Vol. 30, No 2 Summer 2020

Professor B. Nirmal Kumar President, ENT UK

From the President’s Desk The world Before Covid (BC) seems like halcyon days, but this was before we understood why hindsight is 20/20. It is certainly easier to know the right thing to do after something has happened but none of us could have predicted the storm in which we now find ourselves. Our specialty sadly bore the brunt in the early days but I can say that we worked together to ensure that all of us were fully protected before Public Health England agreed and endorsed our requirement for safety when performing aerosol generating procedures (AGP). AGP and PPE are acronyms I barely knew BC, but we have all come to understand and use these without second thought in these weeks that have flown by in a blur. The co-operation of colleagues working together whether as Executives and Trustees, office staff at ENT UK or our larger body of council members, AOT, and sub-specialty councils has been phenomenal, and I am extremely grateful to all for this help.

The guidance we produced in quick time and updated regularly have been useful not only throughout the UK but also in many countries of the world where they have adapted our guidance for local use. This has been the most heart-warming feature of my Presidency where we have come together to help each other, to serve our patients better but also supported other colleagues such as anaesthetists, plastic and oral surgeons in ensuring safety and optimum patient care. The dynamism of our young colleagues on the frontline has been inspiring and the very epitome of the best the NHS has to offer. Many of you have been active in COVID-19 specific audit and research and this has led to many peer reviewed publications in addition to starring roles in the media, both nationally and internationally! Please keep our team informed of all happenings so that we can publicise these.

We have sought to protect vulnerable individuals in certain groups of patients but also in ensuring that we work with colleagues in other allied professional bodies for the common good. Many colleagues led by our exit tsar, Ram Moorthy are working hard on important

ENT UK Newsletter 1

ENT UK, with Nirmal Kumar at the helm, has done a vast amount of work to keep colleagues and patients as safe as possible during the COVID-19 pandemic.

In this newsletter we look to the future, with updates from our ENT UK President, Education Chair, SAC Chair, and Sub-Specialty Societies.

BACO, the UK’s biggest ENT event, is rescheduled for 10-12 Jan 2021 at the ICC in Birmingham. I hope we will all be there.

Emma StapletonEditor

The Newsletter for ENT Professionals

Contents From the President’s Desk

Clinical Otolaryngology

Education Update

SAC Update

BACO 2021

INTEGRATE Update

Sub-specialty Updates

COVID-19 Registry

Obituaries

Vol. 30, No 2 Summer 2020

documents as we begin a gradual return to "normal" activity within the pandemic. This will help us prioritise clinical services and ensure that we can do so safely without excess harm to our patients and to continue ensuring that we and our patients are protected in doing so. The postponement of BACO to a date in January 2021 was done not only to ensure that we follow government guidelines but also to ensure that we run a successful conference reducing the financial risk while maintaining the academic benefits to the wider ENT community both in the UK and abroad.

I am pleased to welcome new Trustees to ENT UK. Tim Mitchell joins us as medical trustee and is well known to us and also on the council of the RCS England. We have Andrew Foster, CBE joining us as lay trustee and as an ex-CEO of an NHS Trust and currently the interim MD of the NHS Leadership Academy he will bring a completely different perspective to ensure we continue our recent record of improved governance in our function as a charity. They both bring an extra dimension to our Trustee board and a wealth of experience which will be beneficial overall. Other recent appointments include Ms Somiah Siddiq as editor-in-chief of e-lefENT to replace James Tysome, and Dheeraj Karamchandani as chair of SFO UK to replace Jayesh Doshi. Both James and Jayesh did a great job in these roles and I am sure their successors will continue the good work.

The world AC (After Covid) is going to be a completely different place from the one we knew but who is to say that it cannot be a better place than the one we left behind. We may find innovative ways of working that will improve our services and the quality of care we provide for our patients and we may find this a cost-effective and clinically efficient way of working. There is no limitation to the creative mind. I trust you will all enjoy our British summer even if restricted from travelling afar!

Professor B Nirmal Kumar

Clinical Otolaryngology The official journal of ENT UK

Authors may now choose to preprint manuscripts

on Authorea at submission, i.e. before peer review.

COVID-19 research is featured on the Wiley COVID-19 microsite.

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l ink to clin otol

Vol. 30, No 2 Summer 2020

Professor Philippa Tostevin ENT UK Director of Education

Education and Training Update

I am delighted to announce the development of a Community ENT group as a subgroup of the ENT UK Education and Training committee. This new group aims to develop a network of GPs with an extended role in the care of ENT patients and other doctors and healthcare professionals delivering ENT care in the community. If you have colleagues who may be interested in joining please get in touch. I’d like to thank GPwER in ENT, Dr Eason Sivayoham from Manchester for agreeing to work with us to optimise the elefENT materials to the GP curriculum. The new GP and allied healthcare professional day will be Monday 11th Jan 2021.

The ENT UK education team have been able to support the learning and development of medical students at this challenging time. Medical schools have had to deliver online equivalence of clinical placements whilst medical schools are closed, most students have been removed from hospitals and ENT teams are not involved in routine and elective care of patients. It has been an enormous privilege to be allowed to provide the SFO e-book Official Guide for medical students and junior doctors to all medical schools in the UK at no cost via the

Medical Schools Council collaboration. This has led to the incorporation of this ENT UK SFO publication in the core curriculum of many medical schools in the UK and abroad. I am enormously grateful to the e-learning team for facilitating the access to the elefENT virtual learning platform to support the medical students in their ENT studies. We are working on mapping the new GMC medical licensing examination ENT content to the elefENT platform materials so all students will have access to materials for the new national assessment.

We have temporarily suspended advertising the MTI scheme until we are sure that newly appointed doctors will be able to come easily to the UK; immediately pre COVID-19 we appointed three new surgeons via the scheme, to work in Nottingham, Medway and St George’s.

I would like to thank Urmil Chalishazar from the SAS group who has prepared a useful telephone clinic guide for ENT Surgeons and Jayesh Doshi and his colleagues in Birmingham for producing quick reference guides to help trainers get up to speed with changes in training all available on the website.

Mr. Craig Murray Chair, Specialist Advisory Committee in Otolaryngology

SAC Update

The COVID-19 pandemic has resulted in loss of normal ENT clinical and surgical experience. We can only hope that the opportunity to return to at least some version of normality is possible soon. The impact upon training has been widespread across Surgery and Medicine. On that basis the Statutory Educational Bodies (SEB) have been working in association with JCST to establish how to deal with these new and very difficult challenges. I will try and explain some of the recent decisions and also the ongoing changes expected ahead.

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Vol. 30, No 2 Summer 2020

National Selection

Following initial constructive meetings with HEE recruitment we submitted our preferred portfolio based assessment that allowed update of evidence and validation. However Medical and Dental Recruitment and Selection (MDRS) decided assessment to be based upon portfolio without update and validation. MDRS have no flexibility on this. I again request that when the trainees are allocated to their new positions we welcome them wholeheartedly.

ARCP

I would hope that the contents of this message will have been superseded by the dissemination of the JCST / SEB publication relating to ARCP. It is close to completion but requires SEB agreement before release as will apply to all of Medicine and Surgery not just ENT. In summary, ARCP processes will go ahead. However, where there are local pressures, the ARCP process will prioritise those at critical stages in training and those who are on a remedial pathway.

It is also clear that there has been a significant loss of training opportunity and that not everyone will be able to complete the expected evidence required through no fault of their own. To help clarify and manage this scenario, more weight will be given to the Educational Supervisor report. Additionally, a new ARCP outcome (outcome 10) has been devised. This is basically a “no fault” outcome and allows the trainee to move forward into the next year of training or to have time extension where required. Those most affected will be those at CCT where exam is still required and will need extension. It anticipated that where minor deficits exist a well-structured Educational Supervisor report can be taken in lieu of the required documentation. The imminent document is comprehensive and should cover the various possible scenarios.

Examination

We have lost a diet of exams (Intercollegiate and DOHNS). No additional diet has been planned and delays will affect some trainees more than

o t h e r s . T h o s e r e q u i r i n g t o p a s s t h e Intercollegiate FRCS (ORL-HNS) exam for CCT this summer will need to extend their training period. Those on run-through who could not complete MRCS (ENT) will proceed to ST3 using ARCP outcome 10, as long as their progress is otherwise satisfactory. This will avoid a bottleneck, but trainees must pass the exam by end of ST3.

Curriculum

This has finally been accepted by the GMC. As I expected, they have not supported the inclusion of learning opportunities (e.g. temporal bone course, FESS course) in the curriculum. I am disappointed with regards to this but would ask that learning opportunities are well defined by the TPD and ES at start of each rotation to ensure funding and support. The start date for the new curriculum has now been deferred due to impact of COVID-19 and will be August 2021.

Final remarks

I once again thank you all for your patience and understanding at this time. Decisions have been made that have been outwith our control, that you may well disagree with. Equally well some of the decisions made, to allow trainees to progress through training, will work well. However, we need to accept that we are in challenging times and the decisions made, like all of the COVID response, are based upon worse case scenario. This hopefully seems to have been averted and I hope for continuing improvement as the weeks pass. It will be good to return back to some form of normal working in the specialty we enjoy. At this time the priority is ensuring the health of the population and making sure you keep yourself safe.

I would like to personally thank Professor Kumar and the ENT UK team who have been proactive in ensuring that we, as ENT Surgeons, have access to the necessary advice to manage our patients and keep ourselves safe. They have risen well to the challenge.

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Vol. 30, No 2 Summer 2020

Miss Catherine Spinou BACO Treasurer, Secretary and Project Lead

BACO 2020-21

We were all ready. We have been working on this for the last two years non-stop. This was going to be an amazing BACO, full of international guests, delegates, plenary speakers, awards and social events. And it was going to be July. BACO has always been in July. Then the news of COVID-19 started coming through and we became more and more anxious. As more information became available it was clear to all of the Executive Committee of BACO that we could not risk the safety of so many colleagues and staff. And we took the decision early on to postpone BACO 2020. It was the right thing to do.

So we now have for the first time ever a BACO in January. We have been lucky and we are grateful. The Birmingham ICC is still our venue, our colleagues and friends in the American Academy of Otolaryngology Head and Neck

Surgery are collaborating with us, and our national and international speakers have committed to BACO in January 2021.

This will be a different one. No strolling into the ICC into the morning sun, no late evening walks across the canals of Birmingham. This will be a BACO to bring us all together after the difficult times we all went through during the pandemic, after the winter holidays and hopefully when some kind of normality has come back to our lives. This will be the winter event to stimulate scientific discussion, showcase new research, and share best clinical practice. All our focus is on delivering an outstanding scientific event. COVID-19 has changed our world and it remains to be seen what its long-term impact is going to be on our lives. Some things have already changed, some will change more, but hopefully much of life as we know it will slowly resurface. If we learned something, is that we need to be proactive when faced with adversity, and innovate solutions in order to deliver our goals. So we remain committed to providing a stellar event in a safe manner and we will continue to evaluate any emerging guidance on how to do so. And we hope to see you all there.

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'We must make BACO 2021 a very special meeting – a triumph of our specialty over the many adversities imposed by COVID-19. It will be an occasion to celebrate the achievements of so many colleagues whom I have no doubt will have responded magnificently to the greatest public health challenge of our time.’

Professor Gerry O’Donoghue, BACO Master 2021

Vol. 30, No 2 Summer 2020

BACO 2021. The UK’s biggest ENT event.

ICC, Birmingham. 10th -12th Jan 2021

Click here for early bird registrationavailable until 30th Sept 2020

ENT UK Newsletter 6

Prestigious BACO awards to celebrate colleagues nominated and voted by you.

Prominent international speakers and educators; a comprehensive array of talks and sessions. Learn from world experts in ENT and related disciplines. Explore cutting-edge research and

developments. Embracing the theme: Translating Research, Transforming Lives.

An exciting day of events for GPs and allied health professionals.

A dedicated SFO Clinical Skills Day.

Vol. 30, No 2 Summer 2020

Mr. Matthew Smith Chair of INTEGRATE, the UK ENT Trainee Research Network

INTEGRATE ENT UK Update

INTEGRATE has been working to support changes to our practice resulting from the COVID-19 pandemic.

Our ENT UK backed INTEGRATE Emergency Care Audit is recording patient outcomes for those presenting with epistaxis and suspected tonsillitis and quinsy. The COVID-19 pandemic has necessitated new ENT UK guidance and many new local protocols for these patients, to limit risk to the clinician and prevent admission where possible. To ensure patient safety and aid clinical governance, a national audit was developed. The aim is to regularly feedback patient and site-anonymised outcomes to UK ENT surgeons via ENT UK, altering our practice if evidence suggests this is needed. Through collaborative effort, the audit was developed and launched within five days. At the time of writing we have 62 sites registered, with first round data collection on 4th May to allow interim reporting.

We are also supporting the ongoing evaluation of the ENT UK two-week wait telephone triage tool. NHS guidance for managing cancer referrals

during COVID-19 pandemic recommends a telephone triage to minimise face-to-face contact and to stream patients for investigations where appropriate. The triage tool uses a head and neck cancer risk calculator, generated and iteratively validated using data from over 10,000 patients across the UK, along with the results of the INTEGRATE BAHNO surveillance audit. ENT UK recommends the decision-making process while using the tool is recorded, with data submitted to allow the evaluation of this new service which may have implications for the way we work in the post-COVID-19 era.

We continue to receive proposals for COVID-19 re lated s tudies , and we welcome new approaches seeking trainee collaboration to see if INTEGRATE can be of benefit to your project. As well as the COVID-19 related work, we hope to publish the results of the BAHNO head and neck follow up audit soon, and following a successful multidisciplinary Delphi exercise we now have agreed diagnostic criteria and a core outcome set for acute otitis externa, aiming to move on to developing a trial in this area.

ENT UK Newsletter 7

The 6th ENT UK SAS Conference 2021 Wales

Thursday June 24th and Friday June 25thThe Royal Glamorgan Hospital

Ynysmaerdy, Cardiff

I hope you are all keeping well, safe, and looking at the excellent COVID-19 guidelines coming through regularly from ENT UK. Please save the dates for the next meeting, further details to follow.

Mr. Shyam Singam Chair of ENT UK SAS Group

Vol. 30, No 2 Summer 2020

Mr. Hesham Saleh President, British Society of Facial Plastic Surgeons

BSFPS Update

I never imagined I would be writing my last newsletter as President of BSFPS amidst a global pandemic that has caused devastating effects in our country and many others. I hope that all our members and their families are safe, our thoughts are with those who have been affected. Many of our colleagues have been redeployed, and most have been directly or indirectly involved in managing COVID-19 in one way or another.

On 11th of March, during the third and last day of the BSFPS Facial Aesthetic Cadaveric Training in Manchester, the BSFPS council took the decision to postpone our annual meeting in Glasgow from the 27th of March to the 7th of December. On the following day, the World Health Organization (WHO) officially announced that COVID-19 outbreak is a pandemic, and 11 days later Prime Minister Boris Johnson declared a UK lockdown.

Weeks later, we have learnt many things from this crisis, crucially that in our speciality we are highly vulnerable to viral infections because of an abundance of aerosol generating procedures, especially from the nose. We have to adapt to a new future with major modifications in the way we handle outpatient clinics and operating

sessions. ENT UK has been working extensively on this, and the BSFPS, as representative of Facial Plastic and Reconstructive Surgery in the UK, have been in continuous discussions regarding the way forward for our subspecialty. Similarly, in my current position as president of the European Academy of Facial Plastic Surgery (EAFPS), I have formed a European task force to specifically look into this and formulated guidelines with the prime goal of safety for the surgeon and the patient. These have been published in Facial Plastic Surgery & Aesthetic Medicine Journal (FPSAM). Some of our European colleagues are already restarting their routine work, and we will certainly learn from their experience.

On a different note, the BSFPS is proud to continue working on developing our subspecialty and representing our members in various endeavours. The Intercollegiate Cosmetic Surgery Oversight Committee has been formed as a cross specialty Committee to oversee the future operation, quality assurance and development of the Cosmet ic Surgery Certification Scheme and any subsequent GMC credential. As President of BSFPS, I am a member of this committee. To assess the scope of facial plastic surgery in ENT and support our members in future certification, many of you responded to a six-item questionnaire that we disseminated at the beginning of the year. The results represent an interesting snapshot of the wide variety of procedures performed by the respondents and will serve as a guide to the certification process. The results are available for you to see on the BSFPS section of the ENT UK website.

I do hope that we all continue to be safe and healthy and will never face a similar crisis again! I am looking forward to the new Presidency in the capable hands of Peter Andrews, who will undoubtedly take the BSFPS to the next level.

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Faculty and delegates of the BSFPS Facial Aesthetic Cadaveric Training Course

Manchester 9-11 March 2020

Vol. 30, No 2 Summer 2020

Professor Claire Hopkins President, British Rhinological Society

BRS Update

The last newsletter feels like it was written in a different lifetime, and certainly a very different world. It's been a very busy few months for the BRS since. Our statement on the link between COVID-19 and anosmia, literally went viral and travelled round the  world  as quickly as its inspiration, prompting a series of newspaper and magazine articles from the NYTimes to Esquire, and subsequently a flurry of peer-reviewed publications. We now have strong evidence that loss of sense of smell (and/or taste) is, in fact, one of the most common symptoms of COVID-19 infection, and a very good predictor of a positive RT-PCR result. It has been adopted as a marker of infection in the US, France, Switzerland and other countries. Although the UK are lagging behind, I am working closely with PHE and hope to have good news in the very near future. In the meantime, I have heard from hundreds of patients who have followed our advice to self-isolate, an example of which is copied at the end of the letter, with permission. I have also received many messages from patients who are very grateful for the advice sheet made available on the ENTUK website, which will be updated shortly with the results of a consensus statement issued by the BRS Council.  We have contributed to many of the ENT UK guidelines, and now are tackling guidance to support return towards elective practice; this is particularly challenging in rhinology, where almost all new referrals would normally undergo endoscopy and surgery, in an area of high viral load and often using powered instruments, which is a 'high-risk AGP' in terms of virus transmission.   Thinking ahead to better times, we decided against finding a new date for the BRS meeting this year (a decision which seems increasingly a

wise choice as the weeks go by) but have been able to carry over deposits until next year, minimising any financial losses to the society. We will instead have a 'Bumper BRS' over two days, with a (not very, probably still at a distance) 'social' event on the Thursday night. I imagine handshakes and a kiss on the cheek will be strictly prohibited, but hopefully a medicinal gin and tonic will not be.   So I leave you with one of the very lovely emails I've received on your behalf, and I'm delighted that we have been able to make a small but important difference in the global fight against COVID-19.   "Thank you for publishing your concerns regarding post viral anosmia. My son is 23 years old. He is a respiratory physio in hospital, working with COVID-19 on the wards and in ICU.  He had a bit of a cold last Sunday/Monday, which he put down to hayfever, so took antihistamine. On Tuesday those symptoms had gone, but he had a profound loss of taste and smell.  This rang alarm bells, so he rang 111 in order to try and get a test as he works for the NHS. He was told to carry on as normal 'as he doesn't have any COVID-19 symptoms.’ He immediately called his boss at the hospital who arranged a test, which is positive.  He has not felt at all unwell since and at no point would his symptoms have prevented him from working.  His sense of taste is slowly returning, but smell is still absent. Five of us live in our family home. In addition to my son working in hospital with elderly patients, my daughter is a children's ICU nurse.  I am a Podiatrist, seeing only a tiny number of patients at the moment, all of whom fall into vulnerable groups. I am grateful to you for formally raising this issue.  In our family alone, you have helped us to prevent the spread of this virus to some of the most vulnerable patients we all see."

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Vol. 30, No 2 Summer 2020

Mr. Michael Wareing British Society of Otology

BSO Update

The BSO committee has been busy working with ENT UK and colleagues across sub-specialties, developing guidelines for our practice during COVID-19. This culminated recently with a Zoom council meeting reflecting the new normal we are all operating under. We have published guidance for undertaking otological procedures during the pandemic, and further guidelines for surgical prioritisation which can be viewed on the ENT UK website. We have also contributed to the development of required PPE in collaboration with the rest of ENT UK. It this been a real team effort, and we pay tribute to Nirmal and his team who have worked so hard and so effectively at this time. We are now looking at guidelines for practice in the future and balancing the needs of patients and protection of staff. We are all building up a backlog of non COVID-19 pathology that will need managing and we will need to consider how our practice is going to change, as it will have to, in the months and perhaps years ahead. A good example is provided on the otology section of the ENT UK COVID-19 guidelines by Will Hellier and colleagues who describe a novel draping method to reduce vapour and bone dust exposure during mastoid surgery.

Although COVID-19 infections appear to be causing greater rhinological and head and neck pathologies, BSO have still taken the opportunity to explore potential associations between COVID-19 infection and otologic disease, and how it affects our practice. A number of research projects are being worked on and we will update you soon. We know that some aspects of otological disease will be impacted by COVID-19 although we are as yet to see a clear pattern emerging and it may well be that the main thrust will be minimising the risk of transmission through otologic interventions. Ongoing issues that continue to be explored include gentamicin induced vestibular damage and ototoxicity of commonly prescribed ear drops. On a happier note looking forward, Manohar Bance is busy organising the BSO Balance Course and the AGM which will be held in Cambridge in the Spring of 2021 (hopefully 22-23 March). We are planning it for a little later in the new year than usual in part so we can enjoy some punting in Cambridge and also so it is not too close to the rescheduled BACO meeting in January. Looking even further ahead we are hoping to visit the newly redeveloped English College in Lincoln’s Inn Fields in 2022.

ENT UK Newsletter 10

Royal Society of Medicine 12th National Temporal Bone Competition

Fri 25th Sept 2020, Addenbrookes Hospital, Cambridge

1st place: £500 and a place on the Addenbrookes Advanced Temporal Bone Course. 2nd place: £200

Free entry for RSM members, £150 fee for non members For details, contact Elinor Warner

Vol. 30, No 2 Summer 2020

Ms. Kate Stephenson Consultant Otolaryngologist, Birmingham Childrens Hospital

ENT UK COVID-19 Registry

We are now in a position to broadly evaluate and report the first results of the ENT UK COVID-19 registry including clinicians confirmed or suspected to have had COVID-19. This aims to inform and assist guidance, PPE and service planning. International collaboration, linking to an international ENT COVID-19 registry, is also intended. This voluntary registry opened on 3rd April and now includes data for a total of 54 individuals. The range of sub-specialities are represented and 20% of respondents were trainees. Respondents ranged in age from 25 to 65 (median 50.5 years). Thirteen percent of affected ENTs were from London whilst the remainder were widely spread across the UK.

Reported symptom onset ranged between 10th March and 19th April 2020. COVID-19 was confirmed by testing in 46%. There was a need for hospitalisation in one of the 54 cases. No individuals requiring intensive care and no cases of mortality have been registered to date. The ENT community is however sadly aware of one confirmed fatality related to COVID-19.

Around 57% of respondents thought their likely source of exposure was inside the workplace whilst 15% thought it was outside of work. In 28% of cases the likely source was unknown. In comments made relating to a likely workplace source, a common theme was the lack of or partial use of PPE - often in an outpatient setting – before formal PPE guidance. ENT UK PPE guidance was published on 16th March and expanded on 20th March whilst updated Public Health England guidance followed on 2nd April. A correlation between COVID-19 incidence and PPE measures may be reflected in the registry data, when accounting for the incubation period; symptom onset peaked within March and no confirmed cases of COVID-19 have been registered since 11th April.

The registry remains open. If you have had suspected or confirmed COVID-19, please consider completing the survey. It is open to members and non-members of ENT UK, is voluntary and can be anonymous. Further analysis and reporting is planned.

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Illustrative map of reported case distribution

Vol. 30, No 2 Summer 2020

Obituary: David Moffat

David Moffat, one of the leading Otologists of his generation died on March18th in Addenbrooke’s hospital in Cambridge, the hospital to which had devoted his professional life. Having survived cancer of the prostate, he succumbed to a second pulmonary primary. He was 72 years old.

David was born in Wales of Celtic stock. His mother was Welsh and his father Scottish. His family moved to London from Glasgow when he was nine years old and he went to school in Northwood. He studied medicine at the London Hospital, where he graduated MBBS in 1971, having been awarded a BSc in Biochemistry along the way. David developed his interest in Otology and Neurotology, as a registrar at the London Hospital inspired by his mentor Andrew Morrison, then Britain’s leading acoustic neuroma surgeon. On completion of his training he spent six months with Mansfield Smith in Palo Alto, and this was the start of a great affection for America, its medicine and an ever-increasing circle of friends in that country.

He was appointed to Addenbrooke’s in 1980 and set about creating one of the world’s finest centres for neuro-otology and skull base Surgery. In col laborat ion wi th h is neurosurgery colleagues, David Hardy and Robert Mcfarlane he built up a large acoustic neuroma and skull base practice, with referrals from throughout the UK

and abroad. In all he operated on 1,800 skullbase cases of which 1200 were acoustic neuromas. His survival figures for carcinoma of the petrous bone were the best recorded. He had a lifelong interest in Ménière’s disease going back to electrophysiogical studies he performed as a registrar with Bill Gibson. He was also an accomplished middle ear surgeon and studied the evolution of cholesteatoma through the temporal bone.

He published widely in the peer-reviewed literature with some 250 papers and 30 chapters. He travelled extensively and was in great demand as a lecturer. His lectures were always beautifully prepared and illustrated, and before the days of Powerpoint he was often to be seen staggering through airports weighed down by cases of carousels of slides. He taught on numerous ear surgery courses and was a founding member of the Combined Univers i t ies Course. He particularly enjoyed his annual trip to Nijmegen, not least because the University awarded him his PhD for his work on tumours of the lateral skull base. He was the recipient of many awards, of which the most prestigious was the House- Hitselberger Lifetime Achievement Award.

He served the specialty conscientiously. He was President of the Section of Otology at the RSM, Master of BACO, Member of the SAC, and Chairman of the Intercollegiate Faculty Board. He was awarded the IFOS Gold Medal for his contributions to Otolaryngology.

These achievements say nothing about David the man. He was the most charming person, amusing, at times self-deprecatingly so, and he valued friendship above all. He was admired by the many Fellows he trained and whom he regarded almost as an extension of his family. He was a compulsive skier and golfer, loved fast cars and good wine, but most of all he was a family man, whose wife Jane, his children, Simon, Claire and Mark and his seven grandchildren were the centre of his life.

Richard Ramsden

ENT UK Newsletter 12

Vol. 30, No 2 Summer 2020

Obituary: Amged El-Hawrani

The tragic death of Consultant ENT Surgeon Amged El-Hawrani from COVID-19 Coronavirus was a devastating blow to his family, colleagues and the wider ENT community. It became evident during the pandemic that ENT doctors were at particular risk of COVID-19 infection. Amged died on 28th March 2020 age 55, after a traumatic three weeks in critical care. He was considered by the NHS to be one of the first UK frontline doctors to die during the pandemic.

Amged was born in Sudan in 1964, the son of a doctor and the second of six boys. The El-Hawrani family moved to the UK in 1975 and finally settled in Bristol in 1979. Amged obtained his medical degree from the University of Ireland in 1993. His specialist ENT training was on the East of Scotland rotation and he greatly enjoyed clinical fellowships in Inverness and Paediatric Otolaryngology in Edmonton, Canada. This was followed by his appointment to a consultant post at Queen ’s Hospi ta l , Burton on Trent , Staffordshire in 2006.

Apart from paediatrics, Amged developed a special interest in Head and Neck surgery, Thyroid surgery and skin cancer. He was well respected by his colleagues and had a reputation

for a very high work load. Recently he had taken on the role of Associate Clinical Director for the ENT Department which stretched him even further, but without complaint. He cared deeply about his patients and always strived to do the best for them. He was very popular around the hospital with a rare skill to engage and talk to people of all ranks and backgrounds. He had time for everyone. He was full of energy with an excellent memory for detail, yet sometimes had an endearing flight of thought and scattered malapropisms to his colleagues’ amusement.

He had a particularly good reputation as a clinical teacher. Juniors enjoyed and looked forward to theatre lists with him. He was exceptionally patient when supervising young registrars, guiding and helping them through the steps of surgical procedures. Most are now consultants themselves and they remember Amged with enormous gratitude and affection.

Amged was devoted to his family and particularly enjoyed summer holidays in Florida with his wife Pam and son Ashraf. It was a privilege to work with him and he will be sorely missed by all that knew him.

Adrian Thompson

ENT UK Newsletter 13

Vol. 30, No 2 Summer 2020

AOT have continued to support and represent the body of trainees in Otolaryngology since the changes brought on by the COVID-19 pandemic. The first change is the postponement of the annual conference to 2021, and will be hosted at the Oxford deanery. Dates will be announced in due course, once the exam dates are known. Under the excellent leadership of Prof. Nirmal Kumar, timely and supportive guidelines from ENT UK have benefitted trainees and trainers alike. AOT have continued to support  trainees and encouraged engagement with the guidance.

We will continue to support and update trainees regarding any updates regarding exam diets. In addition we welcomed the update from the SAC regarding the sensible postponement of the introduction of the new curriculum until August 2021. AOT plan to continue to work with the SAC, ENT UK and consultant colleagues when this key transition does take place.

There has been an impressive effort from trainers and trainees alike in response to the epidemic with initiatives for remote learning and shared resources. AOT have the privilege to work with NAPDENT, and others to make these resources available, for free, to trainees, via our webpage and AOT’s YouTube channel. Please contact us to discuss any other events or innovations that may be suitable for our webpage or calendar. We also encourage trainees to make use of the ElefENT platform from ENT UK.

We recognise that as the pandemic continues to be managed, training will be a priority after patient care and establishment of the “new normal” of ENT practice. AOT are proud to be working alongside ENT UK, and the subspecialty bodies, to support all efforts in relation to this.

ENT UK Newsletter 14

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Newsletter Editor:

Miss Emma StapletonConsultant OtolaryngologistManchester Royal Infirmary

Email: emma.stapleton@mft.nhs.uk

Address: ENT UK

The Royal College of Surgeons35-43 Lincoln's Inn Fields

London, WC2A 3PE

The views expressed

in the ENT UK Newsletter are not necessarily the views of

ENT UK as an organisation, but rather the views of individual contributors

Expressions of interest invitedfor the position of

ENT UK NewsletterAssistant Editor

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