Volume 2 Issue 1 - 2008

Balance and thyroid disease. Not areas of ENT you would normally expect to see in the same sentence and unlikely to excite interest in the same ENT specialists, but both have been affected by recent political changes influencing referral patterns.

First: balance. Most of you will now be aware of a recent position paper from the Royal College of Physicians entitled ‘Hearing and Balance Disorders: Achieving excellence in diagnosis and management’. The paper, the result of a working party on the provision of balance and hearing services in the UK came to a number of conclusions, one of which was that there is a severe lack of service provision for patients with imbalance. This implies that unless the dizzy patient is seeing an audiological physician, preferably leading a multidisciplinary clinic team, they are receiving a substandard service. Given the recent developments in the banking world it can only be a matter of time before its referred to as a ‘sub-prime’ service. ENT Consultants who for years have been providing excellent care for these patients were probably less than amused to hear that they are surgeons rather than doctors, dabbling in an area in which they lack expertise.


Granulomatous disorders (GD) of the nose represent a spectrum of nasal pathology, manifesting themselves either as an isolated nasal problem, or as part of a systemic condition, which may otherwise be occult in nature.

The patient may present with non specific nasal symptomatology, and the clinician should therefore consider the possibility of GD in all patients with chronic nasal symptoms not responding to standard treatment and in those with unusual nasal endoscopic appearances.


Increasingly, chemotherapy plays an important part in the multimodality treatment of locally advanced head and neck cancers. Its role in the neoadjuvant, concurrent and adjuvant setting is reviewed. In addition, chemotherapy is often used to palliate cancer related symptoms in patients for whom curative treatment is not possible. The role of new target agents in head and neck cancer is also expanding. The aim of this article is to provide an overview of the role of chemotherapy in head and neck cancers.

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) has just issued a guidance laminate to all its 10000 members on treatment of severe local anaesthetic toxicity, including cardiac arrest. Because surgeons sometimes administer local anaesthetics in the absence of an anaesthetist, and since local anaesthetics can cause severe and even fatal toxicity, surgeons may have an interest in these guidelines. In the event of a disaster, surgeons will usually be able to find an anaesthetist somewhere nearby. However, this is not always the case. If the US trend towards “office based” surgical practice is followed in the UK, surgeons may more often find themselves administering local anaesthetics with no anaesthetist anywhere nearby


Objectives: Patients with nasal allergy often make several visits to ENT Clinics for assessment and investigations. At our institution a one-stop nasal allergy clinic has been set up, with the aim of investigating and treating patients in a single visit. This paper addresses the efficiency of the one-stop clinic.

Design: Retrospective case-control study.

Setting: Single large University Hospital ENT department


In a period of reduction in surgical training hours the importance of quality surgical courses has increased. The Paris temporal bone course in the author’s experience provides a quality, hands on learning experience at a reasonable cost.

Patients with discharging ears usually present to the general practitioner (GP). There are several causes ranging from otitis externa, acute suppurative otitis media (ASOM) to chronic suppurative otitis media (CSOM). Successful management of these patients depends upon an accurate assessment of the ear, but this is hindered by debris and pus in the ear canal obscuring the tympanic membrane. An accurate history, careful aural cleaning and examination can help make an accurate diagnosis. This article aims to assist the GP in identifying CSOM, some forms of which have the potential to cause serious complications.


We describe a method for recording intraoperative findings and the operative steps performed in Endoscopic Sinus Surgery.


Radiotherapy (RT) is an extremely effective treatment for head and neck cancer, both as a primary modality and as an adjuvant treatment following surgery. In early stage disease, single modality radical RT can cure >90% of cancers in some tumour subsites (eg larynx).1 In more advanced stage disease, RT is usually used in combination with cisplatin chemotherapy, either as radical chemoradiotherapy2, 3 or in an adjunctive fashion after ablative surgery.4


Objectives: To audit the use of antibiotics treat patients admitted to a district general hospital with a diagnosis of acute tonsillitis

. Design: A retrospective and prospective clinical audit.

Setting: A District General hospital.

Participants: 106 patients admitted with a diagnosis of acute tonsillitis between 1st January 2005 and 31st December 2005; and 28 patients admitted with a diagnosis of acute tonsillitis between the 1st February 2007 and 30th June 2007.


Are you hoarse?

Do you lose your voice completely?

Do you have problems projecting your voice in noisy surroundings?

Does it sound breathy, scratchy, or husky?

Does the voice tire with use?

Do you get any throat pain?


The latest incarnation of the Intercollegiate Exam started in January 2007. This article aims to provide an overview of all aspects of the new exam from the perspective of a successful candidate’s recent personal experience.


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