Letters
COMMENT & RESPONSE
Patient Privacy, Clinical Photographs, and Publication To the Editor I read with interest your editorial on “Patient Privacy, Photographs, and Publication” in JAMA Facial Plastic Surgery.1 It is highly commendable that you have touched on this topic, which the trainees are not familiar with, particularly the legalities of publishing a patient’s photograph. To add to all the issues which you have mentioned, we in Scotland work for the National Health Service, and most of our patients (in my practice, >95%) come from the National Health Service and not the private sector. In the National Health Service, the question arises, who “owns” the patients? I am in the process of writing a book on surgical techniques in nasal tip reconstruction, and I face 2 sets of issues apart from what you mentioned in your editorial. 1. Not only do I need to get an informed consent from the patient to publish the photographs, but I also need permission from the hospital to use their patient’s photograph in my publications, as by law in Scotland the patients whom I treat “belong” to the National Health Service. 2. Also, there seem to be issues regarding publishing these photographs in scientific publications like JAMA Facial Plastic Surgery and publications in books that will bring in monetary gains. If it is for publication in a scientific journal without monetary gain, I will get permission from the hospital without any issues, but if there is a monetary gain involved, for example, in a “book” publication the process to get permission from the hospital is more elaborate and complex. Natarajan Balaji, FRCS, ORL-HNS Author Affiliation: Department of Otolaryngology–Head and Neck Surgery, Monklands Hospital, Airdrie, Scotland, United Kingdom (Balaji). Corresponding Author: Natarajan Balaji, FRCS, ORL-HNS, Department of Otolaryngology–Head and Neck Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, Scotland ML6 0JS, United Kingdom ([email protected]). Conflict of Interest Disclosures: None reported. 1. Koch CA, Larrabee WF Jr. Patient privacy, photographs, and publication. JAMA Facial Plast Surg. 2013;15(5):335-336.
Nasal Valve Collapse Treatment To the Editor Nasal airway obstruction is a symptom that is frequently experienced by patients and that every nasal surgeon often has to deal with. Despite several medical treatments and surgical techniques available to address this complaint, the best therapeutic strategy for successfully targeting the cause of this symptom is not always clear. Often, patients have more than 1 etiology provoking nasal airway 66
obstruction, making recognition of the several factors involved not straightforward. The article by Sufyan et al,1 recently published in JAMA Facial Plastic Surgery, casts some light on these patients with multifactorial nasal airway obstruction. This Letter addresses treatment for nasal airway obstruction in a group of patients with nasal valve collapse, with and without allergic rhinitis. As expected, the study by Sufyan et al1 demonstrates that medical treatment with nasal steroids in patients with nasal valve collapse without allergic rhinitis is useless. Surgical treatment with alar batten grafts was, as demonstrated by this study, the treatment of choice for these patients. Alar batten grafts are known for improving static as well as dynamic airway obstruction in cases of nasal valve collapse localized at the external nasal valve or at the intervalve area. What was surprising in this study1 was that alar batten grafts were effective in all patients with nasal valve collapse; therefore, alar batten grafts should have had some positive effect in patients with nasal valve collapse localized at the internal nasal valve. Furthermore, this study 1 demonstrated that surgical treatment of nasal valve collapse also leads to a decrease of allergic symptoms in patients with allergic rhinitis. Sixtytwo percent of the patients included in the study reported allergic symptoms, as supported by the Allergic Rhinitis Questionnaire, before treatment of nasal valve collapse, whereas 12 months after surgery addressing the nasal valve, only 6% of patients were receiving treatment with nasal steroids in an effort to manage their allergic symptoms. Sufyan et al1 speculate that this improvement in allergic symptoms would be due to a decrease of inflammatory cytokines in these patients’ nasal airways as a response to the improved airflow achieved by nasal valve surgery. It would be interesting to find how these allergic patients would be doing after a longer follow-up time. It would also be interesting to measure the concentration of inflammatory cytokines in the nasal mucosa of these patients, before and after surgery. The article by Sufyan et al1 is definitely worth reading. It elegantly shows that treatment for patients with nasal valve collapse should be surgical and suggests that alar batten grafts are effective for improving nasal airflow in all patients with nasal valve collapse. This study also demonstrates that surgical treatment of nasal valve collapse significantly improves allergic symptoms in patients with documented allergic rhinitis and decreases the need for nasal steroids in these patients, therefore raising new perspectives to the best treatment of patients with multifactorial nasal obstruction. Rui Xavier, MD
JAMA Facial Plastic Surgery January/February 2014 Volume 16, Number 1
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archfaci.jamanetwork.com/ by a Purdue University User on 05/23/2015
jamafacialplasticsurgery.com
COMMENT & RESPONSE
Patient Privacy, Clinical Photographs, and Publication To the Editor I read with interest your editorial on “Patient Privacy, Photographs, and Publication” in JAMA Facial Plastic Surgery.1 It is highly commendable that you have touched on this topic, which the trainees are not familiar with, particularly the legalities of publishing a patient’s photograph. To add to all the issues which you have mentioned, we in Scotland work for the National Health Service, and most of our patients (in my practice, >95%) come from the National Health Service and not the private sector. In the National Health Service, the question arises, who “owns” the patients? I am in the process of writing a book on surgical techniques in nasal tip reconstruction, and I face 2 sets of issues apart from what you mentioned in your editorial. 1. Not only do I need to get an informed consent from the patient to publish the photographs, but I also need permission from the hospital to use their patient’s photograph in my publications, as by law in Scotland the patients whom I treat “belong” to the National Health Service. 2. Also, there seem to be issues regarding publishing these photographs in scientific publications like JAMA Facial Plastic Surgery and publications in books that will bring in monetary gains. If it is for publication in a scientific journal without monetary gain, I will get permission from the hospital without any issues, but if there is a monetary gain involved, for example, in a “book” publication the process to get permission from the hospital is more elaborate and complex. Natarajan Balaji, FRCS, ORL-HNS Author Affiliation: Department of Otolaryngology–Head and Neck Surgery, Monklands Hospital, Airdrie, Scotland, United Kingdom (Balaji). Corresponding Author: Natarajan Balaji, FRCS, ORL-HNS, Department of Otolaryngology–Head and Neck Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, Scotland ML6 0JS, United Kingdom ([email protected]). Conflict of Interest Disclosures: None reported. 1. Koch CA, Larrabee WF Jr. Patient privacy, photographs, and publication. JAMA Facial Plast Surg. 2013;15(5):335-336.
Nasal Valve Collapse Treatment To the Editor Nasal airway obstruction is a symptom that is frequently experienced by patients and that every nasal surgeon often has to deal with. Despite several medical treatments and surgical techniques available to address this complaint, the best therapeutic strategy for successfully targeting the cause of this symptom is not always clear. Often, patients have more than 1 etiology provoking nasal airway 66
obstruction, making recognition of the several factors involved not straightforward. The article by Sufyan et al,1 recently published in JAMA Facial Plastic Surgery, casts some light on these patients with multifactorial nasal airway obstruction. This Letter addresses treatment for nasal airway obstruction in a group of patients with nasal valve collapse, with and without allergic rhinitis. As expected, the study by Sufyan et al1 demonstrates that medical treatment with nasal steroids in patients with nasal valve collapse without allergic rhinitis is useless. Surgical treatment with alar batten grafts was, as demonstrated by this study, the treatment of choice for these patients. Alar batten grafts are known for improving static as well as dynamic airway obstruction in cases of nasal valve collapse localized at the external nasal valve or at the intervalve area. What was surprising in this study1 was that alar batten grafts were effective in all patients with nasal valve collapse; therefore, alar batten grafts should have had some positive effect in patients with nasal valve collapse localized at the internal nasal valve. Furthermore, this study 1 demonstrated that surgical treatment of nasal valve collapse also leads to a decrease of allergic symptoms in patients with allergic rhinitis. Sixtytwo percent of the patients included in the study reported allergic symptoms, as supported by the Allergic Rhinitis Questionnaire, before treatment of nasal valve collapse, whereas 12 months after surgery addressing the nasal valve, only 6% of patients were receiving treatment with nasal steroids in an effort to manage their allergic symptoms. Sufyan et al1 speculate that this improvement in allergic symptoms would be due to a decrease of inflammatory cytokines in these patients’ nasal airways as a response to the improved airflow achieved by nasal valve surgery. It would be interesting to find how these allergic patients would be doing after a longer follow-up time. It would also be interesting to measure the concentration of inflammatory cytokines in the nasal mucosa of these patients, before and after surgery. The article by Sufyan et al1 is definitely worth reading. It elegantly shows that treatment for patients with nasal valve collapse should be surgical and suggests that alar batten grafts are effective for improving nasal airflow in all patients with nasal valve collapse. This study also demonstrates that surgical treatment of nasal valve collapse significantly improves allergic symptoms in patients with documented allergic rhinitis and decreases the need for nasal steroids in these patients, therefore raising new perspectives to the best treatment of patients with multifactorial nasal obstruction. Rui Xavier, MD
JAMA Facial Plastic Surgery January/February 2014 Volume 16, Number 1
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archfaci.jamanetwork.com/ by a Purdue University User on 05/23/2015
jamafacialplasticsurgery.com
