Eustachian tube balloon dilatation is a minimally invasive procedure to treat Eustachian tube dysfunction. Although widely adopted in adults, there are no published UK paediatric series. This project evaluated outcomes of balloon dilatation for Eustachian tube dysfunction in children treated at our tertiary ENT paediatric unit.

A retrospective review was conducted of paediatric patients undergoing balloon dilatation for Eustachian tube dysfunction over a three-year period. Eustachian Tube Dysfunction Questionnaire-7 scores were recorded pre-operatively and at six weeks and three months post-operatively.

Sixteen patients underwent balloon dilatation and 46 per cent of patients had concurrent procedures. The mean pre-operative Eustachian Tube Dysfunction Questionnaire-7 score was 27.1, improving significantly to 12.4 at 6 weeks and 11.25 at 3 months (p < 0.0001). All patients demonstrated symptomatic improvement, including those with repaired cleft palate who had undergone repeated ventilation tube insertion previously.

Balloon dilatation significantly improved patient-reported outcomes in paediatric Eustachian tube dysfunction and this study represents the first reported UK paediatric series.

The nasal cycle is a normal physiological process involving alternating congestion and decongestion of the nasal cavities, yet patient awareness of this phenomenon is poorly understood. The objective of this study was to assess patient awareness of the nasal cycle and its association with nasal symptom perception and anxiety.

This prospective observational study included 120 adult ENT outpatients. A structured questionnaire assessed awareness of the nasal cycle, perception of alternating nasal obstruction and anxiety. Nasal symptom severity was measured using the Nasal Obstruction Symptom Evaluation score, and nasal airflow dominance was assessed with the cold spatula test.

Only 28.3 per cent of patients were aware of the nasal cycle. Although 51.7 per cent perceived alternating nasal obstruction, most considered it abnormal. Poor awareness was associated with higher Nasal Obstruction Symptom Evaluation scores (p = 0.01) and increased anxiety (p = 0.003).

Limited awareness of the nasal cycle leads to misinterpretation of normal physiology. Simple counselling may reduce symptom related anxiety.

ENT surgical procedure teaching has long been under-represented in the medical student experience, despite high exposure in clinical practice. We aimed to create a novel ENT-themed escape room to provide an interactive and immersive learning experience with demonstrable educational benefit.

Key ENT concepts were integrated into a series of puzzles that participants needed to solve to ‘escape’, mirroring the problem-solving and real-world pressures required in clinical practice. Twenty-seven 4th-year students completed both pre-test and post-test questionnaires.

A statistically significant increase in open-space questionnaire performance (p < 0.001), confidence in ENT and interest in a career in ENT were observed (p < 0.001). Participants rated the escape room highly for enjoyment (9.7/10), educational value (9.0/10) and likelihood of recommending to colleagues (9.6/10).

The escape room was an effective and educational intervention for medical students, demonstrating statistically significant improvements in knowledge, confidence in ENT and their keenness to pursue a career in ENT.

Sentio™ is novel transcutaneous implantable conductive hearing device. Evidence in paediatric populations, particularly syndromic children, remains limited. We report our local experience in paediatric patients, including syndromic cases.

A prospective case series of patients implanted between March 2025 and February 2026 was reviewed. Data collected included demographics, underlying pathology, subjective outcomes (Children’s Home Inventory for Listening Difficulties), objective outcomes (Bamford–Kowal–Bench) and surgical outcomes.

Four patients (median age, 13.7 years; range, 11–15.5 years) were implanted, with one bilateral case. There was subjective and objective audiological improvement except for one patient, probably caused by poor concentration. Surgical learning points include the use of a longer fixation band to compensate for shallower drilling, careful implant positioning in microtia patients to facilitate future reconstruction and the use of image-guided navigation to avoid previous craniofacial surgery drill holes.

Sentio™ demonstrated favourable audiological and surgical outcomes in paediatric patients, including those with syndromes.

This study aimed to design and evaluate a low-cost, high-fidelity nasal cautery model (CauterClay) for increasing user confidence in carrying out nasal cautery.

We created CauterClay with an air-dry clay scaffold, simulated nasal mucosal lining and bleeding point. We carried out single-centre assessment with a variety of nasal cautery-naive and experienced doctors. Doctors were asked to complete pre- and post-induction surveys regarding confidence, prior experience and model fidelity.

CauterClay use was associated with a statistically significant increase in user confidence in carrying out nasal cautery. All nasal cautery-naive users reported an increase in self-reported confidence following model use. Users rated the fidelity of our model highly, here we demonstrate how others can create their own CauterClay model.

Here we outline the first published low-cost, high-fidelity nasal cautery model. Our findings demonstrate it is associated with increased user confidence, suggesting it may be valuable for training nasal cautery-naive clinicians.

To evaluate the impact of a consultant-governed Advanced Nurse Practitioner-led tonsillectomy assessment pathway on patient access to care and service delivery.

A retrospective service evaluation was conducted using routinely collected data for patients referred for tonsillectomy assessment to one consultant service in 2018, prior to implementation, and during the subsequent four years, from 2019 to 2022.

Prior to implementation, 34 per cent of patients waited more than 36 months for assessment. By 2022, all patients were assessed within 18 months, with 89 per cent assessed within 12 months. Assessment activity increased substantially, overall referral-to-surgical procedure waiting times reduced and many patients were managed within the Advanced Nurse Practitioner-led pathway without onward consultant review.

This consultant-governed Advanced Nurse Practitioner-led pathway was associated with improved access to specialist assessment, increased out-patient capacity and more efficient patient flow within a regional tertiary ear, nose and throat service.

Developmental mentoring is widely advocated within Otolaryngology training, yet programmes are often poorly defined and may not reflect its intended distinction from traditional hierarchical models. This study explored participant understanding of mentoring within a national Otolaryngology mentoring programme.

Prospective participants completed open-ended questionnaires prior to mentor training. Responses were analysed using grounded theory with iterative coding and constant comparison.

Twenty-seven participants responded. Many identified features consistent with developmental mentoring, including empowerment, goal exploration, reflection and psychological safety. However, there was notable variability in interpretation; some uncertain of the concept, others describing supervision or patronage. Broader personal, professional and value-based elements relevant to Otolaryngology training were also emphasised.

Understanding of developmental mentoring is heterogeneous and often diverges from its intended model. This lack of shared understanding may undermine programme effectiveness and efforts to support the Otolaryngology workforce. Clear definition and participant training are essential for successful implementation.

Nasal specula such as Thudichum and Killian have been in use in rhinology for over 100 years. They serve to widen the nasal alar and retract nasal hairs when performing rhinoscopy.

We describe a novel nasal speculum: the repurposing of the Lieberman eye speculum for use in rhinological procedures. This speculum is adjusted to fit the individual and is self-retaining, achieving equivalent retraction to traditional specula and enabling use of a second hand for intra-nasal surgery.

The Lieberman speculum can reach a maximal diameter of 14mm and has successfully been utilised in over 50 rhinological procedures to facilitate bimanual operating. No complications or side effects have occured with use.

Our approach has been successfully trialled under local and general anaesthesia for a range of procedures at similar cost to current practice.

This study aimed to synthesise existing systematic reviews to determine the true long-term recurrence rate of cholesteatoma following primary surgery and to evaluate the comparative effectiveness of surgical approaches (canal wall up vs canal wall down ) and adjunctive procedures on disease recidivism.

A systematic search of PubMed, Scopus and OpenAlex identified 23 studies (predominantly systematic reviews and meta-analyses) encompassing 12,819 patients with an equal to or greater than 12 months’ follow-up and clearly defined recurrence, evaluating canal wall up, canal wall down, mastoid obliteration and endoscopic assistance.

Recurrence increased from 7 per cent at 12 months to 39 per cent at 15 years. Canal wall down showed lower recurrence than canal wall up. Mastoid obliteration (odds ratio, 0.33–0.45) and endoscopic techniques (risk ratio, 0.48–0.68) reduced recidivism and residual disease. Age and staged surgery increased risk, whereas planned second-look surgery was protective.

Cholesteatoma recurrence is strongly time-dependent. Combining appropriate surgical techniques with mastoid obliteration, endoscopic assistance and long-term surveillance improves long-term disease control.

Strategic workforce planning is essential for equitable, high-quality healthcare. ENT services currently hold the second-longest NHS waiting list, with over 638,000 outstanding appointments, underscoring the urgency of accurate workforce planning.

Data were collected across all 135 NHS trusts providing ENT services. Information was collated on consultants, associates, locally employed doctors (LEDs), trainee residents, fellows, advanced nurse practitioners (ANPs) and physician assistants (PAs). For consultants, subspecialty interest, working patterns, age and contract type were recorded.

The UK ENT workforce comprised 1207 consultants (mean 1.77 per 100,000 population), with an over two-fold regional variation. On average, there were 1.29 second-on-call residents and 1.17 first-on-call residents per 100,000 population, with considerable regional variation.

The UK ENT workforce demonstrates marked geographic and subspecialty imbalances with looming retirement risks. Targeted recruitment and retention initiatives, subspecialty redistribution and training capacity adjustments are critical to address current shortfalls and meet future service demands.

The specialties of ENT and anaesthesia have always had a unique relationship because of their longstanding history of co-operation over the shared airway.

This historical review narrates how the modern practice of ENT surgery has developed following advances in anaesthetic techniques, as well as inspiring them.

From the earliest use of anaesthetic gases by Long, Wells and Morton, to their rapid adoption for use in tonsil and cleft palate surgical procedures, ENT surgeons were early beneficiaries of this new technology. The demands of surgery for facial injuries in World War II was a driver for anaesthetic advances, and Ivan Magill reinvented the specialty in response.

Further developments in managing the shared airway, including jet ventilation, total intravenous anaesthesia and awake fibre-optic intubation, have shaped the modern ENT operating theatre, and highlight the vital collaboration between ENT and anaesthesia over the past 150 years.

To map the scope, methods and focus areas of qualitative research in paediatric otolaryngology.

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic mapping review searched MEDLINE, Embase, CENTRAL and PsycInfo (August 2025) for qualitative or mixed-methods studies with a qualitative component related to paediatric otolaryngology. Two reviewers independently applied the inclusion criteria. Key study characteristics were extracted; no formal risk-of-bias assessment was performed, in line with the aims of a mapping review.

Eighty-nine studies were included. Publications rose sharply after 2015, with nearly three-quarters from the USA, Canada and the UK. Otology (49 per cent) and laryngology (40 per cent) predominated; common topics were hearing loss, tonsillectomy and tracheostomy. Interviews, mainly semi-structured (73 per cent), were the dominant method, and caregivers were the most frequent participants (62 per cent).

Qualitative research in paediatric otolaryngology is growing but remains geographically and methodologically narrow. Broader stakeholder inclusion and methodological diversity are needed to deepen understanding and support patient-centred care.

Otolaryngology/ear, nose and throat conditions are common in clinical practice, yet undergraduate exposure in UK medical schools remains limited. The coronavirus disease 2019 pandemic created opportunities to innovate medical education. This review explores the scope of advance in otolaryngology undergraduate education following the coronavirus disease 2019 pandemic.

A search of MEDLINE, Embase, Cochrane, and Education Resources Information Center databases was conducted. Studies that met inclusion criteria were subject to risk-of-bias assessment and narrative analysis.

Interventions such as mixed reality, cadaveric teaching, and anatomical models improved short-term performance and student satisfaction. Surveys limited advancement in clinical exposure to otolaryngology/ear, nose and throat, when compared to pre-coronavirus-disease literature.

Despite the potential for reform following the pandemic, there has been no significant advancement in the provision of undergraduate medical education in the post-coronavirus-disease era. Standardisation of undergraduate education is needed to mirror recent changes to assessment in undergraduate education in the UK.

To evaluate the impact of a two-week otolaryngology rotation incorporating entrustable professional activities, human factors and simulation on medical students’ knowledge, perceptions and career aspirations.

The curriculum included six small-group sessions on compassion, communication, resilience, teamwork and professionalism, and three simulations: suturing, flexible nasendoscopy and grommet insertion. These were delivered alongside standard teaching. Pre- and post-rotation questionnaires assessed otolaryngology knowledge, career interest, surgical confidence and attitudes toward simulation and human factors.

While students’ interest in surgical careers remained unchanged, they reported improved comfort with otolaryngology knowledge, operating theatre environments and recognition of non-technical skills. Perceptions of simulation and essential surgeon qualities significantly improved.

Integrating entrustable professional activities, human factors education and simulation into short surgical rotations enhances both technical and non-technical skills. This approach may help address challenges in attracting students to surgery by enriching their educational experience and building confidence.

This pilot randomised controlled trial evaluated virtual reality as a supplementary teaching tool for peritonsillar abscess drainage among third year medical students.

Twenty students were randomised to virtual reality-based or traditional teaching, each receiving a 90-minute session followed by an objective structured clinical examination and pre-/post-session knowledge tests. The virtual reality group used HTC Vive Focus 3 headsets with Virti, 3D Organon and EXR platforms.

The virtual reality group scored higher in objective structured clinical examinations (26.9 vs. 21.5; p = 0.005) and reported greater procedural confidence (p = 0.008) and engagement (p = 0.003). Both groups improved knowledge (p < 0.001) without significant difference post-session (p = 0.701). Virtual reality was rated highly for effectiveness (9.6/10) and immersion (8.5/10) and had minimal cybersickness (1.8/10).

Virtual reality significantly enhances procedural confidence and performance. Its immersive format supports integration into surgical education, warranting further validation in larger studies.

In recent years, there has been a significant disparity between workforce capacity and clinical demand in surgical specialities, including head and neck surgery (HNS). Our objective was to assess final-year medical student interest in pursuing a career in HNS.

An online survey was distributed via social media and was completed by 633 final-year medical students across seven United Kingdom (UK) universities.

A total of 66.7 per cent (n = 422) had 1–7 days of exposure to HNS. Complex surgery (24.2 per cent), interesting patient population (20.2 per cent) and complex pathology (16.7 per cent) were the main motivators to consider HNS. Work–life balance (23.8 per cent), lack of exposure (31.3 per cent) and length of training (6.5 per cent) were the most common deterrants. A total of 67.1 per cent of students reported inadequate exposure to the field during undergraduate training.

The undergraduate curriculum must place more emphasis on HNS to accommodate increasing disease burden amid a limited workforce capacity within the National Health Service.

Otology training solely using cadavers is challenging because of scarcity and high costs. The use of additive manufacturing technology is a promising alternative. This study aimed to qualitatively validate new additive manufacturing temporal bone specimens for their realism and ability to train surgical skills.

Three additive manufacturing models generated using cadaveric temporal bones were evaluated. Three otologists with experience as trainers dissected and evaluated each specimen.

The additive manufacturing specimens scored an average of 4.26 ± 0.72 (out of 5) points and received positive feedback. The agreement between the three expert raters was high (intra-class correlation coefficient of 0.745).

The results suggested that the additive manufacturing temporal bones were able to faithfully reproduce a training experience similar to that on cadaveric temporal bones. Further studies that investigate the effectiveness of these specimens in training surgical skills are needed before integrating them into surgical training curricula.

To investigate the effect of heated-cigarette smoking on voice.

Participants completed a survey including three sections: section-1 comprised demographic data, section-2 comprised visual analogue scale grading of voice changes and fatigue and section-3 consisted of the voice handicap index-10.

Two hundred and eighty-two participants filled the survey. Heated-cigarette smokers had a significantly higher mean voice handicap index-10 score compared to non-smokers (p < 0.05). The difference in voice handicap index-10 scores between heated- and combustion-cigarette smokers was not statistically significant. The number of abnormal voice handicap index-10 scores was higher in heated-cigarette smokers compared to non-smokers (p < 0.05) and significantly higher in combustion-cigarette and dual heated- and combustion-cigarette smokers compared to the other 2 groups (p < 0.05). Non-smokers had significantly lower grades of voice changes and fatigue when compared to combustion and dual heated- and combustion-cigarette smokers (p < 0.05).

Smokers of heated cigarettes have a significantly higher mean voice handicap index-10 score compared to non-smokers and higher grade of voice changes and fatigue.

Paediatric ear and hearing services in the UK are currently facing significant challenges leading to increased waiting times for patients. This letter aims to explore teleotology, focusing on ear health care delivered via telemedicine, as a potential solution to alleviate service pressures and improve care delivery.

The current state of paediatric ear and hearing services in the UK was reviewed and the potential for teleotology to improve service delivery by reducing face-to-face consultations and improving triage processes was explored.

Evidence from studies conducted in adults in the UK suggests that teleotology can optimise the allocation of resources, ensure timely treatment, and enhance the quality of care, aligning with the NHS Long Term Plan and recommendations from the GIRFT report.

The findings from adult teleotology are encouraging, but further research is required to demonstrate the efficacy of teleotology for children and young people in NHS settings.