The title of this editorial may have existential and philosophical implications but for our purposes is designed to reflect a more everyday requirement. That is to demonstrate to the public that the treatments we purvey are effective in managing their complaints. The need to demonstrate effectiveness is a rational one both in terms of spending healthcare budgets wisely and avoiding unnecessary and useless treatments. A review article in this month's issue summarises the evidence for effectiveness of treatment in a number of common ENT conditions.Reference Seymour1 As Seymour states in her article, ENT operations have frequently come under fire, including recently in a BMJ article that stated: ‘…grommets is an operation (like tonsillectomy) of private practice, in middle class children of families whose standard mantra is “something has to be done”…’.Reference Spence2 Seymour reviews a number of conditions, and points out that surgical treatment often produces parallel benefits in such things as education, behaviour, confidence and neurocognitive abilities that are often not the principle outcome. Particularly with regard to tonsil surgery, the evidence is conflicting, with some studies suggesting that surgery should be reserved for only a more severe group of patients with airway obstruction or severe tonsillitis.Reference Soni-Jaiswal, Anderco and Kumar3 Reporting of outcome is clearly important, including an honest appraisal of the chance of adverse events.Reference Prinsley4
Perhaps the most contentious area when it comes to outcome assessment is in rhinology, and it is notable that this subspecialty was not covered by Seymour in her review. Rhinologists are well aware that the fundamental problem in outcome assessment is that symptoms and patient-reported outcomes frequently correlate poorly with objective measures of nasal function. There have been many assessments of nasal outcome, including from a cost–benefit standpoint.Reference Al Badaai, Valdés and Samaha5 The most used instruments have been the Sino-Nasal Outcome Test-22 (‘SNOT-22’) score and Lund–MacKay computed tomography score, with additional ones such as the Adelaide Disease Severity Score being recently added.Reference Naidoo, Tan, Singhal and Wormald6 In this issue, Haye and colleagues suggest an alternative ‘nasal surgical questionnaire’ for outcome assessment that focuses more on nasal obstruction, which they feel is the principle symptom that should be taken into account when assessing the results of surgery.Reference Haye, Døsen, Shiryaeva and Amlie7
Finally, the effect of the weather on post-tonsillectomy haemorrhage is considered in an article by Cadd and colleagues.Reference Cadd, Rogers, Patel and Crossland8 They found that seasonality had no influence on haemorrhage rates, unlike a previous study from ScotlandReference Lee, Montague and Hussain9 that found a higher incidence in cold weather. Maybe the climates of Scotland and the Northern Territory of Australia are not truly comparable. Certainly, the influence of climate on the throat will probably continue to be contentious, as it has been for many years. An article from The Journal of Laryngology & Otology Archive published in 1893, entitled ‘Dry weather and throat diseases’,Reference Browne10 suggests that this is not a new discussion!
