#AOT23 Programme

TIMETABLE

TOPIC SPEAKERS

0830-0855 Registration and refreshments

0855-0915 A President’s Welcome

0915-0930 The EXIT Procedure

0930-1015

Wellbeing in Surgery

1015-1030 Financial Planning Top Tips

1030-1100 Refreshments and Sponsor Bingo

1100-1110

Otolaryngology Training Update

1110-1140 “Ear We Go Again”

1140-1210 History of ENT Masterclass®

1210-1255 Trainee Oral Presentations

1255-1355

Lunch and Sponsor Bingo

1355-1425 “Cut Throat Opinions in Head and Neck”

1425-1430

1430-1500

ENT UK Foundation

“Things I wish I’d known” – Perspectives from New ENT Consultants

Ms Myuran and Prof Narula

Mr Bateman

Dr Cappleman, Dr Patel, Mr Din, Ms Myuran

Chaired by Ms Herman

Ms Laura Duncan, Wesleyan

Mr Ghosh

Ms Munir, Mr Freeman, Prof Lloyd

Chaired by Ms McClenaghan

Prof Quraishi OBE

Judges: Ms Stapleton, Mr Sharma, Ms Myuran

Ms Penney, Mr Jayaram, Dr Hughes

Chaired by Mr Goswamy

Prof Kumar

Ms Khong, Mr Anwar, Ms Dowling, Mr Dewhurst

Chaired by Ms Tse

1500-1515

Refreshments and Sponsor Bingo

1515-1545 “Who Nose Best?”

1545-1555 Sponsor Bingo, Oral and Poster Prize Announcement

1555-1700 AOT AGM

Silver sponsor logos

Mr De Carpentier, Mr Bhalla, Mr Ghosh

Chaired by Ms Jaiswal

VENUES

BRIDGEWATER HALL

Bridgewater Hall is Manchester’s international concert venue, built to give the best possible space for music. The Hall hosts over 300 performances a year including classical music, rock, pop, jazz, world music and much more. Construction commenced on 22 March 1993 at a former bus station and car park by Renton Howard Wood Levin architectural firm with creative collaboration with Arup Acoustics.

The Hall is home to the Hallé orchestra, and also hosts the BBC Philharmonic and Manchester Camerata regularly. Experience the acoustics yourself during our day conference on Friday, 9 June 2023 at the adjacent Barbirolli Room and Circle Foyer.

For more information of Bridgwater Hall’s history, architecture and the famous Marcussen Organ, please visit https://www.bridgewater-hall.co.uk/about/.

The Auditorium, Bridgewater Hall. Photo taken from https://www.bridgewater-hall.co.uk/

SCIENCE AND INDUSTRY MUSEUM

On the site of the oldest surviving passenger railway station in the heart of the world’s first industrial city, the museum opened in 1969 as the North Western Museum of Science and Industry. Following decades of major restoration work and redevelopment, it was rebranded to become the Science and Industry Museum in 2018.

The black tie dinner on Friday, 9 June 2023 will be held at the Revolution Manchester Gallery, featuring a stunning digital sculpture and a 50-screen video wall. You will dine amongst fascinating exhibits such as a replica of the Small Scale Experimental Machine, nicknamed ‘Baby’, the world’s first stored program computer.

For more information of the history and current exhibits, please visit https://www.scienceandindustrymuseum.org.uk/about-us.

The Revolution Manchester Gallery. Photo taken from https://www.scienceandindustrymuseum.org.uk/

VENUES

CRYSTAL MAZE

Based on the iconic TV game show, originally broadcast in the 1990s on Channel 4 in the UK, teams of players explore 4 themed zones, collecting crystals by completing physical, skill, mental and mystery games. Each crystal won gives you 5 seconds of time in The Crystal Dome where the entire team would collect tokens to determine their final score.

The Crystal Maze LIVE Experience Manchester is a live, immersive attraction based on the original TV show across 75 minutes of unadulterated fun and games.

Is your team good enough to make the leader boards? Join us on Thursday, 8 June 2023!

The Crystal Dome. Photo taken from https://the-crystal-maze.com/manchester/

GOLD SPONSOR

JUDGES AND SPEAKERS

Ms Emma Stapleton

Emma has been a consultant at Manchester Royal Infirmary (MRI) since 2018. She is Clinical Lead for the Manchester Cochlear Implant Programme and Undergraduate Lead for ENT at the MRI. She is academic and educational supervisor for Foundation and ENT Trainees. Her current research includes hearing implants, hearing loss, and mentorship in surgery.

Emma is President of the North of England Otolaryngology Society, Patron of the Manchester Foundation Surgical Society, and a member of the Royal College of Surgeons of Edinburgh Council of Younger Fellows. She was the recipient of the 2022 Royal College of Surgeons Hunter-Doig medal.

Emma is also Past Chair of Women in ENT Surgery UK, where she continues to co-lead the ENT UK national Mentoring Programme. Emma is a a Trustee of the TWJ Foundation; a Trustee, Director and Assistant Editor of the Journal of Laryngology and Otology, and a Council member and Trustee of the British Cochlear Implant Group. She is married with two sons and two dogs.

12.10-12.55

Mr Sunil Sharma

Sunil has been a Consultant Paediatric ENT Surgeon at Alder Hey Children’s Hospital since 2018, having trained in London, and undertook a clinical fellowship in paediatric otology and implantation in Toronto.

His clinical interests include endoscopic ear and implantation surgery, microtia and craniofacial surgery. He is a Training Programme Director, Postgraduate Clinical Tutor, Honorary Senior Clinical Lecturer and Clinical Director for ENT and Audiology. He has over 60 publications, is an advanced NIHR research scholar and NICE guidelines committee member. He is also Section Editor for the Ear in Scott Brown’s Otorhinolaryngology textbook and Local Scientific Committee Lead for the Otology and Implant streams at ESPO 2023.

Outside of work, he supports Liverpool Football Club and he has a keen interest in expedition medicine, long distance running and flying.

12.10-12.55

Trainee Oral Presentations

Trainee Oral Presentations

Tharsika Myuran, also known as TK by her colleagues, is currently an ENT ST7 near her childhood home in the East of England deanery.

She is a UCL graduate who ranked first for the North East Thames Foundation Programme, and then top ten nationally in consecutive years for Core Surgical Training in the London deanery. She has a BSc in Psychology, and Masters in Medical Education.

She is currently our AOT President. She was Secretary for the Women in ENT Surgery society (WENTS) from 2020-22 where she enjoyed encouraging the future generation of ENT surgeons, men and women alike. Outside work, she enjoys practising Mindful Living with her two young children and Physician husband.

8.55-9.15 A President’s Welcome

9.30-10.15 Wellbeing in Surgery

12.10-12.55 Trainee Oral Presentations

Prof Narula is an associate professor at Plymouth University School of Medical & Dentistry and honorary ENT consultant at Imperial Healthcare Trust. He was our first ever AOT President (1989-1990).

He co-founded The Global Tracheostomy Collaborative, became Vice President of the Confederation of British Surgery and continue to be Chairman of the Board of MediX cover ltd. He was a Past President of ENT UK, British Society for Otology and Young Consultant Otolaryngologists. He served as an elected member of Royal College of Surgeons Council until 2014. He was Editor-in-Chief of CME Bulletin Otolaryngology (1996 – 2006) and appointed independent member for Leicester Police Authority (1999-2002).

He continues to be involved in research and teaching, including the Post Graduate ENT Diploma for GPs, membership of ENT training committees and exam boards at various levels. He is currently, completing his own “Grand Designs” project and enjoys playing golf, good wine and spending time with his grandchildren.

8.55-9.15 A President’s Welcome

Ms Tharsika Myuran

Prof Anthony Narula

SPEAKERS

Mr Neil Bateman

Mr Bateman is a Paediatric ENT Surgeon at the Royal Manchester Children's Hospital. He is also the President Elect for British Association for Paediatric Otorhinolaryngology (BAPO).

His clinical practice includes the common ENT problems in children. He also has particular specialist interests in airway reconstruction, head and neck and salivary gland surgery, and ear reconstruction.

​He is co-director of the Paediatric Emergency Skills Course for Consultants, chairs the ENT Coblation Training Courses for Consultants and is on the faculty for the British Paediatric Otolaryngology Course.

9.15-9.30 The EXIT Procedure

Prof

Prof Quraishi is a Consultant Otolaryngologist at Doncaster and Bassetlaw Teaching Hospitals. He is also an Honorary Senior Lecturer at Sheffield University and a Visiting Professor at Capital Medical University, Beijing. He was trained in Dublin, Toronto and Nottingham.

He is the Founding Director of ENT Masterclass®, has been the Training Programme Director in ENT and an FRCS examiner. He was the President of the Royal Society of Medicine (Laryngology and Rhinology section) in 2018.

In June 2017, Her Majesty Queen Elizabeth II appointed him as an Officer of the Order of the British Empire (OBE) for his services to the NHS and medical training. In 2020, he was the first European surgeon to be awarded the International Public Service award by the American Academy of Otolaryngology. Most recently in 2021, he was awarded the FRCS ad Hominem by the Royal College of Surgeons’ Edinburgh for his services to surgical training.

11.40-12.10 History of ENT Masterclass

Muhammad Shahed Quraishi OBE

Dr Hannah Cappleman is a Consultant Psychiatrist working in an Early Intervention in Psychosis service in Bolton. She has a particular interest in medical education and trainee well-being.

She is the LTFT and Supported Return to Training Champion for the North West School of Psychiatry and the Trainee Welfare Lead at Greater Manchester Mental Health NHS Trust. She has spoken widely in the North West on how understanding systemic trauma in the NHS can help us understand how staff relate to each other. Her work includes training trainers in a range of specialties on how we can be more trauma-informed in the way we educate and supervise. She is piloting a reflective practice group for Emergency Medicine trainees to investigate if taking time out to talk about the feelings evoked in the patient-doctor relationship can improve well-being and compassion.

She was shortlisted for the Royal College of Psychiatrists’ Psychiatric Educator of the Year in 2022.

Zahra is training as a General Adult Psychiatrist (ST5) and alongside this, is in her fourth year of training as a psychotherapist in Integrative Transactional Analysis in Manchester.

She has a growing appreciation of how much the quality of our relationship with ourself and with others determines our mental, emotional and physical wellbeing- and with this, the significance of meaningfully addressing unhealthy relational patterns which cause dis-ease within us. She thinks that when we go through difficult personal experiences, compassionately listening to 'what happened to me/us' is more human and meaningful than focusing on 'what is wrong with me/us'.

Zahra is delighted to serendipitously be here at today's conference.

Dr Hannah Cappleman

Dr Zahra Patel

9.30-10.15 Wellbeing in Surgery

9.30-10.15 Wellbeing in Surgery

SPEAKERS

Mr Waqas Din

Waqas is an Otolaryngology surgical registrar, currently working as the HEE Future Leaders Programme fellow. He is also undertaking a Masters at Imperial College London in Surgical Innovation.

Waqas's interest lies in improving the workplace culture in medicine and surgery to make it a more cohesive, compassionate and kind environment. He is undertaking work looking at how enhanced modern leadership methods can improve staff well-being and patient outcomes.

He has also recently started the podcast ‘Defining your Success', in which he interviews a host of distinguished guest speakers, seeking to explore a wide range of possible responses to the question ‘what is success?'

9.30-10.15 Wellbeing in Surgery

Tasha is an ST6 ENT registrar, currently working in the North West of England, following completion of her undergraduate and foundation training in Yorkshire. She recently completed a PGCert in Postgraduate Medical Education and has been both an official and unofficial mentor since 2017.

Having been raised in Indonesia and Australia within a mixed cultural community, she is acutely aware of the importance our background plays in differential attainment.

When not planning this year’s AOT conference, you can find her skiing, desperately trying to learn Portuguese, or indulging in her next foodie trip.

9.30-10.15 Wellbeing in Surgery

Ms Anastasha Herman

Ms Nazia Munir

Miss Munir is a Consultant ENT surgeon with a special interest in Otology, Neurotology and Lateral Skull Base Surgery.

She was appointed to her post in 2012 at the Aintree University Hospital, Liverpool after undertaking advanced skull base training in prestigious fellowships in Cambridge and Toronto.

She is the Merseyside and Cheshire Lateral Skull base lead ENT clinician. She specializes in lateral skull base disorders and advanced parotid / temporal bone malignancy

11.10-11.40

Prof Simon Lloyd

Professor Lloyd is a consultant ENT surgeon at Manchester Royal Infirmary, Royal Manchester Children's Hospital and Salford Royal Hospital. He works as part of the Manchester Skull Base Unit, the Manchester Auditory Implant team and the Manchester Neurofibromatosis Type 2 team. He is also Honorary Professor of Otolaryngology at the University of Manchester.

Having qualified for his Medicine degree and first class honours degree in Biochemistry in London, he was also awarded an MPhil in Neurosciences from Cambridge University. He was trained in London and Cambridge prior to his fellowships in the United States and Denmark.

He is lead for ENT teaching at the University of Manchester. He has published over 70 peer reviewed papers and 12 book chapters. He has also edited 2 books. He was awarded prize from the Royal Society of Medicine for the best original research in ear surgery over the past 5 years. He runs an international advanced ear surgery course and a skull base surgery course.

He is currently president of the British Society of Otology and is a trustee of the British Acoustic Neuroma Association, a charity providing support for patients with acoustic neuromas.

11.10-11.40

“Ear We Go Again”

“Ear We Go Again”

SPEAKERS

Ms McClenaghan is currently the Lateral Skull Base and Cochlear Implant Fellow at Salford Royal Hospital and Manchester Royal Infirmary.

She completed her basic and higher surgical training in London. She has a special interest in medical education, specifically otology in the early training years.

Mr Freeman is a consultant ENT surgeon at Manchester Foundation Trust and Salford Royal Hospital.

He qualified from Manchester University and trained in the North West. He has undertaken advanced fellowships in Otology, Neurotology, Cochlear Implantation and Skull base Surgery, with Professor Gibson in Sydney and then with Professor Ramsden in Manchester.

He was appointed as a Consultant in May 2009. He is a core member of the multidisciplinary Balance service, the Neurofibromatosis type II service at Saint Mary’s and the Facial Function clinic at the Royal Eye Hospital. He is also part of the Skull Base service at Salford Royal Hospital.

Ms Fiona McClenaghan

Mr Simon Freeman

11.10-11.40 “Ear We Go Again”

11.10-11.40 “Ear We Go Again”

Miss Penney is a consultant head, neck and thyroid surgeon employed at Manchester University NHS Foundation Trust with outreach cancer care to patients at Tameside Hospital.

In 2018 she was successful in being promoted to Associate Medical Director at Greater Manchester cancer and is leading on several projects to ensure that anyone who is suspected of or who has cancer receives timely, high-quality care, no matter where they present in Greater Manchester. She also represents the Alliance nationally in several key areas, including perfomance

Within MFT she has recently been appointed to Group Assistant Medical Director with responsibility for Cancer Care. This is on a background of leadership across the organisation for the integration of head and neck services and as lead cancer clinician for Manchester Royal Infirmary. She is firmly committed to high quality cancer care for all who require it, irrespective of background and circumstance

Away from work she has a young daughter who keeps her busy. She also likes to play badminton and race cars (on a track).

Mr Jayaram is an ENT Head and Neck Consultant at Royal Preston Hospital, dealing with head and neck cancers, laryngology (mainly airway stenosis) and thyroid surgery.

He was trained at the All India Institute of Medical Sciences (AIIMS) New Delhi, then completed fellowships at Southampton General Hospital and Queen Elizabeth Hospital Birmingham. He was also an International Visiting Scholar at UPMC Pittsburgh. He worked as a Consultant in Birmingham and North Manchester General Hospital before moving to Preston in 2020.

He enjoys collaborating with his colleagues, Mr Arun Cardozo and Mr John De Carpentier, performing TORS for oropharyngeal cancer and endoscopic resection of sinonasal cancers, respectively. He is also passionate about education, undertaking various roles including deanery training and as Honorary Senior Lecturer at Edgehill University. He is a Principal Investigator for various head and neck trials and has published multiple book chapters and journal articles.

Ms Susannah Penney

Mr Sharan Jayaram

13.55-14.25 “Cut Throat Opinions in Head and Neck”

13.55-14.25 “Cut Throat Opinions in Head and Neck”

SPEAKERS

Dr Chris Hughes

Dr Hughes is a Consultant Clinical Oncologist at The Christie Hospital, the largest single site cancer centre in Europe, since 2022. He treats his head neck and skin cancer patients with systemic therapy, radiotherapy, proton beam therapy.

He graduated from the University of Birmingham in 2012 and completed his medical training in the North West deanery. He then completed his specialty training in Clinical Oncology in 2017 at The Christie.

Mr Goswamy is a Manchester and London trained Head and Neck Surgeon. He splits his time between Head and Neck, Airway and Paediatric ENT Surgery (70:20:10). The most enjoyable part about his working life is the teamwork that comes with Head and Neck surgery, as well as operating on a regular basis with Vascular, Thoracic and Plastic Surgeons. Being in busy teaching hospitals (Wythenshawe and The Christie) means that he gets to spend a lot of his time teaching and training, which energises him.

He first attended AOT as a CT2 and attended almost every year during training, finishing his time as the Examinations Rep which led on to becoming a permanent member of the FRCS question writing committee which appeals to his ENT geekiness.

Outside of work, he enjoys the arts and training for events – next up, Spartan Race.

Mr Jay Goswamy

13.55-14.25 “Cut Throat Opinions in Head and Neck”

13.55-14.25 “Cut Throat Opinions in Head and Neck”

Prof Nirmal Kumar

Professor Nirmal Kumar is currently Chair of the ENT UK Foundation which is the philanthropic and fundraising arm of ENT UK and was President of ENT UK (2019-2022). His full-time clinical role is Consultant ENT surgeon at WWL Teaching NHS Foundation Trust, UK where he is also Associate Medical Director.

Nirmal currently leads many National Institute of Health Research (NIHR) multi-centre trials, is FRCS (ORL) examiner of the Royal College of Surgeons and other universities in UK and abroad, former vice-chair of the Specialist Advisory Committee in otolaryngology and current council member of the Royal College of Surgeons, Edinburgh. Nirmal leads on UG and PG MCh programmes in Edge Hill University Medical School.

He has published extensively in the medical literature with greater than 200 medical publications, delivered keynote and invited presentations around the world and awarded a Gold NHS Clinical Excellence Award.

Ms Grace Khong

Miss Khong joined Alder Hey Hospital as a locum consultant in February 2021. Born and brought up in Malaysia, she graduated from Manipal University, India in 2011 and subsequently obtained early ENT surgical training in Chennai under the Diplomate of the National Board. She then pursued a short-term fellowship in Anterior Skull Base surgery at University Malaya in Malaysia before moving to the northwest in 2017. During her training here, she completed two RCS England accredited Senior Clinical Fellowships England – the Liverpool Rhinology Fellowship at Aintree University Hospital and Paediatric ENT fellowship in Alder Hey Children’s NHS Foundation Trust.

Miss Khong’s clinical interests are Rhinology and Anterior Skull Base Surgery, providing joint services with Neurosurgery, Ophthalmology, Haematology (HHT) and the Cystic Fibrosis team at Alder Hey. She is an associate editor for Clinical Otolaryngology and regularly organises regional Rhinology meetings and practical courses.

14.25-14.30 ENT UK Foundation

14.30-15.00 “Things I wish I’d known – Perspectives from New ENT Consultants”

SPEAKERS

Mr Anwar is an ENT Consultant at Salford Royal Hospital with a specialist interest in rhinology and facial plastic surgery. He is a member of the Salford skin MDT and involved with the anterior skull base service, predominantly in pituitary/CSF leak surgery.

He completed his undergraduate medical training at the University of Cambridge and University College London before returning to Manchester for postgraduate training, receiving CCT in August 2019. He then undertook fellowship training before taking up his consultant role in 2021. Whilst a trainee, he was the North West Trainee Representative and a founding sub-editor for the British Society of Facial Plastic Surgery Newsletter.

Mr Anwar is an enthusiastic trainer with an interest in medical education. He is the Trust Specialty Training Lead and his current role in the School of Surgery involves supporting senior surgical trainees to consultant positions.

Outside of work, he is a lifelong Manchester United FC fan and is kept busy by his two daughters, Zara and Ayla.

Mr Dewhurst has been an ENT Consultant at Fairfield General Hospital since 2022. He has an interest in Laryngology and Benign Head and Neck/cancer diagnosis.

Mr Bilal Anwar

Mr Sam Dewhurst

14.30-15.00 “Things I wish I’d known – Perspectives from New ENT Consultants”

14.30-15.00 “Things I wish I’d known – Perspectives from New ENT Consultants”

14.30-15.00 “Things I wish I’d known – Perspectives from New ENT Consultants”

Ms Antonia Tse

Antonia is an ENT Consultant with an interest in Benign Head & Neck and Facial Plastic Surgery. She is due to join the team at Salford Royal Foundation Trust in July 2023.

Antonia graduated from University College London and undertook surgical training in Oxford, KSS and Manchester. As a trainee, she was actively involved in education and leadership. Her roles included Secretary and Treasurer for the British Rhinological Society Juniors, AOT facial plastics and RCS (Ed) representative, BMA Regional representative, Honorary Lecturer at Edgehill University and Core Surgical & Academic Foundation Training Interview Panelist. She was also the sub-editor for the North West Research Newsletter and on the editorial team for the BSFPS Newsletter. She is part of this year’s organising committee for the BSFPS Conference that will be held in Manchester in October 2023.

Outside of work, Antonia loves to travel. She is a keen skier and an apres ski instructor!

Ms Melanie Dowling

Mel has been an ENT Consultant at Fairfield General Hospital for 6 months. She studied at the University of Manchester and has stayed in the North West after loving everything about the area (except for the weather). She has also completed a part time Medical Education Masters with the University of Manchester.

Mel’s job is a mix of General ENT, Thyroid surgery and Paediatric ENT. She has recently been the appointed joint Clinical Lead for Children and Young Peoples Greater Manchester recovery programme.

14.30-15.00 “Things I wish I’d known – Perspectives from New ENT Consultants”

SPEAKERS

Mr Rajiv Bhalla

Raj is a Consultant Rhinologist and Skull Base Surgeon at Manchester Royal Infirmary and Salford Royal Hospital. His interests are rhinoplasty, sinus and skull base surgery, education and training.

He is an Honorary Senior Lecturer with the University of Manchester, Immediate Past-President of the British Rhinological Society, was Chair for Courses and Simulation with ENT UK, and is on the Councils of ENT UK, the Royal Society of Medicine, and the British Society of Facial Plastic Surgery.

He organises and hosts a number of training courses each year for all stages of ENT clinician, attracting national and international participants. He was Academic Co-Chair for BACO 2018. With his neurosurgical partner, Raj runs one of the busiest endoscopic anterior skull base services in the UK, affiliated to the Manchester Skull Base Unit.

Ms Archana Jaiswal

Ms Jaiswal is a Consultant ENT Surgeon and Rhinologist at the Manchester Royal Infirmary. She is a member of the Manchester Anterior Skull base Program at Salford Royal Foundation Trust. She is also an Honorary Senior Lecturer at the University of Manchester.

Graduated from the University of Leeds in 2001, she stayed on in Yorkshire to complete her early surgical training, moving to Manchester for her higher surgical ENT training and completed it in 2015. Shethen undertook fellowships at Guys and St Thomas’s Hospital in London and at the University of Alberta, Canada.

She has a passion for both undergraduate and postgraduate teaching with educational roles at the University of Manchester and Health Education Northwest. She also provides pastoral care for the ENT trainee doctors at the Manchester Royal Infirmary in her capacity as clinical lead for junior doctors.

15.15-15.45 “Who Nose Best?”

15.15-15.45 “Who Nose Best?”

15.15-15.45 “Who Nose Best?”

After Dinner Speech

Mr John De Carpentier

As an ENT Surgeon in Preston and Chorley since 1996, originally appointed to perform Head and Neck surgery, he developed his Rhinology practice to the point where he is now primarily a rhinologist and skull base surgeon.

His clinical skills have been complemented by an ability to effect change within the seemingly immovable NHS by a combination of providing solutions for patients to management and inspiring collaborative work with expanded nursing roles and between specialties, securing millions in grants directly from NHS England and raising the profile of ENT.

His time now is spent in the skull base MDT working with neurosurgeons, the head and neck MDT dealing with sinus and skull base malignancy, delivering a tertiary rhinoplasty service, being an innovator in local anaesthetic surgery ranging from balloons to pituitary surgery, reorganizing service delivery to assist COVID-recovery and having a modest private and medicolegal practice.

Mr Samit Ghosh

Mr Ghosh is an ENT Consultant at Fairfield General Hospital. He is also the TPD for ENT North West.

11.00-11.10 Otolaryngology

Training Update

15.15-15.45 “Who Nose Best?”

ORAL ABSTRACTS

1. The Role of a Mobile Hearing App in Secondary Care ENT (HAppENT)

Suleman MT, Thompson G, Abdelhamid A, Khudan A, Dobbs S, Salem OM, Khwaja S. Manchester University NHS Foundation Trust

Background: Hearing loss is a very common presentation to both the ENT outpatient and emergency settings. From our experience, there can be a delay of many weeks for a formal manual audiometry, thus, often leading to empirical treatment without formal testing for sudden sensorineural hearing loss (SSNHL).

Objectives: We assess whether hearTest™, a mobile tablet based hearing test, could be used in the ENT secondary care setting to assist clinical decisions. We conducted a multi-centre, prospective, non-randomised study, between October2021 and December 2022, to assess the feasibility, usability and accuracy of hearTest™. Outcome measures: Our primary outcome measure was qualitative data from patients and clinicians regarding their experience on the use of hearTest™. Secondary outcomes were quantitative data on the accuracy of hearTest™ compared to formal audiological assessment via pure tone audiogram (PTA).

Results: In this study, We included a total of 51 participants, providing 102 hearTest™ results. 6 clinicians were recruited to the study. HearTestTM has shown to be an acceptable method of testing for hearing loss by both patients and clinicians. Between 500Hz-4kHzthere was an average clinical agreement rate of 95.1%, when compared to PTA, regarding it accurate in diagnosing hearing loss.

Conclusion: From the results, we propose HearTestTM can be used within secondary care when formal manual audiometry is not available to diagnose hearing loss, including guiding diagnosis and management for SSNHL, such as currently use in our practice.

2. A review of paediatric parathyroidectomies for sporadic primary hyperparathyroidism (PHPT) from the United Kingdom Registry of Endocrine and Thyroid Surgeons (UKRETS)

Embury-Young Y, Jackson S, Brennan L, Aspinall S, Stechman M, Balasubramanian S, Kim D, Ishii H. University Hospital Bristol and Weston NHS Trust

The United Kingdom holds the largest registry of paediatric parathyroidectomy cases globally. Gold standard treatment for paediatric PHPT is parathyroidectomy. There are currently no quoted acceptable cure or complication rates in the literature for paediatric sporadic PHPT.

The aim of this study was to evaluate the efficacy and safety of first-time parathyroidectomy for sporadic PHPT in the paediatric population (<18 years old) through analysis of the UKRETS database (2000-2022). Pre-, intra- and post-operative outcomes were assessed and analysed. Any incomplete datasets were excluded. 143 cases underwent parathyroidectomy;56.6% (81/143) bilateral neck exploration (BNE) and 43.4% (62/143) targeted parathyroidectomy (tPTx). 69.2%(99/143) were female, with mean age 9 years (Range 0-17). Ultrasound was the single most utilised imaging modality (85.3%; 122/143). On average more glands were removed (1.4) during BNE compared to tPTx (1.0)(p<0.05). Fewer glands were removed (1.0) during image-positive tPTx compared to image-negative tPTx (1.5)(p<0.05). Intraoperative parathyroid hormone monitoring was utilised in 31.8% overall (42/132); 32.9% during BNE (25/76) compared to 30% of tPTx (17/56) (p=0.76). Cure was 100% in tPTx versus 96.9% in BNE (p=0.23).Cure was 100% following BNE with ioPTH versus 95.5% without (p=0.36). Cure following image-negative BNE was 100% versus 94.7% in image-positive BNE (p=0.23). Complications were observed in 12.6% overall, with hypocalcaemia being the most common (9.1%). This large (n=143), multicentre national review demonstrates that first-time parathyroidectomy for sporadic PHPT in paediatric patients is effective (cure 98.2%) and safe(complication rate 12.6%), regardless of surgical approach or pre-operative imaging findings.

3. The origin of the Boyle-Davis gag: Boyle or Davis?

Alexander T, Williams SP, De Carpentier JP.

Royal Preston Hospital

What is now commonly known as the Boyle-Davis gag is a specialised instrument utilised by otolaryngologists, dental and maxillofacial surgeons to visualise the oropharynx during operative procedures. Its most common use in current practice is during tonsillectomy.

As with many surgical instruments, it was far from the first piece of equipment to be deployed for its role and there exists a number of what could be considered direct precursors to the gag now in common contemporary use. Indeed, such equipment was often required to assist in the delivery of inhalational anaesthesia. Early descriptions of the Hartman gag show an ergonomic similarity to current equipment, though it was the early twentieth century when a series of different mouth gags were proposed in a succession of publications.

In this presentation we will embark on an etymological journey and recount the development of what is now known as the Boyle-Davis gag. We will begin with its precursor, the Hartman gag, through initial modifications by Edward C. Sewall and taking a particular focus on the subsequent work of the American Anaesthetist, S. Griffith Davis who was championed by his friend and colleague Harvey W. Cushing. Finally, we will explore the role of the British Anaesthetist Henry E. G. Boyle who played a pivotal part in the widespread adoption of this gag but perhaps a contentious one in terms of naming rights, as we delve into the history of equipment used so routinely in Otolaryngology.

4. The Head and Neck clinic, optimised for patients and trainees

Sarwar S, Goswamy J.

Manchester University NHS Foundation Trust

Introduction: Patients referred on a ‘suspicion of head and neck cancer’ pathway require timely assessment, appropriate investigation, and the time to diagnosis, step down or treatment to be minimised. The secondary function of a clinic is training, in an environment optimised for learning.

Methods: A traditional clinic is run with each clinician working in a silo with trainees opting whether or not to discuss patients with the consultant lead for the clinic. We audited this technique for time on the diagnostic pathway and then time to definitive management. The new clinic involved the consultant at the centre, rotating room to room reviewing and meeting every patient following their initial assessment by senior and junior trainees, advanced nurse practitioners, Macmillan nurses and medical students. The audit cycle was completed.

Results: The number of patients seen in each clinic was doubled. There was a 42% increase in the rate of discharge after the first appointment. 49% of patients were stepped down at their first appointment. The time to definitive management decreased from 66 to 46 days. Trainee engagement and enjoyment of the clinic was assessed and improved.

Discussion: The results indicate that this model of working, subject to there being sufficient members of the team in clinic, improves time on the pathway, time to diagnosis and time to treatment whilst improving team cohesion and learning opportunities. Every encounter is potentially a case-based discussion and allows the consultant to have a greater understanding of the strength and areas for development within the team.

5. Facial Analysis Using Machine Learning: A Promising Tool for the Identification of Congenital Syndromes with Ear, Nose or Throat Involvement

Fatoum

H, Coyle P, Sharma S, Bhargava E. East Midlands Deanery

Background: Congenital syndromes affecting the ear, nose, and throat often present with dysmorphic features that can be difficult to identify or distinguish, especially in neonates and children. The early and accurate diagnosis of these syndromes is critical to improving patient outcomes. Artificial intelligence (AI) has revolutionized medicine in recent years, particularly in specialties such as radiology, cardiology, emergency medicine, and genetics. Machine learning algorithms have proven effective in analysing various data types, including medical images, to predict outcomes, identify conditions, and guide diagnoses. This study aimed to evaluate the accuracy of a machine learning algorithm in identifying congenital syndromes using facial analysis. Methods: We used textbook images of congenital syndromes involving the ear, nose, and throat from "Smith's Recognizable Patterns of Human Malformation" and the 'face2gene' (F2G) algorithm, which has been trained on thousands of images and validated across multiple specialties.

Results: The algorithm correctly identified 85% of the 15 common syndromes analysed, although two syndromes lacked frontal images. Among 17 less common syndromes, the F2G algorithm identified 59% of cases correctly as their top diagnosis, with 29% of cases incorrectly identified. One image could not be analysed.

Conclusions: These findings suggest that facial analysis with a machine learning algorithm such as F2G may be a useful tool for identifying congenital syndromes with ENT involvement. However, the algorithm's accuracy may be lower for less common syndromes due to its training. Future studies should evaluate the algorithm's performance on a larger dataset and assess its potential for clinical use.

POSTER ABSTRACTS

1. Time of Delivery of Topical treatments in inpatient ENT conditions

Suleman MT, Siau D.

Topical treatments are commonly used for inpatients ENT conditions. Their use is recommended by NICE guidelines for conditions such as otitis externa and sinusitis. Their use often in combination with medications via alternate routes, provide expedited symptomatic relief and prognostic benefit. We aimed to look at the time to delivery of topical medications for inpatients presenting with common ENT conditions. This was a retrospective single-site study. Data was collected on patients admitted with otitis externa, sinusitis, peri-orbital cellulitis and post-tonsillectomy bleeding between September 2022 and December 2022. Demographic data, including age at admission and gender, and medication prescriptions data, including drug, time of prescription, and time given, was obtained from electronic patient records. 31 topical treatments were prescribed over a 4 month period for otitis externa, sinusitis, periorbital cellulitis and post-tonsillectomy bleeding in 18 patients. 13 out of 31 medications were not given during the inpatient stay. For the 18medications given, the average time was 19 hours resulting in a total of 30 missed doses. Our results demonstrate that there is often a delay in administration of topical medications due to lack of availability in the ward and A&E department. We recommend that commonly used topical treatments in ENT conditions arekept in the A&E department and as ward stock. The presentation will include a closed loop cycle following the introduction of topical medications to ward stock.

2. A review of paediatric parathyroidectomies for familial primary hyperparathyroidism from the United Kingdom Registry of Endocrine and Thyroid Surgeons (UKRETS).

Embury-Young Y, Jackson S, Brennan L, Aspinall S, Stechman M, Balasubramanian S, Kim D, Ishii H.

The United Kingdom holds the largest registry of paediatric parathyroidectomy cases globally. Gold standard treatment for paediatric PHPT is parathyroidectomy. There are currently no accepted cure or complication rates in the literature for paediatric familial PHPT. This study aimed to evaluate the efficacy and safety of first-time parathyroidectomy for paediatric (<18 years old) familial PHPT through analysis of the UKRETS database(2000-2022). Pre-, intra- and post-operative outcomes were analysed. Any incomplete datasets were excluded. 25 cases underwent parathyroidectomy; 88.0% (22/25) bilateral neck exploration (BNE) and 12.0% (3/25)targeted parathyroidectomy (tPTx). 68.0% (17/25) were female, with mean age 14 years (range 1-17). Ultrasound was the most utilised imaging modality prior to BNE (50%; 11/22) whereas nuclear medicine (NM)predominated in tPTx (100%; 3/3). On average 2.8 glands were removed in BNE versus 1.3 glands in tPTx(p=0.06). On average 2.2 glands were removed in image-positive BNE versus image-negative BNE (Mean 3.2)(p=0.05). Intraoperative parathyroid hormone (ioPTH) was utilised in 16.0% (4/25), and used more in tPTx(66.6%; 2/3) versus BNE (9%; 2/22) (p<0.05). Cure was 100% following tPTx versus 88.9% following BNE(p=0.54). Cure without ioPTH in BNE was 93.8% versus 50% with ioPTH use (p=0.06). Cure in image-negative BNE was 90.9% versus 85.7% in image-positive BNE (p=0.73). Complications were observed in 52.0%, all in BNE, with the most common being hypocalcemia (32.0%). This multi-centre national review demonstrates that first-time parathyroidectomy for familial PHPT in paediatric patients is highly effective. However, the notable complication rate is important in consenting patients’ parents.

3. What's the buzz about? An unusual case of unilateral pulsatile tinnitus

Kennett J, Shahidi S, Fashtali S, Osei-Lah V.

Pulsatile tinnitus is a relatively rare form of tinnitus, affecting less than 10% of patients who present with chronic tinnitus. It also has a broad differential which can generally be divided into non-vascular or vascular causes. In this case report we describe an interesting cause of unilateral pulsatile tinnitus in a 90 year old lady.On a background of bilateral moderate sensorineural hearing loss(current ITE user) but nil other relevant past medical history the tinnitus was initially noted after a fall with a head injury. As part of the investigation for the cause of this the tinnitus she had a CT of her petrous bones and head and neck with contrast which revealed a medialised common carotid artery present in the midline up to the retropharyngeal region posterior to the posterior pharyngeal wall, at which point it bifurcates. On discussion in the MDT it was felt that the unilateral pulsatile tinnitus could possibly be explained by combination of moderate-to-severe spine degeneration due to ageing, along with atherosclerotic changes to the right carotid along its unusual path. No further investigation or changes to management was proposed. Whilst it has been described in the literature that the carotid artery can have a highly variable course in the neck this is an unusual variant which has not previously been implicated as a cause of pulsatile tinnitus

POSTER ABSTRACTS

4. Can Chat GPT pass

FRCS-ENT?

Khatoon M, McNally G, Manjaly J, Ghosh S.

Background: The FRCS-ENT exam is a prestigious, internationally recognised qualification and a requirement for completion of ENT Training in the UK. ChatGPT is an artificial intelligence large language model that generates unnervingly human-like and contextually appropriate responses to a vast array of questions. Thisstudy evaluated the ability of ChatGPT to pass the viva section of FRCS-ENT. Methods: ChatGPT was presented with four viva stations each from a different ENT subspeciality. The standardised scenarios were taken from anFRCS-ENT textbook and all sub questions were entered verbatim into ChatGPT without additional contextualisation. The answers were assessed with the marking criteria used for human candidates, covering four areas: basic knowledge, higher order processing, clinical skills and professionalism. The maximum score for each station is 8, with a score of 6 needed to pass. Results: ChatGPT passed three viva stations on laryngomalacia, septal perforation and sudden sensorineural hearing loss with scores of 7, 6 and 7 respectively.The AI model failed a station on thyroid nodules scoring 5. Professionalism was difficult to assess, but empathy, team-working and psychological support was evident. Limitations included higher order thinking,data interpretation and referencing. Conclusion: Artificial intelligence is already playing an increasing role in our healthcare, but may also alter the way we approach medical education. As ChatGPT and other AI models advance further, immediate factual recoil by humans may become obsolete. This highlights the importance of developing exams that stretch our own intellectual capabilities and evaluate the nuances of advanced communication skills, clinical judgement and higher order thinking.

5. BiZact tonsillectomy: A quality improvement project with 333% theatre efficiency improvement Hatfield T, Marsh E, Wilkinson S, Sahota B.

Intro Tonsillectomies are one of the most common surgical procedures, with approximately 40000 performed yearly across the UK. Frequently employed techniques include cold steel, bipolar, and coblation, each having its own merits and drawbacks. Aims In this QIP, we sought to improve efficiency of theatre usage by increasing the throughput of tonsillectomy patients without compromising patient safety or increasing complications.Methods Over the year, we have progressively introduced the use of BiZact: a vessel-sealing device designed for tonsillectomy. BiZact has been validated in international randomised and prospective studies to have comparable or favourable rates of perioperative bleeding, post-operative pain and operative time. Results In comparison with conventional technique tonsillectomies, we have improved operative time by 70.9% (40m:30s– 11m:48s), with average “time-on-tonsil” of just 4m:11s for bilateral tonsillectomy. This has been achieved with a comparable post-operative bleeding and readmission rate. With proven safe implementation and time improvements, we have implemented protocol changes with the support of the anaesthetic and daycase teams, in the creation of specific High Intensity Tonsil Surgery lists. These have proven the ability to perform 10 tonsillectomies in a half day list, in comparison to the conventional system which would have 3. By utilising one theatre, with two rotating teams, the list output can be almost quadrupled, with less than double normal staffing. Conclusion We have successfully introduced the use of a novel surgical device allowing dramatic increases in efficiency and the creation of High Intensity Tonsil Surgery lists with 4x the output and no increase in complications.

6. Laryngeal Dysplasia - A Study on Adherence to Current Follow-up Recommendations

Shariff F, Jain S, Marinakis K.

Background Within the UK, laryngeal cancer is diagnosed around 2,300-2,400 times per year, with an incidence of 2.9 per 100,000 of the population. Laryngeal dysplasia, the premalignant precursor to laryngeal cancer, has been reported to have a malignant transformation rate of 14%. In 2010, a consensus statement on the management of laryngeal dysplasia patients was published and was later adapted into a flowchart. Thisstudy aims to assess current adherence to the flowchart and improve adherence by way of departmental education. Methods A single-centre snapshot analysis was undertaken to ascertain adherence to established recommendations. All patients under the care of the Head and Neck team at the time of writing were included.Results 27 patients were included in the study. Overall adherence to recommendations was 85%. Two patients(7.4%) were not documented to have received reflux prophylaxis. One patient (3.7%) was seen at five months in year 3 post-excision, and one low-risk patient (3.7%) was seen at 7 months in year 1 post-excision.Discussion Whilst adherence to current recommendations was good, there is room for optimisation. Awareness Of current recommendations should be enhanced by departmental education, and the availability of the recommendations flowchart within clinical areas. The reasons for omission in the criteria noted were unclear,and thorough documentation should be encouraged. Conclusion Current guidance based on the consensus statement is generally well followed, however, adherence can be optimised by way of departmental education.

7. Complex multidisciplinary team (MDT) management of intentional sulphuric acid ingestion in a 36 year old male.

Kazemi N, Bola S.

We report the case of a 36-year-old male, who intentionally consumed sulphuric acid following a dispute with his spouse, intending to end his life. He was found to have extensive full thickness grade burns involving the respiratory and gastrointestinal mucosa, posing a high risk of perforation. Consequently, an esophagogastroduodenoscopy was not conducted, and the patient was sent home with a naso-jejunal feeding tube, with plans to re-evaluate surgical intervention after twelve months. However, the patient was readmitted two months later due to worsening dyspnoea. At this point, it was discovered that he had significant remodelling of the oropharyngeal and laryngeal structures, leading to progressive airway obstruction,requiring an emergency tracheostomy under local anaesthesia. During his care, the patient demonstrated a lack of understanding about the severity of his injuries and repeatedly failed to comprehend that there were no curative options for his current condition. This included cultural concerns from the patient about having a"hole in the neck." Despite discussions about the limitations of surgery, the patient refused to accept this and believed that the consequences of his injuries could be surgically corrected, allowing him to eventually eat,drink, and breathe normally again. This ultimately led to a mental health decline, refusal to cooperate withtracheostomy training and concerns about further suicide attempts and safeguarding his children. Numerous multidisciplinary teams were involved, including general surgical and ENT teams, mental health professionals, gastroenterologists, intensivists, dieticians, speech and language therapists. We outline the intricate management of his acute and chronic sequelae.

8. A Literature Review of Whiplash Pathophysiology and Tinnitus, and its Impact on Quality of Life Post Injury

Jaroenchasri R, Walijee H.

Background: Whiplash-associated disorder (WAD) is common in the UK, with 50% of patients experiencing residual symptoms beyond 3 months post injury. Tinnitus, amongst other otological symptoms, have been described in patients with WAD. There are many theories to explain the development of tinnitus. However, the pathophysiology underlying whiplash injuries and tinnitus remains poorly understood. Regardless of the cause,tinnitus is known to have a significant impact on patients’ quality of life. Methods: A comprehensive literature search of electronic databases was undertaken with key words ‘whiplash’, ‘tinnitus’, ‘neural injury’, ‘auditory radiation’, ‘quality of life’; in an attempt to summarise the published hypotheses of the pathophysiological mechanisms of tinnitus following whiplash injury and its impact on quality of life. Conclusion: There is research evidence to support that tinnitus is related to neural injury of peripheral and/or central auditory processing pathways. Therefore, providing a theoretical basis to explain that axonal tearing from acceleration-deceleration injuries could lead to development of clinical symptoms relevant to injured neural tracts.However, the evidence to describe this direct causative link of neural injuries as a consequence of whiplash is still lacking. There are mixed reports of whether whiplash causes injury to the auditory radiation. This is likely due to the complex and heterogeneous nature of the injury and neuro-pathophysiology of the presentation. At present, there are few literatures on the specific effect of tinnitus on quality-of-life post injury. The recurring conclusion is to adopt a holistic and patient-centred approach when managing tinnitus post whiplash injuries.

9. Sensitivity and specificity of MRI in the diagnosis of Meniere’s disease.

Edwards M

Introduction: Ménière's disease (MD) is a disorder of the inner ear that is characterised by vertigo, tinnitus, and sensorineural hearing loss. Although MD remains a clinical diagnosis, contrast magnetic resonance imaging(MRI) may play a role in the future. This study aims to assess the sensitivity and specificity of the reported grading systems, and variation of MRI techniques reported. Methods: A systematic literature review was conducted on PubMed for studies reporting MRI findings in patients with MD. Studies were assessed for technical aspects such as MRI machine model, MRI head coil number, scan times, contrast dose, and evaluators. The sensitivity and specificity of Bernaert's, Nakashima's, and SURI grading scales were reported.Results: Eleven studies were selected for evaluation. The sensitivity and specificity of Bernaert's (0.69-1, 0.71-0.97), Nakashima's (0.8-1, 0.44-1), and SURI (0.36-1, 0.44-1) grading scales varied greatly. There was a significant variation in the technical aspects, with 6 models of MRI machine used. The number of MRI head coils varied (8-32), which directly impacted image quality, validity, reproducibility, and inter-study comparison. Although all evaluators of the MRI images were stated as blinded to clinical data, there was variation in scan times. Finally,there were four different contrast doses utilised. Conclusion: The 3 scales have demonstrated varying degrees of sensitivity and specificity in the identification of MD. There remains no consensus on the technical aspects ofMRI studies in patients with MD, including the diagnostic criteria, contrast dose or administration route, MRI head coil number, or technique used.

10. A Closed Loop Audit of Otitis Externa Management in Primary Care: Are We Over-Prescribing Oral Antibiotics?

Nordin MN, Dranova S, Goddard N, Robson T, Verkerk M, Grammatopoulou V.

Aim: The NICE Clinical Knowledge Summary (CKS) strongly recommends against the use of systemic antibiotics for uncomplicated Acute Otitis Externa (OE), unless there is extension outside the ear canal. From our initial audit cycle, over prescription of oral antibiotics for OE continues to be an issue. In this study, we aim to compare the assessment and initial management of OE referred to our Emergency Clinic, against an acceptable standard. Method: Retrospective analysis of a single cohort; adults (16 years and above) with OE with or without Pinna Cellulitis, Necrotising Externa or concurrent Otitis Media, who were referred to our Emergency Clinic, were included. Three cycles of analysis were done, with interventions introduced in between cycles. Interventions include distributing electronic and physical infographic summary of NICE CKS guideline in OE management, and delivering a targeted teaching to GP trainees during the GP Regional Teaching Day. Results: The percentage of patients who had ear swabs taken for culture and sensitivity by the GP improved from 21%(first cycle) and 14% (second cycle) to 30% in the third cycle. The percentage of patients who receive inappropriate oral antibiotic improved from 33% (first cycle) and 52% (second cycle) to 22% in the third cycle.Conclusions: Interventions implemented led to positive outcomes; better practice of taking ear swabs by theGP during initial treatment failure, and reduction in rate of inappropriate oral antibiotics given for OE. Continuous guided training and teaching are essential to ensure a high quality practice in assessing and managing OE in primary care.

11. A multi-centre cohort study describing the presentation and management of patients with cocaine induced vasculitis.

Benshetrit G, Pendolino L, Navaratnam A, Kuchai R.

Background: It is well known that cocaine insufflation can lead to local tissue destruction of the nasal septum and rhinitis. In rare cases of prolonged recreational cocaine use can lead to a positive ANCA sensitivity of serology indicating the development of a vasculitis type picture. Current data is limited to small case series and the disease characteristics are poorly understood. The aim of this study is to provide an understanding of the clinical, radiological and serological manifestations of disease in cocaine induced vasculitis and review treatment. Methods: A retrospective review of patients attending one of three tertiary centres (Hammersmith,Royal Brompton and RNTNE Hospitals) for treatment of their cocaine induced vasculitis. Data was collected by a named collaborator at each site and inputted onto a central database for analysis. Results: In total there were47 patients with cocaine induced vasculitis with a mean age of 42 years old. Septal perforation (59%) and nasal crusting (43%) were the most common clinical presentations, and septal perforation was most common finding on Cross sectional imaging (80%). Disease extent was generally limited to the sinonasal cavity,although 1 patient (2%) had multiorgan involvement. At initial presentation 71% of patients had positive ANCAserology which was primarily PR3+/MPO -ve (97%) on immunofluorescence. Conclusion: This study is the largest case series on cocaine induced vasculitis to date. It provides clinicians with an overview of the clinical findings and management options of patients presenting to a rhinology clinic with the disease. Multidisciplinary involvement in treatment is key.

12. Closed Loop Audit of Post-operative Documentation in Head and Neck Surgery

Parihar

S, Aurora F, Miller-Molloy G, Padgett J, Surwald CJ.

Aims: The purpose of this audit was to assess the compliance of the OMFS department with regard to post-operative documentation for patients undergoing head and neck surgery. By ensuring accuracy, consistency,and reliability in our documentation protocols, we aimed to improve overall patient care. Methodology: InRound 1, we collected retrospective data by reviewing the patient documentation of 28 individuals who underwent head and neck surgery between May 19, 2019 and May 18, 2020. Specifically, we analysed wardround entries made during the first three days after surgery, and compared them to the record-keeping guidelines set forth by the Royal College of Physicians. We noted any areas where our documentation fell short of national standards, and developed a proforma to target these inefficiencies. Our proforma was designed to be simple and user-friendly, with a focus on improving the documentation of free flap procedures.We implemented this proforma in our department for a period of three months before re-auditing. For Round2, we collected retrospective data by reviewing the patient documentation of 11 individuals who underwent head and neck surgery between September 16, 2020, and December 4, 2020. Results Our findings demonstrated a significant improvement in the documentation of ward round notes for head and neck surgical patients in 9 separate parameters including drain volumes, nutrition, mobilisation and donor site. Conclusions:Our findings demonstrated that as a result of implementing our proforma we were able to achieve a significant improvement in overall documentation and a higher standard of medical record-keeping.

13. Feasibility and acceptability of Smokerlyzer® devices in Head and Neck cancer clinics: a pilot study

Zhou M, Crossley E, Leroy C, Niziol R, Oakley R.

Background: Head and neck cancer incidence is expected to rise, with smoking as a significant risk factor.Smoking cessation is especially important in patients with previous laryngeal dysplasia or cancers. We hypothesised that using a Smokerlyzer® device to measure carbon monoxide levels (ppm) during Head andNeck cancer appointments could act as an objective measure to reinforce smoking cessation for patients.Methods: All patients with a self-reported smoking status attending the lead author’s Head and Neck Cancer clinic from November 2022 onwards were invited to provide a Smokerlyzer® measurement. Data including demographics, clinical diagnosis and carbon monoxide level were stored and analysed on a password-protected Microsoft Excel spreadsheet on a Trust computer. Results: As of March 2023, a total 36 patients with a mean age of 56.78 (range 25–77) consented to provide Smokerlyzer® measurements. Self-reported number of cigarettes smoked daily averaged at 11.28 (range 0-25). Thirty-five of the 36 patients performed theSmokerlyzer®, with an average score of 14.91ppm (range 1–51 ppm). Smoking cessation referral was offered to all patients, and 34 (94.44%) accepted the referral. These patients were frequently diagnosed with cancer(30.56%) and laryngeal dysplasia (19.44%). Discussion: Challenges include time barriers in clinic, safe-keeping of Smokerlyzer® devices, and costs of disposable device mouthpieces. This pilot study has demonstrated acceptability to patients and feasibility for staff. Provisional results suggest that this pilot has further encouraged the clinical team to encourage smoking cessation with patients, representing improved health promotion and intended reduction in the risk of malignancy.

14. A National Survey of the Diagnosis and Management of Ménière’s Disease amongst ENT Consultants, UK Parihar

Introduction Ménière's Disease (MD) is a rare condition whose diagnosis can be challenging. The AmericanAcademy of Otorhinolaryngology-Head and Neck Surgeons (AAO-HNS) criteria are commonly used for diagnosis, but its criteria for "Definite" and "Probable" MD are vague. We surveyed UK ENT Consultants to assess national practices on the diagnoses and management of MD. Methods An online questionnaire was distributed in the UK over four weeks. The questionnaire asked respondents to anonymously rank their confidence in diagnosing MD, identify the minimum investigations required to make a diagnosis, describe their use of AAO-HNS criteria, share their preferred treatment for acute attacks, and state first and second-line preventative treatment options. Results 86 responses were collected. 88% of respondents reported high levels of confidence in diagnosing MD. Most respondents (29.1%) stated the minimum tests required were “history”, “otoscopy”, “pure tone audiometry”, and “MRI” although some chose as few as one test (3.49%) or up to seven(1.2%). Regarding the use of the AAO-HNS criteria, responses ranged from “always” (34.9%) to “never” (20.9%).Prochlorperazine was the first-line treatment for acute attacks for 81.4% of respondents. Betahistine (38.4%)and dietary restrictions (37.2%) were recommended almost equally as first-line preventative measures. The most popular second-line measure was intratympanic steroids (34.9%), followed by betahistine (24.4%) and diuretics (9.3%).

Conclusion Our survey revealed wide disparities in the UK's MD diagnoses and management,indicating a pressing need for more precise guidelines. We intend to conduct a similar international survey to gather a broader perspective on MD practices.

15. A re-audit of the imaging protocol of Pulsatile Tinnitus at Portsmouth Hospitals Trust

Jain C, Chessman R, Pringle

Pulsatile tinnitus (PT) is a rhythmic internal sound heard in one or both ears without an external stimulus. There is no standardised first-line imaging for PT and no cause is found on the majority of scans. Some studies have shown a single CT is an appropriate investigation in these patients.(1) The Portsmouth CT pulsatile tinnitus protocol (contrast-enhanced CT scan of head and neck) was developed in 2008 for investigation of patients with PT within the Trust. Second cycle audit to evaluate 1) whether PT protocol was adhered and 2) the rate of diagnosis of identifiable causes of PT on CT. Method: We evaluated 222 patients with PT who underwent imaging between February 2020 and March 2022. Majority (66%) of clinicians are using the CT pulsatile tinnitus protocol as their first line imaging investigation for patients with only pulsatile tinnitus. Only15% of scans picked up a definite abnormality which could account for symptoms (in comparison to 21% in the previous audit). This reduces to 6% when the patient has no symptoms other than PT. Majority of clinicians are still using the CT PT protocol as their first line imaging investigation for patients with PT. The rate of positive findings on imaging seems to be slightly less that documented on the previous audit. This protocol still seems to be a relevant imaging option that can help to reduce radiology scanning time within the Trust.

S, Koumpa FS, Neumann C, Kanegaonkar RG

POSTER ABSTRACTS

16. Is Unilateral Tonsillar Enlargement (UTE) indicative of Lymphoma in children?

Soni A, Verma R.

Background Unilateral Tonsillar Enlargement (UTE) is a common paediatric presentation in ENT but may indicate Lymphoma so clinicians may elect to perform tonsillectomy for histology. However, Lymphoma is unlikely to present with UTE in the absence of B symptoms or an atypical presentation. Furthermore,tonsillectomy carries risk of bleeding. However, delayed diagnosis of Lymphoma is a worse outcome. This cross-sectional survey and literature review evaluated the diagnostic yield of tonsillectomy for histology and associated complications. Methods Literature search: existing literature was reviewed between 1992 and 2022 using relevant keywords to determine risks of Lymphoma in this setting. Survey: Data was collected from 146UTE patients who underwent tonsillectomy over a 6-year time-period at a tertiary Paediatric unit. ResultsLiterature search: 15 papers were identified. These concluded that malignancy is rarely found in patients without B-type symptoms or atypical presentations. Additionally, clinical judgement of asymmetric tonsils is often incorrect, and many referrals are not true UTE. Survey: There were 2 cases of Lymphoma (1.37%). Both had atypical presentations where UTE was not in isolation. There were 5 post-operative bleeds (3.42%) and 1 episode of uvular swelling which caused an obstructed airway and 1 episode of night terrors due to general anaesthetic giving an overall complication rate of 4.79%. There were no deaths. Conclusions Refinement of inclusion criteria for tonsillectomy for histology will increase the procedure’s diagnostic yield. We recommend it be reserved for patients with a strong clinical indication of malignancy (atypical presentation, B symptoms) to avoid causing unnecessary postoperative complications.

17.

Background Silent sinus syndrome is a rare condition that typically affects the maxillary sinus. A narrowed or blocked sinus drainage pathway leads to persistent hypoventilation of the sinus cavity creating negative pressure. This draws in the sinus cavity walls and leads to chronic opacification with atelectasis causing eventual sinus collapse. This report describes a previously undocumented case of facial asymmetry due to left frontal silent sinus syndrome following multiple childhood nasal injuries. Case History A 23-year-old male with no past medical history presented with unilateral nasal obstruction and deformity. He sustained multiple nasal injuries as a child, undergoing manipulation under anaesthetic of his nasal bones at 4 years old. Onexamination, there was right-sided deviation of his nasal bones, marked facial asymmetry with left sided hyperglobus and enophthalmos, despite no visual disturbance. Nasendoscopy revealed a significantly deviated nasal septum to the right. Computed tomography reported symmetrical maxillary sinus volumes with a hypoplastic and collapsed left frontal sinus. Open septorhinoplasty was performed with postoperative resolution of his cosmetic and functional nasal deformities. Conclusion This unique case describes left frontal silent sinus syndrome causing ipsilateral hyperglobus and enophthalmos with an associated right sided nasal septal and bony deviation. Significant nasal deformity as a child may have led to chronic obstruction of his frontal sinus drainage pathway creating negative pressure and eventual sinus collapse. In conclusion, silent sinus syndrome may rarely affect the frontal sinus and should be considered in otherwise asymptomatic patients with facial asymmetry and upwards displacement of the ipsilateral orbit.

18. Exploring Implicit Bias among ENT Surgeons: An Analysis of the Implicit Association Test Shah-Altaf Z, Miu K, Rainford D, Hopkins C, Surda P.

Objectives: The study aimed to investigate the presence of implicit bias among ENT surgeons and explore the impact of the results of the Implicit Association Test (IAT) on the surgeons' behaviour towards patients. Methods: 7 non-BAME ENT surgeons were asked to complete the IAT. The surgeons also completed a survey about their perceptions of their implicit biases and the impact of the IAT results on their behaviour towards patients. Results: The mean IAT score for the ENT surgeons suggested a slight preference for White over Black. Furthermore, 42% of the surgeons thought they had hidden/unconscious racial bias, 42% said they would change their behaviour towards patients after receiving these results and 85% thought that the IAT was helpful for appraisal. Conclusion: The results suggest that non-BAME ENT surgeons may have implicit biases towards Black patients. These findings highlight the need for interventions to reduce implicit bias among ENT surgeons and improve healthcare outcomes for marginalised populations.

Silent Sinus Syndrome of the Frontal Sinus Khatoon M, McNally G, Ghosh S.

19. Can you hear me? A single centre assessment of the management of SSNHL

Rai A, Oktay L, Pankhania R, Bartram J.

BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is an unexplained hearing loss of 30 decibels or more over a minimum of three consecutive audiometric frequencies within 72 hours. Whilst SSHNL is a relatively common presentation in UK ENT departments, there remains considerable heterogeneity in assessment and management. AIMS: To compare the management of patients with SSNHL to the ENT UK guidelines. METHOD: The management of patients who presented with SSNHL to a single ENT centre in 2022 was collected. Data included: investigations: MRI and audiograms, and treatment: oral and intratympanic steroid (ITS) administration. The data was analysed and presented to the local department. RESULTS: A total of 25 patients were included. It was identified that 92% of patients underwent a same-day diagnostic audiogram and that 76% of patients received an MRI. 88% of patients received treatment with oral steroids, of which 77% of patients were co-administered a proton pump inhibitor. 52% of patients required ITS injections with 100% of these patients receiving ITS injections within 6 weeks. Follow-up audiograms indicated that 66% of patients had either a complete or partial complete resolution of SSNHL. Conclusion: The compliance of the single centre with the national guidelines was greater in undertaking a same-day audiogram for a patient compared to the inclusion of an MRI. Most patients were treated with oral steroids, with 52% treated with ITS. This may have resulted in patient improvement. The literature suggested successive ITS with oral steroids may be advantageous in SSNHL. The national STARFISH trial could provide further evidence for SSNHL management.

20. Use of Artificial Intelligence Systems in Producing ENT Discharge Summaries; Google BARD vs OpenAI ChatGPT Caglayan A.

Introduction: Google BARD and the Microsoft-backed OpenAI ChatGPT are currently the two major natural language processing tools driven by AI technology. Both AI models have vast capabilities ranging from the ability to plan birthday parties, solve coding bugs and answer complex question’s including ‘how to improve the NHS’. One potential application of these systems includes the composition of electronic discharge summaries. Aims: This study aims to understand the role of AI driven natural language tools in the production of discharge summaries in ENT. The wider application of advanced language processing techniques and machine learning algorithms in surgery will also be considered. Methodology: A comparative analysis of Google BARD and OpenAI ChatGPT discharge summary generation was completed. A case example of a paediatric patient who presented for a tonsillectomy was considered. Results: Both Google BARD and OpenAI ChatGPT can generate discharge summaries within seconds of data input. A standardised template is used by both systems with key subheadings, which had sufficient information as per RCS guidance. If data to fulfil these subheadings were not provided, ChatGPT and BARD automatically input clinical data. Conclusion: Overall, AI chatbot models such as ChatGPT and BARD have the potential to not only play a role in writing discharge summaries, but also in the wider surgical setting. However, multiple barriers need to be overcome such as issues regarding data governance, the necessity to manually input vital information and maintaining patient trust.

21. Surgical management of paediatric hyperparathyroidism (primary and familial): a systematic review of the literature Brennan L, Embury-Young Y, Jackson S, Aspinall M, Stechman S, Balasubramanian D, Kim H. Ishii.

Background: Primary hyperparathyroidism (PHPT) is rare in the paediatric population. Therefore, management and outcomes are not widely documented. This systematic review aims to evaluate pre-, peri- and post-surgical outcomes following parathyroidectomy for paediatric PHPT. Methods: English language studies of paediatric patients with sporadic or familial PHPT undergoing parathyroidectomy were included. Results: 191 cases were identified across 7 studies. Mean age was 15.3 years with equal gender distribution. Ultrasound and/or SPECT/CT were used for all patients with sensitivities of 73.6% (n=91) and 81.8% (n=55) respectively and combined sensitivity of 91.4% (n=30). 98% and 93.5% achieved cure following tPTx and BNE, respectively in the sporadic population (p=0.2). 50% and 87.5% achieved cure following tPTx and BNE, respectively in the familial population (p=0.285). Intraoperative parathyroid hormone (ioPTH) was used in 27 cases, 100% of sporadic cases undergoing tPTx were cured (n=21). ioPTH was used in 6 cases undergoing BNE (3 familial and 3 sporadic), 100% and 67% were cured respectively. Transient hypocalcaemia was the most common complication overall, with sporadic population seeing a higher incidence after tPTx vs BNE (37.3% vs 19.2%, p=0.02). No complications were seen in the 2 familial cases undergoing tPTx. Transient hypocalcaemia was documented in 37.5% (n=8) of familial cases undergoing BNE. Conclusion: This review demonstrated high cure rates following surgery in sporadic cases, with lower cure for familial cases. Complication rates were low in both populations. This review demonstrates that paediatric PHPT is a rare entity; however, surgical management, regardless of imaging findings is safe and effective.

POSTER ABSTRACTS

22. A systematic review of artificial intelligence applications to hearing health

Chaudhry A, Gaskill P, Muzaffar J.

Introduction: Artificial intelligence is a growing area of academic interest. We explore the effectiveness of application of artificial intelligence on application to audiometry data. Methodology: A search was conducted through the MEDLINE, PubMed and EMBASE databases with on June 5th 2022. 775 abstracts were screened independently by two reviewers, with disputes resolved by a third reviewer. In total, 34 papers were fully screened and 15 were included [115]. We recorded the population size, dataset size, training-testing ratio and cross validation folds used to train the algorithm. Multiple linear regression was performed on the results of 7 included studies to determine the relationship of features and algorithm type on accuracy. Diagnostic accuracies were performed on algorithms reported by 3 studies that reported complete confusion matrix data. Results: Of the 48 algorithms across 7 papers [1-7] that reported accuracy as an outcome, we found a mean accuracy of 84%. We found a 1% increase in training proportion resulted in a subsequent 1.1% decrease in accuracy (p<0.001). 4 studies [1-3,8] reported 14 algorithms with a mean sensitivity of 85% and mean specificity of 77%. Of these, diagnostic odds ratios for 9 algorithms from 3 studies [2-3,8] ranged from 14.23 (95% Cis 4.12-49.15) to 238.68 (95% Cis 13.77-4137.74). Discussion: We recommend further studies validate algorithms with external datasets, while being used in clinical practice in a diagnostic test accuracy study format. To minimise reporting bias, further studies should report complete confusion matrix data.

23. Closed Loop Audit of Management of Sudden onset sensorineural hearing loss

Kruczynska

Sudden onset sensorineural hearing loss (SSNHL) presents infrequently to ENT services in Aberdeen Royal Infirmary. Although ENT UK guidelines are in place for the management of SSNHL, the practicalities of organising these cases within our department can be challenging. We Aimed to assessed current local practice in comparison compare it to national ENT UK guidelines. For Cycle 1 Retrospective audit of 6 months data set recording management pathway of patients presenting with SSNHL to Rapid Access Clinic of Royal Aberdeen Infirmary Hospital. Electronic patient records were searched for: time of referral, duration of symptoms, times to first ENT review, intervention and audiogram, and timings and management during subsequent reviews. The audit was then repeated with second cycle of 6 months data set after intervention of providing staff education and distributing the up-to-date guidelines in the department. Average times from referral were calculated including time from referral to intervention (1.47 days), from referral to first ENT review (3.82 days), from referral to first audiogram (4.43 says). Average time from presentation to starting oral steroids was very efficient of just 0.33 days. On reauditing the data, we noted reduced time to first audiogram and reduced time from referral to intervention. The data gathered helped our department to reinforce management pathway of SSNHL as per ENT UK guidelines and improved the way urgent audiograms are organised in the hospital. It also emphasised the importance of performing tuning fork test to determine the nature of hearing loss when audiogram is not immediately available.

24. Improving access and shortening wait times for ENT emergency clinic – closed loop audit

Wa Katolo H, Balakrishnan N.

Introduction: Ear, Nose, and Throat (ENT) emergency clinics play a crucial role in providing specialist care for patients with urgent ENT problems. Prolonged waiting times for appointments can result in increased patient anxiety and reduced satisfaction, especially for painful conditions such as otitis externa. The audit aimed to reduce the waiting time for appointments and increase the availability of last-minute appointments in a busy ENT department of a tertiary hospital with challenges in securing short notice appointments in the emergency clinic. Methods: An audit was conducted of emergency clinic appointments over a two-week period, with results being presented at the local clinical governance meeting. The audit revealed a high volume of follow-up appointments and a low rate of last-minute appointments. The interventions were changes to the booking policy such as prompting a senior clinician review following two appointments and reserving specific slots for short-notice appointments, such as post-weekend. A re-audit was conducted one month later. Results: An analysis of 230 appointments revealed a 50% increase in new patients seen post-intervention, and a 46% decrease in follow-up appointments. The average waiting time for an appointment decreased from 6.7 to 5.8 days. Short-notice appointments (seen in < 3 days) increased by 40%. Discussion: The results highlighted the benefits of targeted senior review in a junior clinician-led clinic. By reducing the burden of follow-up appointments, more new patients could be seen earlier. Additional benefits were observed, such as reducing the amount of clinic overbooking. Overall, this closed loop audit successfully achieved its aims.

A, Maini S.

25. Post-Thyroidectomy Hypocalcaemia Management at a High Volume Thyroid Centre

Constantinou C, Ross T, Ahmed J.

Introduction: Hypocalcaemia is a serious complication that can occur after total thyroidectomy. The British Society of Endocrine and Thyroid Surgeons (BAETS) have introduced guidelines for calcium monitoring and management of hypocalcaemia postoperatively. Our objective was to assess adherence of our high volume tertiary head and neck unit to this guideline and propose a local protocol. Methods: Retrospective audit of all total and completion thyroidectomies performed by ENT at the Royal London Hospital between March 2022 and February 2023. Data was collected on calcium and parathyroid hormone levels well as calcium replacement regimens used. Results: A total of 24 completion or total thyroidectomies were identified. Calcium monitoring was requested for 100% of cases. Adjusted calcium was less than 2.10 in 9 cases and of those - calcium replacement given on 6 occasions. Multiple regimens have been used including Sandocal (with or without alfacalcidol), calcium gluconate and Calcichew D3. Clear documentation regarding symptoms was found in 6 cases. Empirical calcium replacement on discharge was given for 4 cases. Finally, post-op PTH levels were low (<1.6) in 6 cases - all of which had low calcium levels requiring replacement in subsequent testing. Discussion: The BAETS hypocalcaemia guideline is a useful aid which has not been followed in all cases performed in our department in the last year. Adherence is occasionally limited by the availability of the specific calcium regime. We propose the creation of a local protocol in conjunction with our pharmacy colleagues to standardise prescription and monitoring for hypocalcaemia in our department.

26. Is barium swallow alone (without endoscopy) is enough to rule out oesophageal cancer?

Binti Che Din NA, Fernandes V.

Introduction ENT team has been involved in assessing dysphagia in Royal Victoria Hospital, Belfast trust. Barium swallow or rigid endoscope are used either alone or in combination to assess dysphagia as red flag for cancer. However few studies have evaluated the role of endoscopy following a normal barium swallow in those with dysphagia. Aim of this study To analyse if barium swallow solely will give sufficient information to rule out cancer without endoscopy. Methods Retrospective study was implemented. Data were collected from PACS system and electronic patient record. Results were then analysed using Microsoft Excel®. Results 54 patients (M:F = 29:25) whom had barium swallow between September 2021 to September 2022 were included in this study. 41 patients out of 54 patients (76%) had barium study only, while 13 patients (24%) had both modalities i.e had endoscopy following the barium swallow. No cancer were diagnosed by barium, whereas 2 oesophageal cancers (3.7%) were detected by endoscopy. One of the barium swallow reported as achalasia while another one was reported with mildly prominent posterior aspect of oesophageal wall. Both then had following endoscopy which confirmed oesophageal adenocarcinoma and oesophageal squamous cell carcinoma respectively. Conclusion 1 barium study was unable to detect cancer change which was later confirmed by the endoscope. This study clearly indicating that endoscopy is more sensitive and accurate in detecting oesophageal cancers than barium studies.

27. Standardising Management Therapy for Patients with Sore Throat: The Manchester Protocol

Introduction: Tonsillitis affects 10% of the population every year. Severe cases often require acute medical input and admission. Whilst there are national guidelines to help manage patients with sore throats, these often vary on a local level. As a result, there is heterogeneity in how the protocol is implemented. Objective: The purpose of this study is standardise management therapy in patients with a sore throat. Methods: A Literature Review was undertaken to evaluate the different protocols available in the UK. A retrospective review of 184 patients who were admitted to a district general hospital was undertaken. Patients who were admitted for at least 1 night had their prescribing practices evaluated and assessed. A protocol was then developed to standardised prescribing practices and management therapy. Results: Patients with sore throat should be given antibiotics, fluid and dexamethasone administration on admission. Local evidence showed dexamethasone administration on admission showed a significant likelihood of a 1 night stay (p<0.05) when compared to no dexamethasone. Patients given regular paracetamol and/or ibuprofen compared to PRN or none also showed a significant likelihood for a 1 night stay (p<0.05). The Manchester Protocol included antibiotics, fluids, dexamethasone, regular paracetamol and regular ibuprofen. Conclusion: This protocol will help standardise prescribing practices and management therapy in patients with sore throat. Whilst based on limited evidence, the evidence suggests implementation of the Manchester Protocol will improve length of stay and the patient journey.

Ahmad M, Thompson G, Khwaja S.

POSTER ABSTRACTS

28. ‘To Pack or Not To Pack?’ - A systematic review and meta-analysis to determine the efficacy of non-medicated middle meatal packing after endoscopic sinus surgery for chronic rhinosinusitis (CRS)

Hong Ta N, Iftikhar H, Abbasi AMA, Mustafa K, Das JK, Javer AR.

Background This systematic review evaluated the effect of non-medicated middle meatal packing, compared to no packing, on synechiae formation up to twelve weeks after endoscopic sinus surgery for CRS. Methodology PRISMA guidelines were utilized to conduct the systematic review. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL and Clinicaltrials.org. Only randomized controlled trials (RCTs) in English were included. The Cochrane risk of Bias tool (Version 2) was used to exact data and conduct a quality assessment. A quality assessment of the outcomes using GRADE was also performed. Meta-analysis for all the outcomes was conducted on RevMan version 5.4.1. Results A total of 390 eligible articles were identified. A total of 139 patients were randomised to receive middle meatal pack in either of the nostrils. At four weeks of follow-up there was no difference in the risk of synechiae formation on either the packed side or the unpacked side RR 0.77 (95% CI: 0.48-1.25). Similarly, no difference was seen at either 8-12 weeks of follow-up RR 0.68 (95% CI: 0.42-1.20). Nasal congestion was reported to be less in the packed side on follow-up in one of the trials. Conclusion Our systematic review, with limited evidence, indicates no difference in synechiae formation between the non-medicated packed and unpacked middle meatus at four and eight or twelve weeks after endoscopic sinus surgery for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long-term sequelae.

29. ‘Two versus Three’ - A systematic review and meta-analysis evaluating two-wall versus three wall orbital decompression for thyroid eye disease Hong Ta N, Iftikhar H, Deewani MH, Abbas SA, Lassi ZS, Mustafa K, Das JK, Ahmed SK.

Background Surgical orbital decompression for thyroid eye disease has been shown to be safe and effective in reducing proptosis and thyroid ophthalmopathy. There is no consensus on surgical approaches used in orbital decompression for thyroid eye disease. This project evaluates the two-wall versus three-wall orbital decompression for thyroid eye disease. Methods PRISMA guidelines were used to conduct the systematic review. A literature search was performed on EBSCO CINAHL plus, Wiley Cochrane Library, Web of science and PubMed. We included all studies that compared two wall (medial and inferior) endoscopic decompression with three wall decompression. The Cochrane EPOC criteria were utilized in data extraction and conducting a quality assessment of the published evidence. Results Out of 111 identified articles, two studies were included. A total of 37 patients underwent two-wall decompression and 35 patients underwent three-wall decompression. There was significant difference seen with change in proptosis between two-wall compared to three-wall decompressions MD: 2.98 mm (95% CI: 1.36 – 4.60) favoring three wall decompression, Z = 3.60 (p = 0.0003). The risk of new onset diplopia was higher two wall decompression but this is statistically insignificant RR: 0.42 (95% CI: 0.06 – 3.11), Z = 0.85 (p=0.39). The quality of the included studies was graded from low to unclear risk of bias. Conclusion There is limited evidence available to determine if three wall orbital decompression is superior to two wall orbital decompression for thyroid eye disease. Prospective randomized trials are needed to accurately determine the superiority of either intervention.

30. What is the role of probiotics in treating allergic rhinitis? – A systematic reviews of level 1 evidence Hong Ta N, Iftikhar H, Awan MO, Awan MS, Mustafa K, Das JK, Ahmed SK.

Background Allergic Rhinitis (AR) affects approximately 30% of the general population. The use of probiotics has been shown to reduce symptoms of allergic rhinitis and improve patients’ quality of life. Several published systematic reviews assessed the role of probiotics in allergic rhinitis. This systematic review aims to evaluate recent evidence with an overview of systematic reviews. Methodology PRISMA guideline was utilised. A literature search was conducted using four data bases: PubMed, EBSCO CINAHL, EBSCO Dentistry and Oral Science source and Wiley Cochrane library up to 14th April 2020. Data was extracted for subjective outcomes (Quality of Life questionnaire, Nasal Symptoms Score, Ocular Symptoms Score, Daily Total Symptoms Score, Incidence of AR and Rhinitis Total Symptom Score) and objective outcomes (Antigen Specific IgE, Total IgE, IL-10, IFN-Gamma, Th1/Th2 Ratio and Eosinophil Rates). Qualitative assessment was performed using AMSTAR-2. Results A total of 419 titles were screened, of which 3 systematic reviews met our eligibility criteria. Probiotics in the treatment of allergic rhinitis has shown to improve quality of life, nasal and ocular symptom score, daily total symptom scores and Th1/Th2 ratio. No difference was ascertained for rhinitis total symptom score, antigen specific IgE, total IgE, IL-10, INF-Gamma and eosinophil rates. Overall, the quality of systematic reviews was moderate to low. Conclusion There is considerable evidence that the use of probiotics is useful in the treatment of allergic rhinitis. Further randomised trials targeting the limitations of the current available evidence is required to further ascertain the usefulness of probiotics in managing allergic rhinitis.

31. Are we listening?’ – A Questionnaire Study on Trainees’ Perspectives of Core Surgical Training

Hong Ta N, Dewhurst S, Philpott C, MacAndie C, Nankivell P, Ghosh S.

Background The initial stage of UK surgical training is Core Surgical Training (CST) which remains the main entry route to higher specialist training. CST programmes vary across different deaneries nationally. The JCST published CST curriculum training and standards. Research reported that CST trainees have less satisfaction than more senior trainees. There is evidence of stress and burnout in CST trainees. The ‘leaking pipe’ concept in CST has been limitedly explored. There is a need to understand CST trainees’ perspectives to improve retention and enhance training. This study aims to •Understand trainees' perspectives of the CST programmes across the UK •Identify factors contributing to a good CST programme for trainees •Recommend an exemplar of CST programme from trainees’ perspectives Methodology An online anonymous questionnaire was distributed to CST trainees nationally via trainees’ networks. Questions include basic demographics, characteristics of CST schemes, associated costs and trainees’ experience. Subgroup analysis was conducted in different anonymised deaneries utilising comparative statistical tests (Chi-squared tests, Wilcoxon test, Kruskal-Wallis ANOVA). Thematic analysis was conducted. Results Out of over 200 responses, there are statistically significant variations (p<0.05) between CST programmes nationally in training opportunities, support, associated costs. Many trainees rated their experience in CST as ‘negative’ and would likely consider CREST route. Characteristics of an exemplary include minimal relocation/commuting, adequately staffed rotas, feeling valued as a surgical team member. Conclusion This study summarises trainees’ perspectives of CST programmes nationally and factors contributing to an attractive CST programme attractive for trainees. Future developments include semi-structured interviews with volunteers.

32. Induction and Confidence in Cross-Specialty Out-of-Hours Coverage: Assessing the Impact on Surgical Trainees' Performance and Patient Safety in the UK

Background In the UK, junior doctors commonly provide out-of-hours coverage across various specialties. The study aimed to evaluate whether junior doctors providing cross-specialty coverage receive induction, and to determine the effects of induction on their confidence, burnout levels, and patient safety. Methods A survey was distributed to junior doctors working in surgical specialties across the UK to evaluate their experiences with induction and out-of-hours cross-specialty coverage. Data on confidence levels in treating patients in non-primary specialties, senior support, and burnout rates were also collected. Results A total of 45 responses were received, with 76% of respondents at the FY1 to core trainee level and 24% being clinical fellows or trust grade doctors. All participants provided cross-specialty out-of-hours coverage, and 51% did not receive induction for this responsibility. Confidence levels in primary specialties were significantly higher than those in cross-cover specialties (Welch two-sample t-test, p < 0.001). Confidence levels were associated with induction status (Kruskal-Wallis, p = 0.0489) and the availability of senior support (Wilcoxon rank sum, p < 0.0001). Four participants (9%) reported serious incidents, all occurring in cross-cover specialties without induction. According to the Oldenburg Burnout Inventory, 11% of participants experienced burnout, but this was not significantly related to induction status (Chi-squared, p = 0.958). Conclusion Proper induction is crucial for junior doctors to feel supported and prepared when transitioning into new roles. Insufficient induction decreases trainees' confidence in providing optimal patient care and may diminish the effectiveness of senior support. 2.

33. Evaluating the Educational Quality of Facebook Videos as a Learning Skills Tool on Cholesteatoma Surgeries

Tan D, Ki Ko T. (Presented by Ki Ko T)

Introduction: This study evaluates the consistency and quality of cholesteatoma videos on Facebook and whether videos shared on Facebook are a valuable educational quality tool. Aim: The aim of the study to provide the clinicians an understanding of the otolaryngology surgical technical skills content that they are exposed to. Methods: A cross sectional analysis of the Facebook video contents were carried out. Surgical videos quality were evaluated using LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS), and categorised into low (0-6), medium (7-12) and high (13- 18) educational quality groups. Facebook search terms ‘cholesteatoma surgery,’’ ‘‘cholesteatoma procedure,’’ ‘‘cholesteatoma removal,’’ and ‘‘cholesteatoma endoscopic surgery” were performed. Only English commentary videos focused on otolaryngology surgical education were included. Results: 52 videos were identified (mean LAPVeGAS score = 10.8 +/- 3.31) and 65% had medium educational quality videos. Majority videos lacked post-procedural outcome results (69%), English audio commentary (54%) and lack of visual graphic aids for anatomical illustration (73%). Conclusion: Clinicians will find difficulty in assessing optimal Facebook educational quality videos on cholesteatoma surgery, health professionals should be aware of the importance of health-related information on Facebook and provide high-quality accurate and up-to-date content.

Rana M, Siddique H, Maweni R.

POSTER ABSTRACTS

34. Can an enhanced low-fidelity Operation™-style simulator improve otomicroscopy skills?

Allman M, Owens D.

Background Otoscopic skills are essential for ENT doctors. They require practice and experience to master and are best learned via reinforced repetition. Early-stage doctors develop these skills whilst treating patients, often with minimal teaching, which may increase risk to patients during skill acquisition. Simulation is used widely in medical education and allows development of initial skills with no additional risk to patients. One issue with simulation is that it typically requires subjective expert review of technique to enhance performance, reducing the ability to ‘self-practice'. This study assesses the value of an enhanced low-fidelity trainer capable of providing objective feedback in an Otology setting. Aim Compare enhanced low-fidelity simulation with standard simulation using a basic otoscopy skills simulator. Methods A low-fidelity ear simulator based on a previously published otoscopy skills model was created. Two types were created: the basic model without feedback and an enhanced model that alarmed when aural instrument tips touched the canal wall. Participants were evaluated using both models to assess whether objective feedback reduced tip touches over time. Results and user feedback were reported as a pilot study. Results Enhanced simulation reduced tip touches over time more than the control model, suggesting better skill uptake. Participants reported the enhanced model improved learning more than the control. Discussion Enhanced low-fidelity models are cheap, easily assembled and provide the opportunity to develop skills without patient risk or the need for subjective expert feedback. Further powered studies will be undertaken to assess whether the observed difference have true statistical value.

35. Improving vascular access in Necrotising Otitis Externa (NOE) patients: a Quality Improvement Project Roscamp J, Rawes C, Collingwood R.

Background: NOE is a severe infection with high mortality. Early insertion of central venous access devices (CVADs) is essential to facilitate administration of protracted courses of intravenous antibiotics. Aims: To reduce the time to CVAD insertion in our NOE patients. Methodology: A retrospective audit (June 2022-October 2022) was conducted on time taken in days from CVAD request to insertion, in patients diagnosed with NOE on our ENT ward. Departmental Advanced Nurse Practitioners (ANPs) were trained and started providing CVAD insertions in-house. A prospective audit (November 2022-February 2023) was conducted to complete the Plan-Do-Act-Study (PDSA) cycle. Cost analyses and case-note reviews were also performed. Results: The preimplementation group (N=6) waited on average 15.66 days for CVAD insertion, compared to 10.5 for the post-implementation group (N=4). Welch’s t-test showed this was not statistically significant (p=0.33). In both groups 4 patients’ length of stay were increased solely waiting for CVAD insertions, incurring an average cost-per-patient of £7332.38 (pre-implementation) and £6159.20 (post-implementation): a 16% cost reduction. Case note review highlighted significant morbidity and mortality in the pre-implementation group, but none in the post-implementation group. Conclusion: Our implementation reduced the average number of days to CVAD insertion in our NOE patients. Although, not statistically significant, this is likely related to small sample sizes and reliance on external oversight during the training process, which will improve with time. It reduced costs to the department as well as improving patient experience. Further PDSA cycles will be completed to continue to measure the impact of this intervention.

36. An unusual approach - Left transorbital approach to repair of lateral sphenoid wall CSF leak under image guidance Ali D.

Objectives: To present a case where transorbital and endonasal approaches were taken simultaneously to repair a cerebrospinal fluid (CSF) leak. Background: The initial management plan for a sinus CSF leak is conservative management, as leakage stops within 1 week for 70% of patients suffering from a traumatic leak. However in cases where the CSF leak does not heal spontaneously, surgical options must be explored as if left untreated patients run the risk of contracting meningitis. The most common approach taken is the endonasal approach whereby a septal flap is used to seal the leak. In cases where the location of the leak is difficult or impossible to reach endonasally, another approach can be considered such as a transorbital approach. In this case a 60 year old lady presented with a CSF leak preceded by a recent episode of meningitis. She had a previous left sided CSF repair endonasally 4 years prior. Imaging revealed a meningo-encephalocoele from a left persistent sternbergs canal – After discussion in MDT a transorbital and endonasal approach was taken to repair the defect, with fat and fascia taken from her thigh. Conclusion: A transorbital + endonasal approach is a safe, minimally invasive approach which can be used as an alternative to endonasal only approach in order to target and manipulate pathology within the skull base.

37. A Systematic Review of Antibiotic Treatment Regimens and their Outcomes in Necrotising Otitis Externa

Lodhi S, Bruce J, Timms S, Stapleton E.

Background: Necrotising otitis externa (NOE) is a serious, invasive infection of the external auditory canal (EAC) with minimal evidence underpinning its diagnosis, investigation, management, and outcomes. This study explores evidence of NOE antibiotic therapies and outcomes. Methods: This study was registered on PROSPERO (CRD42022353244) and conducted according to PRISMA guidelines. Pubmed, Embase, and Cochrane Library were searched for articles detailing antibiotic management of adults with NOE. Randomised controlled trials, case-control, multi and single-centre studies, and case series with ≥ 10 participants were included. Data regarding antibiotic regimens, antibiotic initiation and cessation, and outcomes were extracted. Results: Twenty-nine studies were used for data extraction. Fluoroquinolones were most commonly prescribed antibiotics (69%). Most patients received intravenous (80%) dual therapy (56%) first-line, and oral (30%) monotherapy (23%) second-line. Treatment was initiated on an empiric-then-culture-guided basis (50%) in the inpatient setting (96%), and continued in the outpatient setting (48%). Mean total antibiotic treatment duration was 61 days. Side effects included allergy or intolerance (8%), and renal impairment (8%). Disease progression (14%), relapses (7%), and readmissions (34%) were observed. Discussion and Conclusion: Due to insufficient and heterogenous variable reporting, the most efficacious and safe regimens could not be determined, and an accepted process for treatment cessation could not be identified. The lack of high-quality research and reporting inconsistencies are barriers to identifying best practice. A consensus on initiation, cessation, and modification of treatment, and disease monitoring, is required to facilitate high-quality research.

38. Diagnostic Criteria and Core Outcome Set for Necrotising Otitis Externa: A Delphi Consensus Study

Lodhi S, Stapleton E, COSNOE Collaborative.

Background: Necrotising otitis externa (NOE) is a serious, invasive infection of the external auditory canal (EAC) with minimal evidence underpinning its diagnosis, investigation, management, and outcomes. To optimise future research trials, this study aimed to identify consensus on NOE diagnostic criteria and core outcome set (COS) items. Methods: This study was registered and designed according to Core Outcome Measures in Effectiveness Trials (COMET) methodology (ref:1843). Items were extracted through a systematic literature review. Patient-suggested items were extracted from our qualitative study exploring patient experience of NOE. Stakeholders across the North of England (Consultant otologists, microbiologists, and radiologists, and non-Consultants who have published on NOE) rated items in a two-stage online Delphi process, and a consensus meeting. Results: Thirty-five stakeholders from nine teams participated. Diagnostic item (n=11) themes consisted of: signs and symptoms; advanced disease; EAC granulation biopsy for histology and microbiology; positive CT or MRI scan; persistent symptoms despite treatment for ≥ 2 weeks; and ≥ 1 risk factor for immunosuppression. COS item (n=37) themes consisted of: signs and symptoms; pain; advanced disease; complications; patient survival; antibiotic regimens and side effects; comorbidities; other treatments; compliance; treatment duration and cessation; relapse and re-admission; and multidisciplinary team management. Discussion and Conclusion: Standardised diagnostic criteria and core outcomes have been identified via robust consensus. Several other important themes emerged from this process. Future research should investigate indicators of advanced disease, radiology, disease monitoring, and treatment cessation.

39.

Sheik-Ali

in Paediatric Ent Surgery

Introduction: The Walk in Walk out model (WIWO) was developed as part of COVID recovery programme. It describes a streamlined process of patient admission, recovery and discharge directly from theatre. This project aimed to determine its effectiveness and efficiency in its implementation in a busy district general hospital paediatric unit and which procedures could be suited to this process. Methods: Analysis of all patient day case admissions and discharge from November 2021 to September 2020. This includes procedure performed, time and date of discharge, admission +/- reason for admission.

Results: Total number of procedures N= 197. Number discharged directly from theatre N= 157 (80%). Number admitted to ward but discharged on same day N=26 (13%). Number admitted to ward for overnight stay N=14 (7%). Reasons for admission include pain, bleeding and anaesthetic recovery. List of successful procedures performed via the WIWO model is described in the study. Conclusion: WIWO model is effective in its implementation for certain procedures highlighted in this study. Benefits include less reliance on hospital beds, reduced cancellations and cost effectiveness. Future studies should focus on patient experience of the WIWO models implementation.

Implementation of the “Walk In Walk Out Model”

S, Shehrazi A, Miah M.

40. An Audit of Parathyroidectomy Surgery & Factors Associated with Day Case Surgery

Duvnjak H, Morris S.

Background: Parathyroidectomy is the gold standard for management of primary hyperparathyroidism secondary to parathyroid adenoma. There has been a growing trend towards minimally invasive, day-case parathyroid surgery in localised adenoma. The 2019 NICE guidelines are the most recent standards for UK practice informing pre-operative imaging techniques. Methods: Retrospective review of all parathyroidectomy surgery for primary hyperparathyroidism in a single unit between 2019-2022. Data was collected on compliance with 2019 NICE guidance and factors associated with day-case surgery. Results: 24 patients were included in this series. Ultrasound detected 71.4% of parathyroid adenomas whereas SEPCT Sestimibi detected 91.3%. In total, 21 cases had successful pre-operative localisation; of these 6 (28.6%) cases were day-case procedures. Of these cases, 100% had intra-operative PTH monitoring and histological frozen section to confirm the diagnosis. Conclusions: Despite the NICE recommendations, SPECT sestimibi was more valuable in localising parathyroid adenoma that ultrasound in our study. Day-case surgery was more likely in a localised adenoma, with intra-operative PTH monitoring and frozen section.

2.

41. Surgical Site Infections in ENT: Are we following

NICE guidelines?

Ijaz A & Palaniappan S, Sheikh Z, Young K, Khan A, Kreuzbauer T, Sudin SS, Apata-Omisore J.

Background Surgical site infections (SSIs) are one of the most common post-operative complications and can be associated with significant morbidity and mortality. They place a significant burden on healthcare system with a prevalence rate of 0.5-3%. Traditionally data present is based on non-head and neck procedures. The National Institute of Clinical Excellence has specified guidance on how to minimise these infections. Methods A multi-centre retrospective cohort across hospitals in Yorkshire was undertaken. All patients that underwent an ENT operation requiring a skin incision in the year 2021 were included. Electronic patient notes were used as the data source. Adherence to NICE guidance NG125 was used as the standard. Data on demographics, comorbidities, smoking and alcohol use, operation undertaken, diagnosis, length of procedure, closure and use of antibiotic prophylaxis was also obtained. Descriptive statistics and inferential statistics were undertaken. Results A total of 826 patients were included from 4 centres. Missing data was present across all data points. Mean age was 51.4 years. 43% (354/826) had 2 or more comorbidities. The rate of SSI was 3%. 30-day mortality was 0.3% (3/826). Despite additional measures such as use of topical and oral antibiotics outside of guidelines, this made no impact on reducing rate of SSIs. Conclusion NICE guidance is not being adhered to minimise SSIs with no added benefit in additional treatment. Improvement of the standard and wholesale adoption of electronic operation notes is recommended. This would result in reduced costs and potential side-effects to patients.

3.

42. Acute sore throat - preventing the next epidemic Lynch C.

Background Antibiotic stewardship is becoming critically important as resistant bacteria become increasingly prevalent. NICE states recurrent sore throat has an incidence in UK general practice of 100 per 1,000 population per year. Tonsillitis is a common presentation to primary and emergency care, with 38% of adults being seen by a doctor for acute sore throat. A study of 600 patients presenting with acute tonsillitis found only 24% actually required antibiotics. This QIP implemented change to an A&E department in the Northwest of England after determining the appropriateness of assessment and management of acute sore throat presentations. Methods 100 patients presenting with acute sore throat aged 6 months to 52 years were collected from one A&E department between January and March 2023. Electronic notes were analysed to determine whether patients were adequately assessed according to the Centor criteria. NICE advises supportive care for patients scoring 0-2, with immediate or delayed antibiotic prescription for those scoring 3. Results Preintervention, 16% of clinicians documented all Centor criteria, 48% incorrectly prescribed antibiotics, with only 20% prescribing appropriate antibiotics. A poster, face-to-face teaching, and daily reminders were introduced to improve assessment and management. Post-intervention the figures changed to 54%, 22%, and 56% respectively. Conclusion This QIP supports the literature, providing a snapshot of the inappropriate overuse of antibiotics for the management of acute sore throat in the emergency setting. The intervention of a poster led to change in clinical practice. Widespread implementation of similar interventions are needed to address the potential epidemic of antibiotic resistance.

43. The Post Operative Tonsillectomy (POPT) Study: A multicentre prospective paediatric cohort study

Sarwar S, Heward E, Rocke J, McNally G, Thompson G, Oladokun D, Timms S, Abbas JR, Chu MMH, Akbar S, Dobbs S, Chudek D, Jaiswal I, Vora D, Harrison A, Oremule B, Menon SS, Advani R, Daniels J, Ellis S, Abdelaziz M, Husain P, Anmolsingh R, Venugopal A, Beena M, Sheik-Ali S, Saeed H, Shenton C, Ghosh S, Khwaja , Kumar N.

Aims: Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the postoperative recovery. We aimed to investigate postoperative bleeding and pain following paediatric tonsillectomy using a patient diary. Design: This was a multicentre prospective observational cohort study involving 12 otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed. Participants were children (≥4 years, ≤16 years) undergoing tonsillectomy for benign pathology. Main outcome measures were frequency and severity of postoperative bleeding and intensity and pattern of postoperative pain. Results: 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Postoperative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p=0.001). Bleeding frequency decreased with higher surgeon grade (p=0.003) and when performing intracapsular coblation tonsillectomy (p=0.02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p<0.0001 & p=0.0008). Conclusion: A high frequency of low-level postoperative bleeding was observed. Pain scores remained high for 5 days postoperatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.

2.

44. Risk stratification of suspected head and neck cancers from referral letters: is it safe?

Hill A, Howson K, Lancaster J, Davies K.

Background: Remote triage of suspected head and neck cancer (HNC) referrals has been widely introduced since the Covid-19 pandemic. Previous studies have validated the use of telephone triage via a risk calculator; however, the safety of triaging from the referral letter alone is yet to be assessed. Methods: A prospective cohort study carried out in a tertiary HNC centre in North Liverpool over a 16-week period. Patients were stratified to high or low risk from the GP referral proformas alone, using a validated risk calculator (HaNC-RC-v.2). Patients were followed up to record their cancer status. The outcomes of letter triage were compared to previously published outcomes of telephone triage. Results: Data from 608 referrals was analysed. 58% referrals were triaged as high risk, and 42% as low risk. 28 cancers were diagnosed, 19 of which were HNC. 95% of head and neck cancers were triaged as high risk. For all cancers, the sensitivity of cancers correctly triaged as high risk was 85.8% (92.5% telephone triage). The negative predictive value for a low-risk triage outcome, and no cancer diagnosis, was 98.4% (99% telephone triage). Conclusions: Remote triage using GP referral letters alone, may be as effective as telephone triage, as well as much more time efficient. Triaging patients in this way, enables focused referrals to HNC consultants, with low-risk patients being seen by other ENT consultants or registrars. This facilitates prompt cancer diagnosis and reduces the risk of waiting time breaches, crucial in the post-pandemic era.

45. A case controlled study of chronic laryngeal pathology following level 3 care for Covid-19 patients

Manchip G, Yusuf M, Clohessy S, Rocke J, McGrath B, Khwaja S, Goswamy J.

Introduction Referral to the speech and language team (SLT) increased for patients in level 3 requiring translaryngeal intubation or subsequent tracheostomy during the Covid-19 pandemic. These interventions can cause acute damage leading to chronic sequalae; affecting airway patency and impair swallowing and voice. How much of the laryngeal pathology was due to prolonged intubation versus the virus? The aim of our study is to compare the laryngeal pathology in covid positive (CP) patients requiring airway interventions during the pandemic to Covid negative (CN) patients. Method The prospective SLT database of patients referred from level 3 care to the SLT for Fibreoptic Endoscopic evaluation was analysed over a 12-month period from March 2020. Data collection included demographics, ICNARC data, fibreoptic images noting the laryngeal pathology and proning history. Results Sixty-three patients were identified, 16 females and 47 males. Twenty-six CP and 37 CN. The mean age of the groups was 52 years and 56 years, respectively. The ICNARC score, and APACHE II score was higher in the CP group. Laryngeal erythema and laryngeal oedema were seen in more CP patients than CN patients. There was also a higher rate of vocal cord palsy and vocal fold oedema in the CP cohort. However, posterior commissure hypertrophy was more commonly found in the CN group than the CP group. Conclusion We found a higher rate of laryngeal pathology in our CP cohort. Further analysis will clarify the laryngeal impact of proning intubated covid patients.

3.

POSTER ABSTRACTS

46. Clinical Coding of Procedures in the Urgent Referrals Clinic

Joshi N, Fernando K, Linton-Jude T.

Introduction The Urgent Referrals Clinic (URC) is an SHO led ENT clinic that deals with acute conditions such as otitis externa and epistaxis. A great number of procedures are undertaken in this clinic and appropriate clinical coding is required to ensure the department is reimbursed appropriately. This audit examined the current coding practices of the URC at the Royal National Throat, Nose and Ear Hospital in London. Methods -1st cycle: retrospectively reviewed OPCS-4 codes (the main procedural classification system used by the NHS) attached to each clinic appointment and compared them with the written documentation during a 2 week period in October 2022 -Intervention: teaching session for ENT SHOs on how to code procedures in EPIC, as well as a summary poster put up in the clinic room -2nd cycle: retrospective review conducted as per above method during a 2 week period in November 2022 Results In total, there were 255 appointments and 188 procedures over the 4-week period, with an average of 6 procedures per 8 patient session (am or pm clinic). Microsuction was the most common procedure (45%) with pure-tone audiograms second (27%). Just 6.7% of procedures were coded at baseline, increasing to 61.9% post intervention. Conclusion A simple intervention increased coding compliance by almost 10 times in a procedure heavy clinic. This will benefit the URC by improving future reimbursement for procedures undertaken. A key challenge will be ensuring this improvement is achieved in the long term.

2.

47. Reducing the risk of significant bleeding after thyroid and parathyroid surgery - the role of a protocol driven approach

Abbud N, George H, Kirby G, Balasubramanian S. (Presented by Kirby G)

Aim Post-operative haemorrhage following thyroid and parathyroid surgery is a well-recognised life-threatening complication. Following an audit reporting a re-operation for bleeding rate of 1.3% in 1913 patients (World J Surg 2020), a protocol driven approach involving the implementation of several specific measures at the time of wound closure (captured by the ‘ITSRED Fred’ mnemonic - Irrigation of wound, Time, Systolic blood pressure >100 mm Hg, Relieving neck extension, Elevating venous pressure, Drain avoidance and Flap evaluation) was implemented and evaluated . Method The operative and clinical records of 1525 thyroid and/or parathyroid surgical procedures in a single tertiary unit between 2017 and 2022 were reviewed following the implementation of the ‘ITSRED Fred’ protocol. The rates of re-bleeding requiring surgery were examined. Results The median age of the cohort was 53 years with a male: female ratio of 1:4. 946 had thyroid surgery, 541 had parathyroid surgery and 38 had both. Twelve (0.79%) patients had re-operation for bleeding (lower than previously reported rate of 1.3% from the same unit). Of these, 5 (0.3%) required re-operation before leaving theatre; 5 (0.3%) had bleeding within 6 hours and two (0.13%) after 6 hours. Bleeding rates were 1.06% (n=10) in thyroid surgery (n=946) compared to 0.37% (n=2) in parathyroid surgery (n=541). Conclusions A protocol driven implementation of specific measures (such as the ‘ITSRED Fred’ protocol) may reduce the rate of reoperation for bleeding after thyroid and parathyroid surgery.

4.

48. ‘How to stop a nosebleed’: a combined objective and subjective assessment of YouTube videos on first-aid management of epistaxis

Devakumar H, Tailor B, Perkins V, Ioannidis D.

Introduction: A previous study in 2016 found that the quality of YouTube videos on epistaxis first-aid management was highly variable. This study aimed to reassess the accuracy and patient understandability of such YouTube videos. Method: YouTube was searched using the phrase “How to stop a nosebleed”. The highest 50 ranking videos, based on relevance, were screened. Each video was assessed objectively using a standardised ‘advice score’ and subjectively using a video understandability and actionability checklist, PEMAT-A/V. Results: The mean advice score was 4.1 out of 8. The mean understandability and actionability scores were 76% (SD 17%) and 89% (SD 18%), respectively. There was a strong positive correlation between the actionability scores and advice scores (ρ=0.634; p<0.001), and the actionability scores and understandability scores (ρ=0.519; p=0.002). Conclusion: YouTube videos are providing increasingly relevant advice for patients seeking healthcare information. We propose YouTube is a useful medium for teaching epistaxis management to patients and community practitioners.

1.

49. Improving management of peadiatric cervical lymphadenopathy using a validated algorithm

Golsharifi M, Sinclair A.

Neck lumps are common in children and cervical lymphadenopathy is a frequent cause with the majority being reactive in nature and rarely malignant. However, clinicians must exclude malignancy without over-investigation. A departmental retrospective audit revealed large variation in management strategy leading to multiple attendances and high biopsy rate when analysed against a validated treatment algorithm based on "The validation of an algorithm for the management of paediatric cervical lymphadenopathy" (published by R Locke, F Macgregor and H Kubba). The algorithm was disseminated and installed in appropriate clinical areas. The process was re-audited and compliance rate increased from 31.6% to 85.7%, with a marked reduction in over investigation of non-malignant lumps.

1.

50. Is it feasible to offer day case adenotonsillectomy for OSA children?

Alburaiki A, Conybeare A, Javed F.

Background Adenotonsillectomy is one of the most common otolaryngological operations performed in the paediatric population, most often for obstructive sleep apnoea. Traditionally, children stay overnight for oxygen saturation monitoring, due to the concerns of the general anaesthetic on a patient already obstructing. However there has been a general trend towards day case surgery in those suitable, including recommendations by Get it Right

First Time. We reviewed the feasibility of this in our unit. Methods A retrospective review of all adenotonsillectomies between 22/07/2021 and 11/10/2022 was performed. Patients’ electronic data and paper notes were reviewed, including nurse’s notes and observation charts. Results A total of 78 children underwent adenotonsillectomies in this period. 47 females and 31 males, ranging from 2 to 16 years old. 57% stayed overnight, but 42% were already being managed as a day case. 1 child stayed for 2 nights. 3 patients had post operative saturations under 90%, with two requiring oxygenation (88% and 87% saturations). Both children were 3 years old, with one under 15kg weight. No patient was readmitted with any breathing concerns. Conclusion Using current published guidelines and our data set, it would be feasible to offer day case adenotonsillectomies to any child over the age of 4, as long as there were no underlying syndromes, significant medical comorbidities, reliable caregiver and living within 30 minutes of the hospital.

2.

51. Incidence of vestibular schwannoma in patients with unilateral tinnitus: a systematic review and meta-analysis

Javed A, Okoh M, Mughal Z, Javed F, Gupta K. (Presented by Okoh M)

Vestibular schwannoma (VS) is a tumour of the vestibulocochlear nerve. Current literature indicates that 1.6% of patients undergoing magnetic resonance imaging of the internal auditory meatus (MRI IAM) for audiovestibular symptoms are diagnosed with a VS. However, there is limited research reporting on patients who present with unilateral tinnitus without asymmetrical hearing loss. This study is a systematic review and meta-analysis evaluating how many of these patients had a VS diagnosed on MRI IAM. This meta-analysis was undertaken aligning with PRISMA guidelines. Online searches of Medline and Embase databases were performed up to October 2022. Articles reporting on MRI IAMs carried out for patients presenting with unilateral tinnitus without asymmetrical hearing loss were included. Outcomes measures were patient demographics, VS cases, incidental findings, size and management of tumour. A meta-analysis of proportions was performed using a random-effects model with the restricted maximum likelihood method. Quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist. Seven case series were included in the review: a total of 1394 patients. Seven patients had a VS, with a median size of 4mm. The pooled detection rate for VS was 0.08% (95% confidence interval 0.00 – 0.45). Subsequent management was reported in six cases, of which four were actively monitored and two surgically excised. The most common incidental finding was sinus disease (49 patients). Our findings indicate that MRI IAM has a low diagnostic yield for VS detection in patients presenting with unilateral tinnitus in isolation, with mostly small tumours which are conservatively managed.

POSTER ABSTRACTS

52. The role of Community Healthcare Workers in head and neck cancer: a systematic scoping review of the literature

Meredith E, O'Donovan J, Errington L, Mathur M, Hamilton D.

Study background and aims Head and Neck Cancer (HNC) is anticipated to cause over 500,000 deaths worldwide by 2030. Unfortunately, this is coupled with a shortage of trained healthcare professionals to manage HNC. An alternative cadre of workers – Community Healthcare Workers (CHW) – could be deployed to address this shortage. We evaluated the literature to assess where and how CHW are deployed in HNC strategies. Methods A systematic scoping review was carried out as this gives a broad overview of the topic and allows us to synthesise evidence from a range of methodology - this was appropriate due to limited evidence. Studies were included from across the globe and excluded if the focus was not HNC or if the focus was any professionally trained healthcare worker. Results We identified 13 studies for inclusion. Twelve were based in India. CHW were deployed for education and awareness raising initiatives, screening in the community, and ensuring compliance with treatment and follow-up. CHW were compared to specialists for effectiveness (n = 4) with one reporting sensitivity of 94.3% and specificity 99.3% for HNC screening. There was no evidence identified on costeffectiveness. Discussion This review has highlighted for the first time successful ways in which CHW can be deployed to meet the growing demand for HNC services. The evidence has outlined how CHW can screen for HNC therefore facilitate earlier diagnosis more amenable to treatment. This screening however needs to be supported with better tertiary support to ensure HNC can be appropriately treated.

53. Nasal Fracture Management: Improving Efficiency

Maccloud

Introduction: Nasal injuries account for 8-16% ENT emergency clinic utilisation and these clinics slots create high service demand.1,3,4 Stable nasal fractures with minimal external deformity do not require MULA (manipulation under local anaesthetic). Day 5-7 telephone triage intervention will identify patients who may require MULA and select those to be offered face-to-face appointments.5 Methods: This audit was conducted in the ENT department RD&E Hospital. ENT UK standards were reviewed, and data was collected from the Nasal Fracture Clinic August to October 2022 for the control group, followed by implementation of a telephone triage protocol then collection of data January to March 2023 for the intervention group (ongoing). Primary outcome measures included date of post-injury assessment, number of face-to-face appointments, appointment outcomes and MULA rates according to age Results/Discussion: 80 patients were included in the study (50 in Control and 30 in Intervention group). Following the intervention, preliminary results show a 19% improvement in post-nasal injury assessment rates within the optimal timeframe of 5-7 days, a 7% reduction in Did not Attend, a 42% lower MULA rates in >45yrs group as compared with <45yrs group. Overall clinic appointments were reduced by 33% (Mean 3.6 Control and 2.4 Intervention group). Completed results will follow once post-intervention data is complete. We also noted positive patient feedback i.e., 100% found our telephone triage service convenient and 80% were happy with the care they received. Conclusions: We identified that our intervention led to reduced post-nasal injury assessment time, reduced face-to-face appointments, and improved patient satisfaction.

3.

54. The 100 Most Cited Manuscripts in Hearing Implants: A Bibliometric Analysis

Ki Ko T & Tan D.

Objective: The aim of the study was to characterise the most frequently cited articles on the topic of hearing implants. Method: A systematic search was carried out using the Thompson Reuters Web of Science Core Collection database. Eligibility criteria restricted the results to primary studies and reviews published from 1970-2022 in English dealing primarily with hearing implants. Data including the authors, year of publication, journal, country of origin, number of citations and average number of citations per year were extracted, as well as the impact factors and 5-year impact factor of journals publishing the articles. Results: The top 100 papers were published in 23 journals and were cited 23139 times. The most-cited and influential article (n = 822) was by Wilson et al. (1991) describing the first use of the continuous interleaved sampling strategy (CIS) utilised in all modern cochlear implants. Articles ranged from 1976 to 2014 and included both primary studies and reviews. Most studies (66%) came from the United States and the Ear and Hearing journal had both the greatest number of articles (n = 22) and the greatest number of total citations (n = 4789). Conclusion: This research serves as a guide to the most influential articles on the topic of hearing implants, although bibliometric analyses mainly focus on citations. The most-cited article was an influential description of CIS.

3.

L, Wilson H.

55.

Nasopharyngeal carcinoma - Assessing the Readability and Quality of Patient Information on the Internet

Ki Ko T & Tan D.

Introduction: The Internet has become a major source of information on health-related issues. The aim is to evaluate the quality and readability of online information present on nasopharyngeal cancer using recognised scoring tools. Methods: Keywords including “nasopharyngeal cancer” and “nasopharyngeal carcinoma” were searched for using internet search engines: Google, Yahoo and Bing. Website authorship were classified: academic, commercial, or unspecified. Each website was assessed for readability using the Flesch Reading Ease score and the Flesch-Kincaid grade level. Quality of information was assessed with JAMA and DISCERN tools and presence of a HONcode seal. Results: A total of thirty websites were included in our study. Over half of the websites were academic (60%; 18/30). The average JAMA and DISCERN scores of all websites were 2.57 +/- 0.95 and 50.38 +/- 11.82, respectively, with a median of 2.0 (range 1-4) and 53.50 (range 29-75), respectively. Commercial websites had the highest JAMA score with a mean of 3.50 +/- 0.52. Academic websites had the highest DISCERN score with a mean of 50.83 +/- 12.19. Five websites were HONcode-sealed. Commercial websites had a significantly higher JAMA mean than academic (p< 0.001) and unspecified (p< 0.04) websites. None of the websites were at or below the recommended sixth-grade readability level. Conclusions: Internet information relating to nasopharyngeal cancer is of variable and suboptimal quality. Given this variability, healthcare providers should direct patients to known sources of reliable, readable online information. Identification of reliable sources may be aided by known markers of quality such as HON-code certification.

56. An Exploratory Analysis of UK Junior Doctors’ Knowledge of Nasendoscopic Anatomy

Background Junior doctors in ENT are expected to use flexible nasal endoscopy (FNE) routinely, even independently, during out-of-hours cover. However, their knowledge of nasendoscopic anatomy is not well understood. This study aimed to evaluate the efficacy of a novel interactive video tool in assessing their knowledge. Methods Junior doctors in four UK hospitals were sent an interactive FNE video with 25 anatomy identification and 3 procedural questions, tailor made using H5P software. A questionnaire was also administered to collect trainee demographics, previous ENT exposure, and confidence in identifying FNE anatomy. Results The study received 22 responses from doctors at various levels of training. The average score for the FNE video was 58.6%. CSTs scored significantly higher (91.5%) than GP trainees (33.9%), FY2s (59.1%), and non-training post-FY2 doctors (53.3%) (one-way ANOVA p=0.004). Confidence was moderately correlated with performance (Person’s Coefficient 0.49), but the number of FNEs performed was not significantly correlated with score (Spearman’s rank correlation test rho = 0.479, p = 0.083). Conclusions As well as highlighting a knowledge, and potentially insight, gap in junior doctors' FNE anatomy, the interactive video tool provides a promising approach to identify knowledge gaps and tailor training to individual needs. Further studies using this tool are needed to determine its effectiveness in improving trainees' performance in clinical practice as well as broader application to endoscopic sinus surgery.

3.

57. Best Practice: NGT Placement Verification in Laryngectomy Patients

Maccloud L, Wilson H.

BACKGROUND: Nasogastric tubes (NGT) are one of the most used enteral tubes in head and neck surgical department at RD&E. During laryngectomy, NGT is inserted just before the closure of the pharynx which means that the tube is directly visualised to be in the gastrointestinal tract and an aspirate pH test is sufficient to verify placement. This will improve awareness among staff who care for these head and neck post-operative patients with NGT. METHODS: This audit was conducted at the RD&E Hospital ENT department between the period November to December 2022. Pre and Post intervention assessment were conducted, and the impact noted after teaching and practical session held on Nurses Study Day. RESULTS: 10 Nurses were assessed pre- and post-teaching intervention. Majority 89% were Females and 67% Band-5. Pre-intervention, 89% stated that both aspirate pH test and chest X rays (CXR) are needed to confirm placement of surgically placed NGT which contradicts best practice. Post-intervention 45% selected aspirate pH test (which is reflected in our best practice), and no one selected whoosh test. CONCLUSION: Many persons are unfamiliar with best practice guidance regarding NGT confirmation. Frequent refresher teaching sessions during inductions will be helpful to remind all staff of the NPSA decision tree. A further audit needed to assess the reduction in number of CXR and radiation exposure because of educational intervention, with associated cost saving, and reduced delays in nutrition for patients.

2.

Siddique H, Rana M, Loyala JV, Maweni R, Hettige R.

POSTER ABSTRACTS

58. Audit of the Thyroid Cancer Faster Diagnostic Standard at a Tertiary Centre

Caglayan A, Tolley N.

Background The diagnosis or ruling out of thyroid cancer can often require multiple points of clinical contact. This presents a challenge in achieving the faster diagnostic standard; an initiative first highlighted in the NHS long term plan. This standard requires patients to receive a definitive diagnosis or ruling out of cancer within 28 days, following an urgent suspected cancer referral by their GP. Trusts are expected to meet the national faster diagnostic standard of 28-days at a rate of 75%. Methodology A retrospective analysis of patients whose thyroid cancer faster diagnostic standard pathway ended during January and February 2022 was completed. 30 patients were also selected for detailed retrospective timeframe analysis; half of which breached the faster diagnostic standard and half of which did not. Results During January and February 2022, 46 patient’s faster diagnostic standard pathway was completed. The faster diagnostic standard performance level was 39% with an overall malignancy diagnostic yield of 7%. The mean wait time from referral to diagnosis for the breach and non-breach cohort was 46 and 13 days respectively. Conclusions A large proportion of patients are not meeting the thyroid cancer faster diagnostic standard. This audit has identified key areas that can be focused on in order to reduce timeframes between points of clinical contact. Focused intervention to reduce the time between first outpatient clinic to ultrasound and fine needle aspiration appointment will be essential to reach the national diagnostic standard at the Imperial College Healthcare NHS Trust.

59. Audit on Op-Notes in Head and Neck Surgery (University College London Hospital NHS Trust): Are We Documenting Enough?

Jamalludin A.

Background: Op notes are vital as part of patient care in-line with Good Medical Practice to provide continuity of care and for medicolegal purposes. Aim: To assess compliance of op-notes documentation against Royal College of Surgeons (RCS) England Good Surgical Practice Guidelines “1.3 Record your work clearly, accurately and legibly” in Head and Neck Department, UCLH. To raise awareness among team members. Methods: This is a retrospective 2-cycles audit (n=34) analysing September 2022 op list for first cycle and October 2022 op list for second cycle. Inclusion and exclusion criteria applied toensure uniformity of data collected based on type of operations. Data documentation analysed against domains in RCS guidelines. Results: Results are compared for both cycles in terms of documentations. 100% compliant documentations for both audits are date, time, name of surgeon & anesthetists, details of tissue, post-op instructions, signature. Name of procedure entry showed improved trend from 93% to 100%. Incision improved trend from 66% to 90%. Operative diagnosis improved from 80% to 90%. Operative findings entry improved from 53% to 70%. Closure entry improved from 73% to 100%. Blood loss entry however showed reducing compliance from 93% to 75%. DVT prophylaxis entry also reducing compliance from 46% to 35%. Blood loss should be documented even in minor cases with minor bleeding risk. DVT prophylaxis might be overlooked in some cases (e.g. hemithyroidectomy which require only overnight inpatient). Conclusion: Surgical teams are responsible in documenting clear plans and instructions peri-operatively to provide optimum level of patient care, reduce perioperative complications and improve patient satisfaction.

3.

60. Tactile learning in Undergraduate Medicine – Student opinion on the use of anatomical models vs non tactile distance learning in the context of otolaryngology undergraduate training

Pandya A, Mistry D, Owens D.

INTRODUCTION The amount otolaryngology exposure in the undergraduate curriculum has been a concern for over thirty years. The Government’s plan to increase the number of medical students in the UK along with GMC guidance has put pressures and ultimately changed the medical curriculum . Modern day curriculums are aimed to reduce factual overload, decrease expenses and make teaching more clinically orientated. Medical schools are struggling to meet these requirements, especially in the context of otolaryngology undergraduate training. This pilot study endeavoured to compare student satisfaction between tactile face to face learning with non-tactile videoconference learning, in the context of undergraduate training on the anatomy and function of the larynx. MATERIALS AND METHODS The design was set up as a cohort study with two groups of medical students observing a single educational event on the larynx and management of the airway. The learning opportunity was delivered in a lecture format with the lecturer using an anatomical model of the larynx as an fulcrum to the lecture. Two learning groups were created; one group (tactile group) had an identical model to interact with during the lecture, the other group (non tactile) did not. RESULTS The results of pilot study demonstrated that tactile learning is as effective as non-tactile learning when comparing student satisfaction on a otolaryngology undergraduate training session on the larynx and function. CONCLUSIONS These findings may provide an effective alternative method of teaching for anatomy and teaching sessions in general given the challenges faced by the modern medical school curriculum.

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The RMBF is the UK charity for doctors, medical students and their families.

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CORE COMMITTEE 2022-2023

ENT ST7

East of England

ENT ST6

North West

ENT ST5

North West

FRCS

ENT ST8

Thames Valley

ENT ST4

North West

YCOHNS Rep President 2021-2022

Cochlear Implant and Otology Post CCT Fellow

Sydney, Australia

Ms Tharsika Myuran President

Mr Ding Yang Treasurer

Ms Anastasha Herman Co-Secretary

Mr George McNally Co-Secretary

Ms Summy Bola Vice President

Exam Board Rep

Ms Fenella Shelton

COMMITTEE 2022-2023

Mr Johan Bastianpillai

Education Lead

ENT ST4

East of England

Mr Anthony Bashyam

BACO Rep

ENT ST7

Kent, Surrey and Sussex

Ms Emily Gogo

CT/SFO Rep

ENT CT2

Central London

Mr Joshua Michaels

ASIT Rep

ENT ST4

East of England

Ms Kala Kumaresan

BMA MSWG Rep

ENT ST3

Yorkshire and the Humber

Mr Hussein Walijee

Education/Training Rep

Post CCT Otology Fellow

Gloucester

COMMITTEE 2022-2023

ENT UK Rep

ENT ST - OOPR

North London

ENT ST5

South London

ENT ST5

Kent Surrey and Sussex

North West

ENT ST5

East of England

ENT ST6

Yorkshire and the Humber

Ms Farizeh Jashek-Ahmed

EDI/WENTS Rep

Ms Antonia Tse

Facial Plastics Rep

ENT Consultant

Ms Sarah Law ISCP Rep

Mr Zain Sheikh

Journal/Research Rep

Ms Sarah Louise Humphries ICBSE/MRCS Rep

Ms Eleanor Crossley

Mr Rahul Pankhania

MTI Rep

ENT ST3

North London

Ms Reshma Ghedia

RSM Otology Rep

ENT ST8

North Thames

Ms Karthika Shanthakunalan

Social Media Rep

ENT Clinical Teaching Fellow

East Midlands

Mr Ahmad Moinie

RCSEd Rep

Deanery Trainee Rep

ENT ST7

East of England

Mr Darren Yap

RSM Rhinology and Laryngology Rep

ENT ST8

Thames Valley

Ms Georgina Wellstead

Webmaster

ENT ST5

Severn