International clinical assessment of smell: An international, cross-sectional survey of current practice in the assessment of olfaction.

OBJECTIVES: Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. DESIGN: Anonymous online questionnaire with cross-sectional non-probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non-rhinologists') was performed, with geographical comparisons only made according to subgroup. PARTICIPANTS: ENT surgeons who assess olfaction. RESULTS: Responses were received from 465 clinicians (217 from UK and 17 countries total). Country-specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios-though rhinologists did so more often than non-rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. CONCLUSIONS: To our knowledge, this is the most comprehensive UK-based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems.

Osteoma arising from the middle turbinate-a case series.

This case series aims to highlight that although extremely rare, osteoma can arise from the middle turbinate. We discuss the condition and treatment options. We describe 2 cases of osteomas arising from the middle turbinate. One occurring in a 29-year-old gentleman who presented to the ENT clinic with left nasal obstruction, and the other in a 65-year-old lady admitted to hospital with headaches and hypotension. Both cases were further investigated with CT scan. Both patients were treated with endoscopic fusion navigation assisted excision. Due to the large size of the mass, the gentleman required the mass to be delivered after it was drilled through and requiring septal deflection and vomerine spur reduction. As for the lady, the mass also required drilling and a posterior septotomy to facilitate dissection and removal of the tumour. Both patients made good recoveries with resolution of symptoms. Although extremely rare, osteomas can arise from the middle turbinate causing symptoms such as headache, facial pain, nasal obstruction and visual problems. As they are slow growing, they can be of large size at presentation. Treatment usually involves surgical excision. Endoscopic excision is usually adequate and safe.

Granulomatosis with polyangiitis causing subglottic stenosis-two cases and their management.

Granulomatosis with polyangiitis (GPA) is characterised by vasculitis of small and medium sized blood vessels and granulomatous lesions of the respiratory tract. The aetiology is unclear, however it is thought to be due to an autoimmune process with about 92% of patients with the disease being antineutrophilic cytoplasmic antibodies (ANCA) positive. Patients normally present in early adulthood, more commonly in the winter months. Seventy percent of patients with GPA present with ear, nose or throat symptoms. These include nasal congestion, crusting, epistaxis, nasal septal perforation and nasal saddle deformity. Lesions in the airway can lead to subglottic stenosis with resultant airway obstruction. Treatment of the disease complicated by subglottic stenosis is not straightforward and the benefits and risks of options including medical and surgical management need to be weighed up and tailored to each individual case. We describe two cases of GPA complicated by airway obstruction due to subglottic stenosis and their management.

The development and design of the European Board of Otorhinolaryngology-Head and Neck Surgery Examination (EBEORL-HNS).

The UEMS Otorhinolaryngology-Head and Neck Surgery section is a dedicated body formed to promote the standardisation and harmonisation of European Otorhinolaryngology (ORL). The European Examination Board of Otorhinolaryngology and Head and Neck Surgery was created to establish a supranational final exam and accreditation for ORL Surgeons. It is open to candidates both from the European Union and outside the EU. The exam is composed of a written examination to assess mainly the theoretical knowledge of Otorhinolaryngological diseases. The second part, a viva voce examination, is designed to test the clinical application of knowledge based on case scenarios and clinical conditions presented to the candidates. The inaugural examination written component took place in Mannheim/Germany in 2009 and the inaugural Viva Voce examination in Vienna/Austria in 2010. Up to and including the year 2013, 858 participants have attempted one of the two exam components. Of the 858 participants, 305 were successful in both examinations and obtained the accreditation of the European Diploma (European Board Certification). The historical origins, development of the examination, its formal arrangements and the format of the examination are presented in this article.

Benefits of frenulotomy in infants with ankyloglossia.

OBJECTIVES: Ankyloglossia is a common, congenital abnormality often causing feeding difficulties in infants. This study aimed to evaluate indications and outcomes of frenulotomy performed in infants with ankyloglossia for breast-feeding difficulties. METHODS: 85 patients were prospectively identified as they underwent frenulotomy in Pinderfields Hospital ENT outpatient department between February 2008 and February 2011. 52 patients were successfully followed up with a telephone questionnaire about effects on breast-feeding and any complications. RESULTS: All mothers had experienced problems breast-feeding prior to frenulotomy. Following frenulotomy 40/52 (77%) of mothers reported an improvement in breast-feeding within 2 weeks of the procedure. No complications were reported. CONCLUSION: This study supports the view that ankyloglossia is a common cause of breast-feeding difficulties. However the lack of universal improvement in breast-feeding following frenulotomy suggests that it is not the only cause of problems and supports the clinician approaching these situations holistically and exploring other causes.