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P Harkness

Publications and source records attributed to P Harkness.

11 recordsLinked to original sources
PubMed2001

Management of paediatric otitis media with effusion in the UK: a survey conducted with the guidance of the Clinical Effectiveness Unit at the Royal College of Surgeons of England.

A survey was undertaken of the practice of all Otorhinolaryngologists in England and Wales looking both at practice in general and at management of individual patients, including a patient satisfaction questionnaire, under the auspices of the Clinical Effectiveness Unit at the Royal College of Surgeons. Postal questionnaires enquired about practice in general and management in particular of 20 sequential patients per consultant. Parent questionnaires were sent six weeks and one year post-operatively. Ninety consultants took part and 1503 individual patient proformas were returned. Results showed that these consultants are managing children with otitis media with effusion (OME) in a manner very close to the recommendations of the Effective Healthcare Bulletin (1992) and consistent with the recent Clinical Effectiveness Statement of the BAOHNS, and that the intervention is popular with parents.

Child↗
PubMed2001

An unusual presentation of cat-scratch disease.

Cat-scratch disease (CSD) is a relatively common entity, particularly in children. The most common sites of involvement are the axillary lymph nodes, followed by cervical, pre-auricular and submandibular lymph nodes. We present a case of cat-scratch disease in which the initial clinical features were indistinguishable from those of acute bacterial tonsillitis with jugulodigastric lymphadenopathy. This previously unreported apparent mode of presentation is discussed with reference to the current understanding of the disease.

Acute Disease↗
PubMed1998

Classification of otitis media.

OBJECTIVES: To review the International Classification of Diseases (ICD) system of classifying otitis media. To highlight the failings of this system and to propose an alternative (Read version 3). STUDY DESIGN: An historical review of the literature and a presentation of two distinct classification schemes. METHODS: The advantages and disadvantages of the alternative schemes are analyzed and an algorithm for the classification of otitis media is presented that describes the decisions taken to reach a diagnosis. RESULTS: The proposed classification of otitis media as used in the Read Codes thesaurus is more logical than the ICD classification. CONCLUSIONS: The widely used ICD schema of otitis media fails to provide the otologist or general medical practitioner with a logically organized set of terms to describe inflammatory middle ear disease. This article proposes a simple, hierarchical classification that can be used by specialists, generalists and epidemiologists alike.

Acute Disease↗
PubMed1997

A national audit of sinus surgery. Results of the Royal College of Surgeons of England comparative audit of ENT surgery.

The results of a national audit of sinus surgery are presented. Forty-six consultant ENT surgeons reported on over 2500 sinus procedures. There has been an exponential rise in the number of surgeons in England and Wales performing functional endoscopic sinus surgery (FESS) in recent years. Sixty-five per cent of surgeons in our study used the FESS technique and 81% had formal or other training. Outpatient sinus endoscopy and CT scans have become more routine pre-operative investigations, whilst the use of plain films has waned. There was a wide variation in the numbers of FESS procedures performed by individual surgeons in the 6-month period (between 5 and 85). The overall complication rate was 0.75% for conventional surgery and 1.41% for functional surgery but no major complications were recorded. The primary symptom of blockage was most successfully treated by both conventional and functional surgery (70% and 84% asymptomatic or improved at 6 months). Pain was relieved in 75% of functional procedures and 47% of conventional procedures and discharge relieved in 76% of FESS procedures and 47% of conventional procedures.

Adolescent↗
PubMed1996

Papilloedema, an unusual complication of mastoidectomy.

We report a very unusual case of a patient with a previously undiagnosed congenital absence of the left dural venous drainage system and a prominent system on the right. Due to its prominence it was at risk during a cortical mastoidectomy performed as part of an endolymphatic sac decompression procedure. Manipulation of the lateral venous sinus resulted in partial occlusion of the already compromised venous drainage. The result was a rise in intra-cranial pressure and papilloedema, from which the patient recovered. The abnormality was only detected on post-operative imaging.

Female↗
PubMed1996

Management of epistaxis: a national survey.

A survey to assess variations in management and outcome of patients admitted with epistaxis was conducted. A questionnaire was sent to all consultant otolaryngologists working at NHS hospitals in England and Wales requesting information about management of patients admitted with epistaxis over a 3 month period. Data analysis of information provided by 102 consultants for a total of 933 patients was performed. The average number of patients admitted with epistaxis over a period of 3 months per consultant was 10.2. More than 70% of the patients were aged 60 years or over. Approximately 75% of the patients required nasal packing; the most common pack used was BIPP (Bismuth Iodine Paraffin Paste). Of the patients, 5.6% required general anaesthesia, with less than 1% requiring formal arterial ligation. The mean duration of stay in hospital was 2.9 days. Few complications were reported. Patients admitted with epistaxis were generally managed conservatively, with very few requiring surgical intervention. There was remarkable consensus in various aspects of management of patients admitted with epistaxis.

Adult↗
PubMed1995

Submandibular salivary disease: a proposed allergic aetiology.

Two cases of submandibular gland swelling are documented. In one patient examination of the excised submandibular gland revealed a dense eosinophilia: the other patient had a peripheral blood eosinophilia. Both patients demonstrated a marked decrease in the swelling of the salivary glands after a course of oral antihistamine. Although allergy has been implicated as a cause of recurrent parotid gland swelling, there are no previous reports of such a phenomenon occurring in the submandibular gland.

Adult↗
PubMed1995

A confidential comparative audit of stapedectomies: results of the Royal College of Surgeons of England Comparative Audit of ENT surgery 1994.

This paper presents the results of a national confidential comparative audit of stapedectomy: 185 operations by 28 consultants over a two-year period were retrospectively analysed. This included 10 revision procedures. Small fenestra stapedectomies accounted for 63 per cent of the total. Thirty-nine per cent of consultants operated on the second ear. Of the 168 stapedectomies in which the hearing change was known at six months, 87 per cent achieved improved hearing, eight per cent had no change and five per cent were worse. The overall complication rate was 30 per cent with a 'dead ear' rate of two per cent.

Bone Conduction↗
PubMed1995

Mastoidectomy audit: results of the Royal College of surgeons of England comparative audit of ENT surgery.

This paper presents the results of a national comparative audit of mastoid surgery, retrospectively analysing 611 operations by 55 consultants. Confidentiality for both patient and surgeon was assured. For cholesteatoma 80% of mastoidectomies performed were open cavity procedures and for other middle ear disease 58% used an intact canal wall technique. Thirty-two surgeons used only an open cavity mastoidectomy for cholesteatoma during the period of the audit. There was a statistically significantly greater number of wet ears with open cavities than with closed cavities, but the frequency of the operator did not correlate with the dry ear rate. Ten serious complications (facial palsy and dead ear) were recorded. All occurred in open cavity mastoidectomies. The post-operative hearing status was unknown in 40% of patients.

Cholesteatoma↗
PubMed1994

Complications in ENT--a nationwide audit carried out in November 1992.

We report a prospective audit of complications following ENT surgery during November 1992 from 42 consultants across the United Kingdom. Complications were reported as codes, and results were analysed at the Royal College of Surgeons Comparative Audit Unit. A total of 174 complications were reported, giving an annualized complication rate per consultant of 5.7-7.0% (depending on whether only the most severe complication per patient is counted or all complications). This compares with an annual complication rate of 1.49% reported retrospectively for the year of 1991 by the same consultants.

General Surgery↗