This brief review summarises the efficacy of the treatments for post-irradiation otitis media with effusion.

Literature review.

Studies suggest that tympanocentesis is recommended for patients with post-irradiation otitis media with effusion The efficacy of balloon dilatation Eustachian tube for post-irradiation otitis media with effusion remains unclear.

The efficacy of different treatments for post-irradiation otitis media with effusion is unclear. Therefore, there are no recognised clinical guidelines, and long-term clinical research with a large sample size is needed.

The father of Czech music, Bedřich Smetana was a brilliant, patriotic Romantic composer who spent his last decade completely deaf. He became progressively ill in his final years and passed away prematurely at 60 years old. Since then, there have been two main propositions for the etiology of his neurological symptoms, in particular his hearing loss: neurosyphilis or osteomyelitis of the temporal bone.

This article compares the clinical presentation and pathology of neurosyphilis and osteomyelitis.

This article infers which one is arguably the most likely cause based on Smetana’s own medical history, signs and symptoms and autopsy findings.

Smetana’s clinical presentation and pathological results grant us a clearer picture of his neurological condition and allows us to diagnose his final neurological deterioration as complications of neurosyphilis and not osteomyelitis of the temporal bone.

First bite syndrome refers to pain in the parotid region during the first bite when eating that improves with subsequent bites. There is a paucity of evidence in the literature to justify recommending optimal management therefore this study aimed to review the latest evidence for its management.

A literature search across four databases was conducted using a Population, Intervention, Comparison, Outcome-generated search strategy between 2012 and 2022. Screening was done by two reviewers according to pre-determined inclusion and exclusion criteria, demonstrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

Eleven articles were included. Six articles used repeated botulinum toxin injection, which in all the studies resulted in complete symptoms resolution. Four articles found a watch-and-wait technique to be effective. There were conflicting results on the efficacy of medical treatments such as opioids or anticonvulsants.

Studies have shown that first bite syndrome symptoms eventually resolve with conservative management, but repeated botulinum toxin appeared efficacious for quicker symptom resolution. Further higher-quality studies should be conducted to identify the optimal management.

Necrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an apparent increase in the number of patients admitted to our hospital with this condition.

A retrospective review was conducted of all patients admitted to our hospital with necrotising otitis externa between July 2012 and June 2020.

Among 39 patients included, only 9 were diagnosed in the first four years, and 30 were diagnosed in the last four years. There were 27 males and 12 females, and the mean age was 78.7 years. There were six non-diabetic immunocompetent patients. Cranial nerve palsies developed in 50 per cent of the patients. Disease-related mortality was 7.7 per cent. A favourable outcome was recorded in 66.7 per cent of the patients.

Necrotising otitis externa is associated with high morbidity and mortality. The incidence of the disease is rising in our local geographical area.

To identify changes in hearing loss, tinnitus, vertigo, and migraine in individuals with Ménière’s disease diagnosed with coronavirus disease 2019 and during the UK national lockdown.

Patients were questioned regarding coronavirus disease 2019 status and how their symptoms of hearing loss, tinnitus, vertigo, and migraine changed because of the pandemic. Of the 411 participants recruited into this study, 382 had a self-reported coronavirus disease 2019 status.

Of those individuals with a positive coronavirus disease 2019 diagnosis, 43 (11.3 per cent) were more likely to experience worsening symptoms of hearing loss and tinnitus. Worsening symptoms of hearing loss and tinnitus, but improved symptoms related to vertigo, were observed during the UK national lockdown.

A diagnosis of coronavirus disease 2019 and/or experiencing the consequences of a national lockdown potentially resulted in a worsening of hearing loss and tinnitus symptoms. Symptoms of vertigo were found to have improved during the same period.

Ménière’s disease is a chronic inner-ear disease attributed to endolymphatic hydrops. Magnetic resonance imaging with gadolinium allows visualisation of endolymphatic hydrops in vivo and may be an adjunct to diagnosis.

Thirty-eight patients suspected of having Ménière’s disease underwent T2 weighted three-dimensional fluid-attenuated inversion recovery and true inversion recovery sequence magnetic resonance imaging 4 hours post double-dose intra-venous gadolinium. Presence of endolymphatic hydrops was graded by two radiologists at 0 and 4 months. Correlation to clinical diagnosis was assessed using Fisher’s exact test.

Hydrops was identified in 88 per cent, 17 per cent and 27 per cent of patients with Definite Ménière’s, Probable Ménière’s and Undifferentiated disease, respectively. A significant correlation existed between diagnosis and presence of hydrops. Sensitivity and specificity were 88 per cent and 67 per cent, respectively. Intra- and inter-observer agreement for presence and grading of hydrops was near-perfect and substantial to near-perfect, respectively.

Magnetic resonance imaging demonstrates radiographic hydrops with significant correlation to clinical diagnosis and good intra- and inter-observer agreement.

Deafness is a leading cause of disability worldwide. This prospective cohort study investigates the impact of cochlear implants on self-reported quality of life in post-lingually deaf adults.

The self-administered 36-item World Health Organization Disability Assessment Schedule 2.0 and the Speech, Spatial, and Qualities of Hearing Scale questionnaires were prospectively used to investigate the impact of cochlear implants in 98 post-lingually deaf adults aged more than or equal to 50 years.

Quality of life improved post-cochlear implant in the cumulative scores and scores for all domains of the Speech, Spatial, and Qualities of Hearing Scale (p < 0.05). QoL improved post-cochlear implant in the sub-domains related to cognition and participation in society of the World Health Organization Disability Assessment Schedule 2.0 (p < 0.05), but there was no significant difference in the cumulative score. Subgroup analysis showed improvement in the participation in society domain only and only in males and participants aged younger than 75 years (p < 0.05).

Cochlear implant improves quality of life in post-lingually deaf adults.

This study demonstrates a national programme which has been accepted in Wales as a mandatory part of the induction process for the rotating ENT SHO cohort.

The ENT Induction Bootcamp was established based on the learning needs of ENT SHOs. Pre- and post-course assessment of the subjective and objective benefit of the 1-day course was captured.

Between 2022 and 2024, 152 participants have attended the bootcamp; all of whom (100 per cent) found the course beneficial. The greatest improvements in participant confidence were observed in emergency tracheostomy management, flexible nasendoscopy and nasal examination (all p < 0.01). Based on objective assessment, participant knowledge improved from a mean of 68.5 per cent to 96.5 per cent.

This initiative highlights the value of a bootcamp approach to standardise junior doctors’ abilities to manage ENT emergencies. This bootcamp is now a mandatory component for all SHO entering ENT attachments in Wales, in an easily adoptable format.

To study the clinicopathological features of collision tumours of the thyroid and to develop a logical management regimen in view of the rarity of these tumours.

A retrospective study on collision tumours of the thyroid, diagnosed over the previous 15 years in a tertiary cancer care centre. The inclusion criteria were proven cases of collision tumours of medullary thyroid carcinoma with papillary thyroid carcinoma and/or follicular thyroid carcinoma.

Among the 470 patients with medullary thyroid carcinoma, 24 were found to harbour collision tumours (5.1 per cent). Amongst 18 patients (75 per cent) with lymph node metastases, 88.8 per cent originated from medullary thyroid carcinoma and 22.2 per cent from the papillary thyroid carcinoma component. Two patients (8.3 per cent) presented with distant metastases. Eight patients underwent radioactive iodine scan, of whom seven demonstrated neck uptake and received radioactive iodine therapy. Fifteen patients (62.5 per cent) were disease free, eight patients (33.33 per cent) harboured biochemical and/or structural residual disease, and one patient died due to an unrelated aetiology.

Thyroid collision tumours are relatively rare entities and are usually undiagnosed pre-operatively. The prognosis of the disease primarily depends on tumour aggressiveness the of medullary thyroid carcinoma component. A combined follow up with tumour markers and imaging, including positron emission tomography/computed tomography molecular imaging approaches should be adopted.

This study measured the effectiveness of an in-house designed, cast silicone airway model in addressing the lack of easily accessible, validated transoral laser microsurgery simulation models.

Participants performed resection of two marked vocal fold lesions on the model. The model underwent face, content and construct validation assessment using a five-point Likert scale questionnaire measuring the mean resection time for each lesion and the completeness of lesion excision. Comparative analyses were performed for these measures.

Thirteen otolaryngologists participated in this study. The model achieved validation threshold on all face and content measures (median, ≥4). Construct validation was demonstrated by the improvement in mean resection time between lesions one and two (86 vs 54 seconds, W = 11, p = 0.017). The mean resection time was lower amongst more senior otolaryngologists (61.5 vs 107.1 seconds, W = 11, p = 0.017).

This synthetic silicone model is a low-cost, easily reproducible, high-fidelity synthetic airway model, demonstrating face, content and construct validity.

Assess the post-operative complications of microscopic parotidectomy and its impact on quality of life.

Thirty patients were included in this prospective study. Three to six months post-surgery, patients underwent assessments for Frey’s syndrome by Minor test, aesthesiometer test, facial nerve function and Quality of Life questionnaire.

Frey’s syndrome symptom positive in none, Minor test positive in 50 per cent. The preservation rate of the great auricular nerve posterior branch was 90 per cent, but it had no significant impact on the aesthesiometer test. Transient and permanent facial paresis were observed in 13.3 per cent and 3.3 per cent, and salivary fistula in 3.3 per cent. In quality of life, the rating of general health as good/better was seen in 73.3 per cent, nil/minimal pain in 93.3 per cent, bothersome change of facial contour in none, and dry mouth in 23.3 per cent.

Microscopic parotidectomy achieves good surgical outcomes regarding Frey’s syndrome symptoms, greater auricular nerve preservation, facial paresis, salivary fistula and quality of life.

To determine if there have been changes over time for indications and outcomes of tracheostomies in infants.

Retrospective review of infant tracheostomies at a tertiary children’s hospital across two time periods (epoch 1: 1997–2008; epoch 2: 2009–2020). Patient demographics, tracheostomy indications, comorbidities, length of stay, complications, decannulation and mortality were examined.

Seventy-two infants had a tracheostomy (40 epoch 1 vs 32 epoch 2). Airway obstruction decreased (80 per cent vs 50 per cent*) and long-term ventilation increased (17.5 per cent vs 40.6 per cent*) as the primary indication. Early complications decreased between the time periods (30 per cent vs 6.3 per cent*). The median hospital length of stay was 97 days (interquartile range 53–205.5), total complication rate was 53 per cent, decannulation rate was 61 per cent and mortality rate was 17 per cent (all non-tracheostomy related) across both time periods. There were no significant changes for these outcomes. *(p< 0.05)

Long-term ventilation has increased and airway obstruction has decreased as the primary indication for infant tracheostomy over time.

To examine the patterns of care for octogenarian head and neck cancer patients.

All newly diagnosed patients aged 80 years or older, who presented at our centre between June 2018 and October 2020, were included.

The total number of patients was 42. The median Charlson Comorbidity Index was 5 (range, 4–9). The larynx was the most common subsite (n = 12). Twenty-nine patients (66 per cent) were diagnosed at disease stage IV. Squamous cell carcinoma was the most common histology (86 per cent). Twenty-six patients (62 per cent) had radical treatment and 16 (38 per cent) had palliative treatment. The estimated six-month and one-year overall survival rates for the radical and palliative treatment cohorts were 92.3 per cent and 42.9 per cent (p = 0.001) and 65.4 per cent and 15.4 per cent (p = 0.003), respectively.

This study provides useful information on octogenarian patients with head and neck cancer. This information may help in conducting prospective studies, especially those focusing on older patients with head and neck cancer, in order to define the ideal care of this patient population.

Surgical resection for pterygopalatine fossa schwannomas can be challenging due to the complex anatomy and potential morbidity. Gamma knife radiosurgery (GKRS) offers a minimally invasive alternative with precise targeting and minimal damage to surrounding structures.

A 21-year-old female patient who had a history of progressive left-sided facial numbness over the past year and was diagnosed with progressive pterygopalatine fossa schwannoma underwent gamma knife radiosurgery. The radiological and clinical outcomes of the patient were evaluated over a period of 15 years, with the patient remaining symptom-free and experiencing no adverse effects from the treatment.

The patient’s positive outcome, with significant tumour reduction and symptom relief, underscores the potential of this non-invasive technique as a primary treatment modality for schwannomas in challenging anatomical locations.

Various methods have been described for laryngeal reconstruction after different kinds of neck trauma.

A method of laryngeal reconstruction in a case with severe penetrating destruction of the larynx is presented.

A titanium mesh plate was used in reconstruction to restore the laryngeal framework.

At thirty-six months’ follow up, the reconstruction proved to be adequate, and the patient was free of complaints, with good voice quality and normal swallowing.

Paediatric ear and hearing services in the UK are currently facing significant challenges leading to increased waiting times for patients. This letter aims to explore teleotology, focusing on ear health care delivered via telemedicine, as a potential solution to alleviate service pressures and improve care delivery.

The current state of paediatric ear and hearing services in the UK was reviewed and the potential for teleotology to improve service delivery by reducing face-to-face consultations and improving triage processes was explored.

Evidence from studies conducted in adults in the UK suggests that teleotology can optimise the allocation of resources, ensure timely treatment, and enhance the quality of care, aligning with the NHS Long Term Plan and recommendations from the GIRFT report.

The findings from adult teleotology are encouraging, but further research is required to demonstrate the efficacy of teleotology for children and young people in NHS settings.