Background: Prospective study investigating the incidence of concurrent Eustachian Tube dysfunction (ETD) in patients with CRS refractory to medical therapy, and the effect of Endoscopic Sinus Surgery (ESS) on ETD in this patient group.Methods: Prospective study of 57 CRS patients. Outcome measures were SNOT-22 and ETDQ-7 questionnaires, tympanometry and Valsalva manoeuvre recorded pre-operatively and at 3 and 9 months post ESS.Results: There was a moderate positive correlation between pre-operative ETDQ-7 and SNOT 22 scores (r=0.5715, p<0.0001). 68% of patients recorded positive ETDQ-7 scores pre-operatively, mean=20.6 (SD±10.34). Mean ETDQ-7 scores were significantly lower at 3 months; mean=11.4 (SD±5.65) (P<0.0001) and 9 months mean=11.4 (SD±6.15) (P<0.0001) following ESS. Type A tympanograms increased form 76.6% pre-operatively, to 94.5% at 3 months and 96% at 9 months. Reported positive Valsalva increased from 38% pre-operatively to 96% at 3 and 9 months. Mean ETDQ-7 scores were higher in the CRSwNP group; 24.34 (SD±9.2) compared to the CRSsNP group; 18.11 (SD±10.3), (p=0.6101). 16 patients in the cohort had existing diagnoses of asthma, of which 4 had documented aspirin sensitivity. The mean pre-operative SNOT-22 score in this overall subgroup was 64.81 (SD=±20.13) compared with 49.07 (SD=±21.37) in non-asthmatic patients (p=0.0168). Conclusions:We found a high incidence of concurrent ETD symptoms in patients with severe CRS, which improve following ESS.Further research is required to better understand the association between CRS and ETD in order to provide effective treatments.

Video assessment of myringotomy and ventilation tube insertion may represent a valid, feasible tool for use in summative and formative assessments of trainee ENT surgeons. Remote scoring of assessment procedures minimises bias and enables blinding of raters. ENT is well positioned to benefit from video assessment due to the high number of surgical procedures within the specialty that are performed utilising digital technology.

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Where possible PH should be drained in an operating theatre. Multicentre randomized controlled trials are required to further investigate the impact of drainage technique and post-drainage management on outcome.

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An 89-year-old man presented to the outpatient clinic with a 2-month history of persistent unilateral left-sided otalgia, otorrhoea and reduced hearing despite oral and topical antibiotics. Treatment was protracted, requiring a 4-month hospital admission for intravenous antifungal medication as well as 3 further months of oral antifungal treatment. We describe the clinical presentation, complications and treatment of this potentially fatal condition in the context of an unusual, and easily missed, causative organism.

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Key Clinical MessageAncient schwannomas exhibit characteristic histological features. Fine‐needle aspiration cytology (FNAC) is of limited use. Radiological evidence demonstrating displacement of blood vessels may aid diagnosis of schwannoma. Malignant transformation of ancient schwannoma has been reported. Surgical excision carries a high risk of postoperative Horner's syndrome.