Compared with studies worldwide, the relative proportions of different organisms causing otitis externa and the patterns of antimicrobial resistance differ. Increasing resistance of P aeruginosa to aminoglycosides demonstrates a changing pattern of antimicrobial resistance that has not been previously reported. Reassuringly, quinolone antibiotics remain highly effective when treating P aeruginosa.

Paediatric obstructive sleep apnoea (OSA) is characterised by stertor, intermittent oxygen desaturation and repeated nocturnal awakening. 1 If left untreated, it can have significant repercussions, such as cor pulmonale, growth and developmental delay. 2 Adenotonsillectomy has proven to be effective in improving OSA outcomes in the majority of children. 3 Tonsillectomy (with or without adenoidectomy) is the most frequent ENT procedure comprising of 17% of the workload in the UK. 4 There has been an effort in recent years to improve day case surgery rates for these patients and to ensure safe delivery of services at secondary and tertiary centres within the UK for children with OSA. 5 Improvements in patient care will therefore have a widereaching impact on children and their families. Knowledge of post-operative complication rates for childrenwith OSA undergoing adenotonsillectomy is essential to be able to deliver safe and appropriate care and to support informed consent and shared decision-making. Age and comorbidities have been investigated to varying degrees to determine whether day case surgery and surgical delivery in secondary care centres are safe. [6][7][8] Since 2015, our paediatric tertiary centre has undergone a 3-stage service improvement process aimed at improving the safety of day case adenotonsillectomy for paediatric patients with OSA. We present our data and outcomes from our tertiary centre experience which has been used to help create the national strategy, released in 2019, for managing paediatric patients with OSA undergoing adenotonsillectomy.

Advances in extracorporeal membrane oxygenation have enabled the facilitation of surgical intervention in patients who may otherwise be considered inoperable using conventional ventilation-for example, the resection of an early stage metachronous lung cancer in a patient who has previously undergone a pneumonectomy for a prior lung cancer. We present one such case: a 52-year-old man who underwent right lower lobe segmentectomy for a second primary lung cancer, 3 years after left pneumonectomy, using extracorporeal membrane oxygenation. To our knowledge, there are no published case reports describing the use of extracorporeal membrane oxygenation in resection of metachronous lung cancer after pneumonectomy.

Objectives The coronavirus outbreak has triggered the implementation of nationwide social distancing measures. We aimed to investigate the impact on patients with recurrent tonsillitis and parental perceptions towards tonsillectomy during the COVID-19 pandemic. Methods A telephone questionnaire was conducted for all children awaiting tonsillectomy for recurrent tonsillitis after social distancing for 2 months at our centre. The COVID-19 lockdown period was compared with the 2 months prior to lockdown. Results Forty-four children had been social distancing at home during lockdown. There was a significant reduction in tonsillitis episodes during the 2-month lockdown period in comparison with 2 months prior to lockdown (p = 0.0001). In 70% (n = 31) of cases parents wanted their child's tonsillectomy during the coronavirus outbreak. Conclusion These findings demonstrate that viral exposure is a key factor in the pathophysiology of recurrent tonsillitis and that social distancing measures can reduce the frequency of recurrent tonsillitis. Despite the overall reduction in tonsillitis frequency during the lockdown period, the majority of parents wanted their child's tonsillectomy during the coronavirus outbreak. This demonstrates the impact tonsillitis has on the patient and their family's quality of life.

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Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Setting Stakeholders from the United Kingdom. Subjects and methods Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. Results Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was ‘diffuse inflammation of the ear canal skin of less than 6 weeks duration’. Conclusion The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

Peritonsillar abscesses (PTA, also known as quinsies) are a frequently occurring presentation to emergency departments and represent a common reason for referral to an ENT service. Management options include drainage of the abscess and antibiotic therapy. Without intervention, PTA can develop into deep neck space infections (DNSI) which carry significant morbidity and mortality. 1 Patients who undergo drainage of their PTA have been shown to experience quicker resolution of symptoms. 2

BackgroundPatients with pulmonary arterial hypertension (PAH) are managed according to evidence-based treatment guidelines.Methods and resultsIn this single-centre retrospective analysis, we examined outcomes of patients with PAH caused by congenital heart disease (PAH-CHD) with respect to exercise capacity and survival of adults treated with either bosentan or sildenafil monotherapy or bosentan-sildenafil dual therapy between January 2007 and January 2014. Of the 82 patients analysed, 29 had Down syndrome; 54 (65.8%) received bosentan monotherapy, 16 (19.5%) sildenafil monotherapy and 12 (14.6%) dual therapy. Mean treatment duration was 2.5 years for all patients and 4.1 years for 38 patients treated for ≥2 years. Pooled patient and treatment data showed initial improvement followed by stabilisation in mean 6 min walk distance (6MWD). For Down and non-Down patients, mean 6MWD increased and then stabilised on bosentan monotherapy. Mean 6MWD of patients on dual therapy at the time of analysis was 246.3 m before PAH-specific therapy initiation, 211.9 m immediately prior to addition of a second therapy and 214.4 m at last visit while on dual therapy. 1, 2 and 3-year survival rates for all patients from time of treatment initiation were 96%, 87% and 80%, respectively.ConclusionsFor the majority of patients, monotherapy with a PAH-specific medication provided improved and sustained exercise benefits. For the small percentage of patients who required it, add-on therapy appeared to prevent further deterioration in exercise capacity but did not improve 6MWD.