Vol. 30, No 1 Spring 2020

Prof. B. Nirmal Kumar President, ENT UK

From the President’s Desk In this first letter to members of 2020 I recognise that time flies and I have served as ENT UK President for a year. Approaching my first anniversary also means that we say farewell to Carl Philpott and San Sunkaraneni who served as Honorary Secretary and Assistant Secretary, providing admirable support to me and the staff. While they will be missed they have promised to continue supporting us in various aspects so we can still draw on their expertise. By the time you read this, you will have been informed of the new appointees to executives. Taran Tatla becomes ENT UK Honorary Secretary, May Yaneza becomes Assistant Honorary Secretary, and Nara Orban takes on the role of Second Honorary Assistant Secretary on the Executive team. This will be a great boost, bringing fresh perspectives and a lot of youthful energy which always bodes well for any team, preventing the dinosaurs like me, from becoming complacent! As for the Trustees we say farewell to our lay trustee Stephen Evans, and to Brian Bingham who was Past President. Stephen was an excellent addition to our trustee board for almost five years and invigorated our governance considerably. Brian also provided sage advice and counsel on the board and both will be missed. There are plans in place for their replacements and we will hopefully be able to announce this very soon.

As we approach BACO 2020 we have for the first time an in-house team delivering BACO. The project lead Ms Catherine Spinou is an ENT UK Trustee supported by Christy Hillman as a dedicated BACO officer, and a BACO Executive aiming to deliver an exciting academic programme attracting large numbers of both local and international delegates to enjoy the best of Birmingham in summer. Gerry O’Donoghue, BACO 2020 Master, and I have the pleasure of hosting many luminaries visiting the UK to participate in what promises to be a truly international BACO 2020 extravaganza!

During my Presidency I had promised to concentrate on both the next generation and having an outward looking international view, as UK

ENT UK Newsletter 1

Welcome to the first ENT UK Newsletter of 2020, in which w e i n t r o d u c e a n e w Secretarial Team and a new Editor in Chief of Clinical Otolaryngology, the official journal of ENT UK.

The deadline to nominate colleagues for a BACO award is just a few days away, on 2nd March 2020.

We hope you enjoy the updates from our Specialty Societies, who have all been exceptionally productive so far this year. Keep up the great work!

Emma StapletonEditor

The Newsletter for ENT Professionals

Contents From the President’s Desk

Clinical Otolaryngology

Education Update

SAC Update

BACO Awards

BRS / BSFPS / BSO

Women in ENT Surgery

Members’ News

Vol. 30, No 1 Spring 2020

Otolaryngology still epitomises for much of the world the very best standards. For the next generation my highlight in early 2020 was attending the WENTS (Women in ENT Surgery) event and supporting the launch of their mentoring programme. The next generation of women (and men!) are leading the way in supporting, empowering and allowing people to reach their full potential without external limits being imposed. What a revelation. As for the international view, the Trustee board is supporting me in looking to supplement our activities with fund raising from bequests, sponsors and legacies in the form of a philanthropic arm of ENT UK aiming to deliver for our members in the UK, an International Centre for Otolaryngology Skills Training which will be a centre of excellence in global training and innovation. On the topic of international collaboration, Julianne (ENT UK General Manager) and I are in discussions to have ENT UK assigned as official partner for Emirates Rhinology and Otology Conference (EROC) which takes place in Dubai in January 2021 at the same time as the World Expo in the city. Details on this will be disseminated in the summer.

Finally, I am pleased to see more colleagues offering to endow visiting BACO scholarships and this remains available until early bird registrations close in April. You will join a few of us who are doing this and not only will you have the honour of bestowing the recipient at a special BACO ceremony but will always be remembered for this generosity for years to come by the grateful recipient. After all, our specialty and profession has given so much to us and we owe it to humanity to spread the goodwill.

Official Journal of ENT UK Professor Terry Jones has recently stepped down as Editor in Chief of Clinical Otolaryngology and leaves the journal in a strong position with one of the highest ENT journal impact factors. Congratulations to Mr James Tysome who now takes over as Editor in Chief. James hopes to build on Terry's success and aims to ensure the review process for journal submissions is as efficient as possible to reduce processing times for submitted manuscripts. As part of this process, the Editorial Board will be reviewed and revised to ensure that this aim is achievable. The journal will also be looking to commission more Editorial Comment submissions from  key opinions leaders in their field.

James Tysome, Editor in Chief

Access to the journal remains one of the benefits of ENT UK membership and we encourage our members to use the link in the newsletters to browse articles of interest.

 Click here to see the latest content in Clinical Otolaryngology

ENT UK Newsletter 2

Vol. 30, No 1 Spring 2020

Ms. Philippa Tostevin ENT UK Director of Education

Education and Training Update

After an enormous collaborative effort, the new and vastly improved e-lefENT virtual learning platform is now live. Huge thanks to James Tysome and Vicky Ward for their tenacity and dedication to this project. I am sure that you will all find the new site to be an enormously useful resource for all stages of training and beyond. Please encourage your medical students to log in as they can access the whole range of resources and webinars for free. If you have GPs with extended role in ENT in your teams there is now a dedicated learning track for them.

There is a now a vacancy for a new Editor-in-Chief to work with James, who is now the Director of e-learning. We are seeking a passionate educator with a love of technology. If that sounds like you please click here for details.

Preparations are in place for an exciting SFO Day at BACO after which time our inspiring lead Jayesh Doshi will be ending his term as Chair of this group. Under his leadership the SFO group has grown rapidly and now contains many budding ENT surgeons who need to be nurtured and supported. With our current workforce trajectory it is essential that these early demonstrations of interest in the specialty are sustained and developed. If you are interested in taking on the SFO Chair leadership role after BACO 2020 please apply here.

Several hospitals around the country have recently been able to offer MTI (medical training initiative) posts for international ENT surgeons at Registrar level. If you have availability in a JCST

approved post (or post that has equivalent experience) please get in touch and we can organise to interview prospective candidates together.

There will be a Paediatric airway course in Birmingham on 7th July prior to BACO 2020, and another in London on 6th November this year. In response to request for support from members , ENT UK, SAC and BAPO have written a collaborative document to guide paediatric airway management coverage on-call as it was clear that some units had unreasonable demands placed on paediatric airway surgeons.

The next adult emergency safe course will be held in London on December 16th under the new leadership of Raj Lakhani who will be taking over this role from Philip Clamp. Thank you to Philip for his development of the programme to date. Early preparations are also underway for the next SAS conference in Wales 24th and 25th June 2021.

The complications webinar series developed with the RCSEd has so far covered complications of hearing loss and facial palsy following ear surgery, these recordings and slides are now available on the ENT UK website. We are looking forward to hearing from Professor Erin Wright on the subject of CSF leak post nasal surgery 17th March. Other webinar topics planned in the complications series this academic year include displaced tracheostomy, vocal cord palsy, salivary leak , chyle leak and flap failure.

P lease encourage your Surgica l Nurse Practitioners, Physician Associate and GP colleagues who may have an interest in ENT to attend the GP & Allied Professionals Day at BACO on 9th July, everyone is most welcome to attend, the more the merrier!

ENT UK Newsletter 3

Vol. 30, No 1 Spring 2020

Mr. Craig Murray Chair, Specialist Advisory Committee in Otolaryngology

SAC Update

This will be a brief report. Little has changed over a quiet Christmas period. We are still on course for commencement of the new curriculum this year. There remain a few barriers. As far as JCST are concerned this takes the form of the other specialties being accepted and the GMC accepting the multi consultant report (MCR) after its pilot phase. There has been a push by the GMC to focus on learning opportunities rather than defining courses. We had valuable discussion with the GMC at the end of last year that allowed our specialty to define specific areas that could be defined as learning opportunities, eg a temporal bone dissection course. This has been further discussed at higher levels within the GMC and at this time it looks as though the preferred stance is removal of all reference to courses within the curriculum. The same stance is made regarding research and management courses and these too could be removed from the curriculum. This goes against the desires of our Specialty and the SAC. Jon Lund and Gareth Griffiths will be attending a final meeting with the GMC to finalise a decision. When the curriculum has been formally adopted and starting date agreed I will give a more detailed breakdown of the changes and how you will be affected.

The issue that the Interface Group (TIG) program does not fit within the GMC curriculum model led to anxiety across all surgical specialties where a TIG program exists. Representation was made by the JCST to the GMC explaining the valuable role that TIG programs make in ensuring a cohort of trainees can have additional exceptional training. This is invaluable not only to the trainees but also to the NHS and the patients requiring complex care. The GMC does see the added value in TIGs and will wish a similar scheme to exist in the longer term. This means that there will be a stay of execution for the TIGs and those planning to enter such a program will be able to do so until replaced within the next few years. Several option appraisals are being discussed with the GMC to establish what the TIGs will morph into.

Finally, I would like to clarify a statement from my previous report, regarding National Selection 2019. When I re-read it this evening I realised my words could be misunderstood. I wrote “those that attended last year found it worthwhile and will consider coming back again.” I of course meant the interviewers and not the candidates! Hopefully nobody thought I was that mean and no one took it personally!

ENT UK Newsletter 4

Vol. 30, No 1 Spring 2020

WELCOME TO BACO 2020 ICC Birmingham 8-10 July 2020

BACO Awards nominations closing soon

Nominations for the inaugural BACO awards close on Monday 2 March 2020. Why not nominate a colleague who inspires you, or whose work you feel deserves greater recognition? The awards are open to ENT UK members and can be made in the following categories:

Rising star

Outstanding trainer

Global health

Innovation in otolaryngology

ENT allied professionals

Click here to nominate a colleague

ENT UK Newsletter 5

Key BACO 2020 dates

Early bird registration closes 17 April 2020 Voting for BACO Awards 23 March - 20 April 2020 Launch of BACO 2020 App 8 May 2020 BACO 2020 8-10 July 2020

BACO website

Vol. 30, No 1 Spring 2020

Professor Claire Hopkins President, British Rhinological Society

BRS Update

18th BRS Annual Meeting, Sheffield May 15th

With the British Rhinological Society Meeting (BRS) in Sheffield fast approaching, who better to update you on the two key-note lectures than our Storz International Guest Speakers?

Gwijde Adriaensen, from the Amsterdam Medical Centre writes “Functional rhinoplasty can be a challenging kind of rhinoplasty, as it attracts several groups of people requesting surgery of their nose. There are patients with purely functional complaints of nasal obstruction where the challenge lies in objectifying the extent of their subjective nasal passage problem and relating that to the cause and therefore the likelihood of surgical success. Then there are patients who have next to functional complaints some esthetic wishes as well, where often (in Caucasians) the balance between a smaller a narrower nose as well as improvement in nasal breathing needs to be found. Finally, some patients exaggerate their functional complaints in order to get a free rhinoplasty, a recipe for slightly dissatisfied patients. As with all rhinoplasty, in functional rhinoplasty the nose is built around a straight and stable nasal septum

( c a r t i l a g i n o u s a n d b o n y ) a n d a s h o r t comprehensive structural approach with some key surgical landmarks to achieve this will be presented. Next, functional rhinoplasty is often centered around nasal airway obstruction focusing on the nasal valve area. Bottlenecks in diagnosis and obtaining scientific evidence as well as philosophy in manoeuvres to obtain maximum functional result in this region including the bony pyramid (following evidence where possible) are presented.“

Isam Alobid, from the University Clinic in Barcelona, is considered the world expert in repair of septal perforations. "No gold standard technique has been recognised for the surgical management of septal perforation.  Many endoscopic techniques are available for septal repair, and the choice depends on the osteo-cartilaginous support, characteristics of the perforation (size, location) and the experience of the surgeon. This lecture will provide a meticulous review focusing on the endoscopic approaches to repair septal perforation".

Elsewhere on the programme we’ll be discussing the role of Eustachian tube dilatation, where biologic therapies wil l l ikely sit in the management of nasal polyps, and a panel will discuss challenging cases. The programme should have plenty of practical tips for all those practicing rhinology. Early bird registration closes on the 20th March, and the meeting is one of the cheapest in ENT at a bargain early bird price of £40 for BRS members, and £60 for non-members. How could you miss it!

For more details and to register for the 18th BRS Annual Meeting, click here.

ENT UK Newsletter 6

Vol. 30, No 1 Spring 2020

Mr. Hesham Saleh President, British Society of Facial Plastic Surgeons

BSFPS Update

I hope that 2020 has started well for all our members. At BSFPS we are very pleased with the continuing success of our society and all the recent developments. The first online council election was well subscribed, and the results were announced in December.

Peter Andrews was voted in as President Elect and will take over as President after the AGM at our annual meeting on the 27th March 2020. Anil Joshi was voted in as Secretary and both Pei-Pei Cheang and Anshul Sama shared the same number of votes for the Treasurer position. Pei Pei started her position on the 1st December 2019 and Anshul will take over from 2nd July 2021 to December 2022. Sadie Khwaja remains Media & Newsletter officer and Raj Bhalla has been appointed our Education Officer. We have also appointed new regional representatives to work with the council on promoting facial plastics and to support members in their regions. Positions in Yorkshire, East of England, Wales and Northern

Ireland are still vacant and those of you who are interested please send your application to Lidija with the support of a proposer and a seconder. The new council has already started working on many projects, one of which is organising structured facial plastic training fellowships and observerships for our members.

2020 is promising to be fruitful for BSFPS. Our annual facial plastic cadaveric dissection course 9th - 11th March 2020 in Manchester is now a 3-day course instead of 2 days and is already completely sold out. We look forward to seeing you at our annual meeting that will be held in Glasgow Hilton Grosvenor on the 27th of March 2020 and has a widely varied programme. For the first time there will be a live demonstration on Botulinum toxin, fillers and non-surgical rhinoplasty. We are also pleased that we have been involved in creating a facial plastics programme for BACO 2020 which we trust will be very popular.

ENT UK Newsletter 7

BSFPS Council (Clockwise)

General Secretary Anil Joshi

President Hesham Saleh

President Elect Peter Andrews

AOT rep Anna Slovik

Treasurer Pei Pei Cheang

Vol. 30, No 1 Spring 2020

Mr. Michael Wareing British Society of Otology

BSO Update

The British Society of Otology celebrated a record-breaking Academic Meeting held at St. Bartholomew’s Hospital on 6th February 2020. With a sell-out of 150 delegates, the social functions, networking and trade show took place in the historic setting of The Great Hall. The academic programme took place a short walk away in The Morris Lecture Theatre, a journey back in time for all the Barts alumni in the audience. We were treated to a diverse opening session with contributions from Audiovestibular Medicine (Louisa Murdin, Guys), Neurology (Diego Kaski, Queens Square) and ENT (Manohar Bance, Cambridge) discussing difficult and differing aspects of vertigo. The second session opened with new technological advances in the field of hearing aids from Thomas Behrens of Oticon, especially in the cognitive benefits potentially achievable. Cian Hughes of Google gave us an insight into where we might go with Artificial Intelligence, and Krish Ramdoo gave an update on Tympahealth, a new phone-based device to allow community delivered ear care. The afternoon began with a collaborative update on the NOE project from Emma Stapleton (Manchester) and Monique Andersson (Oxford) and Patrick Axon (Cambridge) gave us a detailed insight into the Addenbrooke’s programme of pulsatile tinnitus management. The final session of the day had talks from Doug Hartley (Nottingham) on developing objective measures

of speech recognition in children, and Rishi Mandavia (UCL) on the evolving field of inner ear medicine. The meeting finished with the AGM. O w e n J u d d ( D e r b y ) a n d T i m M i t c h e l l (Southampton) were successful in the ballot for election to the Council and we look forward to their presence on Council. Philip Robinson, the outgoing President from Bristol was thanked for all his hard work in the role as he handed over to Professor Peter Rea from Leicester. He in turn handed over the role of Secretary to Professor Simon Lloyd from Manchester. The day before, the BSO Balance Course had played to a full audience again at Barts, superbly marshalled by Gerry Kelly (Leeds). Joel Goebel played a major role in, potentially his last visit, delivering a masterclass in explaining balance, ably assisted by the UK based faculty. (Although he may be back next year…) Next year’s BSO Annual Meeting will be held in Cambridge, a little later in the year on March 22 orchestrated by Manohar Bance. Save the date! Otherwise the BSO Council have been busy developing clinical guidelines for important otological conditions including facial palsy and acute mastoiditis. These should appear on the newly developed website in the near future. We are also looking at the important issue of ototoxicity, both for topical medicines and IV gentamicin.

ENT UK Newsletter 8

Vol. 30, No 1 Spring 2020

Ms. Elinor Warner Interim President, WENTS

Women in ENT Surgery

On 6th Feb 2020, WENTS hosted a SOLD OUT collaboration between WENTS and RADA at the Wesley Hotel Euston which included the launch of their mentoring programme. The workshop was the first in a series of professional skills workshops that WENTS are eager to spearhead, focusing on holistic skills that surgeons need, but may not be in key focus during surgical training. The event was titled “Hold your space” and addressed how we each command presence in a room, capture attention and ensure that those that we need to, listen to what we have to say. 

Paula Coyle, WENTS President, summarised WENTS achievements in the last two years. Key achievements include negotiating reduced membership fees for those on parental leave, launch ing our webs i te and mentor ing programme, producing guidance documents on maternity leave, LTFT and advice on out of programme research, and hosting events.

Elinor Warner, Interim President and co-organiser of the RADA event, went on to introduce the programme for the evening introducing Sheelagh McNamara, an internat ional ly recognised voice, speech and presentation skills trainer with over 35 years experience. Her clients have included Oscar nominees, politicians,

judges and CEOs. We were in good hands! A hugely uplifting part of the evening was seeing the wide range of attendees, male and female, from medical students to eminent consultant surgeons. All threw themselves into the event, and took away some key tips and tricks too. The 'Hilary pinch’ was a particular favourite and could be seen being practiced around the room with good effect!

Rujita Bance and Natalie Watson (WENTs mentoring leads) introduced the programme. Key features included the importance of development mentoring, which is mentoring in a positive way to enable people to reach their potential, rather than just for those who are struggling, which is well established in other industries, and a mentoring contract with a no blame dissolution agreement. This was followed by a question and answer session with live answers via Slido. Questions asked of the audience included “What do you want from a mentoring scheme” and “What support would you like from the mentoring committee” Rujita did an excellent job of fielding questions from the audience, and new potential mentors and mentees were encouraged to sign up via the survey monkey link. The evening rounded up with networking and drinks. A brilliant evening! Please get in touch or complete the survey monkey if you would like to be involved.

To contact WENTS, please click here

For mentoring queries, click here

Twitter: @UKWENTS

WENTS Facebook group

ENT UK Newsletter 9

Vol. 30, No 1 Spring 2020

Members’ News

I was honoured to serve as Her Majesty's High Sheriff of the West Midlands in 2019-2020. Except for the Monarchy, the Shrievalty is the old secular office in the country surviving from Saxon times. In Norman and Plantagenet times, the Sheriff was required to enforce the law, act as a judge and collect taxes on behalf of the Crown. Fortunately, today, it is an entirely ceremonial role but carries the status of being the Queen's highest judicial officer in the county. As with many such roles, I have learned more from it than I have contributed.

Michael Kuo, Consultant Paediatric ENT Surgeon

ENT UK Newsletter 10

Newsletter Editor:

Miss Emma StapletonConsultant OtolaryngologistManchester Royal Infirmary

Email: emma.stapleton@mft.nhs.uk

Address: ENT UK

The Royal College of Surgeons35-43 Lincoln's Inn Fields

London, WC2A 3PE

The views expressed

in the ENT UK Newsletter are not necessarily the views of

ENT UK as an organisation, but rather the views of individual contributors

Managing duty of candour at local level

It was recently brought to our attention by one of our members that their trust insists upon providing a Duty of Candour letter to any patient following a complication, expected or otherwise.

This was therefore discussed at our recent ENT UK executive committee meeting. Clear guidance around this exists on the Royal College of Surgeons of England website. A clause in the RCSEng document is clear: “Again, it should be noted that the statutory  duty  of  candour  does not refer to recognised complications or undesirable outcomes that occur as part of  the natural course of  the patient's illness, but rather to safety incidents caused through the provision of care."

Therefore our recommendation to all ENT colleagues is that they should point their trusts to this document. A duty of candour letter is not required for expected complications.

Expressions of interest are invited for an

Assistant ENT UK Newsletter Editor

Do you have Communication skills, IT skills, and the ability to meet deadlines? Would you like to become a valued member of the ENT UK team?

Would you like to have your face on the first page of the ENT UK newsletter? Would you like

to badger the ENT UK Council for articles?

Get in touch if you’d like to know more