The Warsaw otolaryngology in the end of the 19th century and the beginning of the 20th century

Main professional and scientific centries in otolaryngology were the Varsovian hospitals. The origin of several otolaryngological institutions in Warsaw (laryngological ward at St. Roch Hospital, founded in 1881 by Teodor Heryng (1847-1925), otological ward at Ujazdowski Hospital, founded also in 1881 by Teodor Heiman (1848-1917), laryngological out-patient ward at St. Spirit Hospital, founded in 1883 by Alfred M. Soko?owski is described. The origin of otolaryngological ward at Orthodox Jew Hospital, the first otolaryngological ward in Warsaw, founded in 1903 by Leopold Lubliner (1863-1937) is also mentioned. The major otolaryngological operations were performed also at surgical wards. The achievements of such surgeons as W?adys?aw Matlakowski (1851-1895), W?adys?aw Stankiewicz (1838-1929), W?adys?aw Krajewski (1855-1907), Franciszek Kijewski (1851-1919), Franciszek Jawdyński (1851-1896), Bronis?aw Sawicki (1860-1931) were very important for the development of otolaryngology in the Polish territories. Jawdyński is shown as a pioneer of radical neck dissection on account of cancer of neck. Operations performed by Warsaw surgeons and by surgeons in other countries was similar. Above-mentioned Warsaw physicians were good teachers of a great number of distinguished laryngologists, although at Warsaw University otolaryngology were not lectured.     

The problem of specialization in otolaryngology on the turn of the XIX century--Warsaw physician contribution

The problem of specialization in otolaryngology in the end of the XIX and the beginning of XX century in Warsaw is described in detail. The programmes of specialization and specialistic examinations at that time did not exist. The professional trainings of Warsaw physicians in otolaryngology carried out abroad, especially in Vienna, Berlin, Paris and London are presented. The professional training at Warsaw otolaryngological hospital wards, out-patient clinics, infirmieries and consulting-rooms are stressed in more details. Number of physicians specialized in otolaryngology increased in the beginning of the XX century. The Warsaw physicians wrote many scientific papers and several books, they were also competent teachers of a great number of distinguished otolaryngologists. The achievements of Warsaw doctors at the time of the formation of Polish Otolaryngological Society in 1921 are pointed out.     

The achievements of eminent Warsaw physicians in otolaryngology at the turn of the 19th and 20th century

The scientific achievements of many Warsaw otolaryngologists in the second part of the 19th and in the beginning of the 20th century are presented. Karol Benni's (1843-1916) contribution to the world otology is described. The famous Warsaw laryngologist Teodor Heryng (1847-1925) was a creator of a new operating method of the larynx tuberculosis by curettage. He was also a propagator of the diaphanoscopy (transillumination) of maxillary sinuses. Ludwik Guranowski (1853-1926). a distinguished otiatrist performed a first myringoplasty in the Polish territories and explained the causes of external otitis by bacillus pyocyaneous. Jan Sedziak's (1861-1932) work on malignant neoplasms of larynx was given a prize at international congress in Tuluse in 1893. Zdzis?aw Dmochowski (1864-1924) described the pathologic anatomy changes in maxillary sinuses. Benni and Alfred Soko?owski (1849-1924) were the authors of several chapters in foreign medical textbooks. Heryng's inhalation apparatuses exhibited in Paris are described. Sedziak, Przemys?aw Pieniazek (1850-1916) and Teodor Heiman (1848-1917) were also the authors of articles in foreign otolaryngological journals written in connection with the jubilee of famous otolaryngologists: Leopold von Schroetter, Bernhard Fraenkel and Hermann Schwartze. The problem of focal infection in otolaryngology described by Feliks Erbrich (1874-1938) is briefly pointed out.     

O.P.S.C.: Improving delivery of otolaryngological surgical care

Results of over two years' experience with an outpatient surgical center within a private otolaryngology clinic have demonstrated several advantages. Discussed herein are the history of outpatient surgical centers, and the development of our within clinic O.P.S.C. (Outpatient Surgery Center). Developmental stages described include investigation of liability exposure, securing state health department approval, enactment of state legislation, staffing, equipment, and obtaining third party carrier approval. Advantages to the patient, otolaryngologist, community, and third party carriers are enumerated. Statistics regarding types and numbers of procedures performed and types of anesthesia used are included. Experience with the O.P.S.C. indicates that it is a means of improving the delivery of otolaryngological surgical care.     

Adolescent otolaryngology

OBJECTIVE: To determine the pattern of disease amongst ambulatory adolescents referred to a pediatric otolaryngology outpatient department. METHODS: Retrospective chart review of adolescents newly referred to a tertiary pediatric otolaryngology outpatient department over a 12-month period. RESULTS: One hundred and fifteen patients were included (male 56, female 59) mean age 14.9 years. There were 36 (31%) patients who had previously required otolaryngology management for another condition, and 29 patients with complex medical conditions. Investigations, including audiology and medical imaging, were performed in 35 patients. The patients were managed surgically 34 (30%), medically 28 (24%), referred to other departments 10 (9%) had no intervention 21 (18%), while 22 (19%) failed to attend for follow up. CONCLUSION: Ambulatory adolescent patients present with a comparable spectrum of otolaryngological problems to other pediatric age groups. These patients appear to be well managed by pediatric otolaryngologists, and there does not seem to be a need to develop a free standing adolescent otolaryngology subspecialty within tertiary pediatric otolaryngology at this time.     

Improving the otolaryngology consultation service in a teaching hospital

OBJECTIVE: To examine the type and quality of consultations requested from the otolaryngology service at a tertiary care hospital. STUDY DESIGN: Retrospective. METHOD: Review of written documentation of consultations over a 6-month period. RESULTS: One hundred eleven requests were received, and 107 written reports were made. Twenty services made requests. Thirty-two percent of requests had a legible requester or contact listed. Sixty-seven percent of requests stated why the patient was in hospital, and 85% stated the otolaryngological complaint. Thirty-two percent of requests made accurate reference to the otolaryngological history, and 6% recorded an ENT examination that was accurate. Seven percent of patients were intubated, and 16% had a tracheostomy prior to evaluation. Forty-eight percent of patients required flexible nasopharyngolaryngoscopy. Sixteen percent of patients required rhinoscopy, and 16% required tracheotomy. Twelve percent of patients needed audiograms, and small numbers of patients required biopsy, debridement of ears, ventilation tube insertion, nasal packing, or radiological studies. Reports were made by senior residents, and evidence that the case was discussed with or seen by an attending surgeon was present in 43% of reports. A diagnosis was stated in 85% of reports, and in 3% the diagnosis appeared to be inaccurate as compared with the history and physical examination recorded. A follow-up plan was stated in 70% of reports. CONCLUSIONS: There is a need to educate physicians about collegial communication regarding patients. This information can direct curriculum needed to prepare otolaryngology residents to provide a consultative service in a teaching hospital. This method of determining "true learning needs" can be used in other situations to improve resident training.     

A cost comparison between reusable flexible and disposable laryngoscopes

ObjectivesTo compare the costs of disposable laryngoscopes to reusable scopes in outpatient and inpatient settings.MethodsThe total variable and fixed costs involved in flexible scope reprocessing were collected from two general otolaryngology clinics, a pediatric otolaryngology clinic, and a children's hospital. Variable costs of disposable materials and labor were collected from 65 scope reprocessing events to identify the cost of reprocessing. Fixed costs of scope maintenance, monitors, video towers, and storage equipment were collected from financial records. Fixed and variable costs were analyzed to identify the cost per scope event. The costs were then compared to a theoretical model where disposable scopes were used to meet the volume demands of each clinic and children's hospital setting. The model of disposable scopes was generated after obtaining volume costs specific to each setting from a disposable scope company.ResultsThe average cost of a reusable scope model per scope event was $66.02 ± 4.49 at the three clinics and $130.66 at the children's hospital. The average cost of the disposable scope model per scope event was $152.55 ± 0.55 in the three clinics and $172.61 in the children's hospital. The cost differences were $86.53 ± 3.96 and $41.95 respectively.ConclusionsIn an outpatient clinic, reusable scopes are less expensive than a disposable scope model. In children's hospital inpatient setting, the difference in costs between disposable and reusable scopes is lower. When considering other non-economic factors, disposable scopes may be a feasible option, especially in the children's hospital setting.     

Health-related quality of life before and after management in adults referred to otolaryngology: a prospective national study

Clin. Otolaryngol. 2012, 37 , 35–43 Objective:  An assessment of the effect of otolaryngological management on the health‐related quality of life of patients. Design:  Application of the Health Utilities Index mark 3 (HUI‐3) before and after treatment; application of the Glasgow Benefit Inventory (GBI) after treatment. Setting:  Six otolaryngological departments around Scotland. Participants:  A 9005 adult patients referred to outpatient clinics. Main outcome measures:  Complete HUI‐3 data was collected from 4422 patients; complete GBI data from 4235; complete HUI‐3 and GBI data from 3884. Results:  The overall change in health related quality of life from before to after management was just +0.02. In the majority of subgroups of data (classified by type of management) there was essentially no change in HUI‐3 score. The major exceptions were those patients provided with a hearing aid (mean change 0.08) and those whose problem was managed surgically (mean change 0.04). The mean GBI score was 5.3 which is low. Those managed surgically reported a higher GBI score of 13.0. Conclusion:  We found that patients treated surgically or given a hearing aid reported a significant improvement in their health related quality of life after treatment in otolaryngology departments. In general, patients treated in other ways reported no significant improvement. We argue that future research should look carefully at patient groups where there is unexpectedly little benefit from current treatment methods and consider more effective methods of management.     

Major outpatient surgery in the ear, nose and throat clinic

In recent years, outpatient surgery in otolaryngology has advanced because it benefits both patients and health-care systems. We analyzed the surgical procedures that can be performed in outpatient surgery programs, evaluating patient selection, release criteria, and potential complications. A one-year retrospective study was made of 456 patients, of which 369 (80.92%) were discharged from the hospital on the same day as surgery. The operations with the best performance in outpatient surgery were adenoidectomy, tonsillectomy, laryngeal microsurgery, and septoplasty. Most surgical procedures in otolaryngology can be performed without hospitalization. Outpatient surgery is easier for patients and increases their sense of safety. It also has an excellent cost-benefit relation for health-care systems.     

Follow-up care after grommet insertion in children: Review article

BackgroundGrommet insertion is a common procedure in children. A lengthy otolaryngology follow-up can have an adverse impact on clinic waiting times, new patient appointment availability, and pecuniary disadvantage for the hospital.Objective of reviewTo consolidate research and opinion concerning follow-up care following grommet insertion in a pediatric population.Search strategyThe literature between January 1990 and September 2015 was searched on MEDLINE (Ovid), Google Scholar, PubMed and Web of Science databases.ResultsGuidelines and consensus of opinion from the United States advocate that an initial post-operative review should take place within 4 weeks, and subsequent appointments every 6 months until grommet extrusion. Recent audit reports from the United Kingdom have shown that some groups arrange their first post-operative review at 3 months, and subsequent appointments vary considerably from no further follow-up to up to 24 months. Up to 75% of follow-up appointments were scheduled despite normal audiometry and clinical findings after grommet insertion, suggesting a large cohort of patients may undergo unnecessary specialist clinic reviews. General practioners (GP), audiologists or specialist nurses are potential alternative providers of regular reviews to ensure normal hearing thresholds and an adequate tympanic membrane healing course.ConclusionFollow-up schedules are largely driven by consensus of opinion. A significant number of follow-up appointments in otolaryngology clinic appear to be redundant. Recently attention has been drawn to earlier discharge from otolaryngology clinic with subsequent follow-up in less resource and cost intensive clinics coordinated by GPs, audiologist or nurses, which may help alleviate some outpatient workload on acute hospital trusts.     

Otolaryngology and infectious disease team approach for outpatient management of serious pediatric infections requiring parenteral antibiotic therapy.

Children with community-acquired serious otolaryngologic infections are conventionally hospitalized for parenteral antibiotic therapy. However, effective and safe outpatient therapy is desirable since it is less traumatic and less costly. During a 24-month period outpatient parenteral antibiotic therapy, usually once daily i.m. ceftriaxone, was evaluated in 41 children with serious otolaryngologic infections (acute mastoiditis, complicated otitis media, severe external otitis and severe sinusitis with orbital or periorbital involvement). Daily visits and compliant capable parents were considered essential for outpatient management. Diagnosis, plan for management and daily follow-up evaluations were carried out in cooperation by otolaryngology and infectious disease specialists. Nineteen children (45%) were treated initially in the hospital and 22 children (55%) were treated entirely as outpatients. The mean duration of outpatient treatment, using once daily i.m. ceftriaxone was 5.7 days (range 1-13). The overall clinical cure rate was 98% and no serious side effects were observed. One case of sinusitis-orbital cellulitis relapsed during therapy. Most patients and parents returned to normal life activities within 72 h from starting outpatient therapy. Our data suggest that many children with serious otolaryngologic infections can be managed successfully and safely as outpatients by a combined team of otolaryngology and infectious disease specialists.     

耳鼻咽喉科住院总医师1062例会诊病例分析

目的:分析耳鼻咽喉科住院总医师会诊患者的构成特点,从一个侧面反映住院总医师的工作情况。方法:统计第四军医大学西京医院耳鼻咽喉科1名住院总医师在2005年6月1日~2006年3月15日会诊的患者。结果:会诊患者共计1 062例,平均每周新会诊28例。其中急症会诊467例(43.97%),常规会诊595例(56.03%)。急症会诊的患者构成:鼻出血最多,共279例,占急症会诊总数的59.72%,病因主要为凝血机制障碍、高血压、肝肾功能衰竭、外伤等,少数为医源性诱发。喉阻塞及气管切开术113例,占急症会诊的24.19%,位于第2位。气管和支气管异物43例,病情均较危重。内科请常规会诊以炎症性疾病最多,慢性鼻炎及鼻窦炎169例,慢性咽炎及急慢性扁桃体炎162例,注意检查与诊断的全面性。外科因术前准备请耳鼻咽喉科常规会诊67例,目的是围手术期耳鼻咽喉科疾病风险评价和预防。结论:会诊工作具有特殊性和挑战性,住院总医师应该了解会诊患者特点,在会诊中学习和积累经验。     

Virtual scribing within otolaryngology during the COVID-19 pandemic and beyond

Within otolaryngology, scribes have been utilized as a means of increasing clinic efficiency and easing workload on physicians. During the COVID-19 pandemic, a majority of otolaryngology clinic appointments at academic institutions have been moved to telemedicine in order to limit interpersonal contacts. At the height of the pandemic, our institution has protocolized scribe participation from in-person to remote. Scribes have virtually participated in telemedicine appointments in an effort to facilitate documentation and enhance the patient-physician relationship. Beyond the pandemic, as patients start being evaluated in-person, the risk of contamination and spread through aerosol generating procedures has limited the number of ancillary support staff that can be present in the examination rooms. As such, virtual scribing from a separate location within the clinic has been deemed warranted. This paper documents the protocols on virtual scribing for both telemedicine and a hybrid approach for in-clinic appointments where high-risk procedures are being performed.     

多媒体结合PBL教学模式在耳鼻咽喉科实习教学中的应用

目的探讨多媒体技术结合PBL教学模式在耳鼻咽喉科临床实习教学中的效果。方法在临床实习教学中,采用多媒体结合PBL教学法的教学模式,以临床典型病案为基础提出问题,以学生为中心采取分组讨论的方法来解决问题,培养实习医师临床技能及思维能力。结果多媒体结合PBL教学模式可以明显提高耳鼻咽喉科实习医师的临床技能水平及思维能力。结论多媒体结合PBL教学模式有助于耳鼻咽喉科实习医师临床思维和技能的培养,提高教学质量。     

The Otorhinolaryngology Department in Helsinki: organization and otologic research

The organization and the otologic research in the Otorhinolaryngology Department of the University of Helsinki are described. The department has 4 surgical wards, each with 22 beds, and a new surgical wing with 6 full-sized operating rooms. The ear research is centered on middle ear histopathology and immunology, focusing especially on secretory and chronic otitis media. There is an audiological and vestibular unit, the latter is expanding rapidly. Acoustic neuroma surgery is performed as team work with a neurosurgeon. The department takes part in a cochlear implant and Audiant prosthesis program.     

Should all patients referred for magnetic resonance imaging scans of their internal auditory meatus be followed up in ENT clinics?

Magnetic resonance imaging (MRI) is recognised as the “Gold Standard” investigation for symptoms pertaining to the inner ear and detection of retro-cochlear pathology. There is still no accurate clinical predictor for cerebellopontine angle lesions and increasingly more normal scans are being performed. With constantly increasing demands on ENT outpatient clinics, our aim was to investigate whether all patients referred for MRI of their internal auditory meatus (IAM) require follow-up in ENT clinics. A retrospective study was carried out in a tertiary referral centre referring patients for MRI IAM from ENT clinics and neurotology clinics on 153 patients referred for MRI IAM performed over a 4-month period. The MRI reports and the case notes of the patients were reviewed. MRI results and patient symptoms with patient follow-up schedule and follow-up situation for at least 6 months post-scan were compared. There were two patient groups, those referred from main outpatients (81) and those referred by the audiological physicians (72). Of the total number of scans, 101 were reported as normal, 45 had incidental findings, and 7 showed pathology of the cerebellopontine angle. The presenting complaints of the patients, the scan results and the follow-up since were compared. Six months later 63% of those referred from outpatients were no longer being followed up in clinic. We suggest that 56.8% of patients referred for MRI IAM do not require ENT follow-up. Their symptoms and concerns could be dealt with at the first consultation where onward referral could be made if necessary. Once checked by the requesting clinician, uncomplicated scan results could be sent to the patients and general practitioners by post or email. This would reduce the burden on general otolaryngology outpatient clinics and improve resource utilisation.     

Development of otorhinological care of the child

During the last third of the 20th century, pediatric otolaryngology became a defined specialty in many nations, resulting in focused training, fellowships, societies, journals, textbooks, etc. This development occurred as a result of an interaction between the changing sociological and economic status of the child and medical advances. In this paper the history of the status of children is investigated during the Reformation/Counter-Reformation, Enlightenment and Romantic periods, and during the recent era of Entitlement, and an analysis is made of the relationships between otolaryngological care of children during these periods, including a consideration of selected medical advances made during the 17th to 21st centuries, and the evolving status of children. Advances in education of the deaf, understanding the role of the adenoid and care of the airway were applied to the child patient not directly, as it may sometimes seem to physicians caring for a patient in a hands-on fashion, but rather via the bridge of the social and economic context of the time. This interactive process created a special body of knowledge that is now applied in a society that places a high value on the child. In the second half of the 20th century, i.e. during the period of Entitlement, the otolaryngological needs of the child became a demand, based in part upon a need for care of airway pathology in the premature infant, which fostered the establishment of pediatric otolaryngology as a specialty.     

Influence of ethnicity on the frequency of nasal surgery

OBJECTIVE: To determine whether surgery for nasal obstruction differs in frequency between ethnic groups. METHOD: Ethnicity data was collected from all patients attending otolaryngology clinic appointments and compared to census data. Odds ratios with confidence intervals were calculated for attendance at otolaryngology clinics, rhinology clinics, undergoing septoplasty, septorhinoplasty and/ or turbinate surgery for each ethnic group over a 3-year period. RESULTS: The ethnic groups of the 39493 outpatient attendees closely mirrored demographic data from the 2001 Census. Non-Chinese Asian ethnic groups were more likely to undergo septal surgery than the general (mainly white) population (odds ratio 1.44, 95% CI 1.25 to 1.66, p < 0.00001), whereas Black groups (odds ratio 0.31 [0.23 - 0.41], p < 0.00001) and Chinese (odds ratio 0.28 [0.11 - 0.70], p = 0.00311) were much less likely. Similar results were found for rhinoplasty and turbinate surgery. CONCLUSIONS: There is strong statistical evidence for large differences in the frequency of surgery for nasal obstruction between ethnic groups. Asian groups were more likely to undergo surgery, whereas Chinese and Blacks were less likely than the general population, which was predominantly white in this study. This may be due to anatomical variations, differences cultural views towards surgery, or inequalities in clinician's attitudes.     

Development of otorhinological care of the child

During the last third of the 20th century, pediatric otolaryngology became a defined specialty in many nations, resulting in focused training, fellowships, societies, journals, textbooks, etc. This development occurred as a result of an interaction between the changing sociological and economic status of the child and medical advances. In this paper the history of the status of children is investigated during the Reformation/Counter-Reformation, Enlightenment and Romantic periods, and during the recent era of Entitlement, and an analysis is made of the relationships between otolaryngological care of children during these periods, including a consideration of selected medical advances made during the 17th to 21st centuries, and the evolving status of children. Advances in education of the deaf, understanding the role of the adenoid and care of the airway were applied to the child patient not directly, as it may sometimes seem to physicians caring for a patient in a hands-on fashion, but rather via the bridge of the social and economic context of the time. This interactive process created a special body of knowledge that is now applied in a society that places a high value on the child. In the second half of the 20th century, i.e. during the period of Entitlement, the otolaryngological needs of the child became a demand, based in part upon a need for care of airway pathology in the premature infant, which fostered the establishment of pediatric otolaryngology as a specialty.     

What is the impact of consultant supervision on outpatient follow-up rate?

This study investigated the impact of consultants on recycling rates of patients in the ENT outpatient clinic. A retrospective case review of 4205 consecutive patients who attended ENT outpatient clinics of an UK teaching hospital over a 3-month period was conducted. There was a significant association between grade of medical staff and recycling rate of new patients, and also for review patients. Junior doctors have lower recycling rates in consultant-led clinics compared with clinics in the absence of consultants for both new patients (consultant-led 41.0%, without consultant 60.1%; P < 0.01) and old patients (consultant-led 48.9%, without consultant 65.0%; P < 0.01). Individual consultant's practice was reflected upon the overall recycling rate of the clinic as a whole (r = 0.94, P = 0.001). In conclusion, individual consultant's practice dictated recycling rate in the ENT outpatient clinic. Junior doctors were less likely to make follow-up appointments when directly supervised by their consultants.