The BAPO Bulletin

A Message from Mike Saunders

Bristol Children’s Hospital, President BAPO 2021-2023

Dear BAPO members

It has been a strange first year to my BAPO presidency and it was a great shame to have to cancel last years meeting. We are all very much looking forward to meeting face to face in September, particularly having a two day meeting for the first time in BAPOs history. 

The pandemic has been one of the most significant events in many of our memories. It has been painful and at times tragic. However, out of adversity often springs innovation and progress. Although by now most of us are probably sick of ZoomTeams and Webex meetings, at the height of lockdown these platforms allowed us to keep communicating and keep teaching and sharing knowledge. In many ways the electronic means of communication have brought the international medical and academic communities closer together despite being unable to travel.

BAPO has produced a series of Zoom webinars over lockdown and I am delighted with the new series of educational podcasts for trainees that have begun to appear on the website. If any of you would like to be involved in the podcasts please let me know. They are easy to produce and the feedback to date has been fantastic.

As well as arranging a yearly academic meeting, BAPO remains the authoritative voice of paediatric ENT in the United Kingdom. We contribute to post graduate education, national guidelines and the shape of paediatric ENT within the UK.  BAPO is inclusive, friendly and fun. I am delighted to be president of such an organisation and very lucky to have such a motivated and dynamic council to work with.

Steven Powell, Great North Children’s Hospital, Newcastle, Secretary & Ravi Thevasagayam, Sheffield Children’s Hospital, Associate Secretary;

It has been a challenging time over the last year, and we were so disappointed to miss you all at BAPO 2020, but look forward to BAPO 2021 in Birmingham in September.  

There have been some council changes over this time-period.  In light of COVID and the inability to have an election at the AGM, council voted to extend the time period on council of current elected members by 1 year.   This meant that Dan Tweedie, Su De and Hasnaa Ismail served 1 extra year, but will demit this year.  We thank them for all their hard work.  There are 3 vacancies for council members to be voted on at the AGM in September- full details will be on the website.  

There are several upcoming executive changes.  Steven Powell and Will Hellier come to the end of their terms as Secretary and Treasurer.  Ravi Thevasagayam, Dan Tweedie and Hasnaa Ismail Koch were elected as Secretary, Treasurer and Associate Secretary respectively at the recent BAPO council meeting.  We thank Will for all his excellent work as Treasurer and wish Ravi, Dan and Hasnaa all the best for the coming 4 years.

Michelle Wyatt has been elected as the President Elect of BAPO and will take over the Presidency on completion of Mike Saunders’ term in 2022.  Congratulations Michelle.  The council has voted to make Presidential terms 1 year, with 2 pre Presidential years and 1 past presidential year on council.  The constitutional changes will be brought to the AGM for ratification.

Please follow us on twitter @BAPOrl and visit our website www.bapo.co.uk for updates

Best wishes

Trainee Catch-Up with Jason Powell, Great North Children’s Hospital, Newcastle, Trainee Rep & Max Osborne, Worcester Acute Hospital, Trainee Rep 

Dear trainees. 

My name is Jason Powell and I am the trainee representative for BAPO alongside Max Osborne who is the local trainee rep for the upcoming BAPO meeting. We are very keen to increase trainee involvement and membership at BAPO and would ask keen trainees at any stage from medical student, foundation doctor, SHO to registrar to sign up for membership, its cheap and gives reduced rates for the BAPO meeting, just email bapomembership@gmail.com

We are also keen to develop the website and newsletter for trainees and hope to share useful resources such as fellowship information, paediatric ENT resources, books, podcasts and other links. Anything that would be useful to a budding paediatric ENT surgeon. Please send you content to Jason.powell@nhs.net and we will get it uploaded. 

For any junior trainees interested in paediatric ENT but unsure of who to speak to about the career, please drop us a line and we can either give you some advise from our experiences or point you in the direction of someone who can help.

We look forward to meeting you all at BAPO 2021 (hopefully!)

Jason and Max

Michelle Wyatt Consultant Paediatric ENT surgeon at Great Ormond Street Hospital and President Elect of BAPO interviews Kate Heathcote. 

Kate has been a Consultant Otolaryngologist at University Hospitals Dorset since 2012.  She is a true innovator, undertaking the first ever successful laryngeal reinnervation surgery in a child in in the UK.

What was your career pathway to becoming an ENT consultant?

At medical school in London I was sure that I was a physician and so fought for a top medical job at the Chelsea and Westminster Hospital. I thought that I would use my surgical house job though to combine work and pleasure by taking a job in Inverness, where I could access the mountains. I was considering practicing in the developing world and so when I found a standalone SHO job combining ENT, Ophthalmology and Dermatology that seemed perfect to support these ambitions. In fact, I just loved the ENT. The team there were superb and an inspiration to us juniors. When I moved on from Scotland, I was surprised to learn that not all head and neck patients are prescribed Whisky! I also realised that a week without operating was a bad week!

I did my BST in Dundee and then married a farmer in the Wessex area. The livestock wouldn’t move and so I had to get on the local (“Bucket and Spade Rotation”) SpR rotation. I had a 6 week old baby for my first interview and was not appointed but got a post in the next round. After my second child, I was considered a trailblazer, becoming the first surgical trainee in Wessex to be able to go “part time” (a phrase greatly disputed by my husband as I was still doing over 40 hours a week). I loved that period of my life and have no regrets about taking nearly 10 years to CCT and having three kids.

I initially thought I would do head and neck but then came across the work of the French ENT surgeon Prof Jean-Paul Marie. I decided I would be a laryngologist and convinced him he needed a fellow. I followed this with a laryngology fellowship at the Royal National Throat Nose and Ear Hospital, working with the best.

I needed to head back to the farm, my beleaguered husband and filthy children and was appointed to the University Hospitals Dorset. Little did they know they needed a laryngologist. On the back of fantastic role models through my fellowships and working with an incredible global network of colleagues, I have had great pleasure establishing the Robert White Centre for Airway, Voice and Swallow. Joining forces with Southampton Children’s Hospital we now offer as comprehensive a paediatric service as exists anywhere.

What would you like an aspiring paediatric ENT surgeon to know?

Look to the future beyond the child. They will need to function as an adult when demands will be different. For example, once they are outside the protective environment of home and a school community, a significant dysphonia is very debilitating - particularly in the university years and in any job that requires voice projection or phone use.

Collaboration is the key to success for you and your patients. Find it everywhere: in your hospital, region, nationally and internationally. 

You are one of the leading surgeons in the world undertaking laryngeal reinnervation for vocal cord palsy, please could you summarise your views on this intervention?

I learnt the techniques of unilateral non-selective reinnervation (NSR) and bilateral selective reinnervation (BSR) whilst on my fellowship with Prof Marie in Rouen and the transformative effects were obvious.

As I started my own practice, I was able to give patients the opportunity to regain glottic competence post recurrent laryngeal nerve injury. Early injection augmentation of the vocal fold is temporary but immediately restores the voice and swallow function, giving time for possible nerve recovery. If this does not happen, a NSR can be performed alongside further augmentation to maintain glottic closure until reinnervation and long term benefit occurs. 

This contrasts to thyroplasty, where the injectable must wear off before an implant is inserted, leaving the patient dysphonic and at risk of aspiration. For children there is no thyroplasty option and so reinnervation is an incredible opportunity for them to restore voice and also prevent aspiration.

In a recent conversation with Prof Roger Crumley from California, he recalled one of his NSR cases from 1978 who is currently able to sing “O Solo Mio” giving evidence for the longevity of this intervention.

BSR is a highly complex procedure that has the potential to solve the desperate situation of a bilateral vocal fold palsy. Its attraction in children is significant, as many of those affected require a tracheostomy to facilitate an active childhood. The worldwide experience at present is small but promising and I hope that in the future it will become much more widely available as a treatment choice for families.

Events

BAPO 2021 meeting – Birmingham 

The title “past-president” always strikes me as being a bit depressing. Yesterday’s person. Traditionally also, the president hosts the annual meeting of BAPO in their professional hometown and it was depressing also for that to have dropped by the wayside as a result of that petulant virus sweeping across the world. Mike Saunders generously suggesting that we could hold this year’s meeting in Birmingham and that we could have an extraordinary two-day meeting was a better anti-depressant than one could dream of. I take full responsibility for grandiosely renaming the annual meeting A Festival of Paediatric Otolaryngology.

Mike and I, fantastically supported by Steven, Ravi, Hasnaa and Max Osborne, are delighted to present a two-day programme which is relevant but diverse in subject matter, representative of some of the professional activities that BAPO has supported and endorsed, inclusive of all stakeholders in British paediatric otolaryngology and most of all promises to be FUN. We welcome John Russell and Adrian James as our John Evans Lecturers and hope that quarantine restrictions from Ireland and Canada will have been lifted by the end of September. Covid, while mercifully sparing children in general, has brought many aspects of our practice into focus, the clinical ones addressed by Lakh Pabla who experienced its handling in the UK and in Australia, and Aisha Hamza whose role as advanced nurse practitioner in Birmingham Children’s Hospital saw her do a wide range of tasks during the crisis but also found her paediatric anosmia service gaining new traction. Nikki Butler will educate us on the well-recognised but often not well-managed problem of dysfunctional breathing in children. Phronesis and mindfulness have never been more important in our personal and professional lives and we have two people in Mark Pryce and Kristján Kristjánsson who could not be better qualified to lead us in a reflection upon this. I could go on and on but the programme speaks for itself and the otolaryngologists speaking need no introduction.

BAPO 2021 may possibly be the first big face to face otolaryngology meeting since the lockdown in March 2020. It will be a hybrid meeting to reach out to those who want to participate but cannot come but hopefully, we shall have enough space for all those who do wish to come. As a two-day event, we are also hoping to facilitate a networking event on the Thursday evening for everyone to catch up after a less than easy eighteen months. It’s not Glastonbury, but it’s a festival and it’s going to be a blast. Come.

ESPO 2023

The Liverpool meeting will be the first time since Stockholm 2018 that ESPO delegates meet face-to-face and Ray, Su and the team can’t wait. Plans are shaping up in the home of the world’s best football team. The academic programme will focus on scientific advances, audience participation, and a state -of-the art simulation centre. The magnificent backdrop of the Anglican cathedral is the centerpiece for the Gala dinner; you never know what musical act will turn up! Visit the best museums and art galleries in Europe – all on a fabulous riverside setting within a short walk of your hotel. Oldies and newbies alike will want to see the old haunts of the Beatles, including the Cavern Club where the 1960’s Merseybeat music kick-started the modern era of pop-music. Air-guitar for all you are worth as you relive the days of flower-power, flared trousers, and mini-skirts. If you dare, you might even want to dress for the occasion! 

Most of all the team is excited about, having a party to celebrate our exit from these awful days and hugging each other again. In the words of John Lennon ‘All you need is love!”.