Skip to main content Accessibility help
×
Home
Hostname: page-component-568f69f84b-gcfkn Total loading time: 0.316 Render date: 2021-09-17T21:50:14.763Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Papers presented at the Association of Otolaryngologists in Training Annual Meeting, 20 June 2014, Exeter, UK

Published online by Cambridge University Press:  25 May 2015

Zaid Awad
Affiliation:
North Thames Deanery (ENT)
Richard Williams
Affiliation:
South West Peninsula Deanery (ENT)
Natalie Ronan
Affiliation:
South West Peninsula Deanery (ENT)
S A Hickey
Affiliation:
Torbay Hospital
H Khalil
Affiliation:
Derriford Hospital
A Evans
Affiliation:
Great Yarmouth and Waveney Clinical Commissioning Group
T Jones
Affiliation:
Aintree University Hospital
D Skinner
Affiliation:
Shrewsbury and Telford Hospital
B N Kumar
Affiliation:
Royal Albert Edward Infirmary (Wigan)
J Rainsbury
Affiliation:
Derriford Hospital
A Narula
Affiliation:
St Mary's Hospital (London)
J Powles
Affiliation:
Torbay Hospital

Abstract

Type
Online Only Abstract Selection
Copyright
Copyright © JLO (1984) Limited 2015 
Investigating the parotid tumour: are magnetic resonance imaging scans more accurate in diagnosing malignant parotid tumours than fine needle aspiration cytology?
M Bajalan 1
T Biggs 2
S Jayaram 1
P Pracy 1
1University Hospital Birmingham NHS Foundation Trust
2University Hospital Southampton NHS Foundation Trust

Background

The key step in the evaluation of parotid lumps is to differentiate benign lesions from malignant ones. The ENT-UK guidelines advocate the use of fine needle aspiration cytology (FNAC). There are minimal evidence-based data concerning alternative diagnostic tools.

Objective

We decided to investigate the accuracy of magnetic resonance imaging (MRI) compared with FNAC in correctly diagnosing malignant parotid tumours.

Methods

All patients who had undergone parotidectomy from January 2012 to June 2013 were identified. The parotid sample list was acquired from the pathology department. Only parotidectomies carried out for primary tumour removal were considered; all parotidectomies performed as part of a complete dissection for other primary malignancies were excluded.

Retrospective analysis identified the investigations that took place prior to surgery. The results of each test were compared to the definitive histopathology result, which was considered the ‘gold standard’ diagnosis.

Results

Table I Predictive ability of MRI and FNAC in parotid mass diagnosis

Data represent numbers of patients unless indicated otherwise. MRI = magnetic resonance imaging; FNAC = fine needle aspiration cytology; PPV = positive predictive value; NPV = negative predictive value

Conclusion

Accurate pre-operative assessment of benign versus malignant parotid lumps helps the surgeon to plan excision and determine the need for neck dissection; it can also significantly alter the incidence of peri-operative facial nerve paresis or paralysis.

Our results highlight the sensitivity of MRI as a diagnostic tool in differentiating malignant from benign parotid lesions. Fine needle aspiration cytology demonstrates significant accuracy in benign lesions, but appears limited for malignant pathology. There may be a substantial role for MRI; we feel this should be explored by analysing a larger cohort of malignant parotid tumour data, the outcomes of which may have a potentially significant impact on changing current recommended practice.

Quality improvement without significant costs: improving rates of day-case tonsillectomies in the absence of a dedicated day-case unit
W Yeung
H Wilson
Royal Devon and Exeter Hospital

Background and objective

Over 55 000 tonsillectomies are performed in England every year. Historically, patients stay overnight. The Royal College of Surgeons deemed tonsillectomies inappropriate for day-case surgery in 1985, citing reactionary haemorrhage as the contraindication. Since then, published evidence has concluded that this risk is low, prompting a shift in practice. We present the challenges of improving rates of day-case tonsillectomies in the absence of a dedicated day-case unit.

Methods

Data on day-case tonsillectomy rates in both children and adults were collected over six months in 2011 (n=123). New local protocols were designed specifically for day-case tonsillectomies. Day-case tonsillectomy rates were re-audited over six months in 2012 (n = 125) to assess the effect of intervention.

Results

Day-case tonsillectomy rates increased in children from 9 to 25 per cent. A similarly significant increase was noted in adults, from 6 to 43 per cent. There were two re-admissions over the re-audit period, neither of which involved day-case patients.

Conclusion

This project demonstrates how healthcare processes can be streamlined to save time and resources without compromising patient safety. By engaging colleagues and patients, we made dramatic improvements, without needing to construct an expensive, purpose-built day-case facility, which is all the more relevant in times of efficiency savings.

Procedures of limited clinical value in ENT: what effect has there been on operating numbers?
F Shelton
T Biggs
A Henderson
N Patel
University Hospital Southampton Foundation NHS Trust

Background and objective

‘Procedures of limited clinical value’ is a term first highlighted in the McKinsey report (2009), which examined potential cost-cutting measures within the future National Health Service (NHS). It is a term used by some trusts to describe surgical procedures that, they feel, are not cost effective. With the NHS now facing intense financial pressures, we undertook a study to examine whether five core procedures within the specialty of ENT had been restricted.

Methods

Numbers of operative procedures carried out over a six-year period (2007–2012) at six separate hospitals across the Wessex Deanery were obtained. Five surgical ENT procedures commonly classified as procedures of limited clinical value were studied: tonsillectomy, adenoidectomy, septorhinoplasty, pinnaplasty, and myringotomy with grommet insertion.

Results

In total, 22 839 surgical procedures were included. A year-on-year variability in the number of each of the five individual procedures was observed. However, when comparing the cumulative data from pre-2009 to post-2009, there were no significant changes in the numbers of procedures carried out. On individual examination of hospitals, no significant changes were seen in the numbers of tonsillectomies, adenoidectomies and myringotomies performed. However, a significant drop in the numbers of pinnaplasty and septorhinoplasty procedures was observed in some hospitals.

Conclusion

Since the introduction of the concept of procedures of limited clinical value in 2009, there has not been a significant drop in the number of core ENT procedures performed across the Wessex region. However, there seems to be significant inter-hospital variation with respect to some ENT procedures. With the introduction of clinical commissioning, the inter-hospital variation in surgical provision may well increase.

Footnotes

Junior Otolaryngologist in Training prize (presented by Prof Narula) was awarded to Winnie Yeung and Helena Wilson for ‘Quality improvement without significant costs: improving rates of day-case tonsillectomies in the absence of a dedicated day-case unit’.

References

Junior Otolaryngologist in Training prize (presented by Prof Narula) was awarded to Winnie Yeung and Helena Wilson for ‘Quality improvement without significant costs: improving rates of day-case tonsillectomies in the absence of a dedicated day-case unit’.

You have Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Papers presented at the Association of Otolaryngologists in Training Annual Meeting, 20 June 2014, Exeter, UK
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Papers presented at the Association of Otolaryngologists in Training Annual Meeting, 20 June 2014, Exeter, UK
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Papers presented at the Association of Otolaryngologists in Training Annual Meeting, 20 June 2014, Exeter, UK
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *