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Heward E, Rocke J, McNally G, Thompson G, Oladokun D, Timms S, Abbas JR, Chu MMH, Akbar S, Dobbs S, Chudek D, Jaiswal I, Vora D, Harrison A, Oremule B, Sarwar S, Menon SS, Advani R, Daniels J, Ellis S, Abdelaziz M, Husain P, Anmolsingh R, Venugopal A, Beena M, Sheik-Ali S, Saeed H, Shenton C, Ghosh S, Khwaja S, Kumar N. The post-operative tonsillectomy (POPT) study: A multi-centre prospective paediatric cohort study. Clin Otolaryngol 2024; 49:176-184. [PMID: 37915294 DOI: 10.1111/coa.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/01/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary. DESIGN Prospective observational cohort study. SETTING Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed. PARTICIPANTS Children (≥4 years, ≤16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology. MAIN OUTCOME MEASURES Frequency and severity of post-operative bleeding. Intensity and pattern of post-operative pain. RESULTS In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008). CONCLUSION A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.
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Affiliation(s)
- Elliot Heward
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - John Rocke
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - George McNally
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Dare Oladokun
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | | | | | - Michael M H Chu
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Sarah Akbar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Sian Dobbs
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Dorota Chudek
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Ishank Jaiswal
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Devan Vora
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Anna Harrison
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Safdar Sarwar
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Rajeev Advani
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Sarah Ellis
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Mohammed Abdelaziz
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Rajesh Anmolsingh
- Manchester University NHS Foundation Trust, Manchester, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Meera Beena
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Shirwa Sheik-Ali
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Haroon Saeed
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Catriona Shenton
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Samit Ghosh
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sadie Khwaja
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Nirmal Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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Lechner M, Liu J, Counsell N, Gillespie D, Chandrasekharan D, Ta NH, Jumani K, Gupta R, Rocke J, Williams C, Tetteh A, Amnolsingh R, Khwaja S, Batterham RL, Yan CH, Treibel TA, Moon JC, Woods J, Brunton R, Boardman J, Hatter M, Abdelwahab M, Holsinger FC, Capasso R, Nayak JV, Hwang PH, Patel ZM, Paun S, Eynon-Lewis N, Kumar BN, Jayaraj S, Hopkins C, Philpott C, Lund VJ. The burden of olfactory dysfunction during the COVID-19 pandemic in the United Kingdom. Rhinology 2023; 61:93-96. [PMID: 36286227 DOI: 10.4193/rhin22.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M Lechner
- Division of Surgery and Interventional Science, University College London, London, UK; UCL Cancer Institute, University College London, London, UK; ENT Department, Barts Health NHS Trust, London, UK
| | - J Liu
- UCL Cancer Institute, University College London, London, UK
| | - N Counsell
- CRUK and UCL Cancer Trials Centre, University College London, London, UK
| | - D Gillespie
- UCL Cancer Institute, University College London, London, UK
| | - D Chandrasekharan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N H Ta
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Jumani
- Division of Surgery and Interventional Science, University College London, London, UK
| | - R Gupta
- Division of Surgery and Interventional Science, University College London, London, UK
| | - J Rocke
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - C Williams
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - A Tetteh
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - R Amnolsingh
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - R L Batterham
- Centre for Obesity Research, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK
| | - C H Yan
- Department of Otolaryngology, University of San Diego School of Medicine, San Diego, USA
| | - T A Treibel
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J C Moon
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J Woods
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - R Brunton
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - M Hatter
- Medical University of South Carolina, Charleston, SC, USA
| | - M Abdelwahab
- Medical University of South Carolina, Charleston, SC, USA
| | - F C Holsinger
- Medical University of South Carolina, Charleston, SC, USA
| | - R Capasso
- Medical University of South Carolina, Charleston, SC, USA
| | - J V Nayak
- Medical University of South Carolina, Charleston, SC, USA
| | - P H Hwang
- Medical University of South Carolina, Charleston, SC, USA
| | - Z M Patel
- Medical University of South Carolina, Charleston, SC, USA
| | - S Paun
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N Eynon-Lewis
- Division of Surgery and Interventional Science, University College London, London, UK
| | - B N Kumar
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - S Jayaraj
- Division of Surgery and Interventional Science, University College London, London, UK
| | - C Hopkins
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - V J Lund
- Royal National ENT Hospital, University College London Hospitals NHS Trust, London, UK
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Lechner M, Liu J, Counsell N, Gillespie D, Chandrasekharan D, Ta NH, Jumani K, Gupta R, Rao-Merugumala S, Rocke J, Williams C, Tetteh A, Amnolsingh R, Khwaja S, Batterham RL, Yan CH, Treibel TA, Moon JC, Woods J, Brunton R, Boardman J, Paun S, Eynon-Lewis N, Kumar BN, Jayaraj S, Hopkins C, Philpott C, Lund VJ. The COVANOS trial - insight into post-COVID olfactory dysfunction and the role of smell training. Rhinology 2022; 60:188-199. [PMID: 35901492 DOI: 10.4193/rhin21.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction is a cardinal symptom of COVID-19 infection, however, studies assessing long-term olfactory dysfunction are limited and no randomised-controlled trials (RCTs) of early olfactory training have been conducted. METHODOLOGY We conducted a prospective, multi-centre study consisting of baseline psychophysical measurements of smell and taste function. Eligible participants were further recruited into a 12-week RCT of olfactory training versus control (safety information). Patient-reported outcomes were measured using an electronic survey and BSIT at baseline and 12 weeks. An additional 1-year follow-up was open to all participants. RESULTS 218 individuals with a sudden loss of sense of smell of at least 4-weeks were recruited. Psychophysical smell loss was observed in only 32.1%; 63 participants were recruited into the RCT. The absolute difference in BSIT improvement after 12 weeks was 0.45 higher in the intervention arm. 76 participants completed 1-year follow-up; 10/19 (52.6%) of participants with an abnormal baseline BSIT test scored below the normal threshold at 1-year, and 24/29 (82.8%) had persistent parosmia. CONCLUSIONS Early olfactory training may be helpful, although our findings are inconclusive. Notably, a number of individuals who completed the 1-year assessment had persistent smell loss and parosmia at 1-year. As such, both should be considered important entities of long-Covid and further studies to improve management are highly warranted.
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Affiliation(s)
- M Lechner
- ENT Department, Barts Health NHS Trust, London, UK; UCL Cancer Institute, University College London, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - J Liu
- UCL Cancer Institute, University College London, London, UK
| | - N Counsell
- CRUK and UCL Cancer Trials Centre, University College London, London, UK
| | - D Gillespie
- UCL Cancer Institute, University College London, London, UK
| | | | - N H Ta
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Jumani
- ENT Department, Barts Health NHS Trust, London, UK
| | - R Gupta
- ENT Department, Barts Health NHS Trust, London, UK
| | | | - J Rocke
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - C Williams
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - A Tetteh
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - R Amnolsingh
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - R L Batterham
- Centre for Obesity Research, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK
| | - C H Yan
- Department of Otolaryngology-Head and Neck Surgery, University of San Diego School of Medicine, San Diego, USA
| | - T A Treibel
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J C Moon
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J Woods
- The Norfolk Smell and Taste Clinic, Norfolk
| | - R Brunton
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - S Paun
- ENT Department, Barts Health NHS Trust, London, UK
| | | | - B N Kumar
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - S Jayaraj
- ENT Department, Barts Health NHS Trust, London, UK
| | - C Hopkins
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - V J Lund
- Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK
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Ainine A, Heward E, Kapasi R, Rocke J, Darby D, Kumar N, Ashish A. Vitamin D and COVID-19 Infection. Med J Malaysia 2021; 76:881-883. [PMID: 34806677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted the medical world to look at factors that may influence outcomes. There have been connections made between vitamin D and COVID-19, as vitamin D has previously been shown to play a role in the maintenance of immune homeostasis. MATERIALS AND METHODS We performed a prospective cohort study on 103 patients at Wigan Wrightington and Leigh NHS Foundation Trust looking at serum vitamin D levels of patients with positive COVID-19 swabs. Results were collated and correlations were made to compare vitamin D levels with age; severity of illness; hospital outcomes; and frailty. Comparisons were also made between frailty and outcome. RESULTS The results showed that there was a significant statistical difference between vitamin D levels and severity of infection: those who were treated in the intensive care units (ICU) (severe symptoms) had lower vitamin D levels than those treated on the ward (p=0.0446). There was also a correlation between vitamin D levels and frailty: those who were more frail had higher vitamin D levels than fitter patients (P=0.005). Vitamin D and frailty had no effect on hospital outcomes of COVID-19 infection. CONCLUSION Ultimately, we concluded that low vitamin D can increase susceptibility of contracting COVID-19, increase severity of infection but does not affect mortality.
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Affiliation(s)
- A Ainine
- Wrightington, Wigan & Leigh Teaching Hospital NHS Foundation Trust, United Kingdom.
| | - E Heward
- Wrightington, Wigan & Leigh Teaching Hospital NHS Foundation Trust, United Kingdom
| | - R Kapasi
- Wrightington, Wigan & Leigh Teaching Hospital NHS Foundation Trust, United Kingdom
| | - J Rocke
- Wrightington, Wigan & Leigh Teaching Hospital NHS Foundation Trust, United Kingdom
| | - D Darby
- Wrightington, Wigan & Leigh Teaching Hospital NHS Foundation Trust, United Kingdom
| | - N Kumar
- Wrightington, Wigan & Leigh Teaching Hospital NHS Foundation Trust, United Kingdom
| | - A Ashish
- Wrightington, Wigan & Leigh Teaching Hospital NHS Foundation Trust, United Kingdom
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5
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Gopikrishna D, Rocke J, Chu M, Kumar N. 539 Post-Covid-19 Smell Clinic - Management of Patients With ‘Long Covid’. Br J Surg 2021. [PMCID: PMC8524606 DOI: 10.1093/bjs/znab259.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Olfactory dysfunction following COVID-19 infection is a prevalent issue in the post-viral phase of illness. Around 50% of patient’s self-report loss of sense of smell with COVID-19. Approximately 10% of these patients report no recovery in sense of smell at 4-6 weeks after onset. Patients with olfactory dysfunction often describe life as living in 2D, with lasting effects on eating habits and relationships. The aim of this project was to establish a novel ‘Post-Covid-19 smell clinic’ for patients, which monitored any changes relating to olfactory dysfunction and to provide advice on management of the condition for these patients with “Long-Covid”. Method The ‘smell clinic’ was set up based on BRS guidelines. Patients were asked to carry out the ‘UPSIT’ smell test and eODQ questionnaire. Patients were then advised to carry out ‘smell retraining’ for 4 months and pointed to appropriate resources. We analysed patients’ presentations to identify patterns that may identify patients who are likely to suffer long term olfactory dysfunction following Covid-19 infection. Parameters including prevalence of parosmia, cacosmia, dysgeusia, demographics were collected. Results Initial data, from 20 patients, showed 40% experienced parosmia and 40% had associated rhinological symptoms such as rhinorrhoea. The range UPSIT score: 22-34, eODQ score: 42-151. Conclusions Our initial analysis of the clinic identified symptoms range from anosmia, parosmia and loss of flavour. Parosmia patients experienced this in relation to smells such as excrement and coffee. Future implications involve analysing the possible benefits of ‘smell retraining’ after repeating UPSIT and the eODQ score
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Affiliation(s)
- D Gopikrishna
- Royal Albert Edward Infirmary, Wigan, United Kingdom
| | - J Rocke
- Royal Albert Edward Infirmary, Wigan, United Kingdom
| | - M Chu
- Royal Albert Edward Infirmary, Wigan, United Kingdom
| | - N Kumar
- Royal Albert Edward Infirmary, Wigan, United Kingdom
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Chu M, Gopikrishna D, Rocke J, Kumar BN. Implementing a COVID-19 specialist smell clinic: experience at the Wrightington, Wigan and Leigh Teaching Hospitals (WWL), NHS Foundation Trust, United Kingdom. Med J Malaysia 2021; 76:9-13. [PMID: 34558550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION It is clear that a proportion of patients continue to suffer long-lasting symptoms following acute infection with coronavirus disease 2019 (COVID-19). Persistent olfactory dysfunction is one of the commonest complaints reported in the condition colloquially known as long COVID (now known as post-acute sequelae of SARS-CoV-2 infection (PASC)). The prevalence, risk factors and clinical course of long COVID olfactory dysfunction are not yet well understood. At present, the main stay of treatment is olfactory training. Quantitative olfactory testing and impacts on patient quality of life have not been widely studied. This study describes our experiences at Wrightington, Wigan and Leigh Teaching Hospitals, UK (WWL) of establishing a COVID-19 smell clinic, along with preliminary data on patient demographics, baseline smell test scores and quality of life questionnaire scores before olfactory training. METHODS We piloted a COVID-19 smell clinic. We recorded patient demographics and clinical characteristics then performed clinical assessment of each patient. Quantitative measurements of olfactory dysfunction were recorded using the University of Pennsylvania Smell Identification Test (UPSIT). We measured the impact of olfactory dysfunction on patient quality of life using the validated English Olfactory Disorders Questionnaire (eODQ). RESULTS 20 patients participated in the clinic. 4 patients were excluded from analysis due to missing data. Median age was 35 years. 81% (n=13) of the participants were female. 50% (n=8) of patients suffered with a combination of anosmia/ageusia and parosmia, whilst 43% (n=7) of patients suffered with anosmia/ageusia without parosmia. Almost all the patients registered UPSIT scores in keeping with impaired olfaction. Patient scores ranged from 22 to 35, with the median score at 30. All patients reported that their olfactory dysfunction had an impact on their quality of life. The median eODQ score reported was 90, with scores ranging from 42 to 169 out of a maximum of 180. CONCLUSION We have demonstrated that it is simple and feasible to set up a COVID-19 smell clinic. The materials are inexpensive, but supervised completion of the UPSIT and eODQ is time-consuming. Patients demonstrate reduced olfaction on quantitative testing and experience significant impacts on their quality of life as a result. More research is needed to demonstrate if olfactory training results in measurable improvements in smell test scores and quality of life.
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Affiliation(s)
- M Chu
- Teaching Hospitals, Department of Otolaryngology, United Kingdom
| | - D Gopikrishna
- eaching Hospitals, Department of Otolaryngology, United Kingdom
| | - J Rocke
- eaching Hospitals, Department of Otolaryngology, United Kingdom
| | - B N Kumar
- eaching Hospitals, Department of Otolaryngology, United Kingdom.
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Rocke J, Evans C, Kumar BN. Teaching and training in Otorhinolaryngology (ORL) during the pandemic and beyond, in the United Kingdom. Med J Malaysia 2021; 76:27-30. [PMID: 34558554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
No abstract provided.
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Affiliation(s)
- J Rocke
- Health Education England & Wrightington, Wigan and Leigh Teaching NHS Foundation Trust, United Kingdom
| | - C Evans
- Health Education England & Wrightington, Wigan and Leigh Teaching NHS Foundation Trust, United Kingdom
| | - B N Kumar
- Health Education England & Wrightington, Wigan and Leigh Teaching NHS Foundation Trust, United Kingdom.
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8
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Shah S, Rocke J, France K, Izzat S. Sudden sensorineural hearing loss in COVID-19: A case series from the Wrightington, Wigan and Leigh Teaching Hospitals, United Kingdom. Med J Malaysia 2021; 76:55-59. [PMID: 34558562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sudden sensory neural hearing Loss (SSNHL) needs to be identified and managed correctly in a secondary or tertiary centre. Whilst 45% of presentations are said to be idiopathic in nature, several viruses have been linked to its aetiology. It was noted, anecdotally, that more patients were presenting with SSNHL during the COVID-19 pandemic to our ENT service at Wrightington Wigan and Leigh teaching hospitals, UK (WWL). We identified 4 COVID-19 positive patients who presented to our ENT service with SSNHL. Despite normal findings on external ear examination, three of the patients showed bilateral hearing loss, whilst one had a predominantly unilateral loss. Given our findings we would like to present these four cases, as well as providing hypotheses on possible aetiology of this association. This may aid in research, diagnosis and treatment of future COVID positive patients with SSNHL.
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Affiliation(s)
- S Shah
- Hull York Medical School, United Kingdom.
| | - J Rocke
- University of Sheffield, United Kingdom
| | - K France
- Wrightington, Wigan and Leigh NHS Trust, United Kingdom
| | - S Izzat
- Wrightington, Wigan and Leigh NHS Trust, United Kingdom
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Sarwar S, Goswamy J, Rocke J. P-100 Implementing a Consultant-led One-stop Head and Neck Cancer Clinic to increase efficiency in the patient journey. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rocke J. O1 Admission avoidance in tonsillitis and peritonsillar abscess: a prospective national audit during the initial peak of the COVID-19 pandemic. BJS Open 2021. [PMCID: PMC8083388 DOI: 10.1093/bjsopen/zrab033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction During the COVID-19 outbreak, the collaborative network for ENT trainees in the UK (INTEGRATE), conducted a multi-centre prospective audit on the management of Tonsillitis and Quinsy. This was in response to the implementation of new COVID-19 specific guidelines released by ENT UK and to explore factors relating to unscheduled re-presentations discharges direct from the Emergency Department (ED). Methods Consecutive patients with suspected tonsillitis or quinsy, aged 18 or over, and referred to ENT in secondary care were eligible for inclusion. Data was collected, using a standardised electronic case report form, relating to patient demographics, COVID-19 status, clinicians’ grade, assessment and interventions. Each case was followed-up for 10 days to assess predictors of unscheduled re-presentation after discharge direct from the ED. Results 83 centres submitted 765 tonsillitis and 416 quinsy cases. 54.4% of tonsillitis cases and 45.3% of quinsy were discharged directly from the ED. 9.6% of tonsillitis and 10.3% of quinsy discharges re-presented within 10 days, compared to 9.7% and 10.6% for those initially admitted. IV steroids were given to 67.0% of tonsillitis patients and 73.6% of quinsy. 77.2% of quinsy patients underwent drainage during their initial presentation, but there was no significant difference in re-presentation rate in those drained vs not-drained (p = 0.85). Univariable logistic regression showed no significant predictors of re-presentation within 10 days. Conclusion Management of tonsillitis and quinsy was affected during the initial peak of the pandemic, with a shift towards outpatient care. Some patients who may previously have been admitted to hospital may be safely discharged from the ED.
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Affiliation(s)
| | - John Rocke
- INTEGRATE: The UK ENT Trainee Research Network
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11
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Lechner M, Liu J, Counsell N, Ta NH, Rocke J, Anmolsingh R, Eynon-Lewis N, Paun S, Hopkins C, Khwaja S, Kumar BN, Jayaraj S, Lund VJ, Philpott C. Course of symptoms for loss of sense of smell and taste over time in one thousand forty-one healthcare workers during the Covid-19 pandemic: Our experience. Clin Otolaryngol 2020; 46:451-457. [PMID: 33283459 PMCID: PMC8240100 DOI: 10.1111/coa.13683] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Matt Lechner
- Barts Health NHS Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer, Trials Centre, University College London, London, UK
| | - Ngan Hong Ta
- The Norfolk Smell & Taste Clinic, Norfolk & Waveney ENT Service, Norfolk, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - John Rocke
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Sadie Khwaja
- Manchester University NHS Foundation Trust, London, UK
| | - B Nirmal Kumar
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, London, UK
| | | | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - Carl Philpott
- The Norfolk Smell & Taste Clinic, Norfolk & Waveney ENT Service, Norfolk, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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Rocke J, Hopkins C, Philpott C, Kumar N. Is loss of sense of smell a diagnostic marker in COVID-19: A systematic review and meta-analysis. Clin Otolaryngol 2020; 45:914-922. [PMID: 32741085 PMCID: PMC7436734 DOI: 10.1111/coa.13620] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/04/2020] [Accepted: 07/21/2020] [Indexed: 01/05/2023]
Abstract
Aims To systematically review the currently available evidence investigating the association between olfactory dysfunction (OD) and the novel coronavirus (COVID‐19). To analyse the prevalence of OD in patients who have tested positive on polymerase chain reaction (PCR) for COVID‐19. To perform a meta‐analysis of patients presenting with olfactory dysfunction, during the pandemic, and to investigate the positive predictive value for a COVID‐19‐positive result in this population. To assess whether olfactory dysfunction could be used as a diagnostic marker for COVID‐19 positivity and aid public health approaches in tackling the current outbreak. Methods We systematically searched MedLine (PubMed), Embase, Health Management Information Consortium (HMIC), Medrxiv, the Cochrane Library, the Cochrane COVID‐19 Study Register, NIHR Dissemination centre, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify the current published evidence which associates coronaviridae or similar RNA viruses with anosmia. The initial search identified 157 articles. A total of 145 papers were excluded following application of our exclusion criteria. The 12 remaining articles that presented evidence on the association between COVID‐19 and olfactory dysfunction were critically analysed. Results Olfactory dysfunction has been shown to be the strongest predictor of COVID‐19 positivity when compared to other symptoms in logistic regression analysis. In patients who had tested positive for COVID‐19, there was a prevalence of 62% of OD. In populations of patients who are currently reporting OD, there is a positive predictive value of 61% for a positive COVID‐19 result. Conclusion Our review has shown that there is already significant evidence which demonstrates an association between OD and the novel coronavirus—COVID‐19. It is unclear if this finding is unique to this coronavirus as individual viral phenotypes rarely present in such concentrated large numbers. We have demonstrated that OD is comparatively more predictive for COVID‐19 positivity compared to other associated symptoms. We recommend that people who develop OD during the pandemic should be self‐isolate and this guidance should be adopted internationally to prevent transmission.
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Affiliation(s)
- John Rocke
- ENT Department, Royal Albert Edward Infirmary, Wigan, UK
| | | | - Carl Philpott
- The Norfolk Smell & Taste Clinic, The Norfolk & Waveney ENT Service, Norwich Medical School, University of East Anglia, Norwich, UK.,Fifth Sense, Oxfordshire, UK
| | - Nirmal Kumar
- Edge Hill University Medical School, WWL Teaching Hospital NHS Foundation Trust, Wigan, UK
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Cherry G, Rocke J, Chu M, Liu J, Lechner M, Lund VJ, Kumar BN. Loss of smell and taste: a new marker of COVID-19? Tracking reduced sense of smell during the coronavirus pandemic using search trends. Expert Rev Anti Infect Ther 2020; 18:1165-1170. [PMID: 32673122 PMCID: PMC7441792 DOI: 10.1080/14787210.2020.1792289] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives It has been demonstrated that reduction in smell and/or taste is the most predictive symptom in SARS-CoV-2/Covid-19 infection. We used Google Trends to analyze regional searches relating to loss of smell and taste across Italy, Spain, France, Brazil, and the United States of America and determined the association with reported Covid-19 cases. Methods In order to retrieve the data, we built a Python software program that provides access to Google Trends data via an application program interface. Daily COVID-19 case data for subregions of the five countries selected were retrieved from respective national health authorities. We sought to assess the association between raw search interest data and COVID-19 new daily cases per million for all regions individually. Results In total, we yielded 2188 sets of Google Trends data which included 548 time series of 4 anosmia and ageusia search concepts over the study period for 137 regions. These data indicated that differences in search interest for terms relating to anosmia and ageusia, between regions, is associated with geographical trends in new Covid-19 cases. Conclusions We feel that Google search trends relating to loss of smell can be utilized to identify potential Covid-19 outbreaks on a national and regional basis.
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Affiliation(s)
| | - John Rocke
- Wigan and Leigh Teaching Hospitals NHS Foundation Trust , Wrightington, UK
| | - Michael Chu
- Wigan and Leigh Teaching Hospitals NHS Foundation Trust , Wrightington, UK
| | - Jacklyn Liu
- UCL Cancer Institute, University College London , London, UK
| | - Matt Lechner
- UCL Cancer Institute, University College London , London, UK.,Barts Health NHS Trust, Royal London Hospital and Whipps Cross University Hospital , UK
| | - Valerie J Lund
- Royal National Throat Nose and Ear Hospital, UCLH Foundation Trust , UK
| | - B Nirmal Kumar
- Wigan and Leigh Teaching Hospitals NHS Foundation Trust , Wrightington, UK
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Rocke J, Mclaren O, Hardman J, Garas G, Smith ME, Ishii H, Constable J, Tikka T, Wie Liu Z, Williams R. The role of allied healthcare professionals in head and neck cancer surveillance: A systematic review. Clin Otolaryngol 2019; 45:83-98. [DOI: 10.1111/coa.13471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/11/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022]
Affiliation(s)
- John Rocke
- INTEGRATE (UK ENT Trainee Research Network) Manchester UK
| | - Oliver Mclaren
- INTEGRATE (UK ENT Trainee Research Network) Manchester UK
| | - John Hardman
- INTEGRATE (UK ENT Trainee Research Network) Manchester UK
| | - George Garas
- INTEGRATE (UK ENT Trainee Research Network) Manchester UK
| | | | - Hiro Ishii
- INTEGRATE (UK ENT Trainee Research Network) Manchester UK
| | | | - Theofano Tikka
- INTEGRATE (UK ENT Trainee Research Network) Manchester UK
| | - Zi Wie Liu
- INTEGRATE (UK ENT Trainee Research Network) Manchester UK
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Abstract
Introduction
Transnasal esophagoscopy (TNE) is a widely used tool both in the diagnosis and treatment of patients presenting complaints within the head and the neck. This is because this investigative adjunct examination provides the advantage of visualizing above the level of the cricopharyngeus muscle when compared to the more widely used esophagogastroduodenoscopy (EGD).
Objectives
We have assessed if the implementation of TNE within a district general hospital (DGH) was feasible, and investigated if the resources of our patients could be better directed away from other investigations such as barium swallow and EGD in favor of this novel technique. The TNE technique has been largely applied in central teaching hospitals within the United Kingdom, but there are still no published reports of a DGH investigating its applicability in this smaller-sized clinical environment.
Method
We have analyzed our theater database to find all the patients who had undergone TNE, and recorded their reason for presenting, the preceding investigations, and the procedural findings.
Results
In most cases, the TNE was conducted without technical issues, and we were able to identify positive findings in 43% of the patients who underwent Esophagogastroduodenoscopy (EGD). We were able to treat patients successfully during the investigation when a cricopharyngeal stricture or narrowing was found. A normal EGD did not preclude further investigations with TNE. All but one of our patients were treated as day-case procedures.
Conclusion
Transnasal esophagoscopy can be successfully delivered within a DGH. A previous EGD does not mean that the TNE will not reveal positive findings due to its superior visualization of the pharynx and the upper esophagus.
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Affiliation(s)
- John Rocke
- Department of ENT, Lancaster Royal Infirmary, Lancaster, United Kingdom of Great Britain and Northern Ireland
| | - Shadaba Ahmed
- Department of ENT, Lancaster Royal Infirmary, Lancaster, United Kingdom of Great Britain and Northern Ireland
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Rocke J, Quail G, Copley G. Using sildenafil (viagra) to treat congenital lymphatic malformations of the head and neck, our experience. Int J Pediatr Otorhinolaryngol 2017; 96:25-27. [PMID: 28390608 DOI: 10.1016/j.ijporl.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/29/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
Affiliation(s)
- John Rocke
- Red Cross Children's Hospital, The University of Cape Town, South Africa.
| | - Gavin Quail
- Red Cross Children's Hospital, The University of Cape Town, South Africa
| | - Graeme Copley
- Red Cross Children's Hospital, The University of Cape Town, South Africa
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Rocke J, Roydhouse T, Spencer T. Canaliculitis caused byCitrobacter freundii. Clin Exp Ophthalmol 2016; 44:856-858. [DOI: 10.1111/ceo.12774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- John Rocke
- University Hospital Geelong; Geelong Victoria Australia
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Rocke J. South Africa offers great opportunities for trainees. Assoc Med J 2016. [DOI: 10.1136/bmj.i808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vallamkondu V, Ah-See K, Rocke J, Bannister M. Tranexamic acid for the prevention and treatment of tonsillectomy-related haemorrhage in adults. Hippokratia 2016. [DOI: 10.1002/14651858.cd010740.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vamsidhar Vallamkondu
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
| | - Kim Ah-See
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
| | - John Rocke
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
| | - Miles Bannister
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
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Rocke J. Specimen: Lymphangioma of Liver. Proc R Soc Med 1933; 27:123-124. [PMID: 19989568 PMCID: PMC2204594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Rocke J. Congenital Laryngeal Stridor. Case for Diagnosis. Proc R Soc Med 1933; 27:122-123. [PMID: 19989566 PMCID: PMC2204608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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