Introduction: Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. Congenital NLDO is usually conservatively management in the first year of life, failing which surgical interventions such as syringing and probing (S&P), insertion of stents (intubation) or dacryocystorhinostomy (DCR) are offered in a stepwise manner. Methods: This is a retrospective study at a tertiary paediatric hospital. Nasolacrimal surgeries were retrieved from Hospital Episodes Statistics (HES) data for a 5-year period between May 2017 to April 2022. Retrospective case note review was undertaken looking into demographics, presentation, surgical interventions, and outcomes (resolved, partially resolved or persistent). Results: In our institution, NLDO surgeries are performed on a joint ophthalmology/ENT list. A total of 301 procedures were performed on 218 patients (293 eyes). Causes for epiphora were Congenital NLDO (n=193, 88.5%), Secondary NLDO (n=10, 4.6%), Dacryocystitis/Mucocele (n=8, 3.67%) among others. Median age at first procedure was 26 months (range 2-189). Median number of procedures for congenital NLDO is 1(range 1-5). Complete resolution of symptoms was achieved by syringing and probing in 133 cases (73%), intubation in 23 cases (78%) and DCR in 7 cases(58.3%). Patients with craniofacial syndromes required a statistically significant higher number of DCRs. Overall, epiphora was completed resolved in 81% cases, 6.3% partially resolved and is persistent in 12.7%. Conclusion: Multi-disciplinary approach to NLDO ensured efficient delivery of care by minimising number of procedures and hospital attendance. Congenital NLDO can be successfully treated in vast majority of cases with S&P and intubation. In cases with anatomical abnormalities, DCR should be considered early.

Objectives: To evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. Design: Retrospective cohort study. Setting: A single paediatric tertiary unit. Participants: Patients younger than 18 years with radiologically confirmed intracranial abscess including subdural empyema (SDE), epidural (EDA) or intraparenchymal (IPA) abscess secondary to sinusitis. Main outcome measures: The rates of return to theatre, the length of hospital stay (LOS), death <90 days and neurological disability (ND) at 6 months. Results: A cohort of 39 consecutive patients (41% male, mean age 11.5) presenting between 2000-2020 were eligible for inclusion. SDE was the most common intracranial complication (n=25, 64%) followed by EDA (n=12, 31%) and IPA (n=7, 18%). The mean LOS was 42 days (SD 16). Sixteen patients (41%) were managed with combined ENT and neurosurgical interventions, 15 (38.5%) underwent ENT procedure alone and 4 (10.3%) had neurosurgical only drainage. Four patients initially underwent non-operative management. The rates of return to theatre, ND and 90-day mortality were 19 (48.7%), 9 (23.1%) and 3 (7.7%) respectively and were comparable across the four treatment arms. In the univariate logistic regression, only the size of an intracranial abscess (10mm) was found be associated with an increased likelihood of return to theatre (odds radio 7, confidence interval 1.09-45.1), while combined ENT and neurosurgical intervention did not result in improved outcomes. Conclusion: Sinogenic intracranial abscesses are associated with a significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.

Background Coronavirus disease 2019(Covid-19) Personal Protective Equipment (PPE) has been reported to effect communication in healthcare settings. We sought to identify those challenges experimentally. Method Bamford-Kowal-Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for speech intelligibility with and without PPE both at normal speech and raised voice. Results There was a significant difference in speech discrimination scores between normal and PPE wearing subjects in theatre simulated background noise levels (70dB). Conclusion PPE wearing can impact communication and efforts should be made to remind staff about this burden and seek alternative communication paradigms, particularly in theatre environments.

Objectives: To assess droplet splatter around the surgical field and surgeon during simulated Coblation tonsil surgery to better inform on mitigation strategies and evaluate choice of personal protective equipment. Design: Observational study Setting: Operation theatre suite at a tertiary hospital Participants: Life size head model was used to simulate tonsil surgery using fluorescein-soaked strawberries to mimic tonsils Main outcome measures: The Coblation wand was activated over the strawberries for 5 minutes. This was repeated 5 times with 2 surgeons (total of 10 data sets). The presence of droplet around the surgical field and anatomical subsites on the surgeon was assessed in binary fashion: present or not present. The results were collated as frequency of droplet detection and illustrated as a heatmap; 0 = white, 1-2 = yellow, 3-4 = orange and 5 = red. Results: Fluorescein droplets were detected in all four quadrants of the surgical field. The frequency of splatter was greatest in the upper (nearest to surgeon) and lower quadrants. There were detectable splatter droplets on the surgeon; most frequently occurring on the hands followed by the forearm. Droplets were also detected on the visor, neck, and chest albeit less frequently. However, none were detected on the upper arms. Conclusion: Droplet splatter can be detected in the immediate surgical field as well as on the surgeon. Although wearing a face visor does not prevent splatter on the surgical mask or around the eyes, it should be considered when undertaking tonsil surgery as well as a properly fitted goggle.