‘A time bomb ticking in my head’: drawings of inner ears by patients with vestibular schwannoma

with speciality associations and, in otolaryngology has published guidance on topics as diverse as pillar implants for snoring, or cyanoacrylate occlusion of parotid sinuses. Evaluation leads to a recommendation, varying from blanket approval, ‘special arrangements’ for consent, audit and clinical governance, or ‘research only’, where evidence is lacking. As the authors have briefly mentioned, practice outside of a ‘research only’ recommendation can lead to suspension from the GMC Register (their ref 14). Some surgical speciality associations have established rapid routes of communication with members, to allow reporting and national survey of innovative practice. Hopefully ENT-UK can provide such a forum in due course. Balloon dilatation of the Eustachian tube or of subglottic stenosis and laser Eustachian tuboplasty are potential topics for future guidance. What else is out there in ENT? NICE guidance is invaluable in seeking local approval for introduction of a new technique, but also in bargaining with the de-commissioners of health care, so much a feature in the current UK financial climate. Conflict of interest