One in five people in the UK are deaf, with hearing loss affecting more than 70% of people over the age of 70. Despite this being a higher prevalence than asthma, heart disease or diabetes, deaf people experience persistent health inequalities with poorer experiences and outcomes in disease prevention and management. Clear communication and patient engagement with health are key to better outcomes. Nonetheless, there exist cultural, educational and organisational barriers when addressing communication with patients with hearing loss. Foundation doctors have regular and prolonged contact with their patients, and often feel underprepared when interacting with patients with hearing loss. This article aims to highlight these communication barriers and suggest changes for improvement.Improvement will require adaptations from both individual and organisational perspectives, with patient care as a clear focus for change.

Dyskeratosis congenita is a rare condition; however, it is vital to recognise the increased risk of upper aerodigestive tract cancers in these patients. Management of such cancers can be particularly difficult in view of the need to avoid DNA-damaging therapies such as radiotherapy.

Spontaneous cervical lymphocoeles are extremely rare. Their surgical management can pose many challenges with the lack of clear surgical planes potentiating risks. We present the case of a patient with an extensive right-sided cervical lymphocoele. Surgical excision would have involved extensive surgery with risk to the great vessels and lungs. We describe the successful use of talc sclerotherapy in the management of this patient, who made a rapid post-operative recovery with no evidence of recurrence on follow-up. Talc sclerotherapy may be used successfully in the management of patients with cervical lymphocoeles, obviating the need for high risk surgical procedures.Lymphocoeles are subcutaneous lymphatic accumulations lined by an endothelial sac. Primary spontaneous cervical lymphocoeles are extremely rare, the acquired variety occurring more frequently, usually in the context of a traumatic or iatrogenic aetiology.1 They are also predominantly left sided. The exact pathophysiology is elusive. However, there are suggestions that the spontaneous types are a result of congenital weakness.2 The clinical presentation is usually of a fluctuant, asymptomatic cystic swelling of the neck in otherwise healthy individuals. 2 We present the case of a patient with a large complicated spontaneous cervical lymphocoele treated with talc sclerotherapy. Case historyA 35-year-old man was referred to the ear, nose and throat (ENT) clinic with a 12-month history of a right-sided neck lump. There were no other upper aerodigestive tract symptoms. The patient was otherwise fit and well with no other co-morbidities.Examination revealed a large non-tender fluctuant right-sided neck mass in the right supraclavicular region extending below the clavicle (Fig 1). It was not possible to determine the lower extent of the mass. The rest of the ENT examination including the upper aerodigestive tract was normal.Fine needle aspiration revealed a straw coloured aspirate mainly consisting of mature lymphocytes, raising the suspicion of a lymphocoele. Gadolinium enhanced magnetic resonance imaging showed a large unilocular mass lesion, deep to the sternocleidomastoid and extending below the clavicle, inserted between the subclavian vessels without distorting them. The working diagnosis was that of a spontaneous cervical lymphocoele. Surgical excision would involve a combined ENT/cardiothoracic approach, with access to the lower end facilitated by disarticulating the clavicle from the sternum to aid safe dissection from the great vessels. This would carry the risk of significant morbidity. The alternative option would be sclerotherapy. Following a consensus discussion, the plan was to manage this case with sclerotherapy.

The RHINO-ooze scoring tool demonstrates good specificity and sensitivity in predicting the risk of 30 day readmission in patients with epistaxis and can be used as an adjunct to clinical decision making with regards to timing of operative intervention in order to reduce readmission rates.

This review examines the latest evidence for photodynamic therapy (PDT) in treating chronic rhinosinusitis. MedLine, EMBASE and TRIP Database searches were conducted using the terms: "photodynamic" or "phototherapy" or "photo" and "sinusitis" or "rhinosinusitis," date range January 2000 to May 2020. A total of 192 records were initially identified, after duplicates and exclusions, 9 full papers and 3 abstracts were included. All study types including in-vitro, animal and human studies were evaluated. Whilst there is in-vitro evidence for the efficacy of PDT's bactericidal effect on drug resistant bacteria and biofilm viability, there are few clinical studies. PDT is a promising area of research, but larger, focused studies looking at the safety, delivery, efficacy, and patient selection are required before it can be considered a viable treatment for CRS.