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.

To determine if there have been changes over time for indications and outcomes of tracheostomies in infants.

Retrospective review of infant tracheostomies at a tertiary children’s hospital across two time periods (epoch 1: 1997–2008; epoch 2: 2009–2020). Patient demographics, tracheostomy indications, comorbidities, length of stay, complications, decannulation and mortality were examined.

Seventy-two infants had a tracheostomy (40 epoch 1 vs 32 epoch 2). Airway obstruction decreased (80 per cent vs 50 per cent*) and long-term ventilation increased (17.5 per cent vs 40.6 per cent*) as the primary indication. Early complications decreased between the time periods (30 per cent vs 6.3 per cent*). The median hospital length of stay was 97 days (interquartile range 53–205.5), total complication rate was 53 per cent, decannulation rate was 61 per cent and mortality rate was 17 per cent (all non-tracheostomy related) across both time periods. There were no significant changes for these outcomes. *(p< 0.05)

Long-term ventilation has increased and airway obstruction has decreased as the primary indication for infant tracheostomy over time.

The objective of the study is to examine the current state of research and technology related to objective olfactory assessment, highlighting the merits and demerits of the techniques. It aims to specifically explore olfactory event-related potentials, discussing their potential applications, benefits, drawbacks, and prospects in the field.

A five-month narrative review examined English-language articles from PubMed, Scopus, and Google Scholar, critically summarising titles, abstracts, and full texts, while excluding non-English and methodologically weak studies.

This study provides a detailed investigation into various objective methods utilised and the applicability of olfactory event-related potentials for assessing olfaction. We reviewed key elements, such as techniques, stimulus delivery methods, optimal electrode placement, and waveform analysis.

Olfactory event-related potentials offers substantial promise in enhancing the diagnostic accuracy of olfactory dysfunction across various clinical contexts. This thorough review highlights the utility and potential of olfactory event-related potentials in improving the precision and efficacy of olfactory assessments.

This study investigates the association between a history of previous cancers and the subsequent risk of developing head and neck cancer.

A retrospective case–control design was employed, analysing 561 patient records from two National Health Service hospitals, with 273 patients diagnosed with head and neck cancer and 288 patients serving as controls.

Statistical analysis revealed a significant association between prior cancer history, particularly squamous cell carcinoma (SCC), and increased risk of developing head and neck cancer (p < 0.05). Subtype analysis highlighted specific head and neck cancers, such as oropharyngeal and laryngeal cancers, as particularly associated with a history of SCC.

The findings suggest that previous cancer diagnoses, especially SCC, may predispose individuals to head and neck cancer, challenging the traditional focus on tobacco, alcohol and human papillomavirus as primary risk factors. These results underscore the need for incorporating prior cancer history into risk assessment protocols and surveillance strategies to improve early detection and patient outcomes.

Oncological and functional outcomes for T1-2 N0-1 (TNMv8) p16-positive oropharyngeal squamous cell carcinoma patients were analysed according to treatment: either transoral robotic surgery (TORS) (Surgery group – TORS and neck dissection ± adjuvant radiotherapy/chemoradiotherapy) or primary radiotherapy/chemoradiotherapy (Oncology group).

Single-centre retrospective observational study.

The two-year disease-free survival rate was 88 per cent for the Oncology group (n = 42) and 95 per cent for the Surgery group (n = 44). The two-year overall survival rate was 98 per cent for the Oncology group and 100 per cent for the Surgery group. The functional swallowing outcome at two years post-treatment was similar in both groups. Subgroup analysis showed patients treated with surgery-only with no adjuvant treatment had the best functional outcome whilst patients treated with surgery and post-operative chemoradiotherapy had the worst functional outcome.

The overall oncological and functional outcomes at two years were similar in both groups. Patients treated with surgery-only had the best functional outcome without compromised oncological outcome.

Carcinoma ex pleomorphic adenoma is a rare malignant salivary gland tumour for which distinct radiological features are unclear. We aim to identify radiological features that may pre-operatively predict for carcinoma ex pleomorphic adenoma and its degree of invasion.

Systematic review of Ovid Medline, Embase, Scopus, Web of Science (BIOSIS), Cochrane, PROSPERO, OpenDOAR, and OpenGrey from inception to 29 April 2023. Primary outcomes of interest were radiological features in magnetic resonance imaging, computed tomography and ultrasound.

Of 1729 studies, 12 studies (n = 426) underwent qualitative synthesis. Imaging findings for magnetic resonance imaging, computed tomography, and ultrasound were reported in 11 studies (n = 337), five studies (n = 253) and one study (n = 89), respectively. Magnetic resonance imaging features of lower mean apparent diffusion coefficient values and heterogenous T2 intensity were reported.

Magnetic resonance imaging has the greatest utility in predicting for carcinoma ex pleomorphic adenoma. Within the limits, a heterogenous body of evidence, in addition to general radiologic features of malignancy, lower mean apparent diffusion coefficient values and heterogenous T2 intensity, may indicate carcinoma ex pleomorphic adenoma.

The purpose of this study is to investigate whether sex plays a role in donor-site dysfunction after head and neck reconstruction.

In this retrospective case series, 76 patients were assessed for donor-site morbidity using the Short Form 36, Short Musculoskeletal Function Assessment, disabilities of the arm, shoulder, and hand, and lower-limb core scale. Differences by sex were compared using t-tests. Multivariable linear regression analysis was conducted to adjust for potential confounders.

Females observed significantly greater disability for the SF-36 mental component summary score with a mean of 45.9 (standard deviation 10.5) compared to males, with a mean of 51.8 (standard deviation 10.2), p = 0.02. Sex is significantly related to SF-36 mental component summary score after controlling for neuropsychiatric disease and tracheostomy status.

Females reported significantly worse mental component scores compared to males undergoing free flap reconstruction of the head and neck.

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.

Mucoepidermoid carcinoma of unknown primary (MEC-UP) in the head and neck is a rare presentation of the most common salivary gland cancer. Cancers of unknown primary sites often have poorer prognoses than similar cancers with known primary. Few cases of MEC-UP have been reported; therefore, the objective of this report is an overview of the diagnosis and management of MEC-UP.

We present two patients with low-grade MEC-UP at a high-volume tertiary care institution in Ontario, and a database search returning 1560 citations of which five studies with seven MEC-UP cases were identified.

Review of the limited cases suggest many clinicians use positron emission tomography-computed tomography (PET-CT) in addition to panendoscopy and targeted biopsies with consideration for diagnostic tonsillectomy in diagnostic work-up.

Like other salivary gland cancers, primary therapeutic surgical resection is recommended with low threshold for adjuvant radiotherapy to regions at high risk for harbouring the primary malignancy, especially in cases of high-grade histopathology.

To examine the patterns of care for octogenarian head and neck cancer patients.

All newly diagnosed patients aged 80 years or older, who presented at our centre between June 2018 and October 2020, were included.

The total number of patients was 42. The median Charlson Comorbidity Index was 5 (range, 4–9). The larynx was the most common subsite (n = 12). Twenty-nine patients (66 per cent) were diagnosed at disease stage IV. Squamous cell carcinoma was the most common histology (86 per cent). Twenty-six patients (62 per cent) had radical treatment and 16 (38 per cent) had palliative treatment. The estimated six-month and one-year overall survival rates for the radical and palliative treatment cohorts were 92.3 per cent and 42.9 per cent (p = 0.001) and 65.4 per cent and 15.4 per cent (p = 0.003), respectively.

This study provides useful information on octogenarian patients with head and neck cancer. This information may help in conducting prospective studies, especially those focusing on older patients with head and neck cancer, in order to define the ideal care of this patient population.

To compare perioperative and oncological outcomes between stapler and manual closure in patients undergoing total laryngectomy for advanced endolaryngeal squamous cell carcinoma.

Patients with advanced endolaryngeal tumours operated between July 2017 and July 2023 were retrospectively dichotomised into stapler closure and manual closure cohorts and compared.

Seventy-one patients with a median age of 57 years were included in our study. The median surgical duration was 270 minutes for the manual closure cohort and 245 minutes for the stapler closure cohort. The pharyngo-cutaneous salivary fistula rate was 6 per cent less in the stapler closure cohort. The estimated mean survival was not significantly different 54.5 months (95 per cent, confidence interval 46.3–62.71) in the manual closure cohort versus 28.12 months (95 per cent, confidence interval 23.6–32.63) in the stapler closure cohort (p = 0.79).

Stapler closure can be used in endolaryngeal tumours, and it reduces operating time, thus facilitating efficient utilisation of operation time with non-inferior oncological outcomes as compared to traditional manual closure.

This study aimed to assess whether frailty (measured using the 5-Item Modified Frailty Index) was associated with increased morbidity following surgical tracheostomy.

A single-centre retrospective cohort study analysed a prospectively maintained database between 2022 and 2023. Univariable and multivariable regressions were used to determine factors (including frailty) associated with increased morbidity.

A total of 174 patients underwent surgical tracheostomy in the study period with 28 patients determined as frail (16.1 per cent). Overall, 21 patients (12.1 per cent) suffered a tracheostomy-specific complication. Multivariable regression found an association between frail patient status and increased tracheostomy-specific complications (odds ratio 4.09, 95 per cent confidence interval 1.51–11.11; p = 0.006) and longer hospital length of stay (β 15.76 days, 95 per cent confidence interval 1.06–30.44; p = 0.036).

Frailty was associated with increased morbidity and longer hospital stay following tracheostomy. Assessment of frailty may guide decision making and patient discussions when planning tracheostomy.

In the era of the competition for the first transatlantic flight at the beginning of the nineteenth century, numerous accidents occurred. Whereas engine failure, bad weather and navigational problems are usually held responsible, the human factor has hardly been addressed.

In view of current insights, an inventory was made of possible physiologic and otoneurologic factors that could have contributed to failures and accidents.

Extreme fatigue, hyperventilation with vestibular hyperreactivity and airsickness may have played roles. When flying in the dark and in clouds, pilots were subject to spatial disorientation because of vestibulo-visual conflicts and gravitational misinformation. The loudness of the engines was deafening, which may have caused noise-induced vertigo. In some cases, asymptomatic third-window lesions may have become manifest and may have contributed to dizziness.

Accidents and failures in the early days of aviation were not only the result of technical defects. Undoubtedly, human physiology played a role as well.

Surgical resection for pterygopalatine fossa schwannomas can be challenging due to the complex anatomy and potential morbidity. Gamma knife radiosurgery (GKRS) offers a minimally invasive alternative with precise targeting and minimal damage to surrounding structures.

A 21-year-old female patient who had a history of progressive left-sided facial numbness over the past year and was diagnosed with progressive pterygopalatine fossa schwannoma underwent gamma knife radiosurgery. The radiological and clinical outcomes of the patient were evaluated over a period of 15 years, with the patient remaining symptom-free and experiencing no adverse effects from the treatment.

The patient’s positive outcome, with significant tumour reduction and symptom relief, underscores the potential of this non-invasive technique as a primary treatment modality for schwannomas in challenging anatomical locations.

This paper aims to introduce our combined approach, which provides definitive treatment for intractable aspiration while preserving phonation and highlights the importance of performing both procedures together.

We describe a case of intractable aspiration requiring a nasogastric tube and a tracheostomy tube. We propose a combined technique consisting of an open medialisation thyroplasty with intra-operative, intra-glandular botulinum toxin injection. The thyroplasty procedure medialises the left vocal fold to overcome glottic insufficiency. Botulinum toxin injection reduces salivary flow and prevents excessive pooling.

The patient was followed up for twelve months. Video fluoroscopy demonstrated no evidence of aspiration. The patient was allowed a regular oral diet and decannulated two months post-operatively.

This paper demonstrates the feasibility of our combined approach as a viable treatment option for intractable aspiration, particularly in patients with a strong desire for vocalisation. The cases must be selected carefully to ensure a favourable outcome.