Last week, I attended the NoEENT meeting in Bury. It was a packed programme and congratulations to @GhoshENTsurgeon on organising such an interesting and though-provoking day with talks on neck dissection, allergic fungal rhinosinusitis and a fascinating talk by Dr Daniel Sokol - barrister and medical ethicist on truth-telling and deception in medicine. 

The 'Gold Standard' treatment for sleep disordered breathing is CPAP. This is not always achievable in all patients and in those who are intolerant of it or in patients in whom it does not work we do sometimes need to resort to surgery. This article has been commissioned by ENT & Audiology News and outlines some of the surgical treatment options available. 

It has been a busy couple of months for me on the research side. I have published two papers recently. One was a case report on brain tissue in the wrong place found incidentally in the nasal sinuses. 

http://file.scirp.org/Html/5-2460275_54342.htm


The other was part of a collaborative paper led by Carl Philpott at the University of East Anglia looking at the burden of surgery in chronic rhinosinusitis


http://bmjopen.bmj.com/content/5/4/e006680.full?sid=ef35e2f6-3dff-46d6-8da5-83ed3df7d32a

The AAO-HNS have just published some guidelines on the management of sinusitis. They are also advocating nasal rinses and douches for treatment. The recipe is below. 

It was a pleasure and delight to travel across to Liverpool last night to talk on neck lump assessment and ENT for finals. Apologies for the delay and many thanks for your patience. I have posted the slides below for you to view for reference. 

What a pleasure to meet so many GPs and discuss some of the issues of common ENT topics this evening. Thanks for braving the January winds to come and listen

This is an article recently published in Jlife Magazine. It is a question and answer piece with the answers appearing in next month's edition. 

This article has recently been published in the New England Journal of Medicine as well as an accompanying article in the New York Times. Essentially patients in South Korea are screened for thyroid cancer. That means that patients attending their doctors with, say, a sore foot, will be encouraged to have a thyroid scan rather than just investigating patients with symptoms suggestive of thyroid disease such as a lump in the neck. This seems like a good idea, and one would imagine that picking up a cancer must be a good thing. The problem is that many, small, thyroid cancers are indolent and are, oddly enough, unlikely to cause problems. In fact, one study has shown that up to a third of people who have died of other causes will have tiny thyroid cancers present. These micro-papillary cancers will sit in the thyroid causing no trouble and are very unlikely to spread. However, when a doctor has diagnosed a cancer then it is difficult to ignore it and so a large number of patients, as shown in this study from Korea, may end up having unnecessary surgery. The problem with this is that of all patients who have operations, a small number will experience complications for example hoarseness of voice or injury to the parathyroids that sit behind the thyroid and regulate the calcium levels in the blood. 

A difficult conundrum and one that often needs careful discussion between patient and doctor. 

Thyroid cancer accounts for about 2% of cancers in women and men. The outcome for patients with small, localised papillary cancers is excellent with 99% of people being alive 20 years after diagnosis. Treatment ranges from removal of one half of the thyroid to total thyroidectomy with removal of neck glands and radioactive iodine and the complication rate from treatment increases when more 'aggressive' treatment is done. Complications can include damage to the nerves of speech, the need for thyroid replacement and the need for calcium replacement. This thoughtful review discusses the trade-offs between the treatment options and highlights emerging treatment options. The aim of treatment of low risk thyroid disease is to achieve the lowest mortality with the lowest burden of treatment but this can sometimes be difficult to predict. Ultimately, our goal as surgeons is to understand the patient's disease in the context of their wants and needs and formulate a treatment plan that is most appropriate to that individual. 

NCEPOD have recently published their report on tracheostomy care. The slides from the report are attached below and there are some interesting points to make as a speciality.

We do a lot of them and about 70% of them are percutaneous rather than surgical

We probably do not consent adequately for them 

Patients go to a wide variety of wards following their tracheostomy and the protocols for care could be improved. 

This audit gives us a good baseline and we need Nationwide to improve our care of these patients. It will be interesting to see the re-audit in a year or two's time.