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Background: This cross-sectional study investigates the educational background and entry routes of otolaryngology higher surgical trainees in the UK. Method: A survey was disseminated to trainees through training programme directors and 60 responses were received. Results: Most trainees decided to pursue otolaryngology early in their training, with 50 per cent making the decision four or more years before applying for a higher surgical traineeship. Similarly, 68.3 per cent of trainees undertook otolaryngology-themed core surgical training, while two-thirds had an otolaryngology rotation during their foundation training. Most trainees (86.7 per cent) were accepted into core surgical training on their first attempt, and 71.7 per cent gained entry to higher surgical training on their first attempt. Conclusion: The findings highlight the importance of early exposure to otolaryngology and the pursuit of themed core surgical training programmes for building a competitive application. However, unsuccessful first attempts at core surgical training or higher surgical training should not discourage candidates from pursuing a career in otolaryngology. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical features, therapeutic efficacy and symptom time course of post-coronavirus disease 2019 parosmia. Methods: A 22-item online questionnaire was distributed to AbScent research group and Facebook coronavirus disease 2019 anosmia group adult members to assess clinical features, interventions and their subjective efficacy for parosmia. Results: A total of 209 participants (86 per cent females) reported: smell loss on average 3 days after coronavirus symptoms, recovery 4 weeks later, and first parosmia symptoms 12 weeks post infection. Respondents reported 10 per cent body weight loss, and listed onion and garlic as significant parosmia triggers. Regarding quality of life, depression was the most cited item (54 per cent). Smell training was trialled by 74 per cent of participants, followed by nasal corticosteroid spray (49 per cent). Stellate ganglion block, trialled by 16 per cent of respondents, had the highest reported improvement (45 per cent), with 21 per cent reporting a sustained benefit – the highest rate amongst registered treatment options. Conclusion: Post-coronavirus parosmia has a significant impact and remains challenging to treat. Stellate ganglion block appears to be successful relative to other reported treatments. Further research into the pathophysiology, efficacy and mechanism of stellate ganglion block effect is warranted. [ABSTRACT FROM AUTHOR]

Objective: To assess the level of awareness and attitude of ENT surgeons towards dental implants and oral surgery procedures that involve the maxillary sinus. Methods: A cross-sectional survey was conducted using a closed-ended questionnaire on 40 UK-based ENT surgeons. Results: Within the study population, 45 per cent of ENT surgeons were not aware of sinus lift augmentation in implant dentistry. Only 25 per cent of respondents were aware of the two subtypes of sinus lift techniques. Thirty per cent of the respondents were aware of or had heard of benign positional paroxysmal vertigo following dental treatment. Fifty-two per cent of respondents came across a dental foreign body, most commonly a tooth that had been displaced into the maxillary sinus. It was also reported that 82.5 per cent of respondents had liaised with an oral surgeon for an oroantral communication problem or a dental infection. Conclusion: Dental awareness among ENT surgeons needs to be raised for optimum interdisciplinary communication and patient safety. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the effectiveness of an ENT simulation course for equipping foundation doctors with core ENT skills in preparation for an ENT senior house officer post. Method: A total of 41 foundation doctors in the East of England participated in our two-part simulation course. Pre- and post-course surveys, consisting of Likert scales and a Dundee Ready Educational Environment Measure, were sent to assess confidence in core ENT skills and acceptability of course format. Results: Post-simulation, confidence improved in all core ENT skills taught (p < 0.001), along with confidence and preparedness to work as an ENT senior house officer (p < 0.001). Overall course median Dundee Ready Educational Environment Measure score was 48, and 100 per cent of participants would recommend this course to colleagues. Conclusion: Simulation improves foundation doctors' confidence in core ENT skills and increases preparedness for working as an ENT senior house officer. Guidance on core ENT skills requirements should be made available to improve uniformity amongst ENT simulation courses. [ABSTRACT FROM AUTHOR]

Objective: Cone beam computed tomography is an imaging technique that can be used for the paranasal sinuses. This study assessed how widely it is used and the impact it has on chronic rhinosinusitis management in the ENT department of one hospital. Method: A nationwide survey was conducted to assess the use of cone beam computed tomography throughout ENT UK members. A retrospective analysis of four-year rhinology clinic data for patients presenting with chronic rhinosinusitis symptoms was subsequently performed to assess how many scans were achieved the same day and the subsequent patient management. Results: The survey results indicated that a majority of staff do not use cone beam computed tomography to image sinuses (86.5 per cent), and this was largely because of lack of access (92 per cent). This study assessed 355 cone beam computed tomography requests. Overall, 306 cases had a cone beam computed tomography scan on the same day as their clinic appointment with the majority seen back in clinic during the same hospital attendance for the results. Overall, 97 patients were discharged on the same day. Conclusion: This study suggested a lack of awareness and understanding of cone beam computed tomography in managing rhinosinusitis. The 'one-stop' rhinology clinic model offers benefits including reduced patient hospital attendance. [ABSTRACT FROM AUTHOR]

Objective: Management of head and neck cancer patients provides unique challenges. Palliation serves to optimise quality-of-life by alleviating suffering and maintaining dignity. Prompt recognition and management of suffering is paramount to achieving this. This study aimed to assess perceived confidence, knowledge and adequacy of palliative training among UK-based otolaryngologists. Method: Eight multiple-choice questions developed by five palliative care consultants via the Delphi method were distributed over five weeks. Knowledge, perceived confidence and palliative exposure among middle-grade and consultant otolaryngologists were assessed, alongside training deficits. Results: Overall, 145 responses were collated from middle-grade (n = 88, 60.7 per cent) and consultant (n = 57, 39.3 per cent) otolaryngologists. The mean knowledge score was 5 out of 10, with 22.1 per cent (n = 32) stating confidence in palliative management. The overwhelming majority (n = 129, 88.9 per cent) advocated further training. Conclusion: A broad understanding of palliative care, alongside appropriate specialist involvement, is key in meeting the clinical needs of palliative patients. Curriculum integration of educational modalities such as simulation and online training may optimise palliative care. [ABSTRACT FROM AUTHOR]

Objectives: Electrochemotherapy uses electric fields to facilitate the influx of chemotherapy into cancer cells, producing a targeted effect. For head and neck cancer, it is mainly used for palliation of non-skin-origin metastases. It is used infrequently in the UK. This paper presents our experience and a UK survey to identify its frequency of use. Methods: Between 2016 and 2019, a prospective database was created and reviewed. Only patients with non-skin-origin metastatic head and neck cancer, with no other palliative options, were included. Survival length, complications and symptomatic benefit were assessed. The survey was conducted via e-mail. Results: Five patients were included: three with squamous cell carcinoma, one with esthesioneuroblastoma and one with hepatocellular carcinoma. Survival ranged from 1 month to over 20 months. Minor complications were seen. Only 15 out of 69 UK head and neck multidisciplinary teams offer electrochemotherapy. Conclusion: Electrochemotherapy is a well-tolerated adjunct to standard palliation of metastatic head and neck cancer, and is offered by a limited number of UK multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Objectives: This study seeks the opinions of qualified doctors on what they feel medical students should learn about otolaryngology. It aims to identify both the content deemed relevant and the performance levels for medical students in otolaryngology. Methods: A national survey developed from a content analysis of undergraduate otolaryngology curricula from the UK was undertaken, accompanied by a review of the literature and input from an expert group. Data were collected from a wide range of doctors. Results: Participants felt that graduating students should be able to: recognise, assess and initiate management for common and life-threatening acute conditions; take an appropriate patient history; and perform an appropriate examination for the majority of otolaryngology clinical conditions but manage only a select few. Conclusion: This study reports performance levels for otolaryngology topics at an undergraduate level. Participating doctors felt that a higher level of performance should be expected of students treating life-threatening, acute and common otolaryngology conditions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide an objective means of identifying patterns in academic publication among ENT trainees during their higher surgical training. Method: A cross-sectional survey was distributed to ENT higher surgical trainees. Results: A total of 153 ENT specialty trainees participated, giving a response rate of 46.5 per cent. Across all years of training, the mean number of first author publications was three and the mean number of non-first author publications was two. For trainees at specialty trainee year 8 level, these figures were nine and five, respectively. Participants with doctoral degrees and those in academic programmes published more papers but the mean difference was only significant for the doctoral subgroup (p < 0.0001). Those with additional undergraduate degrees and those in less than full-time training had an overall lower number of publications. Conclusion: Participants in the current survey achieved a higher average number of academic publications than is presently required to successfully complete higher surgical training in ENT. It is hoped that these results act as a guide for trainees planning the research component of their training to ensure that they remain competitive at consultant interview. [ABSTRACT FROM AUTHOR]

Background: The 'second victim phenomenon' is a term attributed to the traumatic effect a medical error can have on healthcare professionals. Patient safety incidents have been shown to occur in as many as one in seven patients in hospital. These incidents cause significant, potentially devastating, trauma to patients and their relatives, and can have deep and long-lasting effects on the health professionals involved. These incidents can have a negative impact on doctors' emotional wellbeing; their professional practice in relation to this impact has not been extensively investigated in surgical trainees. Method: A survey of UK otolaryngology trainees was conducted to investigate the effects of complications and medical errors on trainees, and examine how these are discussed within departments. Results and conclusion: The findings suggest that further training is required and would be warmly received by otolaryngology trainees as part of higher surgical training. [ABSTRACT FROM AUTHOR]

Objective: The ENT run through pilot was introduced in 2018 to improve early recruitment to the specialty. This study aimed to understand what makes a successful interview applicant and the experience of the run through trainees during the specialty trainee one and specialty trainee two years. Method: A questionnaire survey was sent to all ENT run through trainees. Results: Twenty-three trainees responded. Of the successful candidates, 74 per cent held additional degrees prior to application. The median core surgical interview rank was 27 (range: 3–174). Trainees felt that being on the run through pilot had increased ENT trainer engagement. Conclusion: The ENT run through posts are highly competitive, and holding an additional degree may improve applicant success. The pilot programme has been successful by increasing trainer engagement at this critical stage of training. These results will enable development of the pilot programme and provide valuable information for those applying to an ENT run through post. [ABSTRACT FROM AUTHOR]

Objective: To explore the opinions of the UK consultant body on endoscopic Eustachian tube balloon dilatation in the context of Eustachian tube dysfunction. Method: A 10-question online survey was distributed to ENT consultants currently practising in the UK (July–September 2018). Results: A total of 137 ENT consultants responded. Twenty-three per cent reported experience of Eustachian tube balloon dilatation, with a further 10 per cent planning to start performing the procedure. Of those performing the procedure, 16 per cent had more than two years' experience. Thirty-two per cent were performing zero to five procedures a year. Eustachian tube balloon dilatation was primarily conducted to treat Eustachian tube dysfunction symptoms, as well as retraction pockets, baro-challenge-induced Eustachian tube dysfunction and otitis media with effusion. The most common reason for not undertaking Eustachian tube balloon dilatation was insufficient evidence of efficacy (65 per cent). Seventy-two per cent of consultants thought that creating a national database for audit and monitoring purposes would benefit the specialty. Conclusion: The majority of UK ENT consultants do not practise Eustachian tube balloon dilatation, citing a lack of high-level evidence to support its use. A national database for auditing and research could facilitate the creation of guidelines. [ABSTRACT FROM AUTHOR]

Objective: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. Methods: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. Results: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. Conclusion: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised. [ABSTRACT FROM AUTHOR]

Background: Silver nitrate cautery and bipolar electrocautery are commonly used in the treatment of epistaxis. Currently, there are no recommendations on optimum contact times or power for nasal cautery. ENT consultant practice in the UK has not previously been evaluated. Methods: This study examined the burn depth associated with silver nitrate (75 per cent concentration) cautery and bipolar electrocautery on porcine septum samples, using varying contact times and power. ENT consultants completed a survey evaluating their practice. Results and conclusion: ENT consultant practice of nasal cautery was shown to vary widely. Silver nitrate cautery with a contact time of less than 30 seconds does not cause a full thickness burn. The findings lend some support to bilateral cauterisation with silver nitrate. Bipolar electrocautery should be set at lower than 10 W and with a contact time of less than 4 seconds to reduce the risk of complications associated with a full thickness burn. [ABSTRACT FROM AUTHOR]

Background: Neck dissection is associated with post-operative shoulder dysfunction in a substantial number of patients, affecting quality of life and return to work. There is no current UK national practice regarding physiotherapy after neck dissection. Method: Nine regional centres were surveyed to determine their standard physiotherapy practice pre- and post-neck dissection, and to determine pre-emptive physiotherapy for any patients. Results: Eighty-nine per cent of centres never arranged any pre-emptive physiotherapy for any patients. Thirty-three per cent of centres offered routine in-patient physiotherapy after surgery. No centres offered out-patient physiotherapy for all patients regardless of symptoms. Seventy-eight per cent offered physiotherapy for patients with any symptoms, with 11 per cent offering physiotherapy for those with severe dysfunction only. Eleven per cent of centres never offered physiotherapy for any dysfunction. Conclusion: The provision of physiotherapy is most commonly reactive rather than proactive, and usually driven by patient request. There is little evidence of pre-arranged physiotherapy for patients to treat or prevent shoulder dysfunction in the UK. [ABSTRACT FROM AUTHOR]

Objective: The present humanitarian crisis in Ukraine is putting strains on its healthcare system. This study aimed to assess services and training in otolaryngology, audiology and speech therapy in Ukraine and its geographical neighbours. Method: Survey study of 327 otolaryngologists from 19 countries. Results: Fifty-six otolaryngologists (17 per cent) from 15 countries responded. Numbers of otolaryngologists varied from 3.6 to 12.3 per 100 000 population (Ukraine = 7.8). Numbers of audiologists varied from 0, in Ukraine, to 2.8 per 100 000, in Slovakia, and numbers of speech therapists varied from 0, in Bulgaria, to 4.0 per 100 000, in Slovenia (Ukraine = 0.1). Ukraine lacks newborn and school hearing screening, good availability of otological drills and microscopes, and a cochlear implant programme. Conclusion: There is wide variation in otolaryngology services in Central and Eastern Europe. All countries surveyed had more otolaryngologists per capita than the UK, but availability of audiology and speech and language therapy is poor. Further research on otolaryngology health outcomes in the region will guide service improvement. [ABSTRACT FROM AUTHOR]

Background:Nasal obstruction is a common ENT complaint; however, decisions on its management are challenging, with high rates of dissatisfaction following surgery. This study investigated the practice of UK clinicians in the evaluation of nasal patency.Method:Seventy-eight UK-based rhinologists were surveyed at the 2015 British Academic Conference in Otolaryngology.Results:Clinical history and examination are almost universally used to evaluate nasal blockage. The most commonly used test was the nasal misting pattern (73 per cent), followed by peak nasal inspiratory flow (19 per cent). The Sino-Nasal Outcome Test 22 or 23 was utilised by 29 per cent of respondents. Sixty-three per cent of respondents reported that a lack of equipment was the principle reason for not using objective measures, followed by time constraints and a lack of correlation with symptom scores.Conclusion:British clinicians rely on clinical skills to evaluate nasal blockage. There is a desire for a simple, non-invasive device that objectively measures airflow for nasal breathing during physiological resting and correlates with subjective symptom scores. [ABSTRACT FROM PUBLISHER]

Background: Chronic rhinosinusitis has many risk factors; however, the effect of anti-tumour necrosis factor therapy has not been investigated in depth. Our experience points to a detrimental clinical effect in overall prevalence of chronic rhinosinusitis, despite its benefit in certain subtypes. Method: A telephone survey was performed to parallel the findings of the Global Allergy and Asthma European Network chronic rhinosinusitis screening survey. This was itself based on the widely recognised European Position Paper on Rhinosinusitis and Nasal Polyps criteria. Results: A total of 120 patients responded to the survey. The prevalence of chronic rhinosinusitis in the anti-tumour necrosis factor therapy population was 20 per cent (95 per cent confidence interval = 12.84-27.16). When compared using a chi-square test, for a two-by-two contingency table, this finding was significant against the prevalence recorded in the normal population. Conclusion: This is the first observational study indicating increased prevalence of chronic rhinosinusitis in patients treated with anti-tumour necrosis factor therapy. These clinical findings require investigation in greater depth to clarify the nature of pathologies currently diagnosed and treated as chronic rhinosinusitis. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is a common and potentially life-threatening emergency. This survey assesses understanding and confidence in epistaxis management amongst current junior doctors. Method: A cross-sectional study was conducted of foundation year one and two doctors based at three National Health Service trusts within a single region of the UK, assessing basic understanding and procedural confidence. Results: A total of 111 foundation doctors completed this survey. The average duration of undergraduate exposure to otolaryngology was 8.1 days. Forty-one per cent of respondents stated that they would apply pressure to the nasal bones to control epistaxis. Seventy-five per cent lacked confidence in their ability to manage epistaxis. Those with two weeks or more of undergraduate exposure to otolaryngology were more confident than those with one week or less of exposure (p < 0.0001). Conclusion: Junior doctors lack understanding and confidence in epistaxis management, with patient safety implications. Confidence is associated with the duration of undergraduate exposure to otolaryngology. A minimum emergency safe competency should be a priority during foundation training if not achieved in UK medical schools. [ABSTRACT FROM AUTHOR]