The Journal of laryngology and otology
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Practice Guideline
Head and neck melanoma (excluding ocular melanoma): United Kingdom National Multidisciplinary Guidelines.
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the United Kingdom. This paper provides consensus recommendations on the management of melanomas arising in the skin and mucosa of the head and neck region on the basis of current evidence. Recommendations • At-risk individuals should be warned about the correlation between ultraviolet radiation (UVR) exposure and skin cancer, and should be given advice on UVR protection. (R) • Dermatoscopy can aid in the diagnosis of cutaneous melanoma. (R) • Histological examination after biopsy is essential to confirm the diagnosis and the tumour thickness. (G) • Excisional biopsy is method of choice. (G) • Staging investigations can be performed for both regional and distant disease. (R) • Scanning (computed tomography (CT) and/or magnetic resonance imaging) is recommended for patients with high-risk melanoma. (G) • Patients with signs or symptoms of disease relapse should be investigated by imaging. (R) • Imaging of the brain should be performed in patients who have stage IV disease. (G) • Patients with melanoma of unknown primary should be thoroughly examined and investigated for a potential primary source. (R) • Primary cutaneous invasive melanoma should be excised with a surgical margin of at least 1 cm. (G) • The maximum recommended excision margin is 3 cm. (R) • The actual margin of excision depends upon the depth of the melanoma and its anatomical site. (G) • Ultrasound-guided fine needle aspiration (FNA) or core biopsy of suspected lymphadenopathy is more accurate than 'blind' biopsy. (R) • Open biopsy should only be performed if FNA or core biopsy is inadequate or equivocal. (R) • Prior to lymph node dissection, staging by CT scan should be carried out. (R) • If parotid disease is present without neck involvement, both parotidectomy and neck dissection should ideally be performed. (R) • There is no role for elective lymph node dissection. (R) • Sentinel lymph node biopsy (SLNB) can be considered in stage IB and above by specialist skin cancer multidisciplinary teams. (G) • Patients should be made aware that SLNB is a staging procedure, and should understand that it has, as yet, no proven therapeutic value. (R) • All patients with cutaneous melanoma should have their original tumour checked for BRAF gene status, and their subsequent targeted biological therapy based on this. (R) • Patients who develop brain metastases should be considered for stereotactic radio-surgery. (R).
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To investigate the assessment and management of paediatric snoring and obstructive sleep apnoea in UK otolaryngology departments. ⋯ There is variation in the assessment and management of paediatric snoring and obstructive sleep apnoea across the UK, particularly in the use of pre- and post-operative pulse oximetry monitoring, and further guidelines regarding this are necessary.
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Case Reports
Acute unilateral sensorineural hearing loss associated with anabolic steroids and polycythaemia: case report.
Unilateral sudden sensorineural hearing loss due to an infarct in the vertebrobasilar system has been widely reported. Most patients have a background of traditional coronary risk factors related to these cerebrovascular episodes. ⋯ To our knowledge, this is the first case report of unilateral sensorineural hearing loss secondary to the use of anabolic steroids causing polycythaemia. This cause should be considered in the differential diagnosis of patients presenting with sensorineural hearing loss, especially in young males, when no other risk factors can be identified.
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Multicenter Study
Epistaxis management: current understanding amongst junior doctors.
Epistaxis is a common and potentially life-threatening emergency. This survey assesses understanding and confidence in epistaxis management amongst current junior doctors. ⋯ Junior doctors lack understanding and confidence in epistaxis management, with patient safety implications. Confidence is associated with the duration of undergraduate exposure to otolaryngology. A minimum emergency safe competency should be a priority during foundation training if not achieved in UK medical schools.
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Given the urgent nature of ENT emergencies, appropriate knowledge is required amongst front-line staff. Junior doctors account for almost one quarter of emergency department doctors. It has been shown that undergraduate coverage of ENT is variable. This study therefore aimed to determine whether emergency department junior doctors were confident in dealing with ENT emergencies, with special focus on the airway. ⋯ Training should be provided to junior doctors starting work in the emergency department. We suggest mandatory multidisciplinary induction training for such staff.