The coronavirus disease 2019 pandemic has greatly disrupted head and neck cancer services in the West of Scotland. This study aimed to assess the impact of the first wave of the pandemic on cancer waiting times.

A retrospective review of multidisciplinary team records was undertaken between March and May in 2019 and the same months in 2020. Time-to-diagnosis and time-to-treatment for new cancers treated with curative intent were compared between the study periods, and subclassified by referral pathway.

A total of 236 new cancer patients were included. During the pandemic, pathways benefitted from reduced diagnostic and treatment times resulting from the restructuring of service provisions. A 75 per cent reduction in secondary care referrals and a 33 per cent increase in urgent suspicion of cancer referrals were observed in 2020.

Head and neck cancer pathway times did not suffer because of the coronavirus pandemic. Innovations introduced to mitigate issues brought about by coronavirus benefitted patients, led to a more streamlined service, and improved diagnostic and treatment target compliance.

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.

The clinical value of tonsillectomy continues to cause much debate, despite tonsil disease representing a significant burden to patients, caregivers and healthcare systems. This study assessed the long-term effect of adenotonsillectomy or tonsillectomy on the Paediatric Throat Disorders Outcome Test (‘T-14’), a validated tool used to objectively assess obstructive and infective symptoms in paediatric throat disorders.

Patients aged under 16 years undergoing adenotonsillectomy or tonsillectomy were recruited consecutively from 2018 into our prospective observational study. The Paediatric Throat Disorders Outcome Test questionnaire was completed by the children's caregivers pre-operatively (n = 80), and at 21 days (n = 68) and 2 years (n = 66) post-operatively.

Significant reductions were noted in mean total Paediatric Throat Disorders Outcome Test scores at 21 days and 2 years post-operatively (p ≤ 0.003).

Our results provide supporting evidence that paediatric adenotonsillectomy or tonsillectomy significantly improves quality of life up to two years post-operatively, and therefore remains a valuable use of healthcare resources.

Eczematous external otitis is a common chronic condition that can have a significant impact on the life of sufferers, causing constant discomfort and pruritus, and leading to sleep deprivation. Treatment is based on the use of topical steroids, moisturisers and occasionally antibiotics. Results, however, can be disappointing, especially over the long term.

This study compared the long-term response to pimecrolimus, administered to a group of 11 patients, against clobetasone butyrate, administered to an equivalent number of patients. Response to the treatment was assessed and statistically analysed at 3 and 12 months.

Whereas the degree of improvement following the use of pimecrolimus and clobetasone butyrate was similar for the two groups at month 3, a highly statistically significant difference was documented at month 12, with a much greater and sustained improvement in the pimecrolimus group.

The impact of coronavirus disease 2019 extends far beyond the immediate burden on healthcare systems caused by hospitalisation of patients with the disease itself.

To investigate the impact of the coronavirus disease 2019 pandemic on the referral rate of patients to the suspected head and neck cancer two-week-wait clinic.

A multicentre retrospective study was performed investigating data collected for all patients attending the suspected head and neck cancer two-week-wait clinic in ENT departments in the West Midlands.

A total of 509 fast-track referrals were received from February to April in 2019, compared to 399 referrals in 2020. April 2020 saw a 62.4 per cent reduction in referral rate compared to April 2019.

The coronavirus disease 2019 pandemic has resulted in changes to health-seeking behaviours, and healthcare provision and delivery. Urgent policy interventions may be required to compensate for the hidden impact that the coronavirus disease 2019 pandemic has had on those with cancer.

To determine the demographic, aetiopathological and diagnostic profiles of patients presenting with hoarseness to a laryngology unit of a tertiary care centre in India.

A retrospective observational study was conducted.

The 1033 patients who presented with dysphonia showed a male predominance (70 per cent), high rates of malignancy (18 per cent), late presentation (mean, 24 months) and poor follow-up trends (53 per cent with 3 months’ follow up), which contrasts with data from developed countries. The patient population hailed from different states in India and neighbouring countries around India, serving as a good sample for the subcontinent. The majority (67 per cent) were managed conservatively; however, surgical management was the preferred choice for those who presented with airway stenosis (91 per cent) and laryngeal trauma (75 per cent). Significant associations between vocal professionalism level and co-morbidities and dysphonia aetiopathologies are discussed.

These findings give insight into the trends of hoarseness in the developing Indian subcontinent, which can aid understanding and management.

This study aimed to develop the Greek versions of the Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire for adult and pediatric populations, discuss their differences and detect the impact of age and gender on quality of life questionnaire results.

Ninety-eight patients with allergic rhinitis participated. Quality of Life evaluation was made by two generic (Short Form-36 and Beck Depression Inventory) and two disease-specific questionnaires (Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire). Symptom evaluation was made by the Total 5 Symptoms Score assessment.

Internal consistency and test–retest reliability of both questionnaires was high. Convergent validity showed statistically significant negative correlations of total Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire with overall Short Form-36 Health Survey score and positive correlations with Beck Depression Inventory and Total 5 Symptoms Score. Discriminative validity demonstrated statistically significant improvement for all instruments and all domains after treatment. Females presented highly significant increased scores. Patient age was positively correlated with total scores of Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire. The clinically significant improvement after treatment was higher among females than males, while it was independent of patient age.

Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire proved to be valid and reliable methods of assessment of allergic rhinitis-related quality of life in children, adolescents and adults.

This study investigated the relationship between physical dimensions of the Eustachian tube and the emergence of primary attic cholesteatoma.

A total of 31 patients with unilateral attic cholesteatoma were selected for radiological comparison. Standard point measurements as well as specific measurements were performed using imaging software. The length, narrowest diameter and bony segment volume, and pharyngeal orifice diameter of both sides of the Eustachian tube (attic cholesteatoma and healthy control ears) were measured and compared.

Comparison of the values did not reveal any statistically significant difference between the attic cholesteatoma ears and the healthy control ears in terms of: Eustachian tube height, narrowest diameter, bony segment volume or pharyngeal orifice diameter.

No statistically significant difference was found between the cholesteatoma ears and the healthy control ears in terms of the osseous Eustachian tube size. The findings indicate that the Eustachian tube bony segment dimensions and pharyngeal orifice diameter are not factors in attic cholesteatoma development.

Platelet-rich plasma has gained interest over the two last decades, mainly because of its role in regenerative medicine. This work aimed to assess the role of intra-operative local application of platelet-rich plasma gel in the improvement of quality of voice after microlaryngeal surgery.

This was a prospective comparative study that included 40 patients undergoing microlaryngeal surgery for benign vocal fold lesions. There were two groups divided equally into study group A and control group B. The assessment of voice was performed by videostroboscopy and acoustic analysis pre-operatively and at two weeks and one and three months post-operatively.

The data demonstrated that all the stroboscopic and acoustic parameters showed significant improvement in both groups. Group A showed significant improvement regarding acoustic parameters at the third post-operative follow up when compared with group B.

Platelet-rich plasma has a beneficial effect on voice quality following microlaryngeal surgery based in particular on acoustic parameters.

Obstructive pathology is a benign condition of the salivary glands that can affect elderly and co-morbid people. Sialoendoscopy is a minimally invasive surgical procedure with a success rate comparable to standard sialoadenectomy and has the advantage that it can be performed under local anaesthesia.

This study aimed to assess sialoendoscopy benefits in elderly patients unfit for general anaesthesia. A group of elderly patients (aged 65 years or more) undergoing sialoendoscopy under local anaesthesia were evaluated. Age, co-morbidities, surgical time, hospital stay, and complication and recurrence rates were assessed.

Nineteen sialoendoscopies were performed in 18 elderly patients with a mean age of 69.7 ± 5.6 years, with some of them suffering from multiple co-morbidities. Surgery was successful in 16 patients, while surgery was unsuccessful in 2 patients because of intraglandular stones. The average surgical duration was 54.5 ± 30.1 minutes, and all patients were discharged 2–3 hours after surgery. No post-operative complications were found and only one patient had recurrence during follow up.

Sialoendoscopy under local anaesthesia is a safe and effective procedure in elderly patients who are more prone to complications.

This study aimed to characterise the laryngological presentations of Ehlers–Danlos syndrome and conduct a preliminary exploration of patient-reported outcome measures.

This paper describes a retrospective case series of patients with Ehlers–Danlos syndrome seen by the senior author between 2005 and 2019. A literature review was conducted to summarise the existing findings.

Twenty-one patients met the inclusion criteria. All reported symptoms were grouped; this showed that swallowing, voice and hyolaryngeal skeletal complex problems were commonest. Patient-reported outcome measures were available for eight patients, which showed large variations in: the Reflux Severity Index (median = 25.5; range = 0–33), Eating Assessment Tool score (median = 21.5; range = 0–35) and Voice Handicap Index (median = 21.5; range = 0–104). Twelve studies met our literature review inclusion criteria, involving at least 91 patients with laryngological presentations of Ehlers–Danlos syndrome.

Ehlers–Danlos syndrome patients experience musculoskeletal issues, which in the throat manifest as hyolaryngeal skeletal complex problems. Future studies with larger patient numbers are required to validate laryngological patient-reported outcome measure tools in Ehlers–Danlos syndrome.

This study aimed to determine the number, reasons and costs of surgical voice restoration related tracheoesophageal valve attendances over 36 months at a head and neck oncology unit.

Demographic, medical and valve related details from all patient contacts were recorded, including self-change information, urgent appointment information, modifications required and costs of prostheses.

Over 3 years, 99 patients underwent 970 valve changes. The main reasons for changes were central leakage, prophylactic change and self-change at home. Changes were significantly more frequent in the first 12 months (mean, 42 days) compared with longstanding patients (mean, 109.96). Intervals between changes were unpredictable; no predictive factors reached statistical significance. Mean expenditure on valves was £966.63 per week (including value added tax and in-house customisation).

Valve lifespan is comparable with outcomes in similar units despite more pre-emptive and patient-led changes and more comprehensive data inclusion. Investigation into how patient satisfaction and costs relate to valve selection and units’ service delivery models is needed.

This study evaluated the olfactory, sinonasal and mucociliary functions of patients with post-coronavirus disease 2019 long-term persistent olfactory dysfunction.

Three groups of 30 patients each were formed: patients with a history of coronavirus disease 2019 infection with self-reported, persistent, sudden-onset olfactory dysfunction (group 1), patients with a history of coronavirus disease 2019 infection without any self-reported olfactory dysfunction (group 2) and healthy controls with no history of coronavirus disease 2019 infection (group 3). Saccharin time, Sniffin’ Sticks, Turkish Nasal Obstruction Symptom Evaluation and Sino-Nasal Outcome Test 22 scores were compared.

Turkish Nasal Obstruction Symptom Evaluation scores were similar between groups (p = 0.252). Sino-Nasal Outcome Test-22 scores were higher in group 1 than groups 2 and 3 (p < 0.01 and p < 0.001, respectively). Saccharin time was significantly longer in group 1 than groups 2 and 3 (p < 0.05 and p < 0.01, respectively). Group 1 had lower olfactory scores than groups 2 and 3 (p < 0.001 and p < 0.001, respectively).

Mucociliary clearance time was significantly prolonged in patients with post-coronavirus disease 2019 persistent olfactory dysfunction. Coronavirus disease 2019 infection was likely to cause asymptomatic olfactory dysfunction.

To analyse the treatment results of bilobed flap reconstruction performed for skin defects after parotid carcinoma surgery.

Ten patients who underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery in our hospital, from 2014 to 2020, were retrospectively enrolled.

All patients underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery. The size of the skin defect was 2.7 × 2.2 cm in the smallest dimension and 9.0 × 6.3 cm in the largest dimension. All bilobed flaps except one healed without any problems. One patient developed partial flap necrosis in the retroauricular region, and was treated with skin grafts after removal of the necrotic tissue under local anaesthesia. All bilobed flaps, including the cases in which skin grafts were performed, survived after post-operative radiotherapy or chemotherapy.

A bilobed flap is a good reconstruction option for skin defects after parotid carcinoma surgery in some cases.

To assess the impact of the coronavirus disease 2019 pandemic on head and neck urgent suspected cancer referral pathways in rural areas of Wales.

A retrospective audit was conducted of 2234 head and neck urgent suspected cancer referrals received from January 2019 to November 2020.

The referrals dropped by 35 per cent in 2020 compared to the same period in 2019. The time from general practitioner referral to the first ENT appointment improved during the pandemic (8.0 vs 10.0 days; p < 0.001). Of referrals, 92.1 per cent were seen within a 14-day period in 2020, compared with 79.6 per cent in 2019 (p < 0.001). There were no differences between 2020 and 2019 in terms of: the (confirmed cancer) conversion rate (10.6 per cent vs 9.7 per cent; p = 0.60), general practitioner referral to multidisciplinary team discussion time (35.5 vs 41.5 days; p = 0.40) or general practitioner referral to initiation of treatment time (68.0 vs 78.0 days; p = 0.16).

Whilst coronavirus disease 2019 reduced the number of overall head and neck urgent suspected cancer referrals, the pathways were generally unchanged, if not slightly improved, in rural Wales.

The aetiology and significance of internal carotid artery variations at the skull base remain controversial after decades, with limited available literature. Approximately 10–40 per cent of the general population has parapharyngeal internal carotid artery variations.

A prospective observational study was conducted on internal carotid artery variations in 36 cadavers, in a tertiary care hospital, between March 2019 to March 2020.

The most common internal carotid artery variation observed in the specimens was tortuosity, in 30 per cent, followed by kinking in 18 per cent and coiling in 10 per cent. Thirty per cent of specimens had variations present bilaterally. A loop pattern of the internal carotid artery was identified. Coiling of the internal carotid artery may present as a node; hence, meticulous dissection is advocated near the skull base to avoid complications. These variations hold utmost importance for otorhinolaryngologists performing pharyngeal and nasopharyngeal surgical procedures.

A detailed knowledge of anatomy, along with its variations, and surgical expertise, will help reduce the incidence of surgical complications.

Risk factors for salivary gland carcinoma are poorly understood. Although links between background radiation, smoking and obesity have been previously suggested, no studies have so far established any significant results. This study aimed to establish correlations between common environmental and lifestyle risk factors and different subtypes of salivary gland carcinoma.

A study of population data in Wales spanning 27 years was conducted; 2 national databases were used to identify 356 cases of primary salivary gland carcinoma over this period. Histological subtype of cancer and geographical location of each case was recorded. Public health data was used to establish radon levels, smoking, obesity and activity levels of populations in each geographical location. A population matched multivariate analysis of variance analysis was performed using histological subtype and risk factor data for each geographical location.

A significantly higher incidence of mucoepidermoid cancer in populations with higher background radon levels (p = 0.006), epithelial-myoepithelial cancer in populations with higher smoking levels (p = 0.029) and adenoid cystic cancer in populations with higher obesity levels (p = 0.028) was found.

To the authors’ knowledge, this is the first study to establish significant links between background radiation, smoking and obesity with different subtypes of salivary gland carcinoma.

YouTube has become the preferred resource for trainees to learn and prepare for surgical cases. This study evaluated the educational quality of YouTube videos detailing thyroidectomy and parathyroidectomy.

YouTube was systematically searched using 11 terms related to thyroidectomy and parathyroidectomy. Four independent clinical reviewers assessed the videos using Laparoscopic Surgery Video Educational Guidelines as well as modified Laparoscopic Surgery Video Educational Guidelines subgroup tools.

Sixty-five videos were identified and evaluated. Overall Laparoscopic Surgery Video Educational Guidelines score was 8.58 ± 3.85 (mean subgroup score, 5.67 ± 2.40). Twenty-eight of 65, 25 of 65 and 12 of 65 videos were deemed medium, low and high quality, respectively. Inter-rater reliability was good for both attending surgeons and residents. Presence of audio or visual commentary had a positive correlation with total Laparoscopic Surgery Video Educational Guidelines scores (R2=0.38). Videos produced by otolaryngologists and US-based physicians scored higher on total scores compared to non-otolaryngology and non-US based physicians.

Some YouTube videos on thyroidectomy and parathyroidectomy exhibit high educational value. Future efforts should increase the number of high-quality YouTube videos containing both audio and visual commentary or create an online repository of videos for medical students and residents to augment their surgical training.

Congenital midnasal stenosis has previously been described as a cause of nasal obstruction in infants, and conservative and interventional treatments have been suggested. However, midnasal stenosis in adults has not been reported and related normative measurements have not been studied.

Three adult patients presented with nasal obstruction and, based on examination and radiological findings, were diagnosed with midnasal stenosis. Anatomical measurements were studied in axial and coronal computed tomography scans, and compared with findings for 161 healthy individuals.

Anatomical measurements showed that the endonasal cavity was larger in males than females. The midnasal region was found to be constricted in patients compared to healthy controls.

This is the first study to report on midnasal stenosis in adults and to define normative anatomical measurements in adults. In patients presenting with nasal obstruction, midnasal stenosis should be suspected during endoscopic visualisation of medially located middle turbinates and uncinate processes in nasal cavities. A definitive diagnosis of midnasal stenosis can be made by examining paranasal sinus computed tomography scans. Endoscopic middle turbinectomy, complete uncinectomy, mega maxillary antrostomy and partial anterior ethmoidectomy have been suggested to relieve midnasal stenosis.

To elucidate the aetiopathogenesis of facial neuritis in coronavirus disease 2019 associated mucormycosis.

A retrospective review was conducted of coronavirus disease 2019 associated mucormycosis patients who presented with peripheral facial nerve palsy from January 2021 to July 2021. The clinico-radiological details of four patients were assessed to examine the potential mechanism of facial nerve involvement.

Serial radiological evaluation with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging revealed infratemporal fossa involvement in all cases, with the inflammation extending along fascial planes to reach the stylomastoid foramen. Ascending neuritis with an enhancement of the facial nerve was demonstrated in all cases.

The likely explanation for facial palsy in patients with coronavirus disease 2019 associated mucormycosis, backed by radiology, is the disease abutting the facial nerve at the stylomastoid foramen and causing ascending neuritis of the facial nerve.