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Safety standards for invasive procedures in out-patient departments, managing subglottic stenosis in pregnancy, a critical review on follow up of head and neck cancer patients, and a new classification for cochleovestibular malformations

Published online by Cambridge University Press:  11 June 2019

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Abstract

Type
Editorial
Copyright
Copyright © JLO (1984) Limited, 2019 

The inception of the World Health Organization checklist has transformed the way surgeons operate around the world. The emphasis has hitherto been on in-patient procedures, with an increase in out-patient based operative procedures in British Isles checklists to avoid errors. Coates and CarrieReference Coates and Carrie1 have produced a useful safety standard for endoscopic procedures performed under local anaesthetic in the out-patient setting. The authors draw attention to the shift toward ambulatory care in the health service, directed by patient choice, technological advances and the opportunity for cost savings.

The presence of subglottic stenosis in pregnant women is significant and rare, and may lead to a life-threatening delivery;Reference Scholz, Srinivas, Stacey and Clyburn2 management therefore requires expertise. Damrose and colleaguesReference Damrose, Manson, Nekhendzy, Collins and Campbell3 describe their use of balloon dilatation with non-invasive ventilation techniques in the treatment of pregnant patients with idiopathic subglottic stenosis. There is limited experience in the management of this condition, so this paper is an excellent addition to our knowledge.

Kytö et al.Reference Kytö, Haapio, Minn and Irjala4 have challenged the current follow-up duration of head and neck cancer patients. The Journal of Laryngology and Otology published the UK consensus documents on head and neck cancer, including various aspects of follow up,Reference Simo, Homer, Clarke, Mackenzie, Paleri and Pracy5Reference Rogers, Semple, Babb and Humphris7 that has informed British practice. Kytö et al. report on 456 patients with new malignancies of the head and neck, seen over nine years, who were followed up for five years in keeping with current guidelines. The authors found that 22 per cent of patients (n = 94) relapsed during the study period; 90 per cent of these relapses occurred in the first three years of follow up. Interestingly, all patients with a late recurrence had symptoms of the disease; however, cases of a recurrent tumour in patients with no symptoms were all found within 34 months of the original therapy.

Various classifications for cochleovestibular malformations exist. Grover et al.Reference Grover, Sharma, Preetam, Gupta, Samdani and Agarwal8 have added to this in their well thought out paper that considers three features of cochlear anatomy. Their multicentre study, comprising 436 patients, is an important contribution to the earlier works of Jackler et al.,Reference Jackler, Luxford and House9 and Sennaroglu and Bajin.Reference Sennaroglu and Bajin10

References

1Coates, ML, Carrie, S. A local safety standard for invasive procedures for out-patient endonasal procedures performed under local anaesthetic: a template from Newcastle upon Tyne hospitals. J Laryngol Otol 2019;133:441–4Google Scholar
2Scholz, A, Srinivas, K, Stacey, MR, Clyburn, P. Subglottic stenosis in pregnancy. J Laryngol Otol 2008;100:385–8Google Scholar
3Damrose, EJ, Manson, L, Nekhendzy, V, Collins, J, Campbell, R. Management of subglottic stenosis in pregnancy using advanced apnoeic ventilatory techniques. J Laryngol Otol 2019;133:399403Google Scholar
4Kytö, E, Haapio, E, Minn, H, Irjala, H. Critical review of the follow-up protocol for head and neck cancer patients. J Laryngol Otol 2019;133:424–9Google Scholar
5Simo, R, Homer, J, Clarke, P, Mackenzie, K, Paleri, V, Pracy, P et al. Follow-up after treatment for head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(suppl 2):S208–11Google Scholar
6Paleri, V, Urbano, TG, Mehanna, H, Repanos, C, Lancaster, J, Roques, T et al. Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(suppl 2):S161–9Google Scholar
7Rogers, SN, Semple, C, Babb, M, Humphris, G. Quality of life considerations in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(suppl 2):S49–52Google Scholar
8Grover, M, Sharma, S, Preetam, C, Gupta, G, Samdani, S, Agarwal, S et al. New SMS classification of cochleovestibular malformation and its impact on decision-making. J Laryngol Otol 2019;133:368–75Google Scholar
9Jackler, RK, Luxford, WM, House, WF. Congenital malformations of the inner ear: a classification based on embryogenesis. Laryngoscope 1987;97:214Google Scholar
10Sennaroglu, L, Bajin, MD. Classification and current management of inner ear malformations. Balkan Med J 2017;34:397411Google Scholar