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The incidence of coagulopathies in children presenting with post-tonsillectomy haemorrhage

Tonsillectomy is often the first haemostatic challenge for a child. Postoperative haemorrhage may therefore represent the first presentation of a child’s underlying bleeding disorder. This study aimed to quantify the rate of occult coagulopathy in patients who had experienced a...

The pioneers of endoscopy and the sword swallowers

Adolf Kussmaul drew inspiration from an unlikely source to further the development of endoscopy… The early pioneers of airway endoscopy and oesophagoscopy were bedevilled by two major and seemingly insurmountable problems. One was the paucity of light sources, with reliance...

Argon plasma coagulation for epistaxis in HHT

In this study from the Czech Republic, the authors looked at the effectiveness of argon plasma coagulation (a non-contact form of monopolar electrocoagulation) in treating recurrent epistaxis in patients with hereditary haemorrhagic telangiectasia (HHT). The advantage of argon plasma coagulation...

The future of rhinology: What will come first, a radical change in rhinological management or the decimation of the world?

In this article, Simon Gane looks forward to what the future holds, on the presumption he survives. Setting aside the questions of the UK even existing, the NHS still working, or the fact we’ll be commuting to our jobs in...

Simulation: human factors scenario training

It is said that surgical training has suffered as a result of a combination of factors – through the introduction of work time restrictions such as the European Working Time Directive (EWTD) [1], a limit on the number of years...

Peripheral nerve stimulation for chronic refractory pain

Peripheral nerve stimulation (PNS) plays an important role in treating chronic refractory pain syndromes that manifest in limited distributions and overlap with areas of neurologic innervation. The process is generally thought to capitalise on the inhibition and activation of pain-related...

Coblation versus microdebrider submucosal inferior turbinoplasty

This prospective randomised study from Riyadh compares submucosal coblation and submucosal microdebrider inferior turbinate reduction. Seventy patients were recruited who had failed medical treatment and were undergoing isolated inferior turbinate surgery. Outcome measures included the Friedman score and VAS for...

Anaesthesia for sleep nasendoscopy and snoring / obstructive sleep apnoea surgery

Surgery for sleep disordered breathing inevitably requires surgeon and anaesthetist to share the airway. Here, Edward Bick gives us the anaesthetic viewpoint, reiterating that communication is the key. A specific note is made of the anaesthetic technique for sleep nasendoscopy,...

The EU Medical Device Regulation (MDR)

Back in May 2017, the EU Medical Device Regulation (MDR 2017/745) entered into force, replacing existing directives: Active Implantable Medical Devices (AIMD) In-vitro Diagnostic Directive (IVDD) Medical Device Directive (MDD) By 26 May 2020, the new regulation will have completed...

Multidisciplinary airway simulation workshops: ‘preparing your team for the difficult airway’

Can human factor issues be better addressed within a multidisciplinary learning environment? Would this improve team working and patient outcomes? Are these important training considerations? Mona Thornton discusses the experience of a multidisciplinary simulation airway workshop in the unit she...

Neuromodulation in drug resistant epilepsy

Treatment of epilepsy can be considered generally as medical or surgical. Anti-epileptic drugs achieve a five-year seizure freedom in 54-70% patients. It is estimated that 50-90% of patients with drug-refractory epilepsy may not be candidates for resective surgery. For example,...

Can prediction models help identify dysphagia in ventilated patients?

Dysphagia commonly affects patients in intensive care units (ICU), particularly those on mechanical ventilation, and is associated with high risk of mortality. This systematic review and meta-analysis aimed to identify predictors for dysphagia in ventilated ICU patients by summarising existing...