Fungal infections are a subset of infectious processes that an otolaryngologist is required to be familiar with. They can be encountered in otology, rhinology and head and neck surgery. The presence of fungal rhinosinusitis is well recognised by otolaryngologists, but the classifications and appropriate management are not so well understood. The prevalence of fungal sinus disease is thought to be have been increasing in recent decades There is speculation that this may be due to increased awareness, antibiotic overuse and increased use of immunosuppressant medications. Added to this, there has been a large amount published on the role of fungi as a causative organism in chronic rhinosinusitis. Given the importance of fungal rhinosinusitis in clinical practice, we aim to review the classification and current management strategies based on up-to-date literature.

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Being turned down for AAA repair carries a significant short-term risk of mortality. Those turned down for repair carried significant levels of comorbid disease but no factors considered were found to be independently predictive of the length of survival.

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Objective This study aims to investigate the variations in publicly available nasal irrigation recipes published in the United Kingdom (UK). Design Internet searches used to identify eligible nasal irrigation recipes. These were then examined for their physical and biochemical properties, through theoretical calculations and experimental measurement. Setting Recipes produced by healthcare providers or official national bodies in the UK. Participants No human participants. Main outcome measures Solution osmolality (classified into hypo‐, iso‐ and hypertonic), acidity (pH) and specific gravity. Results Thirteen unique recipes were identified from 17 sources. Osmolality ranged from 166.2 to 1492.2 mosmol/kg in volumes ranging from 142 to 1136 mLs (isotonic range 275‐295 mosmol/kg). Specific gravity ranged from 1.006 to 1.034. pH ranged from 7.74 to 8.11. No recipe produced a solution with isotonic properties. The majority produced hypertonic irrigations. Conclusions Most publicly available nasal irrigation recipes produce hypertonic solutions but there is great variability in the osmolality and volume. UK organisations should take action to review published recipes to bring these into alignment with latest guidelines (recommending against hypertonic saline use) and reduce variability in patient interpretations.