We aim to investigate nutritional management of chyle leaks by a systematic review of the published literature.

We searched the following databases (Medline, Embase, Cochrane) for literature incorporating nutritional aspects in chyle leak management. We excluded non-English papers, paediatric studies, conference papers, and studies without nutritional intervention.

Among 260 patients (out of 26,270), 81.5.% (n=212/260) achieved chyle leak resolution with nutritional management, while 18.5% (n=48/260) required surgery. Median resolution duration with nutritional management was 8.7 days (range: 4.3 to 22.2), compared to surgical treatment’s median of 32 days (range: 18 to 40).

We recommend use of nutritional management in all patients with chyle leaks. There is no evidence supporting one diet over the other however clinically we suggest starting with medium–chain triglyceride/non–/low–fat diets and moving onto total parenteral nutrition, unless medically indicated otherwise.

Langerhans cell histiocytosis is a rare disorder in children that can involve the head and neck, may mimic common ENT conditions and delay diagnosis. While various case reports exist, ENT-focused reviews remain limited.

We conducted a literature review of 73 studies encompassing 244 paediatric patients with head and neck Langerhans cell histiocytosis, extracting data on presentation, treatment and outcomes. We also present a retrospective case series of 25 patients treated at a single tertiary institution.

Otologic and craniofacial bone involvement were the most common presentations. Treatments ranged from surgical curettage and intra-lesional steroids to systemic chemotherapy. Recurrence was more common in multifocal and multisystem disease. Our institutional series supported many of these findings, with detailed follow-up data and treatment responses.

This is the most extensive ENT-focused review of paediatric Langerhans cell histiocytosis to date. It highlights key clinical patterns and management approaches to aid early recognition and tailored treatment.

Human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) exhibits a favourable prognosis compared to non-HPV OPCSCC. Tumour infiltrating lymphocytes (TILs) may predict better survival outcomes for patients with HPV+OPSCC.

A retrospective review of patients treated for HPV+OPSCC between 2003-2018. TIL density scores for each patient’s tumour specimen were determined. Patients were categorised as TIL-Hi or TIL-Lo. Survival outcomes for the two TIL groups were compared.

Fifty-seven patients, 33 in the TIL-Hi group, were included. 5-year overall survival was 81.8% in the TIL-Hi and 75% in the TIL-Lo groups. 5-year disease specific survival was 87.9% and 87.5%, respectively. There was no statistically significant difference in survival outcomes between TIL-Hi and TIL-Lo.

TIL density in HPV+OPSCC has been reported to predict survival outcomes. This is not supported by the findings of this study. Further prospective evaluation with a standardised scoring technique may fully elicit the prognostic value of TILs in HPV+OPSCC.

This study examines changes in supportive care needs, quality of life and social support among laryngeal cancer patients following total laryngectomy.

Ninety-nine patients were assessed pre-operatively (T0), one (T1), three (T2) and six months (T3) post-total laryngectomy using SCNS-SF34, FACT-H&N and PSSS. Statistical analysis included repeated-measures analysis of variance and paired t-tests.

Unmet needs increased significantly over time in physical/daily (46.46 per cent →86.87 per cent), psychological (60.61 per cent →93.94 per cent), patient care (83.84 per cent →97.98 per cent) and health system domains (85.86 per cent →96.97 per cent), while sexual needs remained low. SCNS-SF34 scores rose (113.03→145.25; p < 0.001), FACT-H&N declined (97.17→75.19; p < 0.001) and PSSS decreased (55.48→41.99; p < 0.001), with family support most affected. All scales showed significant timepoint differences (p < 0.05). Notably, none of the patients underwent voice function restoration surgery during the study follow-up period, which may have amplified voice-related impacts on these outcomes.

Following total laryngectomy, laryngeal cancer patients experience escalating supportive care needs, alongside significant declines in quality of life and social support—with family support particularly affected by caregiving burdens.

Transoral robotic surgery is increasingly used for selected base-of-tongue tumours, but is often impractical in patients with severe trismus and remains cost prohibitive. Conventional transmandibular approaches are associated with significant morbidity. We describe a transpharyngeal technique incorporating hyoid suspension to address these limitations.

A retrospective series of patients undergoing transpharyngeal resection for base-of-tongue carcinoma is presented. The technique includes neck dissection with vascular control, lateral-inferior pharyngotomy, tumour excision under direct visualisation and reconstruction with pectoralis major myocutaneous flap with routine hyoid suspension. Hypoglossal nerve preservation was undertaken where oncologically appropriate.

Fifteen previously untreated patients were treated, including 12 with severe trismus. Clear margins were achieved in 13 cases. Reconstruction was performed with a pectoralis major myocutaneous flap in 13 patients. Most patients achieved decannulation and oral feeding within 30 days.

Transpharyngeal resection with hyoid suspension is a feasible and cost-effective alternative to transoral robotic surgery in selected base-of-tongue cancers, particularly in patients with severe trismus.

This retrospective study evaluated the concordance between fine-needle aspiration cytology and histopathology in parotid gland masses and assessed the diagnostic value of magnetic resonance imaging features.

Forty-two patients who underwent parotidectomy with available fine-needle aspiration cytology, magnetic resonance imaging, and histopathology results were included. fine-needle aspiration cytology–histopathology agreement was analysed for multicategorical and binary (benign vs. malignant) classifications. Magnetic resonance imaging findings, including signal intensity, contrast enhancement, cystic-like appearance and lesion size, were compared, and predictors of malignancy were evaluated using Firth logistic regression.

Thirty-eight lesions (90.5 per cent) were benign and four (9.5per cent) were malignant. Fine-needle aspiration cytology–histopathology concordance was low for histological subtype differentiation (κ = 0.082) but substantial for benign–malignant distinction (κ = 0.636; p < 0.01). All lesions were T2-hyperintense, and cystic-like appearance was strongly associated with Warthin tumour (p = 0.001; odds ratio 38.5).

No magnetic resonance imaging or clinical variable independently predicted malignancy. Overall, these findings support fine-needle aspiration cytology as the cornerstone of pre-operative evaluation of parotid masses, with magnetic resonance imaging serving primarily for surgical planning.

Post-operative haemorrhage following thyroid and parathyroid surgery is a rare but life-threatening complication. A structured protocol (“ITSRED Fred” mnemonic: Irrigation, Time, Systolic BP greater than 100 mmHg, Relief of neck extension, Elevation of venous pressure, Drain avoidance, Flap evaluation) was introduced to standardise haemostasis and closure.

Records of 1525 thyroid and parathyroid operations over a five-year period at a tertiary unit were reviewed following protocol implementation. Re-operation for bleeding and management outcomes were analysed.

Twelve patients (0.79 per cent) required re-operation for bleeding, lower than the previous 1.3 per cent. Bleeding occurred intra-operatively (n = 4), within 6 hours (n = 6) and after 6 hours (n = 2). Thyroid surgery had a higher bleeding rate (1.06 per cent) than parathyroid surgery (0.37 per cent). Hospital stay was unaffected.

The ITSRED Fred protocol was associated with reduced re-bleeding rates. Beyond safety, its structured format provides a reproducible training tool to teach junior surgeons systematic haemostatic assessment at closure.

Endoscopic lens fogging is a frequent problem during diagnostic nasal endoscopy, often necessitating scope withdrawal and increasing patient discomfort. This study compared the defogging efficacy and nasal mucosal tolerance of Savlon and warm sterile saline.

In this prospective pilot comparative study, 40 adult patients undergoing diagnostic nasal endoscopy with a 0° rigid endoscope were randomly assigned to Savlon or warm sterile saline as the defogging agent. Lens fogging severity, patient-reported discomfort, mucosal irritation and need for repeat defogging were assessed.

Both agents demonstrated comparable effectiveness in preventing lens fogging. However, the Savlon group reported significantly higher nasal discomfort and showed greater mucosal irritation compared with the warm saline group.

Warm sterile saline offers effective lens defogging with improved mucosal tolerance and patient comfort compared with Savlon during routine nasal endoscopy.

This study aimed to evaluate the efficacy of diced cartilage and platelet-rich fibrin–wrapped diced cartilage in nasal septal perforation repair.

Thirty-six rabbits were allocated to three groups. The Control group underwent repair with flaps; the Diced Cartilage group received cartilage grafts with flaps; and the Diced Cartilage plus Platelet-Rich Fibrin group received platelet-rich fibrin–coated diced cartilage with flaps.

Persistent perforations occurred in all controls. Closure rates were 66.7 per cent in the Diced Cartilage group and 81.8 per cent in the Diced Cartilage plus Platelet-Rich Fibrin group, both significantly higher than controls (p < 0.001), with no significant difference between graft groups. Fibrosis level and re-epithelialisation scores were significantly increased in both graft groups versus controls (p < 0.001).

Inter-positional graft use is crucial for successful nasal septal perforation repair; diced cartilage is an effective alternative when block cartilage is unavailable, and platelet-rich fibrin combination may further enhance outcomes.

This study aimed to evaluate the effectiveness of the SmartNav in detecting tip fold-over during cochlear implantation and to compare angular insertion depth measurements obtained via SmartNav and transorbital X-ray imaging.

This retrospective multicentre study included patients with normal cochlear anatomy, comprising 163 individuals and 213 ears who underwent cochlear implantation using Nucleus CI522 and CI622 systems at Gazi University Faculty of Medicine and Gaziantep City Hospital.

Of the 213 cochlear implantations, tip fold-over was detected in 4 implantations (1.88 per cent) intra-operatively with SmartNav. One case (0.47 per cent) of tip fold-over was not detected by SmartNav and identified post-operatively through X-ray imaging. SmartNav showed a sensitivity of 80 per cent, specificity of 100 per cent. A strong correlation was found between SmartNav and X-ray angular insertion depth measurements (p < 0.001).

The SmartNav is a reliable tool for the intra-operative detection of tip fold-overand the assessment of angular insertion depth in patients with normal cochlear anatomy.

Medications for middle-ear diseases are commonly delivered into the middle-ear cavity either by the eardrop method with a tympanostomy tube followed by tragal pumping or by intratympanic injection. The solution delivery of the eardrop method was compared with that of intratympanic injection.

Thirty rats were used. For the eardrop method, tympanostomy tube insertion, dye solution eardrop application and tragal pumping were performed in one ear. Intratympanic injection of the same solution was performed in the other ear. The ratio of the area stained by the dye solution to the total area of the middle-ear cavity in haematoxylin and eosin-stained temporal bone sections was evaluated.

The stained area ratio was not significantly different between the eardrop method and intratympanic injection (p = 0.897).

In our rat model, the eardrop method achieved solution delivery into the middle-ear cavity as effectively as intratympanic injection.

This study aimed to investigate the prevalence of misophonia among university students, examine its relationship with hyperacusis and tinnitus and explore the sensory processing patterns of individuals with misophonia in comparison to the control group.

Based on the Misophonia Questionnaire severity scores, 81 clinical misophonia and 163 subclinical misophonia patients and 60 matched healthy-controls participated the study and evaluated with the Tinnitus Handicap Inventory, Khalfa Hyperacusis Questionnaire and the Dunn Adult/Adolescent Sensory Profile questionnaire.

The incidence of clinical misophonia was 19 per cent. The clinical misophonia group had significantly higher sensory-sensitivity and sensation-avoiding scores and lower low-registration scores (Mann–Whitney U-test with Bonferroni correction; p < 0.017). Sensory processing scores across all sensory domains were significantly correlated with Misophonia Questionnaire scores. The strongest associations were moderate positive correlations in the touch (r = 0.444; p = 0.00) and visual (r = 0.420; p = 0.00) processing domains.

Findings indicate that misophonia involves heightened sensitivity and avoidance not only in auditory but also in movement, visual, touch and activity-related sensory areas, suggesting it is a complex atypical multisensory condition rather than purely audiological or psychiatric.

Difficulty visualising the round window is occasionally encountered during cochlear implant surgery. This paper presents a novel method for predicting difficult round window accessibility using pre-operative computed tomography (CT) imaging.

This is a retrospective multicentre study of all cochlear implantation surgical procedures conducted in two Singaporean tertiary hospitals between 2018 and 2021. Pre-operative CT temporal bone scans were reviewed and two lines were drawn on a single axial cut. Where both lines intersect medially, difficult round window visualisation is predicted. Computed tomography predictions were compared with intra-operative findings, and statistical analysis was performed.

In 9 of 89 cases (10.1 per cent) difficult round window access was noted intra-operatively and 8 cases (88.9 per cent) were correctly predicted by the novel method (p < 0.001; sensitivity, 89 per cent; specificity, 100 per cent).

This study describes a simple, effective method to predict difficult round window access on axial CT temporal bone images, without reconstructed images or complex calculations.

Total ossicular replacement prostheses are commonly used to restore hearing in the conductive hearing impaired. However, total ossicular replacement prostheses are expensive and scarcely available in low- and middle-income countries. Therefore, the aim was to develop and validate an open-source design of a total ossicular replacement prosthesis that can be produced locally for low- and middle-income countries hospitals.

Based on input from literature and clinicians a design was made and verified. Accuracy, re-bending safety, cadaver ear fitting, sound transmission and production learning curves were tested.

A titanium sheet metal total ossicular replacement prosthesis, costing 9 euro, showed accurate dimensions, surgeons showed short learning curves, and sound transmission was similar to commercial total ossicular replacement prostheses. Re-bending tests demonstrated bending corrections could be safely done. Good cadaver ear fitting could be demonstrated, without conflicts between the titanium sheet metal total ossicular replacement prosthesis and anatomical features.

The titanium sheet metal total ossicular replacement prosthesis design has proved to be feasible for implementation in low- and middle-income countries.

To explore the effect of parental presence on the recovery period of paediatric patients undergoing general anaesthesia for snoring surgery.

Forty-two paediatric patients who underwent snoring surgery were randomly divided into control and observation groups. The control group received routine nursing intervention, while the observation group allowed either the father or mother to enter the recovery room immediately after the child was awake and extubated, in addition to the routine nursing intervention.

Paediatric anaesthesia emergence delirium score during the recovery period was significantly lower in the observation group than the control group. The Face, Legs, Activity, Cry, Consolability score during the recovery period was also significantly lower in the observation group. Parental satisfaction with nursing was significantly higher in the observation group.

Immediate parental presence can effectively alleviate insecurity, reduce pain, decrease crying and restlessness of paediatric patients, and improve parental satisfaction with nursing.

Deep neck space infections are uncommon but potentially life-threatening conditions with variable presentation in children without clear indications for medical versus surgical management. This study aimed to identify predictors of surgical intervention.

A retrospective review was conducted of paediatric patients with deep neck space infections at a tertiary centre between 2014 and 2024. Patients were grouped by treatment approach: medical therapy, primary surgery or surgery following medical therapy. Clinical, radiological and outcome variables were analysed to identify predictors of surgical intervention.

Ninety-two patients were included: 51.1 per cent were managed successfully with antibiotics alone, and 48.9 per cent required surgery initially or after medical trial. Independent predictors of surgical intervention included younger age, fever (< 38.0° Celsius) at presentation, computed tomography confirmed abscess and cross-sectional area greater than 3.00 cm2.

Most deep neck infections respond to medical management, though younger age, fever and larger abscess size should prompt consideration for surgical consideration.