To compare the efficacy and safety characteristics of endoscopic and microscopic stapes surgery based on current evidence.

A systematic literature search was conducted of three medical databases, focusing on randomised, controlled studies or observational studies. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarised using the pooled mean differences or pooled odds ratios, along with their 95 per cent confidence intervals.

Thirteen studies were included in the meta-analysis. Success rate was evaluated by estimating air–bone gap improvement; this revealed comparable outcomes for the two techniques (mean difference = −0.20; 95 per cent confidence interval = −0.53, 0.14). No statistically significant difference was detected concerning post-operative complications, except for dysgeusia (odds ratio = −1.12; 95 per cent confidence interval = −1.97, −0.28) and pain (odds ratio = −2.00; 95 per cent confidence interval = −2.97, −1.04), which favoured the endoscopic approach.

Though both techniques result in commensurate outcomes concerning success rate, post-operative pain and dysgeusia favour the endoscopic approach. Further high-quality studies are needed to adequately compare the two methods.

Politzer's tuning fork test is a little-known special examination with a chequered history.

This paper gives Politzer's original description, and explains how he intended it to be used.

The historiographical research in this study is based on primary references. Secondary documentation is only cited when it is necessary to substantiate any historical argument.

After the apparent disappearance of Politzer's tuning fork test from the otological scene in the 1950s, its consequent resurrection was not what it seemed. This story underlines the need for a standardisation of otological nomenclature, particularly when eponyms are used.

Radiotherapy is considered a risk factor for pharyngocutaneous fistula after a total laryngectomy. This study aimed to analyse the impact of exclusive radiotherapy versus chemoradiotherapy and the time interval between radiotherapy and surgery on the risk of pharyngocutaneous fistula.

This study was a retrospective revision of 171 patients treated with a total laryngectomy after radiotherapy or chemoradiotherapy.

Pharyngocutaneous fistula occurred in 33 patients (19.3 per cent). Patients previously treated with chemoradiotherapy showed a non-significant higher pharyngocutaneous fistula rate compared with patients treated with radiotherapy (25.0 per cent vs 18.0 per cent; p = 0.455). Patients with a pharyngocutaneous fistula after chemoradiotherapy treatment required a surgical repair more frequently than patients treated with radiotherapy (p = 0.005). There were no significant differences in the pharyngocutaneous fistula rate depending on the time interval between radiotherapy and surgery (p = 0.580).

There were no differences in the pharyngocutaneous fistula rate after total laryngectomy depending on the previous treatment with radiotherapy or chemoradiotherapy, or depending on the interval between radiotherapy treatment and surgery.

Burnout, anxiety and depression are commonly reported among surgical residents and faculty members. Resident training programmes are encouraged to implement structured wellness initiatives, to address emotional stress.

Thirty otolaryngology residents and faculty members were invited to participate in this prospective pilot trial. Participants were randomised to either the intervention group, which involved completing 10 mobile meditation sessions, or the control group. Outcomes were measured with the Generalized Anxiety Disorder scale-7, Patient Health Questionnaire and Professional Quality of Life scale.

Nineteen participants completed the study. Participants in the intervention group had a significantly greater mean change in Generalized Anxiety Disorder scale-7 score (−2.7 ± 3.335 vs 0.33 ± 1.225; p = 0.04). There was no significant difference in average change in Patient Health Questionnaire-9 scores or Professional Quality of Life scale sub-scores between the intervention and control groups.

Short meditation sessions can significantly improve anxiety in surgical residents and faculty members, and they offer a simple, attainable and effective wellness intervention.

To assess the correlation of serum prestin level and audiological findings in adults with idiopathic sudden sensorineural hearing loss.

Audiometry and serum prestin measurements were performed at study entry (T0), at day 14 (end of treatment, T1) and at day 30 (T2).

A total of 25 idiopathic sudden sensorineural hearing loss patients and 25 healthy adults were included. The geometric mean prestin level in the case and control groups at T0 was 227.7 pg/ml and 130.5 pg/ml, respectively. The geometric mean prestin level in the case group demonstrated a downward trend at T1 and T2 (214.0 pg/ml and 180.1 pg/ml, respectively; p < 0.001). Of 17 patients with high baseline prestin levels (over 150 pg/ml), prestin levels tended to decrease in 11 patients, and 5 of them (45.5 per cent) showed good recovery.

The prestin concentrations increased in two-thirds of patients with idiopathic sudden sensorineural hearing loss. Future work is recommended to determine the location of injury.

Granular myringitis is a chronic and difficult-to-treat condition of the tympanic membrane. This paper presents a minimally invasive treatment technique using the potassium titanyl phosphate laser.

A retrospective case review of patients who underwent potassium titanyl phosphate laser treatment between 2015 and 2020 was performed. All patients underwent final telephone follow up in 2020 to ascertain whether they had any ongoing myringitis symptoms, and all were offered further face-to-face follow up.

Fourteen patients with myringitis were identified, with one patient having both ears affected. Of the 15 affected ears, 2 required a second treatment, resulting in a total of 17 laser treatment cases. At the first post-operative review, the appearance of the drum had improved in 10 out of 17 treatments (59 per cent).

Potassium titanyl phosphate laser surface tympanoplasty may provide safe, quick and effective resolution of myringitis.

The two-week-wait referral is designed to improve early detection in cancer patients. This retrospective study analysed those ENT two-week-wait referrals to out-patient clinics in a tertiary head and neck oncology centre, from January to June 2018, which were not compliant with National Institute for Health and Care Excellence guidelines (2015 update).

Referral symptoms were statistically analysed against National Institute for Health and Care Excellence guidelines, with detailed analysis of reasons for non-compliance. In addition, a systematic review of similar previously published articles was conducted.

There were 1107 patients referred through the two-week-wait pathway. Of these referrals, 52 per cent were compliant with National Institute for Health and Care Excellence 2015 guidelines. Six errors were identified for non-compliant referrals, most commonly inconsistencies in referral (e.g. globus sensation) and intermittent disease course (e.g. intermittent hoarseness). Of all patients referred, 93 per cent were diagnosed with benign conditions, with laryngopharyngeal reflux being the commonest. Twenty-two per cent of referred patients were discharged after the first visit.

Two-week-wait referral is inappropriately overused. There are many non-compliant referrals, and most of the outcomes are benign.

This study aimed to analyse a three-dimensional transcanal transpromontorial approach to the internal auditory canal using three-dimensional computed tomography.

This study was a retrospective investigation of 48 ears of 24 patients using three-dimensional reconstruction data from normal temporal bone computed tomography. The inner structures of the temporal bone were three-dimensionally reconstructed. Eight points were marked in the three-dimensional object with reference to the axial, coronal and sagittal plane images of the computed tomography scans. Distances and angles to each point were measured from the oval and round windows.

The point of the facial nerve from the internal auditory canal to the labyrinthine segment could be traced between the cochlear apex and the geniculate ganglion based on the oval window.

This technique helps with identifying the locations of important surgical landmarks using three-dimensional reconstructions of pre-operative computed tomography scans and to identify the facial nerve from the internal auditory canal during surgery.

To determine the accuracy of 1.5 Tesla magnetic resonance imaging in identifying the bony defect in superior semi-circular canal dehiscence syndrome.

A retrospective case–control study was conducted in tertiary university settings. The study included 12 patients with a definite diagnosis of superior semi-circular canal dehiscence syndrome and a control group comprising 12 non-superior semi-circular canal dehiscence syndrome patients, all with available magnetic resonance imaging data. The imaging scans were anonymised, and reviewed blindly and independently by three experienced radiologists.

There was low sensitivity and specificity, with average values of 47 per cent (range, 16.7–66.7 per cent) and 69 per cent (range, 66.7–75 per cent) respectively. Cohen's kappa was 0.75, indicating substantial inter-rater reliability.

Given the low accuracy of 1.5T magnetic resonance imaging in identifying the bony defect in superior semi-circular canal dehiscence syndrome, despite its value in inner-ear imaging, computed tomography or equivalent should be used when superior semi-circular canal dehiscence syndrome is suspected.

The clinical value of tonsillectomy continues to cause much debate, despite tonsil disease representing a significant burden to patients, caregivers and healthcare systems. This study assessed the long-term effect of adenotonsillectomy or tonsillectomy on the Paediatric Throat Disorders Outcome Test (‘T-14’), a validated tool used to objectively assess obstructive and infective symptoms in paediatric throat disorders.

Patients aged under 16 years undergoing adenotonsillectomy or tonsillectomy were recruited consecutively from 2018 into our prospective observational study. The Paediatric Throat Disorders Outcome Test questionnaire was completed by the children's caregivers pre-operatively (n = 80), and at 21 days (n = 68) and 2 years (n = 66) post-operatively.

Significant reductions were noted in mean total Paediatric Throat Disorders Outcome Test scores at 21 days and 2 years post-operatively (p ≤ 0.003).

Our results provide supporting evidence that paediatric adenotonsillectomy or tonsillectomy significantly improves quality of life up to two years post-operatively, and therefore remains a valuable use of healthcare resources.

Adenotonsillectomy is a recognised treatment for paediatric obstructive sleep apnoea. Recent literature highlights the need to assess outcomes in the extremely obese subpopulation. This study reviewed the efficacy of adenotonsillectomy performed in patients with extreme obesity.

A retrospective analysis of attendees at a tertiary paediatric obesity clinic was performed, identifying patients with a body mass index z-score equal to or more than three who had undergone adenotonsillectomy for obstructive sleep apnoea. Electronic patient records, including respiratory polygraphy, were analysed.

Nine patients met the study criteria. All required nocturnal non-invasive ventilation pre-operatively. Mean age at referral was 6.9 years, and average age of non-invasive ventilation commencement was 7.8 years. Post-operatively, 8 patients (89 per cent) required non-invasive ventilation with evidence of post-operative obstructive sleep apnoea.

In extreme obesity, adenotonsillectomy does not prevent the need for non-invasive ventilation. Management of this patient group requires treatment of obesity alongside potential surgical intervention. Poor efficacy in treating obstructive sleep apnoea may influence the decision to proceed with adenotonsillectomy.

Commercially available suction devices are expensive, large and heavy, and need electricity, and thus restrict the outdoor activity of tracheostomised children and their carers. This study evaluated the efficacy and usability of a simple suction assembly using a syringe and feeding tube in paediatric tracheostomised patients.

Following the domiciliary usage of this suction assembly instead of their existing suction device for a minimum of 15 days, carers responded to a set of questionnaires containing a subjective scoring system.

Ninety-three per cent of the carers considered this assembly as average, good or very good in cleaning the tracheostomy tube. Eighty per cent of the carers considered that this assembly would be suitable when their existing suction machines are unavailable, indicating high usability, and 66.67 per cent of the carers would be confident using this assembly in outdoor settings.

Larger studies with objective evaluation methods can validate the high efficacy of this simple, inexpensive and easy-to-use, hand-held suction apparatus as reported by the carers of 15 paediatric tracheostomised patients in this study.

This study aimed to evaluate the long-term hearing outcomes in stapedotomy surgery using skeeter oto-drill and to assess safety in difficult situations.

A retrospective study was conducted with 944 patients who underwent 1007 stapedotomy procedures over 16 years, performed by a single surgeon using a trans-canal approach and a self-retaining ear canal retractor. Hearing thresholds were calculated over four frequencies. Air–bone conduction hearing thresholds were obtained at 1, 5 and 10 years post-operatively and compared to the pre-operative records.

Out of 1007 operated ears with one year follow up, 98.61 per cent of cases showed a negligible air–bone gap of equal to or less than 5 dB, 1.19 per cent of cases showed an air–bone gap equal to or more than 5 dB but less than 10 dB, and only 0.2 per cent of cases showed an air–bone gap of more than 10 dB.

In this study, using skeeter drill with a 0.6 mm diamond burr to make the fenestra was constant in all the cases and one of the safest techniques, showing persistent long-term hearing results.

Surgery is the recommended treatment for resectable T4a laryngeal and hypopharyngeal carcinoma. Non-surgical treatment is an option in a select few patients.

This retrospective study was undertaken to assess the treatment outcomes in patients with resectable T4a carcinoma of the larynx and hypopharynx who received either surgical or non-surgical treatment at our institute and to assess factors influencing these outcomes.

A total of 120 patients were included in the study. They were divided into groups A, B and C based on the presence of extralaryngeal spread through laryngeal membrane, cartilage or both. The overall survival was better among patients who received surgery than those who received non-surgical treatment in the three groups. The factor influencing overall survival was the treatment given in the form of surgical versus non-surgical treatment.

Surgery is the preferred treatment for T4a laryngeal and hypopharyngeal carcinoma, even in patients with extralaryngeal spread without cartilage erosion.

This study aimed to elucidate whether molecular signalling involved in upper airway remodelling is enhanced in patients with obstructive sleep apnoea.

Twenty patients with mild obstructive sleep apnoea (control group) and 40 patients with moderate to severe obstructive sleep apnoea (obstructive sleep apnoea group) who desired uvulopalatopharyngoplasty were recruited for the study. After uvulopalatopharyngoplasty, surgical specimens of the uvula were subjected to haematoxylin and eosin, Masson's trichrome and immunohistochemical staining. Western blot and reverse transcriptase-polymerase chain reaction were used to evaluate the protein and messenger RNA expressions.

The obstructive sleep apnoea group showed more severe inflammation, increased collagen deposition and higher immunohistochemical staining intensity for TGF-ß and MMP-9 as well as higher protein and messenger RNA expression of MMP-9, VEGF, TGF-ß, p38 MAPK, SMAD 2/3, AKT and JNK in the uvula than control group.

Patients with obstructive sleep apnoea demonstrated more severe inflammation, increased airway remodelling, and increased protein and messenger RNA expression of pro-inflammatory and pro-fibrotic cytokines in the uvula than control participants.

Advanced malignant neoplasms of the larynx and hypopharynx pose many therapeutic challenges. Total pharyngolaryngectomy and total laryngectomy provide an opportunity to cure these tumours but are associated with significant morbidity. Reconstruction of the pharyngeal defect following total pharyngolaryngectomy demands careful consideration and remains an area of debate within surgical discussions.

This paper describes a systemic analysis of pharyngeal reconstruction following total pharyngolaryngectomy and total laryngectomy, leveraging data collected over a 20-year period at a large tertiary referral centre.

Analysing 155 patients, the results show that circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. In addition, free tissue transfer in larger pharyngeal defects showed lower rates of post-operative anastomosis leak and stricture.

Pharyngeal resection carries a substantial risk of post-operative complications, and free tissue transfer appears to be an effective means of reconstruction for circumferential defects.

Acute facial palsy is a consequence of various diseases, with the number of patients increasing with advancing age. This study aimed to analyse the clinical characteristics of acute peripheral facial palsy in older adults.

A total of 30 patients with a mean age of 68.4 ± 9.1 years were included in the study. All patients received a standardised investigation and follow up. The hospital charts of the patients with acute facial palsy were reviewed retrospectively.

The predominant causes of acute facial palsy in older adults were: Bell's palsy, Ramsay Hunt syndrome, trauma, otitis media and malignancy. At baseline, complete and incomplete facial palsies were seen in 26.7 per cent and 73.3 per cent of patients, respectively. The overall rates of good recovery, partial recovery and no recovery were 66.7 per cent, 10 per cent and 23.3 per cent, respectively. Increased age led to a significantly lower level of recovery in older adults.

Bell's palsy and Ramsay Hunt syndrome were the most common aetiologies of acute facial palsy in older adults, and such patients are likely to have incomplete recovery. Active early treatment is necessary for achieving good outcomes in older adults.

Delay in the diagnosis of head and neck cancer can result in significant excess morbidity and mortality. How the pandemic has affected patient presentation in Scotland is unknown.

This retrospective cohort study compared all presentations of head and neck cancer between June and October of 2019 with the same period following the peak of the pandemic in 2020 in West Scotland, a region populated by 2.5 million people.

A total of 528 patients met our inclusion criteria. Compared with 2019, patients in 2020 were more likely to present with a higher American Joint Committee on Cancer stage (odds ratio, 1.67 (95 per cent confidence interval = 1.20 to 2.31); p = 0.002), a longer preceding symptom duration (odds ratio, 2.03 (95 per cent confidence interval = 1.44 to 2.87; p < 0.001) and to have an emergency presentation (odds ratio, 2.53, (95 per cent confidence interval = 1.15 to 5.55; p = 0.017).

Patients are presenting later with more advanced head and neck cancer following the coronavirus disease 2019 pandemic.

To summarise and describe the clinical presentations, diagnostic approaches and airway management techniques in children with laryngotracheal trauma.

The clinical data related to laryngotracheal trauma diagnosed and treated at the Beijing Children's Hospital, between January 2013 and July 2018, were retrospectively reviewed. Disease diagnosis, treatment, management and outcomes were analysed.

A total of 13 cases were enrolled, including 7 cases of penetrating laryngotracheal trauma. The six cases of blunt laryngotracheal trauma were caused by collisions with hard objects. In all cases, voice, airway and swallowing outcomes were graded as ‘good’, except for one patient who had residual paralysis of the vocal folds.

Flexible fibre-optic laryngoscopy and computed tomography can play an important role in diagnosing laryngotracheal trauma. The airway should be secured and, if necessary, opened by tracheal intubation or tracheostomy.