Confidence among surgeons is required for complex decision-making and surgical ability. However, surgical trainees’ confidence is decreasing. This systematic review aims to explore factors that affect the confidence of surgical trainees.

A systematic review was performed following the PRISMA guidelines. Pubmed®, Embase™, Scopus, ClinicalTrials.gov and grey literature were searched for primary research on factors affecting surgical trainee confidence.

Eleven studies were included. Key factors positively impacting trainee confidence were receiving regular positive feedback, working with a supportive trainer and having a calm working environment and effective team dynamic. The main factors negatively impacting trainee confidence were experiencing undermining behaviour from trainers and stressful, time-pressured environments. Female gender was also associated with reduced confidence. Greater confidence was associated with higher perceived performance.

This work assimilates the factors impacting surgical trainees’ confidence, which could guide training programmes to improve trainee self-confidence and therefore patient care.

The present review aims at an insight into the pathophysiology of chronic rhinosinusitis with nasal polyposis through the combination of three tissue sources: (1) nasal polyp, (2) neighboring non-polypoid mucosa (MS) and (3) healthy controls.

The primary outcomes included three lists of molecules (1) those significantly different between nasal polyp, neighboring non-polypoid mucosa and controls (2) those up/downregulated in nasal polyp, but comparable between MS and controls and (3) those comparable between nasal polyp and neighboring non-polypoid mucosa, but different between NP and controls.

Ten studies investigating a large variety of 68 molecules presented comparisons between nasal polyp and neighboring non-polypoid mucosa in endotype-specified populations. Comparisons between nasal polyp and neighboring non-polypoid mucosa are approached separately for eosinophilic/non-eosinophilic chronic rhinosinusitis with nasal polyposis . The small number of studies prohibits a meta-analysis.

Inclusion of neighboring non-polypoid mucosa in future studies may provide a bias-free list of the molecules that contribute to the actual pathogenesis and preservation of nasal polyps within the chronic rhinosinusitis inflammatory environment.

The aim of this study is to systematically review and analyse the literature regarding clinical application of picrotoxin for vertigo caused by peripheral vestibular disorders.

We conducted a search in PubMed/MEDLINE and Google Scholar in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. The primary selection included all studies exploring the effect of this phytopharmacological substance on the vestibular system and vertigo. The secondary selection included only reports on its clinical use for treatment of Ménière’s disease and other peripheral vestibular disorders.

From the 398 identified studies, 18 were included from the primary selection and 6 from the secondary selection. In total, 203 patients received picrotoxin; 85 of them were treated for vertigo with 1-mg picrotoxin suppositories. In this subgroup vertigo was reduced in 74.9 per cent.

Picrotoxin is a non-invasive treatment option worth considering, especially in cochlear-implanted patients with recurring disabling vertigo.

Otolaryngology/ear, nose and throat conditions are common in clinical practice, yet undergraduate exposure in UK medical schools remains limited. The coronavirus disease 2019 pandemic created opportunities to innovate medical education. This review explores the scope of advance in otolaryngology undergraduate education following the coronavirus disease 2019 pandemic.

A search of MEDLINE, Embase, Cochrane, and Education Resources Information Center databases was conducted. Studies that met inclusion criteria were subject to risk-of-bias assessment and narrative analysis.

Interventions such as mixed reality, cadaveric teaching, and anatomical models improved short-term performance and student satisfaction. Surveys limited advancement in clinical exposure to otolaryngology/ear, nose and throat, when compared to pre-coronavirus-disease literature.

Despite the potential for reform following the pandemic, there has been no significant advancement in the provision of undergraduate medical education in the post-coronavirus-disease era. Standardisation of undergraduate education is needed to mirror recent changes to assessment in undergraduate education in the UK.

To report clinical outcomes following primary thyroglossal duct cyst surgery.

Retrospective case note review of 79 patients undergoing surgery for suspected thyroglossal duct cyst at a tertiary referral paediatric centre between 2014 and 2018.

Thyroglossal duct cyst was confirmed histologically in 57.0 per cent. Classic Sistrunk procedure was performed in 60.0 per cent, modified Sistrunk procedure with central neck dissection in 35.6 per cent, and cystectomy in 4.4 per cent. Overall recurrence rate was 15.6 per cent; of recurrence patients, 85.7 per cent had a classic Sistrunk procedure and 14.3 per cent had cystectomy. There were no recurrences in modified Sistrunk procedure with central neck dissection patients. Post-operative infection occurred in 14.8 per cent undergoing classic Sistrunk procedure, 12.5 per cent undergoing modified Sistrunk procedure with central neck dissection and 0 per cent undergoing cystectomy. Return to theatre was required in 7.4 per cent undergoing classic Sistrunk procedure and 0 per cent undergoing modified Sistrunk procedure with central neck dissection or cystectomy. None experienced post-operative haemorrhage.

Modified Sistrunk procedure with central neck dissection for primary thyroglossal duct cyst was not associated with increased morbidity compared with classic Sistrunk procedure, and appears to have lower recurrence risk.

The primary aim of this study was to investigate qualitative themes contributing to a successful ENT induction.

Responses were gathered as part of “RecENT SHO”, a multi-centre retrospective cross-sectional survey. Qualitative data were analysed thematically, with key themes supported by direct quotations.

A total of 380 eligible responses identified four major themes: induction methodology, induction duration, senior clinician involvement and post-induction support. Respondents strongly favoured face-to-face, simulation-based training and practical skill development under senior supervision.

This study highlights the critical components of successful ENT inductions, emphasising the necessity of practical skill training and senior clinician involvement. Future induction programmes should incorporate these findings to improve resident doctor preparedness and patient safety.

This study compares outcomes of open versus percutaneous tracheostomies in coronavirus disease 2019 patients to guide clinical decision-making based on disease severity.

A retrospective cohort study using the 2020 National Readmissions Database identified 4810 coronavirus disease 2019 patients (International Statistical Classification of Diseases and Related Health Problems 10th Revision code U071) who underwent tracheostomy. Of these, 2061 had open and 2749 had percutaneous tracheostomies. Patient demographics, severity (All Patient Refined-Diagnosis Related Groups) and outcomes (mortality, readmission, complications) were analysed using chi-squared tests, both overall and by severity.

Mortality was higher in the percutaneous group (29.25 per cent) compared to the open group (26.35 per cent) (p = 0.0265). For severe cases (All Patient Refined-Diagnosis Related Groups 3–4), open tracheostomies had significantly lower mortality, readmission and complication rates (p < 0.05).

Open tracheostomies are associated with better outcomes in severe coronavirus disease 2019 cases. Percutaneous tracheostomies are effective in mild cases, but patient selection and procedural planning should consider disease severity. Future research should validate these findings.

Few studies have investigated stapedotomy using 1470 nm diode laser, and the present article contributes with clinical experience.

A retrospective analysis was conducted to investigate hearing performance of 22 patients undergoing 1470 nm diode laser-assisted primary stapedotomy.

In 8/22 cases, accidental breaches to the inner ear by the laser and in 14/22 cases the stapedotomy was performed as planned only by drill. Air–bone gap and loss of sensorineural hearing were low and with no significant differences for groups at follow-up. No patients with breaches by laser reported new or worse tinnitus.

Accidental breaches in the stapes footplate using this diode laser did not appear to equate with inner ear damage within this limited cohort. Hearing outcomes were not significantly affected. These findings should be interpreted with caution. Further studies evaluating this laser wavelength in stapedotomy is required.

Efficacy of gastric inlet patch (GIP) ablation using argon plasma coagulation (APC) for patients presenting with persistent throat symptoms was evaluated.

Retrospective observational study from a single university hospital. Consecutive patients who had GIP ablation for persistent throat symptoms between 01/10/2018-31/10/2023 were reviewed and patients who met all of the set inclusion and exclusion criteria were included in this study for analysis.

50% (n = 18/36) of patients responded to APC ablation (median follow-up 3 months) with their post-ablation GETS score decreasing by 30-100%. Long-term follow-up results could be obtained from 22 patients (n = 22/36) and 75% (n = 9/12) had their clinical effects maintained (median follow-up 4.5 years; range 2.7–5.8 years).

GIP ablation can be a very effective treatment for patients with persistent throat symptoms with its therapeutic effects long-lasting. Future studies should focus on evaluating the optimal patient selection process for GIP ablation for persistent throat symptoms.

To investigate socio-economic and clinical disparities in the utilisation of robotic surgery for head and neck cancer.

Using the National Cancer Database (2010–2020), 212 449 surgically treated patients were analysed. Multivariate logistic regression identified predictors of robotic versus non-robotic surgery (p < 0.05).

Robotic surgery utilisation increased over time during the study period. The following characteristics positively correlated with the use of robotic surgery: male, aged 41–80 years, White race, insured (with private insurance, Medicaid and Medicare) and treatment at an Academic/Research centre. Metropolitan residency, higher income/education levels, lower comorbidity (Charlson–Deyo score of 0) and Stage I disease were also associated with increased robotic surgery utilisation.

Significant socio-economic disparities exist in robotic surgery access, potentially exacerbating outcome inequities. Targeted interventions are needed to improve equity in treatment access and standardise care protocols. Further research should validate trends and address systemic barriers.

To evaluate early postoperative complaints using the Palate postoperative Problems Score in patients undergoing modified barbed reposition pharyngoplasty with tonsillectomy and tonsillectomy alone.

The study included 40 patients who underwent modified barbed reposition pharyngoplasty with tonsillectomy and 18 patients who had tonsillectomy alone. Patients completed the Palate Postoperative Problems Score questionnaire at the first, third and sixth months post-operatively, and changes in their complaints were observed. Additional data included the Epworth Sleepiness Scale and sleep parameters (apnea-hypopnea Index, body mass index and oxygen saturation).

In the modified barbed reposition pharyngoplasty group, Palate Postoperative Problems Scores decreased significantly from 8.85 (month 1) to 4.07 (month 6). The tonsillectomy group also showed significant improvement (from 5.28 to 2.61 by month 3).

The Palate Postoperative Problems Score questionnaire is an effective tool for assessing post-operative symptoms after palate surgery. Repeated use enables monitoring of patient recovery and the impact of tonsillectomy should be considered in Palate Postoperative Problems Score-based evaluations.

To show our experience in performing endoscopic-assisted maxillectomy (EAM), with the aim of facilitating delineation of tumour resection and improve the achievement of free tumour resection margins.

Patients undergoing EAM between 2021 and 2024 were reviewed. During the endoscopic approach, the medial and lateral plates of the pterygoid were drilled, taking as reference the superior margin of the inferior turbinate.

Six patients underwent an EAM surgery. The maxillectomy was completed with an external transfacial approach in four patients and with a transoral approach in two. No intraoperative complications were observed. Five patients had postoperative flap dehiscence; two cases healed spontaneously and three cases required surgery.

EAM allows delimitation of the posterior limit of tumour resection in total or subtotal maxillectomies. This endoscopic approach facilitates the drilling of the pterygoid process to complete the posterior osteotomy, which is a complex manoeuvre during the exclusive external approach.

To evaluate the impact of a two-week otolaryngology rotation incorporating entrustable professional activities, human factors and simulation on medical students’ knowledge, perceptions and career aspirations.

The curriculum included six small-group sessions on compassion, communication, resilience, teamwork and professionalism, and three simulations: suturing, flexible nasendoscopy and grommet insertion. These were delivered alongside standard teaching. Pre- and post-rotation questionnaires assessed otolaryngology knowledge, career interest, surgical confidence and attitudes toward simulation and human factors.

While students’ interest in surgical careers remained unchanged, they reported improved comfort with otolaryngology knowledge, operating theatre environments and recognition of non-technical skills. Perceptions of simulation and essential surgeon qualities significantly improved.

Integrating entrustable professional activities, human factors education and simulation into short surgical rotations enhances both technical and non-technical skills. This approach may help address challenges in attracting students to surgery by enriching their educational experience and building confidence.

To investigate the stapes superstructure removed during surgical procedure under a light microscope, see whether the stapes superstructure was directly or indirectly affected by otosclerosis, and evaluate the results using the audiometric data.

Histologic section of the stapes superstructures of 30 patients operated for otosclerosis were retrospectively analysed.

There were no obvious active/inactive otosclerotic foci in the investigated stapes superstructures. Nevertheless, stapes superstructures had certain histopathologic findings that were not normally expected. Patients with otosclerotic alterations (Group 1) and without otosclerotic alterations (Group 2) were compared by pre-operative and post-operative air conduction, bone conduction, and air–bone gap.

The stapes superstructure contained degenerative findings similar to osteoarthritis of long bones and histopathologic changes that might be considered significant in terms of otosclerosis. Nevertheless, these changes did not significantly affect pre-operative and post-operative pure tone audiometry data. This is the first study known to us that investigated the stapes superstructure from the otosclerosis perspective, and the cases were assessed in combination with audiometric data.

To evaluate the indications, outcomes, and recurrence rates of elective paediatric functional endoscopic sinus surgery at a tertiary centre, and to highlight the continued importance of multidisciplinary management.

A retrospective review included 65 patients (age range 5–17 years) undergoing elective paediatric functional endoscopic sinus surgery from January 2017 to December 2024. Data on demographics, surgical details, additional procedures, and revision rates were collected. Logistic regression identified predictors of revision.

Chronic rhinosinusitis was the most common indication (45/65), with 62 per cent requiring polypectomy and 84 per cent undergoing middle meatal antrostomy. Fifteen percent had cystic fibrosis; cystic fibrosis status significantly predicted revision (odds ratio 8.5, p = 0.007). A multidisciplinary approach was crucial for the 20 per cent needing additional procedures. No major complications were reported.

Paediatric functional endoscopic sinus surgery is safe and effective for paediatric sinonasal disease, particularly where balloon sinuplasty is insufficient for polyposis. Multicentre collaborations will help refine selection criteria and enhance long-term outcomes.

To explore the treatment options and prognostic factors of vocal fold leukoplakia.

The study examined conservative and surgical treatment approaches, and analysed prognostic factors influencing vocal fold leukoplakia outcomes.

In the conservative treatment group, lesion size (p = 0.035) and smoking (p < 0.001) were identified as independent factors influencing treatment outcomes. In the surgical treatment group, lesion size (p = 0.018) was identified as an independent factor affecting recurrence. There was no statistically significant difference in the effectiveness of conservative versus surgical treatment for patients with hyperplasia (p = 0.223), mild dysplasia (p = 0.634) and moderate dysplasia (p = 0.758).

Smoking and lesion size are key factors influencing the outcome of conservative treatment, while lesion size is a significant factor affecting recurrence in surgically treated patients. More importantly, conservative treatment should be prioritised for patients with moderate dysplasia and milder vocal fold leukoplakia.

Ear arteriovenous malformation is a complex problem with a lack of data and a clear consensus on its management. This paper aims to develop an algorithm for protocol-based ear arteriovenous malformation management.

All patients underwent pre-operative discussions at a multi-disciplinary team meeting to plan excision and pre-operative embolisation.

Nineteen patients were included in this study. Following excision, 26.3 per cent of cases had flap cover, 10.5 per cent needed a skin graft, 15.3 per cent had total amputation of the ear, and the rest underwent excision of the arteriovenous malformation with or without cartilage excision and primary closure. Recurrence was observed in 10.5 per cent of cases.

Surgical excision is the treatment of choice for ear arteriovenous malformations. Cartilage should be preserved whenever possible. The wound cover should be either a primary closure or a flap cover. A protocol-based guide facilitates decision-making of this complex problem.

This study aimed to evaluate the quality of information provided by artificial intelligence (AI) applications regarding ENT surgeries and usability for patients.

ChatGPT 4.0, GEMINI 1.5 Flash, Copilot, Claude 3.5 Sonnet and DeepSeek-R1 were asked to provide detailed responses to patient-oriented questions about 15 ENT surgeries. Each AI application was queried three times, with a 3-day interval between each session. Two ENT specialists evaluated all responses using the Quality Analysis of Medical Artificial Intelligence (QAMAI) tool.

Average QAMAI scores for each AI application were as follows: ChatGPT 4.0 (27.56 ± 1.20), GEMINI 1.5 Flash (26.24 ± 1.26), Copilot (26.84 ± 1.35), Claude 3.5 Sonnet (28.24 ± 0.77) and DeepSeek-R1 (28.13 ± 0.84). A statistically significant difference was found among the applications (p < 0.001). ICC analysis indicated high stability across evaluations conducted for all five AI applications (p < 0.001).

AI has the potential to provide patients with accurate and consistent information about ENT surgeries, yet differences in QAMAI scores show that information quality varies between platforms.

Adenoid hypertrophy contributes to nasal obstruction and obstructive sleep disorders in children, but can be difficult to assess. This study examines whether inferior turbinate hypertrophy can predict adenoid hypertrophy severity in children with obstructive sleep disorders.

This retrospective cohort study included children (0–18 years) with a diagnosis of obstructive sleep-disordered breathing or obstructive sleep apnoea who underwent drug-induced sleep endoscopy. Analyses explored demographic, clinical and endoscopic associations with adenoid hypertrophy.

A total of 269 children were included. Separate univariate analyses showed that older age and greater inferior turbinate hypertrophy predicted greater adenoid hypertrophy (p < 0.05). However, in multivariate ordered logistic regression, only inferior turbinate hypertrophy remained significant (p < 0.01), while age did not (p = 0.11).

These findings suggest inferior turbinate hypertrophy may serve as a proxy for adenoid hypertrophy, aiding clinicians in assessment and guiding further evaluation or intervention.