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Necrotising otitis externa, turbinate surgery, tonsillotomy, and care of octogenarian head and neck cancer patients

Published online by Cambridge University Press:  05 May 2022

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Abstract

Type
Editorial
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Necrotising (‘malignant’) otitis externa has been the topic of many articles published in The Journal of Laryngology & Otology, with recent years seeing more publications as the incidence of necrotising otitis externa increases.Reference Eveleigh, Hall and Baldwin1Reference Hopkins, Bennett, Henderson, MacSween, Baring and Sutherland3 An article in this month's issue from Leicester, UK,Reference Rojoa, Raheman, Saman, Mettias, Das and Rea4 looks retrospectively at prognosis and the application of a scoring system to help predict outcomes. In one year of study, 26 patients were seen, with a 19 per cent mortality at one year. A high score using the Charlson Comorbidity Index predicted a poor prognosis at one year.Reference Charlson, Pompei, Ales and MacKenzie5 This scoring system uses inherent patient factors rather than the usual disease severity related assessments, so might help raise vigilance in patients who could otherwise be seen as relatively low risk based on disease status alone. Eweiss and colleagues from Essex, UK,Reference Eweiss, Al-Aaraj, Sethukumar and Jama6 found that the incidence of necrotising otitis externa in their geographical area had increased dramatically in recent years, with cases sometimes and surprisingly involving immunocompetent patients.

Inferior turbinate surgery has been a topic of articles in The Journal since the early days of the twentieth century,Reference Melzi7 when The Journal had a slightly different name. Since then, traditional radical surgery has been superseded by more conservative techniques (or avoidance altogether, using medical therapy, if possible), and a wide variety of resection methods have been tried, including laser, cryotherapy and various partial resection techniques.Reference Elwany and Harrison8 Arguments continue, with avoidance of bleeding or ‘empty nose syndrome’ usually playing a part in discussions. This issue of The Journal has a paper from Israel,Reference Levy, Ronen, Sela, Layos, Eisenbach and Ibrahim9 which has a very high throughput of isolated turbinate surgery cases (1035 cases in just under two years), and compares bleeding rates from three conservative turbinate surgery techniques: traditional partial turbinectomy, submucosal turbinate resection, and endoscopic turbinoplasty using a micro-debrider. All techniques involved bayonet bipolar forceps for the electrocautery of potential bleeding vessels. The bleeding rate was lowest in the endoscopic turbinoplasty group (3 per cent), but the other techniques had similar bleeding rates (8.4 per cent and 10.7 per cent).

Tonsillectomy (with or without adenoidectomy) has been the mainstay of surgical treatment of paediatric obstructive sleep apnoea for many years.Reference Powell, Tremlett and Bosman10 Recent years have seen a rise in intracapsular tonsillectomy or tonsillotomy procedures, with lower bleeding rates than traditional surgery and usually faster recovery periods,Reference Wood, Cho and Carney11,Reference Koempel, Solares and Koltai12 which are great advantages for children who may often be lower in weight compared to the average candidate for tonsillectomy for recurrent infections. Many studies have shown quality of life and cost benefits from tonsil surgery in children and adolescents.Reference Nokso-Koivisto, Blomgren, Roine, Sintonen and Pitkaranta13 This issue includes a paper from Helsinki,Reference Sakki, Roine, Mäkinen, Sintonen and Nokso-Koivisto14 which examines quality of life and the healthcare costs as outcome measures for tonsillotomy surgery in children aged 5–11 years, followed for 12 months, and compares these results with a previous cohort of patients who underwent traditional tonsillectomy. They found that both techniques led to similar improvements in quality of life and an overall reduction in healthcare costs. This is our ‘paper of the month’.

The elderly population is growing world-wide, and patients who are very elderly with head and neck cancer often receive different care than younger patients. A study from Newcastle upon Tyne, UK,Reference Iqbal, Navarro-Rodriguez, Munro, Ozalp and Kelly15 included in this issue, examines the patterns of care for patients aged over 80 years, in order to inform future studies and discussions on care for this group, who are usually under-represented in clinical trials.Reference Abbasi16

References

Eveleigh, MO, Hall, CEJ, Baldwin, DL. Prognostic scoring in necrotising otitis externa. J Laryngol Otol 2009;123:1097–102CrossRefGoogle ScholarPubMed
Chawdhary, G, Liow, N, Democratis, J, Whiteside, O. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends. J Laryngol Otol 2015;129:600–3Google ScholarPubMed
Hopkins, ME, Bennett, A, Henderson, N, MacSween, KF, Baring, D, Sutherland, R. A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa. J Laryngol Otol 2020;134:487–92CrossRefGoogle ScholarPubMed
Rojoa, DM, Raheman, FJ, Saman, Y, Mettias, B, Das, S, Rea, PA. Necrotising otitis externa – is poor outcome predictable? The application of a diagnosis-based scoring system in patients with skull base osteomyelitis. J Laryngol Otol 2022;136:379–85Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83CrossRefGoogle ScholarPubMed
Eweiss, AZ, Al-Aaraj, M, Sethukumar, P, Jama, G. Necrotising otitis externa: a serious condition becoming more frequently encountered. J Laryngol Otol 2022;136:386–90Google Scholar
Melzi, U. On the surgical treatment of the commonest form of nasal obstruction, with notes of 100 resections of the inferior turbinal. J Laryngol Rhinol Otol 1902;17:422–4CrossRefGoogle Scholar
Elwany, S, Harrison, R. Inferior turbinectomy: comparison of four techniques. J Laryngol Otol 1990;104:206–9CrossRefGoogle ScholarPubMed
Levy, E, Ronen, O, Sela, E, Layos, E, Eisenbach, N, Ibrahim, N et al. Inferior turbinate reduction: comparing post-operative bleeding between different surgical techniques. J Laryngol Otol 2022;136:427–32.Google Scholar
Powell, SM, Tremlett, M, Bosman, DA. Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy. J Laryngol Otol 2011;125:193–8CrossRefGoogle ScholarPubMed
Wood, JM, Cho, M, Carney, AS. Role of subtotal tonsillectomy (‘tonsillotomy’) in children with sleep disordered breathing. J Laryngol Otol 2014;128(suppl 1):S3–7CrossRefGoogle Scholar
Koempel, JA, Solares, CA, Koltai, PJ. The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children. J Laryngol Otol 2006;120:9931000CrossRefGoogle ScholarPubMed
Nokso-Koivisto, J, Blomgren, K, Roine, RP, Sintonen, H, Pitkaranta, A. Impact of tonsillectomy on health-related quality of life and healthcare costs in children and adolescents. Int J Pediatr Otorhinolaryngol 2014;78:1508–12CrossRefGoogle ScholarPubMed
Sakki, AJ, Roine, RP, Mäkinen, LK, Sintonen, H, Nokso-Koivisto, J. Impact of tonsillotomy versus tonsillectomy on health-related quality of life and healthcare costs in children with sleep-disordered breathing. J Laryngol Otol 2022;136:454–60Google Scholar
Iqbal, MS, Navarro-Rodriguez, C, Munro, S, Ozalp, B, Kelly, C. Patterns of care for octogenarian patients with head and neck cancer. J Laryngol Otol 2022;136:461–63.Google Scholar
Abbasi, J. Older patients (still) left out of cancer clinical trials. JAMA 2019;322:1751–3CrossRefGoogle ScholarPubMed
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