BACKGROUND:Computed tomography is the standard pre-operative imaging modality for sinonasal papilloma. The complementary use of magnetic resonance imaging as an additional investigation is debated. This study aimed to establish whether magnetic resonance imaging can accurately detect tumour extent and is a useful adjunct to computed tomography.METHODS:A retrospective review was conducted on 19 patients with sinonasal papilloma. The interpretation of computed tomography and magnetic resonance imaging scans, by three clinicians, was conducted by comparing prediction of tumour extent. The perceived necessity of magnetic resonance imaging was compared between clinicians.RESULTS:The addition of magnetic resonance imaging improved accuracy of pre-operative interpretation; specifically, this finding was significant in cases with frontal sinus involvement. Surgeons were more likely than a radiologist to request magnetic resonance imaging, particularly when computed tomography indicated frontal sinus disease.CONCLUSION:Pre-operative combined magnetic resonance imaging and computed tomography helped predict disease in the frontal sinus better than computed tomography alone. A close working relationship between the ENT and radiology departments is important for accurate tumour localisation.

Background: Inverted papilloma is the most common benign tumour affecting the nose. There is a high rate of recurrence and a potential of malignant transformation. This review article aimed to identify the best available management of this pathology today.Method: A systematic review of the current English-language literature was performed. Only original articles with a minimum follow up of one year and an average follow up of two years were included.Results: A total of 1385 patients from 16 case series were identified. The total recurrence rate for all patients was 11.5 per cent. Significantly lower recurrence rates were found for procedures using an attachment-oriented excision (recurrence of 6.9 per cent; p = 0.0001) and utilising frozen sections (recurrence of 7.0 per cent; p = 0.0001).Conclusion: There is a general trend towards endoscopic surgery. There may be some benefit to the use of attachment-oriented surgery and frozen sections. Multi-centred randomised controlled trials are required.

Background: There has been a shift towards conservative management of penetrating neck trauma in selected patients.Methods: A retrospective case note review of the management of penetrating neck trauma (2007-2013) was undertaken at our large teaching hospital and compared against best-evidenced practice.Results: Sixty-three patients were admitted over six years. The incidence of penetrating neck trauma is reducing, contrary to our belief. Most cases were knife inflicted (33 out of 63), and of these most were attempted suicide. There was a high rate of negative findings for neck explorations under general anaesthesia (18 out of 22). Only nine cases had justification for general anaesthesia exploration according to best practice.Conclusion: The rate of neck explorations under general anaesthesia has dramatically fallen, in line with best practice. The need for operative intervention in patients with penetration of the aerodigestive tract or a major vascular injury should be based on clinical features, and these have been shown to be reliable indicators prior to open exploration.

Clinical OtolaryngologyVolume 40, Issue 5 p. 486-490 Correspondence: Our Experience Do mandatory nasal interventions after epistaxis just delay discharge? – Our experience in 90 adults A.S. Lau, Corresponding Author A.S. Lau orcid.org/0000-0002-6489-204X Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKCorrespondence: A. Lau, Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool L9 7AL, UK. Tel.: +44 151 525 5980; Fax: +44 151 529 5237; e-mail: andrew.lau@liverpool.ac.ukSearch for more papers by this authorK. Smith, K. Smith Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorL. Mealey, L. Mealey Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Rylands, J. Rylands Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Heseltine, J. Heseltine Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorS.P. Williams, S.P. Williams Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorA.C. Swift, A.C. Swift Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this author A.S. Lau, Corresponding Author A.S. Lau orcid.org/0000-0002-6489-204X Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKCorrespondence: A. Lau, Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool L9 7AL, UK. Tel.: +44 151 525 5980; Fax: +44 151 529 5237; e-mail: andrew.lau@liverpool.ac.ukSearch for more papers by this authorK. Smith, K. Smith Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorL. Mealey, L. Mealey Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Rylands, J. Rylands Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Heseltine, J. Heseltine Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorS.P. Williams, S.P. Williams Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorA.C. Swift, A.C. Swift Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this author First published: 09 March 2015 https://doi.org/10.1111/coa.12411Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume40, Issue5October 2015Pages 486-490 RelatedInformation

INTRODUCTION:Sore throats and tonsillitis represent a considerable health burden as well as a significant source of expenditure for the National Health Service (NHS). As part of the recent NHS savings drive, the introduction of 'procedures of low clinical effectiveness' (PoLCE) lists has reinforced a large reduction in the number of tonsillectomies performed. We carried out a cross-sectional study of trends in emergency sore throat admissions in the context of the number of tonsillectomies performed.METHODS:Hospital Episode Statistics (HES) data were extracted. Office for National Statistics data were also used.RESULTS:Between 1991 and 2011, the overall tonsillectomy rate fell by 44%. In the same time, the admission rate for tonsillitis rose by 310% (Pearson's r=-0.67, p=0.01). The peritonsillar abscess admission rate rose by 31% (r=-0.79, p<0.01). Between 1996 and 2011, the overall tonsillectomy rate fell by 41% and the retro and parapharyngeal abscess admission rate rose by 39% (r=-0.55, p=0.026). There was a 14% overall increase in tonsillectomy and sore throat associated bed days. This was despite the large fall in tonsillectomy numbers and the reduction in length of hospital stay.CONCLUSIONS:Efforts to reduce the tonsillectomy rate are correlated with a significant rise in emergency admissions. The rise in the retro and parapharyngeal abscess rate is perhaps most alarming given the very high mortality of these conditions. Bed day data suggest that no net saving has been made despite the new measures.

Background and methods: Chronic cough is defined as a cough persisting for more than eight weeks. This condition generates significant healthcare and economic costs. It is associated with a spectrum of disorders across multiple medical specialties and can provide significant challenges for effective evaluation and management. The current literature was reviewed to gain further insight into chronic cough, including its relationship with sinonasal disease.Results: Within the reviewed literature, there was strong emphasis on post-nasal drip syndrome as a major causative factor.Conclusion: Cough is the most common complaint for which adult patients seek medical consultation in primary care settings. Chronic cough is associated with a deterioration in the quality of patients' lives. Thorough assessment of a patient with a chronic cough relies on a multidisciplinary approach.

Abstract Background: A biofilm is a community of micro-organisms encased within a self-produced, extracellular, polymeric substance. The role of biofilms as a major pathological aetiology in chronic rhinosinusitis would help explain the clinical manifestation of the disease. Objectives: To examine the current evidence, and to discuss possible future research directions, in relation to biofilms and chronic rhinosinusitis. Study design: Systematic literature review. Evaluation method: Two assessors independently undertook critical appraisal of the studies identified by the literature search. Significant findings were incorporated into this review. The primary outcome assessed was the presence of biofilm in human mucosal biopsy samples taken from patients with chronic rhinosinusitis, and from healthy controls. Results: We identified 11 studies examining biofilm formation in human mucosal biopsy samples taken from patients with chronic rhinosinusitis. Conclusion: It is unlikely that biofilms occur in every case of chronic rhinosinusitis; consequently, the significance of ‘biofilm detection’ in some series should be considered carefully. Several authors have argued strongly for the use of confocal scanning laser microscopy with fluorescent in situ hybridisation probes as the ‘gold standard’ for biofilm imaging. This imaging modality should be combined with further investigation of the microbiology of chronic rhinosinusitis, and of the efficacy of traditional culture techniques used for pathogen identification.

Clinical OtolaryngologyVolume 35, Issue 3 p. 257-261 EU law, national examinations in ENT in the UK and restructuring surgical careers: a reliable system of assessment for the public and the profession A.B. Drake-Lee, A.B. Drake-Lee Queen Elizabeth Hospital, ENT, Birmingham, UKSearch for more papers by this authorD. Skinner, D. Skinner Royal Shrewsbury Hospitals, ENT, Shrewsbury, UKSearch for more papers by this authorP.J. Robb, P.J. Robb Epsom & St Helier University Hospitals NHS Trust, ENT, Epsom, UKSearch for more papers by this authorA.C. Swift, A.C. Swift University Hospital Aintree, Otolaryngology/Head and Neck Surgery, Liverpool, UKSearch for more papers by this author A.B. Drake-Lee, A.B. Drake-Lee Queen Elizabeth Hospital, ENT, Birmingham, UKSearch for more papers by this authorD. Skinner, D. Skinner Royal Shrewsbury Hospitals, ENT, Shrewsbury, UKSearch for more papers by this authorP.J. Robb, P.J. Robb Epsom & St Helier University Hospitals NHS Trust, ENT, Epsom, UKSearch for more papers by this authorA.C. Swift, A.C. Swift University Hospital Aintree, Otolaryngology/Head and Neck Surgery, Liverpool, UKSearch for more papers by this author First published: 23 June 2010 https://doi.org/10.1111/j.1749-4486.2010.02132.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume35, Issue3June 2010Pages 257-261 RelatedInformation

There is a well-recognized association of aspirin sensitivity, aspirin-induced asthma, nasal polyposis or sinusitis, known as Samter's triad. This article outlines the pathogenesis and clinical features of this condition and reviews current management options.

Background: Inverted nasal papilloma is a benign tumour with variable biological behaviour. It is a unique neoplasm and is often difficult to manage, being characterised by a tendency to recur following excision, an association with malignancy and an ability to destroy bone. Radiological diagnosis has traditionally been based on computed tomography, but it is often impossible to differentiate between polyps with entrapped debris and inverted nasal papilloma. Magnetic resonance imaging, especially T2-weighted images, is perhaps a better tool in differentiating inverted nasal papilloma from other nasal lesions, and has recently been advocated as the imaging modality of choice.Aims: To review the evidence on the ideal imaging modality for pre-operative planning of surgery for patients with histologically proven inverted nasal papilloma.Materials and methods: A systematic review of studies was undertaken, focusing on radiological assessment of inverted nasal papilloma (primary and recurrent). All English language articles were potentially included in the review. However, we excluded single case reports, case series, pictorial essays, 'teaching' reviews and reviews of inverted nasal papilloma not focusing on pre-operative imaging.Results: Sixteen studies were identified based on our search strategy. Only 10 fulfilled our criteria. Computed tomography scanning was the standard imaging modality of choice, for assessing sinus involvement of inverted papilloma and for planning the extent of surgery. T2-weighted magnetic resonance imaging scans were able to distinguish tumour (intermediate signal) from inflammatory tissues (bright signal), but not post-operative scarring from recurrent tumour. No studies were found which compared the specificity and sensitivity of magnetic resonance imaging and computed tomography in the accurate pre-operative identification of the extent of inverted papilloma.Conclusions: There is currently not enough evidence to suggest one sole modality as providing optimum imaging for inverted nasal papilloma. Computed tomography remains the imaging modality of first,choice for inverted nasal papilloma, despite certain disadvantages. Magnetic resonance imaging is. able to distinguish tumour from inflammation and is advocated as a better tool for recurrent tumour, but bone destruction of sinus walls is less easy to recognise, compared with computed tomography. Evaluation of sinus tumours usually involves both imaging modalities, and inverted nasal papilloma should be included within this pathological group. The cohort of patients is usually small, so cost-effectiveness should not generally be an issue when considering whether to use computed tomography, magnetic resonance imaging or both. A well structured, prospective study is needed to evaluate the efficacy of magnetic resonance imaging versus computed tomography for pre-operative planning of histologically proven inverted nasal papilloma.

BACKGROUND AND METHODS:Young's syndrome describes a combination of male infertility, azoospermia, bronchiectasis and sinusitis. Although Young's syndrome is a well accepted disorder within the realms of infertility medicine, it is also accepted as being a potential cause of sino-nasal disease which is rarely seen by otolaryngologists. However, the significance of the sinus component within this triad is not fully understood. To gain further insight into the relationship of sinusitis with Young's syndrome, we reviewed all of the currently available published literature.RESULTS:Within the reviewed literature, the diagnosis of sinusitis in Young's syndrome was crude and poorly defined; there was little emphasis on sinus disease in most publications.CONCLUSIONS:The prevalence of Young's syndrome is reported to be declining, and the level of evidence regarding sinus disease within this syndrome is limited to case series only. There is, in fact, little evidence to support Young's syndrome being a significant aetiological factor for sinus disease, nor indeed to support the existence of Young's syndrome as an entity in its own right. The only documented aetiological factor is mercury exposure in childhood, an event that is seldom currently encountered; this would support our theory of the extinction of the condition. As an incidental finding, we found that the term Young's syndrome refers to two different medical conditions.

AbstractObjective:To review Behçet's disease and to describe its clinical features in the head, neck and upper respiratory tract.Method:A literature review was undertaken, following a Medline search of publications over a 30-year period, and utilising the expert knowledge of one of the authors (RJM) with a specialist interest in Behçet's disease.Results:Twenty-seven articles with ENT relevance were obtained. Otorhinolaryngological manifestations included symptoms and signs in the mouth, nose, sinus, larynx and ear.Conclusion:Behçet's disease is usually considered to be a condition affecting the oral cavity, eyes and genitals. This article shows that most patients will also exhibit other ENT symptoms, hearing loss in particular. Indeed, Behçet's disease may present with features other than the classic triad of symptoms. Raised awareness of the clinical features within the head and neck region will hopefully enable early diagnosis and treatment of this potentially serious condition.

Disorders in olfaction are common, yet poorly understood. This article explains the mechanism of the olfactory system and the pathogenesis of dysosmia, along with current trends in management and treatment.