Smoking is a risk factor for head and neck cancer. Referral for suspected head and neck cancer can be an opportunity for reassessing smoking behaviour. This study examined attitudes towards smoking in patients referred urgently with suspected head and neck cancer.

A total of 98 smokers were referred urgently for suspected head and neck cancer. Patients completed the Fagerstrom Test for Nicotine Dependence and the Perceived Risk and Benefits Questionnaire.

In the Fagerstrom Test for Nicotine Dependence, higher education background (education beyond secondary or high school level) had a lower dependence score (p = 0.02) and men were more likely to have higher dependence scores (p = 0.02). In the Perceived Risk and Benefits Questionnaire, women scored higher for concerns regarding the negative effects of smoking cessation (p = 0.01) and the perceived health benefits of smoking cessation were greater in those with higher education (p = 0.03).

Men are more nicotine dependent. Women are concerned about perceived side effects of smoking cessation. Patients with a higher education background are more receptive to cessation interventions and should be identified early.

This study measured the effectiveness of an in-house designed, cast silicone airway model in addressing the lack of easily accessible, validated transoral laser microsurgery simulation models.

Participants performed resection of two marked vocal fold lesions on the model. The model underwent face, content and construct validation assessment using a five-point Likert scale questionnaire measuring the mean resection time for each lesion and the completeness of lesion excision. Comparative analyses were performed for these measures.

Thirteen otolaryngologists participated in this study. The model achieved validation threshold on all face and content measures (median, ≥4). Construct validation was demonstrated by the improvement in mean resection time between lesions one and two (86 vs 54 seconds, W = 11, p = 0.017). The mean resection time was lower amongst more senior otolaryngologists (61.5 vs 107.1 seconds, W = 11, p = 0.017).

This synthetic silicone model is a low-cost, easily reproducible, high-fidelity synthetic airway model, demonstrating face, content and construct validity.

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.

Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disorder characterised by mucocutaneous telangiectasia, leading to recurrent epistaxis in nearly all affected individuals. Treatment strategies are broadly categorised into conservative, medical and surgical approaches. This study aimed to provide a concise summary of the existing literature on epistaxis associated with hereditary haemorrhagic telangiectasia.

The Medline/PubMed database was searched for relevant articles using the keywords ‘hereditary haemorrhagic telangiectasia’, ‘Osler-Weber-Rendu’ and ‘epistaxis’.

Out of 93 reviewed articles, 59 contained pertinent information. Interventions were categorised into self-delivered therapy, intravenous treatment, in-office procedures and surgical intervention.

A stepwise approach to managing epistaxis in patients with HHT involves a gradual escalation of treatments, starting with conservative measures and progressing to more invasive interventions as necessary. Topical oils can be efficient and intranasal bevacizumab injection shows promise, but more data are needed. Surgical options range from bipolar cautery and laser therapy to complete closure of the nasal cavity. Proper patient selection remains crucial.

This study investigated the influence of socioeconomic factors on the incidence of laryngomalacia in paediatric in-patients.

Data from the 2016 Healthcare Cost and Utilization Project Kid Inpatient Database were analysed. Variables included zip code median income, race and/or ethnicity, primary expected payer and associated International Statistical Classification of Diseases and Related Health Problems 10th Revision codes in admission.

Lower median income zip codes showed a 6.4 per cent increase in laryngomalacia admissions, while higher-income zip codes had an 8.0 per cent decrease. Black patients exhibited a 24.5 per cent increase and Asian or Pacific Islander patients showed a 42.5 per cent decrease in laryngomalacia admissions. Medicaid and other government programme payers had a 22.1 per cent increase, while Medicare, private insurance and self-pay patients had decreases of 35.5, 20.9 and 55.7 per cent, respectively. Laryngomalacia was associated with a number of disease processes from a multitude of organ systems in a statistically significant manor.

Socioeconomic status, race, primary expected payer and co-morbid disease process significantly impact laryngomalacia admissions.

The aim of this study was to compare the internet and social media use of teenagers with hearing loss with that of their normal hearing peers.

The study included 27 hearing-impaired and 27 normal-hearing peers (12–18 years). The Social Media Attitude Scale, the Internet Use Purposes Scale, University of California, Los Angeles Loneliness Scale and the Problematic Internet Use Scale were used to compare hearing-loss and normal-hearing groups.

The social isolation subscale and Social Media Attitude Scale total score differed between groups (p = 0.001 and p = 0.048, respectively). Internet Use Purposes Scale education subscale differences were statistically significant (p = 0.042). Negative consequences (p = 0.007), excessive use (p = 0.021) and Problematic Internet Use Scale total score (p = 0.005) differed significantly. The University of California, Los Angeles Loneliness Scale had a moderate negative connection with the Problematic Internet Use Scale's social benefit/comfort subscale and total score (r = 0.369, p = 0.006 and r = −0.309, p = 0.023, respectively).

While adolescents with hearing loss have limited online educational resources, problematic internet use is a concern. When overused, the internet can reduce loneliness, but it can also have harmful consequences.

This study aimed to explore the influence of laryngopharyngeal reflux on the features of vocal fold polyps and prognosis after office-based transnasal vocal fold polypectomy.

Eighty-four vocal fold polyp patients were retrospectively analysed. Patients were assigned to laryngopharyngeal reflux or non-laryngopharyngeal reflux groups using pre-operative Reflux Symptom Score-12.

The laryngopharyngeal reflux group had significantly higher pre-operative Reflux Sign Assessment scores, worse lifestyle and worse eating habits than the non-laryngopharyngeal reflux group. After office-based transnasal vocal fold polypectomy, the Reflux Symptom Score-12 and Reflux Sign Assessment score decreased in both groups, although the laryngopharyngeal reflux group still had higher values. The non-laryngopharyngeal reflux group had better vocal fold morphology recovery than the laryngopharyngeal reflux group. Multivariate logistic regression analysis demonstrated that smoking and a higher pre-operative Reflux Symptom Score-12 score were independent risk factors for poor prognosis.

Laryngopharyngeal reflux is detrimental to vocal fold recovery of vocal fold polyp patients following office-based transnasal vocal fold polypectomy. For vocal fold polyp patients with laryngopharyngeal reflux, lifestyle and diet guidance should be focused.

To describe vestibular dysfunction accompanied by sudden sensorineural hearing loss and explore its potential prognostic role.

A total of 44 Idiopathic Sudden Sensorineural Hearing loss cases were enrolled. Pure tone audiometry (PTA) was performed at the first visit and three months after standard therapy. Patients’ improvement and severity of hearing loss were categorised based on Siegel and American Speech and Hearing Association criteria. Their recovery rate and factors affecting recovery were explored.

The mean age of the participants was 52.1 years. The caloric and cervical vestibular-evoked myogenic potential test abnormalities were detected in 36.4 and 31.8 per cent of participants. Vertigo was present in 36.4 per cent at the first visit. Based on American Speech and Hearing Association criteria, 16 patients experienced at least 1 grade improvement to a less severe hearing loss status at the follow up. A total of 31.7 per cent of patients demonstrated complete or partial recovery. Vestibular dysfunction was associated with poorer PTA results.

Abnormal caloric and cervical vestibular-evoked myogenic potential tests, as well as the presence of vertigo, can indicate more profound inner-ear damage.

The aim of this study was to evaluate the rate of dysplasia and carcinoma-ex-papillomatosis in patients with recurrent respiratory papillomatosis and assess for any risk factors.

A 15-year retrospective observational cohort study was performed from a single centre. Data on patient demographics, treatment history and pathology results were extracted from clinical records.

Of the 123 patients identified, nine had juvenile-onset recurrent respiratory papillomatosis and 114 had adult-onset recurrent respiratory papillomatosis. Thirteen (11 per cent) of patients with adult-onset recurrent respiratory papillomatosis had dysplasia, and one patient progressed to carcinoma-ex-papillomatosis. Patients with evidence of dysplasia had an average older age of disease onset compared to those without dysplasia (49 years vs 39 years, p = 0.03).

An older age of recurrent respiratory papillomatosis onset was the only risk factor for dysplasia. Gender, tobacco use, subglottic or tracheal involvement, number of surgeries and cidofovir were not prognostic factors in this series.

Surgical treatment of auricular concha, the helix root and the external auditory canal tumours, and their reconstruction, is a challenge because of the complexity of this anatomic region and the significant functional and aesthetic requirements of these treatments. The purpose of this study is to describe our experience with the retroauricular revolving door island flap technique.

This was a retrospective descriptive study (series of nine clinical cases) conducted between 2020 and 2023 of revolving door island flap reconstruction of auricular conchal and external auditory canal defects caused by tumour removal.

In all the cases, tumour-free margins and total reconstruction of the defect were achieved through the revolving door island flap intervention, with optimal aesthetic and functional results.

Revolving door island flap reconstruction is a viable surgical option for the reconstruction of auricular conchal and external auditory canal defects because of its versatility, reproducibility, low post-operative morbidity and optimal results.

The important role of the saccule is the sensing of gravity. In other words, gravity always stimulates the macula of the saccule.

The aim of this study was to clarify whether nystagmus and dizziness occur by intentional changes upon stimulation to the saccules.

The subjects were eight healthy humans. Experiment 1: Subjects were asked to maintain a supine position to check for nystagmus and dizziness. Experiment 2: Subjects were asked to tilt their heads 45º to the left in the supine position to check for nystagmus and dizziness. Experiment 3: Subjects were asked to maintain a left-ear-down 90º position to check for nystagmus and dizziness.

In all the experiments, no one revealed nystagmus and no one complained of dizziness.

Neither nystagmus nor dizziness occurs by intentional changes in the stimulation to the saccules.

The relationship between clinical examination findings and objective nasal patency measures in structural nasal obstruction remains uncertain. This review aims to explore the relationship between clinical nasal examination findings and objective nasal patency measures using acoustic rhinometry, peak nasal inspiratory flow, rhinomanometry and rhinospirometry.

Qualitative systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement.

A total of 17 articles were included in the systematic review. Several studies showed a positive relationship between objective nasal patency measures and clinical nasal examination findings, however evidence in the literature is limited and confined to cohort studies. Objective nasal patency measures using acoustic rhinometry, rhinomanometry and rhinospirometry assessment correlate positively in severe anterior septal deviation but its role in assessing middle/posterior and mild/moderate septal deviation in isolation remains uncertain. There is limited evidence in the literature to assess the relationship between peak nasal inspiratory flow and clinical examination findings.

Objective nasal patency measures has a limited role in supporting clinical examination findings in severe structural nasal obstruction.

To appraise clinical practice guidelines for anaplastic thyroid carcinoma treatment and management using the Appraisal of Guidelines for Research and Evaluation II tool.

A literature search was performed using MEDLINE/PubMed, Embase, Scopus, Cochrane, and Google Scholar. Four reviewers evaluated clinical practice guidelines utilising Appraisal of Guidelines for Research and Evaluation II, with domain scores requiring a threshold of greater than 60 per cent. Inter-reviewer agreement was evaluated using intraclass correlation coefficients.

Twelve clinical practice guidelines were evaluated after application of inclusion and exclusion criteria. There were two “high-”, four “average-”, and six “low-” quality clinical practice guidelines. The domains with the highest scores were “clarity of presentation” (69.44 ± 16.75) and “scope and purpose” (68.87 ± 20.88), while “applicability” (7.12 ± 6.17) and “rigor of development” (50.26 ± 20.77) had the lowest scores. Intraclass correlation coefficients showed a high level of inter-reviewer agreement (0.689–0.924; good–excellent).

These results showcased wide variability in quality amongst guidelines for the treatment and management of anaplastic thyroid carcinoma. These findings necessitate greater standardisation among clinical practice guidelines and greater focus on the applicability of recommended practices.

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.

Assess the post-operative complications of microscopic parotidectomy and its impact on quality of life.

Thirty patients were included in this prospective study. Three to six months post-surgery, patients underwent assessments for Frey’s syndrome by Minor test, aesthesiometer test, facial nerve function and Quality of Life questionnaire.

Frey’s syndrome symptom positive in none, Minor test positive in 50 per cent. The preservation rate of the great auricular nerve posterior branch was 90 per cent, but it had no significant impact on the aesthesiometer test. Transient and permanent facial paresis were observed in 13.3 per cent and 3.3 per cent, and salivary fistula in 3.3 per cent. In quality of life, the rating of general health as good/better was seen in 73.3 per cent, nil/minimal pain in 93.3 per cent, bothersome change of facial contour in none, and dry mouth in 23.3 per cent.

Microscopic parotidectomy achieves good surgical outcomes regarding Frey’s syndrome symptoms, greater auricular nerve preservation, facial paresis, salivary fistula and quality of life.

This article aimed to evaluate the diagnostic accuracy of the contrast swallow study and its role in informing management decisions in patients following laryngectomy.

A five-year retrospective case note review on all patients who underwent laryngectomy between April 2018 and July 2023 at a tertiary head and neck cancer centre.

A total of 82 patients met inclusion criteria; 22 had reported radiological evidence of a pharyngocutaneous fistula on contrast swallow study; of these only 1 developed a clinical pharyngocutaneous fistula. Of the 60 with no radiological evidence of a pharyngocutaneous fistula, 3 developed clinical pharyngocutaneous fistulas. This represents a positive predictive value of 5 per cent and a negative predictive value of 95 per cent.

In this cohort, the contrast swallow study was a sub-optimal investigation. The high NPV may support decision-making when there is little clinical suspicion, however the low PPV represents significant over-reporting and may cloud the clinical decision-making process.

Ultrasound-guided wire localisation may improve intra-operative identification and outcomes of non-palpable cervical lymphadenopathy in a previously treated neck. We undertook a literature search and present our case series to determine the safety and efficacy of ultrasound-guided wire localisation.

A search of databases up to 29 April 2024 was performed. At our tertiary centre, ultrasound-guided wire localisation was utilised for 20 patients with cervical lymphadenopathy between February 2021 and April 2024.

Seventeen studies with a combined total of 92 patients were identified, with one complication reported. Within our case series, all 20 patients had accurate lesion localisation using ultrasound-guided wire localisation and none required repeat operations.

Ultrasound-guided wire localisation is a safe and cost-effective technique for lesions in an otherwise difficult area to operate, providing confidence to the multidisciplinary team, particularly where histopathology indicates benignity. Surgical outcomes do not appear worse than outcomes without ultrasound-guided wire localisation. We advocate its use provided appropriate patient selection is considered.

The aim of this research is to determine the rate of recurrence, metastasis and survival outcomes of patients diagnosed with and treated for parathyroid carcinoma.

This research is a retrospective chart review for patients diagnosed with parathyroid carcinomas between 1 January 2007 and 31 December 2022 in a UK tertiary centre.

Fourteen patients were identified, all of whom received surgery following their diagnosis. On presentation, all patients (100 per cent) were hypercalcaemic, with two patients (14 per cent) having metastatic lesions. There was a single case (7 per cent) of loco-regional recurrence following surgery. Six patients passed away after a median follow up of 2.5 years, four due to causes related to parathyroid carcinoma.

Surgical excision remains the mainstay of treatment, but this can only be undertaken after the patient has been medically stabilised. Mortality in this group of patients generally arose from the effects of hypercalcaemia. Metastasis and recurrence from our cohort were rare, but long-term follow up with monitoring of calcium and parathyroid hormone levels remain keys.

To analyse the evolution of the vertigo index and its relationship with perceived disability in unilateral and bilateral Ménière’s disease, assessing differences based on disease progression and clinical subtypes.

A longitudinal descriptive study was conducted on unilateral and bilateral Ménière’s disease patients, with data collected between 1977 and 2023 from two referral centres. Clinical and functional data were retrospectively reviewed to ensure compliance with updated diagnostic criteria. The vertigo index, integrating episode duration and frequency, quantified vertigo burden. Functional impact was assessed using the six-item American Academy of Otolaryngology Head and Neck Surgery disability scale, categorising patients into mild or moderate/severe disability groups.

Bilateral Ménière’s disease patients had a higher proportion of moderate/severe episodes (31.4 per cent) than unilateral Ménière’s disease patients (11 per cent). In unilateral Ménière’s disease patients, disability perception increased after 20 years of disease evolution. The vertigo index declined over time, except in later stages, where episodes were more disabling.

These findings underscore the need for long-term follow up, particularly in bilateral Ménière’s disease, where greater disability was observed. Disease management should adapt over time, addressing both vertigo burden and psycho-affective consequences.

The healthcare industry is estimated to contribute 4.4 per cent of global greenhouse gas emissions. This pilot study aimed to investigate the impact of rationalising surgical instruments in tonsillectomy trays on greenhouse gas emissions and costs.

We conducted a prospective observational study over a six-month period. All patients who underwent tonsillectomy were included. The instruments used during the procedure and their frequency of use were counted, with the operating surgeon being unaware of the study.

During the 6-month timeframe, 46 tonsillectomies were performed. From the standard tonsillectomy tray containing 38 pieces, 9 pieces were never used. The removal of unused reusable instruments resulted in an estimated total reduction of 594 g of carbon dioxide equivalents and a saving of €9.63 per operation.

Rationalising the contents of the surgical instrument tray can have a positive environmental impact by reducing greenhouse gas emissions. There are also pecuniary benefits for the National Health Service because of the potential for cost savings.