Volume 11 Issue 1 - 2018

It has been a busy time in the Editorial office at ‘The Otorhinolaryngologist’ over the last few months as issues are being organised and we try hard to keep each issue balanced in terms of the various specialist areas of ORL-HNS. This issue has some excellent articles, which we feel are comprehensive and cover a wide range of topics within the speciality. The aim of the journal is to provide a clear update on topics (for example paediatric vertigo) as well as interesting research and audits. I was very pleased at a recent revision course for the intercollegiate exam to hear from candidates about to sit the exam that the viva articles in the journal are well received; as strong supporters of the AOT and YCOHNS we pride ourselves on being a journal that hopefully trainees find useful.

Each year there seems to be an increase in the ‘must attend’ conferences around the globe with a conflicting increase in the scrutiny from hospitals regarding study and professional leave. This makes one have to pick which conferences to attend carefully and in ORL we are somewhat spoilt for choice but hopefully we will see you at BACO this July. Please feel free to discuss any papers that you are considering submitting to the journal or any ideas you may have for review articles with Francis or myself at anytime; we would warmly welcome any suggestions.

With best wishes,

Sanjai Sood

Editor in Chief

Cerebrospinal fluid (CSF) rhinorrhea occurs when a breakdown in the integrity of the anterior skull base is associated with communication between the subarachnoid space and the nasal cavity. The aim of surgical repair is to re-establish the barrier between the nasal cavity and intracranial cavity, restoring anatomy, preserving physiological function and reducing the likelihood of ascending infection. The endoscopic repair of anterior skull base defects is now common practice ever since it was first described by Wigand et al in 1981, albeit, using evolved techniques and graft materials.1 It is associated with high success rates and low complication rates.


Background: Balance disorders are much less common and less well understood in paediatric populations compared to adults. They can cause significant morbidity in a time where children are still developing.

Method: A review of relevant databases was performed using key words “vertigo” and “paediatric”, between 2005 and 2017.

Results: The most common causes of true paediatric vertigo were found to be vestibular migraine, benign paroxysmal vertigo of childhood and acute labyrinthitis. Migraine related syndromes such as vestibular migraine and benign paroxysmal vertigo of childhood are now well defined by the ICD-10, and treatments are available.

Conclusion: Balance disorders are important conditions that need to be recognised as they can cause considerable morbidity among children, and treatments can help relieve this.


Introduction: Facial paralysis affects all age ranges and is a functionally and psychosocially devastating condition. Unfortunately there lacks uniformity in how these patients are currently managed. We aim to review the common treatment strategies for reversible facial paralysis (cable grafting, nerve transfer). We will also describe the management of permanent facial paralysis and contrast regional muscle transfer to free muscle transfer and give an overview of the management of post paralytic facial nerve paralysis syndrome.


Choanal atresia is a malformation in which the nasal passages do not open onto the pharynx . It is relatively uncommon but important cause of nasal obstruction in children. This review provides an overview of the aetiology, diagnosis and management of choanal atresia. It includes a review of the available literature on the subject, particularly the surgical management and adjunct treatments such as nasal stents. We have also included a section on assessment questions with answers provided, to highlight certain key learning points.


Prevertebral abscesses are an uncommon but serious and potentially life threatening form of deep neck space infection (DNSI). DNSI can occur in any of the potential spaces within the neck and are often secondary to odontogenic or upper respiratory tract infections. We present the rare case of an extensive Tuberculosis (TB) prevertebral abscess with associated cervical spine involvement in a 32 year old immunocompetent male patient. This was definitively managed with insertion of a radiologically guided trans-cervical drain and anti-tubercular chemotherapy. The aim of this case report is to highlight an unusual case of extrapulmonary TB that was successfully treated without surgical incision and drainage. We also present an overview of the current literature.

These are a series of T2 weighted MRI images, in axial, coronal and sagittal planes. There is no information regarding the patient’s demographics or preceding history. The most obvious abnormality appears to be a well circumscribed lesion in the left parapharyngeal space. It appears to carry a uniform high intensity signal on T2 imaging but I cannot comment on T1 imaging as this is not shown. It does not demonstrate any signs suggestive of local infiltration and instead the great vessels have been displaced posteriorly. There are no other lesions of note.

This is a coronal view of a Computerised Tomography (CT) scan of the paranasal sinuses. It shows complete opacification of the left frontal sinus with areas of calcification within. The sinus appears to be expanded and exhibits features of thinning of the surrounding bone. From this particular image, it does not appear that there is extension into the orbit.


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