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The ENT operating theatre viewed down the retrospectoscope

We learn much of our future by looking at our past; Douglas MacMillan provides us with a fascinating glimpse into his years as a junior doctor. The operating theatre was a somewhat alien environment in the late 1960s: theatre sisters...

Effects of nasal sprays on ciliary function

What do topical nasal sprays do to the nasal mucosa in the long term? This study reports the effect of corticosteroids, antihistamines and common preservatives in nasal sprays, benzalkonium chloride (BKC) and potassium sorbate (PS), on an in-vitro model of...

Evidence and nasal polyp treatments

The change in the routine management of nasal polyps in the past 2-3 decades has been fascinating and this review from Charleston covers the topics of systemic treatment, local treatment, perioperative treatment and immunotherapy and touches on the lower airway...

Patients with auto-immune Meniere’s disease more likely to respond to intratympanic steroids

The authors retrospectively reviewed the duration of symptom control after intratympanic dexamethasone (IT) injections in 27 patients with Meniere’s disease (MD) over a six-year period. The patients received two IT injections of 3.3mg/ml of dexamethasone one-to-two weeks apart. Eleven patients...

Location, location, location: How to get the steroid where you need it, in chronic rhinosinusitis

What almost all current guidelines on chronic rhinosinusitis have in common is the importance of intranasal steroid (INCS) use. However, it is increasingly understood that the efficacy of INCS depends on their efficient delivery to the point of need, i.e....

Allergen specific subcutaneous immunotherapy helps in prolonged control of allergic rhinitis

One of the commonest allergens involved in perennial allergic rhinitis is house dust mite. A good proportion of these cases prove intractable to treatment with oral and intranasal antihistamines and intranasal steroid sprays. Immunotherapy is considered a useful alternative and...

IL-25 and nasal polyps, another target

Immune response in chronic rhinosinusitis with nasal polyps (CRSwNP) is mainly via type 2 T-helper (Th2) cells while Th1 cells characterise chronic rhinosinusitis without nasal polyps (CRSsNP) immune response. CRSwNP is heterogeneous on a cytological level causing a varied response...

Recovery rates in sudden sensorineural hearing loss

Sudden sensorineural hearing loss (SSNHL) is most commonly idiopathic, and is seen relatively frequently in ENT practice. Recovery spans a period of around 1-2 months, and ultimate outcomes are highly variable, from complete recovery to no detectable hearing. Although the...

Timing of surgery in chronic rhinosinusitis: does it matter?

While many patients with chronic rhinosinusitis respond to medical treatment, some do not. The next step for these patients is surgery, but how soon should this be offered? Sooner rather than later seems to be the answer, as Claire Hopkins...

Rhinology: what does the future hold?

David Kennedy surveys the past, the present and the future of rhinology practice and research. An evolution of understanding in rhinology The dramatic growth of clinical and translational research within the field of rhinology in recent years is illustrated by...

How trainees can make major contributions to practice

At a time when many of our trainees feel poorly supported and disheartened, the formation of a National ENT Trainee Research Network (Integrate) has been a major advance, enabling them to develop and execute research projects directly relevant to clinical...

Chronic rhinosinusitis management: back to the future?

Immunology is a dim and distant medical school memory to many ENT surgeons, but the increasingly complex immunology of chronic rhinosinusitis is fascinating (honestly!). Medical management options in CRS no longer just involves saline and steroids, and we need to...