Otorhinolaryngology.

Abstract

As in all other specialties, changes in the organisation of the NHS and the purchaser-provider split have had effects on the practice of otorhinolaryngology. The most extensive change in practice over the past 12 months has not been the widespread adoption of a radical new diagnostic technique or surgical procedure but the increasing introduction of day case surgery. Procedures such as grommet insertion and reduction of fractured noses have long been performed as day cases, but many departments are now carrying out adenoidectomy, tonsillectomy, all types of nasal surgery, and even major ear surgery on a day case basis.1 This has necessitated changes in working practices and philosophy as well as an appraisal of the safety of such a move to day case surgery. The specialty is also being changed, however, not just by financial considerations and pressures from purchasers but by technical advances in fields as diverse as molecular biology, optical fibres, computers, microelectronics, and metallurgy. The complex and variable anatomy of the middle and inner ear, and the disastrous consequences of operative errors, means that the otorhinolaryngologist in training must spend much time operating on cadaver temporal bones before even starting to deal with patients. Computers running virtual reality programs are becoming increasingly sophisticated and widespread,2 and a virtual cadaver system is already available for training medical students and junior surgeons. A virtual temporal bone model is currently under development and will allow the complex three dimensional anatomy of the temporal bone and the relation between the middle ear ossicles, cochlea, vestibular labyrinth, and the facial nerve to be better understood and appreciated. The advantages of such a system are that the anatomy can be viewed from any angle and not just from those possible by operation or temporal bone dissection. It is possible, for example, …