The increased incidence of necrotising otitis externa over the last decade has had a significant burden on healthcare providers. Several factors may affect outcome, and stratifying risk may allow personalised treatment.

Retrospectively identified patients were prospectively surveyed over 12 months. The Cox proportional hazards model was used to identify predictors of poor prognosis.

Twenty-six patients with necrotising otitis externa (average age of 80 years) were admitted from 2018 to 2019. At one year, 19 per cent mortality was observed. A high Charlson Comorbidity Index was associated with increased mortality (p = 0.03), prolonged in-patient stay (p = 0.047) and increased odds of adverse outcomes (odds ratio = 1.48, 95 per cent confidence interval = 0.26–2.67, p = 0.019). The Charlson Comorbidity Index in our prognostic model was validated using the receiver operating characteristic curve (area under the curve = 0.76). Charlson Comorbidity Index score of 5 or more independently predicted one-year morbidity and mortality (hazard ratio = 1.30, 95 per cent confidence interval = 0.94–1.79, p = 0.03).

Risk-stratifying patients may enable clinicians to holistically counsel patients and tailor their treatment to improve their prognosis and subsequently alleviate the burden of necrotising otitis externa.

Necrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an apparent increase in the number of patients admitted to our hospital with this condition.

A retrospective review was conducted of all patients admitted to our hospital with necrotising otitis externa between July 2012 and June 2020.

Among 39 patients included, only 9 were diagnosed in the first four years, and 30 were diagnosed in the last four years. There were 27 males and 12 females, and the mean age was 78.7 years. There were six non-diabetic immunocompetent patients. Cranial nerve palsies developed in 50 per cent of the patients. Disease-related mortality was 7.7 per cent. A favourable outcome was recorded in 66.7 per cent of the patients.

Necrotising otitis externa is associated with high morbidity and mortality. The incidence of the disease is rising in our local geographical area.

The aim of the present study was to perform a retrospective review of the lesion sites in congenital middle-ear cholesteatoma and any accompanying ossicular defects, as well as to explore the possible aetiology of congenital middle-ear cholesteatoma associated with such ossicular chain defects.

The clinical characteristics and pathogenic mechanisms of ossicular chain defects were investigated in 10 patients with early-stage congenital middle-ear cholesteatoma confirmed by surgery, from August 2011 to February 2019.

Monofocal cholesteatoma was located in the anterosuperior quadrant in 3 cases and in the posterosuperior quadrant in 7 cases; all 10 cases showed an absence of the long crus of incus, and 8 cases showed a complete or partial absence of stapes superstructure. The lesions were confined to the vestibular window and the stapes region and had no contact with the long crus of the incus or stapes in nine cases. None of the 10 patients had any recurrence of cholesteatoma.

Although cholesteatoma can cause erosion of ossicles, the present cases suggest that residual epithelium of the cholesteatoma may coexist with ossicular malformations. Therefore, the aetiology of the clinical characteristics in these patients may derive from residual epithelial hinderance of ossicle development.

The location of the vertical segment of the facial nerve varies greatly among patients undergoing otological surgery. Its position relative to the incus determines facial recess width, which has implications for ease of cochlear implantation.

To investigate the variation in facial nerve depth, relative to the incus, on pre-operative computed tomography in patients undergoing cochlear implantation.

A retrospective cohort study was conducted of paediatric patients undergoing cochlear implantation at a tertiary referral centre. Distance between the incus short process and facial nerve, in the transverse (medial-lateral) dimension, was measured at six imaging slices, ranging from 1.25 to 7.25 mm below the tip of the incus short process.

Facial nerve depth relative to the incus short process demonstrated significant variability. Among all subjects and at all measurements taken inferior to the incus, the mean dimension between the facial nerve and the incus short process was 1.71 mm.

This paper presents a rapid, repeatable technique to assess the depth of the facial nerve vertical segment on pre-operative computed tomography, as measured relative to the tip of the incus short process. This allows the surgeon to anticipate facial recess width and round window access during cochlear implantation.

To highlight the close anatomical relationship between the middle turn of the cochlea and the labyrinthine segment of the facial nerve, which will be helpful to predict the probability of occurrence of facial nerve stimulation following cochlear implant surgery.

High-resolution computed tomography of 40 cadaveric temporal bones was performed, followed by microscopic dissection. Cochleo-facial distance was measured with the help of a Digital Imaging and Communications in Medicine (‘DICOM’) viewer on high-resolution computed tomography and by a millimetre scale in the dissected specimen.

The cochleo-facial distance on high-resolution computed tomography was 0.62 ± 0.09 mm, ranging from 0.41 to 0.81 mm, and on dissection it was 0.57 ± 0.10 mm, ranging from 0.35 to 0.74 mm.

The labyrinthine segment is the most likely area of stimulation in patients suffering from facial nerve stimulation following cochlear implantation. Pre-operative high-resolution computed tomography of the temporal bone can be used to examine the bone separating the labyrinthine segment of the facial nerve from the middle turn of the cochlea. This has clinical significance regarding implant side selection and pre-operative patient counselling.

To examine the effects of mastoid and middle-ear volume on the anatomical and functional success of type 1 tympanoplasty in paediatric patients.

This study included 45 paediatric patients who underwent type 1 cartilage tympanoplasty. Patients’ demographic data, pre- and post-operative audiological evaluation results, and post-operative graft status were evaluated. Middle-ear and mastoid cavity volumes were calculated (in cubic centimetres) using temporal bone high-resolution computed tomography. Middle-ear and mastoid cavity volume values were compared between patients with and without post-operative anatomical and functional success.

Anatomical success was achieved in 82.2 per cent of patients (n = 37), and functional success in 68.9 per cent (n = 31). When anatomical success and failure groups were compared, a statistically significant difference was found in mean mastoid volume (p = 0.037), while there was no significant difference in relation to mean middle-ear volume (p = 0.827). The comparison of functional success and failure groups revealed no significant difference in mean mastoid volume (p = 0.492) or middle-ear volume (p = 0.941).

The study showed that mastoid pneumatisation volume affects surgical success in paediatric tympanoplasty.

This study investigated the effects of the coronavirus disease 2019 pandemic on tinnitus severity and quality of life in individuals with subjective tinnitus.

The study was carried out during the coronavirus disease 2019 pandemic. Sixty patients were evaluated with the Tinnitus Handicap Inventory and a visual analogue scale on resonance intensity and disturbance, together with questions assessing their emotional states.

There was a significant difference between the visual analogue scale and the Tinnitus Handicap Inventory scores before the pandemic and during the pandemic. It was determined that tinnitus loudness and annoyance were significantly worse in the pandemic and, consequently, that the coronavirus disease 2019 pandemic negatively affected perceptions of tinnitus and quality of life.

Psychological support can affect positively the perception of tinnitus and the change in moods experienced during the pandemic. Because personal contact and quotidian activities are severely limited during the pandemic, internet-based interventions should be prioritised in tinnitus therapy.

To review the clinical characteristics, prevalence and outcomes of chronic rhinosinusitis patients with a hypoplastic maxillary sinus who underwent functional endoscopic sinus surgery.

A retrospective review was performed for the 814 consecutive, elective functional endoscopic sinus surgery procedures performed at an academic centre from 2010 to 2020, to identify patients with a hypoplastic maxillary sinus.

A total of 56 hypoplastic maxillary sinus cases were detected. Maxillary sinus hypoplasia presented unilaterally in 20 cases and bilaterally in 18 cases. Of the maxillary sinus hypoplasia cases, 38 were type I, 17 were type II and 1 was type III. The average Lund–McKay score was 8.6. No major post-operative complications were reported. Four patients had minor complications and one had persistent post-nasal drip.

Functional endoscopic sinus surgery is a safe and effective procedure for improving the clinical condition of patients with a hypoplastic maxillary sinus; however, careful pre-operative radiological evaluation, identification of intra-operative endoscopic landmarks and use of additional techniques may be essential to achieve satisfactory results and avoid possible serious complications.

This study aimed to investigate the association of nasal nitric oxide and olfactory function.

A cross-sectional study was performed in 117 adults, including 91 patients with chronic rhinosinusitis and 26 healthy controls. Scores on the 22-item Sino-Nasal Outcomes Test, Lund-Mackay scale and Lund-Kennedy scale were recorded to assess severity of disease. All participants were screened for common inhaled and food allergens. Nasal nitric oxide and fractional exhaled nitric oxide testing, acoustic rhinometry and anterior rhinomanometry testing were performed to measure nasal function. The validated Sniffin’ Sticks test battery was used to assess olfactory function.

Higher nasal nitric oxide was an independent protective factor for odour discrimination and odour threshold in participants with chronic rhinosinusitis after adjusting for age, gender, drinking, smoking, 22-item Sino-Nasal Outcomes Test, Lund-Mackay score, Lund-Kennedy score, immunoglobulin E and the second minimal cross-sectional area by acoustic rhinometry. Nasal nitric oxide also showed high discrimination in predicting impaired odour discrimination. In addition, nasal nitric oxide was lower in older participants, those with higher Lund-Mackay or Lund-Kennedy scores and higher with elevated total serum immunoglobulin E concentrations above a threshold of 0.35 kU/l.

Higher nasal nitric oxide is associated with better odour discrimination in chronic rhinosinusitis and is modulated by age, degree of allergy and severity of chronic rhinosinusitis.

Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty.

Post-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up.

Of 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02–10.43).

Endoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention.

To evaluate the impact of early intervention using combined swallow therapy, consisting of traditional swallow exercises and transcutaneous neuromuscular electrical stimulation, on patients with advanced oropharyngeal squamous cell carcinoma.

A cohort study of 60 prospectively enrolled patients was performed. Thirty patients with advanced oropharyngeal squamous cell carcinoma starting combined swallow therapy two weeks after surgery that continued throughout chemoradiotherapy were compared with a matched cohort of 30 patients starting combined swallow therapy after cancer treatment completion. Gastrostomy tube status, modified barium swallow, and Functional Oral Intake Scale scores were assessed before and after therapy.

Both cohorts demonstrated a statistically significant improvement in Functional Oral Intake Scale scores. All patients in the early intervention cohort discontinued gastrostomy tube use, compared with one-third in the control cohort, with greater improvements in Functional Oral Intake Scale scores. The tongue base was the site of greatest improvement in the early intervention group.

Early initiation of combined swallow therapy may optimise swallow outcomes in patients with advanced oropharyngeal squamous cell carcinoma.

This study aimed to determine the incidence of laryngeal penetration and aspiration in elderly patients who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy for laryngeal cancer.

A retrospective analysis of dynamic videofluoroscopic swallowing studies was performed in patients who had received supracricoid laryngectomy with cricohyoidoepiglottopexy as a treatment for laryngeal cancers. Digital analysis of videofluoroscopic swallowing studies included measurements of displacement and timing related to swallowing safety.

Videofluoroscopic swallowing studies from 52 patients were analysed. All participants were male and over 65 years old. Studies were performed five years after surgery. Among 52 videofluoroscopic swallowing studies, analysis showed that elevated pharyngeal constriction ratio (pharyngeal constriction ratio more than 0.0875, odds ratio = 5.2, p = 0.016), reduced pharyngoesophageal sphincter opening time (pharyngoesophageal sphincter open less than 0.6 seconds, odds ratio = 11.6, p = 0.00018) and reduced airway closure time (airway close less than 0.6 seconds, odds ratio = 10.6, p = 0.00057) were significantly associated with aspiration.

Deteriorated pharyngeal constriction, shortened airway closure and reduced pharyngoesophageal sphincter opening time are key factors for predicting laryngeal penetration or aspiration after supracricoid laryngectomy with cricohyoidoepiglottopexy.

The impact of modern high-precision conformal techniques on rare but highly morbid late complications of head and neck radiotherapy, such as necrosis of the bone, cartilage or soft-tissues, is not well described.

Medical records of head and neck cancer patients treated in prospective clinical trials of definitive high-precision radiotherapy were reviewed retrospectively to identify patients with necrosis.

Twelve of 290 patients (4.1 per cent) developed radiotherapy necrosis at a median interval of 4.5 months. There was no significant difference in baseline demographic (age, gender), disease (primary site, stage) and treatment characteristics (radiotherapy technique, total dose, fractionation) of patients developing radiotherapy necrosis versus those without necrosis. Initial management included antibiotics or anti-inflammatory agents, tissue debridement and tracheostomy as appropriate followed by hyperbaric oxygen therapy and resective surgery for persistent symptoms in selected patients.

Multidisciplinary management is essential for the prevention, early diagnosis and successful treatment of radiotherapy necrosis of bone, cartilage or cervical soft tissues.

This study aimed to explore health-related quality of life and use of healthcare services and ensuing costs before and after tonsillotomy in children with sleep-disordered breathing and to compare the results to an earlier cohort of children who had undergone tonsillectomy.

Children undergoing tonsillotomy answered the 17-dimensional, standardised health-related quality of life instrument questionnaire and a questionnaire on use of healthcare services and sick leave before and after surgery. Costs of specialist care were obtained pre- and post-operatively. The data were compared with similar data collected previously from children with tonsillectomy.

Tonsillotomy improved mean total health-related quality of life score significantly at 6 and 12 months. Healthcare costs and number of sick-leave days diminished significantly from 3 months pre-operatively to 12 months after surgery. Tonsillotomy had similar positive effects compared with tonsillectomy regarding health-related quality of life and healthcare costs.

Tonsillotomy improves health-related quality of life in children with sleep-disordered breathing and reduces healthcare service needs and sick leave similarly to tonsillectomy.

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.

Severe paediatric obstructive sleep apnoea in typically developing children with adenotonsillar hypertrophy is primarily managed surgically. Non-emergency ENT surgery was paused early in the coronavirus disease 2019 pandemic and children were offered medical management for obstructive sleep apnoea.

A service evaluation was performed to assess the impact of continuous positive airway pressure alongside medical management for severe obstructive sleep apnoea.

Over 5 months during 2020, in a tertiary care setting, two children (one boy and one girl), aged 2.7 years and 4.1 years, were offered continuous positive airway pressure and medical treatments for severe obstructive sleep apnoea whilst surgery was paused during the coronavirus disease 2019 pandemic. Both children failed to establish continuous positive airway pressure therapy because of ongoing disturbed sleep on ventilation, and they proceeded to adenotonsillectomy. Sleep-Related Breathing Disorder scale scores improved following surgical intervention.

Continuous positive airway pressure therapy is poorly tolerated in children with severe obstructive sleep apnoea secondary to adenotonsillar hypertrophy. Surgery remains the most appropriate treatment.

In a bid to end the ongoing coronavirus disease 2019 pandemic, many countries, including the UK, have rolled out mass immunisation programmes. While considered generally safe and effective, vaccines against coronavirus disease 2019 have been reported to be associated with rare and potentially adverse reactions and side effects.

This paper reports an unusual case of a patient who developed a unilateral vocal fold paralysis shortly after receiving the first dose of the Oxford-AstraZeneca ChAdOx1 nCov-19 vaccine.

To our knowledge, this is the first reported case of vocal fold paralysis following administration of the Oxford-AstraZeneca vaccine. The authors support the position that currently approved coronavirus disease 2019 vaccines remain safe and effective; however, further surveillance and vigilance using real-world data are highly encouraged.