This study aimed to explore the current practices of the UK rhinology consultant body in regard to cocaine screening in nasal reconstructive surgery.

A 12-question online survey was distributed to rhinology consultants (October 2021 to February 2022) currently practising in the UK.

A total of 55 consultants responded. Fifty-three per cent asked patients about cocaine use prior to consideration of surgery, and 45 per cent performed cocaine testing prior to consideration of surgery. Of these, the majority employed urine testing alone (60 per cent), with hair testing being less common as a single screening modality (4 per cent). Sixteen per cent opted for both urine and hair testing. The most common reasons for not performing cocaine testing included patient history or clinical examination that was not suggestive of cocaine use (44 per cent), lack of formal guidelines (33 per cent) and lack of testing availability (27 per cent). Sixty-four per cent were in favour of a national policy for cocaine screening.

There is marked variation in cocaine screening practices for nasal reconstructive surgery among UK rhinologists.

To assess the current standard of consent for functional endoscopic sinus surgery and determine whether it complies with the law following the Montgomery ruling.

Ten complications following functional endoscopic sinus surgery were identified as common or serious from a literature search. Using questionnaires, ENT surgeons were asked which of these complications they discussed with patients, and patients were asked how seriously they regarded those risks using a five-point Likert scale.

Consent practice from 21 ENT surgeons and data from 103 patients were analysed. The ‘reasonable patient’ would expect to be consented for all risks, except for pain, and scarring or adhesions. Most ENT surgeons would routinely discuss all risks that were considered significant, except for facial paraesthesia (29 per cent) and damage to the nasolacrimal duct (24 per cent). A negative change in sense of smell was not mentioned by 29 per cent of surgeons.

This paper demonstrates that the current consent process for functional endoscopic sinus surgery is likely to be substandard medicolegally.

This study reviewed all rhinology clinical negligence claims in the National Health Service in England between 2013 and 2018.

All clinical negligence claims held by National Health Service Resolution relating to rhinology in England between 1 April 2013 and 1 April 2018 were reviewed.

There were 171 rhinology related claims with a total estimated potential cost of £13.6 million. There were 119 closed claims (70 per cent) with a total cost of £2.3 million, of which 55 claims resulted in payment of damages. Over three quarters of all rhinology claims were associated with surgery (n = 132). Claims associated with endoscopic sinus surgery had the highest mean cost per claim (£172 978). Unnecessary pain (33.9 per cent) and unnecessary operation (28.1 per cent) were the most commonly cited patient injuries.

Patient education and consent have been highlighted as key areas for improvement from this review of rhinology related clinical negligence claims. A shift in clinical practice towards shared decision making could reduce litigation in rhinology.

The Blakesley fenestrated ethmoid forceps, eponymously named after Theodore Seward Blakesley, belong today in every set of endonasal surgical instruments. This study aimed to go back to Blakesley's original description, and to follow its introduction, variations and acceptation by rhinosurgeons.

Historical review of literature.

In 1915, Blakesley described two nasal instruments: a submucous septum resection instrument and an ethmoid instrument. The history of the ethmoid instrument is in close relationship to another quite similar one described by Moriz Weil. The difference between the Weil and the Blakesley ethmoid forceps lies essentially in the base of the cutting jaws, which are narrower in Weil's instrument.

Blakesley's eponym must only be used for the instrument without the narrower base of the cutting jaws.

Tissue engineering using biocompatible scaffolds, with or without cells, can permit surgeons to restore structure and function following tissue resection or in cases of congenital abnormality. Tracheal regeneration has emerged as a spearhead application of these technologies, whilst regenerative therapies are now being developed to treat most other diseases within otolaryngology.

A systematic review of the literature was performed using Ovid Medline and Ovid Embase, from database inception to 15 November 2014. A total of 561 papers matched the search criteria, with 76 fulfilling inclusion criteria. Articles were predominantly pre-clinical animal studies, reflecting the current status of research in this field. Several key human research articles were identified and discussed.

The main issues facing research in regenerative surgery are translation of animal model work into human models, increasing stem cell availability so it can be used to further research, and development of better facilities to enable implementation of these advances.

We aimed to evaluate a practical, computerised database for collection of patient-reported and clinical outcome data, introduced as a means of characterising our patient population and assessing the effect of our interventions.

A prospectively updated, computerised database was used to detail each patient's coded and structured diagnosis and clinical findings. Response to treatment was recorded using the Sino-Nasal Outcome Test 22 and changes in graded clinical examination findings.

Data for 770 patients were prospectively entered into the database. Patients were grouped diagnostically as follows: rhinitis (20.4 per cent), chronic rhinosinusitis (12.2 per cent), chronic rhinosinusitis with polyps (24.7 per cent), anatomical anomaly (22.7 per cent), epistaxis (3.4 per cent) and ‘other’ (18.4 per cent). Following initial medical intervention, the greatest improvement in the Sino-Nasal Outcome Test 22 score was seen in the chronic rhinosinusitis with polyps group (−11.3), followed by the rhinitis group (−6.1) and the chronic rhinosinusitis group (−5.4).

The tested rhinology database provides a simple, effective and practical tool for integrating the recording of clinical and patient-reported outcome measures during the out-patient visit. It enables characterisation of the patient population, and accurately monitors and records treatment responses.