Objectives: To evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. Design: Retrospective cohort study. Setting: A single paediatric tertiary unit. Participants: Patients younger than 18 years with radiologically confirmed intracranial abscess including subdural empyema (SDE), epidural (EDA) or intraparenchymal (IPA) abscess secondary to sinusitis. Main outcome measures: The rates of return to theatre, the length of hospital stay (LOS), death <90 days and neurological disability (ND) at 6 months. Results: A cohort of 39 consecutive patients (41% male, mean age 11.5) presenting between 2000-2020 were eligible for inclusion. SDE was the most common intracranial complication (n=25, 64%) followed by EDA (n=12, 31%) and IPA (n=7, 18%). The mean LOS was 42 days (SD 16). Sixteen patients (41%) were managed with combined ENT and neurosurgical interventions, 15 (38.5%) underwent ENT procedure alone and 4 (10.3%) had neurosurgical only drainage. Four patients initially underwent non-operative management. The rates of return to theatre, ND and 90-day mortality were 19 (48.7%), 9 (23.1%) and 3 (7.7%) respectively and were comparable across the four treatment arms. In the univariate logistic regression, only the size of an intracranial abscess (10mm) was found be associated with an increased likelihood of return to theatre (odds radio 7, confidence interval 1.09-45.1), while combined ENT and neurosurgical intervention did not result in improved outcomes. Conclusion: Sinogenic intracranial abscesses are associated with a significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.

Objectives As we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will globally emerge from the shadow of COVID-19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery. Design Systematic literature review. Results The literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: those which made an assessment as to the aerosolisation of droplets during sinus surgery, further subdivided into work which considered macroscopically visible droplets and that which considered smaller particles, and those studies which examined the mitigation of this risk. Conclusion Studies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. Whilst results both highlight a range of innovative adjunctive strategies and support suction as an important variable to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery given studies have demonstrated that close adherence to PPE use is effective at preventing COVID-19 infection.

Objectives: Systemic steroids are a well-known, proven treatment for olfaction impairment. Topical nasal steroids are an attractive alternative that avoids systemic side effects and might provide an increased local drug activity. Nonetheless, the access of the medication to the olfactory cleft (OC) by using low- volume devices, such as nasal drops, is greatly dependent on the position of the head. We aimed to examine the accessibility of nasal drops to the OC area in two different head positions: the Mygind (lying head back) position and the Kaiteki position. Design and Setting: This is a cadaver study; the specimens were firstly positioned in Mygind and thereafter in Kaiteki positions. Nasal drops mixed with blue food dye were administered into the nostril in each head position. Endoscopic videos were recorded, and two blinded observers scored the extent of olfactory cleft penetration (OCP) using a 4-point scale (0 = none, 3 = heavy). Participants: Twelve fresh-frozen cadaver specimens Main outcome measures: The dye’s penetration to the OC Results: The mean score of nasal drops penetrance to the OC in the Mygind position was 1.34, as compared to 1.76 in the Kaiteki position. The difference in the OCP score between the two groups was not statistically significant (p>0.05) Conclusion: Both Mygind and Kaiteki head positions are reasonable alternatives in treatment with nasal drops for olfaction impairment. The preference of one position over another should rely on the patient’s comfort.

Objectives: To assess droplet splatter around the surgical field and surgeon during simulated Coblation tonsil surgery to better inform on mitigation strategies and evaluate choice of personal protective equipment. Design: Observational study Setting: Operation theatre suite at a tertiary hospital Participants: Life size head model was used to simulate tonsil surgery using fluorescein-soaked strawberries to mimic tonsils Main outcome measures: The Coblation wand was activated over the strawberries for 5 minutes. This was repeated 5 times with 2 surgeons (total of 10 data sets). The presence of droplet around the surgical field and anatomical subsites on the surgeon was assessed in binary fashion: present or not present. The results were collated as frequency of droplet detection and illustrated as a heatmap; 0 = white, 1-2 = yellow, 3-4 = orange and 5 = red. Results: Fluorescein droplets were detected in all four quadrants of the surgical field. The frequency of splatter was greatest in the upper (nearest to surgeon) and lower quadrants. There were detectable splatter droplets on the surgeon; most frequently occurring on the hands followed by the forearm. Droplets were also detected on the visor, neck, and chest albeit less frequently. However, none were detected on the upper arms. Conclusion: Droplet splatter can be detected in the immediate surgical field as well as on the surgeon. Although wearing a face visor does not prevent splatter on the surgical mask or around the eyes, it should be considered when undertaking tonsil surgery as well as a properly fitted goggle.