To identify changes in hearing loss, tinnitus, vertigo, and migraine in individuals with Ménière’s disease diagnosed with coronavirus disease 2019 and during the UK national lockdown.

Patients were questioned regarding coronavirus disease 2019 status and how their symptoms of hearing loss, tinnitus, vertigo, and migraine changed because of the pandemic. Of the 411 participants recruited into this study, 382 had a self-reported coronavirus disease 2019 status.

Of those individuals with a positive coronavirus disease 2019 diagnosis, 43 (11.3 per cent) were more likely to experience worsening symptoms of hearing loss and tinnitus. Worsening symptoms of hearing loss and tinnitus, but improved symptoms related to vertigo, were observed during the UK national lockdown.

A diagnosis of coronavirus disease 2019 and/or experiencing the consequences of a national lockdown potentially resulted in a worsening of hearing loss and tinnitus symptoms. Symptoms of vertigo were found to have improved during the same period.

This study investigated the risk factors for developing pharyngocutaneous fistula, the most common complication following total laryngectomy.

We included all patients who underwent total laryngectomy and bilateral neck dissection from 2009 to 2021. Patients excluded were those with hypopharyngeal involvement, total or partial pharyngectomy, base of the tongue resection, large pharyngeal defects requiring free/pedicle flap reconstruction, or salvage laryngectomy.

A total of 164 patients participated in the study. Multivariate regression analysis identified two independent predictors of pharyngocutaneous fistula formation: pharyngeal reconstruction with simple interrupted sutures (odds ratio: 3.12, 95 per cent confidence interval: 1.31–17.00, p = 0.010) and radical neck dissection (odds ratio: 3.16, 95 per cent confidence interval: 1.13–8.82, p = 0.028).

Our findings suggest that pharyngeal reconstruction using simple interrupted sutures and radical neck dissection are independent risk factors for pharyngocutaneous fistula development. Based on this, we recommend using the modified Cushing suture technique over simple interrupted sutures due to its association with a significantly lower pharyngocutaneous fistula rate.

This study aimed to investigate the impact of vitamin D deficiency on vestibular function and recurrence in patients with benign paroxysmal positional vertigo.

This study enrolled 138 patients diagnosed with benign paroxysmal positional vertigo. Vestibular function was evaluated, including ocular vestibular evoked myogenic potentials, cervical vestibular evoked myogenic potentials and caloric tests. Vitamin D levels were recorded.

There was a significant difference in mean vitamin D levels between the normal and abnormal groups of the caloric test, cervical vestibular evoked myogenic potentials, and ocular vestibular evoked myogenic potentials. The likelihood of abnormal vestibular function was lower in patients with normal vitamin D levels than those with deficient levels (< 10 ng/ml). Vitamin D levels were the only predictive factor for recurrence among patients with benign paroxysmal positional vertigo.

A deficiency in vitamin D is more likely to result in abnormalities in the caloric test, cervical vestibular evoked myogenic potentials, and ocular vestibular evoked myogenic potentials in benign paroxysmal positional vertigo patients. The interaction among these factors may contribute to the recurrence.

Salvage neck dissection for squamous cell carcinoma is performed for residual or recurrent nodal disease after chemoradiotherapy or radical radiotherapy for locally advanced head and neck cancer. Our study aims to investigate the extent to which salvage neck dissection can be safely performed in treating recurrent or residual nodal metastasis.

A retrospective analysis of 53 patients with suspected residual or recurrent nodal disease after primary treatment (January 2016 to December 2018) was performed.

Pathological confirmation of viable squamous cell carcinoma following surgery was found in 43.4 per cent of patients. Post-operative infection, accessory and vagal nerve injuries were more common in patients with dissection of levels I–V than that of levels II–IV. There was no significant difference in three-year survival rate between patients with levels II–IV dissection and that of levels I–V dissection (p = 0.84).

The extent of salvage neck dissection can be limited to reduce post-operative complications while maintaining acceptable oncological outcomes.

This study aimed to describe outcomes of paediatric stapes surgery at an academic tertiary care centre.

Electronic medical records of patients younger than 21 years who underwent stapedotomy between September 2013 and July 2020 were reviewed.

A total of 17 patients (7 male, 10 female) were included in our study; 14 underwent surgery on one ear while 3 underwent surgery on both ears (20 ears total). Mean pre-operative air-bone gap was 34.5 dB (standard deviation, 11). At three months, the mean post-operative air-bone gap was 20.6 dB (standard deviation, 10.2), with a mean improvement of 17 dB (standard deviation, 12.1). Sixty-four per cent of patients had closure of their air-bone gap to 20 dB or less. A negative correlation between pre-operative body-mass index and post-operative air-bone gap was statistically significant (n = 14, p = 0.03, r = -0.57 [95% confidence interval -0.85, -0.04]).

Paediatric stapedotomy can be effective and safe. In this cohort, age was not correlated with improvement in air-bone gap; pre-operative body mass index was significantly correlated with post-operative air-bone gap.

Congenital hearing loss is a chronic condition which occurs worldwide. In the past, investigations focused on testing the most common genes associated with hearing loss (such as Connexin 26-related hearing loss). Targeted testing of specific genes was requested only when a particular syndrome was suspected. Recent advances have led to the development of a large gene panel which utilises next-generation sequencing to simultaneously test for pathogenic variants in many genes associated with hearing loss.

This review article aims to highlight the changes in the approach to congenital hearing loss in the context of the R67 gene panel, and how its use may increase the efficiency of the diagnosis and management of this condition.

The use of this large gene panel has revolutionised the approach to hearing loss. Uptake of this large gene panel has resulted in prompter diagnosis and therefore more appropriate clinical management.

This study evaluates the safety and utility of Eustachian tube balloon dilatation in treating Eustachian tube dysfunction symptoms in adults without middle-ear disease.

A prospective cohort study was performed. Adults with dilatory Eustachian tube dysfunction symptoms and no middle-ear disease underwent Eustachian tube balloon dilatation. A clinical assessment including tympanometry, pure tone audiometry, otoscopy, ability to Valsalva, and Eustachian Tube Dysfunction Questionnaire-7 was performed pre-operatively and repeated during a 12-month follow-up period.

Fifteen participants were enrolled. The mean pre-operative Eustachian Tube Dysfunction Questionnaire-7 score of 4.6 reduced to 2.5 at six weeks (P < 0.01), 3.0 at six months (P = 0.02) and 2.6 at 12 months (P < 0.01) post-operatively. All patients without evidence of negative middle-ear pressure had Eustachian Tube Dysfunction Questionnaire-7 score improvements. There were no post-operative complications.

Eustachian tube balloon dilatation is safe and effective at treating Eustachian tube dysfunction in patients with no middle-ear disease or evidence of negative middle-ear pressure.

For 50 years, the Thomas Wickham-Jones (TWJ) Foundation has promoted the advancement of otology and audiology in the UK and Republic of Ireland through a series of overseas Fellowships and other grants.

The paper examines the history of the Foundation since its establishment in 1974, drawing upon the Foundation's archives and personal recollections. The analysis is located within a framework concerning the factors that shape the success or failure of a foundation including vision, strategy, information, leadership and finance.

The activities of the TWJ Foundation are charted over five decades, and the governance of the Foundation is detailed. Particular attention is given to the Major Fellowships offered, at first in North America, and to their subsequent development into the Foundation's current rotation.

The paper offers an assessment of the TWJ Foundation's impact on the training of otologists in the British Isles and concludes with a brief self-reflective analysis.

The adipofascial anterolateral thigh (AF-ALT) free flap represents a versatile technique in head and neck reconstructions, with its applications increasingly broadening. The objective was to detail the novel utilization of the AF-ALT flap in orbital and skull base reconstruction, along with salvage laryngectomy onlay in our case series.

We conducted a retrospective analysis at Roswell Park Comprehensive Cancer Center, spanning from July 2019 to June 2023, focusing on patient demographics and reconstructive parameters data.

The AF-ALT flap was successfully employed in eight patients (average age 59, body mass index [BMI] 32.0) to repair various defects. Noteworthy outcomes were observed in skull base reconstructions, with no flap failures or major complications over an average 12-month follow-up. Donor sites typically healed well with minimal interventions.

Our series is the first to report the AF-ALT flap's efficacy in anterior skull base and orbital reconstructions, demonstrating an additional innovation in complex head and neck surgeries.

Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD)

To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities.

Building on the current Cochrane review of medications in BPD, an update literature search was done in March 2024. We followed the methods of this Cochrane review, but scrutinised all identified placebo-controlled trials post hoc for reporting of non BPD-specific (‘co-occurring’) psychopathology, and explored treatment effects in subgroups of samples with and without defined co-occurring disorders. GRADE ratings were done to assess the evidence certainty.

Twenty-two trials were available for quantitative analyses. For antipsychotics, we found very-low-certainty evidence (VLCE) of an effect on depressive symptoms (standardised mean difference (SMD) −0.22, P = 0.04), and low-certainty evidence (LCE) of an effect on psychotic–dissociative symptoms (SMD −0.28, P = 0.007). There was evidence of effects of anticonvulsants on depressive (SMD −0.44, P = 0.02; LCE) and anxious symptoms (SMD −1.11, P < 0.00001; VLCE). For antidepressants, no significant findings were observed (VLCE). Exploratory subgroup analyses indicated a greater effect of antipsychotics in samples including participants with co-occurring substance use disorders on psychotic–dissociative symptoms (P = 0.001).

Our findings, based on VLCE and LCE only, do not support the use of pharmacological interventions in people with BPD to target co-occurring psychopathology. Overall, the current evidence does not support differential treatment effects in persons with versus without defined comorbidities. Medications should be used cautiously to target co-occurring psychopathology.

Endoscopic endonasal surgery of the skull base carries the risk of meningitis. However, no consensus on the prophylactic antibiotic regimen exists.

A prospectively held database documenting endoscopic endonasal repair of cerebrospinal fluid (CSF) leaks in the anterior skull base was reviewed. Post-operative meningitis and antibiotic usage within 30 days of the index procedure were recorded.

A total of 285 consecutive cases were identified with a post-operative meningitis rate of 3.5 per cent. The post-operative confirmed bacterial meningitis rate was 2 per cent. All cases received a single dose of a single agent antibiotic peri-operatively.

The risk of developing post-operative meningitis was associated with a post-operative CSF leak in cases undergoing tumour resection of the anterior skull base.

A single dose, single agent peri-operative antibiotic regimen would appear to be adequate following an endoscopic endonasal approach to repair a CSF leak in the anterior skull base.