Publications in peer-reviewed medical journals indexed by
 
Live, Continuously updated PubMed link to publications authored by Fairley JW indexed by the United States National Library of Medicine
Medical publications indexed by Google Scholar
Live, continuously updated Google Scholar link to publications authored by Fairley JW
Correlation of nasal symptoms with objective findings and surgical outcome measurement
Original thesis submitted for the degree of Master of Surgery in the University of London, 1993. Revised version (excluding chapter 9) published 1996. Online HTML version June 2007
Chapters in Master of Surgery thesis |
| Abstract | Abstract |
| Chapter 1 | General Introduction and Historical Review |
|
Chapter 2 | Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate in healthy volunteers |
|
Chapter 3 | Nasal pressure probe studies using a new device in healthy volunteers: Pressure applied to middle turbinate causes pain at lower threshold than inferior turbinate or nasal septum |
|
Chapter 4 | Reliability and validity of a nasal symptom questionnaire for use as an outcome measure in clinical research and audit |
|
Chapter 5 | The relationship between pain projected on a diagram of the face and systematically documented findings using rigid nasendoscopy |
|
Chapter 6 | The relationship between symptom scores on a specially designed questionnaire and corresponding objective measurements: Nasal inspiratory peak flow and subjective sensation of nasal obstruction |
|
Chapter 7 | The relationship between symptom scores on a specially designed questionnaire and corresponding objective measurements: Postnasal drip, rhinorrhoea, nasal obstruction, cough and mucociliary clearance time |
|
Chapter 8 | The effect on symptoms of facial pain and headache of medical treatment and operations designed to remove endoscopically documented areas of mucosal contact between the turbinates and nasal septum |
|
Chapter 9 | A prospective randomized controlled trial of Functional Endoscopic Sinus Surgery: Endoscopic middle meatal antrostomy versus conventional inferior meatal antrostomy. Interim results |
Chapter 9: my contribution to evidence based otolaryngology
In the late 1980’s I began applying my knowledge of pharmaceutical drug trials into the field of surgical operations. I designed and set up a randomized controlled trial, to research the clinical effectiveness of the then new technique of functional endoscopic sinus surgery (FESS) versus the standard inferior meatal inranasal antrostomy operation. The work was carried out at the Royal Hallamshire Hospital, Sheffield between 1990 and 1992. It was submitted as part of my original 1993 Master of Surgery thesis to the University of London, presented at meetings of the Otolaryngological Research Society and at several International ENT meetings, but was not published. In 2006, my unpublished 1993 study "A prospective randomized controlled trial of functional endoscopic sinus surgery: endoscopic middle meatal antrostomy versus conventional inferior meatal antrostomy. Interim results" was selected by the unbiased systematic review process of the Cochrane collaboration. It was one of only three studies (out of more than two thousand papers on FESS published in the world medical literature) which met their strict quality criteria for inclusion in the evidence base.
Full text Chapter 9 RCT of FESS, 1993
Read Cochrane Review of FESS, 2006
Recent diagnostic and therapeutic advances using rigid nasendoscopy are diffusing into clinical ENT practice without good scientific evidence of benefit. There is diagnostic confusion over rhinosinusitis, and a lack of reliable and valid outcome measures for the results of treatment. Surgical attention has turned from the maxillary antrum to the anterior ethmoid and middle meatus. There is a risk that variants of normal may be interpreted as being the cause of symptoms, and result in unnecessary, ineffective and potentially dangerous surgical treatment. If the ostiomeatal complex has been ignored in the past, there may be too much uncritical acceptance of its importance now. Outcome measures for treatment of rhinosinusitis are difficult to establish because subjective symptoms correlate poorly with clinical findings and measurements of nasal function. To help develop suitable outcome measures, subjective symptoms of rhinosinusitis were correlated with clinical findings and measurements of nasal function. In a series of physiological experiments, clinical observations and surgical trials, statistically significant associations were found between subjective nasal obstruction and nasal inspiratory peak flow, between facial pain / headaches and nasendoscopic abnormalities, and between rhinorrhoea, cough and impaired mucociliary function. In all clinical studies, predictive value of objective measurements was poor, the relationships accounting for around 7% of the variation in subjective symptoms. Subjective post nasal drip appeared unrelated to any objective measurement. Outcome measurement for sinus surgery must therefore be based primarily on subjective symptoms. A 12-item self-scored nasal symptom questionnaire was shown to be a convenient, reliable and valid outcome measure for treatment of rhinosinusitis. It was used in a randomized controlled trial of endoscopic middle meatal antrostomy versus conventional inferior meatal intranasal antrostomy. Interim results have not revealed any significant difference between conventional and endoscopic sinus surgery.
Further publications
Book
Dhillon RS and Fairley JW. (1989)
Multiple Choice Questions in Otolaryngology - with explanatory answers.
Macmillan Press, London.
Fairley JW and Dhillon RS (1999)
Multiple Choice Questions in Otolaryngology (2nd Edition)
Butterworth Heinemann, Oxford
Video
Fairley JW. Dhillon RS, Epstein R, Davies DG. (1989)
Spastic Dysphonia: Diagnosis and Treatment
Shiley prize entry 1989; shown at XIV World Congress ORL, Madrid, Sept 1989.
Patient education booklet
Fairley JW. (1989)
Sinusitis
Health Information Network, Maidenhead, Berks, UK.
Papers - published
Fairley JW. Reynolds FR. (1981)
An intradermal study of the local anaesthetic and vascular effects of the isomers of mepivacaine. British Journal of Anaesthesia, 53; 1211-1216.
Croft CB, McKelvie P, Fairley JW. Hol-Allen RTJ, Shaheen O. (1986)
The treatment of paralysis of the vocal cords.
Journal of the Royal Society of Medicine, 79; 473-475
Fairley JW. Dhillon RS, Weller IDV. (1988)
HIV Glue Ear and adenoidal hypertrophy.
Lancet;1422
Fairley JW. (1989)
Making computerized surgical audit work. Hospital Doctor, 16 February
Fairley JW. (1989)
Invention of flexible fibreoptic endoscope.
Journal of Laryngology and Otology, 103; 647
Fairley JW. Glover GW. (1989)
Treating malignant otitis with oral ciprofloxacin.
British Medical Journal, 299; 794-799.
Fairley JW. (1990)
Adenoidal hypertrophy and HIV infection.
Journal of Laryngology and Otology, 104; 449
Fairley JW. Hunt BJ, Glover GW. Radley-Smith RC, Yacoub MH. (1990)
Unusual lymphoproliferative oropharyngeal lesions in heart and heart-lung transplant recipients.
Journal of Laryngology and Otology, 104(9); 720-724.
Fairley JW. (1991)
Patrick Watson-Williams and the concept of focal sepsis in the sinuses: An historical caveat for functional endoscopic sinus surgery.
Journal of Laryngology and Otology, 105(1); 1-6.
Fairley JW. (1991)
Endoscopic Sinus Surgery.
Medical Society (BUPA Hospitals) 12; 5.
Fairley JW. Cross S, Shaw JD, Glover GW. Bennett MH. (1991)
Kikuchi's necrotising lymphadenitis.
Journal of Laryngology and Otology, 105(6); 496-499.
Fairley JW. (1991)
Computers in Medicine. (Meeting Report)
Journal of the Royal Society of Medicine, 84(9); 566-567.
Fairley JW. Hughes M. (1992)
Acute stridor due to bilateral vocal fold paralysis as a presenting sign of myasthenia gravis.
Journal of Laryngology and Otology 106(8); 737-738.
Fairley JW. Yardley MPJ, Durham LH. (1992)
Pressure applied to middle turbinate causes pain at lower threshold than inferior turbinate or nasal septum.
Abstract book - 14th Congress European Rhinologic Society, Rome, Oct 6-10; 96; Also published as ORS Abstract in Clinical Otolaryngology (1993) 18; 87.
Fairley JW. Yardley MPJ, Durham LH. Stevens JC. (1992)
The Sheffield nasal pressure probe: A new device to measure pain thresholds.
Abstract book - 14th Congress European Rhinologic Society, Rome, Oct 6-10; 189.
Ell SR, Stephenson L, Fairley JW. Parker AJ. (1992)
The effect of changes in atmospheric weather conditions on the incidence of epistaxis.
Abstract book - 14th Congress European Rhinologic Society, Rome, Oct 6-10; 97.
Fairley JW. (1992)
Diagnosing maxillary sinusitis. (letter)
British Medical Journal 305; 1223. (14 November)
Fairley JW. Durham LH. Ell SR. (1993)
Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate.
Clinical Otolaryngology 18; 19-22.
Fairley JW. Yardley MPJ, Durham LH. Parker AJ. (1993)
Reliability and validity of a nasal symptom questionnaire for use as an outcome measure in clinical research and audit of functional endoscopic sinus surgery.
Clinical Otolaryngology 18; 436-437.
Fairley JW. (1993)
Outcome measures for sinus surgery: A randomized controlled trial of endoscopic middle meatal antrostomy versus conventional inferior meatal antrostomy.
Proceedings of the third International Conference on Pediatric Otorhinolaryngology Jerusalem. (Elsevier, Amsterdam)
Fairley JW. Yardley MPJ, Durham LH. Stevens J. (1994)
The Sheffield Nasal Pressure Probe: The development of a new device to measure intranasal pain thresholds.
Rhinology 32(1); 45-46
Fairley JW. (1994)
A prospective randomized controlled trial of functional endoscopic sinus surgery: Endoscopic middle meatal antrostomy versus conventional inferior meatal antrostomy. Interim results.
Clinical Otolaryngology 19; 267
Yardley MPJ, Fairley JW. Durham LH. Parker AJ. (1994)
Day case tonsil and adenoid surgery: How many are eligible?
Journal of the Royal College of Surgeons of Edinburgh 39; 162-163
Fairley JW. (1995)
Outcome measures for sinus surgery: A randomized controlled trial of endoscopic middle meatal antrostomy versus conventional inferior meatal antrostomy.
in Tos, M. Thomsen J. & Balle V. Rhinology - a state of the art. Kugler, Amsterdam. ISBN 90 6299119 X
Fairley JW. (1996)
Correlation of nasal symptoms with objective findings and surgical outcome measurement
(Master of Surgery Thesis, University of London)
1. General introduction and historical review.
2. Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate in healthy volunteers.
3. Nasal pressure probes studies using a new device in healthy volunteers: Pressure applied to middle turbinate causes pain at lower threshold than inferior turbinate or nasal septum.
4. Reliability and validity of a nasal symptom questionnaire for use as an outcome measure in clinical research and audit.
5. The relationship between pain projected on a diagram of the face and systematically documented findings using rigid nasendoscopy
6. The relationship between symptom scores on a specially designed questionnaire and corresponding objective measurements: Nasal inspiratory peak flow and subjective sensation of nasal obstruction.
7. The relationship between symptom scores on a specially designed questionnaire and corresponding objective measurements: Postnasal drip, rhinorrhoea, nasal obstruction, cough and mucociliary clearance time.
8. The effect on symptoms of facial pain and headache of medical treatment and operations designed to remove endoscopically documented areas of mucosal contact between the turbinates and nasal septum.
Fairley JW (1996)
Chronic Sinusitis: Evaluation of Surgical Results (Abstract)
Nordisk-Oto-Laryngologisk Forening XXVI Kongress, Tammerfors, Finland.
ISBN 952-9705-06-9
Fairley JW. (1996)
ENT Problems in HIV infection
Clinical Focus Otolaryngology Head & Neck Surgery 1.3;9-10
Fairley JW. (1996)
The Historical ENT Perspective
CME Bulletin Otolaryngology Head & Neck Surgery 1.1;1MBBS
Fairley JW. (1997)
The Joseph Society
CME Bulletin Otolaryngology Head & Neck Surgery 1.2;42
Fairley JW (1997)
Pricking the FESS bubble: time for a realistic look (anonymous editorial)
CME Bulletin Otolaryngology Head & Neck Surgery 1.1
Konstantinidis I, Vaz F, Triaridis S, Fairley JW (2002)
Causse Laser Stapedotomy. Results and Patient Satisfaction Rate Audit in a District General Hospital
Hippokratia 6 Suppl. 1; 15-18 full text (pdf, 146 kB)
Gillett D, Fairley JW. Chandrashaker TS, Bean A, Gonzalez J. (2006)
Bone-anchored hearing aids: results of the first eight years of a programme in a district general hospital, assessed by the Glasgow benefit inventory
J Laryngol Otol Jul;120(7):537-42 Abstract
Fairley JW. (2006)
Cochrane reviews of surgical treatments (Editorial)
Clinical Otolaryngology 31;(Dec) 496-98 published text, html Extended text as submitted, html
Fairley JW. (2007)
IT is damaging doctor-patient relationship
News / Opinion: Visions for the NHS
Hospital Doctor, Elsevier Healthcare, Sept 5 2007
Leong AC, Fairley JW, Padgham ND. (2007)
Sudden hearing loss
Clin Otolaryngol. 2007 Oct;32(5):391-4. full text, html
Fairley JW. (2007)
Digital age distraction or radiology revolution?
Clinical Services Journal 2007 Nov;6(10): 18-19
Information for authors
| CME Bulletin Otorhinolaryngology Head & Neck Surgery Copyright © 1994-2005 Rila Publications.
All rights reserved
ISSN: 1364-8829
Volume 1, Issue 4, Pages 0 - 0 (1997)
Editorial
Antony A Narula, Ram S Dhillon
|
|
“Pricking the FESS bubble: Time for a realistic look”
It is now over 10 years since David Kennedy coined the term "Functional Endoscopic Sinus Surgery"1 after his conversion, on the road to Damascus, via Heinz Stammberger's clinic in Graz.1 There is no doubt that outpatient nasendoscopy has been a significant advance. It has literally shed new light on what had become a neglected backwater of ENT practice, and caused the "Renaissance in Rhinology" of the late 1980's.
Messerklinger's concept of FESS, extrapolated with Evangelical fervour into the conviction that obstruction of the ostiomeatal complex is the root of all evil in sinusitis, has spawned an entire industry of ethmoid and middle meatal surgery, but little systematic critical investigation. The theory is that bony or mucosal abnormalities in the middle meatus and anterior ethmoids cause critical stenosis and obstruction of mucociliary clearance pathways. Secondary pathology then occurs in the larger but dependent maxillary and frontal sinuses, and this dominates the clinical picture. Precise, limited surgical intervention in the ostiomeatal complex and frontal recess, aided by the endoscope, can resolve more major pathology.....
This is a highly attractive and logical proposition, but it has not had sufficiently rigorous testing. Surgical operations based on logical deduction from pathophysiology can seem bizarre at a later date, when our understanding of that pathophysiology has moved on.2 The problem is not that the results of FESS are poor. The problem is that the results of previous surgical techniques such as inferior meatal antrostomy, now considered to be "unphysiological", are also good.3 No-one has yet proven, in a published prospective randimized controlled trial, that the results of FESS are any better than what we did before - except for Matti Penttila's demonstration that FESS is better than Caldwell-Luc.4 To enable comparisons between treatments, we need valid and reliable outcome measures. For a chronic relapsing and generally non-fatal condition like rhinosinusitis, these are difficult to establish.5 Furthermore, subjective symptoms correlate poorly with clinical findings and measurements of nasal function. In Fairley’s series of 167 patients attending a nasal research clinic6 it was found that objective findings (nasal peak inspiratory flow, mucociliary clearance time, and systematic nasendoscopy) had poor predictive value for symptom severity, accounting for only 7% of the variations. Subjective post nasal drip appeared unrelated to any objective measurement. Outcome measurement for sinus surgery must therefore be based primarily on subjective symptoms. A 12-item self-scored nasal symptom questionnaire was shown to be a valid outcome measure for treatment of rhinosinusitis and was used in a pilot randomized controlled trial of endoscopic middle meatal antrostomy (FESS versus conventional inferior meatal intranasal antrostomy(INA).7 33 patients with chronic or recurrent acute rhinosinusitis were randomly allocated to receive either FESS or INA. All patients had failed adequate medical treatment with antibiotics, topical steroids and antral washouts. Subjective symptoms scores were improved in both groups (p<0.001). Interim results revealed no significant difference between conventional and endoscopic sinus surgery, but there was a strong possibility of a Type II statistical error.
Power analysis indicates that at least 90 patients will be necessary to give 80% chance of demonstrating 50% outcome difference in favour of FESS. If the true difference between FESS and INA is less than this, larger numbers will be required. Before getting carried away with the latest advances in power tools for FESS, we should look a little more critically and carry out the necessary trials to investigate the fundamental basis of the technique. This will almost certainly mean a multi-centre trial, and/or replication for meta-analysis.
References
1. Kennedy DW. Functional Endoscopic Sinus Surgery Technique. Arch Otolaryngol. 1985; 111: 643-9.
2. Fairley JW. Patrick Watson-Williams and the concept of focal sepsis in the sinuses: An historical caveat for functional endoscopic sinus surgery. J Laryngol Otol 1991; 105: 1-6.
3. Lund VJ. Inferior meatal antrostomy: Fundamental considerations of design and function. J Laryngol Otol Suppl. 1988; 15: 1-18.
4. Penttila M. Functional Endoscopic Sinus Surgery: A prospective comparison with Caldwell-Luc operation in the treatment of chronic maxillary sinusitis. Acta Universitatis Tamperensis ser A. 1995; vol 470. Academic Dissertation, University of Tampere, Finland.
5. Lund VJ, MacKay IS. Outcome assessment of endoscopic sinus surgery. J Roy Soc Med 1994; 87: 70-72.
6. Fairley JW. Correlation of nasal symptoms with objective findings and surgical outcome measurement. 1996 Master of Surgery Thesis, University of London.
7. Fairley JW. A prospective randomized controlled trial of functional endoscopic sinus surgery: Endoscopic middle meatal antrostomy versus conventional endoscopic antrostomy. Interim results. Clin. Otolaryngol. 1994; 19: 267. |
Causse Laser Stapedotomy. Results and Patient Satisfaction Rate Audit in a District General Hospital
Konstantinidis I, Vaz F, Triaridis S, Fairley JW (2002)
Hippokratia 2002; 6 Suppl 1: 15-18
Abstract Full text
Patients as well as surgeons consider hearing improvement as the main indicator of success in surgery for otosclerosis. However patient’s opinion does not always agree with the audiological measurements. It is important for the ear surgeon to refine a specific technique in an effort to maximize postoperative patient satisfaction. We present a retrospective review of all Causse Laser Stapedotomies performed by the same surgeon in a District General Hospital during a 5-year period (1995-2000). The analysis of our data (56 operations) was based on the guidelines from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery. We also present analysis of the complication rate and improvement in quality of life post-operatively using the Glasgow Benefit Inventory (GBI). The response rate for the GBI questionnaire was 76%, which is high. The postoperative hearing benefit of the patients reviewed in this study were in line with the patient satisfaction rate. Our results are comparable with those from major centers and show that stapedotomy is a safe procedure in hands of an experienced otologist with great postoperative results and significant improvement in patient’s quality of life.
Key words: Causse Laser Stapedomy, Postoperative Patient Satisfaction, Quality of Life, Glasgow Benefit Inventory.
This page last updated 1 March, 2008
|
