Ear magnetic discs to prevent cauliflower ear: a case gone wrong.

We present a case of pinna pressure necrosis secondary to the use of ear magnetic discs, used in the management of auricular haematoma. A man in his 20s sustained a left auricular haematoma while wrestling. His coach aspirated the haematoma and advised the use of commercially available compression magnets on either side of the pinna to prevent haematoma reaccumulation. 5 days later, he presented to accident and emergency with left ear pain and swelling. Perichondritis was evident on examination and the compression magnets were removed to reveal significant pressure necrosis of the pinna. The skin underlying the placement of magnets (both anteriorly and posteriorly) was black and necrosed, with erosion of the underlying cartilage. In addition to this, the haematoma had reaccumulated in the surrounding pinna. The haematoma was drained via an incision, and pressure dressing applied with dental rolls. The patient was given a course of oral antibiotics to manage the perichondritis. He was reviewed regularly in the ear, nose and throat emergency clinic to monitor wound healing. 3 months later, he was reviewed in the otology clinic; there was persistent helical rim deformity, and delayed cartilage augmentation was advised.This case highlights the importance of prompt and effective management of auricular haematoma, to prevent long-term deformity. Commercially available pinna magnets for auricular haematoma should be used with caution, and patients should be counselled as such.

The Implementation of Virtual Clinical Skills Teaching in Improving Procedural Confidence in ENT Trainees.

PURPOSE: Medical education has faced new challenges with the recent coronavirus pandemic. Traditional teaching methods for face-to-face learning have shifted towards the delivery of digital teaching. The difficulty arises in specialties, such as otorhinolaryngology, where clinical procedural skills are necessary for diagnosis and management. This article aims to determine the impact of a clinical skills video on the confidence of postgraduate ENT trainees when managing nasal fractures. PATIENTS AND METHODS: Postgraduate ENT trainees completed a baseline questionnaire, declaring their subjective confidence across 5 domains relating to nasal fractures using a 10-point Likert scale. They were then given a lecture, and this questionnaire was repeated. Lastly, trainees were shown a clinical skills video, and the questionnaire was repeated once more. The qualitative data was analysed using Kruskal-Wallis testing. RESULTS: There was poor overall confidence in the management of nasal fractures prior to focused teaching. There was a marked statistically significant (P < 0.01) improvement in subjective confidence following the lecture intervention. There was further statistically significant improvement across all domains following the introduction of the clinical skills video. CONCLUSION: This study confirms that clinical skills videos are a useful accessible learning tool in medical education. We advocate their use in the postgraduate setting, to mirror their current use in undergraduate medical education.

IJV thrombophlebitis: be wary of the occult.

A 43-year-old woman was referred to the Ear, Nose and Throat Department with a 3-day history of left-sided neck pain and swelling associated with fevers and night sweats. She also reported a cough, oral thrush and a dental extraction more than a month previously. A CT scan of the neck with contrast revealed left internal jugular vein (IJV) thrombophlebitis and the patient was initially managed for suspected Lemierre's syndrome. Subsequent investigations revealed a locally advanced metastatic colorectal adenocarcinoma as the cause of her thrombosis, which was deemed inoperable. The patient was referred to oncology and commenced on palliative chemotherapy.The incidence of thrombophlebitis in patients with cancer is high. Although the IJV is a relatively uncommon site of thrombus formation, IJV thrombophlebitis is associated with significant morbidity and mortality. As it may be the first manifestation of an occult malignancy, a neoplastic cause should always be considered.

An unusual headache: sphenoiditis in children and adolescents.

Sphenoid sinus infection is a rare cause of headaches in children and adolescents. Its symptoms are often non-specific and confusing. The diagnosis is made on the history, examination, nasendoscopy, cultures and CT or MRI. Prompt and aggressive medical treatment in the form of parenteral antibiotics and nasal decongestants is advised to reduce the risk of serious complications such as permanent cranial neuropathies or intracranial spread. Surgical intervention is advocated when symptoms persist or complications develop. Although sphenoiditis is potentially devastating, early collaboration between pediatric medical and ENT surgical teams generally leads to an excellent outcome. This article presents three cases of adolescent sphenoid sinus infection, and reviews the literature on this uncommon condition.