North of England Otolaryngology Society

Autumn Meeting- October 19th

, Liverpool Medical

Institution

President’s Welcome

It is a great source of joy to host the North of England

Otolaryngology Society in Liverpool. Council have put

together a super programme, with an emphasis on head

and neck but much else besides, and some very

promising papers and posters by our trainee colleagues,

who are the life-blood of the society.

The venue, the Liverpool Medical Institute with its rich

history and quaint but charming old Victorian lecture

theatre has long associations with otolaryngology in

Liverpool. The late Prof PM Stell is a former President

of both the Institute and the Society, and the Stell

lecture this year will, fittingly, be delivered by his

successor, Prof Terry Jones.

I hope to see as many old and new friends as possible

and warmly welcome you to Liverpool. Enjoy the day!

Ray Clarke

President, North of England Otolaryngology Society.

1

Agenda - morning

9 15 President’s Introduction

9 30 Stell Memorial Lecture- Prof Terry Jones (Liverpool)

‘Oropharyngeal cancer – Management in the HPV era’

10. 15 Short papers:

Management Strategies in Iatrogenic Tracheal

Injuries: a literature review and case series; John

Rocke, Asghar Nawaz, Rajesh Shah, Manchester

Metabolism and anti-metabolic therapeutic

strategies in human papillomavirus-positive

squamous cell carcinoma of the head and neck

(SCCHN)

Mark D Wilkie, Andrew S Lau, Nikolina Vlatkovic,

Terence M Jones, Mark T Boyd, Liverpool

10 45 Steven Powell ‘Airway Database Update’

11.00 Coffee and poster viewing

11 30 Short papers:

Localisation of parathyroid adenoma: is there a role

for preoperative CT imaging? A nine-year

retrospective study in a district general hospital;

Sara Timms, Rajesh Anmolsingh, Kristina Lee,

Simon Hargreaves, Bolton

2

Optimal Wound Closure Techniques for Thyroid

and Parathyroid Surgery: A Systematic Review of

Cosmetic Outcomes; Kristina Lee, Nicholas Ward,

Babatunde Oremule, Navin Mani; Blackburn

12 00 Nazia Munir ‘Proximal facial nerve localisation in

parotid surgery'

12. 30 Short papers

Efficacy and tolerability of intratympanic

gentamicin injections in the outpatient clinic; Areej

Paracha (Alexander Pearman – to present), Simon

Lloyd, Emma Stapleton; Salford

Drainless, sutureless day case superficial

parotidectomy with Artiss - a case series; Jacob

Duffin, Craig McCaffer, Lakh Pabla, Shane Lester;

Middlesbrough

3

1 00 Lunch and poster viewing. Council meeting

2 00 AGM

2 15 Su De ‘Role Models and Mentors in ENT Surgery’

2 30 Ian Street ‘ENT problems in children with special

needs’

2 45 Andrew Kinshuck ‘Laryngotracheal reconstructive

surgery post-cancer’

3 15 Short papers:

‘I Get Out of Breath Playing at Anfield...’

Development & Evaluation of a Complex

Breathlessness Clinic; Thomas Hampton, Claire

Hepworth, Ian Sinha, Sunil Sharma, Su De

(Liverpool)

3 45 Prize-giving and closing remarks

4 00 Finish

Agenda - afternoon

4

Speakers

Professor Terry M Jones

BSc, FRCSEd, FRCS (ORL-HNS), MD, SFHEA,

FASE(RCS), FAcadTM

Professor of Head and Neck Surgery, University of

Liverpool

Honorary Otolaryngologist / Head and Neck Surgeon,

Aintree University Hospitals NHS Foundation Trust

Director, Liverpool Head and Neck Centre

Head and Neck GeCIP Lead, 100k Genomes Project

Editor-in-Chief, Clinical Otolaryngology

Over recent decades the incidence of oropharynx cancer

(OPSCC) has doubled in many countries of the Developed

World. Whilst much of this increase has been attributed to

infection with Human papillomavirus (HPV+), recent UK

data confirms a parallel rise in HPV negative OPSCC.

HPV+ OPSCC affects patients who are younger, fitter,

drink less alcohol and smoke less than patients presenting

with HPV- head and neck cancer. Whilst they typically

present with clinico-pathological features (multiple

cervical lymph nodes with a high prevalence of

extracapsular spread) traditionally associated with

aggressive behaviour and poor treatment outcome, they,

paradoxically, respond better to treatment. Current

treatments based on cisplatin based chemoradiotherapy

(CRT), however, result in marked early and late toxicity,

particularly with respect to swallowing function. Whilst

most patients with HPV+ disease will experience a

favourable survival outcome, a significant minority,

together with patients presenting with HPV- disease, will

do less well.

5

This talk will highlight the contribution of contemporary

minimally invasive transoral surgery in the quest to

develop novel

1. De-intensified treatment strategies for patients with

favourable disease, in order to maintain current survival

outcomes whilst reducing detrimental treatment-related

effects on swallowing

2. More effective strategies for patients likely to

experience a poorer outcome

6

Steven Powell

Bio

Steven graduated from Newcastle University, and went on

to higher surgical training in the Northern Deanery. He

was awarded an MSc in Health Research from the

University of Leeds in 2012.

Steven undertook a fellowship in paediatric otolaryngology

at the Royal Children’s Hospital in Melbourne, returning

to the North East in 2012 to a consultant post in Newcastle

upon Tyne with a special interest in paediatric airway

surgery. Steven has research interests in OSA and airway

stenosis and was the national lead for the NICE Airway

Intervention Register (AIR) balloon database. He is on

the national steering group for the AIR Recurrent

Respiratory Papillomatosis database. He is a regional

surgical advisor for the Royal College of Surgeons of

Edinburgh and the honorary secretary of the British

Association for Paediatric Otorhinolaryngology.

Abstract

The first UK Recurrent Respiratory Papillomatosis (RRP)

registry opened on 1st April 2018 through the AIR (Airway

Interventional Registry) platform. Patients are being

actively recruited and there is much anticipation that this

will provide benefit to patient and managing surgeons

alike. RRP is still an enigma despite the many publications

on this condition. There is currently no cure and further

research in needed. Evaluating current therapies for

effectiveness and safety will allow a baseline to be

established. From the surgeons perspective the registry

will allow a better understanding of the patient’s condition

by delivering results for scores on how voice is affected

and a more objective approach to disease severity with

7

Derkay scoring. The graphical representation of the

clinical course allows an instant appraisal of the patient’s

condition over time. The patient will benefit from these

summaries as they will be able to view their progress. The

patient portal will open soon and allow a patient to

perform a VHI from their home. The registry will allow a

Nationwide evaluation of the interventions for RRP and be

a vital resource for demonstrating benefits of future

therapies.

8

Nazia Munir

Bio: Nazia Munir is a Consultant ENT surgeon with a

special interest in Otology, Neurotology and Skull Base

Surgery. She was appointed to her post in 2012 at the

Aintree University Hospital, Liverpool after undertaking

advanced skull base training in prestigious fellowships in

Cambridge and Toronto. She is the Merseyside and

Cheshire Skull base lead ENT clinician and MDT chair.

She specializes in lateral skull base disorders and

advanced parotid / temporal bone malignancy.

Abstract: Facial nerve preservation without

compromising surgical clearance is the aim of all

parotid surgery for both benign and malignant

pathologies. The facial nerve, however, is at a greater at

risk in the presence of large, complex, recurrent and pre-

auricular lesions. There is also the additional risk of

tumour spillage and incomplete surgical resection due to

the limited space between the skull and the

tumour. Intramastoid localisation of the facial nerve

allows a posterior approach, and access to the dissection

plane that lies medial to the nerve. Limited dissection of

the temporal bone and identification of the facial nerve

proximally in the mastoid portion can facilitate resection

whilst better preserving facial nerve function, reducing

the risk of tumour spillage, and optimising the clearance

margin for resection in malignant disease. This also

allows better access for nerve grafting if the facial nerve

has to be sacrificed.

9

Su De

Biog:

Sujata De has been a Consultant Paediatric ENT Surgeon

at Alder Hey Childrens Hospital, Liverpool, UK since

2007. Her clinical interests include paediatric airway,

paediatric otology, microtia and bone anchored hearing

devices, Downs syndrome, Craniofacial surgery and

EILO (exercise induced laryngeal obstruction).

She is a member of the Specialised Surgery in Children

Clinical Reference Group and an elected member of the

British Association of Paediatric Otolaryngology (BAPO)

Council. She holds an honorary appointment with the

University of Liverpool and is Chair of the Health

Education England North West Training and Education

Committee and is an FRCS (ORL-HNS) examiner.

Title: Role Models and Mentors in ENT Surgery

Abstract: Surgical training has moved over the years from

an apprenticeship model to a competency-based model.

Shortened training and a welcome but increased

emphasis on patient safety has made training more

difficult and stressful for both the trainer and trainee.

There are periods of stress throughout a surgeons career

like the transition to new consultant, ‘the midlife crisis’,

the transition to senior consultant. Surgeons from diverse

backgrounds and female surgeons may also face

particular pressures. Mentorship is a process whereby an

experienced empathetic person guides another individual

in the development of their own ideas, learning and

professional development. A role model on the other

hand is someone who inspires another person to be like

them. The talk will cover aspects of both of these roles.

10

Mr Ian Street

Consultant ENT Surgeon,

Alder Hey Children’s NHS Foundation Trust,

Liverpool L12 2AP.

Bio –

Ian Street has been a consultant ENT surgeon in Alder

Hey hospital since 2014. He has a general interest in

Paediatric ENT, including Down syndrome, and in

maximising the rate of day surgery where possible.

Abstract –

Many ENT conditions have a considerable impact on

quality of life Maximising quality of life in children with

Special Educational Needs can be somewhat more

challenging due to communication difficulties and time

pressures in clinic. This talk will explore some

suggestions to help manage this small but

disproportionately affected group of patients.

11

Mr A Kinshuck

Biog: Andrew Kinshuck is an ENT consultant in Aintree

University Hospital NHS Foundation Trust, Liverpool

sub-specialising in the field of laryngology and airway

reconstruction.

On completion of his specialist training in Mersey

deanery, he undertook a laryngology and airway

fellowship at the National Centre for Airway

Reconstruction, Imperial College Healthcare NHS Trust

working closely with Mr Guri Sandhu. On completion of

the fellowship he continued to work at the National

Centre for Airway Reconstruction as a locum consultant.

In 2018 he joined the tertiary centre in Aintree University

Hospital NHS Foundation Trust and is in the process of

setting up a laryngology and airway tertiary service, to

complement the busy and well-established Head & Neck

department.

He has published and written book chapters in the field of

laryngology and his MD researched voice outcomes

following treatment of early glottic cancer at the

University of Liverpool.

Title: Laryngotracheal reconstruction post-cancer

treatment

Abstract: Head & Neck cancer treatment can result in

different long-term morbidity for the patient. Surgery,

chemotherapy and radiation can all result in loss of

laryngotracheal function.

12

In managing the sequelae of treatment careful assessment

is required in a MDT approach; working closely with

speech and language therapists to diagnose, assess and

treat laryngeal dysfunction. Restoring function is a

constant balance between the airway, voice and swallow

to improve the patient’s quality of life.

This series highlights some of the challenges in managing

the laryngotracheal effects of Head & Neck cancer

treatment.

13

Abstracts Abstract 1 – John Rocke - Abstract Title: Management

Strategies in Iatrogenic Tracheal Injuries: a literature review

and case series.

Introduction: Iatrogenic injury to the tracheobronchial tree

during intubation is a rare but life-threatening event. Since

1995 there have been isolated case reports of the use of

Extracorporeal Membrane Oxygenation Therapy (ECMO) as

an adjunct in the treatment of tracheal injuries. Here we

present a literature review of the management strategies

employed in iatrogenic tracheal injury and the first case series

using ECMO as an adjunct in its management. Methods: We

searched MEDLINE and EMBASE databases using the

Healthcare Databases Advanced Search (HDAS) through the

National Institute for Health and Carel Excellence (NICE). We

limited our search to articles after 1995, when ECMO was first

introduced as an adjunct, and to articles written in the English

language. We also searched the same databases separately for

articles evidencing the use of ECMO in the treatment of

iatrogenic tracheal injury. Results: More recently conservative

approach has been favoured over operative intervention unless

the injury is observed intraoperatively and repaired primarily.

Evidence for stenting is limited and of poor quality. No studies

have investigated the use of prophylactic antibiotics.

Numerous prevention strategies have resulted in a reduction in

the incidence of iatrogenic tracheal injury. ECMO has been

utilised successfully in the last 4 years in numerous institutions

in addition to our case Conclusion: We have demonstrated in

our case reports and the others reviewed that ECMO can be

useful in patients with ventilatory difficulty either caused by

concurrent respiratory pathology, direct sequelae relating to

the injury or in the immediate post-operative recovery phase.

series.

14

Abstract 2 – Mark D Wilkie Abstract Title: Metabolism and

anti-metabolic therapeutic strategies in human papillomavirus-

positive squamous cell carcinoma of the head and neck

(SCCHN).

Introduction: A major objective in the treatment of HPV-positive

SCCHN is to identify means of reducing the long-term functional

ramifications. Altered tumour metabolism is an attractive putative

target, and we have shown previously that metabolism and anti-

metabolic treatment depend on TP53 status in HPV-negative

SCCHN. The aim of this study was to examine the metabolic

profile in HPV-positive SCCHN and to determine whether anti-

metabolic therapy might be employed to potentiate ionsing

radiation (IR) effects. Methods: Extracellular acidification and

oxygen consumptions rates, respective measures of glycolytic

flux and mitochondrial respiration, were assayed for a panel of

HPV-positive SCCHN cell lines using an XF24 extracellular flux

analyser (Seahorse Bioscience, Billerica, USA) during

specifically designed stress tests. Sensitivity to IR +/- 25mM 2-

deoxyglucose (glycolytic inhibitor) +/- 20mM metformin

(electron trasport chain inhibitor) was evaluated using clonogenic

assays. p53 expression levels were examined by Western blotting.

Results: HPV-positive SCCHN cells exhibited a diverse

metabolic phenotype, displaying robust mitochondrial and

glycolytic reserve capacities, and were also observed to express

p53 under basal conditions, albeit at low levels. This metabolic

profile, in turn, correlated with IR response following

administration of anti-metabolic agents, in that both 2-

deoxyglucose and metformin were required to significantly

potentiate IR effects. Conclusion: HPV-positive SCCHN cells

can be sensitised to IR using a dual anti-metabolic approach

targeting both mitochondrial respiration and glycolysis, reflecting

their metabolically diverse phenotype. Notionally, this may

provide an attractive platform for treatment de-intensification by

facilitating IR dose reduction to minimise the impact of treatment

on long-term function.

15

Abstract 3 – Sarah Timms - Abstract Title: Localisation of

parathyroid adenoma: is there a role for preoperative CT

imaging? A nine-year retrospective study in a district general

hospital

Introduction: Parathyroid adenoma is the main cause of

primary hyperparathyroidism.(PHPT). International guidelines

recommend surgery in all symptomatic and certain

asymptomatic patients1. When preoperative localising

ultrasonography and technetium (99mTc) sestamibi imaging

are inconclusive there is little evidence to favour CT or

surgical exploration. Methods: Every parathyroidectomy

performed for PHPT 2009-2017 inclusive was investigated.

Adenoma site was analysed. Histology and biochemistry were

reviewed where preoperative imaging was inconclusive.

Results: 241 parathyroidectomies were performed. Among 171

histologically identified adenomas, variation in laterality was

not statistically significant (p=0.59). Forty-three patients had

no localising data (ultrasound or sestamibi) prior to initial

exploration. Of these, twenty-nine (67%) achieved

normocalcaemia postoperatively with histological

confirmation of adenoma removal. Eight patients had CT

following unsuccessful surgery: six (75%) identified an

adenoma. All six had surgery and subsequently became

normocalcaemic. Conclusion: PHPT without localising

ultrasound or sestamibi imaging should be treated with

surgical exploration initially: if unsuccessful, CT is indicated.

16

Abstract 4 – Kristina Lee - Abstract Title: Optimal Wound

Closure Techniques for Thyroid and Parathyroid Surgery: A

Systematic Review of Cosmetic Outcomes.

Introduction: Cosmesis after surgical wound closure is an

important outcome. This is particularly relevant after thyroid

and parathyroid surgery, as anterior neck scars are visible and

often of concern to patients. We aimed to investigate whether

wound closure method influences cosmetic outcome in thyroid

and parathyroid surgery and determine an optimum closure

method. This review compares wound closure methods

including sutures, staples, steri-strips and glue on cosmesis

following thyroid and parathyroid surgery. Methods: A

systematic review was performed with independent searches of

MEDLINE, PubMed, EMBASE, CINAHL and Cochrane

databases for relevant articles. Results: Initial search found 304

papers and after systematic review, a total of 10 studies

compared different closure methods and cosmetic outcomes.

There were 9 randomised controlled trials and one cohort

study, with a total of 712 patients. Three studies compared

staples versus glue; three compared sutures versus clips; two

compared suture versus adhesive tape and two studies for

suture versus glue. In general, short-term cosmesis was better

with subcuticular sutures compared to glue or clips, long-term

cosmetic outcomes were not influenced by closure method.

Conclusion: In this systematic review, wound closure for

thyroid and parathyroid surgery with subcuticular suture or

adhesive tape produced superior cosmetic outcome short term.

Although long-term cosmetic outcome is not influenced by

closure method, given the superior cosmetic outcome and

advantage of not needing removal, we recommend

subcuticular sutures should be performed for wound closure in

thyroid and parathyroid surgery.

17

Abstract 5- Areej Paracha - Abstract Title: Efficacy and

tolerability of intratympanic gentamicin injections in the

outpatient clinic.

Introduction: The use of intratympanic gentamicin (ITG)

injections to obliterate ipsilateral balance function and

facilitate vestibular rehabilitation is well established, with an

increasing number of clinical applications. However, the

efficacy and tolerability of this procedure in the outpatient

setting has never been previously assessed. The aim of this

study was to assess the efficacy and tolerability of ITG

injections in the outpatient setting Methods: All patients

undergoing serial ITG between September 2016 and

September 2017 were included. All patients had vestibular

schwannoma and measurable ipsilateral vestibular function.

Patient demographics were recorded. Patients were asked to

quantify pain at two timepoints: during needle insertion, and

during injection of gentamicin to the middle ear. A Likert pain

scale was used, where a score of 1 represented no pain and 10

the most severe pain. Post-treatment vestibular function was

measured using ice calorics. Complications were recorded.

Results: 12 men and 13 women, mean age 48.4yrs (range 21-

74) were included. 23 were pre-operative patients; 2 were non-

surgical patients. 81 separate injection episodes were scored;

19 patients underwent 3 injections which successfully ablated

their ipsilateral vestibular function; 6 patients underwent a 4th

injection, following which minimal residual vestibular function

was detected. Across the group, mean subjective pain level

during needle insertion was 0.56 (range 0-10) and during

middle ear filling was 4.1 (range 0-10). Mean subjective pain

scores improved between the first, second and third injections,

and were comparable across age ranges, but slightly higher in

males (0.76 during needle insertion, 4.27 during middle ear

filling) compared to females (0.39 during needle insertion,

4.07 during middle ear filling). All patients completed their

recommended course of injections. 1 patient had troublesome

18

balance symptoms between injections, 1 patient sustained

tympanic membrane perforation following treatment.

Conclusion: This study demonstrates that ITG injections in the

outpatient setting are effective and well tolerated. Further work

to introduce measures aimed at decreasing pain scores at the

time in middle ear filling would be valuable. This study of

their efficacy and tolerability adds new information to the

literature and is especially relevant with regard to the widening

use of this treatment.

19

Abstract 6– Jacob Duffin - Abstract Title: Drainless,

sutureless day case superficial parotidectomy with Artiss - a

case series.

Introduction: Superficial parotidectomy is a common

procedure performed for the surgical excision of benign

parotid tumours. Standard practice involves placing a vacuum

drain in the operated site, which necessitates an overnight

inpatient stay. Fibrin sealants aim to adhere to the

subcutaneous tissues therefore eliminating dead space and

obviating the need for a drain and overnight stay. This case

series describes our experience of progression away from

traditional parotid surgery towards a drainless, sutureless day

case procedure using Artiss fibrin glue. This change could

potentially result in both improvement in patient satisfaction,

through reduction in length of patient stay and complications

and confer financial benefits to the NHS. Methods: Patients

with a superficial parotid lump that had a benign preoperative

biopsy result underwent a superficial parotidectomy. Initially,

a standard sized vacuum drain was inserted in addition to

Artiss fibrin sealant (2ml), which was sprayed onto the

surgical bed prior to closure. Wounds were closed using

absorbable sutures in the dermis and skin glue therefore no

sutures required removal post-operatively. Drains were

removed if the total volume since theatre was <40ml at 7am

the next day. We then moved on to using Artiss alone, with

select patients going home on the same day. Patients were

followed up routinely and complications and final histology

reports were noted. Results: 78 patients were included in the

study with 42 having Artiss alone, 12 of which were done as

day case procedures. Average inpatient stay in the Artiss and

drain group versus Artiss alone group was 0.7 and 1.11 days

respectively. 3 patients with a drain had a haematoma of which

2 required a return to theatre for evacuation, compared to 0

haematomas recorded in the Artiss alone group (p=0.0564).

There were 4 recorded salivary leaks in the drain group

20

compared to 2 in the Artiss alone group (p=0.294). Of the 12

day case procedures, none had either a haematoma or a

salivary leak. Conclusion: Artiss was found to be easy to set up

and use and our study demonstrated improved outcomes and

reduced inpatient stay with its use. This raises the possibility

for wider adoption of fibrin based sealants in parotid surgery

and more cases done as day case procedures.

21

Abstract 7 Tom Hampton Abstract Title: I Get Out of Breath

Playing at Anfield. Development & Evaluation of a Complex

Breathlessness Clinic.

Introduction: paediatric patients with vocal cord dysfunction

often have a delay in diagnosis and can even be misdiagnosed

with asthma. We set up a new MDT clinic (Resp, physio,

ENT) for these patients. This study aimed to review the

usefulness of the clinic to our patients. NoE ENT 19th October

2018 Meeting Abstracts

Methods: prospective review of children presenting to

breathless clinic during an 8 month period using Nimjegen and

PEDSQL questionnaire at clinic and again 4months later.

During project some informal feedback suggested these was a

lack of understanding about the clinic from the patient point of

view so a collaboration with a university Illustration MA

course was established to develop a patient friendly leaflet

through a design competition. Results: 19 patients attended. 5

were diagnosed with vocal cord dysfunction and had no further

episodes after treatment. 89% patients were successfully

discharged with resolution of symptoms. 2 were referred to

psychiatry. The new leaflet was well received by staff and

patients alike. Conclusion: The development of this new

multidisciplinary clinic with multisector involvement to

manage children with complex breathlessness has led to

improved outcomes and satisfaction for patients with vocal

cord dysfunction.

22

Abstract 8 - J Kenth Abstract Title: Respiratory Changes in Patients with

Mucopolysaccharidosis type IVA: A Retrospective Cohort

Study.

Introduction: Mucopolysaccharidosis type IVA is a rare,

autosomal recessive lysosomal storage disease, manifesting in

substrate accumulation in various tissues. MPS IVA is

associated with sleep-disordered breathing (SDB), both

obstructive and restrictive airway disease and with respiratory

failure being the primary cause of death. Our aim was to

ascertain the long-term respiratory changes in patients treated

with ERT.

Methods: In this retrospective cohort study descriptive

statistics and non-parametric correlation were performed for

demographic, oximetry, and respiratory function variables over

a study period from January 2003 to December 2017.

Results: Sequential spirometry and oximetry values were

collected from 16 patients, of which 13/16 were ERT treated.

In the ERT treated group, spirometry values significantly

decreased across all parameters (besides FVC). Oximetry

showed a general improvement in the ERT group, whereas

decline in the non-ERT group. Adenotonsillectomy appeared

to improve oximetry or attenuate the decline in the ERT group.

FEV1, FVC [%predicted] & ODI 3% exhibited a strong

positive correlation (r 0.63 - 95% CI .46 to 0.74, P<0001).

Conclusion: We report one of the largest series of respiratory

changes in children with MPS IVA. Whilst spirometry values

showed a gradual decline across all groups, oximetry showed

modest improvement in respiratory function. The

amalgamation of FEV1, FVC [%predicted] and ODI 3%

appeared predictive of changes in respiratory function in this

study, possibly guiding response to ERT.

23

Poster 1

‘Management of nasal foreign bodies in a tertiary

paediatric hospital in the United Kingdom: The Alder Hey

experience’

Authors: Richard Siau, Hannah Emerson, Dee Baptiste,

Su De

Poster 2

‘Spontaneous resolution of frontal sinus mucocele’

Authors: D Chudek, M Wilkie, A Panarese

Poster 3

‘Education versus Service: Otorhinolaryngology

outpatient activity amongst trainees and consultants.’

Authors: Eriola Mushi, Gyorgy Banhegyi, Alessandro

Panarese

Poster 4 –withdrawn

Poster 5

‘Investigating the cost-effectiveness and rate of post-

operative complications of ArtissTM used in

parotidectomies performed at Salford Royal NHS

Foundation Trust’

Authors: Yanish Poolovadoo, Rohini Aggarwal, Sean

Loughran

Poster 6 -withdrawn

Posters

24

Poster 7

‘Cost effectiveness of Radioallergosorbent test (RAST)

versus Skin Prick Test in the Management of Allergic

Rhinitis’

Authors: Grace Hui Chin Lim, Kealan McLaughlin

Poster 8

‘Development of a management protocol for Non-Fatal

Strangulation injury’

Authors: Stefan Linton, Navin Mani

Poster 9

‘Canal wall down mastoidectomy with mastoid

obliteration versus combined approach tympanoplasty in

primary cholesteatoma surgery’

Authors: Mark D Wilkie, Christopher J Webb, Alessandro

Panarese, Gyorgy Banhegyi

Poster 10

‘An Audit of Acute Otitis Media Management in a GP

Practice in Runcorn compared with a GP Practice in

Droitwich Spa’

Authors: Megan Griffiths

Poster 11

‘Clinical audit of UPSIT & Zurich tests in an ENT

outpatient clinic’

Authors: Mina Mesri, Grace Khong, Andrew Swift

Poster 12

‘Immunodeficiency and ENT disorders: When does it

matter?’

Authors: Mina Mesri, Grace Khong, Andrew Swift

25

Poster 13

‘Audit of prophylactic antibiotic prescribing for elective

ENT surgery’

Authors: Derek Falls, Stephen Ball

Poster 14

‘Correlation between thyroid ultrasound classification and

cytology compared to histological diagnosis of thyroid

lesions’

Authors: Waqas Din, Emily Lowe, Richard Gan, Salil

Sood, Chris Bem, Ian Smith

Poster 15

‘3D reconstructed septal buttons’

Authors: Gaurav Medikeri, Samuel Leong

Poster 16

‘NHS litigation in otorhinolaryngology – An analysis of

the past 22 years of claims’

Authors: Alisha Patel, Babatunde Oremule

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