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To compare 12-month functional, aesthetic and scar outcomes after septorhinoplasty in patients with and without allergic rhinitis and to assess allergy symptoms in the allergic rhinitis group. Ninety-six patients were included (allergic rhinitis, n = 47; non-allergic rhinitis, n = 49). No turbinate surgery was performed. Allergy symptoms (allergic rhinitis group) were rated pre-operatively and at 12 months using a visual analogue scale (VAS). At 12 months, all patients completed the Standardised Cosmesis and Health Nasal Outcomes Survey; scars were evaluated with the Stony Brook Scar Evaluation Scale and patient- and physician-reported VAS scores for scar and nasal shape. The Standardised Cosmesis and Health Nasal Outcomes Survey, the Stony Brook Scar Evaluation Scale and scar VAS scores were similar between groups. Nasal shape VAS scores were higher in the non-allergic rhinitis group, significant only for physician ratings (p = 0.03). In the allergic rhinitis group, allergy VAS decreased from 39.32 ± 42.25 to 24.22 ± 31.96 (p < 0.001). Allergic rhinitis does not adversely affect functional, aesthetic or scar outcomes after septorhinoplasty, and septorhinoplasty may clinically reduce allergy symptoms in patients with allergic rhinitis.
This study aimed to investigate the prevalence of misophonia among university students, examine its relationship with hyperacusis and tinnitus and explore the sensory processing patterns of individuals with misophonia in comparison to the control group. Based on the Misophonia Questionnaire severity scores, 81 clinical misophonia and 163 subclinical misophonia patients and 60 matched healthy-controls participated the study and evaluated with the Tinnitus Handicap Inventory, Khalfa Hyperacusis Questionnaire and the Dunn Adult/Adolescent Sensory Profile questionnaire. The incidence of clinical misophonia was 19 per cent. The clinical misophonia group had significantly higher sensory-sensitivity and sensation-avoiding scores and lower low-registration scores (Mann-Whitney U-test with Bonferroni correction; p < 0.017). Sensory processing scores across all sensory domains were significantly correlated with Misophonia Questionnaire scores. The strongest associations were moderate positive correlations in the touch (r = 0.444; p = 0.00) and visual (r = 0.420; p = 0.00) processing domains. Findings indicate that misophonia involves heightened sensitivity and avoidance not only in auditory but also in movement, visual, touch and activity-related sensory areas, suggesting it is a complex atypical multisensory condition rather than purely audiological or psychiatric.
Medications for middle-ear diseases are commonly delivered into the middle-ear cavity either by the eardrop method with a tympanostomy tube followed by tragal pumping or by intratympanic injection. The solution delivery of the eardrop method was compared with that of intratympanic injection. Thirty rats were used. For the eardrop method, tympanostomy tube insertion, dye solution eardrop application and tragal pumping were performed in one ear. Intratympanic injection of the same solution was performed in the other ear. The ratio of the area stained by the dye solution to the total area of the middle-ear cavity in haematoxylin and eosin-stained temporal bone sections was evaluated. The stained area ratio was not significantly different between the eardrop method and intratympanic injection (p = 0.897). In our rat model, the eardrop method achieved solution delivery into the middle-ear cavity as effectively as intratympanic injection.
Total ossicular replacement prostheses are commonly used to restore hearing in the conductive hearing impaired. However, total ossicular replacement prostheses are expensive and scarcely available in low- and middle-income countries. Therefore, the aim was to develop and validate an open-source design of a total ossicular replacement prosthesis that can be produced locally for low- and middle-income countries hospitals. Based on input from literature and clinicians a design was made and verified. Accuracy, re-bending safety, cadaver ear fitting, sound transmission and production learning curves were tested. A titanium sheet metal total ossicular replacement prosthesis, costing 9 euro, showed accurate dimensions, surgeons showed short learning curves, and sound transmission was similar to commercial total ossicular replacement prostheses. Re-bending tests demonstrated bending corrections could be safely done. Good cadaver ear fitting could be demonstrated, without conflicts between the titanium sheet metal total ossicular replacement prosthesis and anatomical features. The titanium sheet metal total ossicular replacement prosthesis design has proved to be feasible for implementation in low- and middle-income countries.
This retrospective study evaluated the concordance between fine-needle aspiration cytology and histopathology in parotid gland masses and assessed the diagnostic value of magnetic resonance imaging features. Forty-two patients who underwent parotidectomy with available fine-needle aspiration cytology, magnetic resonance imaging, and histopathology results were included. fine-needle aspiration cytology-histopathology agreement was analysed for multicategorical and binary (benign vs. malignant) classifications. Magnetic resonance imaging findings, including signal intensity, contrast enhancement, cystic-like appearance and lesion size, were compared, and predictors of malignancy were evaluated using Firth logistic regression. Thirty-eight lesions (90.5 per cent) were benign and four (9.5per cent) were malignant. Fine-needle aspiration cytology-histopathology concordance was low for histological subtype differentiation (κ = 0.082) but substantial for benign-malignant distinction (κ = 0.636; p < 0.01). All lesions were T2-hyperintense, and cystic-like appearance was strongly associated with Warthin tumour (p = 0.001; odds ratio 38.5). No magnetic resonance imaging or clinical variable independently predicted malignancy. Overall, these findings support fine-needle aspiration cytology as the cornerstone of pre-operative evaluation of parotid masses, with magnetic resonance imaging serving primarily for surgical planning.
Electronic consent (eConsent) and procedure-specific consent forms have been highlighted as methods of improving the consent process. In this two-cycle audit, we assessed the quality of consent documentation pre- and post-implementation of eConsent. We reviewed paper (first cycle) and eConsent (second cycle) forms for discussion of benefits, risks and alternatives for septorhinoplasty and functional endoscopic sinus surgery. A survey which included the System Usability Scale was distributed to clinicians. Post-implementation of eConsent, there was a statistically significant increase in the number of risks documented in septorhinoplasty (p-value < 0.001) though this was not the same for functional endoscopic sinus surgery. Feedback was generally positive with a System Usability Scale score of 85.3 indicating high usability. The implementation of eConsent with procedure-specific consent forms in our centre was well received with significant improvements in septorhinoplasty documentation and more modest improvements in FESS.
To analyse the clinical characteristics, treatment and outcomes of minor salivary gland tumours of the upper aerodigestive tract. A retrospective study was conducted of patients treated for minor salivary gland tumours between 1988 and 2020. Clinical, pathological and treatment variables were analysed. Survival outcomes were assessed using the Kaplan-Meier method. Seventy-three patients were included, of which 64 (87.7 per cent) had malignant tumours. The most common histological type was adenoid cystic carcinoma (46.9 per cent), followed by mucoepidermoid carcinoma (32.8 per cent). The oropharynx was the most frequent tumour site. Treatment consisted mainly of surgery with or without adjuvant radiotherapy. During follow up, 28.1 per cent of patients developed local recurrence and 32.8 per cent developed distant metastases. Five- and 10-year disease-specific survival rates were 77.0 and 50.8 per cent, respectively. Advanced stage, tumour location and histological grade were associated with survival. Minor salivary gland tumours are predominantly malignant and show heterogeneous behaviour. Prognosis is mainly determined by tumour stage, location and histological grade, supporting the need for long-term follow up.
This study aimed to determine the incidence of post-operative dysphonia following anterior cervical discectomy and fusion, identify associated risk factors and assess utilisation of diagnostic and therapeutic interventions. This retrospective cohort study analysed data from the PearlDiver Mariner Patient Records Database (2010-2022). Adults (≥18 years) undergoing primary anterior cervical discectomy and fusion without pre-existing dysphonia were included (n = 613,978). Outcomes included incidence, risk factors (odds ratios, 95 per cent confidence intervals) and intervention rates. Dysphonia occurred in 2.6 per cent of patients. Risk factors included female sex (odds ratio 1.43), age 50-64 (odds ratio 1.10), 65-79 (odds ratio 1.21), smoking (odds ratio 2.41), obesity (odds ratio 2.80), diabetes (odds ratio 1.89) and multilevel anterior cervical discectomy and fusion (odds ratio 1.20) (p < 0.01). Diagnosis was delayed (>12 months) in 73.2 per cent. Only 52.7 per cent underwent laryngoscopy; 15.0 per cent received voice therapy. Post-operative dysphonia is under-recognised and undertreated. Structured screening and otolaryngology referral pathways may improve diagnosis and management.
Deep neck space infections are uncommon but potentially life-threatening conditions with variable presentation in children without clear indications for medical versus surgical management. This study aimed to identify predictors of surgical intervention. A retrospective review was conducted of paediatric patients with deep neck space infections at a tertiary centre between 2014 and 2024. Patients were grouped by treatment approach: medical therapy, primary surgery or surgery following medical therapy. Clinical, radiological and outcome variables were analysed to identify predictors of surgical intervention. Ninety-two patients were included: 51.1 per cent were managed successfully with antibiotics alone, and 48.9 per cent required surgery initially or after medical trial. Independent predictors of surgical intervention included younger age, fever (< 38.0° Celsius) at presentation, computed tomography confirmed abscess and cross-sectional area greater than 3.00 cm2. Most deep neck infections respond to medical management, though younger age, fever and larger abscess size should prompt consideration for surgical consideration.
This study aimed to determine what motivates rhinoplasty surgery after septoplasty, and the clinical characterisation of patients undergoing these interventions. This is a retrospective observational study including all patients submitted to rhinoplasty after septoplasty between January 2018 and July 2023. Demographic, clinical and surgical data were collected using patients' digital hospital records. Of 219 patients who underwent rhinoplasty, 15 per cent (n = 33) had a previous history of septoplasty. All patients (n = 33) who had undergone septoplasty before rhinoplasty reported maintenance of nasal obstruction, with most patients presenting with nasal deformities upon physical examination (54%; n = 18), of which 15 per cent (n = 5) presented with nasal tip ptosis and with 9 per cent (n = 3) presenting with nasal septum perforation. The mean interval between septoplasty and rhinoplasty was 77 months. An open approach was used in 58 per cent of patients, and grafts in 73 per cent, most commonly columella struts, with cartilage harvested from the nasal septum in 55 per cent but requiring auricular cartilage in 18 per cent. Persistent nasal obstruction is the main indication for rhinoplasty after septoplasty, commonly associated with residual septal deviation, nasal valve dysfunction or external nasal deformities. These findings emphasise the importance of a thorough pre-operative assessment of all nasal structures in patients with nasal obstruction. Rhinoplasty in this context often represents a more complex surgical challenge, frequently requiring an open approach and a greater use of cartilage grafts, sometimes harvested from sites beyond the nasal septum. A comprehensive approach that addresses both functional and aesthetic components during the primary surgery may reduce revision rates, facilitate easier corrective procedures if needed and improve long-term patient satisfaction.
To evaluate the efficacy and safety of stellate ganglion block for persistent and refractory sensorineural olfactory dysfunction. A systematic search of PubMed, Scopus, Embase, Web of Science, Google Scholar and the Cochrane Library was conducted for studies published before December 2025. Eligible studies assessed subjective and/or objective olfactory outcomes before and after stellate ganglion block and, when available, compared stellate ganglion block with placebo or no treatment. Nine studies involving 441 participants were included. Stellate ganglion block was associated with greater improvements in olfactory composite, identification and subjective scores than controls, but between-group differences were not statistically significant. Subjective and objective improvement rates following stellate ganglion block were 68.9 and 63.4 per cent, respectively. No major adverse events were reported. Stellate ganglion block appears safe and may provide modest olfactory improvement, but its superiority over control treatments remains unproven, warranting further randomised controlled trials.
Post-operative haemorrhage following thyroid and parathyroid surgery is a rare but life-threatening complication. A structured protocol ("ITSRED Fred" mnemonic: Irrigation, Time, Systolic BP greater than 100 mmHg, Relief of neck extension, Elevation of venous pressure, Drain avoidance, Flap evaluation) was introduced to standardise haemostasis and closure. Records of 1525 thyroid and parathyroid operations over a five-year period at a tertiary unit were reviewed following protocol implementation. Re-operation for bleeding and management outcomes were analysed. Twelve patients (0.79 per cent) required re-operation for bleeding, lower than the previous 1.3 per cent. Bleeding occurred intra-operatively (n = 4), within 6 hours (n = 6) and after 6 hours (n = 2). Thyroid surgery had a higher bleeding rate (1.06 per cent) than parathyroid surgery (0.37 per cent). Hospital stay was unaffected. The ITSRED Fred protocol was associated with reduced re-bleeding rates. Beyond safety, its structured format provides a reproducible training tool to teach junior surgeons systematic haemostatic assessment at closure.
This study aimed to investigate the risk of laryngopharyngeal reflux in Hubble Bubble smokers in comparison to non-smokers. The medical records of patients who presented with hoarseness were reviewed. Patients with a history of Hubble Bubble smoking and a control group of non-smokers were included in the study. The risk of laryngopharyngeal reflux was assessed using the Reflux Symptom Index and the Reflux Finding Score. Eighty-six Hubble Bubble smokers and 86 controls were included in the study. There was a statistically significant difference in the mean RSI between the two subgroups (10.05 ± 8.27 vs. 5.05 ± 6.58; p < 0.001). Hubble Bubble smokers were 4.24 times more likely to have a Reflux Symptom Index score greater than 13 in comparison to non-smokers (odds ratio = 4.24; 95 per cent confidence interval: 1.97-9.14). Hubble Bubble smoking increases the risk of laryngopharyngeal reflux by two-fold. A larger prospective study is needed to substantiate the association between Hubble Bubble smoking and laryngopharyngeal reflux.
To investigate whether socioeconomic deprivation is associated with residual or recurrent cholesteatoma following primary mastoidectomy. A retrospective cohort study included all patients undergoing primary mastoidectomy for cholesteatoma in National Health Service Tayside between 2012 and 2020. Socioeconomic status was assessed using the Scottish Index of Multiple Deprivation 2020 and divided into quintiles. Patients were stratified into paediatric (≤16 years) and adult (>16 years) groups. Recurrence/residual rates across Scottish Index of Multiple Deprivation quintiles were compared using Fisher's exact tests, and time to recurrence was analysed using Kaplan-Meier survival curves. One hundred eighty-four patients were included (59 children, 125 adults). Recurrence/residual occurred in 39 per cent of children and 24 per cent of adults. In children, higher deprivation was significantly associated with risk of recurrence/residual disease (p = 0.0013). No significant association was observed in adults. Socioeconomic deprivation is linked to higher recurrence/residual in children, highlighting disparities in postoperative outcomes and the importance of targeted follow-up.
Strategic workforce planning is essential for equitable, high-quality healthcare. ENT services currently hold the second-longest NHS waiting list, with over 638,000 outstanding appointments, underscoring the urgency of accurate workforce planning. Data were collected across all 135 NHS trusts providing ENT services. Information was collated on consultants, associates, locally employed doctors (LEDs), trainee residents, fellows, advanced nurse practitioners (ANPs) and physician assistants (PAs). For consultants, subspecialty interest, working patterns, age and contract type were recorded. The UK ENT workforce comprised 1207 consultants (mean 1.77 per 100,000 population), with an over two-fold regional variation. On average, there were 1.29 second-on-call residents and 1.17 first-on-call residents per 100,000 population, with considerable regional variation. The UK ENT workforce demonstrates marked geographic and subspecialty imbalances with looming retirement risks. Targeted recruitment and retention initiatives, subspecialty redistribution and training capacity adjustments are critical to address current shortfalls and meet future service demands.
This study aims to provide an updated systematic review on the clinicopathological features, treatment modalities and survival outcomes on SMARCB1-deficient sinonasal carcinoma. Five databases were searched: PubMed, Cochrane, Embase, Web of Science and Scopus. Extracted information include demographic data, clinicopathological characteristics and survival outcomes. A total of 70 studies were included making up a total of 372 patients. Univariable and multivariable analysis performed for prognostic factors of SDSC showed that N+ disease was a statistically significant poor prognostic factor for overall survival, while surgical treatment was a favourable prognostic factor. Treatment with surgery combined with chemotherapy and/or radiotherapy conferred significantly better prognosis compared to chemotherapy or radiotherapy alone. Our study suggests that N+ disease and isolated treatment with radiotherapy or chemotherapy alone are significant poor prognostic factors for SMARCB1-deficient sinonasal carcinoma, while patients who undergo surgical treatment have significantly better prognosis.
We evaluated airway volume in patients after total laryngectomy. A total of 53 patients who underwent total laryngectomy were included in this study. Twelve of the patients had supraglottic Ca and 41 had transglottic Ca. Total lung volume, and intrapulmonary and tracheal airway volumes were measured. After total laryngectomy, tracheal airway volume decreased more in transglottic Ca patients compared with supraglottic Ca patients (p < 0.05). Even though intrapulmonary airway volumes and total lung volumes were not different between transglottic Ca and supraglottic Ca patients (p > 0.05), these volumes decreased post-operatively in both groups (p < 0.05). In older patients, the post-operative decrease in the tracheal airway volume was higher than in younger patients (p < 0.05). Pre-operative radiotherapy was applied in 50.0 per cent of supraglottic Ca patients and 58.5 per cent of transglottic Ca patients (p > 0.05). Because lower airway volume and total lung volume decrease after total laryngectomy, pulmonary rehabilitation should be administered post-operatively and appropriate follow up is essential to prevent tracheostomal narrowing.
This study aimed to evaluate the clinical applications, observed haemostatic outcomes of a self-assembling peptide haemostat (PuraBond®) across a range of ENT surgical procedures using a large UK observational registry. A two-cycle observational study of 600 patients at University Hospitals Birmingham NHS Foundation Trust (September 2019-July 2024). Data collected included patient demographics, comorbidities, anticoagulation status, surgical details, intra-operative haemostatic outcomes and post-operative complications. Intra-operative haemostasis was documented without the need for additional haemostatic intervention in 99.8% of cases (599/600). Immediate haemostasis-related complication rate was 0.2% (1/600). The overall complication rate was 3% per cent, with most complications unrelated to haemostasis or the use of PuraBond. The study limitations include participant heterogeneity, absence of a control group and small subspeciality sample sizes underscoring the need for comparative studies. This registry demonstrates PuraBond's broad applicability in ENT surgery as an adjunct to routine haemostats and provides essential groundwork for designing future comparative trials.
Assess the impact of anticoagulation or antiplatelet medications on endoscopic ear surgery visibility and procedural progress. A case-control retrospective chart review of patients on anticoagulation/antiplatelet undergoing endoscopic ear surgery from April 2018 to April 2023 was conducted. Surgical videos were blindly rated by two surgeons utilising the Modena Bleeding Scale during clips of key operative steps; scores and outcomes were compared. Equivalence analysis was performed using two one-sided tests with an equivalence range of plus-or-minus 0.4 Modena Bleeding Scale points. Fourteen cases were matched with 28 controls. Cases were more male (85.7 per cent; p < 0.01) and older (median: 54.9 years) than controls (median: 37.8; p < 0.01). Eleven cases (78.6 per cent) were on aspirin 81 mg, two (14.2 per cent) coumadin (4-6 mg) and one (7.1 per cent) aspirin 325 mg. No significant differences in Modena Bleeding Scale, blood loss, complications or outcomes were found. This study revealed no significant difference in intra-operative visibility, progress, complications or outcomes with patients on anticoagulation/antiplatelet. Endoscopic ear surgery may be considered while on anticoagulation/antiplatelet.
This study aimed to evaluate the efficacy of diced cartilage and platelet-rich fibrin-wrapped diced cartilage in nasal septal perforation repair. Thirty-six rabbits were allocated to three groups. The Control group underwent repair with flaps; the Diced Cartilage group received cartilage grafts with flaps; and the Diced Cartilage plus Platelet-Rich Fibrin group received platelet-rich fibrin-coated diced cartilage with flaps. Persistent perforations occurred in all controls. Closure rates were 66.7 per cent in the Diced Cartilage group and 81.8 per cent in the Diced Cartilage plus Platelet-Rich Fibrin group, both significantly higher than controls (p < 0.001), with no significant difference between graft groups. Fibrosis level and re-epithelialisation scores were significantly increased in both graft groups versus controls (p < 0.001). Inter-positional graft use is crucial for successful nasal septal perforation repair; diced cartilage is an effective alternative when block cartilage is unavailable, and platelet-rich fibrin combination may further enhance outcomes.