Cholesteatoma is a pathological growth of squamous epithelium in the middle ear and mastoid. Pre-operative high-resolution computed tomography is commonly performed to guide the surgical approach and evaluate disease extent. The purpose of this review is to demonstrate the level of correlation between high-resolution computed tomography and intra-operative findings during cholesteatoma surgery.

Medline, Embase and Cochrane databases were searched in December 2024 for studies comparing high-resolution computed tomography and intra-operative findings of adult patients diagnosed with cholesteatoma.

Out of 2514 abstracts identified, 15 were included. The correlation between pre-operative high-resolution computed tomography and intra-operative findings was strongest for the identification of erosion of the malleus (k = 0.77), followed by the lateral semicircular canal and tegmen tympani (k = 0.69). The weakest correlation was found for facial nerve dehiscence (k = 0.55).

High-resolution computed tomography is useful for providing a roadmap for surgery. It offers a strong correlation for intra-operative detection of malleus, incus, lateral semicircular canal and tegmen tympani involvement.

Perineural invasion (PNI) is an unfavorable pathological characteristic associated with poor prognosis. The relationship between PNI and clinicopathological features of hypopharyngeal squamous cell carcinoma (HPSCC) remains unclear. The aim of this study was to investigate the relationship between PNI and clinicopathological features and risk factors for PNI in HPSCC.

Clinicopathological data from 182 patients with HPSCC treated at our hospital between September 2019 and March 2024 were collected and analysed retrospectively.

PNI was observed in 68 (37.4%) patients, and was associated with tumor thickness (TT), lymph node metastasis (LNM), lymphovascular invasion (LVI), number of positive nodes (pN), and lymph node density (LND). PNI was only significantly correlated with TT in the multivariate analysis.

We observed a definite correlation between PNI and TT, LVI, LNM, LND, and pN value. TT emerged as an independent risk factor for PNI, with its incidence increasing with TT.

This study aimed to evaluate the epidemiological characteristics, incidence trends and survival outcomes of nasopharyngeal carcinoma from 2000 to 2021.

A retrospective analysis of 10,419 NPC cases from the SEER database (2000–2021) was conducted. Incidence rates were calculated per 100,000 population. Joinpoint regression assessed trends, and Kaplan–Meier and Cox regression evaluated survival.

Most patients were male (68.9 per cent) and White individuals (51.2 per cent), with 49.5 per cent presenting at a regional stage. Males were more likely to present with distant disease than females (72.2 per cent vs. 27.8 per cent; p < 0.001). Nasopharyngeal carcinoma incidence was higher in males (0.8/100,000) and Asian populations (1.87/100,000). Overall incidence declined (average annual per cent change: –0.8 per cent; p = 0.002). Median survival was 79 months, longer in females (90) and Asian populations (118). Distant disease predicted higher mortality (hazard ratio 1.71; p < 0.001). Nasopharyngeal carcinoma was the leading cause of death (43.6 per cent).

Males and Asian populations had higher nasopharyngeal carcinoma incidence. Female sex and Asian race predicted better survival, while distant-stage disease increased mortality.

The aim of this study is to assess outcomes in managing post-operative chyle leaks, following neck dissection using a volume-based risk stratification algorithm.

A retrospective series (2010–2024) at a tertiary head and neck centre included all patients with chyle leaks after neck dissection for malignancy. Chyle leaks were stratified as low, medium or high volume and managed either medically or with planned intervention, video-assisted thoracoscopic surgery, thoracic duct ligation or thoracic duct embolisation.

Thirty-five patients were identified. Sixty-five point seven per cent (n = 23) with low-volume leaks resolved with conservative management, 31.4 per cent (n = 11) with moderate-/high-volume leaks underwent video-assisted thoracic duct ligation, with 10/11 resolving within one day post-operatively, 5.7 per cent (n = 2) underwent thoracic duct embolisation. All cases with ongoing chyle leaks resolved without neck re-exploration surgery.

Volume-based risk stratification, paired with early video-assisted thoracoscopic surgery ligation or embolisation, provides a highly effective, low-morbidity strategy for managing post-operative chyle leaks.

Clinical trials provide valuable treatment insights but often fail to represent real-world outcomes. This is particularly true for advanced laryngeal cancer patients, who face significant co-morbidities and socioeconomic challenges. This study evaluates whether outcomes from research datasets in The Cancer Imaging Archive reflect real-world survival in a regional cohort from North-East England.

This retrospective analysis compares outcomes between The Cancer Imaging Archive (n = 198) and North-East England (n = 222) cohorts. Demographics, treatment modalities and five-year disease-specific survival were assessed via Kaplan–Meier curves and Cox regression.

North-East England had a lower five-year disease-specific survival (59.2 per cent vs. 76.9 per cent; p = 0.0018) and was characterised by greater co-morbidity burden and upfront surgery with adjuvant therapy (51 per cent), whereas The Cancer Imaging Archive patients received upfront chemoradiotherapy (53 per cent) or radiotherapy alone (41 per cent).

The poorer real-world outcomes reflect the challenges of generalising research data to heterogeneous populations. Bridging the gap between research efficacy and real-world effectiveness is critical to delivering equitable care for advanced laryngeal cancer.

One-Stop Neck Lump Clinics have gradually been implemented across the UK over the past two decades; however, long-term data reporting is sparse. This study describes data over five years of a successfully implemented One-Stop Neck Lump Clinic.

The One-Stop Neck Lump Clinic is led by ENT surgeons and a dedicated head and neck sonographer working alongside a biomedical scientist. Yearly data (2019–2024) have been collected on all patients undergoing ultrasound +/- fine-needle aspiration in the OSNLC.

A total of 2198 patients were assessed over the five-year period. Fine-needle aspiration was performed in 45.0 per cent cases (n = 990), of which 134 samples were inadequate (13.5 per cent). Abnormal findings were reported in 19.9 per cent (n = 437). A “normal neck” with no pathology demonstrated was observed in 392 cases (17.8 per cent). Benign diagnoses comprised 1235 cases (56.2 per cent).

The OSNLC offers a streamlined pathway for rapid head and neck cancer assessment and diagnosis substantiated by long-term data.

Patients with locally advanced laryngeal malignancy may be offered total laryngectomy or chemoradiotherapy. Laryngeal dysfunction is a consequence of non-surgical treatment and can result in issues with airway, voice, and swallow.

Semi-structured qualitative interviews explore the experiences of patients who have undergone functional laryngectomy for non-functional larynx in one UK health board.

3 patients were identified and interviewed. Thematic Analysis generated four main themes: Preparation for treatment, Tipping Points, Post-Operative Quality of Life and Attitudes to Future Healthcare. These themes uncover the functional and psychological experiences of patients undergoing functional laryngectomy.

This study explores the many facets of the decision to undergo functional laryngectomy; namely recognising a patient’s tipping point and changes in attitudes towards surgical intervention. Ultimately this enhances our understanding of the rationale of patient’s choices, which can aid in the counselling of future patients.

Currently, there is no guideline to support the conversion of inhaled medications to formulations suitable for patients undergoing tracheostomy or laryngectomy. This study aimed to evaluate prescribing practices and post-operative respiratory complications.

The first cycle of this cohort study (1 October 2018 to 28 February 2022) examined existing practice, while the second cycle (1 August 2023 to 31 July 2024) assessed the impact of a newly introduced prescribing tool. The primary outcomes were the proportion of patients prescribed appropriate inhaler formulation and the incidence of post-operative respiratory complications, stratified by formulation appropriateness.

Our study demonstrated the tool improved appropriate formulation prescribing from 45 per cent to 60 per cent. In both cycles, patients receiving appropriate formulations had fewer post-operative respiratory complications.

A prescribing tool to facilitate formulation conversion was associated with improved prescribing practices and reduced complications, supporting the need for structured guidance in this high-risk population.

This study aimed to investigate morphological and signal changes of the anterior olfactory nucleus (AON) on high-resolution magnetic resonance imaging (MRI) in patients with olfactory dysfunction (OD) of varying aetiologies.

A retrospective analysis of 135 patients with post–coronavirus disease 2019 (COVID-19), post-viral, or post-traumatic OD was conducted. High-resolution MRI was used to assess AON signal intensity and area, as well as olfactory bulb (OB) morphology. Clinical evaluation included Threshold (T), Discrimination (D), and Identification (I) scores and the presence of parosmia.

AON signal abnormalities were present in 55.5 % of cases. Post–COVID-19 patients had significantly lower TDI scores than other groups. While AON signal and morphological differences were observed across aetiologies, a consistent correlation with TDI scores was not found, except in limited subgroup analyses.

Abnormalities of the AON are common in OD, but do not reliably indicate severity or aetiology. Further research is needed to determine their clinical relevance.

This study evaluates the effectiveness of a newly implemented protocol for the management of permanent childhood hearing impairment in a UK district general hospital.

A retrospective closed-loop audit was conducted over two 24-month cycles. Children diagnosed with permanent childhood hearing impairment, through the national hearing screening program, were included.

Implementation of the new protocol led to significant improvements between the two cycles. The mean time from diagnosis to first ENT review reduced from 439.4 to 188.1 days. The interval from diagnosis to magnetic resonance imaging acquisition improved from 617.8 to 58.5 days (p < 0.05), whilst the mean age at magnetic resonance imaging reduced from 758.3 to 102.6 days (p < 0.05). Magnetic resonance imaging utilisation increased from 60 per cent to 100 per cent, and genetic referrals rose from 28.6 per cent to 100 per cent.

These findings highlight the effectiveness of a streamlined protocol in improving multidisciplinary care for children with permanent childhood hearing impairment, offering a model for broader adoption in similar healthcare settings

The Association of Otolaryngologists in Training wanted to assess the experiences of bullying, harassment and raising concerns in their otolaryngology posts.

An online survey of otolaryngology trainees, with 190 responses out of 350 targeted, included questions on bullying and harassment.

Many respondents had experienced or witnessed a range of bullying, harassment and sexual harassment behaviours, including: unrealistic expectations about workload, responsibilities or level of competence; inadequate or absent supervision; and undervaluing someone’s contribution (in their presence or otherwise). However, very few (5 per cent or less) had reported them. Twenty-one per cent would not feel confident in reporting bullying/harassment or sexual harassment problems, and 40 per cent do not feel safe raising concerns. Just 10 per cent said the existing reporting mechanisms are sufficient.

A number of initiatives have been introduced recently in the UK to address bullying and harassment within the medical workplace, but there is still potential for further development.

The Association of Otolaryngologists in Training wanted to assess trainee well-being.

A survey was developed that incorporated the Copenhagen Burnout Inventory, the short Warwick–Edinburgh Mental Wellbeing Scale and the Brief Resilience Scale plus questions on working conditions.

There were 190 responses and while most respondents had low or moderate levels of burnout, 15 per cent had high personal burnout and 13 per cent had high work-related burnout. The mean well-being score for respondents was lower than for the whole population mean. In addition, 39 per cent of respondents reported their mental well-being had been slightly affected in a negative way by their working environment and conditions in the last 6 months, and 26 per cent reported it being significantly affected negatively. Of these, 43 respondents reported an impact on patient safety.

This first-ever survey of ENT trainees in the UK identified several areas of concern, including how the working environment and conditions affect trainee well-being and impact patient safety.

Tonsillectomy is a common paediatric procedure with potential morbidity, notably post-operative pain and bleeding. One proposed factor influencing these outcomes is the surgeon’s level of training.

To evaluate whether surgical training level affects short-term outcomes in paediatric tonsillectomy.

In a prospective randomised study (2019–2022), outcomes were compared in children undergoing cold dissection tonsillectomy performed by either an attending or a supervised resident. Measured outcomes included duration of analgesia use, time to resume oral intake, length of hospital stay and post-operative bleeding.

A total of 115 children were included in the study, of which 60 (52.2 per cent) were operated on by residents and 55 (47.8 per cent) were operated on by attending surgeons. Baseline characteristics were similar. Operations by attending surgeons were shorter (20.4 vs 29.1 minutes), but no significant differences were found in post-operative pain, diet resumption, length of stay (1.1 days) or bleeding.

Supervised residents achieve comparable outcomes to attending surgeons. Surgical training level does not impact tonsillectomy outcomes under supervision.

Clinical exposure is vital in medical education, but in paediatric otolaryngology traditional bedside teaching can cause children distress and fatigue. Augmented reality technology offers a solution to enhance learning while reducing these challenges. This study evaluated the feasibility of using Microsoft HoloLens 2 augmented reality technology in clinical paediatric ENT to reduce children distress during bedside teaching.

An 18-month pilot study at Alder Hey Children’s Hospital involved 109 4th-year medical students from the University of Liverpool. Students participated in virtual ward round sessions, where one student performed a clinical review using HoloLens 2, while others observed and interacted remotely. Feedback from students, patients and parents was collected verbally and via questionnaires.

Overall, 69 per cent of students rated the augmented reality session as equivalent or better than traditional bedside teaching. Most students (87 per cent) had no prior experience with augmented reality, yet found it engaging and beneficial. Parent reported reduced stress for their children.

Augmented reality using HoloLens 2 is a promising tool for teaching clinical paediatric ENT, providing an immersive, child-friendly learning experience. While effective, high costs and technical challenges may restrict wider implementation. Future studies should explore further integration of augmented reality in medical education.

To characterize treatment trends and facial weakness outcomes in vestibular schwannoma management using real-world data from a large US patient cohort.

This retrospective cohort analysis utilized the TriNetX US Collaborative Network. The study included 72,496 patients diagnosed with vestibular schwannoma, managed with observation, stereotactic radiosurgery or surgical treatments. Main outcome measures were demographic profiles, treatment modality utilization, facial weakness incidence and historical (2022–2025) and predicted (2025–2026) treatment trends.

It showed a slight female predominance (54.35 per cent) and underrepresentation of Black and Asian patients. Observation was most common (87.6 per cent), followed by surgery (65.3 per cent) and stereotactic radiosurgery (34.7 per cent). Facial weakness rates: 4.7 per cent (observation), 9.1 per cent (stereotactic radiosurgery), 24.4 per cent (surgery). Combined treatments had higher facial weakness rates. Stereotactic radiosurgery use was stable; translabyrinthine surgery declined; posterior fossa approaches increased.

This comprehensive analysis highlights varying facial weakness risks across treatment modalities, disparities in the treatments and evolving treatment preferences.

Cystic neck masses have a wide differential diagnosis. Fine-needle aspiration cytology with or without thyroglobulin washout may be non-diagnostic or false-negative, while a primary thyroid tumour may be sonographically occult. We aim to demonstrate the value of biochemical thyroglobulin measurement in directly aspirated cyst fluid in diagnosis or exclusion of papillary thyroid cancer cystic nodal metastases.

Prospective case series (n = 10) of patients presenting with a lateral cystic neck mass with or without thyroid abnormality, where thyroglobulin measurement of aspirated cyst fluid was part of the diagnostic workup.

N1b papillary thyroid cancer diagnosis was predicted by elevated thyroglobulin in cyst fluid aspirate in seven cases, all greater than 200 µg/L, confirmed at surgical resection. Papillary thyroid cancer nodal metastasis was refuted by low thyroglobulin result in three benign cystic lesions, all less than 6 µg/L.

Biochemical thyroglobulin analysis of fluid aspirate is a valuable adjunct for evaluation of cystic neck masses and pre-operative diagnosis of papillary thyroid cancer cystic nodal metastases.

Pharyngeal high-resolution manometry provides detailed insights into pharyngeal swallowing biomechanics by offering high-resolution pressure measurements across the pharynx and upper oesophageal sphincter. Here we present our early experience using the technology.

Retrospective cohort study of 43 patients who underwent pharyngeal high-resolution manometry assessment for dysphagia at a tertiary dysphagia clinic. Swallows of varying consistencies were tested, and key metrics based on international guidelines were analysed.

PHRM facilitated the diagnosis of cricopharyngeal spasm, pharyngeal weakness and upper oesophageal sphincter dysfunction. It revealed pharyngeal weakness in 50 per cent and ruled out cricopharyngeal spasm in 20 per cent of patients with suspected findings. In post-treatment failures, it detected pharyngeal weakness in 83 per cent of cases. Pharyngeal high-resolution manometry also supported diagnosis and management of retrograde cricopharyngeal dysfunction and globus sensation.

Pharyngeal high-resolution manometry is a valuable adjunct in evaluating dysphagia, enabling more accurate diagnoses and tailored treatments. It helped avoid unnecessary surgeries and improved care for patients with complex swallowing disorders.