ObjectiveThis study aimed to assess whether increasing operative experience results in better surgical outcomes in endoscopic middle-ear surgery.MethodsA retrospective single-institution cohort study was performed. Patients underwent endoscopic tympanoplasty between May 2013 and April 2019 performed by the senior surgeon or a trainee surgeon under direct supervision from the senior surgeon. Following data collection, statistical analysis compared success rates between early (learning curve) surgical procedures and later (experienced) tympanoplasties.ResultsIn total, 157 patients (86 male, 71 female), with a mean age of 41.6 years, were included. The patients were followed up for an average of 43.2 weeks. The overall primary closure rate was 90.0 per cent.ConclusionThis study demonstrates an early learning curve for endoscopic ear surgery that improves with surgical experience. Adoption of the endoscopic technique did not impair the success rates of tympanoplasty.

Objectives To assess outcomes following cochlear implantation (CI) in patients with hearing loss secondary to primary or secondary autoimmune inner ear disease (AIED). Methods A systematic review and narrative synthesis was completed according to PRISMA guidelines. Databases searched included MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Collection, and http://clinicaltrials.gov. No limits were placed on year of publication or language. Results A total of 551 studies were identified, of which 29 were included after removal of duplicates, and screening the title, abstract, and full text. All except one study were OCEBM grade IV. 114 of 115 patients displayed improvement in hearing following cochlear implantation. With implant use, roughly a third of these patients had hearing that improved over time, a third improved and plateaued, and a third remained stable. There was no additional risk of perioperative complications found in AIED patients compared what is generally accepted in general cochlear implantation, although two episodes of device failure after 6 months were noted, and four patients with secondary AIED displayed poor initial audiological outcomes. Conclusion CI in both primary and secondary AIED provides marked improvement in hearing. Early CI may be a valid management option, provide long‐lasting hearing in patients and reduce the side effects of long‐term systemic immunosuppressants. However, patients should be counseled residual hearing may be lost if there is cochlear ossification or fibrosis which may make implant insertion more traumatic. Level of Evidence NA.

Background: On 11 March 2020, the World Health Organization (WHO) declared a global pandemic in the wake of the coronavirus disease 2019 (COVID-19) outbreak. The unpredictable nature of transmission of COVID-19 requires a meticulous understanding of guidance on personal protective equipment (PPE) as published by WHO and Public Health England (PHE). Aim: To assess perceived confidence and knowledge of PHE guidance relating to PPE by nursing staff. Methods: A nationwide survey was disseminated between May and June 2020 through social media platforms as well as internal mail via regulatory bodies and individual hospital trusts. Results: Data were collated from 339 nurses. Perceived confidence as measured on a Likert scale was a mode score of 3/5, with the average score for knowledge-based questions being 5/10. Of the respondents, 47% cited insufficient training on PPE guidance, and 84% advocated further training. Conclusions: Unifying published PPE guidance and ensuring consistency in training can improve awareness, confidence, and knowledge among nursing staff.

Erdheim–Chester disease is a rare infiltrative histiocytic disorder with around 800 cases being reported worldwide. Patients most commonly present with skeletal pain, but the condition has been shown to affect multiple other organs. We describe a rare presentation in which the disease infiltrated the sinuses and affected an ex-RAF pilot’s vision. After extensive investigation of the elusive diagnosis, repeating of a molecular test using polymerase chain reaction analysis allowed for identification of a mutation (BRAF V600) ultimately leading to the diagnosis of Erdheim–Chester disease.

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BACKGROUND Otological diseases make up a large proportion of global disease. In 2015, the Global Burden of Disease Project ranked otitis media as the third most common short-term disease with an incidence of 471 million worldwide. Furthermore, hearing loss was ranked the fourth most common chronic disease, affecting over 1 billion people (which is even thought to be an under estimation) (Saunders 2018). The World Health Organization has noted a discrepancy between burden of disease and current resources for many specialties including otology, encouraging advances in technology and telemedicine to help bridge this gap around the world (World Health Organization 2010). Recently, with the continual rise of availability of smart phones, mobile applications and attachments have become a way to achieve this, with some applications showing promise for streamlining referrals to ENT specialists (Casale 2018, Erkkola-Anttinen 2018). The aim of this study was to assess the usability and practicality of such a novel technology that shows potential for improving patient care (Mistry 2017). OBJECTIVE To determine the usability and practicality of the endoscope-i system; a novel mobile attachment for aural endoscopy. To observe the ease of use of different professionals with the device exploring ways to improve the attachment with the aim of improving future ontological practice. Objectives: To assess its ease of use in conducting an aural examination. To assess its feasibility for integrating its use into clinical practice. To assess its ease and practicality over current practices with otoscopes. To confirm or deny the ability of the device to produce an image of sufficient quality to make a clinical assessment. To assess the usefulness of the current training given for using the device. To gain insights into future recommendations for the product from the differing specialists METHODS A formative usability study of the endoscope-i system was conducted with five healthcare professionals. Each session lasted 40 minutes and involved: Audio/Video (A/V) consent, hands-on session, private semi-structured interview, and an option to discuss the device with a company representative. RESULTS Results: All participants found the endoscope-i system easy to use. The image quality was perceived to be greater than that achieved by current otoscopes. The ability to record images and view them retrospectively was also seen as a positive. CONCLUSIONS Conclusion: The study has not identified any significant issues relating to design, functionality or application. Participants perceived the system as superior to current options with a directly positive impact on their clinical practice.