Denton et al.'s multi-centre study into the learning curve of students undertaking myringotomy and ventilation tube insertionReference Denton, Daglish, Smallman and Fishpool1 compares the endoscopic to the microscopic technique. The study surprisingly does not support an assumption that the endoscopic technique is harder to learn, and may be easier than the standard microscope technique. This will be a boost for proponents of the endoscopic approach to ear surgery in the UK and beyond.Reference Clark2,Reference Mitchell and Coulson3
Patulous Eustachian tube syndrome is a difficult condition, and has been the subject of several recent papers in The Journal of Laryngology & Otology exploring various methods of treatment.Reference Rodriques, Waddell and Cook4–Reference Alli, Shukla, Cook and Waddell6 This issue's contribution is from Korea,Reference Choi, Park, Lee, Oh and Kong7 in which a large series of patients were managed with conservative measures or transtympanic catheter placement. The study focuses on the association of an anatomical defect in the anterolateral wall of the tubal valve with the likelihood of success of conservative measures versus surgery. They conclude that the presence of this defect is more likely to indicate a need for surgery.
The heterogeneity of content, fitness for purpose and timing of ENT undergraduate education in the UK have been topics of discussion in The Journal and other journals for many years.Reference Dimitrov, Unadkat, Khanna, Rennie and Saleh8–Reference Mace and Narula11 With an evidence-based guideline for the ENT curriculum being published in 2014, after applying a Delphi method,Reference Lloyd, Tan, Taube and Doshi12 it might be reasonable to have hoped that much of the angst surrounding this subject, one close to the heart of ENT surgeons and general practitioners, would have dissipated. Mayer et al.'s survey of UK medical schoolsReference Mayer, Smith and Carrie13 suggests that such hopes are premature and that there are still significant deviations from a suggested curriculum, including the omission of important topics such as tracheostomy. A frequent theme in recent relevant educational articles,Reference Hogg, Kinshuck, Littley, Lau, Tandon and Lancaster14–Reference Elloy and Sama16 echoed here, has been encouraging supplementary ENT teaching opportunities. These include an introductory or emergency-focused course at a later stage, sometimes using simulation, to limit potential adverse effects on patient safety from undergraduate ENT provision that is perceived to be inadequate. Getting things right at undergraduate level seems preferable, with later courses giving ‘added value’, rather than being essential for safe working.
Necrotising (formerly ‘malignant’) otitis externa continues to pose a challenge for the otologist. Previous work has highlighted changes over time based on hospital statistics, with a radical increase in incidence over the past decade and more, some of which can be explained by an increasing prevalence of diabetes mellitus and an increasingly ageing population.Reference Chawdhary, Pankhania, Douglas and Bottrill17,Reference Chawdhary, Liow, Democratis and Whiteside18 A recent Journal of Laryngology & Otology article discussed the role of diffusion-weighted magnetic resonance imaging in predicting severity.Reference Razek AAK and Mahmoud19 This issue contains a review of the subject,Reference Hopkins, Bennett, Henderson, MacSween, Baring and Sutherland20 based on experience in NHS Lothian of 20 cases, and proposes evidence-based guidelines for management, including a useful algorithm. Defining high-risk cases early in management is the crux of these guidelines, and may lead to better patient outcomes for this dangerous disease.
Finally, we send our heartfelt congratulations to Robin Youngs, Emeritus Editor, who was recently appointed to an Associate Professorship at the London School of Hygiene and Tropical Medicine in recognition of his work in World Medicine, which is richly deserved.
