Amro Hassaan and Aaron Trinidade
The purpose of this paper is to determine a tinnitus patient information pack’s (TPIP) usefulness in patients suffering with tinnitus with respect to their need for further…
Abstract
Purpose
The purpose of this paper is to determine a tinnitus patient information pack’s (TPIP) usefulness in patients suffering with tinnitus with respect to their need for further tinnitus retraining therapy (TRT) and in reducing TRT cancellations and non-attenders.
Design/methodology/approach
The paper consists of prospective case series in a district general hospital ENT out-patient department.
Findings
Patients with tinnitus-related symptoms constitute around 2 per cent of the ENT OPD workload at the West Middlesex Hospital, Chelsea & Westminster NHS Trust, London, i.e., 365 patients with intrusive tinnitus were referred by the ENT surgeon for TRT; 56/365 patients (15.3 per cent) failed to attend and 60 (16.4 per cent) cancelled their appointments. The following year, a TPIP was administered to all tinnitus sufferers, despite the affliction’s intrusiveness, and told to contact the audiology department if they felt that TRT was required, which resulted in 43/233 patients (18.5 per cent) over a one-year period self-referring for TRT; 2/233 (0.9 per cent) did not attend, and 1/233 (0.4 per cent) were cancelled appointments.
Practical implications
The patient-focussed TPIP acts as an initial therapy for the tinnitus sufferer by providing reassurance and self-therapy. This results in patients who are less likely to seek TRT, leading to more efficient clinical resource usage (p<0.01).
Originality/value
The data suggest that all tinnitus sufferers presenting to ENT clinics could be handed a TPIP and empowered with the decision whether they require further intervention.
Details
Keywords
Amro Hassaan, Aaron Trinidade, Bhik Kotecha and Neil Tolley
Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography…
Abstract
Purpose
Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography. Pre-operative magnetic resonance imaging (MRI) can be a useful adjunct in objective upper airway assessment, in particular the tongue base, providing useful information for surgical planning and outcome assessment, though care must be taken in patient positioning during surgery. The purpose of this paper is to identify pitfalls in this process and suggest a protocol for pre-operative MRI scanning in OSA.
Design/methodology/approach
This study is a four-patient prospective case-series and literature review. Outcome measures include pre- and post-operative volumetric changes in the pharynx as measured on MRI and apnoea–hypopnea indices (AHI), with cure being OSA resolution or a 50 per cent reduction in AHI.
Findings
All patients achieved AHI reduction and/or OSA cure following TORS, despite a decrease in pharyngeal volume measurements at the tongue base level. This study and others lacked standardisation in the MRI scanning protocol, which resulted in an inability to effectively compare pre- and post-operative scans. Pitfalls were related to variation in head/tongue position, soft-tissue marker usage and assessed area boundary limits.
Practical implications
TORS appears to be effective in OSA management. A new protocol for patient positioning and anatomical landmarks is suggested.
Originality/value
The findings could provide directly comparable data between scans and may allow correlation between tongue base volumetric changes and AHI through subsequent and historical study meta-analysis.
Details
Keywords
Aaron Trinidade, Prasad Kothari, Zenon Andreou, Richard J.D. Hewitt and Paul O'Flynn
The purpose of this paper is to determine head and neck cancer patients' perspective of their follow‐up regime and to suggest ways in which these perspectives can be incorporated…
Abstract
Purpose
The purpose of this paper is to determine head and neck cancer patients' perspective of their follow‐up regime and to suggest ways in which these perspectives can be incorporated into current practice.
Design/methodology/approach
This is a prospective survey‐based study. A total of 263 patients consecutively attending a head and neck cancer clinic completed a survey about their experience of the follow‐up process in the post‐treatment period between January 2009 and October 2009.
Findings
The paper finds that, of the patients, 67 per cent (n=176) felt that the clinic met the goals they hoped would be achieved during their visit; 84 per cent (n=221) felt that their follow‐up visits were too frequent. In total 60 per cent (n=159) were booked to see both an allied health professional and the attending clinician. Of these, 84 per cent (n=134/159) felt that issues addressed at follow‐up with the clinician duplicated those addressed by the allied healthcare professionals. When asked about their opinion of a less intensive follow‐up system based on patients reporting problems and requesting appointments, 73 per cent (n=192) favoured it. When asked who they would like to contact first in such a system, most patients (n=118, 45 per cent) stated a clinical nurse specialist.
Practical implications
Current follow‐up regimes may be too prescriptive in their approach without taking patient perspective into consideration. Patients felt that being seen intensively for the first year, then having visits tapered off over the next two years and finally being seen according to symptoms thereafter to be appropriate and felt that this represented an overall better system.
Originality/value
These data suggest the need for a more patient‐focused, individualised approach to follow‐up in head and neck cancer.