Aaron Trinidade

Mid & South Essex NHS Foundation Trust

Purpose of Review When persistent postural-perceptual dizziness (PPPD) entered the diagnostic nomenclature in 2017, treatment options were adopted from its predecessors, including use of vestibular rehabilitation, psychotherapy, and serotonin reuptake inhibitors. Individualised treatment may require additional interventions to cover the full range...

Background: The literature on predictors of persistent postural-perceptual dizziness (PPPD) following peripheral vestibular insults has not been systematically reviewed. Methods: We systematically reviewed studies on predictors of PPPD and its four predecessors (phobic postural vertigo, space-motion discomfort, chronic subjective dizziness and v...

Background The COVID-19 pandemic has affected most industries, including health education. In this study, we surveyed students studying healthcare-related courses at our university on how their lifestyles and behaviours, mental health and education had been affected by the pandemic. Methods Mixed methods cross-sectional study. Results Two hundred...

Objectives: In response COVID-19, re-establishing safe elective services was prioritised in the UK. We assess the impact on face-to-face hospital attendance, cost, and efficiency of implementing a virtual sleep clinic (intervention 1) to screen for children requiring level 3 ambulatory sleep studies using newly implemented ENT-UK guidelines for ob...

Objectives: To quantify patient eligibility for cochlear implantation following National Institute for Health and Care Excellence 2019 guidelines (TA566) over five years at our institution, and identify factors influencing patients' decisions surrounding cochlear implantation referral. Methods: A multi-perspective service evaluation was conducte...

Purpose To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation. Methods A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and...

Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core...

Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core O...

Objective: To present the results of a 15-year longitudinal study in a pediatric and adult population with secondary obliteration of troublesome mastoid cavities. Study design: Prospective longitudinal study. Patients: Children (≤16 yrs) and adults who had obliteration surgery (228 ears) between 2000 and 2017. Interventions: Therapeutic. Se...

Objectives: (1) To assess whether neuroticism, state anxiety, and body vigilance are higher in patients with persistent postural-perceptual dizziness (PPPD) compared to a recovered vestibular patient group and a non-dizzy patient group; (2) To gather pilot data on illness perceptions of patients with PPPD. Materials and Methods: 15 cases with PPPD...

Objectives To report changes in practice brought about by COVID‐19 and the implementation of new guidelines, and to explore factors relating to unscheduled re‐presentations for patients discharged from the emergency department (ED). Design Prospective multicentre national audit over 12 weeks from 6th April 2020. Setting UK secondary care ENT depa...

Purpose Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography. Preoperative magnetic resonance imaging (MRI) can be a useful adjunct in objective upper airway assessment, in particular the tongue base, providing useful information f...

Purpose: The purpose of this paper is to determine a tinnitus patient information pack's (TPIP) usefulness in patients suffering with tinnitus with respect to their need for further tinnitus retraining therapy (TRT) and in reducing TRT cancellations and non-attenders. Design/methodology/approach: The paper consists of prospective case series in...

Objectives To determine: (1) the incidence of incidental ‘mastoiditis’ reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a repo...

Objective: To present a systematic review of the current data on persistent postural-perceptual dizziness (PPPD), a useful and relatively new diagnosis for a disorder that has previously been known by many different names. In addition, to discuss diagnostic criteria and management strategies for this condition with the otologist in mind. Data sou...

Objective To determine whether patients within an otolaryngology department presenting with asymmetrical sensorineural hearing loss and/or unilateral tinnitus can be safely and cost-efficiently screened for acoustic neuroma by audiologists as a first or only point of contact. Methods A prospective case series and cost analysis were conducted at a...

Patients and parents in particular can find the decision regarding which device to have implanted difficult due to the amount of often complicated information that is available. The desire to choose the 'right' implant for themselves or their child takes on great importance due to the finality of the procedure. There is some evidence that certain p...

Objective: No consensus guidelines exist regarding intraoperative testing during cochlear implantation and wide variation in practice habits exists. The objective of this observational study was to survey otologists/neurotologists to understand practice habits and overall opinion of usefulness of intraoperative testing. Study design: Cross-secti...

Objective: To study long-term complications after ossiculoplasty. Study design: Case series with chart review. Setting: Tertiary care referral center otology practice. Patients: One hundred ninety-five patients (18-88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts, ret...

Objective: To review our use of intraoperative testing during cochlear implantation (CI) and determine its impact on surgical decision-making. Study design: Retrospective chart review. Setting: Tertiary referral center. Patients: A total of 197 children and adults who underwent a total of 266 primary and/or revision CI by a single surgeon fr...

Objectives/hypothesis: From a purely surgical efficiency point of view, simultaneous cochlear implantation (SimCI) is more cost-effective than sequential cochlear implantation (SeqCI) when total direct costs are considered (implant and hospital costs). However, in a setting where only SeqCI is practiced and a proportion of initially unilaterally i...

Objectives: To determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty. Study design: Case series with retrospective chart review. Setting: Tertiary care otology practice. Patients: Adult and pediatric patients (3-88 years of age). Interventions: Ossiculoplasty with cartilage tympanoplasty, with or witho...

Objective: Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management. Data sources: PubMed, Google Scholar, Medline Embase, Coc...

Objectives: To assess long-term outcomes after secondary mastoid obliteration. Study design: Case series with chart review. Setting: Tertiary care center. Patients: Adult patients (20-80 yr of age) undergoing secondary mastoid obliteration. Outcome measures: Hearing results (improvement in pure-tone average air-bone gap [PTA-ABG] from base...

The vertical juxtaposition junction (VJJ) flap is a useful adjunct to the technique of mastoid obliteration and is readily created during the process of cartilage graft harvesting from the conchal bowl. It allows for greater inward rotation of a Palva flap into the mastoid cavity; provides a platform for overlying soft tissues, thus helping to prev...

In this article we describe the surgical management of retrosternal goiters via a limited thoracocervical approach, and we explore how the respective surgical know-how can be used in the management of the carotid blowout syndrome. Four cases involving patients who had undergone thyroidectomy via a limited thoracocervical approach are retrospectivel...

Neck injuries in lacrosse are rare and mostly involve the musculoskeletal system. The lacrosse ball is a solid rubber ball of approximately 20 cm in diameter and the fastest shot recorded in professional lacrosse is over 100 mph. Despite wearing full protection, the neck remains prone to blunt trauma by this ball. A23-year man sustained a direct bl...

The assessment and treatment of patients with ENT disorders requires significant specialist knowledge and skills not routinely taught during medical school or Foundation training. Furthermore, ENT emergencies can be rapidly life-threatening and may necessitate systematic and multidisciplinary management and resuscitation. We aimed to develop a prac...

CWU and CWD surgery for cholesteatoma both have advantages and disadvantages; CWD surgery with primary obliteration aims to deliver to the patient the advantages of both. Using Kaplan-Meier survival analysis, the probability of residual cholesteatoma after 5 years was 3.5% (95% CI: 1.3%-9.3%), representing four residual cholesteatomas; there were n...

Introduction: The use of complementary and alternative medicine (CAM) is increasing in all parts of the UK. Based on the published data, CAM use appears to be more prevalent among patients attending the otolaryngology outpatient department who are in higher education cohort. Aim: This study aims to establish the CAM use by university students and a...

Objectives: Tonsillectomy is one of the most commonly performed otolaryngological procedures. Bilateral palsy of the glossopharyngeal nerve is an exceedingly rare complication that can result in significant morbidity. This case report aimed to raise awareness of this complication and outline management strategies. Case report: A 31-year-old woman...

Introduction: ENT is an under-taught specialty at medical schools, with some even having completely removed it from the curriculum. This may have an impact on how doctors in the Accident & Emergency (A&E) Department manage patients with ENT problems at first contact. Method: Clinical audit. We assessed whether relevant interventions and appropriate...

Objective: To present the results of a 5-year longitudinal study in a pediatric population undergoing surgery for extensive cholesteatoma using a canal wall down (CWD) approach with obliteration. Study Design: Prospective longitudinal study. Patients: Children (<16 years) undergoing surgery for cholesteatoma (58 ears) between 1999 and 2013. Interve...

Background: Nasal packing is often used after functional endoscopic sinus surgery (FESS). Variousnon-absorbable agents are used but these packs can be uncomfortable and cause pain and bleeding on removal. Increasingly, biodegradable nasal packs are being used and have shown promising effects on post-operative bleeding and healing after FESS. Aim: W...

ENT presentations are common both in primary care and accident and emergency departments. Unfortunately, many clinicians are not comfortable handling ENT emergencies due to a lack of knowledge and skill stemming from an undergraduate level onwards. An 'Introduction to ENT' course has been cited as an answer to bridge the gap in knowledge and promot...

To present the results of a 5-year longitudinal study in a pediatric population undergoing surgery for extensive cholesteatoma using a canal wall down (CWD) approach with obliteration.

Objectives Symptoms including tinnitus, otalgia, and vertigo have been reported following exposure to wind turbine noise; a condition termed wind turbine syndrome (WTS). We describe a case of an individual suffering following exposure and analyze the evidence for the detrimental physiologic effects of infrasound and low-frequency noise, thereby que...

Objectives Compare the efficacy of 3 steroid regimes in the management of idiopathic sudden sensorineural hearing loss (ISSNHL) in an adult population in Trinidad, West Indies, where management of this phenomenon has not previously been described. Methods Retrospective review from 2005 to 2013 of 71 adults presenting with unilateral ISSNHL and tre...

Objectives Present the results of a 5-year longitudinal study in a pediatric population undergoing cholesteatoma surgery using a canal wall down approach with obliteration. Methods Prospective longitudinal study in a district general hospital from 1999 to 2013.46 children (<16 years) with cholesteatoma were included. Outcome measurements were: (1)...

In its 2002 document Delivering the NHS Plan, the Department of Health set a target of 75% of all surgical procedures being performed as day-case procedures. 1 Tonsillectomy is quoted as one of the operations in the ‘basket’ of 25 procedures deemed suitable by the Audit Commission and the British Association of Day Surgery (BADS). 2 , 3 With respec...

Objective To investigate Fallopian canal dehiscence (FCD) during cholesteatoma surgery.Study DesignProspective case-control study. PATIENTS: 401 patients with cholesteatoma and 172 with otosclerosis. InterventionsTherapeutic.SettingDistrict general hospital.Main Outcome Measures(1) Intra-operative incidence of FCD during (a) surgery for cholesteato...

The bone-anchored hearing aid (BAHA) is an effective treatment for hearing loss that relies on the use of bone conducted sound directly to the cochlea, thus bypassing pathology affecting sound transmission through the ear canal or middle ear. The optimal site for placement of the abutment has been described as a post-auricular point lying approxima...

ObjectiveA specialist balance clinic to effectively deal with dizzy patients is recommended by ENT-UK. We audit the patient pathway before and following the introduction of a consultant-led dedicated balance clinic. DesignProcess evaluation and audit. SettingENT out-patients department of a district general hospital. Outcome MeasuresThe journey of...

Introduction: Complementary and alternative medicine usage, though rising, remains largely devoid of a sound scientific basis; however, there is increasing evidence to support its use in cancer therapy. Aim: To present the case of a patient with laryngeal carcinoma who made a full recovery following mistletoe therapy, despite failing to respond...

Introduction: Salivary gland pathology in the paediatric population is rare and can present management challenges regarding both investigation and treatment. Method: Case report and review of available literature. Results: A seven-year-old, fit, well girl presented with a two-month history of a painless mass over the left parotid area. Ultraso...

Objective: To determine whether there is a change in the epidemiology of nasal fractures in females in the UK, and the potential contribution of the 'ladette' culture. Methods: This paper reports a multi-centre retrospective study. Operating theatre data for all females who underwent manipulation of nasal fractures under anaesthesia between 2002...

Caffeine is implicated as causing or aggravating numerous otorhinolaryngological conditions, including tinnitus, Ménière's disease, laryngopharyngeal reflux, globus pharyngeus and dysphonia. We address caffeine's effects in such conditions and to determine whether such implications are founded. The defined search limits of data sources included hum...

We report and explain unilateral pupillary dilatation following routine septoplasty and trimming of inferior turbinates. The unilateral pupillary dilatation was caused by inadvertent instillation of sympathomimetic, (xylometazoline hydrochloride) in the eye during preparation for nasal surgery. The effect was short-lived and the patient made a full...

Chylous leak is a documented complication of radical neck dissection with well recognised morbidities, including wound breakdown, hypovolaemia and hypoalbuminaemia. Other less well-documented electrolyte imbalances can also ensue. We aim to raise awareness about hypo-osmotic hyponatraemia as a potentially fatal, commonly overlooked complication of...

Objective: Symptoms, including tinnitus, ear pain and vertigo, have been reported following exposure to wind turbine noise. This review addresses the effects of infrasound and low frequency noise and questions the existence of 'wind turbine syndrome'. Design: This review is based on a search for articles published within the last 10 years, condu...

The present study aimed to compare outcomes of cricopharyngeal myotomy (CPM) in patients with documented cricopharyngeal dysfunction (CPD) and those in whom the diagnosis is complex or in doubt. Retrospective comparative study of all patients undergoing CPM between 2001 and 2010 at a single UK centre. Patients were classified as having either CPD (...

Background: A spontaneous cerebrospinal fluid leak can sometimes only become apparent following grommet insertion and usually represents dehiscence of the tegmen tympani, which is an uncommon condition. Objectives: This report aimed to reaffirm the importance of recognising this unusual presentation and outline management options. Case report:...

Background: Subclinical infection of the sinuses can result in delayed diagnosis and unusual presenting complications. Case report: This paper describes the case of a 14-year-old boy with a rare combination of periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis following a late presentation of unilateral frontal sinu...

The authors investigated the prevalence of complementary and alternative medicine usage among medical students and assessed their knowledge and attitude. A survey was conducted, and the following results were obtained: the response rate was 91% (408/450), 61% were female and 67% were 22 years old or younger, 66% had used complementary and alternati...

Objective: To determine re-admission rate for post-tonsillectomy pain; the primary and secondary post-tonsillectomy bleeding rate; the percentage requiring control of post-tonsillectomy bleeding in children undergoing coblation tonsillectomy. Study design: A descriptive study. Place and duration of study: Royal Hospital for Sick Children (York...

Solitary bone plasmacytoma is a rare haematological malignancy that can present in a variety of ways. This study aimed to present a case of plasmacytoma of the atlas, as a rare cause of unilateral vocal fold palsy. Case report. Following diagnosis via imaging and direct biopsy through the posterior pharyngeal wall, the patient was referred to the h...

Complementary and alternative medicine (CAM) use is common among patients attending the department of the authors of this article. With expanding roles of nurses in various clinics, the nurses are often asked for their advice on CAM use by their patients. CAM education is not part of the nursing curriculum in various parts of the world. The aim of...

Retention within the middle ear cleft is an unusual complication of T-tube insertion. A 40-year-old woman with Kartagener's Syndrome presented with hearing impairment in the right ear. She was found to have a previously inserted Goode T-tube lying within the middle ear behind an intact drum. She underwent successful removal of the T-tube via a myri...

Nowadays, internet and e-mail are important modes of communication and information. This paper seeks to determine internet usage as a source of health information amongst ENT patients and to investigate whether patients prefer to communicate primarily with the hospital via e-mail. The method used is a questionnaire study and 201 patients attending...

Lipomas are common benign tumours but can present in unusual locations. The authors present the rare case of a pedunculated lipoma of the pinnal helix. The lipoma was excised with good cosmetic result. Lipoma of the cartilaginous pinnal helix is rare and has not been described previously in the literature.

Oncocytomas are rare tumours, usually occurring in the salivary glands, but may very occasionally occur in other sites. The authors present a skull base oncocytoma as a rare cause of spontaneous epistaxis. Following diagnosis through imaging and intranasal biopsy, the patient opted for annual surveillance instead of active treatment and made a full...

The purpose of this paper is to determine head and neck cancer patients' perspective of their follow-up regime and to suggest ways in which these perspectives can be incorporated into current practice. This is a prospective survey-based study. A total of 263 patients consecutively attending a head and neck cancer clinic completed a survey about the...

To study the effect of intraoperative ondansetron and dexamethasone on postoperative vomiting in children undergoing tonsillectomy, adenotonsillectomy, or adenoidectomy. Retrospective chart review. Academic tertiary care referral centre in the west of Scotland. A retrospective chart review was conducted on 432 children admitted to our institute bet...

Non-arteritic ischaemic optic neuritis is a known post-operative complication of ophthalmological and maxillofacial surgery, but has not been widely described as a potential consequence of head and neck surgery. To highlight non-arteritic ischaemic optic neuritis as a potential risk in patients undergoing head and neck surgery. Case report of a 60-...

A 45 years old man with tuberculosis (TB) and secondary vasculitis presented with perforation of the nasal septum, involving skin and cranial nerves. Vasculitis is a recognized, tough rare complication of tuberculosis and has not been previously described in the literature as a cause of nasal septal perforation. It presents a diagnostic dilemma. Th...

Patients with head and neck cancer have complex swallowing and nutritional concerns. Most patients are malnourished, and treatment modalities within the aerodigestive tract have profound effects on future swallowing and nutrition. The objective of this study is to investigate whether the introduction of fortified soft ice-cream to post-operative he...

Replacing a speech valve can be a difficult procedure to learn and perform. In this letter the authors propose a method using an operating microscope, which their department has found useful in performing this procedure, and in teaching trainees.

Complementary and alternative medicine is very much in the public arena as a treatment option. The pharmacodynamics of most complementary and alternative medicines are not well understood, and some can lead to significant adverse drug interactions. This report aims to present the case of a cancer patient who abandoned traditional medicine in favour...

To assess the initial management of acute otitis externa (AOE) in primary care and the appropriateness of referrals to the otolaryngology department. Prospective audit. Tertiary referral centre. Data were collected from 100 consecutive patients referred by their general practitioners (GPs) during a 6-week period to our otolaryngology department. A...

Myofibrosis of the ear is rare. Myofibromas are mesenchymal tumours which usually present in infancy but have been reported sporadically in adults. To present a rare case of trauma as a cause of pinnal myofibrosis. Case report. A 29-year-old soldier suffered repeated trauma from helmet wear and sports, and presented to our clinic with an exquisitel...

Objective: This case report is of a 34 year-old female with borderline personality disorder/obsessive-compulsive disorder who presented in the Accident & Emergency (A&E) Department on repeated occasions having swallowed 121 razor blades over an eighteen-month period. Method: Case report. Results: Rigid oesophagoscopy was performed to remove the raz...

To highlight a rare scenario where a delay in diagnosis caused unilateral blindness. A 45-year-old Aboriginal woman with a history of non-Hodgkin's lymphoma presented with a severe left-sided headache, pyrexia and positive blood cultures. Following admission, the patient rapidly developed unilateral blindness, but did not inform her physician until...