ENT Research

Below are links to various papers, articles, guidelines to important updates and reviews in clinical research. Currently it is confined to ENT. Other areas of research may be available in the future.

NICE Guidance on Cochlear Implants

On the 28th January 2009 the National Institute of Clinical Excellence issued its guidance on cochlear implants for severe to profound deafness in children and adults. NICE basically supports the use of these implants in those with profound deafness but in the same breath seems terrified of the economic implications of this advice. There are entire sections on how to reduce costs and to ‘shop around’ for the best price from manufacturers. This may indicate that NICE are concerned that this will become extremely costly for the NHS in the future as this technique evolves and becomes more popular.

The guidance can be found by clicking here.

NICE Guidance on Surgical Site Infections

On the 22nd October 2008 the National Institute of Clinical Excellence issued its guidance on how to prevent surgical site infections. This is obviously important for all surgeons, but in actual fact much of the guidance is not vastly different to current practice in the UK. There are one or two points that I noticed on reading the documents. Some neurosurgeons shave the head before operating, and I remember being told it was to reduce the infection rates. As ENT surgeons, we also shave around the ear before any major operation. NICE states that one should not shave an area if it is to avoid infections as this is not beneficial in this respect. I have friends in plastics who get rather upset when I mention that we shave around the ear before operating. To counter this argument however, I would suggest that the reason why neurosurgeons and ENT surgeons shave the head to avoid hair from falling into the wound whilst drilling. The hair gets locked round the burr and can cause serious damage if in a ‘delicate’ area. On saying that I have noticed some surgeons shaving the head when using a face lift incision for a parotidectomy. So perhaps this advice may change practice.

The guidance can be found by clicking here.

NICE Guidance on Sinuplasty

Admittedly I have posted this a little late – on the 28th September 2008 the National Institute of Clinical Excellence issued its guidance on Sinuplasty or balloon catheter dilation of paranasal sinus ostia for chronic sinusitis.

Basically this is when you use a balloon to open up the nasal sinus ostia akin to the technique used in angioplasty (which is where the idea came from). The idea is that you can preserve as much tissue as possible with ‘micro-fractures’ of these channels rather than the more conventional method of FESS surgery.

NICE says the current evidence shows that sinuplasty is a safe procedure and should only be used by surgeons who are experienced in complex sinus surgery. The limitations seem to be the lack of evidence for its effectiveness (although more is becoming available) and the fact it isn’t used for ethmoidal sinus disease. They consider a combination type surgery in the future, although it seems currently in the UK most people consider it’s best use is for frontal sinus disease. I note the price of the equipment is rather high as well. £700 pounds I believe is the cost of the disposable materials used for each patient. One may be able to offset this cost of this with the reduction in inpatient stays and morbidity – but it still seems quite expensive.

The guidance can be found by clicking here.

National Institute for Health and Clinical Excellence (NICE)

Feb 2008 - Surgical Management of Otitis Media with Effusion. NICE have stated that children with glue should have grommet insertion WITHOUT adenoidectomy unless there is a history of frequent upper airways symptoms. This is obviously counter to the as yet unfinshed TARGET trial which appears to show that grommet insetion WITH adenoidectomy would be the correct management plan. The quick reference copy is available here.