It was in twentieth-century Britain that the two distinct surgical disciplines, otology and laryngology, became united under the title oto-laryngology. Aural departments were established in general hospitals in the hands of specialists long before throat departments. The development and politics of the specialty occurred in London, while provincial services commenced in the early eighteenth century, with ophthalmologists, setting up a clinic or dispensary, progressing onto a hospital.

The following resources were used: the Nottinghamshire Archives; Manuscripts and Special Collections at the University of Nottingham Libraries and The Local Studies Library, Nottingham Central Library.

The Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose was established in 1886, staffed by part-time general practitioners. The Nottingham Children's Hospital appointed two qualified surgeons in the 1910s and subsequently the General Nottingham Hospital appointed them as honorary assistant surgeons. Both hospitals provided access to beds, not available to the Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose. Following The Education Act of 1907, Nottingham created a School Health Services. By the 1920s, Nottingham had four institutions providing clinical and surgical ENT services. The National Hospitals Survey conducted in 1945 recommended that the Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose be closed and amalgamated with The General Hospital Nottingham.

The General Hospital Nottingham was slow to create a service for the diagnosis and treatment of ENT diseases and disorders, but established a Departmental Service by 1927. The surgical staffing was common to all four of the ENT services from mid-1930.

There has been a recent deluge of coronavirus disease 2019 associated mucormycosis in our country. It affects the paranasal sinuses; however, it has a rapid extrasinus progression (the orbit being most common), which can be fatal if not detected early. It may meander into the orbit through various foramina without frank bone destruction.

This paper reviews the various gateways of the spread of coronavirus disease 2019 associated mucormycosis to the orbit, even before advent of bone destruction or ocular symptoms. Plausible pathways of invasion and subtle imaging findings are depicted, to enable an early diagnosis.

Relevant anatomy and imaging examples have been illustrated to familiarise the surgeons with various routes of coronavirus disease 2019 associated mucormycosis spread to the orbit. Emphasis is laid on searching for subtle imaging findings for the detection of early orbital invasion.

Early detection and extension of coronavirus disease 2019 associated mucormycosis is facilitated by knowledge of its gateways of spread, which aids the surgeon in prognostication and planning of the surgical approach.

Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media.

A systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted.

From 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application.

Mesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.

There are significant drug–drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome.

All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted.

A literature search and further cross-referencing yielded a total of seven reports on drug–drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019.

The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

Litigation in the National Health Service continues to rise with a 9.4 per cent increase in clinical negligence claims from the period 2018 and 2019 to the period 2019 and 2020. The cost of these claims now accounts for 1.8 per cent of the National Health Service 2019 to 2020 budget. This study aimed to identify the characteristics of clinical negligence claims in the subspecialty of otology.

This study was a retrospective review of all clinical negligence claims in otology in England held by National Health Service Resolution between April 2013 and April 2018.

There were 171 claims in otology, 24 per cent of all otolaryngology claims, with a potential cost of £24.5 million. Over half of these were associated with hearing loss. Stapedectomy was the highest mean cost per claim operation at £769 438. The most common reasons for litigation were failure or delay in treatment (23 per cent), failure or delay in diagnosis (20 per cent), intra-operative complications (15 per cent) and inadequate consent (13 per cent).

There is a risk of high-cost claims in otology, especially with objective injuries such as hearing loss and facial nerve injury.

This study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell carcinoma.

This study was a systematic review in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed until January 2018; pertinent studies were screened. Quality of evidence was assessed using the grading of recommendation, assessment, development and evaluation working group system.

Eight articles were chosen that reported on 437 patients with external auditory carcinoma. The 5-year overall survival rate was 53.0 per cent. The pooled proportion of survivors at 5 years for T1 tumours was 88.4 per cent and for T2 tumours was 88.6 per cent. For the combined population of T1 and T2 cancer patients, it was 84.5 per cent. For T3 and T4 tumours, it was 53.3 per cent and 26.8 per cent, respectively, whereas for T3 and T4 tumours combined, it was 40.4 per cent. Individual analysis of 61 patients with presence of cervical nodes showed a poor survival rate.

From this review, there was not any significant difference found in the survival outcome between T1 and T2 tumours. A practical classification incorporating nodal status that accurately stratifies patients was proposed.

The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery.

A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay.

A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay.

Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

The present systematic review aimed to explore the published literature on the application of yoga and meditation for tinnitus.

A systematic search was carried out to identify the eligible studies exploring the effect of yoga and meditation on tinnitus in PubMed, Scopus and Cochrane Library electronic databases. Studies on the application of yoga and meditation on tinnitus were identified following a three-step screening process by both the authors independently. A mixed-methods appraisal tool was used to perform the quality appraisal of the included studies.

Five studies were shortlisted and included in the present review. Four studies had used different types of yoga and pranayama, while one used relaxation therapy. Three studies concluded that there were positive effects of yoga on tinnitus, such as a reduction in severity, stress, anxiety and irritability associated with tinnitus and improved quality of life.

This review highlights the application of yoga and meditation in management of tinnitus along with regular otological and audiological treatment options. Furthermore, there is a need to have more randomised controlled trials in this area to evidence the effect of yoga and meditation on tinnitus empirically.