Introduction  Transnasal esophagoscopy (TNE) is a widely used tool both in the diagnosis and treatment of patients presenting complaints within the head and the neck. This is because this investigative adjunct examination provides the advantage of visualizing above the level of the cricopharyngeus muscle when compared to the more widely used esophagogastroduodenoscopy (EGD). Objectives  We have assessed if the implementation of TNE within a district general hospital (DGH) was feasible, and investigated if the resources of our patients could be better directed away from other investigations such as barium swallow and EGD in favor of this novel technique. The TNE technique has been largely applied in central teaching hospitals within the United Kingdom, but there are still no published reports of a DGH investigating its applicability in this smaller-sized clinical environment. Method  We have analyzed our theater database to find all the patients who had undergone TNE, and recorded their reason for presenting, the preceding investigations, and the procedural findings. Results  In most cases, the TNE was conducted without technical issues, and we were able to identify positive findings in 43% of the patients who underwent Esophagogastroduodenoscopy (EGD). We were able to treat patients successfully during the investigation when a cricopharyngeal stricture or narrowing was found. A normal EGD did not preclude further investigations with TNE. All but one of our patients were treated as day-case procedures. Conclusion  Transnasal esophagoscopy can be successfully delivered within a DGH. A previous EGD does not mean that the TNE will not reveal positive findings due to its superior visualization of the pharynx and the upper esophagus.

Introduction: Endoscopic staple-assisted diverticulostomy (ESD) is generally accepted as the preferred treatment option for patients with Zenker’s diverticulum (ZD). However, anatomical factors may preclude the use of ESD in certain patients. In recent years, the harmonicscalpel has been introduced as an alternative device for endoscopic management of ZD, which may be useful in certain cases where diverticulum anatomy prevents the use of ESD. This review aims to assess the efficacy and safety of endoscopic ZD-repair using the harmonic-scalpel, including comparative analysis of the harmonic and staple assisted approaches in terms of their surgical outcomes. Conclusion: Most studies support the use of the harmonic-scalpel as a safe and effective treatment option for ZD. Although the harmonic-assisted technique may not replace ESD as the initial treatment of choice for ZD, it may serve as a useful adjunct to treatment in selected cases. However, given the low quality of evidence and concerns regarding treatment complications, large prospective randomised trials comparing the harmonic and staple-assisted techniques are necessary in order to determine whether the harmonic-scalpel is truly a viable option for endoscopic ZD-management.

* NICE recommend that children with persistent bilateral otitis media with effusion (OME) documented over a 3-month period and associated hearing impairment should be considered for surgical intervention. * Treatment of OME often requires repeated tubulation of the tympanic membrane if the grommets are extruded before the disease of the middle ear has remitted. * Triune tubes appear to remain in situ and functional for longer than the standard ventilation tubes. * Use of triune grommets may reduce need for repeated tubulation of the tympanic membrane. * Complications from infection or recurrent effusion were similar, regardless of type of grommet used. Key points • NICE recommend that children with persistent bilateral otitis media with effusion (OME) documented over a 3-month period and associated hearing impairment should be considered for surgical intervention. • Treatment of OME often requires repeated tubulation of the tympanic membrane if the grommets are extruded before the disease of the middle ear has remitted. • Triune tubes appear to remain in situ and functional for longer than the standard ventilation tubes. • Use of triune grommets may reduce need for repeated tubulation of the tympanic membrane. • Complications from infection or recurrent effusion were similar, regardless of type of grommet used.