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D D Pothier

Publications and source records attributed to D D Pothier.

14 recordsLinked to original sources
PubMed2006

ENT in general practice: training, experience and referral rates.

A postal survey of 500 general practitioners (GPs) in south-west England was undertaken to evaluate the levels of undergraduate and postgraduate otolaryngology training and/or experience received by GPs in that area. Most GPs had received two weeks of undergraduate training in ENT, which had involved no formal assessment. Three-quarters of GPs considered this inadequate. A quarter of GPs had completed a hospital post in ENT prior to entering general practice, most of which lasted three months. Sixty-one per cent of GPs had received some formal postgraduate training in ENT, in the form of courses, lectures or hospital training sessions. Almost half of the GPs considered this inadequate. Seventy-five per cent of GPs stated they would like further training in ENT. Subjective estimates of referral rates to hospital ENT specialist clinics varied considerably. This study illustrates the variability and level of dissatisfaction regarding ENT training amongst GPs at both undergraduate and postgraduate levels.

Education, Medical, Undergraduate↗
PubMed2006

Information technology in ENT: are we ready to be 'Connected For Health'?

The NHS Connecting for Health agency continues to implement the national programme for information technology within the National Health Service (NHS). In preparation, NHS employees are being encouraged to develop their information technology skills via the European computer driving licence training course. A postal survey of British Association of Otorhinolaryngologists members was undertaken to evaluate their levels of information technology training, competency and knowledge. Three hundred and thirty-six surgeons responded. Most respondents had received no formal information technology training. Only 3.9 per cent had taken the European computer driving licence course. Most surgeons felt comfortable using word processing and presentation software but were less comfortable with other applications. Junior surgeons were more confident in all areas of information technology application than senior surgeons. Seventy-two per cent of surgeons wanted more information technology training. Most felt that such training should be routine at undergraduate and postgraduate level. With the national programme committed to improving information technology infrastructure within the NHS, more formal training should be provided to ensure a basic standard of information technology competency amongst ENT surgeons.

Adult↗
PubMed2006

Management of surgical airway emergencies by junior ENT staff: a telephone survey.

OBJECTIVE: To determine levels of confidence in the management of surgical airway emergencies by junior ENT staff. DESIGN: Telephone survey. PARTICIPANTS: 100 Senior House Officers (SHOs) from 100 hospitals in the UK, providing 24 hour first on-call emergency ENT cover. METHOD: A list of questions was put to participants. The effects of different variables on confidence with airway emergencies and what SHOs considered to be adequate training were compared. RESULTS: Most SHOs provided cover for the management of surgical airway emergencies. Many of the participants were not confident to handle airway emergencies or felt that their training was inadequate. As expected, the amount of previous experience in ENT and the ability to perform advanced airway procedures gave SHOs greater confidence, but attendance at airway courses did not. CONCLUSION: Confidence in the management of airway problems is variable and does not correlate well with perceived adequacy of training. We suggest that systems of training in airway management are improved. Training issues may be better approached at an individual level, where deficiencies can be addressed.

Airway Obstruction↗
PubMed2006

Timing of co-phenylcaine administration before rigid nasendoscopy: a randomized, controlled trial.

Rigid nasendoscopy is a commonly used method of examining the nasal cavity and postnasal space. Co-phenylcaine is useful for its vasoconstrictive and anaesthetic properties, but the length of time allowed for it to take effect is variable. We performed a single-blind, randomized, controlled trial to determine whether it was better to allow one or 10 minutes for co-phenylcaine to take effect. Fifty patients were randomized into two groups, 25 in each. Patients in the 10 minute group experienced less discomfort (p=0.02) and less pain (p=0.018) than those in the one minute group. Ease of examination was also greater in the 10 minute group, as was the quality of the image obtained (p<0.001).

Adolescent↗
PubMed2006

Hearing aid insertion: correlation between patients' confidence and ability.

INTRODUCTION: Once fitted with hearing aids, much reliance is placed on patients' own ability to manage their devices effectively. There has, however, been little research to assess how patients' own confidence compares with their actual ability to manage their hearing aids. This study compares patients' perceptions of their ability to insert their hearing aids with their observed ability to insert the devices satisfactorily. METHOD: Eighty-five patients provided a rating of their level of confidence in fitting their hearing aid, using a visual analogue score (VAS). This was then compared with their observed level of ability, assessed by an audiologist, also using a VAS (both scores 0-100 mm). RESULTS: We found a weak to moderate correlation between the subjective and objective scores (Pearson r = 0.4912). CONCLUSIONS: From these results, we would advise caution when accepting a patient's perceived level of ability as the only indicator of their true ability to insert their hearing aid. This also has important implications for follow-up services that rely only on telephone conversations with patients after a first fitting.

Adult↗
PubMed2006

Should we aspirate middle-ear effusions prior to insertion of ventilation tubes?

BACKGROUND: Routine aspiration of middle-ear effusions prior to ventilation tube (grommet) insertion is practised by many surgeons. It has been suggested that removing the fluid from the middle ear improves immediate post-operative hearing levels and reduces the chance of the ventilation tube becoming obstructed. The potential adverse effects of applying suction to the middle ear include acoustic trauma and an increased risk of tympanosclerosis and otorrhoea. We undertook a review of the literature in order to determine the benefits or side effects associated with middle-ear aspiration prior to ventilation tube insertion. OBJECTIVES: To compare clinical outcomes associated with aspirating versus not aspirating the middle ear prior to ventilation tube insertion. METHODS: The Cochrane ENT group trials register, DARE, the Cochrane central register of controlled trials (CENTRAL), MEDLINE (1960-2005) and EMBASE (1960-2005) were searched using relevant terms. Reference lists of selected studies were scanned for additional research material. RESULTS: Seven studies were identified, of which three fitted the inclusion criteria of our review. Current evidence suggests that aspiration of middle-ear effusions prior to insertion of ventilation tubes is not associated with any improvement in clinical outcome, in terms of post-operative hearing levels, otorrhoea or rates of blockage of ventilation tubes. Significantly increased rates of tympanosclerosis were observed in one study and the development of acoustic trauma was observed; however, no significant association was confirmed. Although more research is needed, there is no evidence that aspiration of middle-ear effusion prior to grommet insertion confers any advantage.

Hearing Loss, Noise-Induced↗
PubMed2006

Tragal cartilage harvesting and 'in the ear' earphones: a pilot study.

'In the ear' headphones are held in position by the cartilaginous skeleton of the pinna. The tragus is an important part of this skeleton and plays a significant role in holding these devices in place. We designed a retrospective case-control study to determine whether the harvesting of tragal cartilage had any effect on the ability to wear 'in the ear' earphones. Fifty patients who had undergone ear surgery requiring harvesting of tragal cartilage, along with 50 age-matched controls who had undergone similar procedures without tragal cartilage harvesting, were sent a questionnaire about their experiences with 'in the ear' earphones both pre- and post-operatively. Ten of the 12 patients in the tragal harvesting group who had used earphones pre- and post-operatively had had problems with earphones post-operatively, which in eight cases were due to pain or the devices falling out. Of the 12 respondents in the non-tragus group, only one had similar problems (p<0.05). Tragal harvesting may affect the ability of patients to wear certain types of headphones post-operatively and this should be discussed pre-operatively with the patient.

Case-Control Studies↗
PubMed2006

How we do it: technical note: endoscopic removal of cerumen.

* Syringing of ears to remove cerumen is losing favour in primary care owing to the fact that it is carried out 'blind' and that the potential exists for serious complications. * Dewaxing under direct vision is difficult without a microscope. * A technique is described where wax is removed under direct vision using a rigid endoscope in conjunction with a Jobson-Horne probe and St Bartholomew's wax hook. * This is a relatively inexpensive technique that could be introduced to primary care practitioners or to ENT surgeons who do not have easy access to an operating microscope in the outpatient department.

Cerumen↗
PubMed2006

A randomized controlled trial: is water better than a standard lubricant in nasendoscopy?

OBJECTIVES: Previous studies have shown that nasendoscopy is made easier with the use of lubrication at the expense of the quality of the view obtained, but had no effect on the discomfort or pain experienced by the patient. We set out to determine whether the advantages of lubrication with a standard lubricant (KY Jelly) could be achieved by using water, without incurring the same disadvantages. DESIGN: Single blind randomized controlled trial. SETTING: Outpatient Departments at two District General Hospitals. PARTICIPANTS: One hundred and fifty participants selected sequentially from patients requiring a nasendoscopy where the endoscope would be passed far enough to view the larynx. Patients requiring topical anaesthetic were excluded. METHODS: Patients were randomly assigned to have either water or standard lubricant applied to the nasendosope prior to nasendoscopy. Levels of pain experienced by the patient were recorded on a visual analogue score as well as visual analogue scores from the clinician for the levels of difficulty in passing the endoscope. All participants who were entered the study completed the study. Endoscopy was performed by all grades of medical staff. MAIN OUTCOME MEASURES: Levels of pain experienced by the participants were assessed by a visual analogue scale. Difficulty of passing the scope was indicated by the endoscopist using a visual analogue scale, as was the quality of image obtained. RESULTS: Endoscopists found the insertion of the endoscope was easier and the image better when water was used rather than KY Jelly. There was no significant difference in reported in levels of pain experienced by the patient. CONCLUSION: Although the use of water as a lubricant during nasendoscopy confers no additional benefit in term of the levels of pain suffered by patients during the procedure, it makes the insertion of the endoscope easier and provides a better quality image than standard lubrication.

Adult↗
PubMed2006

How we do it: analysing GP referral priorities: the unforeseen effect of 'Choose and Book'.

The introduction of Choose and Book may have a significant effect on the proportion of urgent referrals seen by ENT surgeons. Much of the responsibility for prioritisation will be transferred to the GP. Patients who are considered urgent by the ENT surgeon will be added to those considered urgent by the GP. Our results show that there was little agreement between GPs and ENT surgeon on what constitutes an urgent referral. The combined effect of joint prioritisation and the removal of the 'soon' category resulted in a 270% increase in 'urgent' referrals in our sample. This potentially unforeseen consequence of the Choose and Book system should be taken into consideration by ENT departments to allow for an expansion of the 'urgent' category.

Appointments and Schedules↗
PubMed2006

A comparison of endoscopic and microscopic removal of wax: a randomised clinical trial.

OBJECTIVES: Using a microscope to achieve a view of the canal during dewaxing is the most commonly performed method of dewaxing in secondary care, but an endoscope can also be used. We set out to compare endoscopic and microscopic dewaxing. DESIGN: Randomised clinical trial. SETTING: Otolaryngology Outpatient Department. PARTICIPANTS: One hundred participants selected sequentially from patients requiring dewaxing of their ears to allow examination of the tympanic membrane. Patients with external or middle ear pathology were excluded. METHODS: Patients were randomly assigned to have dewaxing performed using microinstruments aided by vision with a microscope or an endoscope. All participants who were entered the study completed the study. MAIN OUTCOME MEASURES: Levels of pain and discomfort experienced by the participants were assessed by a visual analogue scale (VAS). Difficulty of performing the dewaxing indicated by the endoscopist using a VAS. The length of time taken to perform the dewaxing was also recorded. RESULTS: Endoscopic dewaxing was less uncomfortable than microscopic dewaxing for patients (VAS median values 5 and 25 respectively; P < 0.002) as well as less painful (VAS median values 3.5 and 10 respectively; P < 0.075). Endoscopic dewaxing was easier to perform than microscopic dewaxing (VAS median values for difficulty were 9 and 20 respectively; P < 0.005) and took less time (mean time for endoscopic dewaxing was 1.8 min versus 3.3 min for microscopic dewaxing (P < 0.001). Ninety-one per cent of ears could be dewaxed with a Jobson-Horne probe or wax hook. CONCLUSIONS: The cost of an operating microscope suitable for use with dewaxing is approximately 10 times that of a suitable endoscope, dewaxing is a cheaper alternative to microscopic dewaxing that has benefits for the patient and clinician.

Adolescent↗
PubMed2005

The use of lubrication in flexible fibreoptic nasendoscopy: a randomized controlled trial.

OBJECTIVES: To determine how lubrication of the endoscope prior to flexible fibreoptic nasendoscopy affects levels of patient discomfort and pain during endoscopy. To assess the extent to which lubrication affects the ease of nasendoscopy and the quality of the image obtained. DESIGN: Single blind, randomized controlled trial. SETTING: Outpatient clinic of the Department of Otolaryngology at a secondary level referral centre. PARTICIPANTS: A total of 150 participants selected sequentially from patients requiring a nasendoscopy where the endoscope would be passed far enough to view the larynx. Patients requiring topical anaesthetic were excluded. All participants who were entered in the study completed the study. Endoscopy was performed by all grades of medical staff. MAIN OUTCOMES MEASURES: Levels of discomfort and pain experienced by the participants were assessed by a visual analogue scale (VAS). Difficulty of passing the scope was indicated by the endoscopist using a VAS, as was the quality of image obtained. RESULTS: There was no significant difference between mean scores for pain or discomfort of the lubricated and unlubricated groups (P = 0.46 and P = 0.82 respectively). Scores for difficulty of passing the scope were significantly lower in the lubricant group (P = 0.003) but loss of image was significantly greater (P = 0.008). CONCLUSIONS: Lubrication of the endoscope prior to nasendoscopy does not reduce levels of discomfort or pain for the patient, but increases ease in insertion for the operator. However, this may be at the expense of reduced image quality.

Adult↗