Malignant otitis externa is a potentially fatal infection of the skull base. With an ageing population and increasing prevalence of diabetes, the incidence of malignant otitis externa in the British population is rising. To date, there remain no accepted diagnostic criteria, few prognostic indicators and no consensus treatment pathways.

A prospective case series was conducted at a tertiary referral teaching hospital.

A cohort of susceptible individuals predominates (elderly, male, with immunosuppression and diabetes), with 25 per cent reporting a preceding incident. Otorrhoea, otalgia and canal granulation were the commonest presenting features, alongside positive pseudomonas cultures. No clear markers for predicating disease severity were isolated; however, a high initial haemoglobin A1c level demonstrated a significant moderately positive correlation with length of treatment.

A treatment pathway designed to provide a standardised approach to investigation and treatment is proposed, which aims to increase earlier diagnosis, streamline care and facilitate the development of best practice.

This study aimed to compare the diagnostic reliabilities of transient evoked otoacoustic emissions, automated auditory brainstem responses and brainstem auditory evoked responses for detecting hearing loss, and to use the information regarding hearing level of automated auditory brainstem responses for planning rehabilitation.

A total of 144 high-risk infants (288 ears) completed the 3 hearing tests. The sensitivity and specificity of otoacoustic emissions and automated auditory brainstem responses were compared using the chi-square test.

Automated auditory brainstem response was the most reliable test of hearing levels, with a sensitivity of 91.7 per cent and specificity of 92.1 per cent; the sensitivity of otoacoustic emissions was 78.7 per cent and the specificity was 88.8 per cent.

Automated auditory brainstem responses have acceptably high sensitivity and specificity. Additionally, the hearing level from automated auditory brainstem responses can help the screeners explain to the parents the importance of further diagnosis and rehabilitation.

To propose a new classification of inner-ear anomalies that is more clinically oriented and surgically relevant: the SMS (Sawai Man Singh) classification of cochleovestibular malformations.

A retrospective multicentric study was conducted of 436 cochlear implantations carried out in 3 Indian tertiary care institutes. Patients with anomalous anatomy were included and classified, as per the new SMS classification, into cochleovestibular malformation types I, II, III and IV, based on cochlear morphology, modiolus and lamina cribrosa.

There were 19, 23, 8 and 4 patients with cochleovestibular malformation types I, II, III and IV, respectively. Two-year post-operative Meaningful Auditory Integration Scale scores were statistically analysed.

This new classification for inner-ear anomalies is a simpler, more practical, outcome-oriented classification that can be used to better plan the surgery. These merits make it a more uniform classification for recording results.

This study investigated the relationship between disease severity and taste and smell functions in patients with obstructive sleep apnoea syndrome.

A total of 65 patients with recurrent upper airway obstruction during sleep were included. Participants were divided into four groups according to apnoea-hypopnoea index, obtained on polysomnography. Smell and taste tests were performed on these patients.

A significant difference was observed between the smell thresholds of the groups for the identification test (p = 0.016). In the taste test, significant differences were observed between the groups in terms of sweet, sour, salty and bitter taste test thresholds (p = 0.029, p = 0.0005, p = 0.001 and p = 0.017, respectively).

As sleep apnoea severity increased (according to the apnoea-hypopnoea index) in obstructive sleep apnoea syndrome patients, the taste and smell thresholds decreased due to the effect of neuropathy and inflammation in the upper respiratory tract.

To study the clinical outcomes of a posterior nasoseptal flap used in the endonasal reconstruction of anterior skull base defects.

The early harvested flap was used to reconstruct anterior skull base defects in patients with high-flow on-table cerebrospinal fluid leak. Post-operatively, the patients were analysed for cerebrospinal fluid leak and bleeding.

Of the 100 patients, 87 had macro defects while 13 had micro defects. Non-secretary lesions were present in 60 patients, while secretary lesions were present in 40 patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery, and the majority of them had a lumbar drain fitted. Post-operatively, two patients experienced bleeding and only two patients had a cerebrospinal fluid leak.

The use of a posterior nasoseptal flap for reconstruction of the anterior skull base amongst patients with a high-flow intra-operative cerebrospinal fluid leak can help prevent post-operative cerebrospinal fluid leak. Its applicability to wide patient profiles, with respect to age, size of defect and diagnosis, make it a versatile choice for reconstruction after endonasal anterior skull base surgical procedures.

Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.

A retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.

The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.

The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.

It is hypothesised that patients with muscle tension dysphonia have a high prevalence of dysphagia in comparison to normative values reported in the literature.

This prospective study included 44 subjects diagnosed with muscle tension dysphonia, based on symptoms and laryngoscopic findings, and 25 control subjects with no history of dysphonia and normal laryngeal examination findings. Demographic data included age, gender and smoking history. The aetiology of muscle tension dysphonia was classified as primary or secondary. Evaluation involved the Eating Assessment Tool (‘EAT-10’) questionnaire.

Patients’ mean age was 45.93 ± 14.95 years, with a female to male ratio of 1.2:1. Fourteen patients had primary muscle tension dysphonia, while 30 had secondary muscle tension dysphonia. Among patients with secondary muscle tension dysphonia, Reinke's oedema was the most common aetiology. There was a significant difference in the prevalence of dysphagia between the study group and the control group (40.9 per cent vs 8 per cent respectively, p < 0.05).

This study demonstrates a higher prevalence of dysphagia in patients with the presenting symptom of dysphonia and diagnosed with muscle tension dysphonia in comparison to subjects with no dysphonia.

To explore the role of T-helper 17 cells and their cascade in the pathogenesis of laryngeal cancer.

Prospectively, 110 consecutive patients with a suspicious laryngeal lesion were evaluated for serum levels of T-helper 17 cell related interleukins, including interleukins 23, 17A and 22, determined by enzyme-linked immunosorbent assay. The patients were divided into 2 groups after pathological evaluation: 49 patients with malignancy and 61 with benign pathology. Associations between interleukin levels and malignancy were determined via correlation analyses.

Interleukin 17A and 22 levels were significantly higher in the malignancy group than the benign lesion group. Pearson correlation analysis showed that interleukins 17A and 22 acted in a cascade, but interleukin 23 did not. According to predictive values, interleukin 17A levels were 3.87 times and interleukin 22 levels were 1.09 times more likely to be associated with laryngeal cancer. The cut-off values for predicting laryngeal cancer were 3.55 pg/ml for interleukin 17A and 119.82 pg/ml for interleukin 22.

T-helper 17 cell related interleukins are potential biomarkers that may be helpful in diagnosing laryngeal cancer. Moreover, these data may support neutralisation of T-helper 17 cell related cytokine activity, which could be an attractive strategy for treating laryngeal cancer.

To describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.

The medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.

Objective improvement of subglottic stenosis was seen in all four cases, with end-result Myer–Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.

Laryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.

To assess published reports of oncological surgical success rates in patients who underwent transoral laser supraglottic surgery and robotic surgery for supraglottic cancer.

A systematic review of the literature was conducted and a meta-analysis of published data was performed. PubMed, Sage, Medline and Cochrane data sources were investigated. Overall survival rates, disease-specific survival rates, additional treatments and recurrence rates were investigated to determine the success of the surgical procedures.

The meta-analysis included 24 studies; 1617 studies were excluded. There were no statistically significant differences between the transoral laser supraglottic surgery and transoral robotic supraglottic surgery groups in terms of overall survival (77.0 per cent and 82.4 per cent respectively) and disease-specific survival (75.8 per cent and 87.0 per cent respectively). There was recurrence in 164 out of 832 patients (19.7 per cent) in the transoral laser supraglottic surgery group and in only 6 out of 66 patients (9 per cent) in the transoral robotic supraglottic surgery group.

Transoral laser surgery and robotic surgery appear to have comparable and acceptable oncological success rates.

This study compared the complications and functional outcomes of patients with oral tongue cancer who had undergone reconstruction using a submental island flap or a radial forearm free flap.

Of the 54 patients, 29 underwent reconstruction with a submental island flap and 25 patients with a radial forearm free flap. The complications and outcomes of speech and swallowing were evaluated.

In the submental island flap group, all the flaps were successfully transferred with no donor site complications. In the radial forearm free flap group, partial skin graft loss and arm function restriction were recorded. Mean operative time and duration of hospital stay were significantly shorter in the submental island flap group. Speech and swallowing function were comparable between the two groups. There was no significant difference in locoregional recurrence between the groups.

The submental island flap is reliable and is suitable for oral tongue reconstruction. It has a lower complication incidence when compared to the radial forearm free flap, while maintaining speech and swallowing function.

Sjögren's syndrome is a rheumatological condition. Diagnosing Sjögren's syndrome can be challenging given the overlapping nature of clinical presentations. Currently, minor salivary gland biopsy is considered the definitive test for diagnosing Sjögren's syndrome. Various surgical techniques have been described, targeting biopsy of minor salivary glands from the lower lip. Identification of minor salivary glands is often difficult because of bleeding. One common complication of minor salivary gland biopsy is lip paraesthesia from iatrogenic sensory nerve injury.

To describe a minor salivary gland biopsy technique in a bloodless operative field using a chalazion ophthalmic clamp under local anaesthesia, and to report our clinical outcomes.

A prospective study was performed on patients who underwent minor salivary gland biopsy using a chalazion ophthalmic clamp between July 2017 and April 2018.

The study included 23 patients. The histopathological reports positively identified minor salivary glands for all patients. In nine cases, the histological findings were positive for Sjögren's syndrome. No lip paraesthesia complications were reported post-operatively.

This technique facilitates a superior yield, ensures adequate sampling of appropriate glands for histopathological analysis, and minimises the complications associated with traditional techniques.

Head and neck cancer follow-up length, interval and content are controversial. Therefore, this study aimed to evaluate the efficacy of the follow-up protocol after curative treatment in head and neck cancer patients.

Clinical data of 456 patients with new malignancy of the head and neck from a tertiary care centre district from 1999 to 2008 were analysed. Time from treatment, symptoms and second-line treatment outcomes of patients with recurrent disease were evaluated.

A total of 94 (22 per cent) patients relapsed during the 5-year follow-up period; 90 per cent of recurrences were found within 3 years. Fifty-six per cent of the patients had subjective symptoms indicating a recurrence of the tumour. All recurrent tumours found during routine follow-up visits without symptoms were found within 34 months after completion of treatment.

Routine follow up after three years is questionable; recurrent disease beyond this point was detected in only 2 per cent of patients. In this study, all late tumour recurrences had symptoms of the disease. Easy access to extra follow-up visits when symptoms occur could cover the need for late follow up.

This study aimed to determine the incidence of metastatic squamous cell carcinoma in patients with an isolated cervical cystic mass, and to describe the clinical features that might predict the origin of cystic tumours.

Adult patients with isolated lateral cervical cystic masses who were scheduled for surgery from 1st January 2010 to 31st August 2016 in two tertiary care referral centres in Slovakia were analysed retrospectively.

The incidence of cystic metastases in the whole cohort and in patients aged over 40 years were 9.9 per cent and 18.5 per cent, respectively. The incidence in patients aged over 40 years (18.5 per cent) was statistically significant (p = 0.003).

The incidence of cystic squamous cell carcinoma metastases in lateral cervical cysts in patients aged over 40 years is high enough to call for excisional biopsy with frozen section, panendoscopy with direct biopsies, tonsillectomy and even neck dissection in cases of histologically confirmed carcinoma.

Medical equipment can transmit pathogenic bacteria to patients. This single-institution point prevalence study aimed to characterise the types and relative amount of bacteria found on surgical loupes, headlights and their battery packs.

Surgical loupes, headlights and battery packs of 16 otolaryngology staff and residents were sampled, cultured and quantified. Plate scores were summed for each equipment type, and the total was divided by the number of users to generate mean bacterial burden scores. Residents completed a questionnaire regarding their equipment cleaning practices.

The contamination rates of loupes, headlights and battery packs were 68.75 per cent, 100 per cent and 75 per cent, respectively. Battery packs cultured more bacteria (1.58 per swab ± 1.00) than loupes (0.75 per swab ± 0.66; p = 0.024). Headlights had non-significantly greater growth (1.50 per swab ± 0.71) than loupes (p = 0.052). Bacterial growth was significantly higher from inner surfaces of loupes (p = 0.035) and headlights (p = 0.037). Potentially pathogenic bacteria were cultured from the equipment of five participants, including: Pantoea agglomerans, Acinetobacter radioresistens, Staphylococcus aureus, Acinetobacter calcoaceticus baumannii complex and Moraxella osloensis.

This study demonstrates that surgical loupes and headlights used in otolaryngology harbour non-pathogenic skin flora and potentially pathogenic bacteria.

In November 2017, a working feasibility analysis commenced of a local anaesthetic endonasal procedures out-patient clinic service at Freeman Hospital, Newcastle upon Tyne. Fundamental to introducing an innovative ambulatory out-patient practice is the development of a novel local safety standard for invasive procedures to support this service.

This paper presents the new safety standard developed for this purpose and implemented in our institution.

Increasingly, there is a shift toward ambulatory services, directed by patient choice, technological advances and the opportunity for cost savings. It is hoped that this local safety standard for invasive procedures will provide a useful template for those considering implementing ambulatory endonasal services, or other novel procedures, within the specialty of ENT.