Volume 2 Issue 2 - 2008

Mentoring and revalidation. These are two issues, which are likely to be pushed to the front of your conscious thought over the next two years on an increasingly regular basis. There is a presumption that surgeons are either no longer as proficient as they used to be, or, that they never were that proficient in the first place - but no-one thought to monitor them. As training in surgery enters a phase of compacted education with less emphasis on experience gained, it is right to put in safeguards to protect standards of patient care, but is this an admission that the fully trained surgeon is a less capable beast? Whatever the philosophical debate, the fact is that ENT Consultants in the future are likely to find their practice under scrutiny


Septoplasty is being increasingly performed on a day case basis. A good outcome in day case surgery depends on careful patient selection, careful surgery by experienced surgeons and a careful anaesthetic by experienced anaesthetists. The objectives of this study were to look at our results of day case septoplasty, specifically evaluating patient’s views on this procedure by patient questionnaire and case notes review. Three hundred and twenty five patients were included in this study. Of these 296 patients who underwent day-case septoplasty 25 patients (8.44%) had to stay in overnight. Of these, 16 patients were admitted due to post-operative bleeding (5.4%) and the rest 9 (3.0%) due to anaesthetic related complications. Most of the patients (252, 85.1%) reported symptomatic improvement and were satisfied at the first follow up appointment at 6 weeks. The majority of the patients (78.7%, 233) recommended that septoplasty should be done as day case surgery.


Between 0 and 55% of patients seen in casualty each year with a head injury are reported to suffer from a sensorineural hearing loss. There are 2 broad groups; those with and those without a temporal bone fracture, the former generally having a better outcome. Temporal bone fractures are classified as longitudinal, transverse or mixed types. The location of fractures responsible for causing a sensorineural loss are most commonly through the cochlear. Associated complications include facial nerve palsy, cerebrospinal fluid leak, a perilymph fistula, dizziness and tinnitis.

Investigation and management of these cases involves MRI scanning and audiometric studies, including stapedial reflex decay, evoked brainstem auditory response and otoacoustic emission cochleography. Treatment options are hearing aids and cochlear implants for selected patients.


Patients with facial pain are commonly referred to the otorhinolaryngology department by their general practitioner and other specialists. Most patients are convinced that it is sinus related pain although in reality only a small proportion of these patients have sinogenic pain. This review aims to present the common causes of facial pain and the management of this condition.


Voice recognition software has been available since the early 1980s and has undergone a dramatic improvement in terms of the degree of training required and the accuracy of the software. This technology lends itself to applications within the medical profession but its overall take-up has been relatively poor. In this article I will discuss my experiences with this type of software as I have been using this, in its various incarnations, for the last six years.


In this paper we highlight the importance of recognising gastrointestinal symptoms as an early sign of metastatic medullary thyroid carcinoma (MTC) as part of MEN 2B syndrome. We describe the case of a patient with many years of intractable chronic diarrhoea, who underwent numerous futile investigations at multiple centres. The diagnosis was finally made at a much advanced stage of the disease. We review presentation, diagnosis and management of MTC in sporadic and familial settings.

Dear International reader, I accepted the offer to write an article about ENT training in Croatia with enthusiasm. Croatia is a small country with 4,5 million people in Southeast Europe opposite to Italy. It borders the beautiful Adriatic Sea with an equally beautiful coast which some of you may have visited. The capital is Zagreb with population 1.2 million. I work as a registrar at the Department of Otorhinolaryngology and Head and Neck Surgery in Clinical Hospital Osijek city in the east of the country, with a population of about 105 000.

It was around the early part of 2005 when I started looking for a basic surgical training post. Rumours were gradually filtering down to surgical trainees about the new face of surgical training in line with Modernising Medical Careers (MMC) – speciality training (ST). What was it? How was it going to work? All valid questions when your intended career pathway was going to dramatically change in August 2007. The trouble was nobody really knew. I managed to get a place on a pilot Speciality Training post (ST1 and ST2) in ENT in the Northern Deanery, set-up by the Intercollegiate Surgical Curriculum Project (ISCP). I would like to share my views on the pilot programme


Spontaneous cerebrospinal fluid (CSF) leakage through the temporal bone in adults is thought to be rare1,2,3 and therefore misdiagnosis or failure to make an early diagnosis is common.4 It is defined as one that has no identifiable cause such as trauma, surgery, infection, neoplasia or congenital abnormalities.5 Most commonly these defects occur in the tegmen tympani or tegmen mastoideum and less commonly in the posterior fossa plate. The meningeal defects are either meningoencephalocoeles or simply holes in the dura.1 Patients usually present in adulthood with aural fullness and hearing loss and the most common signs are a clear middle ear effusion and clear tympanostomy tube otorrhoea.6 In this review of the literature we discuss the pathogenesis, natural history, salient investigations and the surgical management of the condition.


Keratinizing stratified squamous epithelium within the middle ear cleft and mastoid


Approximately 10 per 100 000 per year


Malignant otitis externa (MOE) describes an invasive, locally destructive infection rather than a malignancy. It starts in the external auditory canal and progresses to skull base osteomyelitis. Although our understanding of the pathogenesis and management of the disease has become clearer since first described five decades ago, MOE can still lead to cranial nerve palsy/-ies and eventually death.

We present an interesting case of MOE which proved to be very difficult to control despite aggressive treatment and close monitoring. The relevant literature was thoroughly reviewed. This case highlights the dilemma surrounding the ability to predict the course of the disease.


The management of pituitary tumours should take place within the setting of a multidisciplinary service, including clinical endocrinology, pituitary surgery and radiotherapy. Although patients may present to a number of different specialties, a clinical endocrinologist with a particular interest in pituitary tumours should assume responsibility for coordination of care to avoid repetition of expensive investigations and repeated outpatient appointments. Access is also required to specialist ophthalmology, radiology and histopathology services as well as pituitary support groups.


Facial nerve schwannomas are uncommon tumours which may occur at different sites along the facial nerve. We present a case in which the tumour arose from the middle ear portion of the nerve adjacent to the oval window. The pathology of these lesions and its implications for surgical management are discussed.


Objective: Clinic letters form an essential part of good patient care. The information contained in referral and reply letters often does not meet the information needs of the recipient. Most general practitioners prefer letters from hospital doctors to contain a problem list. The aim of this study was to assess GP’s preference on style of clinic letters.


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