Govt eyes cuts to elective surgery

In a recent article in the Herald ,the NZ National Health Committee has to find savings of $30 million this financial year from elective procedures deemed to be of little benefit. The New Zealand Government are using data from a  similar committee in Wales. The Welsh Committee has come up with a specific procedures list, under 17 surgical and dental headings, including tonsillectomy, grommets, varicose veins, haemorrhoids, dilatation and curettage, hysterectomy, gallbladder removal, caesarean section, lower-back procedures, circumcision, eye-lid surgery, nose surgery and surgery to correct protruding ears.

The committee said it had completed a technological note on the use of ventilation tube grommets for treating middle-ear infections (otitis media).

"The evidence indicates that the use of ventilation tubes is of limited value in treating otitis media with effusion, although it does not suggest that it should be stopped completely."

BUT when you look at what has happened in UK I found a well written article from the Daily Mail. This talks about the dangers of delaying grommet insertion. New research shows the number of referrals in UK to hospital for treatment of glue ear - a chronic condition that is the biggest single cause of hearing loss in children - has plummeted in the past few years.

The article also  includes information on a New Zealand Study.

"The study of more than 1,000 children born in New Zealand in the early Seventies suggests early glue ear affects behaviour, IQ and reading, into late teens.

It found that compared with 'normal' children, those with a history of glue ear had lower IQ up to the age of 13, more hyperactive and inattentive behaviour up to 15, and reduced reading ability up to 18.

It concluded that 'early middle ear disease history appears to have a deleterious effect on reading ability, verbal IQ and behaviour problems'."

The people of Northland need to be very wary of a new breed of Health Administrator in Wellington, many of whom have recently been exported from UK, who have plans to cut services particularly to the  poorest children in New Zealand.

New Zealand Balance and Dizziness Centre

A few weeks ago I attended the opening of the NZ Balance and Dizziness Centre (NZBDC) in Auckland.

The services on offer include everything from initial assessment through objective diagnosis to rehabilitation. Initial assessment will be by experienced Neuro-Otologists, followed by directed investigations by the Vestibular Audiologist and Vestibular Physiotherapist to allow confirmation of diagnosis and documentation of the degree and severity of the underlying problem.


I was impressed by the quality of the staff running this new clinic as well as the new equipment for diagnosis and treatment.

This is a private facility but may be well worth a patient attending particularly with dizziness of uncertain origin.

Indications for Adenotonsillectomy in Children

The indications for Tonsillectomy have changed over the years with more understanding about the effects of Obstructive Sleep Apnoea (OSA) in children.
The paper published below is from the Paediatrics and Child health Division of the Royal College of Physicians and The Australian Society of Otolaryngology head and Neck Surgery. It was published in 2008 but still relevant today and to the New Zealand Population.

It emphasises the need to increase the access for adenotonsillectomy for children with moderate to severe OSA.

This is in contrast to what is happening in UK where there has been a 40% planned reduction in Adenotonsillectomy. " The operation has been placed on lists of treatments classed as 'of limited benefit' which are being used by primary care trusts to refuse funding on the NHS."
see http://www.telegraph.co.uk/health/healthnews/9195475/NHS-rationing-leaving-thousands-of-children-suffering-tonsillitis-surgeons.html
So I personally believe we need to be wary of any governmental plan to reduce and control the number of T's and Ads. JG


Final Approved Tonsillectomy Document (3)

Head thrust test- an important test for vertigo.

The head impulse or head thrust test was first described by Halmagyi and Curthoys in 1988.  It has acquired an increasingly important place in the clinical examination of the vertigo patient. It detects severe unilateral loss of semicircular canal (SCC) function clinically; it is more sensitive and specific than the traditional Romberg and similar tests; and it is particularly important in the emergency unit, where it can distinguish between vestibular neuritis and cerebellar infarction, which can both generate similar symptoms suggesting an initial attack of severe acute vertigo.
The result of the head thrust test is definitely normal in a patient with a cerebellar infarction but abnormal in a patient with vestibular neuronitis.

                                                                                                                    Kerber K A , Baloh R W Neurol Clin Pract 2011;1:24-33

see youtube video- Halmagyi Head Thrust Maneuver

Incidental MRI and CT findings in paranasal sinuses and mastoid cells

With increasing numbers of CT and MRI scans being performed, this has lead to an  increase in diagnosis of Sinusitis and Mastoiditis being made and referral to our department.
 Fluid signal in the mastoid can be an incidental finding on T2-weighted magnetic resonance imaging and often is interpreted as mastoiditis by radiologists. 

A recent study examined 28 consecutive cases of such erroneously diagnosed "mastoiditis" and documents the presence or absence of otologic symptoms and clinical signs. They found a very low prevalence of otologic symptoms or pathology and no cases of mastoiditis in these patients, and they determined that magnetic resonance imaging is not an effective screening modality for mastoiditis.

Another study showed 61 % of children had one or more salient findings in their paranasal sinuses or mastoid cells. 48 % had mucosal swelling in their paranasal cavities, 25 % in their mastoid cells. The prevalence was higher among children less than 10 years of age (60 % and 42 %) and among children with current upper respiratory tract infection (71 % and 35 %). There was no correlation to a history of headache, snoring, asthma and allergies, or to gender or place of residence.

CONCLUSION:

Mucosal swelling in paranasal sinuses and in mastoid cells is a frequent incidental finding in adults and more commonly in children. Even major mucosal swelling in a paranasal sinus is not necessarily a sign of infection. In radiological reports the terms "sinusitis" and "mastoiditis" should therefore be used with great caution. The initiation of treatment should be based on clinical symptoms and not on radiological abnormalities alone.

The Northern Cochlear Implant Programme (NCIP)

The Northern Cochlear Implant Programme (NCIP) is a publicly funded programme for profoundly deaf children and adults in the northern region of New Zealand.

They have opened a new web-site with information on referral criteria for adults and children. 

http://www.ncip.org.nz/health-professionals.html#who-can-refer-to-the-ncip






Chris Cairns shares a moment with daughter Isabel, who has just received a cochlear implant and can hear for the first time.(Courtesy of stuff.co.nz and Canberra times)

Whangarei Hospital Adult Hearing Aid Service - Information & Guidelines for Referrers

Whangarei Hospital Adult Hearing Aid Service - Information & Guidelines for Referrers

Please refer patients for hearing aid services to the Audiology service rather than the ENT clinic. I also have added the criteria for the referral.

Information for Referrers (1)