have achieved mixed results so we have employed functional endoscopic sinus surgery (FESS) since 1990. The presentation and outcome of 39 patients with recurrent sinus barotrauma managed by FESS have been reviewed. Ninety-five per cent were able to resume their full flying duties without further treatment or recurrence of sinus barotrauma. Passing a postoperative decompression testing is a reliable indicator of an aviators's fitness to fly after FESS.     

A child with silent sinus syndrome and spontaneous improvement after sinus surgery

Silent sinus syndrome is characterized by an asymptomatic hypoplastic maxillary sinus with progressive enophthalmos and hypoglobus. This is a disease rarely affecting children with the majority of reported cases involving adult patients. Treatment is primarily surgical with endoscopic sinus surgery to restore aeration of the sinus along with orbital reconstruction to restore facial symmetry. In this report, we describe a 7 year old child with facial asymmetry and no sinonasal symptoms. CT showed an opacified hypoplastic right maxillary sinus. One year after endoscopic sinus surgery, there was spontaneous improvement of facial asymmetry and relative maxillary sinus size.     

鼻内窥镜下蝶筛区域手术51例临床分析

目的:探讨蝶筛区域病变的特点,提高对本病的诊断及治疗水平。方法:经鼻内窥镜行蝶筛区域手术51例,41例蝶筛窦同时受累者采用经筛窦进路,10例孤立性蝶窦病变采用经鼻腔进路。结果:均无大量出血及其它严重并发症。随访6～36个月,48例痊愈,3例复发,经再次手术后痊愈。结论:蝶筛区域位置隐蔽,早期无特征性症状,易被临床医师忽视。CT检查对本病有较大价值,且对手术具有指导作用;经鼻内窥镜对蝶筛区域病变进行手术治疗,具有创伤少,痛苦小,面部不遗留瘢痕的优点。     

The effect of maxillary sinus surgery on its development

Conclusion. The study showed that surgery in the maxillary sinus can affect its development. Objective. To quantitatively evaluate the long-term impact of sinus surgery on its development in the rabbit. Materials and methods. This was an experimental study performed at an academic tertiary medical center using 20 4-week-old New Zealand white rabbits. The rabbits underwent unilateral right maxillary sinus surgery. The contralateral maxillary sinus used as a control did not undergo the operation. The maxillary sinus ostium was enlarged on the operated side. Volumetric analysis of the maxillary sinus was performed 1 year post-surgery. The maxillary sinus volumes of both sides were calculated using Multidedector CT and the volumetric measurements of the operated side were compared with the non-operated side. Results. Maxillary sinus development was significantly reduced on the surgical side. Maxillary sinus growth on the surgical side was determined as 87% compared with the non-surgical side.     

鼻内窥镜手术并发症及相关因素分析

目的 :探讨鼻内窥镜手术并发症发生的原因及其处理措施。方法 :对 5 2 6例鼻内窥镜手术中 31例并发症的情况进行分析 ,再手术者并发症的发生率为 38.9% ;术中出血量≥ 2 0 0ml者为 30 .2 % ;病史 >10年者为30 .0 %。结果 :除 1例视力障碍者未恢复外 ,其余均恢复正常。结论 :内窥镜鼻窦手术并发症与鼻腔正常结构的破坏、鼻腔鼻窦解剖结构变异、术中出血量及病程长短有关。对于并发症的处理方法应得当 ,必要时应请眼科医师协助处理     

功能性内镜鼻窦手术并发症的临床分析

目的：探讨功能性内镜鼻窦手术(FESS)并发症的相关因素。方法：FESS手术l207例，在严格规定其手术适应证和手术范围的情况下，对并发症的发生率进行分析。结果：本组手术并发症36例，发生率为3．0％。眼睑淤斑、肿胀是本组最常见的并发症(18例)。术中出血15例，一过性复视l例，无原因发热2例。结论：FESS并发症发生率较低，且都比较轻微，没有严重并发症，这与手术切除局限，医生有较好的筛窦手术基础有关。     

Major complications of functional endoscopic sinus surgery

The results of a postal questionnaire indicate an exponential rise in the practice of functional endoscopic sinus surgery (FESS) in the UK and a major complication rate of 0.23%. Cerebrospinal fluid leak was the most common serious complication accounting for 24 of the 36 reports.     

百力特在鼻内窥镜鼻窦手术后的应用观察

为探讨加速鼻窦内窥镜术腔创面愈合的方法，应用百力特，即１％醋酸泼尼松龙混悬液，对７５例行该手术的患者，于术后经鼻滴入术腔。结果显示，显效１３例，有效５６例，总有效率为９２．０％。该药为混悬液，较之同一药物的水溶液，具有药物分布均匀，作用持久，毒副作用少等优点。     

The evolution of sinus surgery in England in the last decade – An observational study

Background and objectiveSinus surgery has seen significant changes over the years with advancements in instruments, endoscopes and imaging. This study aimed to use Hospital Episode Statistics (HES) data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period. We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.MethodsData from HES was extracted for the years 2010–2019. The operative (OPCS-4) codes relevant to all sinus procedures between E12.1 and E17.9 were analysed. After examination of overall sinus related procedures, further subgroup analysis was performed with regards to open or endoscopic techniques.ResultsThe total number of sinus procedures performed between 2010 and 2019 was 89,495. There was an increase in endoscopic surgeries by 21.1% and a decrease of open surgeries 35.3% during this time. There was an overall increase in maxillary, frontal and sphenoid sinus procedures, with a decrease in ethmoid sinus and lateral rhinotomy operations. There was an increase in the proportion of endoscopic cases overall by 5.7% and for all sinuses individually.ConclusionOverall, we see an increase in sinus surgery over the last 9 years from 2010 to 2019. These findings are in keeping with our initial hypotheses. Although our data set is limited by coding, and lack of patient factors, it represents most, if not all, of the data in England over a large study period. It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.     

鼻腔,鼻窦冠状位CT扫描解剖学观测及其指导意义

对１００例无明显鼻部疾病的成人行鼻腔，鼻窦冠状位ＣＴ扫描，从不同层面观测鼻腔，鼻窦重要解剖结构的值限范围和形态。结果昌：高台型筛板与筛顶间的平均高度差为５．１７ｍｍ，筛泡宽度为１１．１５ｍｍ，中鼻甲的宽度为５．４０ｍｍ；Ｈａｌｌｅｒ气房的出现率为１４．０％，中鼻甲气化为１４．０％，Ｏｎｏｄｉ气房的出现率为８．５％。