Objective This study aimed to assess whether increasing operative experience results in better surgical outcomes in endoscopic middle-ear surgery. Methods A retrospective single-institution cohort study was performed. Patients underwent endoscopic tympanoplasty between May 2013 and April 2019 performed by the senior surgeon or a trainee surgeon under direct supervision from the senior surgeon. Following data collection, statistical analysis compared success rates between early (learning curve) surgical procedures and later (experienced) tympanoplasties. Results In total, 157 patients (86 male, 71 female), with a mean age of 41.6 years, were included. The patients were followed up for an average of 43.2 weeks. The overall primary closure rate was 90.0 per cent. Conclusion This study demonstrates an early learning curve for endoscopic ear surgery that improves with surgical experience. Adoption of the endoscopic technique did not impair the success rates of tympanoplasty.

Background: Patients with advanced otosclerosis can present with hearing thresholds eligible for cochlear implantation. This study sought to address whether stapes surgery in this patient group provides a clinically significant audiological benefit. Objectives: To assess pre- and post-operative hearing outcomes of patients with advanced otosclerosis, and to determine what proportion of these patients required further surgery including cochlear implantation. Methods: Between 2002 and 2015, 252 patients underwent primary stapes surgery at our institution. Twenty-eight ears in 25 patients were deemed to have advanced otosclerosis, as defined by pure audiometry thresholds over 80 dB. The patients’ records were analysed to determine audiological improvement following stapes surgery, and assess whether any further surgery was required. Results: The audiological outcome for most patients who underwent primary stapes surgery was good. A minority of patients (7 per cent) required revision surgery. Patients who underwent cochlear implantation after stapes surgery (10 per cent) also demonstrated a good audiological outcome. Conclusion: Stapes surgery is a suitable treatment option for patients with advanced otosclerosis, and should be considered mandatory, before offering cochlear implantation, for those with a demonstrable conductive component to their hearing loss. A small group of patients get little benefit from surgery and subsequently a cochlear implant should be considered.

Coblation is one of the more recent techniques for tonsillectomy; however, it remains unclear whether it exhibits any benefit or increased risk when compared to other techniques. This review provides an updated assessment of coblation tonsillectomy and how it compares to other tonsillectomy techniques. Systematic review and descriptive analysis of published literature. Electronic searches of MEDLINE, EMBASE, Web of Science and the Cochrane Database were performed. We included all randomized control trials comparing coblation tonsillectomy (not 'tonsillotomy') with any other tonsillectomy technique. Studies were excluded if tonsils, rather than individuals, were randomized. 16 eligible studies were identified, including a total of 567 patients, both adults and children. Coblation was compared with a variety of other tonsillectomy techniques. Outcomes included pain, primary and secondary haemorrhage, intraoperative bleeding and operation time. Postoperative pain was the primary outcome in most studies. There was a trend towards less pain in the coblation group in seven of the included studies. More recent studies appeared to fare more favourably in terms of pain outcomes and operating time. The coblation technique appears to be comparable with other commonly employed techniques for tonsillectomy; however, there is still no strong evidence to suggest that it possesses any definitive benefits. Findings would advocate further work being done through carefully designed randomised control trials, which compare coblation with cold dissection as the 'gold standard' and place an emphasis on reducing the amount of adjuvant electrocautery used so as to maximise the benefits of coblation and the lower temperature it generates.

Objectives: To summarise published research investigating maximal temperatures associated with endoscopes used in otology. Possible thermal issues surrounding the use of endoscopes in middle-ear surgery are discussed, and recommendations regarding the safest ways to use endoscopes in endoscopic ear surgery are made. Methods: A non-systematic review of the relevant literature was conducted, with descriptive analysis and presentation of the results. Results: There are currently no reports of any temperature-related deleterious effects in patients having undergone endoscopic ear surgery. There is debate regarding heat issues in endoscopic ear surgery, with a limited body of work documenting potential negative impacts of middle-ear heat exposure from endoscopes. The diameter of endoscope, type of light source used, distance from endoscope tip and duration of exposure are highlighted potential factors for high temperatures in endoscopic ear surgery. Conclusion: There is a trend towards endoscopes being used routinely in ear surgery. Simple practice points are recommended to minimise potential thermal risks.

Introduction: Digital and mobile device technology in healthcare is a growing market. The introduction of the endoscope-i, the world’s first endoscopic mobile imaging system, allows the acquisition of high definition images of the ear, nose and throat (ENT). The system combines the e-i Pro camera app with a bespoke engineered endoscope-i adaptor which fits securely onto the iPhone or iPod touch. Endoscopic examination forms a salient aspect of the ENT work-up. The endoscope-i therefore provides a mobile and compact alternative to the existing bulky endoscopic systems currently in use which often restrict the clinician to the clinic setting.Areas covered: This article gives a detailed overview of the endoscope-i system together with its applications. A review and comparison of alternative devices on the market offering smartphone adapted endoscopic viewing systems is also presented.Expert commentary: The endoscope-i fulfils unmet needs by providing a compact, highly portable, simple to use endoscopic viewing system which is cost-effective and which makes use of smartphone technology most clinicians have in their pocket. The system allows real-time feedback to the patient and has the potential to transform the way that healthcare is delivered in ENT as well as having applications further afield.

Clinical OtolaryngologyVolume 38, Issue 1 p. 104-106 Correspondence: Letters The ‘endoscope-i’: a mobile solution for endoscopy in otolaryngology A. George, A. George georgea288@aol.com Department of Otolaryngology, West Midlands Deanery, Birmingham, UKSearch for more papers by this authorM. Prince, M. Prince Department of Mechanical Engineering, Aston University, Birmingham, UKSearch for more papers by this authorC. Coulson, C. Coulson Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UKSearch for more papers by this author A. George, A. George georgea288@aol.com Department of Otolaryngology, West Midlands Deanery, Birmingham, UKSearch for more papers by this authorM. Prince, M. Prince Department of Mechanical Engineering, Aston University, Birmingham, UKSearch for more papers by this authorC. Coulson, C. Coulson Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UKSearch for more papers by this author First published: 19 February 2013 https://doi.org/10.1111/coa.12062Citations: 4Read 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 Volume38, Issue1February 2013Pages 104-106 RelatedInformation

Clinical OtolaryngologyVolume 32, Issue 4 p. 310-310 Procalcitonin: A bacterial specific marker of infection A. George, A. George The West Midlands Deanery, University Hospital of North Staffordshire, Stoke-on-Trent, UK, E-mail: [email protected]Search for more papers by this authorC. Coulson, C. Coulson The West Midlands Deanery, University Hospital of North Staffordshire, Stoke-on-Trent, UK, E-mail: [email protected]Search for more papers by this authorR. De, R. De The West Midlands Deanery, University Hospital of North Staffordshire, Stoke-on-Trent, UK, E-mail: [email protected]Search for more papers by this author A. George, A. George The West Midlands Deanery, University Hospital of North Staffordshire, Stoke-on-Trent, UK, E-mail: [email protected]Search for more papers by this authorC. Coulson, C. Coulson The West Midlands Deanery, University Hospital of North Staffordshire, Stoke-on-Trent, UK, E-mail: [email protected]Search for more papers by this authorR. De, R. De The West Midlands Deanery, University Hospital of North Staffordshire, Stoke-on-Trent, UK, E-mail: [email protected]Search for more papers by this author First published: 20 July 2007 https://doi.org/10.1111/j.1365-2273.2007.01502.xRead 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Ahsan F., Rashid H. & Eng C. (2007) Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measure of infection in a prospective cohort. Clin. Otolaryngol. 32, 24–27 10.1111/j.1365-2273.2007.01381.x CASPubMedWeb of Science®Google Scholar 2 Maruna P., Nedelnikova K. & Gurlich R. (2000) Physiology and genetics of procalcitonin. Physiol. Res. 49 (Suppl. 1), S57–S61 CASPubMedWeb of Science®Google Scholar 3 Gendrel D., Raymond J., Coste J. et al. (1999) Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon alpha for differentiation of bacterial vs viral infections. Pediatr. Infect. Dis. J. 18, 875–881 10.1097/00006454-199910000-00008 CASPubMedWeb of Science®Google Scholar 4 Nicolcescu P., Badulescu F. & Schenker M. (2006) Diagnosis of nosocomial pneumonia: conventional and new indicators. Pneumologia 55, 52–57 PubMedGoogle Scholar 5 Gervaix A. & Pugin J. (2005) Usefulness of procalcitonin in adults and children. Rev. Med. Suisse 1, 872–874, 877 PubMedGoogle Scholar 6 Christ-Cain M. (2006) Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomised trial. Am. J. Respir. Crit. Care Med. 174, 84–93 10.1164/rccm.200512-1922OC CASPubMedWeb of Science®Google Scholar 7 Elsammak M., Hanna H. & Ghazal A. (2006) Diagnostic value of serum procalcitonin and C-reactive protein in Egyptian Children with streptococcal tonsillopharyngitis. Pediatr. Infect. Dis. J. 25, 174–176 10.1097/01.inf.0000199273.37314.b2 PubMedWeb of Science®Google Scholar Volume32, Issue4August 2007Pages 310-310 ReferencesRelatedInformation

Objectives: To determine how nasal injuries are managed by accident and emergency (A&E) consultants and produce a management protocol if the survey indicated a need. Method: A postal survey of UK A&E consultants. Results: The response rate was 59%. A great deal of variation was found between departments and clinicians regarding the training of junior A&E staff, the equipment available, the management strategies employed, and the reasons for referral to ENT or maxillofacial departments. Conclusions: This survey shows that many more nasal injuries could be managed within the A&E setting without referral to ENT or maxillofacial departments. A flow chart of the optimal management of nasal injuries in Accident and Emergency departments is presented.