Volume 1 Issue 2 -2007

So its official. MTAS is a disaster. Who would have guessed the system would crash under the huge weight of internet activity? Who would have thought there would be disgruntled trainees up and down the country complaining about the crassness of a system which appears to disregard CVs and experience. Who would have thought that the MMC insistence on simple yet cunning enquiries such as "Why did you apply to this region/speciality?" to select the wheat from the chaff would be such a poor discriminator? Er… most of us actually. At MTAS meetings up and down the country expressions of concern were made prior to the system becoming active but were brushed away as the ravings of those protecting their own interests. With the spate of recent resignations it appears that culpability is being established but the question remains – why did it happen in the first place?


The natural history of a sporadic Vestibular Schwannoma (VS) continues to be a mystery. It may be that initial tumour size1 and positive growth in the first year of observation2–5 relates to subsequent tumour growth. But in a majority of studies, no predictive factors are identified. To confuse matters further, the growth pattern of this tumour may vary with time.5,6


‘What has been will be again, what has been done will be done again; there is nothing new under the sun’ Ecclesiastes 1: 9–14.

Current literature is full of examples of small variations or additions to an established body of medical knowledge. The description of the previously unrecognised clinical condition of superior semicircular canal (SSCD) dehiscence by Minor et al. represents a true discovery.1


The use of information technology in medicine has revolutionised the way we deliver care to our patients, but the way we interface with computers has changed little since the computer was first invented. One of the holy grails of computing has been to allow the use of voice to input data. Voice recognition software has been available since the early 80s, but has never gained mainstream acceptance, largely due to the fact that the software packages produced for public consumption were not powerful or user-friendly enough to be of much use in an every day situation.


Allergen specific immunotherapy is the practice of administering increasing doses of an allergen to an allergic patient in order to reduce symptoms on subsequent exposure. The exact mechanism of action is unclear. It is thought to invoke a state of immune unresponsiveness among peripheral T-cells and a subsequent shift from the allergic type immune response to the non-allergic type. Immunotherapy is highly effective in reducing symptoms and medication need, and also improves objective measures of nasal allergy. Traditional subcutaneous administration can rarely lead to severe systemic reactions, but it is now being superseded by sublingual immunotherapy, which appears to be as effective but with less risk. This article reviews the immunological basis of immunotherapy and its clinical applications.


Keloids are defined as scar tissue that extends beyond the boundaries of the incision or wound.


This is not completely understood but growth factors play a part in the stimulation of fibroblast proliferation. To emphasise this, VEGF suppression1 using steroids has been shown to stop fibroblast growth by interfering with glucocorticoid receptors and Transforming growth factor-Beta (TGF-B) upregulation2,3 has increased keloid growth.


Objectives: The NHS modernisation agency encourages utilisation of non-ENT specialists for the follow up of patients following grommet insertion. This study aims to determine whether the practices of clinicians and the preferences of patients are in accord with these recommendations.

Competing Interests

RM, VV and LA are all currently Junior Doctors who have benefited from available study leave funding.

RM is: President of the Association of Otolaryngologists in Training.

Member of UK JDC of BMA Terms & Conditions of Service team of UKJDC of BMA

The approach of MMC

In late 2005 it became clear that training in the UK was about to undergo a massive transition. Under modernising medical careers the “Lost Tribe” (of which I was allegedly a member) would be saved from the confusion of the SHO grade and transition from medical graduate to competent consultant would be smooth and structured.


Middle Ear & Mastoid

1. From IAM the nerve bends back on itself at the geniculate ganglion (1st genu) just above the processus cochleaformis (with tensor tympani looping around it.)

2. Then it heads posteriorly until it curves around the superior aspect of the oval window to head inferiorly (2nd genu.) Here it lies just anterior (‘kissing’) to the lateral scc.

The educational climate change is our current topic and “Icecap” refers to the Intercollegiate Surgical Curriculum Project (ISCP- pronounced Icecap). This is a web-based curriculum and training record for the surgical specialties and it is going to impact on the way we all train.

The MTAS fiasco has upset everyone but especially the surgical community. In March when the West Midlands general surgical appointments committee met at 0800 on a Monday morning and refused to proceed with the day of planned interviews, the cat was finally let out of the bag. The ‘Birmingham Ten’ did us all a huge favour by just saying ‘no’. Other groups found their voice including the London ENT selection committee. In the interim many of the nearly 15,000 junior doctors who were offered no interviews at all were becoming vocal and their families were mobilising the press (notably the Daily Telegraph). On the 21st March the RCS held an emergency meeting of elected members and voted unanimously not to support the existing process. All this led to panic in Whitehall as civil servants suddenly realised that the ship was sinking.


The aim of this study was to determine if parathyroidectomy for primary hyperparathyroidism produces improvement in patient-reported quality of life in a United Kingdom population which so far have only been demonstrated in non-UK populations.


Laryngomalacia is the most common cause of neonatal and infantile stridor. Until the 1980s tracheostomy was the standard treatment for severe laryngomalacia. Aryepiglottoplasty was first performed in 1984, it has since been widely adopted as a safe and effective treatment for children with laryngomalacia. We present our experience of this procedure and highlight the clinical features affecting the likelihood of admission to a paediatric intensive care unit, complication rate and the length of post-operative hospital stay.


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