The aim of this study was to perform a systematic review and meta-analysis of existing evidence on the role of hot saline irrigation in patients undergoing functional endoscopic sinus surgery and its impact on the visibility of the surgical field.

A search of PubMed, Cochrane, Ovid databases and Google Scholar was performed.

Three randomised controlled trials were included. Pooled meta-analysis demonstrated a statistically significant better visibility of the surgical field, and a reduction in total blood loss and operating time during functional endoscopic sinus surgery in the hot saline irrigation group compared with the room temperature irrigation group. Subgroup analysis of studies that did not use vasoconstrictors showed a significant reduction in total blood loss and operating time.

This is the first systematic review that addresses hot saline irrigation for haemostasis in functional endoscopic sinus surgery. The results suggest that hot saline irrigation in functional endoscopic sinus surgery for chronic rhinosinusitis may significantly improve visibility of the surgical field, reduce total blood loss by 20 per cent and decrease operating time by 9 minutes. However, there are limitations of the study because of the significant heterogeneity of the methods, quality and size of the studies.

Endoscopic endonasal surgery is a minimally invasive technique that has revolutionised the management of complex neurosurgical, otolaryngological, skull-base and craniofacial lesions. Traditionally performed under general anaesthetic, this study explores the growing role of local anaesthetic techniques.

A contemporaneous review of modified dental techniques and intraoral anatomy provides a supportive guide for performing endoscopic sinus surgery under local anaesthetic.

The practical procedures for four midfacial nerve blocks are described with relevance to endoscopic surgery under local anaesthetic. Anatomy, surgical technique and potential complications are discussed for the incisive foramen block, sphenopalatine ganglion block (via endonasal approach), maxillary nerve block (via the greater palatine foramen and the transoral lateral pterygoid plate approach) and transcutaneous approach to the pterygomaxillary fissure.

Ultimately, such techniques may extend the safety and efficacy of endoscopic sinus surgery, limit surgical risk and increase satisfaction for patients, surgeons and healthcare managers alike.

There are gaps within current meta-analyses looking at the effects of tranexamic acid on sino-nasal surgery. This study aimed to update and summarise all current available evidence on the use of tranexamic acid in sino-nasal surgery.

A literature search was performed using four medical databases, Cochrane Library, Embase, Medline and PubMed. Data analysis was performed using dedicated meta-analysis software Review Manager (Revman).

Thirteen studies were included in the meta-analysis. The amount of blood loss and duration of surgery in tranexamic acid groups was statistically lower than placebo for both sinus and nasal surgery. Tranexamic acid improves the surgical field quality in sinus surgery but worsens the field in nasal surgery. Topical or intravenous administration of tranexamic acid in sinus surgery reduces blood loss, duration of surgery and improves the quality of the surgical field.

This study suggests that the use of tranexamic acid in sinus surgery reduces blood loss, decreases surgical duration and improves surgical field quality.

Tracheostomy in the neurocritical care population is associated with poorer outcomes. This study hypothesised that a multidisciplinary approach to tracheostomy care can improve outcomes.

This study was a prospective longitudinal study of all tracheostomised patients in the neurocritical care units of a quaternary centre over 17 years. All patients were managed by a tracheostomy team with a constant core membership of an intensive care consultant, speech and language therapist, and physiotherapist with consultant ENT input.

A total of 51 per cent of patients were decannulated in hospital at an average of 48 (neuromedical) and 57.6 (neurosurgical) days. Of the 42 per cent of patients transferred to another facility with a tracheostomy tube in situ, 37.5 per cent were at an advanced stage of tracheostomy weaning. Complication rates were low at 4.8 per cent with no tracheostomy associated mortalities.

A multidisciplinary approach can enable good outcomes in the neurocritical care population. Consistency of care spanning the step-down from critical to ward-level care is crucial to improving outcomes.

This study aimed to assess the incidence and severity of arytenoid adduction asymmetry in normophonic speakers and to identify related demographic characteristics.

A retrospective observational clinical study on normophonic patients was conducted. Videos of flexible laryngoscopy of the study group (aged 18 to 45 years) were reviewed. Arytenoid adduction asymmetry, if present, was graded as mild (grade 1), moderate (grade 2) and severe (grade 3).

Video recordings of 347 normophonic patients were analysed. The total prevalence of arytenoid adduction asymmetry was 36.4 per cent, with a predominance in males and on the right side. Right-sided predominance was statistically significant (p < 0.01). A total of 60.3 per cent of patients with arytenoid adduction asymmetry had only mild asymmetry, whereas 34.9 per cent had moderate asymmetry. Only 4.8 per cent showed severe asymmetry.

Arytenoid adduction asymmetry is found in more than one third of the normophonic population, has significant right-sided preponderance and was more common in males.

Post-tonsillectomy haemorrhage remains a significant complication despite modifications of technique and instrumentation. Intracapsular tonsillectomy spares the capsule as a protective barrier for underlying blood vessels and musculature. Its efficacy in children with sleep-disordered breathing has been established, along with lowered rates of haemorrhage and pain, but research pertaining to adults and for recurrent infections has been limited.

This retrospective study, encompassing 730 patients, compared post-operative haemorrhage rates between extracapsular (n = 379) and intracapsular tonsillectomy (n = 351) across all ages and indications using CoblationTM technology.

A significant difference in post-operative haemorrhage rate was observed between extracapsular and intracapsular tonsillectomy techniques (2.1 vs 0.3 per cent; p = 0.025). In addition, an age of 18 years or older was also found to be an independent risk factor for post-operative haemorrhage (p = 0.01).

CoblationTM intracapsular tonsillectomy was shown to be safe and effective across all ages and indications, with a low risk of bleeding and revision surgery.

Day-case functional endoscopic sinus surgery is associated with increased patient satisfaction and reduced costs. This study aimed to identify reasons for overnight admission with a view to improving same-day discharge.

This was a retrospective observation study over a one-year period. All consecutive patients who underwent elective functional endoscopic sinus surgery were included.

A total of 172 patients were included in this study. Functional endoscopic sinus surgery was planned as a day-case procedure in 152 patients (88 per cent), with a planned overnight stay in 20 (12 per cent). The rate of same-day discharge in patients who underwent elective functional endoscopic sinus surgery was 80.2 per cent (n = 138). Reasons for an unplanned overnight admission were: bleeding (n = 8), urinary retention (n = 3), medical co-morbidities (n = 1), post-operative pain (n = 1) and social reasons (n = 1).

There is scope to further improve the functional endoscopic sinus surgery day-case rate by utilising techniques to minimise post-operative bleeding. This has the potential to improve both patient satisfaction and service efficiency.

Necrotising otitis externa is increasingly being seen and treated within the UK. The aim of this study was to explore the potential cost of a cohort of patients with necrotising otitis externa presenting to a single tertiary NHS trust.

This was a retrospective study with data from 14 patients with confirmed necrotising otitis externa who were treated, monitored, discharged or who died between October 2016 and November 2018. Direct costs using the tariffs from the 2018 to 2019 financial year included in-patient stay, imaging, peripheral inserted central catheter line cost, ENT and out-patient parenteral antibiotic therapy visits and antimicrobial duration.

The mean cost of treatment per patient was £17 615 (range, £9407 to £38 230) with an extreme outlier costing more than £122 000.

Awareness and education at a primary care level and research into robust imaging to aid termination of treatment may lower costs in the future by catching pathology early and reducing treatment duration.

Injectable anaesthetic agents, topical creams and aqueous solutions have previously been used to anaesthetise the tympanic membrane for minor ear procedures. Topical creams take 20–30 minutes to work and injectable anaesthetics can cause canal swelling. The effectiveness of lidocaine spray has not previously been investigated in patients undergoing minor ear procedures.

Eighteen participants attending for out-patient grommet insertion or intratympanic steroid injection were prospectively recruited for this study over six months. Post-operatively, they were asked about their perceived level of pain and overall experience.

The median level of pain measured on an 11-point visual analogue scale was 2 out of 10. Forty-four per cent reported the overall experience as pleasant, with the remainder selecting slightly unpleasant (66 per cent). All participants stated they would undergo the procedure again.

Xylocaine spray is simple to administer, rapid-acting and well tolerated by patients for anaesthesia of the tympanic membrane during minor ear procedures in the out-patient setting.

Platelet-rich plasma has gained interest over the two last decades, mainly because of its role in regenerative medicine. This work aimed to assess the role of intra-operative local application of platelet-rich plasma gel in the improvement of quality of voice after microlaryngeal surgery.

This was a prospective comparative study that included 40 patients undergoing microlaryngeal surgery for benign vocal fold lesions. There were two groups divided equally into study group A and control group B. The assessment of voice was performed by videostroboscopy and acoustic analysis pre-operatively and at two weeks and one and three months post-operatively.

The data demonstrated that all the stroboscopic and acoustic parameters showed significant improvement in both groups. Group A showed significant improvement regarding acoustic parameters at the third post-operative follow up when compared with group B.

Platelet-rich plasma has a beneficial effect on voice quality following microlaryngeal surgery based in particular on acoustic parameters.

This study evaluated the olfactory, sinonasal and mucociliary functions of patients with post-coronavirus disease 2019 long-term persistent olfactory dysfunction.

Three groups of 30 patients each were formed: patients with a history of coronavirus disease 2019 infection with self-reported, persistent, sudden-onset olfactory dysfunction (group 1), patients with a history of coronavirus disease 2019 infection without any self-reported olfactory dysfunction (group 2) and healthy controls with no history of coronavirus disease 2019 infection (group 3). Saccharin time, Sniffin’ Sticks, Turkish Nasal Obstruction Symptom Evaluation and Sino-Nasal Outcome Test 22 scores were compared.

Turkish Nasal Obstruction Symptom Evaluation scores were similar between groups (p = 0.252). Sino-Nasal Outcome Test-22 scores were higher in group 1 than groups 2 and 3 (p < 0.01 and p < 0.001, respectively). Saccharin time was significantly longer in group 1 than groups 2 and 3 (p < 0.05 and p < 0.01, respectively). Group 1 had lower olfactory scores than groups 2 and 3 (p < 0.001 and p < 0.001, respectively).

Mucociliary clearance time was significantly prolonged in patients with post-coronavirus disease 2019 persistent olfactory dysfunction. Coronavirus disease 2019 infection was likely to cause asymptomatic olfactory dysfunction.

This study aimed: to evaluate the association between coronavirus disease 2019 infection and olfactory and taste dysfunction in patients presenting to the out-patient department with influenza-like illness, who underwent reverse transcription polymerase chain reaction testing for coronavirus; and to determine the sensitivity, specificity, and positive and negative predictive values of olfactory and taste dysfunction and other symptoms in these patients.

Patients presenting with influenza-like illness to the study centre in September 2020 were included in the study. The symptoms of patients who tested positive for coronavirus on reverse transcription polymerase chain reaction testing were compared to those with negative test results.

During the study period, 909 patients, aged 12–70 years, presented with influenza-like illness; of these, 316 (34.8 per cent) tested positive for coronavirus. Only the symptoms of olfactory and taste dysfunction were statistically more significant in patients testing positive for coronavirus than those testing negative.

During the pandemic, patients presenting to the out-patient department with sudden loss of sense of smell or taste may be considered as positive for coronavirus disease 2019, until proven otherwise.

To determine histopathological changes in nasal mucosa associated with duration of nasal packing with Merocel tampons.

This study included 24 healthy rabbits, 6 rabbits per group. In group A, no tampon was applied. In group B, Merocel nasal tampons were applied and removed after 24 hours. In group C, the tampons were removed after 48 hours. In group D, the tampons were removed after 5 days. Specimens were obtained from the septum of each rabbit, including cartilage. Histopathological examination was performed.

Significant differences were observed in terms of inflammatory infiltration and loss of cilia between groups A and B. Significant differences were also observed in terms of inflammatory infiltration, haematoma, cilia loss, epithelium dysplasia and cartilage degeneration between groups B and C. There were significant differences in terms of cilia loss, epithelium dysplasia and subepithelial fibrosis between groups C and D. Cartilage degeneration was mild in one animal in group B and in two animals in group C, and was moderate in four animals in group C.

It is recommended that Merocel nasal tampons are removed within 48 hours to preserve nasal mucosal function. Keeping the pack longer may cause cartilage degeneration and other complications.

To quantify patient eligibility for cochlear implantation following National Institute for Health and Care Excellence 2019 guidelines (TA566) over five years at our institution, and identify factors influencing patients’ decisions surrounding cochlear implantation referral.

A multi-perspective service evaluation was conducted at a district general hospital, comprising cochlear implantation eligible patients. The main outcome measures were: eligibility numbers for 2014–2019, comparing application of TA566 versus 2009 (TA166) guidelines; and patient interview transcripts and questionnaires.

There was a 259 per cent average increase in cochlear implantation eligibility from 2014 to 2019. Most patients’ thresholds were 80 dB HL or more at 3 kHz and 4 kHz. There are several cochlear implantation barriers, including patient-centred issues (e.g. health-related anxieties, implantation misperceptions) and external barriers (difficulty getting to regional implant centres). Motivating factors for cochlear implantation include improved quality of life and access to local cochlear implantation services.

The TA566 guidelines have increased cochlear implantation eligibility, putting pressure on cochlear implantation centres and referring hospitals. Current referral systems have external and patient-centred implantation barriers. British cochlear implantation delivery may need rethinking to meet increasing populational demands and improve accessibility for those most vulnerable to these barriers.

Tinnitus is a common auditory disorder in which patients experience noise in the absence of an external source. It is a consequence of irreversible cochlear damage. This study examined the distortion product otoacoustic emissions and P300 components of event-related potentials.

This study included a control group of 25 normal-hearing adults not complaining of tinnitus and a study group that consisted of 45 normal-hearing adults complaining of tinnitus. Measures included patient history, basic audiological evaluation, the Arabic version of Tinnitus Handicap Inventory, distortion product otoacoustic emissions testing and P300 recording.

The study group showed significantly higher hearing thresholds at all frequencies as well as delayed latencies and reduced amplitude of P300. The Tinnitus Handicap Inventory showed mean scores of 35.2 ± 16.9, and the distortion product gram showed higher amplitudes in the control group.

Patients with tinnitus might have neural dysfunction at either peripheral or central levels of the auditory pathway.

The aggressiveness of paediatric cholesteatoma has long been a matter of debate. While much of the evidence is substantiated by data from the Western world, it is further limited by the retrospective nature of most studies. Therefore, this paper presents a comparative analysis of various characteristics of cholesteatoma between paediatric and adult populations seen at our centre.

A total of 50 patients (25 adults and 25 paediatric) with clinical diagnosis of chronic suppurative otitis media with cholesteatoma underwent canal wall down mastoidectomy over a period of two years. The intra-operative findings were noted and patients were followed up for six months.

There was more extensive spread and ossicular erosion in paediatric cases. However, complications such as facial canal dehiscence and lateral semicircular canal dehiscence were more common in adults.

Paediatric cholesteatoma is more aggressive and invasive than adult cholesteatoma, and the clinical behaviour is consistent with findings from other parts of the world.

In transnasal endoscopic surgical procedures, the lens of the endoscope often becomes fogged or smeared with mucus or blood. The surgeon has to clean the lens and reintroduce the endoscope multiple times during the surgery, making it a tiring process.

This paper describes an innovative lens irrigation system comprising a modified 16 Fr Foley catheter, a 20 cc or 50 cc syringe filled with warm normal saline (0.9 per cent), and a commercially available intravenous infusion set. The rigid endoscope is introduced into the catheter through the urine draining port. When the lens gets smudged with blood or mucus, the irrigating saline in the syringe is forced through the inflating port.

A clear vision was restored immediately on flushing the syringe. The system did not compromise the operative space or hinder manoeuvrability.

This cost-effective, innovative lens irrigation system saves the time spent in cleaning the lens and enhances operational efficiency, especially in a low-income setting.

Laryngotracheal reconstructive surgery very often requires placement of laryngeal stents, but most of the available stents either do not conform to the shape of the glottis or are open at the upper end, causing significant tissue reaction and aspiration. LT-Mold is an ideal stent in this respect, but it is not readily available.

The authors of this study fashioned a laryngeal stent out of a readily available Montgomery T-tube in such a way that it had a closed upper end and was well-conformed to the architecture of the larynx. This stent was used in a case of posterior expansion laryngoplasty, and post-operatively the patient had a patent airway with good voice and no aspiration.

A customised laryngeal stent is well tolerated and helps to solve complicated cases of posterior glottic stenosis.

Sudden hearing loss, or progressive hearing loss occurring over months to years, are well-established presentations. However, little is described in the medical literature on how to approach patients presenting with a rapidly progressive hearing loss occurring over weeks. This study aimed to evaluate the clinical significance of patients presenting with rapidly progressive hearing loss.

A case of rapidly progressive hearing loss occurring over 12 weeks is presented. A PubMed literature review was performed to determine the evidence-based differential diagnoses for rapidly progressive hearing loss.

Fifteen causes were identified for rapidly progressive hearing loss: intracranial aetiologies (meningioma, lymphoma, metastatic deposit, cavernous angioma, meningitis, superficial siderosis); paraneoplastic syndrome (small cell lung carcinoma, thymoma); inflammatory or autoimmune disorders (autoimmune inner-ear disease, sarcoidosis, vasculitis, Sjögren's syndrome); infective disorders (syphilis, human immunodeficiency virus); and medication-induced causes.

Rapidly progressive hearing loss should be considered a ‘red flag’ symptom that warrants urgent action. Most causes are systemic or sinister in nature, and the patient's hearing loss can potentially be reversed.