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James Arwyn-Jones,1,* Sanjana Bhalla,1,* Vikas Acharya,1 Issa Beegun,2 Zaid Awad,1 Neil Tolley1 1Otolaryngology Department, Imperial College Healthcare NHS Trust, The Bays, London W2 1NY, UK; 2Otolaryngology Department, Barts Health NHS Trust, Trust Headquarters, The Royal London Hospital, London, E1 2ES, UK*These authors contributed equally to this workCorrespondence: James Arwyn-JonesUndergraduate Education Office, Reynolds Building, Imperial College London, Charing Cross Campus, St Dunstan’s Road, London W6 8RP, UKTel +442033115811Email james.jones12@nhs.netObjective: We hypothesize that poor consideration of specialist surgery is due to a lack of exposure to information about careers and practice itself. Ear, Nose, and Throat (ENT) surgery is given little weight in medical school curricula, despite ENT problems being extremely common. Our objective is to assess whether a specialty showcase day was sufficient to boost informed consideration of this career.Design: We designed a half-day course involving an interactive careers workshop exploring ENT as a specialty choice, alongside simulation stations of commonly presenting ENT problems led by ENT doctors. We used pre- and post-course evaluation sheets to explore factors that encourage and discourage students from surgical careers and perceptions of ENT.Setting: A large proportion of UK medical schools do not offer ENT placements, and of those that do, nearly half are not compulsory. This leaves students unaware of ENT as a career option and unclear about what an ENT career comprises. Our half-day course took place in the simulation suite at St Mary’s Hospital, London.Participants: Medical students were mainly in their third year of study and had aspirations towards a variety of surgical and non-surgical careers, with a minority aspiring towards ENT before the course.Results: Our results demonstrate that all students found the session useful and had a much better understanding of ENT practice, with almost all students leaving more likely to consider a career in ENT.Conclusion: We would like to repeat this session in different student year groups and compare their perceptions with our results. We find our results a good case for including informative careers workshops as part of medical school teaching. We pose that interactive workshops exploring specialist surgical careers are a valid way to enable students in making informed career decisions – particularly in specialties that are under-represented at medical school.Keywords: undergraduate education, careers, specialist surgery, otorhinolaryngology, simulation

A study published in the Bulletin of The Royal College of Surgeons of England has developed a simulation model for training healthcare professionals in managing post-thyroidectomy hematoma, a potentially life-threatening complication. The homemade simulation model, which involves an actor and an assistant, demonstrated good face validity and content validity. Participants agreed that the model taught transferable skills and should be included in training programs. This is the first simulation model of its kind to undergo formal validity testing, and further studies are recommended to enhance its utility. [Extracted from the article]

Objective: To ascertain whether simulation-based teaching is superior to lecture-based teaching for an induction programme using a home-made induction model. Methods: A simulation-based induction programme was designed and separate lecture-based teaching covering the same content was organised for junior doctors. The junior doctors were asked to complete pre- and post-induction surveys regarding confidence and anxiety levels. The skills taught included microsuction, flexible nasendoscopy, and anterior and posterior nasal packing. Structured interviews were conducted after the programme to gain qualitative data for analysis. The trainees' knowledge retention was compared using a standardised written assessment one month after the session. Results: Simulation-based teaching using the induction model was associated with a statistically significant increase in confidence levels and reduction in anxiety levels, and was associated with greater knowledge retention. Conclusion: A regular simulation induction programme should be introduced using the induction model, as it leads to better knowledge retention and increased confidence levels. [ABSTRACT FROM AUTHOR]

The mechanisms that lead to disease onset and propagation in patients with chronic rhinosinusitis (CRS) are not fully elucidated. Maresins (MaR) are a family of essential fatty acid-derived lipid mediators that play a central role in the regulation of inflammation with several studies demonstrating that these mediators display protective activities in airway inflammation. Therefore, in the present studies we evaluated whether concentrations of these mediators were altered in both peripheral blood and nasal secretions from CRS patients. Herein, we focused on patients with CRS that also develop nasal polyps (CRSwNP), given that therapeutic options for the treatment of these patients are limited. Thereby, insights into disease mechanisms in these patients may help design more effective treatments. For this purpose, we compared maresin concentrations from CRSwNP patients with those found in healthy volunteers or patients with an upper respiratory tract infection (URTI), as a self-resolving inflammatory condition. Using liquid chromatography tandem mass spectrometry, we found that MaR concentrations were significantly decreased in plasma from patients with CRSwNP when compared to healthy volunteers. MaR concentrations were observed to be significantly upregulated in nasal secretions from patients with CRSwNP when compared with both healthy volunteers and URTI subjects. Concentration of these mediators in both plasma and nasal secretions from CRSwNP patients were positively correlated with quality-of-life scores in these patients. Assessment of the concentrations of other pro-resolving and pro-inflammatory lipid mediators (LM) demonstrated that there was a general shift in LM levels in both plasma and nasal secretions from CRSwNP when compared with healthy volunteers and URTI subjects. Of note, incubation of peripheral blood cells from CRSwNP patients with MaR1 downregulated the expression of activation markers on peripheral blood phagocytes, including CD41 and CD62P, markers of platelet-leukocyte heterotypic aggregates. Together these findings demonstrate that both local and systemic LM concentrations, in particularly those of the MaR family, become altered in patients with CRSwNP. They also suggest that therapeutics designed around MaR1 may be useful in regulating the activation of phagocytes in patients with CRSwNP thereby potentially also limiting the local inflammatory response in these patients., Competing Interests: JD is Scientific founder and director of Resolomics Ltd and Inventor on several patents and patent applications assigned to Brigham and Women’s Hospital (Boston, MA) and Queen Mary University of London (London, UK) for the therapeutic and diagnostic use of specialized pro-resolving mediators. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Beegun, Koenis, Alusi and Dalli.)

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Objectives: To test a novel, low-cost, home-made model for needle aspiration of PTA.To ascertain whether simulation-based teaching using this model was superior to lecture-based teaching in increasing confidence and reducing anxiety relating to PTA aspiration.To assess whether there was an improvement in outcomes for PTA patients at one hospital following the delivery of a simulation-based training session using our model., Methods: We designed two teaching sessions for junior doctors starting work in ENT: a simulation-based teaching session using a low-cost home-made simulation model and a lecture-based teaching session covering the same content. We asked the participants to complete pre- and post-session surveys regarding confidence and anxiety levels and analyzed this data. We also retrospectively collected data over 3 months for patients referred to ENT with suspected PTA and assessed their outcomes. We assessed patient outcomes before and after the delivery of a simulation-based training course using our model., Results: Simulation-based teaching using our model was shown to be associated with a statistically significant increase in junior doctors' confidence levels. Reaccumulation and reattendance rates for PTA following aspiration were 16.67% and 22.7% respectively preintervention and 0% and 7.14% respectively postintervention., Conclusion: A regular simulation-based teaching session should be introduced using a PTA aspiration model for junior doctors as it leads to increased confidence levels, and reduced reaccumulation and recurrence rates of PTA., Level of Evidence: Level 4., Competing Interests: This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors. We have no conflicts of interest to report., (© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society.)

Objectives: To demonstrate face and content validity of a home-made simulation model as a training tool for front of neck access (FONA) procedures., Design: This was a prospective evaluation study, in which experienced otolaryngologists and trainees were recruited to complete 3 tasks using our FONA model., Setting: The study was completed during regular simulation training days and international conferences., Participants: A total of 52 participants completed the questionnaire and were included in the study; 25 were experts and 27 were trainees., Main Outcome Measures: All participants completed a validated 15-item questionnaire using a 5-point likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task-specific content (TSC) and curriculum applicability (CTR)., Results: There were no statistically significant differences between the groups ratings for FV, GC, TSC or CTR (P = .76, .13, .4 and .67, respectively). The model achieved a median FV of 4 (IQR 4-5) with the agreement of experienced and trainee groups (68.9% and 92%, respectively). The median GC validity score was 5 (IQR 4-5) with the agreement of 87.6% and 98.4% in respected groups. The model achieved a median TSC of 4.8 (IQR 4-5) with the agreement of 54.5% and 99% in respected groups. The median CTR score was 5 (IQR 4-5) with the agreement of 54.4% and 100% in respected groups., Conclusion: Our home-made FONA model achieved face and content validity for training and is safe and affordable for teaching basic front of neck access skills to otolaryngology trainees., (© 2020 John Wiley & Sons Ltd.)

In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is to measure the outcomes after surgery. Rhinoplasty is a unique operation because the surgeon affects three aspects: shape, function, and psychology of the patient. In an ideal world, the surgeon should have objective means of screening that cover these three aspects before and after surgery to measure outcomes. The goal of this article is to review these tools and compare them., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

A 72-year-old man presented with epistaxis on two occasions requiring admission. Prior to performing a bilateral sphenopalatine artery ligation diathermy, anaesthetic concern was raised regarding what the patient described as a 'congenital aortic aneurysm', with an overlying scar secondary to explorative surgery as a child. The abnormality was a cervical aortic arch (CAA). CAA is a rare vascular anomaly, which most commonly manifests as a pulsatile neck mass. In this case, we discuss the differential diagnosis for a pulsatile neck mass and considerations to be made in the workup. We also highlight the importance of cardiovascular risk factor management in patients with CAA., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To systematically review the literature to assess the efficacy of corticosteroids in treating post-parotidectomy facial nerve palsy (FNP)., Methods: We searched the Cochrane library, EMBASE and MEDLINE (from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies., Results: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP post-parotidectomy is transient. Preoperative factors (size of tumour and malignancy), intraoperative factors (extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur., Conclusion: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term follow-up are required to increase scientific evidence.

A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18 h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3 h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording >200 mm Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2 weeks post-tonsillectomy., (2014 BMJ Publishing Group Ltd.)

Objective: We report a case of malignant peripheral nerve sheath tumour seen in our department., Method: We present case reports and a review of the world literature concerning malignant peripheral nerve sheath tumour., Results: A 38-year-old Caucasian woman was diagnosed with malignant peripheral nerve sheath tumour of the infraorbital nerve. She underwent a wide enbloc resection followed by a course of radiotherapy. A five-year post-operative magnetic resonance imaging scan revealed no evidence of recurrence., Conclusion: Malignant peripheral nerve sheath tumours are rare in the head and neck. An awareness of their occurrence is important for early diagnosis. Management involves: accurate histological diagnosis; radiological imaging to define tumour extent and plan resection; wide surgical excision with histologically negative margins; reconstruction of the tissue defect; and post-operative radiotherapy.