Volume 3 Issue 1 - 2010

This issue of the Otorhinolaryngologist has had a lot of input from an expanded editorial board and I am delighted to have had so much enthusiasm from the newest members of the editorial board. We continue to make changes and improvements to the general format of the journal. You will note that each article now has several multiple choice type self assessment questions which can be used for CPD and I hope that you find this useful. It is our aim to provide a journal which, in addition to being useful and interesting reading, will also become a useful CPD vehicle for busy otorhinolaryngologists.


Paediatric airway endoscopy is an important part of the core curriculum for ENT speciality trainees, however, it tends to be a procedure that is limited to major children’ hospitals as a result not all trainees have a very great exposure in this sub speciality.

Furthermore, because of the relatively limited number of cases in routine ENT practice, established consultants in some units will tend to get out of practice with airway assessment but may on rare occasions be called upon to act in an emergency where more specialized help is not available.


The initial investigation of patients with thyroid masses continues to be an object of controversy. This is multifactorial and due to the diversity of clinicians managing these patients. Thyroid pathology seen in outpatients will include solitary thyroid nodules, multinodular goitres, thyrotoxicosis, thyroid cancer and thyroiditis. Although the great majority of patients attending head and neck and endocrine surgery clinics will present with solitary nodules, patients may also present with multinodular or diffuse masses with or without compression symptoms.


The surgical treatment of differentiated thyroid cancer involves an increasing trend of elective central compartment neck dissection. Here, we critically evaluate the available literature to identify the benefit of elective central neck dissection and the risks associated with this procedure.


Aim: Acute frontal sinusitis can present with serious complications and is currently treated by a variety of health care providers. This article reviews presentation and potential predictive factors in the management of frontal sinusitis

Methods: Cases of acute frontal sinusitis presenting to a hospital department were identified in a retrospective review over 6 years.

Results: Forty-six cases were identified of which 80% required an operative procedure to aid symptom resolution. Eighteen patients presented with complications, 15 orbital and 3 frontal soft tissue abscesses. Past medical history or the severity of the rhinosinusitis using Lund-Mackay scoring did not correlate with operative management in uncomplicated frontal sinusitis.

Conclusion: Hospital presentation with acute frontal sinusitis is associated with a 39% complication rate. Simple drainage procedures are effective in the majority of cases. In uncomplicated acute frontal sinusitis CT staging does not predict if operative intervention will be required.


Tumours of the naso-lacrimal apparatus are rare. Benign symptoms can harbour the possibility of a neoplasm in patients presenting with lacrimal outflow obstruction resulting in misdiagnosis. Tumours are usually unilateral and more common in middle-aged males. Management of theses lesions is by joint Multi-Disciplinary Team. Surgical management includes lateral rhinotomy with en-bloc excision, orbital exenteration and even craniofacial resection. History and clinical findings are imperative in prompt diagnosis and management. We review the embryology, anatomy, tumour types and surgical approaches to these tumours from an ENT perspective.

The aim of this new section within the new look Otorhinolaryngologist is to look at common intercollegiate viva questions in all 4 sections and provide a model answer. It is not unusual to start a question with a clinical photograph or scan. Often in the viva situation there are not wrong or right answers but a body of opinion, the examiner is trying to ascertain whether you are familiar with these opinions and what YOU think. – I will try to illustrate some of these points in this question. Also the examiners sometimes want to know how you do it and why, so make sure you are happy with your own technique and if it is a new or different way make sure you have evidence to back it up.

Flexible training is a term encompassing a range of training options, the descriptions of which can be confusing, such as job share, slot share, supernumerary and less–than-full-time training. It was not something either of us had ever envisaged doing as budding doctors and ENT trainees. However, personal circumstances change, such as having a family and the ensuing responsibilities. Consideration of working less than full time is usually more applicable to the female doctor; however the option of applying is open to any one who has valid reasons to do so. You can find out if you are eligible by talking to your employer (See appendix 1 for example in Northern Deanery) and on the Directgov website (Appendix 2).


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