I was reading the front page of the BMA News yesterday. The headline was ‘Juniors must take lead on future of training’. This one sentence gives more information than was intended. First, the use of the term ‘juniors’, seems to indicate a bunch of youngsters who may be enthusiastic but naïve. In other areas of life, it may even be thought to apply to adolescents struggling into the ways of adulthood. My brother in law of roughly the same age as me was managing major financial accounts in the City when I was still going through the ‘junior’ ranks of registrar and senior registrar (how dated that sounds). He was always highly amused by the term ‘junior doctor’. So let us clear up a longstanding problem. In medicine, the term ‘junior’ applies to doctors in their late twenties and early thirties who have held down responsible positions for many years. They may even have negotiated the hurdles of marriage and procreation, to say nothing of mortgages. Their contemparies who went into general practice may, by comparison, be considered wise old pillars of the community by the time ‘junior doctors’ are looking for consultant jobs and yet surprisingly may look of a similar age!
The failure to provide oxygenated blood to the brain and other vital structures rapidly results in death. Prevention of hypoxaemia requires a protected, unobstructed airway and adequate ventilation must take priority over all other conditions.1 This review intends to discuss managing acute airway problems in the paediatric age group that could present to any practising otolaryngologist.
Hoarseness is an abnormal quality of voice best described as a combination of harshness (raspy or rough) and breathiness. Current literature suggests that between 6 and 23% of school-aged children suffer from hoarseness.1 The specific condition of velopharyngeal insufficiency is an entire topic in itself and is only mentioned here to draw the attention of the occasional paediatric otolaryngologist to its existence.
Good quality photographs are a valuable tool in all aspects of Otolaryngology. They allow documentation that is far superior to words alone and has been termed photodocumentation. They may be used to record operative findings, follow-up treatment, enhance communication and for education of the patient. Photography is also invaluable for peer-reviewed publications and textbooks, for teaching purposes and presentations, and for medico-legal case work.
Cavernous sinus thrombosis (CST) was first recognized in 1821 as a pathological entity.1 Throughout the 19th century, it was reported as a disorder with a catastrophic outcome and in this preantibiotic era was associated with an almost 100% mortality. Death due to CST was typically due to sepsis. Attempts were made to alter the morbid course of this disease by recommending surgery, but unfortunately the outcome was often just as fatal as the disease itself. Sulphur drugs were introduced in the 1930s and it was during this era that the first survivor was reported. In the ‘40s and ‘50s with the development of antibiotics more patients survived1 and by the ‘60s the disease had become a rarity. Since the introduction of antimicrobial agents the incidence had markedly reduced yet the threat of morbidity and mortality (still at 20–30%)1 necessitates early diagnosis and treatment to minimise these risks. The authors present
A new NSCAG funded national diagnostic service has been established to allow state of the art diagnostic testing for children and adults suspected of primary ciliary dyskinesia (PCD). This article highlights the clinical presentations which should make you suspicious of the diagnosis and outlines the diagnostic tests used to establish the diagnosis.
Introduction: NHS trusts must provide suitable facilities and a supportive environment for clinical audit. According to NICE, trusts should provide adequate staff, funding, time, feedback and monitoring of audit activity.
Aims: To assess available facilities for clinical audit in NHS trusts in relation to current NICE guidelines.
Materials andMethods: A Telephone questionnaire study of19 local Acute Hospital NHS trusts.
Thyroid disease is dealt with increasing frequency by ENT surgeons. There is much debate and controversy, particularly regarding the management of the thyroid and protocols will differ nationally, however this is aimed as an overview for the exam and to illustrate some of the controversies.
Rhinoliths are mineralized masses within the nasal cavity.1 The foreign body, which acts as the nucleus for encrustation, can be either endogenous or exogenous.2 If the foreign material has been present for sometime, it may form a nidus for deposition of calcium and magnesium salts, producing a rhinolith that is usually radio-opaque.3
Temporal bone dissection courses are an important part of ENT training. There are many courses available in Britain and abroad. The courses abroad may be excellent, but a fundamental weakness can be a lack of instruction in English language, which may compromise the full potential of the course. A review of the well-known Clínica Clarós temporal bone dissection course is presented here.
This new technique for shortening a drain can be done easily by all grades of Surgeons and is suitable for all patients. It prevents the need for further re-suturing and further application of general or local anaesthesia. It is of great use in Head and Neck surgery.
In January 2007 the new written paper of the Intercollegiate Specialty Board in Otolaryngology was introduced. There has been much debate about the methodology behind the examination process and the level of knowledge assessed seems to be a particular issue. This article aims to inform the reader about the purpose, process and strategic ideas leading to the creation of the new exam.
Hydrogen peroxide is commonly used as a wound irrigant in many surgical settings. We report on its use in the surgical management of a 68-year-old diabetic gentleman who presented with an aggressive left parapharyngeal abscess and his subsequent catastrophic outcome. We discuss the relevant features of this case, the mechanisms of toxicity of hydrogen peroxide and the available literature.
Background: Carcinoid tumours are rare neuroendocrine tumours of the middle ear. Review of the literature has shown that since 1980 only 40 cases of primary carcinoid of the middle ear have been described.
Method:We report the case of a 56-year-old man with right-sided continuous tinnitus for 2 years. Tympanomastoid exploration was done and the tumour mass removed. Frozen section suggested the possibility of carcinoid tumour.
Upper aero-digestive tract foreign bodies are common ENT Emergencies. History and physical examination remain the hallmarks for assessment of these patients. Plain radiographs are routinely used in the management of upper airway FB1 although their usefulness remains debatable.2 Our hypothesis was that plain radiographs provide a valuable input into the management of patients presenting with non-aspirated upper aero-digestive tract foreign bodies