Ear, Nose And Throat Surgeons Research Articles

Proximie in the operating theatre: evaluation of a virtual operating platform for medical student education.

Medical students often hesitate to enter the operating theatre because of poor visibility of the surgical field and anxiety about the theatre environment. In addition, ear, nose and throat (ENT) surgery is underrepresented in many medical curricula. Virtual systems like Proximie offer flexible viewing of surgeries with surgeon commentary, potentially addressing these issues. This descriptive survey study aimed to evaluate the use of Proximie as a surgical education tool for delivering ENT teaching to medical students. Live ENT procedures were recorded at the ENT Department of the John Radcliffe Hospital and shared with interested clinical medical students through Proximie accounts. Students were added to a private group chat to ask questions and provided feedback through structured forms, assessing procedural effectiveness and the platform's technology. Live-streaming and recording of procedures were facilitated by ENT surgeons providing commentary. Conducted over four virtual theatre days, the study gathered 52 responses: 96% of students rated Proximie's educational value as 4 of 5 or higher; 57% preferred the virtual experience over physical attendance because of its convenience and the improved view of the surgical field. Students valued the live commentary and showed interest in using Proximie for a broader range of surgeries. Suggested improvements included fixing technical issues, better communication of theatre lists, and expanding surgical specialty coverage. Proximie has been highly rated by medical students for its effective and engaging approach in the instruction of surgical skills, underscoring its value as an educational tool. Future research is needed to formally assess knowledge acquisition and retention across multiple surgical subspecialties. This work is the first step towards evaluating the utility of virtual operating theatre platforms for medical student education.

Voice Handicap Index: Cut-Off Points for Screening European Portuguese With Voice Disorders

To determine cut-off values of the Voice Handicap Index (VHI) and the shortened version (VHI-10) for European Portuguese (EP) with voice disorders. In addition, to analyze the discriminatory power of individual items of the VHI-10 and the ability to detect differences in various Ear Nose and Throat (ENT) diagnoses. Cross-sectional cohort study. All participants completed the EP VHI and a 4-point self-assessment of voice disorder severity. The case group (subjects with voice disorders) underwent assessment through strobovideolaryngoscopy examinations by ENT surgeons and perceptual analyses by speech-language pathologists (SLPs). In contrast, the control group was evaluated solely by SLPs. Data were analyzed using a receiver-operating characteristic curve to determine the accuracy and cut-off values of the VHI and VHI-10. The study involved a sample of 350 adults (171 cases and 179 controls), predominantly women aged 18-88years. The area under curve (AUC) for VHI and VHI-10 was 0.997 [95% confidence interval (CI): 0.992-1] and 0.998 [95% CI: 0.995-0.999], respectively. Optimal cut-off values were identified as 13.5 for VHI (0.994 sensitivity and 0.989 specificity) and 5.5 for VHI-10 (0.977 sensitivity and 0.955 specificity). Each individual item within the VHI-10 significantly contributed to the overall assessment, exhibiting varying discriminatory power ranging from excellent (AUC=0.937) to poor (AUC=0.637). Significant differences were found in the case group between neurogenic disorders and healthy larynx (P=0.014), structural and physiologic minor laryngeal abnormalities (P=0.006), and inflammatory disorders (P=0.043). The VHI and the VHI-10 exhibited accurate screening properties for predicting EP speakers with voice disorders.

DS27 Establishing clinician and patient perspectives on a proposed trial investigating antibiotics in skin surgery

Abstract Surgical site infection (SSI) following excision of ulcerated skin cancers is a well-recognized complication; however, the exact risk is unknown and there is no consensus on antibiotic prescribing in this setting. The EXCISE trial (EXamining antibiotics for ulCerated skIn cancer Surgical Excision) aims to address this evidence gap. An online survey was distributed to the UK Dermatology Clinical Trials Network (UKDCTN), British Society for Dermatological Surgery and plastic surgery, ear, nose and throat (ENT) and maxillofacial surgery networks (December 2022). The survey aimed to establish clinicians’ views about the proposed EXCISE trial. A focus group with patient representatives with lived experience of skin cancer surgery was also conducted (n = 5). Ninety questionnaire responses were received: six plastic surgeons (7%), 19 oral and maxillofacial surgeons (21%), four ENT surgeons (4%) and 61 dermatologists (68%). Sixty-five per cent of responders were consultants, and 34% were registrars. Seventy-one (79%) were willing to recruit to the EXCISE trial. Forty-eight (53%) agreed to randomize patients to 0 (no antibiotics), 1, 2, 3, 5 or 7 days of postoperative flucloxacillin. Thirty-seven (41%) agreed a 6–10% absolute increase in risk of SSI would justify a shorter course of antibiotics (1–3 days) with fewer side-effects. Thirty-three (37%) felt a 0–5% absolute risk increase would be acceptable, 17 (19%) felt an absolute risk increase of 11% or greater was acceptable, and three (3%) did not respond. Eighty-one (90%) agreed that if the EXCISE trial demonstrated a reduction in SSI, they would prescribe antibiotics, 61 (68%) would prescribe longer courses (5–7 days) and 17 (19%) would prescribe shorter courses (1–3 days). Patients reported a preference for shorter antibiotic courses (1–3 days) vs. longer (5–7 days) if there were fewer side-effects and no increased risk of infection. All patients agreed, in principle, to randomization to the proposed groups and highlighted the need to recruit from diverse socioeconomic backgrounds. They also suggested highlighting zero days of postoperative antibiotics often reflects usual practice to encourage participation. All participants agreed with the proposed 10% noninferiority margin. In summary, our data demonstrate acceptability of the proposed EXCISE trial among both clinicians and patients. An absolute noninferiority margin of 10% between SSIs occurring in the context of longer courses of antibiotics vs. shorter courses of antibiotics is acceptable to patients when associated with fewer side-effects. Clinicians showed mixed responses, suggesting that further work is required to explore the barriers and facilitators to prescribing and for future implementation. Acknowledgments: The study was developed with support from the UK Dermatology Clinical Trials Network (UK DCTN). The UKDCTN is grateful to the British Association of Dermatologists and the University of Nottingham for financial support of the network.

An appropriate verbal probability lexicon for communicating surgical risks is unlikely to exist.

Effective risk communication about medical procedures is critical to ethical shared decision-making. Here, we explore the potential for development of an evidence-based lexicon for verbal communication of surgical risk. We found that Ear, Nose and Throat (ENT) surgeons expressed a preference for communicating such risks using verbal probability expressions (VPEs; e.g., "high risk"). However, there was considerable heterogeneity in the expressions they reported using (Study 1). Study 2 compared ENT surgeons' and laypeople's (i.e., potential patients) interpretations of the ten most frequent VPEs listed in Study 1. While both groups displayed considerable variability in interpretations, lay participants demonstrated more, as well as providing systematically higher interpretations than those of surgeons. Study 3 found that lay participants were typically unable to provide unique VPEs to differentiate between the ranges of (low) probabilities required. Taken together, these results add to arguments that reliance on VPEs for surgical risk communication is ill-advised. Not only are there systematic interpretational differences between surgeons and potential patients, but the coarse granularity of VPEs raises severe challenges for developing an appropriate evidence-based lexicon for surgical risk communication. We caution against the use of VPEs in any risk context characterized by low, but very different, probabilities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Precision Medicine in Adult Obstructive Sleep Apnea and Home Diagnostic Testing: Caution in Interpretation of Home Studies Without Clinician Input Is Necessary

PurposeTo assess the validity of home sleep apnea test directed diagnosis and treatment of obstructive sleep apnea (OSA) in a real-life clinical setting and establish the extent to which clinical evaluation alters diagnosis and therapeutic intervention, in the context of the evolving realm of precision medicine.MethodsRetrospective consecutive cohort study of 505 patients referred to a single center between 15th September 2015 to 14th September 2016, multidisciplinary specialist sleep clinic presenting with a home sleep apnea test prior to referral. We evaluated the effect of sleep medicine practitioner (SMP) and ear, nose, and throat surgeon (ENTS) review on patient diagnoses, disease severity, and management options in OSA.ResultsHundred and fifteen patients were included. Repeat evaluation with in-lab polysomnogram (PSG) was required in 46/115 (40.0%) of patients, of which 20/46 (43.5%) had OSA severity changed. Sleep medicine practitioner review decreased the need for repeat testing with formal in-lab PSG (p < 0.05) and increased patient acceptance of continuous positive airway pressure (CPAP) as a long-term management option for OSA. Sleep medicine practitioner/ENTS review resulted in discovery of a non-OSA related sleep disorder or change in OSA severity in 47.8% (55/115). Ear, nose, and throat surgeon review resulted in additional or changed diagnosis in 75.7% (87/115) of patients.ConclusionIn the clinical assessment and diagnosis of OSA, patients should be reviewed by medical practitioners with an interest in sleep disorders to better navigate the complexities of assessment, as well as the identification of co-morbid conditions.

Etiology, Clinical Profile, Evaluation, and Management of Stridor in Children.

ObjectiveTo evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.MethodsRetrospective study of 67 stridor cases in pediatric age group (from birth to 18 y), admitted to the Department of Pediatrics and ENT (Ear, Nose and Throat) from May 2018 to April 2020 were included in the study. Data were obtained from medical records regarding age, gender, clinical presentation, and management.ResultsOut of 67 cases of pediatric stridor, 28.3% were infants, 50.7% were between 1 to 5 y, while 20.9% were between 5 to 18 y. Foreign body trachea (FB) was the most common (38.8%) cause of stridor. The commonest cause of stridor among infants was laryngomalacia (47.4%) while FB trachea (55.9%) was the commonest cause among 1 to 5 y age group. In age group between 5 to 18 y, peritonsillar abscess and bacterial tracheitis (21.4% each) were found to be the most common. Primary management with securing of airways were done in all cases. Curative treatment was provided according to the underlying pathology. Eight patients (11.9%) required tracheostomy to bypass airway obstruction. There was no mortality in the present study population.ConclusionPediatric stridor management is a teamwork between ENT surgeons, pediatricians, and anaesthetists. Management starts with suspicion from history followed by clinical and radiological evaluation. Securing airway is of utmost importance and precise management of cause is carried out later.

The psychological impact of COVID-19 on ear, nose and throat (ENT) specialists.

IntroductionEar, nose and throat (ENT) specialists are a high-risk group for COVID-19. Although the implications of SARS-CoV-2 infection on physical health are well-documented, the psychological impact is frequently overlooked.AimsThe aim of this study was to gauge the psychological impact of COVID-19 on ENT specialists in Ireland.MethodsA national, cross-sectional, web-based survey was distributed to ENT specialists during the peak of the COVID-19 pandemic (21st May 2020–21st June 2020). The questionnaire collected sociodemographic and COVID-19 related data. The GAD-7 was utilized to measure symptoms of clinically significant anxiety disorder.ResultsThirty-eight ENT specialists (M/F:24/12, median age, 38.7 years (23–60 years)) completed the survey. About 34% (n = 13) of participants screened positive for an anxiety disorder, of which 2 (5%) had moderate symptoms. The majority of participants (n = 32, 84%) felt ENT specialists had increased exposure to SARS-CoV-2 compared with other medical specialties. Additionally, 32% (n = 12) felt incapable of protecting themselves from infection. An encouraging proportion of ENT specialists (n = 22, 58%) were aware of psychological support available from national and institutional organizations.ConclusionsThe long-term psychological sequelae of COVID-19 will be felt as the physical burden eases. As we adjust to new normalities, ENT surgeons must be conscientious of the mental health issues that arise from the working environment. Sources of anxiety emanated from a lack of control over infection risk, increased vulnerability to COVID-19 relative to other specialties and the implications this has for ENT specialists and their families. Future interventions must focus on increasing awareness of the available psychological support services for our healthcare workers.

Oropharyngeal Bleeding Due to Cannabidiol Oil Vape Use

Vaping has become an increasingly popular alternative to smoking in recent years. We present a rare and unusual case of upper airway bleeding caused by inhalation of a cannabidiol (CBD) oil-based vape due to a chemical burn. There are no case reports of this injury in the literature, and we discuss the clinical presentation, diagnosis and our management of this potentially life-threatening injury.A 27-year-old man presented to the accident and emergency department after using a CBD oil vape. After one inhalation of the CBD oil vape, the patient experienced immediate onset pain in the oropharynx, dyspnoea, expectoration of blood and hoarseness. The patient had used a CBD oil vape four hours earlier that evening for the first time, which was procured from an unregulated online source.The patient was referred to the Ear, Nose and Throat (ENT) team where the examination of oropharynx identified a posterior pharyngeal bleeding point. Flexible nasal endoscopy was undertaken showing profound erythema and inflammation throughout the oropharynx and posterior pharyngeal wall. The mucous membranes had been detached leaving an exposed bleeding submucosa.The patient was commenced on three cycles of back-to-back adrenaline nebulisers (1:1000 adrenaline in 5ml of 0.9% NaCl), 6.6mg dexamethasone intravenously and hydrogen peroxide gargles (5ml of 3% hydrogen peroxide in 10ml of water) three times a day. There were early involvement and review of the airway by the anaesthetic and intensive care teams, which was deemed safe at the time. A plan was made for a definitive airway if bleeding reoccurred.Upper airway bleeding can present as a rare form of vape-induced injury and should be considered part of the differential diagnosis particularly in those using CBD oil vapes. History taking is pertinent and patients should be questioned on the specific vape liquids used. Airway stabilisation is the priority with early involvement of the multi-disciplinary team including anaesthetists, intensive care specialists and ENT surgeons.

How COVID-19 Changed Our Management of Nasal Bone Fractures and Its Impact on Patient Outcomes-A Retrospective Study.

Nasal bone fractures are a common presentation to the Ear, Nose and Throat (ENT) surgeon. Simple, closed fractures are assessed and considered for closed manipulation under anesthesia (MUA #nasal bones). Most departments perform this under general anesthesia (GA). Our protocol changed in the face of COVID-19, where procedures were alternatively performed under local anesthesia (LA) in the clinic, to cope with lack of elective theater capacity during the pandemic, while still allowing a nasal fracture service to take place. We present postoperative patient outcomes on breathing and shape, comparing GA versus LA. Patient records retrospectively analyzed (January 2020-August 2020), and patients undergoing MUA #nasal bones interviewed by telephone after one month. Exclusion criteria were open injuries or depressed nasal bones requiring elevation. Breathing and shape scores were evaluated subjectively using a Likert scale (1 = very unsatisfied, 5 = very satisfied). Two hundred five nasal injury referrals were made (21 MUA #nasal bones under GA and 27 under LA). Manipulation under anesthesia #nasal bones significantly improved both breathing satisfaction scores (GA; 2.88 ± 0.24 to 4.06 ± 0.23, P < 0.05; LA; 2.86 ± 0.22 to 3.77 ± 0.27, P < 0.05) and aesthetic scores (GA; 2.00 ± 0.21 to 3.94 ± 0.23, P < 0.05; LA; 1.64 ± 0.19 to 3.59 ± 0.28, P < 0.05) in both GA and LA groups. There was no statistically significant difference between LA and GA in postoperative outcomes. There was a trend toward greater satisfaction for GA, though this was not statistically significant and may be impacted by the rate of cartilaginous deformity in the LA group. Both techniques were well tolerated and most patients would repeat the procedure in hindsight. Local anesthesia could provide a safer, cheaper, and satisfactory alternative for performing MUA #nasal bones in the clinic for selected patients, particularly with reduction of elective theater capacity in the event of further COVID-19 surges. We recommend training junior ENT surgeons to perform this procedure under supervision with adequate protective measures.

Editorial note and Conference Highlights of Journal of Otology & Rhinology

Editorial note and Conference Highlights of Journal of Otology & Rhinology

Australian contribution to global otolaryngology research: 2008-2018.

Obtaining research funding in Otolaryngology - Head and Neck Surgery (ORL-HNS) can be challenging. In this paper, an analysis of research output in ORL-HNS in Australia and worldwide between 2008 and 2018 was conducted and then adjusted for the number of specialist surgeons in each country. Scopus by Elsevier was used to measure research output of Ear, Nose and Throat (ENT) surgeons in Australia between 2008 and 2018. Each individual's career and 10-year h-index was identified and then repeated with self-citations excluded. Total and 10-year citations were also recorded. The top 15 countries in terms of research output in ORL-HNS were also ranked based on the number of ENT articles published in the 10-year period, and then adjusted by the number of actively practicing ENT surgeons per country. Between 2008 and 2018, Australia published 1510 articles out of a total global output of 48 613 papers in ORL-HNS with the top 10 authors having an h-index placing them within the world's top 100. Whilst the USA made the greatest total contribution with 12 912 publications, when adjusted for the number of specialist ORL-HNS clinicians in each country, Australia, Canada and India in order topped the rankings. Australia has established itself as a research leader in the global field of ORL-HNS, publishing more articles per surgeon than any other country between 2008 and 2018. The Australian ORL-HNS Academic Surgeons also rank highly on an individual basis when compared to global peers.

THYROID ULTRASOUND PERFORMED FIRST HAND BY THE ENT SURGEON

The next level in thyroid disease management is the use of first hand surgeon performed sonography. Given the fact that many of the cases with thyroid carcinoma are referred to Ear Nose and Throat (ENT) departments, this diagnostic imaging modality should be available on site. We present a case series with thyroid pathology that benefited from sonography performed first hand by the ENT surgeon in a tertiary teaching hospital. Thyroid pathology is varied from benign cysts to papillary and medullar carcinomas. Further data are necessary for establishing the learning curve for this exam used by ENT surgeons. The foreseeable advantages are faster protocol in oncology cases, cost efficiency and wide scale availability of thyroid ultrasonography.

Tracheal Surgery

Surgery of the trachea is a specialised field in which many disciplines work jointly due to the variety of indications and the extended topography. Not only because of its particular functional importance, but also because of its complex morphology, anatomy and physiology, this organ represents a special therapeutic challenge. A variety of diseases require surgical procedures of the trachea; the therapeutic strategy is influenced both by the disease itself as well as patient-dependent parameters. Regardless of the nature of the underlying disorder, good results require a high level of expertise in airway management, a careful diagnosis and interventional planning as well as an experienced surgical team that masters extended operative techniques. An optimal treatment decision always requires a multidisciplinary assessment of the patient's individual situation by interventional pulmonologists, thoracic surgeons, visceral surgeons, ENT (ear, nose and throat) surgeons and anaesthesiologists.

Africa\u2019s challenged ENT services: highlighting challenges in Zambia

BackgroundDiseases of the ear, nose and throat (ENT) are common and are a major cause of morbidity and mortality. In many low income countries like Zambia, the high ENT disease burden has not received the required resources for treatment. We investigated ENT service provision in hospitals in Zambia by documenting the profile of hospitals offering ENT services and examining the country’s ENT services with regards to human resource, infrastructure and availability of equipment based on the levels of care of various hospitals.MethodsThe study was a cross-sectional descriptive survey conducted using a structured and piloted questionnaire which was administered to the 109 Ministry of Health (MoH) registered hospitals across the country. Ethical clearance was granted by University of KwaZulu-Natal and the Zambia National Health Research Authority. Participation in the study was voluntary and all respondents signed informed consent. Descriptive statistics were used to analyse the data.ResultsOf the 109 hospitals approached to participate in the study, 61 (55.9%) hospitals responded. This represented 83.3% (n = 5) of Third Level Hospitals (TLH), 89.5% (n = 17) of Second Level Hospitals (SLH) and 41.7% (n = 35) of First Level Hospitals (FLH) countrywide. Of the participating hospitals, 6.6% (n = 4) were unclassified. Within this sample, 8.6% (n = 3) FLH, 11.8% (n = 2) SLH and 60.0% (n = 3) TLH had an ENT examination room. Only 2.9% (n = 4) hospitals had an audiology booth and 1.6% (n = 1) had a speech therapy room. Of the second and third level hospitals, 9.1% (n = 2) had flexible rhinolaryngoscopes, 18.2% (n = 4) had operating microscopes and 68.2% (n = 15) adenotonsillectomy sets. The data revealed that there were 4 ENT surgeons, 1 Audiologist and no Speech Therapists across the country.ConclusionZambia’s ENT services were deficient at all levels of hospital care. There were deficiencies in infrastructure, human resource and equipment in hospitals. With the current burden of disease, critical intervention is required. These findings should be used to direct national policy on the improvement of ENT service provision in Zambia.

The O.P.E.N. Survey: outreach projects in Ear, Nose and Throat (ENT) in New South Wales

Background: This study aims to map the coverage of Ear, Nose and Throat (ENT) outreach clinics in New South Wales (NSW) over a 5-year period [2012–2016]. It also aims to determine the extent of engagement in outreach work among NSW and ACT-based ENT surgeons over this period. Methods: Online and telephone survey of ENT surgeons practising in NSW and ACT conducted between December 2016 and May 2017. The survey was designed to identify the location, frequency and the number of ENT surgeons providing outreach services in NSW. A secondary outcome of the survey was the current and future rates of participation in outreach projects by NSW and ACT-based ENT surgeons. Results: Eighteen surgeons provided at least one ENT outreach service in NSW between 2012 and 2016. The average yearly commitment was 5.5 days (SD 4.2 days). Eighteen distinct towns in NSW received an outreach service. In the majority of cases, a visiting surgeon provided outreach services to the same town for at least three consecutive years. Surgeons who obtained their Fellowship of the Royal Australasian College of Surgeons (FRACS) after 2005 had the highest interest in future participation. Conclusions: Approximately 1 in 5 NSW and ACT-based ENT surgeons perform outreach activities. The data suggests that many remote and rural towns within NSW are not receiving outreach services. Better coordination of services and a commitment to regular and well-constructed outreach programs could redress this imbalance. The expressed intention to become involved in future outreach programs, particularly among the younger surgeons, needs to be encouraged and supported for this to be realised.

Personal otolaryngology–head-and-neck wet lab

Objectives: To have professional surgical instrumentational skills in a low-cost, readily available, personal wet lab, instead of having it on a real patient in the operation theatre or in the costly cadaveric workshops. This study was conducted to assess the feasibility of sheep's head as a valid ear, nose and throat (ENT) surgical training model and to establish a small yet comprehensive ENT wet laboratory. Methods: Sheep's heads, already checked by the veterinarian and safe to use, were collected from the abattoir. However, neck surgery specimens were specifically requested from butchery with more neck tissue and intact skin. Surgical instruments were collected from medical exhibitions, online and the industrial market. With the help of cheap functional industrial instruments, a personal surgical laboratory was established. Ovine specimens were evaluated for human simulation. Moreover, the applicability of most ENT procedures and operations was assessed by a team of six ENT surgeons including three junior surgeons and three senior ENT surgical consultants. Results: Utilising simple basic surgical instruments, a wide variety of surgeries performed with very similar conditions to human operations. Endoscopic procedures include middle ear surgeries, laryngeal fissure, tracheal resection and laryngotracheal reconstruction. Open surgeries, facial nerve decompression, dissection and repair were also performed. Moreover, fibre-optic intubation, fibre-optic bronchoscopy and foreign-body extraction training were tried. Some structures are very similar to human ones; some show mild-to-moderate differences, whereas few structures are totally absent in the sheep head. The consistency of, skin, subcutaneous tissues and bone are remarkably similar to that seen in humans. Lamb's heads are good and accepted substitute models for cadaveric specimens. This personal laboratory could be (at a certain level) a good substitute solution to repeated cadaveric workshops. Personal wet laboratories low-cost training improves surgical skills and if followed by few human cadaveric workshops, could enable the surgeon to start human operations with lower complication rate and shorter intervention time. Conclusion: Province otolaryngologist must build up his own experience before practicing on humans. Using sheep tissues do not carry any risks for disease transmission and are ethically defensible. Structural fresh, ovine heads provide a readily available, anatomically compatible, affordable, model for training. It could hone dexterity, surgical skills and teamwork behaviour well before venturing into real patient training. Anatomical variations in sheep's head such as mastoid, paranasal sinuses and skull base are minimal and do not affect the applicability of most of the procedures.

Management of Maxillo Facial Fractures in a Cameroonian Tertiary Hospital

This is a descriptive study that was carried out at the accident and emergency, Dental, and Ear Nose and throat (ENT) units of the Douala General Hospital between April 2014 to September 2014 on patients with maxillofacial trauma referred to this tertiary hospital. Maxillofacial injuries were found among 7 (23%) female and 24 (77%) males in patients mostly of between 21-31 age groups most of whom are motorcycle bike riders 10(32.3%). All patients were first resuscitated at the emergency department and 22 (71%) of the patients were referred to the general surgery department. The lips (13) 41.9%, facial trauma 10 (32.3%), facial edema 28 (90.3%), bleeding 25 (80%), dental articulation disorders 23 (74.2%), para symphyseal fractures38 (51.6%) were the most clinical signs. Treatment took place between the 5th and 10th day after consultation with anti-inflammatory 15 (48.4%), 24 (77.4%) on mouth washes and more than half were prescribed antitetanus prophylaxis. The majority 25(81%) of patients were treated using open reduction 6(48%), closed reduction 20(65%), intermaxillary fixation 26(84%) and 4(13%) pterigo-zygomatic suspension for the management of maxillofacial fractures either by the dentist or the ENT surgeons.

Current practice in the surgical management of parathyroid disorders: a United Kingdom survey.

Surgery for primary hyperparathyroidism is undertaken by many specialties but predominantly endocrine and ear, nose and throat (ENT) surgeons. There is currently no consensus on the peri-operative management of primary hyperparathyroidism. We sought to determine current surgical practice and identify any inter-specialty variation in the United Kingdom (UK). An online survey was disseminated to members of the British Association of Endocrine & Thyroid Surgeons (BAETS) in the UK. 78 surgeons responded (40 Endocrine, 37 ENT and 1 maxillofacial). 90% of surgeons used ultrasound and sestamibi for pre-operative localisation. Intraoperative frozen section (31%) and parathyroid hormone monitoring (41%) were the most common adjuncts used intraoperatively. 68% of surgeons did not use any wound drains. Nearly two-thirds of surgeons (64%) discharged patients from the clinic within 3months, There were some significant differences (p < 0.05) in particular areas of practice between endocrine and ENT surgeons (%, p): use of single-photon emission computed tomography (SPECT) (Endocrine 25% vs. ENT 5%), preoperative laryngeal assessment (endocrine 58% vs. ENT 95%), intraoperative laryngeal nerve monitoring (endocrine 35% vs. ENT 68%), use of monopolar diathermy (endocrine 58% vs. ENT 22%), bipolar diathermy (endocrine 60% vs. 89%) and surgical ties (endocrine 48% vs. ENT 19%). Our study demonstrates some similarities as well as some notable differences in practice between endocrine and ENT surgeons, and therefore, highlights the need for national consensus with respect to some key areas in parathyroid surgery.

Rationale for and design of the "POSTA" study: Evaluation of neurocognitive outcomes after immediate adenotonsillectomy compared to watchful waiting in preschool children

BackgroundIQ deficits are linked to even mild obstructive sleep apnoea (OSA) in children. Although OSA is commonly first diagnosed in the pre-school age group, a randomised trial is still needed to assess IQ outcomes after adenotonsillectomy in the pre-school age-group. This randomised control trial (RCT) will primarily determine whether adenotonsillectomy improves IQ compared to no adenotonsillectomy after 12 months, in preschool (3–5 year-old) children with mild to moderate OSA.MethodsThis protocol is for an ongoing multi-centred RCT with a recruitment target of 210 subjects (105 in each arm). Children age 3–5 years with symptoms of OSA, are recruited through doctor referral, at the point of referral to the Ear Nose and Throat (ENT) services. Screening is initially with a questionnaire (Paediatric Sleep Questionnaire, PSQ) for symptoms of obstructive sleep apnoea (OSA). Where questionnaires are positive (suggestive of OSA) and ENT surgeons recommend them for adenotonsillectomy, they are invited to participate in POSTA. Baseline testing includes neurocognitive testing (IQ and psychometric evaluation with the neuropsychologist blinded to randomisation) and overnight polysomnography (PSG). Where the Obstructive Apnoea-Hypopnea Index (OAHI) from the PSG is <10/h per hour, consent for randomisation is sought; children with severe OSA (OAHI ≥ 10/h) are sent for immediate treatment and excluded from the study. After consent is obtained, participants are randomised to early surgery (within 2 months) or to surgery after a usual wait time of 12 months. Follow-up studies include repeat neurocognitive testing and PSG at 12 (with the waiting list group studied before their surgery) and 24 months after randomisation. Analysis will be by intention to treat. The primary outcome is IQ at 12 months’ follow-up.DiscussionIf IQ deficits associated with OSA are reversible 12 months after adenotonsillectomy compared to controls, future clinical practice advise would be to undertake early surgery in young children with OSA. The study could provide data on whether a window of opportunity exists for reversing IQ deficits linked to OSA in the pre-school age-group.Trial registrationAustralian and New Zealand Clinical Trials Registration Number ACTRN12611000021976.

Complication rates of thyroidectomy by an experienced, high-volume thyroid surgeon in a private hospital in Abu Dhabi, United Arab Emirates

Background: Thyroidectomy is one of the most common endocrine surgical procedures; it is performed by surgeons of various specialities including general surgeons, endocrine surgeons, ear, nose and throat (ENT) surgeons and head and neck surgeons. Thyroidectomy carries a significant and immediate risk of complications, some of which can be life threating. Improved surgical techniques and surgeons experienced in thyroid surgery can significantly reduce morbidity and mortality. Objective: The objective of this prospective study was to determine the overall complication rate and demonstrate that a permanent complication rate of 0% can be achieved. Study Design and Settings: The study was carried out between January 2013 and May 2015 and involved 228 patients. All patients were assessed preoperatively by an endocrinologist and an ENT surgeon for vocal cord functions; all were operated on by the same surgeon, who had >10 years' experience and performed over 100 thyroidectomies per year. Patients were followed up at 6 months to record any complications. Data were analysed using SPSS version 13.0 (IBM, Armonk, NY, USA) and a Chi-squared test was used to calculate P values. Results: There was an overall complication rate of 16.23%; 15.8% of patients experienced transient hypocalcaemia and 0.4% experienced post-operative bleeding. There were no permanent complications, and the rate of both recurrent laryngeal nerve injury and wound infection was 0%. Conclusion: We conclude that the rate of complications of thyroidectomy can be significantly reduced and the rate of permanent complications reduced to 0% if the procedure is performed by an experienced, high-volume surgeon with a special interest in thyroid surgery.