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Patients with coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present with a wide range of symptoms. In this paper, a detailed characterisation of mild-to-moderate ear, nose nd throat (ENT) symptoms is presented with the aim of recognising the disease early to help reduce further spread and progression.A total of 230 cases testing positive for SARS-CoV-2 and 134 negative controls were recruited for a case-control analysis. Symptoms were analysed using the Acute Respiratory Tract Infections Questionnaire, while other symptoms were investigated byAmong the study samples (n = 364), 149 were males and 215 were females with age ranging from 20 to 89 years (mean 52.3). Four main groups of symptoms were obtained: influenza-like symptoms, ENT-symptoms, breathing issues and asthenia-related symptoms, representing 72%, 69%, 64% and 53% of overall referred clinical manifestations, respectively. ENT symptoms, breathing issues and influenza-like symptoms were associated with positivity to SARS-CoV-2, whereas asthenia-related symptoms did not show a significant association with SARS-CoV-2 infection after controlling for other symptoms, comorbidities and demographic characteristics.ENT symptoms are equally represented with influenza-like ones as presenting symptoms of COVID-19. Patients with ENT symptoms should be investigated for early identification and prevention of SARS-CoV-2 spread.Importanza del rilevamento precoce dei sintomi ORL nella COVID-19 lieve-moderata.I pazienti con malattia da Coronavirus-19 (COVID-19) causata dal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) possono presentare una vasta gamma di sintomi. In questo articolo, è mostrata una caratterizzazione dettagliata dei sintomi nei pazienti con malattia lieve-moderata, al fine di riconoscere precocemente la malattia e ridurne l’ulteriore diffusione.Un totale di 230 pazienti risultati positivi per infezione da SARS-CoV-2 e 134 soggetti risultati invece negativi sono stati reclutati per questa analisi caso-controllo. I sintomi sono stati analizzati utilizzando l’Acute Respiratory Tract Infections Questionnaire, mentre altri, sono stati indagati mediante domande ad hoc.La popolazione oggetto dello studio era composta da 364 soggetti; 149 erano maschi e 215 femmine con età compresa tra 20 e 89 anni (media 52,3). Sono stati identificati quattro gruppi di sintomi: sintomi simil-influenzali, sintomi ORL, problemi respiratori e sintomi astenia-correlati che rappresentavano rispettivamente il 72%, 69%, 64% e 53% delle manifestazioni cliniche. Sintomi ORL, problemi respiratori e sintomi simil-influenzali erano associati a positività a SARS-CoV-2, mentre i sintomi correlati all’astenia non mostravano un’associazione significativa con l’infezione da SARS-CoV-2 dopo il controllo di altri sintomi, co-morbidità, e caratteristiche demografiche.I sintomi ORL sono ugualmente rappresentati rispetto a quelli simil-influenzali nell’esordio della COVID-19. I pazienti con sintomi ORL devono essere studiati per l’identificazione precoce e la prevenzione della diffusione del SARS-CoV-2.

Purpose Primary: To determine the rate of occult cervical metastases in primary temporal bone squamous cell carcinomas (TBSSC). Secondary: to perform a subgroup meta-analysis of the risk of occult metastases based on the clinical stage of the tumour and its risk based on corresponding levels of the neck. Methods A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to November 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle–Ottawa scale. Results Overall, 13 out of 3301 screened studies met the inclusion criteria, for a total of 1120 patients of which 550 had TBSCC. Out of the 267 patients who underwent a neck dissection, 33 had positive lymph nodes giving a pooled rate of occult metastases of 14% (95% CI 10–19%). Occult metastases rate varied according to Modified Pittsburg staging system, being 0% (0–16%) among 12 pT1, 7% (2–20%) among 43 pT2 cases, 21% (11–38%) among 45 pT3, and 18% (11–27%) among 102 pT4 cases. Data available showed that most of the positive nodes were in Level II. Conclusion The rate of occult cervical metastases in TBSCC increases with pathological T category with majority of nodal disease found in level II of the neck.

Objectives of review: To review the literature for the evidence base for the aetiology and management of referred otalgia, looking particularly at non-malignant, neuralgic, structural and functional issues. Type of review: Systematic review. Search strategy: A systematic literature search was undertaken from the databases of EMBASE, CINAHL, MEDLINE®, BNI, and Cochrane Library according to predefined inclusion and exclusion criteria. Evaluation method: All relevant titles, abstracts and full text articles were reviewed by three authors who resolved any differences by discussion and consultation with senior author. Results: 44 articles were included in our review. The overall quality of evidence was low, with the vast majority of the studies being case-series with three cohort and four randomised-controlled trials included. The prime causes and management strategies were focussed on temporomandibular joint dysfunction (TMJD), Eagle syndrome and neuralgia. Our meta-analyses found no difference on the management strategies for the interventions found. Conclusions: Referred otalgia is common and treatment should be aimed at the underlying pathology. Potential aetiologies are vast given the extensive sensory innervation of the ear. An understanding of this and a structured approach to patient assessment is important for optimal patient management.

Introduction: The prevalence of hearing loss and its consequences is increasing as the elderly population grows. As the guidelines for cochlear implantation (CI) expand, the number of elderly CI recipients is also increasing. We report complication rates, survival duration, and audiological outcomes for CI recipients aged 80 years and over and discuss the cost utility of CI in this age group. Methods: A retrospective cohort study was undertaken of all CI recipients (126 cases), aged 80 years and over at the time of their surgery, implanted at our institution (Cambridge University Hospitals) during a period from January 1, 2001, to March 31, 2019. Data on survival at 1, 3, and 5 years post-implantation, post-operative complications and functional hearing outcomes including audiometric and speech discrimination outcomes (Bamford-Kowal-Bench sentence test) have been reported. Results: The mean age at implantation was 84 years. The mean audiometric score improved from 108 dB HL to 28 dB HL post-implantation. The mean Bamford-Kowal-Bench score improved from 14% to 66% and 73% at 2 and 12 months post-implantation, respectively. The complication rate was 15.3%. The survival probability at 1 year post-implantation was 0.95 for females and 0.93 for males, at 3 years was 0.89 for females and 0.81 for males, and at 5 years was 0.74 for females and 0.54 for males. Conclusion: CI is safe and well-tolerated in this age group and elderly patients gain similar audiometric and functional benefit as found for younger age groups.

To assess all available data and determine the success rates and tolerability of local anaesthetic myringoplasty in comparison with those undertaken under general anaesthetic myringoplasty.The study was designed following a PRISMA-P protocol and registered with the PROSPERO database. MEDLINE, Cochrane Library (CDSR/Central), EMBASE and CINHAL-were directly searched for studies, which met the inclusion criteria.Primary objective was to compare perforation closure rates between patients undergoing myringoplasty under local anaesthetic and those under general anaesthetic from all available published data. Secondary outcomes include complications, such as 'any minor complications', infection rates in the first 6 month post-op, facial nerve weakness, dysgeusia and patient satisfaction.27 studies were included in the final analysis and found that myringoplasty had an overall perforation closure rate of 89%. The pooled proportion of closures after myringoplasty under local anesthesia was 87% and for myringoplasties under general anesthesia was 91%. Analysis of myringoplasty under local anaesthesia focusing on 'in-office' performed procedures only, found a closure rate of 88%.There is no significant difference in the success rate of myringoplasty surgery when performed under local or general anaesthetic as measured by perforation closure rates. However, there are other factors, which can drive choosing local anaesthetic surgery, such as minimising anaesthetic risks, reducing costs and reducing environmental impact.

Background Work-related musculoskeletal disorder (WRMD) is a rising concern for surgeons, particularly those involved in minimally invasive surgery (MIS). Severe WRMD can adversely affect surgeon’s health and foreshorten their careers if not appropriately managed. Aims The aim of this study was to assess the prevalence of WRMD among Irish otolaryngologists and determine their knowledge of the best ergonomic principles. Methods A national survey was distributed electronically to all otolaryngology consultants and non-consultant hospital doctors (NCHDs) in Ireland. The survey assessed respondents’ age, grade, history of WRMD, and treatments sought for WRMD and knowledge of best ergonomic practice. Results Forty-nine of one hundred and two respondents completed the survey. The lifetime prevalence of WRMD among this cohort was 75.5%. Pain was the most commonly experienced symptom at 71.4%. The neck was the most frequently affected location (59.2%). Treatment for WRMD was sought by 36.7% of participants. The majority of respondents (73.5%) were unaware of recommendations made in the field of surgical ergonomics, while 85.7% were interested in learning ergonomic principles. Conclusion This study demonstrates a high prevalence of WRMD amongst otolaryngologists working in Ireland and demonstrates a need for ergonomic training for surgeons.

OBJECTIVES: To report changes in practice brought about by COVID-19 and the implementation of new guidelines, and to explore factors relating to unscheduled re-presentations for patients discharged from the emergency department (ED). DESIGN: Prospective multicentre national audit over 12 weeks from 6th April 2020. SETTING: UK secondary care ENT departments. PARTICIPANTS: Adult patients with acute epistaxis. MAIN OUTCOME MEASURES: Re-presentation within 10 days for patients discharged from the ED. RESULTS: Eighty three centres from all four UK nations submitted 2631 valid cases. The majority of cases were ED referrals (89.7%, n = 2358/2631). 54.6% were discharged from the ED following ENT review (n = 1267/2322), of whom 19.5% re-presented within 10 days (n = 245/1259) and 6.8% were ultimately admitted (n = 86/1259). 46.7% of patients had a non-dissolvable pack inserted by ED prior to referral to ENT (n = 1099/2355). The discharge rates for ED patients and their subsequent re-presentation rates were as follows: non-dissolvable packs, 29.5% discharged (n = 332/1125), 18.2% re-presented (n = 60/330); dissolvable products, 71.1% discharged (n = 488/686), 21.8% re-presented (n = 106/486); cautery only, 89.2% discharged (n = 247/277), 20.0% re-presented (n = 49/245); and no intranasal intervention, 85.5% discharged (n = 200/234), 15.2% re-presented (n = 30/198). Univariable logistic regression showed that not being packed by ED, antiplatelet medications, failed cautery and recent epistaxis treatment were significant predictors of re-presentation within 10 days. CONCLUSIONS: Management of acute epistaxis was notably affected during the initial peak of the pandemic, with a shift towards reduced admissions. This national audit highlights that many patients who may previously have been admitted to hospital may be safely discharged from the ED following acute epistaxis.

The coronavirus disease 2019 (COVID-19) caused by the Severe-Acute-Respiratory-Syndrome Coronavirus 2 (SARS-CoV-2) has widely spread throughout the world since December 2019 . One of the main symptoms of COVID-19 is alteration of smell or taste, suggesting that high viral load can be found in the nose . CDC guidelines have recommended that diagnostic swabs should be performed in specific areas of the respiratory tract such as the nasopharynx, oropharynx, nasal turbinate, and anterior nares. Nasal and nasopharyngeal swabbing requires the introduction of a foreign body into a delicate area that can result in harm to the patient. In this paper we present the complications encountered in a series of health workers who underwent oro/nasopharyngeal swab for detection of SARS-CoV-2.

ObjectiveMicroscopic surgery is currently considered the ‘gold standard’ for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic.MethodCombined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively.ResultsSurgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training.ConclusionThe Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.

Objectives: Vestibular schwannomas (VS) are rare benign tumours of the vestibular nerve that cause hearing loss. Management strategies include watchful waiting, radiotherapy or surgical resection. ...

The purpose of this review is to systematically appraise the English-language literature to identify methods of objectively diagnosing and measuring the severity of subjective idiopathic nonpulsatile tinnitus.A systematic literature search was undertaken from the databases of MEDLINE (1946-May 2018), EMBASE (1980-May 2018), CINAHL (1981-May 2018), and BNI (1992-May 2018) according to predefined inclusion and exclusion criteria.We identified 21 articles in this field. Reported objective tests include blood tests, electrophysiology measures, radiological measures, and balance tests. The overall quality of evidence was low, with most studies being low-powered.Our review has not identified any reliable or reproducible objective measures of tinnitus. However, this piece of work has highlighted emerging areas where further high quality research may lead to the development of an effective method for objectively identifying and measuring the severity of tinnitus.

Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Setting Stakeholders from the United Kingdom. Subjects and methods Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. Results Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was ‘diffuse inflammation of the ear canal skin of less than 6 weeks duration’. Conclusion The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

Objectives To report changes in practice brought about by COVID‐19 and the implementation of new guidelines for the management of tonsillitis and peritonsillar abscess (PTA), and to explore factors relating to unscheduled re‐presentations for patients discharged from the emergency department (ED). Design Prospective multicentre national audit over 12 weeks from 6 April 2020. Setting UK secondary care ENT departments. Participants Adult patients with acute tonsillitis or PTA. Main outcome measures Re‐presentation within 10 days for patients discharged from the ED. Results 83 centres submitted 765 tonsillitis and 416 PTA cases. 54.4% (n = 410) of tonsillitis and 45.3% (187/413) of PTAs were discharged from ED. 9.6% (39/408) of tonsillitis and 10.3% (19/184) of PTA discharges re‐presented within 10 days, compared to 9.7% (33/341) and 10.6% (24/224) for those admitted from ED. The subsequent admission rate of those initially discharged from ED was 4.7% for tonsillitis and 3.3% for PTAs. IV steroids and antibiotics increased the percentage of patients able to swallow from 35.8% to 72.5% for tonsillitis (n = 270/754 and 441/608) and from 22.3% to 71.0% for PTA (n = 92/413 and 265/373). 77.2% of PTAs underwent drainage (n = 319/413), with no significant difference in re‐presentations in those drained vs not‐drained (10.6% vs 9.5%, n = 15/142 vs 4/42, P = .846). Univariable logistic regression showed no significant predictors of re‐presentation within 10 days. Conclusions Management of tonsillitis and PTA changed during the initial peak of the pandemic, shifting towards outpatient care. Some patients who may previously have been admitted to hospital may be safely discharged from the ED.

OBJECTIVE OF REVIEW: Surgical site infections are a recognised complication of cochlear implant (CI) surgery with significant morbidity. Our aim was to search for the optimum prevention and management strategy to deal with this issue. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: A systematic literature search was undertaken from the databases of Embase, CINAHL, MEDLINE® , Web of Science, Scopus and Cochrane Library according to the predefined inclusion and exclusion criteria. EVALUATION METHOD: All relevant titles, abstracts and full-text articles were reviewed by two authors who resolved any differences by discussion and consultation with senior authors. RESULTS: Fourteen articles were included in our review. The overall quality of evidence was low with the vast majority of the studies being retrospective case series and expert opinions. No randomised controlled trials were noted. We found consistent reports that intraoperative prophylactic antibiotics should be given to all patients undergoing CI and that the vast majority of CI wound infections had grown Staphylococcal spp. or Pseudomonas spp. CONCLUSION: Our review has not identified any reliable or reproducible strategies to prevent and deal with wound infections after CI. We strongly encourage further research within this field and would suggest that a consensus of opinions from a multidisciplinary panel of experts may be a pragmatic way forward as an effective guide.

Objective To review our experience with cochlear implant infections over the past 5 years, the management strategy and to identify predictive factors that led to explantation. Study design Retrospective record-base case series of cochlear implant infections. Setting Tertiary otology and implant center. Patients All patients who had cochlear implantation over a period of 5 years. Intervention(s) None. Main outcome measure(s) To identify risk factors, rates and outcomes of cochlear implant infections, and to formulate strategies to develop clearer management protocols to prevent cochlear implant explantation. Results Of 704 implanted patients, 22 suffered a postoperative soft tissue infection (3%). Fifty-nine percent of these infected patients resulted in explantation, giving an explantation rate of 1.8% over the whole study population. One hundred percent of the infected implants identified as having either Staph. Aureus or Pseudomonas spp. as the single causative organism resulted in explantation. Conclusions There is a high rate of explantation when infection is detected. Currently there is no clear consensus on medical management, such as choice of antibiotics or length of antibiotic course. A registry of cochlear implants would facilitate standard reporting methods for severity and type of infection, to be able to pool data across centers and form a more robust management protocol for cochlear implant infections.

BackgroundAdvances in endoscopic technology have allowed transnasal oesophagoscopy to be used for a variety of diagnostic and therapeutic procedures.MethodA review of the literature was carried out to look into the extended role of transnasal oesophagoscopy within otolaryngology, using the Embase, Cinahl and Medline databases.ResultsThere were 16 studies showing that transnasal oesophagoscopy is safe and cost effective and can be used for removal of foreign bodies, tracheoesophageal puncture, laser laryngeal surgery and balloon dilatation.ConclusionThis study presents a summary of the literature showing that transnasal oesophagoscopy can be used as a safe and cost-effective alternative or adjunct to traditional rigid endoscopes for therapeutic procedures.

OBJECTIVES This review summarizes current evidence on causes and management strategies for delayed pain post-cochlear implantation (CI) surgery, without clinical evidence of inflammation or infection. METHODS The systematic review was undertaken in line with Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 guidelines. A literature search was undertaken, with inclusion of patients who underwent CI and presented with delayed pain (>3 months post-operatively) around their device site without an identifiable cause. Analysis was undertaken using MATLAB (MathWorks, Natick, MA) and the R-software package (www.r-project.org). RESULTS 4 articles (48 patients), all retrospective case series, met inclusion criteria. The mean onset of pain post-CI was 60 months and mean follow-up was 15.8 months, there was no difference in the prevalence of pain between device brands (p=0.13). The majority (90%) did not have any hearing deterioration, and investigations did not reveal a cause for the pain in any of the patients. In terms of management, medical therapies, including oral therapy (analgesia, non-steroidal anti-inflammatories, antibiotics) and local treatments (topical, injections) resolved pain in 41% and 63%, respectively. Surgical intervention (explantation, magnet replacement, tympanic neurectomy), where undertaken, resolved pain in 100%. A minority had an identifiable infective microorganism cultured from intra-operative soft tissue or biofilm samples. CONCLUSIONS Evidence for the causes and management of delayed pain post-CI without clinical evidence of inflammation is scarce. A stepwise approach is deemed best, with decisions being made on an individual basis, evaluating each patient's specific circumstances and priorities. Further evaluation of explanted devices would allow for better understanding of the causes and treatment of this group of patients.

Musculoskeletal pain is a common occupational hazard experienced by surgeons. Otologists are predisposed to neck and back pain due to regular prolonged microscopic work. We conducted a prospective pilot study to investigate the effects of sustained microscopic work on the neck and back, its correlation to surgical experience and to assess the benefits of a prototype postural support chair (PSC) amongst 10 male ear, nose and throat (ENT) clinicians. We used a subjective measure of time to fatigue and pain for the neck and back as well as objective readings from a surface electromyogram (sEMG). We found that an increase in surgical experience correlated with the time taken to experience fatigue and pain in the neck and back. This was corroborated by our sEMG findings. The PSC significantly delayed the sensations in the neck and also eliminated the difference seen amongst the varying seniority of clinicians.

Background:Careers in medicine are embarked on by people with various personalities, with highly strung and motivated characters usually drawn to surgery. This study was conducted to identify the personality types of ENT surgeons in comparison to a control group of foundation doctors.Method:A validated personality questionnaire was distributed to ENT specialty trainees and two cohorts of foundation doctors between October 2013 and November 2015. The questionnaires were scored and individuals were categorised as having either type A or type B personalities.Results:Response rates were 90 per cent (26 out of 29) for ENT specialty trainees and 76 per cent (79 out of 104) for foundation doctors. There was a significantly higher proportion of type A personalities in the ENT specialty trainees compared to the foundation doctors (18 out of 26 ENT specialty trainees vs 32 out of 79 foundation doctors; p = 0.01, chi-square = 6.4708). There were no associations between personality type and grade, gender or subspecialty of interest.Conclusion:ENT surgeons are more likely to be of type A personality in comparison to foundation doctors. This could be a reflection of the recruitment process into the specialty or a characteristic of individuals that get drawn to ENT.

Objective:Surgeons are exposed to a variety of occupational risks, including work-related musculoskeletal disorders. This study investigated the prevalence of these latter disorders amongst UK ENT surgeons and compared this with the existing literature.Methods:A survey containing questions on work-related musculoskeletal disorders was distributed to the entire membership of ENT-UK electronically, with the assistance of its Survey Guardian. A literature review on the subject was then performed.Results:A total of 323 completed questionnaires were received (a 24 per cent response rate). Work-related musculoskeletal disorders had been experienced by 47.4 per cent of respondents. There were no statistical differences between the occurrence of work-related musculoskeletal disorders and: grade, length of time spent in the specialty or the subspecialty of respondents. Eighty-five per cent of affected surgeons sought treatment, with 22.9 per cent taking time off work and six surgeons retiring early. The literature review only identified five related studies.Conclusion:Despite the scarcity of studies, work-related musculoskeletal disorders are common amongst ENT surgeons in the UK. Such disparity highlights the need for more research and appropriate ergonomic intervention within the specialty.

Background:Sharps injuries are a common occupational hazard amongst surgeons. Limited work has been conducted on their effects within the ENT community.Methods:A literature review was performed and a survey on sharps injuries was distributed to the entire membership of ENT-UK electronically.Results:The literature review revealed 3 studies, with 2 of them performed more than 20 years ago. A total of 323 completed questionnaires were returned (24 per cent response rate). Of the respondents, 26.6 per cent reported having experienced sharps injuries. There was no statistical difference between the occurrence of sharps injuries and the grade, length of time spent in the specialty or subspecialty of respondents. Only 33.7 per cent of afflicted clinicians reported all their injuries as per local institutional policies. No seroconversions were reported.Conclusion:The study found poor evidence on sharps injuries amongst ENT surgeons, and low reporting rates that were comparable to other studies conducted in the UK. This highlights the need for further research and increasing awareness on sharps injuries regulations within the specialty.

Introduction A large number of patients present in Otolaryngology clinics with vague upper gastro intestinal symptoms, some potentially originating from the oesophagus. In the United Kingdom there is no consensus for investigation protocols. The concern is that diagnosis of early oesophageal malignancy can be delayed with detrimental effects to the prognosis of the patient. The aim of this paper is to attempt to establish the impact of Ear Nose and Throat (ENT) work up in the diagnostic pathway of these patients. Methods Retrospective analysis of case notes of newly diagnosed oesophageal carcinoma over a 15 month period. Results Sixty five patients with a new diagnosis of oesophageal carcinoma were identified from the upper GI cancer network. A cohort of 7 patients was initially referred to ENT with related symptoms. Delays occurred at different stages during the course of their diagnostic pathways. Only 2 patients were diagnosed from ENT prior to referral to upper GI. Conclusion We support the creation of one stop clinics incorporating the use of transnasal oesophagoscopy. The current literature is discussed.

Nasal bone fractures represent the most common isolated facial fracture and are involved in as many as 50% of facial fractures (1). Its relative prominence in the centre of the face as well as its relatively thin, fragile structures makes it particularly susceptible to injury. Acute management is centred on restoring an aesthetically acceptable external nose with minimal airflow limitation. Conventional UK management typically involves assessment 5-7 days following injury, followed by closed reduction within two weeks, to avoid problems associated with fracture healing and bone remodelling (2). This article is protected by copyright. All rights reserved.

Objectives To assess current variation in the management of pinna haematoma (PH) and its effect on outcomes. Design Multicentre retrospective observational record-based study. Setting Eleven hospitals around the UK. Participants Eighty-three patients above the age of 16 with PH. Outcome Measures The primary outcome measure was recurrence rate of PH over a six-month period post treatment, assessed by treatment type (scalpel incision vs. needle aspiration). Secondary outcome measures assessed the impact of other factors on recurrence, infection and cosmetic complications of PH over a period of six months. Results After adjusting for confounding factors, involvement of the whole ear, and management within an operating theatre were associated with a lower rate of recurrence of pinna haematoma. The drainage technique, suspected aetiology, choice of post-drainage management, grade and specialty of practitioner performing drainage, the use of intra-auricular antibiotic injection and hospital admission did not affect the rate of haematoma recurrence, infection or cosmetic complications. Conclusions Where possible PH should be drained in an operating theatre. Multi-centre randomized-controlled trials are required to further investigate the impact of drainage technique and post drainage management on outcome. This article is protected by copyright. All rights reserved.

Occupational-related hazards (OH) are noted to be prevalent within the medical community. However, there is limited evidence of its effects amongst ENT surgeons. A national survey was carried out with the assistance of ENT-UK to investigate the prevalence of various OH amongst ENT doctors in the UK. A literature search was also conducted to search for articles within English literature worldwide on this subject. 70.6 % of the responding 323 ENT surgeons had reported a form of OH throughout their career. Musculoskeletal pain was the most commonly reported (47.4 %) followed by stress/psychiatric morbidities (38.4 %) and sharps injuries (26.6 %). We found no correlation between OH and consultants/non-consultant status, time spent in ENT and subspecialty. Our literature search revealed 16 articles pertaining to OH amongst ENT doctors. OHs are prevalent within the UK ENT community. There is good evidence within literature on musculoskeletal pain, however, higher level studies are required to thoroughly investigate the other hazards.

Objective:This paper reports a rare case of cerebrospinal fluid leak due to a Hyrtl's fissure and discusses the non-operative management of the case.Background and case report:Cerebrospinal fluid otorrhoea is a rare phenomenon arising from an abnormal communicating tract between the subarachnoid space and middle ear. Affected patients are at a higher risk of developing meningitis and other neuro-otological complications. There are four common congenital causes of cerebrospinal fluid otorrhoea in the region of a normal labyrinth. This paper describes a case of cerebrospinal fluid in the middle ear resulting from a Hyrtl's fissure, which resolved spontaneously.Conclusion:A literature search indicated this to be the first case with such a resolution without the need for any intervention.

ENT presentations are common both in primary care and accident and emergency departments. Unfortunately, many clinicians are not comfortable handling ENT emergencies due to a lack of knowledge and skill stemming from an undergraduate level onwards. An ‘Introduction to ENT’ course has been cited as an answer to bridge the gap in knowledge and promote confidence in doctors. A pre- and post-course analysis was performed on 29 participants attending an ‘Introduction to ENT’ course using a standardised questionnaire. Five were excluded from our analysis. Of the remaining 24, there was a lack of significant changes on the amount of ENT knowledge gained (pre-course mean score 2.71 vs post-course mean 4.63, p = 0), confidence in dealing with ENT emergencies (pre-course mean score 2.54 vs post-course mean score 4.58, p = 0) and confidence performing ENT procedures (pre-course mean score 2.375 vs post-course mean score 4.46, p = 0). We feel that the course alone is insufficient in providing a basic and safe emergency ENT service. We suggest a period of shadowing be introduced in addition to the compulsory induction programme for junior doctors rotating through ENT.

Background:Endoscopic hypopharyngeal diverticulotomy is now largely performed using an endoscopic stapling device. A poorly applied endoscopic stapling device can result in incomplete division of the cricopharyngeal bar, necessitating the application of a second set of staples. Applying more than one set of staples is associated with an increased risk of complications and greater cost. Small pharyngeal pouches are difficult to staple because of difficulties engaging the stapling device over the cricopharyngeal bar.Method:Two pairs of oesophageal forceps are used in conjunction with a 0 degree Hopkins rod to optimise the endoscopic stapling of small and large pharyngeal pouches.Results and conclusion:Applying grasping forceps to the cricopharyngeal bar improves the accuracy of the stapling procedure, thus reducing the morbidity and cost associated with multiple staple applications.