Volume 5 Issue 3 - 2013

The NHS policy of ‘care closer to home’ appears to be gaining momentum as many Consultant ENT Surgeons are now working in clinics in G.P. health centres across the country. This of course means that the Consultant is invariably taken away from the hospital that they are employed at to do these clinics thus leaving a void at the hospital.

This article reviews the investigation and treatment of advanced laryngeal cancer. We also explore more controversial themes including the relative indications for primary surgical and non-surgical treatments. Common dilemmas in acute airway management are highlighted in the diagnostic quiz section below.

Although a common disorder, nosebleeds can cause significant morbidity and are occasionally fatal. The standard method of managing heavy bleeding has been to insert impregnated ribbon gauze packs and admit patients for bed rest, often for several days. There are now several available options, each of which will be discussed within this article.
The use of selective arterial embolization and management of hereditary haemorrhagic telangiectasia will also be discussed.

Children presenting with nasal masses in rare. A diagnosis is made easier if the clinician understands their classification and presentational symptoms. The presenting symptoms and signs are discussed together with the principles of management.

Tonsillectomy is one of the commonest paediatric surgical procedures in the Western world. We aimed to evaluate the most recent evidence concerning paediatric tonsillectomy for the last five years.

Background: Septoplasty is commonly undertaken to improve nasal airways or to correct cosmetic septal deviation. The most difficult areas to correct are the caudal and/or superior regions.

Methods: We describe our technique of partial extracorporeal septoplasty using polydioxanone plate to support the cartilage, allowing correction of very anterior and/or superior deviations without affecting the stability or shape of the nose.

Discussion: The senior author has been using this technique routinely since 2004 with excellent results and no increase in complication rates. PDS plate supports the repositioned cartilage and stimulates cartilage regeneration; we discuss the experimental evidence for its use.

Conclusion: Adequate correction of caudal deviations is difficult. This reliable technique allows complete correction of the deviation.

Carotid body tumours are one of the more uncommon causes of a lateral neck lump. It is important to have a logical approach to the diagnosis and management of all neck masses. Clinicians must also to be able to pick up on more subtle signs that allow differentiation between overt malignancy and other, rarer tumours. This will ensure appropriate investigation and management of what is a relatively rare clinical problem.

Case – A 48 year old man presents with progressive sensorineural hearing loss. He is struggling with conventional hearing aids.

Examiner: What key points in the history lead to a differential diagnosis?
I would first enquire about the nature of the patient’s pre-existing hearing loss, asking about the onset of hearing loss, whether this was congenital or acquired. What previous investigations (if any) the patient has had for their hearing loss.

Finally, after completing the FRCS exit examination and entering your final year of training, the time to spread your wings and apply for Consultant posts is fast approaching, the last major final hurdle is to gain the Certificate of Completion of Training (CCT). This is a legal requirement for any doctor wanting to practise as a Consultant within the National Health Service. It confirms that a General Medical Council (GMC) approved training programme has been completed and that you are eligible for entry onto the specialist register. Luckily for us the GMC both approves and also quality assures our training and we are applying to the very same body for CCT, which therefore simplifies this process significantly.

A Review of Malleo-Stapedotomy in a District General Hospital

A wide range of ossiculoplastic procedures are available for hearing restoration in the ear with combined incus and stapes supra-structure abnormalities. We aim to demonstrate the indications, efficacy and safety and outcomes of one particular type of malleo-stapedotomy procedure.


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