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Surgical management of sleep disordered breathing

Snoring and sleep-disordered breathing are often described as multi-level problems, and different surgical procedures are required to treat the various sites of airway narrowing and/or collapse. Jonathan Hobson gives us an eloquent run-through the various options available to the ENT...

Why do septoplasties fail?

If you are amongst the ones who wonder what keeps your patient blocked in spite of a reasonable septoplasty, it will be worth your time going through the chapter on nasal valve management. The concise table detailing the surgical techniques...

Surgery for hypopharyngeal obstruction causing OSA

Surgical treatments for OSA are evolving with improved diagnostic accuracy of the level(s) involved. Where the collapsing segment lies below the soft palate, a variety of surgical techniques to correct the affected segment(s) are emerging. This article concentrates on one...

How should I excise sinonasal tumours, open or endoscopic? En bloc or piecemeal?

Sinonasal tumours often present late because initial symptoms mimic benign disease. They tend to produce more unilateral nasal symptoms, and patients with advance disease often describe paraesthesia and other cranial neuropathies. They only account for approximately 3% of upper aerodigestive...

Use of tranexamic acid in ENT surgery

Postoperative bleeding in otolaryngologic procedures causes delayed discharge, requires re-admission and adds considerably to the cost of patient care. Whether the anti-fibrinolytic activity of tranexamic acid should be used routinely to prevent haemorrhagic complications after ENT operations is speculation but...

Surviving oropharyngeal squamous cell carcinoma – does subsite matter?

Human papilloma virus (HPV) status is a known prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). The eighth edition of American Joint Cancer Committee (AJCC) has modified the TNM staging to reflect this. However, subsite as an independent prognostic factor...

Predicting swallowing outcomes post radiotherapy for head and neck cancer

A videofluroscopic swallow study (VFSS), also known as modified barium swallow (MBS) offers a dynamic view of swallow biomechanics and associated swallowing physiology. The authors of this paper investigated whether quantitative timing and displacement measures of key structures involved in...

Posterior nasal neurectomy – long-term data shows tailing off of benefits but still improvement after three years

It is well understood that allergic rhinitis has a very detrimental effect on quality of life for afflicted patients. This study looks at patients with allergic rhinitis but no other associated sinonasal or respiratory diagnoses. Patients with a history of...

ENT in this issue...Rhinoplasty

Joanne Rimmer, MBBS, MA(Hons)Cantab, FRCS(ORL‑HNS), Consultant Otolaryngologist / Rhinologist, Monash Health, Melbourne, Australia. E: rimmer.joanne@gmail.com Rhinoplasty may be done purely for aesthetic reasons, as an essential part of a functional septorhinoplasty, or for a combination of both cosmetic and functional...

Predicting CSF leaks pre FESS: Gera classification - a new tool?

An interesting study from Italy looking at an anterior skull base classification that may be useful in predicting risk of intraoperative CSF leak during FESS surgery. Traditionally we have used the Keros classification system, developed in 1962 to categorise olfactory...

OBITUARY: Nobuhiko Isshiki (1930–2022)

Ushering in a new era, the pioneer of laryngeal framework surgery remains an inspiration to this day. Prof Nobuhiko Isshiki in 2016 (courtesy: Mr Yakubu Karagama). The laryngological world has lost a great man. Professor Nobuhiko Isshiki passed away in...

Clinical assessment in OSA

This paper divides the assessment up into anatomical (nasal and oropharyngeal), endoscopic and imaging. It points out the salient features to look out for in OSA patients with regards the nasal valve and also oropharyngeal anatomy, with tonsil hypertrophy grading...