The aim of this study is to identify risk factors for residual dizziness in benign paroxysmal positional vertigo patients after repositioning manoeuvres and explore the mediation role of lipid indicators.

In all, 110 benign paroxysmal positional vertigo patients treated from January 2019 to February 2022 were studied. Data on demographics, diseases, behaviours, and lipids were collected. Multivariate logistic regression assessed risk factors, and mediation analyses explored effects via lipid indicators. Odds ratios and 95 per cent confidence intervals are reported.

Differences between groups with and without residual dizziness included limb weakness, hypertension, nausea, arteriosclerosis, medication, dizziness handicap inventory scores, hospital anxiety and depression scale scores, and lipid distributions (p < 0.05). Significant risk factors were sleep disorders, medication, hypertension, triglycerides, and total cholesterol (p < 0.05). Total cholesterol mediated 9.1 per cent of the effect of sleep disorders on residual dizziness.

Managing lipid levels and sleep disorders is crucial in treating residual dizziness in benign paroxysmal positional vertigo patients after repositioning.

The aim of this study is to investigate hearing outcomes in patients who have undergone cerebrospinal fluid (CSF) leak repair via a middle cranial fossa (MCF) approach and to identify any variables that influence post-operative hearing outcomes.

This is a multi-centre study. A total of 65 patients who underwent an MCF approach CSF leak repair were included. Retrospective case review was conducted to collect patient demographic and clinical data including pre- and post-operative audiometry.

A total of 65 patients were included: 9 patients (9.2per cent) had an encephalocele confirmed on magnetic resonance (MR) imaging, whilst the remaining patients had biochemically confirmed, beta-trace protein positive CSF leaks. Post-operatively, there was a statistically significant improvement in both bone conduction (Z = -3.71, p < 0.001) and air conduction thresholds (Z = -5.82, p < 0.001). None of the studied variables were found to be associated with the degree of hearing improvement.

The MCF approach for CSF leak repair yields favorable audiological outcomes.

This study aims to assess the pure tone auditory thresholds in infantry and artillery personnel to evaluate potential hearing loss and ascertain the effect of military service duration on these thresholds.

A total of 108 participants, comprising 35 infantry, 30 artillery personnel, and 43 healthy volunteers as controls, underwent conventional and high-frequency pure tone audiometry. Thresholds were measured across frequencies of 125–16000 Hz.

Artillery personnel exhibited significantly higher hearing thresholds compared to controls across various frequencies, particularly in the right ear. Infantry personnel showed elevated thresholds at specific frequencies in the left ear. Correlations were observed among age, years of service and number of shots fired.

Repetitive exposure to firearm noise can lead to significant hearing loss across a broad frequency range. Implementing comprehensive ear protection programs for military personnel is crucial to mitigate these risks.

Managing benign tumours of the external nose involves balancing optimal excision with the preservation of nasal function and aesthetics. This study aims to identify histologic diagnoses, surgical strategies and post-operative outcomes.

A retrospective cohort study was conducted from November 2006 to March 2023. All surgeries were performed by a single surgeon

The included 24 patients with a mean age of 32.7 ± 19.2 years (range, 3 months to 65 years) at diagnosis. Tumours were predominantly located on the nasal dorsum (n = 11). Among the 11 histologic tumour types, haemangioma was the most common (n = 8). Most patients (70.8 per cent) underwent an open rhinoplasty approach. Recurrence occurred in four patients (16.7 per cent).

Benign tumours of the external nose exhibit diverse pathology. Partial tumour removal may be considered in extensive cases with skin involvement for preserving nasal aesthetics. A tailored surgical strategy is crucial for managing these rare tumours.

This study investigates the seasonal and regional distribution of paediatric laryngomalacia admissions in the United States, hypothesizing higher admission rates in winter and colder regions due to reduced sunlight exposure affecting vitamin D levels.

We analyzed data from the 2016 Kids’ Inpatient Database (KID), focusing on children under three years old. Laryngomalacia cases were identified using International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) code Q31.5. Seasonal and regional differences in admission rates were assessed using Pearson’s chi-squared test, with a significance level of p less than 0.05.

Of 4,512,196 estimated national admissions, 11,638 were due to laryngomalacia. Admissions increased by 10.0 per cent in winter and decreased by 10.9 per cent in summer (p < 0.005). Regionally, admissions were higher in the Midwest/Central (18.6 per cent) and Northeast (9.3 per cent) and lower in the South (7.4 per cent) and West (11.1 per cent) (p < 0.005).

Laryngomalacia admissions are significantly influenced by seasonal and regional factors, likely related to environmental conditions affecting vitamin D synthesis.

Management of paediatric non-tuberculous mycobacteria cervicofacial lymphadenitis (NTMCL) is variable without standard practice in the U.K. We undertook a survey to evaluate current U.K. practice in tertiary paediatric units.

A survey of twenty-one tertiary paediatric centres to evaluate NTMCL management.

We received over 90% response rate. Only 21% have local guidelines, with the majority believing that written national guidance would improve management. Surgery is the most common management choice (69%), with a more limited procedure if skin is involved and/or in proximity to important structures. Observation alone is favoured (32%) when there is no skin involvement but in close proximity to the facial nerve. When treated medically, rifampicin and clarithromycin for 3 months was the commonest choice. Over 25% of respondents state their management has changed following previous adverse outcomes within their own practice or department.

This survey consolidates the current management of NTMCL in U.K. tertiary paediatric units.

Head and neck cancer has a 5 per cent incidence of synchronous primary cancer. Synchronous primary cancers are commonly detected with imaging and flexible nasoendoscopy. Routine panendoscopy is still being used to screen for synchronous primary cancers. The aim was to establish the method of detection of synchronous primary cancer.

A retrospective cohort study of newly diagnosed head and neck cancer patients with a synchronous primary cancer, presented at the West of Scotland Head and Neck Multidisciplinary Team from December 2020 to August 2022. This study is Level 3 evidence.

A total of 2325 patients were presented to the Multi-Disciplinary Team with head and neck cancer and 54 (2.3 per cent) had SPC; 63.8 per cent (30) of patients had a panendoscopy. All patients with comprehensive out-patient assessment had their synchronous primary cancer detected on examination or imaging, without the need for panendoscopy.

Panendoscopy did not detect any new synchronous primary cancer in patients assessed with flexible nasoendoscopy and imaging. With modern high-resolution imaging and fibreoptics, panendoscopy does not play a role in the detection of synchronous primary cancers.

First branchial arch abnormalities are rare. Surgical excision is the mainstay of treatment and described in the literature. Excision can be associated with significant complications. We describe factors influencing operative and non-operative management of patients.

Case review was conducted between January 2012 and September 2022 of patients with first branchial arch abnormalities at Alder Hey Children’s Hospital, UK. Analysis of electronic patient records, operation notes and extraction of clinical outcomes were obtained.

Four patients were identified with an average age of 2 years and 4 months. Three were female. Three underwent operative intervention, one of which had a recurrence post-operatively and was manged conservatively. The non-operatively managed patient remains conservatively managed with no complications.

First branchial arch abnormalities can be managed operatively and non-operatively, depending on patient factors. Steps to improve surgical planning such as constructive interference in steady state magnetic resonance imaging may help decision making and risk stratification of operative management.

To gather and analyse information from the literature concerning the management of otitis media with effusion in adults.

A review of the English-language literature from 1970 to the present.

Ventilation tubes have been the standard treatment for otitis media with effusion in adults, but examination of the results of published studies shows that they are associated with disappointing outcomes and significant complications, notably intermittent or chronic discharge, particularly in cases associated with nasopharyngeal carcinoma. Balloon dilatation of the Eustachian tube, intratympanic steroid therapy and cortical mastoidectomy appear to be possible alternatives.

A rethink of the management of otitis media with effusion in adults is needed, together with further research. For cases not associated with nasopharyngeal carcinoma, intratympanic steroid therapy appears to be a promising option.

Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disorder characterised by mucocutaneous telangiectasia, leading to recurrent epistaxis in nearly all affected individuals. Treatment strategies are broadly categorised into conservative, medical and surgical approaches. This study aimed to provide a concise summary of the existing literature on epistaxis associated with hereditary haemorrhagic telangiectasia.

The Medline/PubMed database was searched for relevant articles using the keywords ‘hereditary haemorrhagic telangiectasia’, ‘Osler-Weber-Rendu’ and ‘epistaxis’.

Out of 93 reviewed articles, 59 contained pertinent information. Interventions were categorised into self-delivered therapy, intravenous treatment, in-office procedures and surgical intervention.

A stepwise approach to managing epistaxis in patients with HHT involves a gradual escalation of treatments, starting with conservative measures and progressing to more invasive interventions as necessary. Topical oils can be efficient and intranasal bevacizumab injection shows promise, but more data are needed. Surgical options range from bipolar cautery and laser therapy to complete closure of the nasal cavity. Proper patient selection remains crucial.

The relationship between clinical examination findings and objective nasal patency measures in structural nasal obstruction remains uncertain. This review aims to explore the relationship between clinical nasal examination findings and objective nasal patency measures using acoustic rhinometry, peak nasal inspiratory flow, rhinomanometry and rhinospirometry.

Qualitative systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement.

A total of 17 articles were included in the systematic review. Several studies showed a positive relationship between objective nasal patency measures and clinical nasal examination findings, however evidence in the literature is limited and confined to cohort studies. Objective nasal patency measures using acoustic rhinometry, rhinomanometry and rhinospirometry assessment correlate positively in severe anterior septal deviation but its role in assessing middle/posterior and mild/moderate septal deviation in isolation remains uncertain. There is limited evidence in the literature to assess the relationship between peak nasal inspiratory flow and clinical examination findings.

Objective nasal patency measures has a limited role in supporting clinical examination findings in severe structural nasal obstruction.

The objective of the study is to examine the current state of research and technology related to objective olfactory assessment, highlighting the merits and demerits of the techniques. It aims to specifically explore olfactory event-related potentials, discussing their potential applications, benefits, drawbacks, and prospects in the field.

A five-month narrative review examined English-language articles from PubMed, Scopus, and Google Scholar, critically summarising titles, abstracts, and full texts, while excluding non-English and methodologically weak studies.

This study provides a detailed investigation into various objective methods utilised and the applicability of olfactory event-related potentials for assessing olfaction. We reviewed key elements, such as techniques, stimulus delivery methods, optimal electrode placement, and waveform analysis.

Olfactory event-related potentials offers substantial promise in enhancing the diagnostic accuracy of olfactory dysfunction across various clinical contexts. This thorough review highlights the utility and potential of olfactory event-related potentials in improving the precision and efficacy of olfactory assessments.

Carcinoma ex pleomorphic adenoma is a rare malignant salivary gland tumour for which distinct radiological features are unclear. We aim to identify radiological features that may pre-operatively predict for carcinoma ex pleomorphic adenoma and its degree of invasion.

Systematic review of Ovid Medline, Embase, Scopus, Web of Science (BIOSIS), Cochrane, PROSPERO, OpenDOAR, and OpenGrey from inception to 29 April 2023. Primary outcomes of interest were radiological features in magnetic resonance imaging, computed tomography and ultrasound.

Of 1729 studies, 12 studies (n = 426) underwent qualitative synthesis. Imaging findings for magnetic resonance imaging, computed tomography, and ultrasound were reported in 11 studies (n = 337), five studies (n = 253) and one study (n = 89), respectively. Magnetic resonance imaging features of lower mean apparent diffusion coefficient values and heterogenous T2 intensity were reported.

Magnetic resonance imaging has the greatest utility in predicting for carcinoma ex pleomorphic adenoma. Within the limits, a heterogenous body of evidence, in addition to general radiologic features of malignancy, lower mean apparent diffusion coefficient values and heterogenous T2 intensity, may indicate carcinoma ex pleomorphic adenoma.

This paper aims to introduce our combined approach, which provides definitive treatment for intractable aspiration while preserving phonation and highlights the importance of performing both procedures together.

We describe a case of intractable aspiration requiring a nasogastric tube and a tracheostomy tube. We propose a combined technique consisting of an open medialisation thyroplasty with intra-operative, intra-glandular botulinum toxin injection. The thyroplasty procedure medialises the left vocal fold to overcome glottic insufficiency. Botulinum toxin injection reduces salivary flow and prevents excessive pooling.

The patient was followed up for twelve months. Video fluoroscopy demonstrated no evidence of aspiration. The patient was allowed a regular oral diet and decannulated two months post-operatively.

This paper demonstrates the feasibility of our combined approach as a viable treatment option for intractable aspiration, particularly in patients with a strong desire for vocalisation. The cases must be selected carefully to ensure a favourable outcome.

To report a case of cutaneous tumour seeding following core biopsy of a thyroid malignancy.

This paper presents a case report of cutaneous tumour seeding following core biopsy and a review of the literature concerning the role, and risks, of fine needle aspiration and core biopsy in the diagnostic evaluation of neck lumps.

A 75-year-old woman presented with a left-sided level IV neck lump adjacent to the left lobe of the thyroid. Fine needle aspiration revealed that the neck lump contained follicular epithelial cell groups; however, nuclear grooves and pseudo-inclusions could not exclude a diagnosis of papillary thyroid carcinoma. Subsequent core biopsy confirmed features of a thyroid neoplasm, although abundant necrosis and limited lesional cells within the specimen made histological diagnosis difficult. The patient underwent total thyroidectomy and left-sided selective neck dissection for symptom control. A superficial nodule overlying the core biopsy site was noted at operation and excised; it was found to contain cells of poorly differentiated papillary carcinoma identical to the subsequently confirmed thyroid primary.

This case highlights a rare but important risk associated with sampling neck lumps. Nevertheless, ultrasound-guided sampling is an essential investigative step with great diagnostic accuracy and patient acceptability.

Toxic shock syndrome is an uncommon but lethal infectious disease. To date, toxic shock syndrome related to otological surgical procedures has rarely been reported.

A 43-year-old man was admitted for surgery for a discharging ear with chronic otitis media. Gelfoam and tela iodoform were used to pack the mastoid cavity. Twelve hours post-operatively, he developed a high fever, dramatic gastrointestinal symptoms, and subsequent shock without local signs of infection or meningeal irritation. Culture of ear discharge grew methicillin-resistant Staphylococcus aureus. A macular rash was noted 2 days post-operatively. The patient received aggressive fluid resuscitation, antibiotics and intensive life-sustaining treatment, and the mastoid cavity was opened to facilitate drainage. However, his condition deteriorated promptly and he died of septic shock. Multiple blood cultures showed negative results.

Clinicians should be vigilant for toxic shock syndrome in patients after surgery for a discharging ear with chronic otitis media, even without local signs of infection.