Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to reduce the incidence of fistulae and neopharyngeal strictures.

Following a systematic search of Embase, Medline and Cochrane databases (1946 – current), included articles were assessed for bias according to the Cochrane Handbook for Systematic Reviews of Interventions.

Three case–control trials showed reduced pharyngocutaneous fistula rates with the use of salivary bypass tubes; six case series reported widely varied fistula rates. With regards to stricture rates, the largest case–control trial found no improvement with salivary bypass tube use. No fatal adverse events were observed among the 204 patients who received a salivary bypass tube.

Low-level evidence suggests salivary bypass tubes may reduce the incidence of fistula in high-risk patient groups. A robust randomised controlled trial, or large, multicentre cohort studies, are needed to further examine this intervention.

Advanced hypopharyngeal carcinoma has a dismal prognosis. The optimal treatment for these patients remains under debate. This systematic review aimed to compare survival following surgical and non-surgical treatments.

A systematic review was conducted of randomised studies, with a descriptive analysis of retrospective observational studies.

Two randomised trials and 11 observational studies were included in the review. A meta-analysis of randomised trials reported a hazard ratio of 0.89 for overall survival in favour of surgical treatment (p = 0.44). Neither treatment was favoured in terms of overall survival. Observational studies did not report a survival advantage with either treatment. The five-year larynx preservation rates for non-surgically treated patients were between 38 and 58 percent.

Chemoradiotherapy offers similar survivorship compared to surgery in advanced disease, while also making larynx preservation feasible. It can be used as a treatment in all patients as an alternative to surgery.

To observe the effects of magnetic resonance imaging scans in Vibrant Soundbridge 503 implantees at 1.5T in vivo.

In a prospective case study of five Vibrant Soundbridge 503 implantees, 1.5T magnetic resonance imaging scans were performed with and without a headband. The degree of pain was evaluated using a visual analogue scale. Scan-related pure tone audiogram and audio processor fitting changes were assessed.

In all patients, magnetic resonance imaging scans were performed without any degree of pain or change in pure tone audiogram or audio processor fitting, even without a headband.

In this series, 1.5T magnetic resonance imaging scans were performed with the Vibrant Soundbridge 503 without complications. Limitations persist in terms of magnetic artefacts.

In order to achieve a faster and more reliable anterior rhinomanometric evaluation, nasal skin was prepared using benzoin tincture solution, which provides simpler and better adhesion of the foam tape to the nasal skin.

Two consecutive anterior rhinomanometry measurements were made, one with and one without benzoin tincture application.

The average time taken to perform classic foam tape anterior rhinomanometry without benzoin tincture application was 281.32 seconds, and the average coefficients of variation for the right and left passages were 7.48 and 7.59 per cent, respectively. When benzoin tincture was used, the average time taken for completion of the tests was 121.24 seconds, and the average coefficients of variation for the right and left passages were 2.17 and 2.32 per cent.

The use of benzoin tincture to clean the nasal skin before placing foam tape shortens the procedure duration and significantly increases test reliability.

This study aimed to analyse findings of functional endoscopic sinus surgery to estimate the post-operative course of patients with chronic rhinosinusitis.

From 2007 to 2015, 291 adult patients with bilateral chronic rhinosinusitis, divided into eosinophilic chronic rhinosinusitis (n = 210) and non-eosinophilic chronic rhinosinusitis (n = 81) groups, who underwent primary functional endoscopic sinus surgery were enrolled. Functional endoscopic sinus surgery findings, scored as operating score, were analysed in relation to pre-operative olfactory recognition threshold and sinonasal computed tomography imaging score, as well as post-operative endoscopic appearance.

Operating scores in eosinophilic chronic rhinosinusitis were significantly worse than those in non-eosinophilic chronic rhinosinusitis. The anterior ethmoid sinus and superior meatus were predominantly inflamed. Operating score significantly correlated with pre-operative olfaction recognition threshold, computed tomography score and pre-operative endoscopic appearance score. In eosinophilic chronic rhinosinusitis, higher operating scores were related to post-operative deterioration of endoscopic appearance score.

The operating score reflects the course following functional endoscopic sinus surgery. Patients with more severe operative findings require longer post-operative treatment.

To investigate the likelihood of allergic rhinitis and potential co-morbidities, and to assess whether allergic rhinitis is associated with arterial blood pressure and hypertension.

In this population-based study, 369 adults with allergic rhinitis and asthma were assessed via a questionnaire and immunoglobulin E levels. There were four groups: control (n = 90), allergic rhinitis (n = 99), asthma (n = 87) and hypertension (n = 93). Arterial blood pressure was measured in all groups.

There were no significant differences in systolic or diastolic blood pressure between males and females in any group. Pairwise comparisons revealed no significant differences between: the control and allergic rhinitis groups, the control and asthma groups, or the allergic rhinitis and asthma groups. The systolic and diastolic blood pressure values of males and females were significantly higher in the hypertension group than the allergic rhinitis group. There were no significant differences in systolic blood pressure or diastolic blood pressure for seasonal and perennial allergic rhinitis patients.

Rhinitis was not associated with increased blood pressure. Allergic rhinitis can coincide with asthma and hypertension. The findings do not support the need for blood pressure follow up in allergic rhinitis patients.

To describe a newly observed frontal sinus anatomical variant, the fronto-septal rostrum.

Consecutive sinus computed tomography scans performed during 2013 were reviewed. The fronto-septal rostrum was defined as a mucosa-lined air space formed in the attachment of the most upper bony nasal septum and the central floor of the frontal sinuses.

The study included 400 computed tomography scans from 189 women (47.3 per cent) and 211 men (52.8 per cent), with a mean age of 46.8 years. A fronto-septal rostrum was observed in 122 patients (30.5 per cent), with a mean length of 10.63 mm, width of 4.52 mm, height of 2.18 mm and volume of 63.52 mm3. There was no statistically significant difference related to gender (p = 0.343), and no association between the side of the fronto-septal rostrum and age (p = 0.811) or volume (p = 0.203).

The newly described fronto-septal rostrum has possible clinical and surgical implications. It is suggested that this aerated space is used in specific surgical indications and its presence evaluated in cases of septal infection.

Oropharyngeal squamous cell carcinoma is thought to rarely metastasise to bone. This study hypothesised that in p16-positive disease there is a significant incidence of bony metastasis.

This was an ambispective cohort review. All patients with oropharyngeal squamous cell carcinoma diagnosed and treated at one centre were included.

A total of 180 consecutive patients were identified over 5 years. Fifteen patients were excluded because of lack of p16 status, none of whom had bony metastasis. The final analysis included 165 patients: 48 (29.09 per cent) in the p16-negative group and 117 (70.91 per cent) in the p16-positive group. Ten patients (8.55 per cent) in the p16-positive group developed bony metastasis, compared with zero in the p16-negative group; this difference was statistically significant (p = 0.036).

Expression of p16 was associated with an increased incidence in bony metastasis in this cohort. This is the first study to explore this specific question.

In Scotland, patients with suspected head and neck cancer are referred on the basis of the Scottish Referral Guidelines for Suspected Cancer, rather than the National Institute for Health and Care Excellence guidelines. A chest X-ray should be requested by the general practitioner at the same time as referral for persistent hoarseness. The evidence for this is level 4.

This audit identified adherence to this recommendation and X-ray results. All ‘urgent suspicion of cancer’ referrals to the ENT department in the National Health Service Greater Glasgow and Clyde for 2015–2016 were audited.

Persistent hoarseness for more than 3 weeks instigated referral in 318 patients (15.7 per cent). Chest X-ray was performed in 120 patients (38 per cent), which showed: no abnormality in 116 (96.7 per cent), features of infection in 2 (1.7 per cent) and something else in 2 patients (1.7 per cent). No chest X-ray altered the management of a patient.

Performance of chest X-ray does not alter management and its removal from the Scottish Referral Guidelines for Suspected Cancer is recommended.

This study aimed to investigate the relationship of epicardial fat thickness with severity of obstructive sleep apnoea, and clinical and polysomnographic parameters, and to determine independent predictors for epicardial fat thickness.

A total of 84 patients with a body mass index of less than 30 kg/m2 and suspected sleep-disordered breathing were included in the study. The correlations of epicardial fat thickness with polysomnographic and clinical data, and severity of obstructive sleep apnoea, were investigated.

Mean epicardial fat thickness was 3.75 ± 1.07 mm in the study group (n = 62) and 2.97 ± 0.62 mm in the control group (n = 22) (p < 0.001). There were significant positive correlations between epicardial fat thickness and: apnoea/hypopnoea index, oxygen desaturation index 3 and minimum oxygen saturation, as well as with age, body mass index, and neck and waist circumferences.

Non-obese obstructive sleep apnoea patients have thicker epicardial fat compared to controls. Oxygen desaturation index 3 has a strong correlation with epicardial fat thickness and is an independent predictor of it.

This study investigated the incidence and routes of submandibular gland involvement in oral cavity carcinoma to determine the feasibility of submandibular gland sparing neck dissection.

The records of 155 patients diagnosed with oral cavity squamous cell carcinoma, with a total of 183 neck specimens, including those involving level I, were reviewed retrospectively.

Submandibular gland involvement, via direct invasion from the anatomical proximity of T4a tumours, was evident in two patients. The floor of mouth location, either primarily or as an extension of the primary tumour, was the only risk factor for submandibular gland involvement in oral cavity carcinoma (p = 0.042). Tumour location, clinical and pathological tumour (T) and nodal (N) stages, and radiological suspicion of mandible invasion, were not found to be statistically relevant (p > 0.05).

The results suggest the feasibility of preserving the submandibular gland in early stage oral cavity carcinoma unless the tumour is located in, or extends to, the floor of mouth.

Identifying the nerve of origin in head and neck schwannomas is a diagnostic challenge. Surgical management leads to a risk of permanent deficit. Accurate identification of the nerve would improve operative planning and patient counselling.

Three patients with head and neck schwannomas underwent a diagnostic procedure hypothesised to identify the nerve of origin. The masses were infiltrated with 1 per cent lidocaine solution, and the patients were observed for neurological deficits.

All three patients experienced temporary loss of nerve function after lidocaine injection. Facial nerve palsy, voice changes with documented unilateral same-side vocal fold paralysis, and numbness in the distribution of the maxillary nerve (V2), respectively, led to a likely identification of the nerve of origin.

Injection of lidocaine into a schwannoma is a safe, in-office procedure that produces a temporary nerve deficit, which may enable accurate identification of the nerve of origin of a schwannoma. Identifying the nerve of origin enhances operative planning and patient counselling.

To report a novel management strategy for mixed hearing loss in advanced otosclerosis.

A 50-year-old male was referred to St Thomas’ Hearing Implant Centre with otosclerosis; he was no longer able to wear conventional hearing aids because of recurrent otitis externa. The patient underwent short process incus vibroplasty (using the Med-El Vibrant Soundbridge device), followed at a suitable interval (six weeks) by stapes surgery. The main outcome measures were: pure tone audiometry, functional gain and monosyllabic word recognition scores.

Post-operative pure tone audiometry showed a reduction of the mean air–bone gap from 55 dB HL to 20 dB HL. The residual mixed hearing loss was rehabilitated with the Vibrant Soundbridge, with an average device gain of 32 dB. The monosyllabic word recognition scores in quiet at 65 dB improved from 37 to 100 per cent when using the Vibrant Soundbridge at six months after switch-on of the device.

Stapedotomy in conjunction with incus short process vibroplasty (i.e. inner-ear vibroplasty) is a safe and promising procedure for managing advanced otosclerosis with mixed hearing loss in selected patients.

During tonsillectomy, one of the key concerns is establishing adequate haemostasis. Intra-operative haemorrhage from the upper pole of the tonsil fossae can be a challenge to deal with because of an inability to clearly visualise bleeding points. Laryngeal mirrors are readily available in an ENT operating theatre and routinely used for indirect visualisation of the post-nasal space during adenoidectomy.

This paper describes a technique, utilising a laryngeal mirror placed within the tonsil fossa (after having removed the palatine tonsil), to visualise the upper pole and any bleeding points.

Laryngeal mirrors can be used with case to inspect the tonsil fossa post-tonsillectomy for bleeding points which may not be directly visible, so that these can be cauterised.