Enhanced recovery programmes have been widely adopted in other surgical disciplines but are not commonplace in head and neck surgery. The authors of this study created a pathway for post-operative laryngectomy patients.

A multidisciplinary working group reviewed the literature and agreed standards of care. A retrospective audit was conducted to measure current practice against our new pathway; after programme implementation our performance was reaudited in two prospective cycles, with an education programme and review after the first prospective cycle.

Statistically significant improvement in performance was realised in catheter and surgical drain removal, opiate analgesia use, mobilisation, and timeliness of swallow assessment. The rate of hospital acquired pneumonia reduced from 23.1 to 9.5 per cent and length of stay reduced by a median of 5.2 days to 14.8 days (non-significant).

The programme improved consistency of patient care across most areas that were measured. Improving patient stoma training needs to be prioritised.

There is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children.

The study comprised in-depth qualitative interviews (n = 22) with parents of children (2–9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically.

General practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed.

Guidelines for the management of paediatric sleep-disordered breathing are needed.

This study aimed to research risk factors of hearing loss among neonates in the neonatal intensive care unit.

Hearing screening tests were performed on 572 neonates in the neonatal intensive care unit. Those who failed screening tests were referred for diagnostic tests.

The pass rates for automated auditory brainstem response, distortion product otoacoustic emission and acoustic impedance tests at first hearing screening were 69.93 per cent, 70.02 per cent and 92.92 per cent for 1144 ears. Failure in the first screening correlated with preterm birth, very low birth weight, revised advanced maternal age, neonatal hyperbilirubinaemia and Activity, Pulse, Grimace, Appearance, Respiration score less than 8. Thirty cases failed in diagnostic hearing tests for brainstem auditory evoked potentials, 28 failed in otoacoustic emissions and 33 failed in acoustic impedance, which correlated with preterm birth, very low birth weight, twins, advanced maternal age and revised advanced maternal age.

Abnormalities in the hearing levels of most neonates who needed hearing retests were completely or partially reversible. Preterm birth, very low birth weight, twins and advanced maternal age are potential risk factors for hearing impairment.

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.

To evaluate the use of acrylic bone cement with a Tutopatch collagen implant for frontal sinus obliteration after mucocele excision using a subjective assessment of patient satisfaction.

Patients with a recurrent frontal sinus mucocele with posterior table erosion, for whom an endoscopic approach was not feasible, and who underwent osteoplastic frontal sinus obliteration, were included. The post-operative outcomes were evaluated using a non-standardised questionnaire, comparing pre- and post-operative scores.

All patients expressed post-operative satisfaction. Except for hyposmia, significant improvements were observed in all symptom scores. No major complications were observed during the post-operative course.

Acrylic bone cement with Tutopatch can be effectively used in frontal sinus reconstruction in cases where an endoscopic approach is not feasible.

Odontogenic sinusitis is a common cause of rhinosinusitis that is often undiagnosed and overlooked. No single sign or symptom is specific for odontogenic sinusitis, and failure to focus on the specific radiological features can delay diagnosis.

This paper presents four cases of chronic sinusitis that had an odontogenic origin. Each case was referred for a second opinion. Three patients had previously undergone unsuccessful surgical management.

The literature, and the associated contributory clinical, radiological and microbiological features required for correct diagnosis and management, are reviewed.

Each case resulted in a positive patient outcome following the involvement of both otolaryngology and maxillofacial surgery departments.

A high index of suspicion is advocated for odontogenic sinusitis in cases not responding to standard management plans. Collaboration with a maxillofacial specialist is important for diagnosis and management. This should be considered where standard management fails, or clinical features and radiological signs of odontogenic sinusitis are present. This paper also highlights the need for otolaryngologists to incorporate, at the very least, a basic dental history and examination as part of their assessment in recalcitrant cases.

Vestibular schwannomas can demonstrate great heterogeneity in their behaviour; approximately one-third will grow and two-thirds will not. This study aimed to determine whether there are factors present at diagnosis that can help predict outcomes.

This retrospective cohort study compared data from 735 patients from the past 20 years. Analysis of serial magnetic resonance imaging was carried out to place patients into growing and non-growing cohorts. Factors including size, age, follow-up time and presence of balance symptoms were compared.

The median size of a growing vestibular schwannoma at diagnosis was 13 mm, whereas the non-growing median size was 10.65 mm (p < 0.001). Balance symptoms were present in 60.76 per cent of growing vestibular schwannoma patients but only in 38.75 per cent of patients with non-growing vestibular schwannomas (p < 0.001).

This study highlights initial tumour size and balance symptoms as potential predictors of whether or not a vestibular schwannoma will grow; these results better facilitate our understanding of vestibular schwannoma natural history.

To assess benefits of surgical intervention at an early age and focus on surgical techniques using exclusively autologous cartilage grafts.

Five children aged 8–15 years, treated between March 2016 and 2020, underwent augmentation rhinoplasty using autologous cartilage, with post-operative follow up ranging from 1.5 to 2 years. Photographs and Rhinoplasty Outcome Evaluation questionnaire scores were examined.

Augmentation was achieved without complications. No restricted skin or mucosal pockets were encountered. Patients showed improved confidence and perspective with regard to self-image, and were less socially self-conscious. There was significant improvement in all Rhinoplasty Outcome Evaluation questionnaire scores.

Early surgery allows augmentation with easier release of skin and mucosal pockets, and without the tension otherwise encountered if primary augmentation is performed at a later age. It offers a chance to improve confidence and self-perception in a growing child conscious about their appearance, which may make them socially withdrawn. Autologous cartilage gives better results than bone grafts, and is comparable with silicone but without its complications.

Advice to patients following grommet insertion and waterproofing can vary from clinician to clinician. A laboratory based experiment was performed to determine at what depth water contamination would occur through various grommet tubes.

A novel experimental ear model was developed using an artificial tympanic membrane and ventilation tubes. Water contamination was identified using an effervescent solid that reacts when in contact with water. Measures of dispersion were used to describe the results.

The average depth of water contamination was: 19.64 mm (range = 11–33 mm, standard deviation = 5.55 mm) using a Shepard grommet; 20.84 mm (range = 18–26 mm, standard deviation = 1.97 mm) with a titanium grommet; and 21.36 mm (range = 18–33 mm, standard deviation = 3.03 mm) using a T-tube. Water contamination was possible at depths of 11–33 mm. The average pressure at water effervescent activation was 0.20 kPa.

Submersion underwater at any depth with grommets is likely to lead to middle-ear contamination. These findings are concordant with clinical studies.

This study investigated the audiometric and sound localisation results in patients with conductive hearing loss after bilateral Bonebridge implantation.

Eight patients with congenital microtia and atresia supplied with bilateral Bonebridge devices were enrolled in this study. Hearing tests and sound localisation were tested under unaided, unilateral and bilateral aided conditions.

Mean functional gain was higher with a bilateral fitting than with a unilateral fitting, especially at 1.0–4.0 kHz (p < 0.05, both). The improvement in speech reception threshold in noise with a bilateral fitting was a 2.3 dB higher signal-to-noise ratio compared with unilateral fitting (p < 0.05). Bilateral fitting had better sound localisation than unilateral fitting (p <0.001). Four participants who attended follow up showed improved sound localisation ability after one year.

Patients demonstrated better hearing threshold, speech reception thresholds in noise and directional hearing with bilateral Bonebridge devices than with a unilateral Bonebridge device. Sound localisation ability with bilateral Bonebridge devices can be improved through long-term training.

To determine the accuracy of 1.5 Tesla magnetic resonance imaging in identifying the bony defect in superior semi-circular canal dehiscence syndrome.

A retrospective case–control study was conducted in tertiary university settings. The study included 12 patients with a definite diagnosis of superior semi-circular canal dehiscence syndrome and a control group comprising 12 non-superior semi-circular canal dehiscence syndrome patients, all with available magnetic resonance imaging data. The imaging scans were anonymised, and reviewed blindly and independently by three experienced radiologists.

There was low sensitivity and specificity, with average values of 47 per cent (range, 16.7–66.7 per cent) and 69 per cent (range, 66.7–75 per cent) respectively. Cohen's kappa was 0.75, indicating substantial inter-rater reliability.

Given the low accuracy of 1.5T magnetic resonance imaging in identifying the bony defect in superior semi-circular canal dehiscence syndrome, despite its value in inner-ear imaging, computed tomography or equivalent should be used when superior semi-circular canal dehiscence syndrome is suspected.

To determine whether: the N95 respirator affects nasal valve patency; placement on the bony vault improves patency; and external nasal anatomy affects the outcome.

A prospective study with 50 participants was conducted. Nasal patency was measured by the minimal cross-sectional area via acoustic rhinometry, and using the Nasal Obstruction Symptom Evaluation survey, before and after wearing the N95 respirator and after adjustment.

The minimal cross-sectional area was narrowed by 27 per cent when wearing the N95 respirator (p < 0.001), and improved by 9.2 per cent after adjustment (p = 0.003). The total Nasal Obstruction Symptom Evaluation score increased from 10.2 to 25.4 after donning the N95 respirator (p < 0.001), and decreased from 25.4 to 15.6 after adjustment (p < 0.001). There was no correlation with external nasal anatomy parameters.

Wearing the N95 respirator causes narrowing of the nasal valve, and adjustment onto the bony vault improves symptoms. The findings were not affected by external nasal anatomy.

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.

Cell-mediated immunity plays an important role in host defence against fungal pathogens, regulated by differentiation of lymphocytes towards T-helper 1 or 2 cells. This study reports intracellular cytokine variation in terms of invasive fungal sinusitis type and outcome.

The mononuclear leukocytes of 15 patients with invasive fungal sinusitis (mucormycosis in 8, aspergillus in 7) were stained with antibodies against intracellular cytokines, after fungal antigen stimulation and culture, and immunophenotyped. Patients were followed up for six months, with clinical course categorised as improvement, worsening or death.

The mean percentages of mononuclear cells producing interleukins 4, 5, 10 and 12, and interferon-γ, in the mucormycosis group were 0.575, 0.284, 8.661, 4.460 and 1.134, respectively, while percentages in the aspergillosis group were 0.233, 0.492, 4.196, 4.466 and 1.533. Cells producing interleukin 4 and 10 were higher in the mucormycosis group, while those producing interleukin-12 and interferon-γ were lower. Cells producing interleukins 4 and 12 were higher in patients with a poor outcome (p-values of 0.0662 and 0.0373, respectively), while those producing interferon-γ were lower (p = 0.0864).

Adaptive cell-mediated immunity is expressed differently in two categories of invasive fungal sinusitis, and the cytokine expression pattern is related to prognosis.

To investigate associations between multimodal analgesia and post-operative pain among patients undergoing transoral robotic surgery for oropharyngeal squamous cell carcinoma.

Records of patients who underwent surgery from 5 September 2012 to 30 November 2016 were abstracted. Associations were assessed using multivariable analysis.

A total of 216 patients (mean age of 59.1 years, 89.4 per cent male) underwent transoral robotic surgery (92.6 per cent were human papilloma virus positive, 87.5 per cent had stage T1–T2 tumours, and 82.9 per cent had stage N0–N1 nodes). Gabapentin (n = 86) was not associated with a reduction in severe pain. Ibuprofen (n = 72) was administered less often in patients with severe pain. Gabapentin was not associated with increased post-operative sedation (p = 0.624) and ibuprofen was not associated with increased bleeding (p = 0.221). Post-operative opioid usage was not associated with surgical duration, pharyngotomy, bilateral neck dissections, tumour stage, tumour size, subsite or gabapentin.

Scheduled low-dose gabapentin was not associated with improved pain control or increased respiratory depression. Ibuprofen was not associated with an increased risk of bleeding and may be under-utilised.

Injectable anaesthetic agents, topical creams and aqueous solutions have previously been used to anaesthetise the tympanic membrane for minor ear procedures. Topical creams take 20–30 minutes to work and injectable anaesthetics can cause canal swelling. The effectiveness of lidocaine spray has not previously been investigated in patients undergoing minor ear procedures.

Eighteen participants attending for out-patient grommet insertion or intratympanic steroid injection were prospectively recruited for this study over six months. Post-operatively, they were asked about their perceived level of pain and overall experience.

The median level of pain measured on an 11-point visual analogue scale was 2 out of 10. Forty-four per cent reported the overall experience as pleasant, with the remainder selecting slightly unpleasant (66 per cent). All participants stated they would undergo the procedure again.

Xylocaine spray is simple to administer, rapid-acting and well tolerated by patients for anaesthesia of the tympanic membrane during minor ear procedures in the out-patient setting.

To correlate computed tomography findings and endoscopic localisation of the anterior ethmoidal artery during surgery, and to analyse the intranasal landmarks and abnormalities of the artery.

The anterior ethmoidal artery was studied with high-resolution computed tomography and endoscopic surgery in 30 patients undergoing functional endoscopic sinus surgery (group A), and with endoscopic dissection on 30 human cadavers (group B).

The anterior ethmoidal artery was demonstrated on computed tomography in 25 patients and intra-operatively in 12 (group A). It was identified in 26 cadavers (group B). Dehiscence of bony canal and branching was noted in 10.53 per cent of cases. The mean (± standard deviation) intranasal length of the anterior ethmoidal artery was 7.29 (± 1.21) mm, the distance of the artery from the axilla of the middle turbinate was 16.24 (± 2.75) mm, and the mean distance from the ground lamella was 8.97 (± 1.46) mm.

High-resolution computed tomography scanning prior to functional endoscopic sinus surgery is mandatory to identify the anterior ethmoidal artery. Endoscopically, the axilla of the middle turbinate and the ground lamella can serve as dependable reference points to identify the artery. Cadaver dissection improves understanding of anatomy.

Subjective tinnitus is a common symptom, and there is often an underlying otological cause. This study investigated the degree of tinnitus-related annoyance in patients with chronic otitis media and analysed whether associations with tinnitus severity exist.

The multinational collaborative Chronic Otitis Media Questionnaire-12 study collected prospective data on 478 adult patients suffering from chronic otitis media across 9 otology referral centres in 8 countries. Based on this dataset, we investigated tinnitus severity using participant responses to item 7 of a native version of the Chronic Otitis Media Questionnaire-12.

With respect to tinnitus severity, 23.8 per cent, 17.4 per cent, 15.5 per cent, and 43.4 per cent of participants reported no, minor, moderate, and major inconvenience or greater, respectively. The absence of ear discharge, absence of cholesteatoma, and poorer disease-specific health-related quality-of-life were associated with increased tinnitus severity in patients with chronic otitis media, whereas age, hearing disability and geographical region showed no association.

This analysis provided novel insight into potential risk factors for tinnitus in patients with chronic otitis media.

To determine the prevalence of human papillomavirus in paediatric tonsils in Southwestern Ontario, Canada.

Patients aged 0–18 years undergoing tonsillectomy were recruited. Two specimens (left and right tonsils) were collected from each participant. Tonsillar DNA was analysed using quantitative polymerase chain reaction to determine the presence of human papillomavirus subtypes 6, 11, 16 or 18.

A total of 102 patients, aged 1–18 years (mean age of 5.7 years), were recruited. Ninety-nine surveys were returned. There were 44 females (44.4 per cent) and 55 males (55.6 per cent). Forty patients (40.4 per cent) were firstborn children and 73 (73.7 per cent) were delivered vaginally. Six mothers (6.1 per cent) and one father (1.0 per cent) had prior known human papillomavirus infection, and one mother (1.0 per cent) had a history of cervical cancer. All tonsil specimens were negative for human papillomavirus subtypes 6, 11, 16 and 18.

No human papillomavirus subtypes 6, 11, 16 or 18 were found in paediatric tonsil specimens from Southwestern Ontario.

This study investigated whether inferior turbinate reduction combined with septoplasty improves patients’ outcomes, as assessed by objective and subjective methods.

A single-centre, parallel-group, randomised, open-label trial was conducted at a tertiary hospital ENT clinic. Patients who underwent septoplasty were divided into two groups: group A underwent septoplasty with radiofrequency ablation; group B underwent only septoplasty. All patients were assessed before and three months after surgery using acoustic rhinometry and peak nasal inspiratory flow measurements, as well as Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores.

Seventy-four patients completed the study (36 in group A and 38 in group B). The patients in both groups showed significant improvements in acoustic rhinometry and peak nasal inspiratory flow measurements and in Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores after the surgery (p < 0.05). However, the differences between the groups were not significant (p > 0.05).

Inferior turbinate ablation combined with septoplasty does not provide any more benefit to the objective and subjective outcomes of patients than septoplasty alone.