The OtorhinolaryngologistThe Otorhinolaryngologist has been accredited by ENT-UK for the purposes of providing ENT specialists with online eLearning Continuing Professional development.The content of the publication covers a range of CPD related topics including "Clinical reviews", "Operative techniques", "Case reports" and a "Trainees section". The articles are all peer-reviewed.

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Satisfactory completion of the CPD assessment related to any SINGLE article, that is attaining a minimum threshold of 70% correct responses, will permit the participant to download a certificate of CPD completion, with an indication of 1 hour CPD activity. Clinicians should only claim credit commensurate with the extent of their participation in the activity.

Latest Articles

  • from the editor...

    Welcome to the summer edition of The Otorhinolaryngologist. As ever we have an educationally filled journal with some superb reviews and practical information. As ever I encourage you to use the CPD section of the website too.

    I would like to take this opportunity to thank Iain Bruce, our paediatric ENT section editor, for his efforts of over the past few years as he leaves the journal. He has contributed and reviewed a large number of articles for the journal and Sanjai and myself are indebted to him. I would also like to welcome Yogesh Bajaj, who fills his place and I know holds medical education close to his heart and is warmly welcomed.

    As ever I encourage all who read the journal to continue to submit and support their teams submissions which maintain the high educational value of the journal. I also remind you of our Update meeting in December 2016 the details of which are on the website.

    Wishing you a wonderful summer

    Francis Vaz
    Co-Editor of The Otorhinolaryngologist

    Tags: editorial
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  • Granulomatosis with polyangiitis of the carotid artery: a case report and literature review

    Abstract

    A 45-year-old Caucasian female was seen in the outpatient department with an 8-month history of left sided otalgia, throat pain and neck swelling and a 3-day history of amaurosis fugax. On examination she was found to have a left sided level II/III neck lump. A florid peri-vascular infiltration, involving and stenosing the left common carotid artery and carotid bifurcation was identified at CT angiogram and open biopsy. Auto-immune screening was negative. Histology confirmed a diagnosis of granulomatosis with polyangiitis. We present an unusual case with specific features never previously reported in the published literature.

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  • A practical approach to the management of a patient with unilateral tonsil enlargement

    Abstract

    Background: Unilateral tonsil enlargement frequently poses a clinical dilemma regarding tonsillectomy to rule out malignancy. There is clear morbidity associated with tonsillectomy including bleeding, the risk of anaesthesia and post operative pain. Therefore a decision has to be made considering the risks of tonsillectomy versus the risk of missing malignancy if the tonsil is not removed.

    Method: A pubmed search was performed using the terms unilateral tonsil enlargement and unilateral tonsil hypertrophy.

    Results: The likelihood of finding a malignancy in unilateral tonsil enlargement, with no other clinical features, is low and does not warrant a tonsillectomy in all cases. In this situation we would suggest a “watchful waiting” policy of three months. However, age, systemic and specific symptoms, and how quickly the swelling developed are important factors to take into account when assessing the patient.

    Conclusions: We suggest a period of “watch and wait” in patients who present with asymmetric tonsil enlargement, with no other clinical symptoms or signs on examination.

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  • Head and Neck Skin Lesion Excision Margin Completed Audit Cycle

    Abstract

    Introduction and Aims: Ascertain how significant the reduction in incomplete excision would be with an increase in surgical excision margins. Identify any patterns of incomplete excision.

    Methods: Data was collected retrospectively in the first cycle from 2007 to 2010. The implemented change was to increase the excision margin from 3-4 to 4-5mm and to compare results with gold standard dermatology guidelines (Telfer et al). The second cycle involved retrospective data collection from 2011 to 2012. Both patient demographics and pathology demographics such as the number of lesions, facial subunit, histology and completeness of excision were collected.

    Results: The majority of lesions were Basal Cell carcinomas (117/151 in the first and 110/205 in the second cycles) affecting either the nose or ears of older patients in both cycles. Over half the incomplete excisions were involving the ear. 9.9% (15/151) were incompletely excised in the first cycle compared with 4.4% (9/205) in the second cycle (P=0.053). 11.1% (1/9) of the incompletely excised cases in the second cycle resulted in recurrence over an average of 17 months follow up.

    Conclusions: There was an appreciable reduction in incomplete excision with increase in surgical margins. Margins are more difficult to achieve in certain facial subunits of ear e.g conchal bowl and nose e.g. columella. Consider the original size of the lesion and pre-clinical suspicion with planning excision margins. Incomplete excision will not always lead to recurrence.

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  • Frontal Sinus Mucoceles

    Introduction

    The term mucocele was first coined by Rollet in 1896. Onodi first described the histology of a Mucocele in 1901. Mucoceles are mucous filled epithelium lined sacs that typically fill a paranasal sinus. Macroscopically, mucoceles are thick walled grayish cysts which are histologically characterised by a pseudostratified columnar epithelial cells with few ciliated cells, hypertrophic goblet cells, fibrous thickening of submucosa and sterile mucus with cholesterol crystals.

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