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Diagnostic criteria and core outcome set development for necrotising otitis externa, symptomatic evaluation in patients awaiting septoplasty and early versus late tracheostomy in critically ill patients

Published online by Cambridge University Press:  28 October 2024

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Abstract

Type
Editorial
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

A tour de force article in this month's issue describes the development of standardised diagnostic criteria and a core outcome set for necrotising otitis externa, achieved using international best practice guidelines and incorporating patient and multidisciplinary stakeholder engagement.Reference Lodhi, Dodgson, Dykes, Vishwanath, Bazaz and Mathur1 Adoption of these diagnostic criteria and the core outcome set should facilitate the optimisation of future necrotising otitis externa research through consistency in reporting and enhanced data synthesis, thereby enabling best practice to be identified.

Nasal septoplasty is one of the most performed procedures within ENT. In a study by Williams et al. in this month's issue, patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool, the Nasal Obstruction Symptom Evaluation instrument, to assess symptom severity.Reference Williams, Chin Liu, Navaratnam and Ferguson2 A pre-defined threshold of 30 or more on the Nasal Obstruction Symptom Evaluation scale was taken to warrant nasal surgery in patients with nasal airway obstruction secondary to a deviated nasal septum, based on the recently published Nasal Airways Obstruction Study trial.Reference Carrie, O'Hara, Fouweather, Homer, Rousseau and Rooshenas3 The authors found that the Nasal Obstruction Symptom Evaluation questionnaire is a quick and simple way to evaluate, triage and prioritise patients on septoplasty waiting lists, helping to identify patients still requiring surgery.

Other notable articles in this month's issue deserve special mention. The treatment of the clinically node-negative contralateral neck in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma remains controversial. An article in this month's issue analyses of the rate of contralateral nodal metastasis in HPV-associated oropharyngeal squamous cell carcinoma, thereby helping to clarify which patient cohorts would benefit from bilateral neck treatment.Reference Kornfeld, Kyang, Taha, McCloy, Chin and Leavers4 The contralateral nodal disease rate was 12.7 per cent, of which 2 per cent were occult findings. The most commonly involved contralateral nodal station was level II. The presence of extra-nodal extension and multiple ipsilateral positive nodes was associated with an increased risk of contralateral nodal disease.

Finally, a manuscript in this month's issue adds to the growing body of literature examining the benefits of early versus late tracheostomy in critically ill patients, demonstrating an association of early tracheostomy with both shorter intensive care unit length of stay and lower mortality.Reference Patel, Patel, Revercomb, Cohen, Tseng and Hsueh5

References

Lodhi, S, Dodgson, K, Dykes, M, Vishwanath, V, Bazaz, R, Mathur, S, et al. Diagnostic criteria and core outcome set development for necrotising otitis externa: the COSNOE Delphi consensus study. J Laryngol Otol 2024;138:913–20Google Scholar
Williams, IJM, Chin Liu, M, Navaratnam, AV, Ferguson, M. Nasal obstruction symptom evaluation score outcomes in patients awaiting septoplasty at a tertiary ENT centre. J Laryngol Otol 2024;138:902–5Google Scholar
Carrie, S, O'Hara, J, Fouweather, T, Homer, T, Rousseau, N, Rooshenas, L et al. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. BMJ 2023;383:e075445CrossRefGoogle ScholarPubMed
Kornfeld, B, Kyang, L, Taha, A, McCloy, R, Chin, V, Leavers, B et al. Incidence and distribution of contralateral lymph node metastasis associated with HPV-related oropharyngeal squamous cell carcinoma. J Laryngol Otol 2024;138:965–72Google Scholar
Patel, AM, Patel, R, Revercomb, L, Cohen, DA, Tseng, CC, Hsueh, WD et al. Association of early tracheostomy with length of stay and mortality in critically ill patients. J Laryngol Otol 2024;138:921–7Google Scholar