Drop attacks are described as an instantaneous fall to the ground, occurring without warning and without loss of consciousness, a consequence of abrupt deformation of the otolithic membrane due to high endolymphatic pressure. Drop attacks present significant injury risk, therefore effective treatment is imperative. This review is the first to examine all evidence for the management of drop attacks in Ménière’s disease, and make recommendations.

We conducted a systematic literature review. Inclusion criteria consisted of all published English language examining treatments of drop attacks in Ménière’s disease.

One hundred and five articles were identified, 19 met criteria (case series and/or cohort studies). Two articles identified conservative treatments, eight examined intratympanic gentamicin, seven examined surgery, one examined all three and one examined intratympanic dexamethasone.

Evidence for the management of drop attacks in Ménière’s disease is limited due to small studies. Some surgical approaches have limited effect. Intratympanic dexamethasone remains a promising treatment; further research is recommended.

This study analyses the current literature to evaluate the effectiveness of dabrafenib and trametinib in the multi-modal treatment of anaplastic thyroid cancer (ATC).

A systematic review and meta-analysis of the literature were undertaken. The primary endpoint measured was overall response rate (ORR) defined by the RECIST v1.1 guidelines. Secondary endpoints were 12-month overall survival (OS), median OS and progression-free survival (PFS).

Of 656 identified reports, 8 studies were included which featured 95 patients (median age 68.5 years, 46 per cent male). Median follow-up period was 11.8 months with a 12-month OS of 51 per cent. Median OS was 10.4 months. Progression-free survival (PFS) was 6.5 months. The ORR was 71 per cent. A total of 65 patients exhibited a partial or complete response in radiological tumour size. Side effects compared favourably to other kinase inhibitors.

Dabrafenib and trametinib exhibit a promising tumour response with a tolerable side profile. BRAF/MEK inhibitors continue to provide robust responses in BRAF-mutated ATC. The heterogeneity and lack of controls in included studies limits the confidence in the conclusions drawn.

To assess the face and content validity of artificial temporal bone dissection in surgical training in the UK.

Expert and non-expert groups participated in artificial temporal bone dissection at the Queen Elizabeth Hospital, Birmingham, UK. Face and content validity were assessed by a validated post-dissection questionnaire.

The median content validity score was 34 out of 35 (interquartile range 32.00–35.00). Mean face validity score compared to human was 45.76 out of 65 (95 per cent CI 42.57–48.94). Face validity compared to cadaveric models demonstrated equivalence (95 per cent CI 25.30–30.70, crossing equivalence value 27.00). Experts rated face validity less favourably than non-experts (p = 0.012 and 0.042, respectively). Content validity was equivalent between experts and non-experts (p = 0.052). There were no significant differences in total content (p = 0.606) and face validity (p = 0.133, p = 0.105) scores between different artificial bones.

The high content and face validity suggests ENT training programs should consider formally incorporating artificial models into mastoid surgery training pathways.

Despite a lot of scientific advancements in otology, canal wall-down mastoidectomy is still considered to be the standard of care in the management of extensive cholesteatoma. To avoid large cavity related problems, mastoid obliteration has been described in the literature for many decades. Controversy prevails among otologists regarding the materials used for obliteration. This study aimed to evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement.

Retrospective analysis was performed of all consecutive patients who underwent canal wall down mastoidectomies and primary mastoid obliteration with ready-to-use, self-setting hydroxyapatite bone cement. Minimum follow-up was 1 year. Primary Outcome measures include need for explantation and post-operative complications.

Total of 26 patients were included in the study. Only one patient required complete explantation. All patients acquired dry cavities in the final follow-up. Few minor complications including external auditory canal granulations and post-aural wound dehiscence. There was no cholesteatoma recidivism.

Ready-to-use, self-setting hydroxyapatite bone cement serves the purpose of mastoid obliteration. In addition, it is time efficient and requires less expertise. It has excellent outcomes in terms of cholesteatoma recidivism. We recommend further research in this area with a large cohort.

This study aimed to predict the risk of falling using patient characteristics, computerized dynamic posturography and functional balance tests in machine learning.

One hundred twenty elderly individuals were included in this study. The fall status, physical characteristics and medical history of individuals were investigated. Pure tone audiometry test, simple functional balance tests and sensory organization test were applied to the individuals.

The machine learning model that incorporated co-morbidities, physical characteristics and functional balance tests achieved a 100 per cent accuracy in predicting fall risk. Models using only co-morbidities and physical characteristics, functional balance tests or the sensory organization test had accuracies of 87.5 per cent, 83.34 per cent and 91.66 per cent, respectively.

Advanced balance systems are not always necessary to assess fall risk. Instead, fall risk can be effectively determined using simple balance tests, co-morbidities, and patient characteristics in machine learning.

Otology training solely using cadavers is challenging because of scarcity and high costs. The use of additive manufacturing technology is a promising alternative. This study aimed to qualitatively validate new additive manufacturing temporal bone specimens for their realism and ability to train surgical skills.

Three additive manufacturing models generated using cadaveric temporal bones were evaluated. Three otologists with experience as trainers dissected and evaluated each specimen.

The additive manufacturing specimens scored an average of 4.26 ± 0.72 (out of 5) points and received positive feedback. The agreement between the three expert raters was high (intra-class correlation coefficient of 0.745).

The results suggested that the additive manufacturing temporal bones were able to faithfully reproduce a training experience similar to that on cadaveric temporal bones. Further studies that investigate the effectiveness of these specimens in training surgical skills are needed before integrating them into surgical training curricula.

Primary neoplasm of the external auditory canal has historically been documented to have a low incidence rate of between one and six per million internationally, with UK incidence yet to be officially cited.

Here, we report a rise in incidence at a single UK trust with seven carcinomas (six T4 external auditory canal squamous cell and one T4 basal cell) reported within an 18-month period. All tumours underwent next generation sequencing.

The cases recorded represented a twofold rise in incidence in reference to international literature from a population-adjusted estimate of 0.5–3 cases for the catchment area to seven cases. All cases were treated with temporal bone resections (n = 7) and with post-operative radiotherapy in six cases. Tumour analysis showed all were TP53 mutant and human papilloma virus (HPV)/P16 negative.

We suggest chronic inflammation and genetic alterations as putative contributory factors in our case series and outline clinical strategies for timely detection of external auditory canal neoplasms.

We intended to investigate the deviation of septal swell body, perpendicular plate, septal spur and vomer in patients with and without nasal obstruction.

We compared the deviation of these septal areas in computed tomography scans of patients scheduled for nasal surgical procedures (cases) and of patients without clinically relevant nasal obstruction (controls).

Septal swell body was similarly deviated between 56 cases (median value: 6.5 mm) and 56 controls (6.4 mm; p > 0.2). Septal spur was more deviated in cases (5.6 mm) than in controls (4.7 mm; p < 0.001). The deviation of perpendicular plate (found in 28/112 subjects) did not differ significantly between cases (3.0 mm) and controls (2.2 mm; p > 0.2). The deviation of vomer (found in 71/112 subjects) was larger in cases (7.1 mm) than in controls (4.3 mm; p = 0.001).

Septal spur, vomer and perpendicular plate were more frequent causes of nasal obstruction compared to septal swell body.

Transoral robotic surgery is a minimally invasive technique used in the management of head and neck cancer, though post-operative odynophagia can be a significant issue. There is debate about the necessity of elective nasogastric tube placement during the peri-operative period. This study examines the proportion of patients requiring elective nasogastric tube placement and evaluates whether pre-operative factors predict the need for nasogastric tube feeding.

Data from patients who underwent transoral robotic surgery in Oxford were analysed to assess correlations between pre-operative factors and nasogastric tube feeding.

Fifty-three patients undergoing transoral robotic surgery underwent elective nasogastric tube placement; 43 per cent required the nasogastric tube for feeding or medication. Multivariate analysis showed significant associations between nasogastric tube feeding and sex (p = 0.028), peri-neural invasion (p = 0.024), tumour size (p = 0.012) and concurrent neck dissection (p = 0.019).

Although nearly half of the patients benefited from elective nasogastric tube placement, the remainder did not. Benefits and risks of elective nasogastric tube placement should be carefully considered.

This study investigated the influence of socioeconomic factors on the incidence of laryngomalacia in paediatric in-patients.

Data from the 2016 Healthcare Cost and Utilization Project Kid Inpatient Database were analysed. Variables included zip code median income, race and/or ethnicity, primary expected payer and associated International Statistical Classification of Diseases and Related Health Problems 10th Revision codes in admission.

Lower median income zip codes showed a 6.4 per cent increase in laryngomalacia admissions, while higher-income zip codes had an 8.0 per cent decrease. Black patients exhibited a 24.5 per cent increase and Asian or Pacific Islander patients showed a 42.5 per cent decrease in laryngomalacia admissions. Medicaid and other government programme payers had a 22.1 per cent increase, while Medicare, private insurance and self-pay patients had decreases of 35.5, 20.9 and 55.7 per cent, respectively. Laryngomalacia was associated with a number of disease processes from a multitude of organ systems in a statistically significant manor.

Socioeconomic status, race, primary expected payer and co-morbid disease process significantly impact laryngomalacia admissions.

The aim of this study was to evaluate the rate of dysplasia and carcinoma-ex-papillomatosis in patients with recurrent respiratory papillomatosis and assess for any risk factors.

A 15-year retrospective observational cohort study was performed from a single centre. Data on patient demographics, treatment history and pathology results were extracted from clinical records.

Of the 123 patients identified, nine had juvenile-onset recurrent respiratory papillomatosis and 114 had adult-onset recurrent respiratory papillomatosis. Thirteen (11 per cent) of patients with adult-onset recurrent respiratory papillomatosis had dysplasia, and one patient progressed to carcinoma-ex-papillomatosis. Patients with evidence of dysplasia had an average older age of disease onset compared to those without dysplasia (49 years vs 39 years, p = 0.03).

An older age of recurrent respiratory papillomatosis onset was the only risk factor for dysplasia. Gender, tobacco use, subglottic or tracheal involvement, number of surgeries and cidofovir were not prognostic factors in this series.

Ultrasound-guided wire localisation may improve intra-operative identification and outcomes of non-palpable cervical lymphadenopathy in a previously treated neck. We undertook a literature search and present our case series to determine the safety and efficacy of ultrasound-guided wire localisation.

A search of databases up to 29 April 2024 was performed. At our tertiary centre, ultrasound-guided wire localisation was utilised for 20 patients with cervical lymphadenopathy between February 2021 and April 2024.

Seventeen studies with a combined total of 92 patients were identified, with one complication reported. Within our case series, all 20 patients had accurate lesion localisation using ultrasound-guided wire localisation and none required repeat operations.

Ultrasound-guided wire localisation is a safe and cost-effective technique for lesions in an otherwise difficult area to operate, providing confidence to the multidisciplinary team, particularly where histopathology indicates benignity. Surgical outcomes do not appear worse than outcomes without ultrasound-guided wire localisation. We advocate its use provided appropriate patient selection is considered.

Mucoepidermoid carcinoma of unknown primary (MEC-UP) in the head and neck is a rare presentation of the most common salivary gland cancer. Cancers of unknown primary sites often have poorer prognoses than similar cancers with known primary. Few cases of MEC-UP have been reported; therefore, the objective of this report is an overview of the diagnosis and management of MEC-UP.

We present two patients with low-grade MEC-UP at a high-volume tertiary care institution in Ontario, and a database search returning 1560 citations of which five studies with seven MEC-UP cases were identified.

Review of the limited cases suggest many clinicians use positron emission tomography-computed tomography (PET-CT) in addition to panendoscopy and targeted biopsies with consideration for diagnostic tonsillectomy in diagnostic work-up.

Like other salivary gland cancers, primary therapeutic surgical resection is recommended with low threshold for adjuvant radiotherapy to regions at high risk for harbouring the primary malignancy, especially in cases of high-grade histopathology.