Ear Nose and Throat

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Eosinophilic granulomatosis with polyangiitis presenting as unilateral acute anterior ischaemic optic neuropathy.
(Taylor & Francis, 2020-06-25) Fong, Anthony; Ahmed, Shahzada; Ramalingam, Satheesh; Brown, Rachel M; Harper, Lorraine; Mollan, Susan P; Ear, Nose and Throat; Radiology; Cellular pathology; Renal medicine; Medical and Dental; Ahmed, Shahzada; Ramalingam, Satheesh; Brown, Rachel M; Harper, Lorraine
Eosinophilic granulomatosis with polyangiitis (eGPA) is a rare vasculitis of small-medium sized vessels that can cause both anterior and posterior ischaemic optic neuropathies. Herein, the authors present a rare case of eGPA presenting initially as an acute unilateral anterior ischaemic optic neuropathy from short posterior ciliary artery vasculitis. The diagnosis presented a challenge as clinical and histopathological evidence suggested allergic rhinosinusitis, and no invasive fungal sinusitis was found. The high serum eosinophilia, asthma, optic neuropathy and paranasal sinus abnormalities fulfilled the criteria for a diagnosis of eGPA. Furthermore serum was positive for myeloperoxidase antibodies. Subsequently the case was successfully treated with oral glucocorticoids and intravenous rituximab.
Assistive communication devices for patients with hearing loss: a cross-sectional survey of availability and staff awareness in outpatient clinics in England.
(Informa Healthcare, 2019-04-23) Jama, Guled M; Shahidi, Shayan; Danino, Julian; Murphy, John
Purpose: Fair and equal access to health care for all is a fundamental principle of the National Health Service (NHS) in England. However, findings from a previous national survey examining the experiences of hearing-impaired patients when accessing services within the primary care setting have revealed that significant barriers continue to exist. The aim of this study was to examine the availability of assistive communication devices for patients with hearing loss at reception desks and in patient waiting areas in hospital outpatient settings.Methods: We conducted a cross-sectional telephone survey involving Audiology and Ear, Nose and Throat (ENT) clinics in NHS hospitals in England. Questionnaires were administered to members of staff at clinic reception desks.Results: All NHS hospital trusts in England providing Audiology and ENT services were included in the survey. Information was obtained from a total of 208 individual clinic reception desks. Assistive communication devices were reported to be available at 64 per cent of Audiology (49/76), 42 per cent of ENT (32/76) and 71 per cent of shared Audiology and ENT reception areas (40/56). The most common type of device was an induction loop system. A substantial proportion of survey respondents were not aware of existing facilities.Conclusions: There is a shortage of assistive communication devices in Audiology and ENT clinic reception areas in England. The range of technology currently in place is insufficient. We have identified a significant lack of "deaf awareness" among frontline staff.Implications for rehabilitationProviders of health care services must recognize their legal obligation to ensure that their services are made more accessible to patients with hearing loss.The use of multimodal assistive technology ensures that more patients can benefit.Staff awareness and training is essential in improving the quality of service provision.
Evaluation of smoking as a modifying factor in chronic rhinosinusitis.
(American Medical Association, 2021-02-01) Hutson, Kristian; Clark, Allan; Hopkins, Claire; Ahmed, Shahzada; Kumar, Nirmal; Carrie, Sean; Erskine, Sally; Sunkaraneni, Vishnu; Philpott, Carl; Ear, Nose and Throat; Medical and Dental; Ahmed, Shahzada
Importance: The negative association of smoking with the respiratory tract is well known; however, the association between smoking and chronic rhinosinusitis (CRS) has not been well characterized. Objective: To analyze whether active smoking was a risk factor for CRS development, smoking was associated with disease-specific quality of life, and smokers experience an increased symptom burden than nonsmokers. Design, setting, and participants: This subanalysis of the Chronic Rhinosinusitis Epidemiology Study (CRES), a prospective, questionnaire-based case-control study conducted between October 2007 and September 2013 was conducted across 30 UK tertiary/secondary care sites. Participants were identified at ear, nose, and throat outpatient clinics and classified into CRS phenotypes as per European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria. The overall response rate of those identified to take part in the study was 66%. A total of 1535 questionnaires were returned, with 1470 considered eligible for inclusion. Data analysis was conducted in January 2020. Main outcomes and measures: The CRES was designed to distinguish differences in socioeconomic status, geography, medical comorbidities, lifestyle, and quality of life between patients with CRS and healthy controls. Results: A total of 1450 patients completed the smoking question, comprising 219 controls (15.1%; mean [SD] age, 47.3 [14.9] years; 143 women [68%]), 546 participants with CRS (37.7%; mean [SD] age, 51.8 [15.3] years; 259 women [53%]) without nasal polyps (CRSsNPs), and 685 participants (47.2%; mean [SD] age, 56.0 [14.5] years; 204 women [33%]) with CRS and nasal polyps/allergic fungal rhinosinusitis (CRSwNPs+). The mean age was similar, with a greater female preponderance in the control group and male in the CRSwNP group. The greatest number of active smokers was found among control participants (33 [15%]), with a lower rate of smokers in the patients with CRSwNPs+ (9.9%) and CRSsNPs (13.9%), respectively. We found a clinically significant difference in the mean difference in Sino-nasal Outcome Test (SNOT-22) scores between active smokers and nonsmokers for both CRS phenotypes (4.49, 12.25). In both CRS subgroups active smokers had significantly worse SNOT-22 scores than nonsmokers by a mean (SD) magnitude of 10 (18.99, 24.14) points. Nonsmokers also demonstrated a higher percentage of surgical procedures (1 or more), although this was not clinically or statistically different (0.34, 1.10). Conclusions and relevance: This questionnaire-based case-control study demonstrated a clinically significant symptom burden associated with active cigarette smoking, with worse SNOT-22 scores in the smoking cohort by a mean magnitude of 10 points. We could find no demonstrable evidence that smoking increases the likelihood of need for revision sinus surgery. Clinicians should encourage smoking cessation alongside general CRS medical management.
Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography.
(Blackwell Scientific Publications, 2020-08-06) Amin, Nikul; Walker, Abigail; Alobid, Isam; Anari, Shahram; Bast, Florian; Bhalla, Rajiv K; Cathcart, Russell; Harries, Philip G; Hathorn, Iain; Philpott, Carl M; Ramakrishnan, Yujay; Stew, Benjamin; Surda, Pavol; Ting, Fiona; Hopkins, Claire
Objectives: Conebeam computed tomography (CBCT) imaging is commonly requested by dental implant surgeons, preoperatively, for patients being considered for dental implants. Incidental maxillary sinus findings often result in otolaryngology (ENT) referral for further assessment. CBCT findings include transient and benign mucosal changes that may not require any intervention and therefore unnecessarily delay implant surgery. We aim to define appropriateness criteria for ESS in the management of adult dental implant patients with incidental maxillary sinus findings on CBCT and provide guidance to both dental implant and ENT surgeons. Design: The RAND/UCLA appropriateness methodology was used to develop and define the appropriateness criteria. Setting: A virtual panel of 13 international experts in ESS. Participants: The expert panel completed two rounds of a modified Delphi ranking process for nine clinical scenarios, considering various factors affecting decision-making processes. Main outcome measures: To define appropriateness criteria for ESS in adult dental implant patients who have incidental maxillary sinus findings on CBCT. Results: Patients with clinical symptoms and endoscopic findings of chronic rhinosinusitis together with an obstructed ostiomeatal complex (OMC) and concentric mucosal thickening of the ipsilateral maxillary sinus or pansinusitis were deemed appropriate candidates for ESS prior to their dental implant. ESS was not appropriate in asymptomatic patients with a patent OMC and mucosal thickening isolated to floor of the ipsilateral maxillary sinus. For uncertain scenarios, further discussion between dental implant and ENT surgeon should be considered. Conclusions: This study has developed and reported a list of appropriateness criteria to offer ESS in adult dental implant patients with incidental maxillary sinus findings on CBCT.
Acute otitis externa: consensus definition, diagnostic criteria and core outcome set development.
(Public Library of Science, 2021-05-14) Smith, Matthew E; Hardman, John C; Mehta, Nishchay; Jones, Gareth H; Mandavia, Rishi; Anderson, Caroline; Khan, Maha; Abdelaziz, Aula; Al-Dulaimy, Bakir; Amin, Nikul; Anmolsingh, Rajesh; Anwar, Bilal; Bance, Manohar; Belfield, Katherine; Bhutta, Mahmood; Buchanan, Ruaridh; Chandrasekharan, Deepak; Chu, Michael; Chundu, Srikanth; Conroy, Katherine; Crundwell, Gemma; Daniel, Mat; Daniels, Jessica; De, Sujata; Dobbs, Sian; Doshi, Jayesh; Farr, Matthew; Ferdous, Tanjinah; Fragkouli, Eleni; Freeman, Simon; Ghosh, Samit; Gosnell, Emma; Hannan, S Alam; Heward, Elliot; Javed, Faisal; John, Deepa; Nicholls, Helen; Kasbekar, Anand V; Khan, Haroon; Khan, Hammad; Khwaja, Sadie; Kotecha, Bhik; Krishnan, Madhankumar; Kumar, Nirmal; Lamb, Tamara; Lancer, Hannah; Manjaly, Joseph G; Martinez Del Pero, Marcos; McClenaghan, Fiona; Milinis, Kristijonas; Mistry, Nina; Mohammed, Hassan; Morris, Elizabeth; Morris-Jones, Stephen; Padee, Jessica; Pal, Surojit; Patel, Sanjay; Pericleous, Agamemnon; Qayyum, Asad; Rouhani, Maral; Saeed, Haroon; Santhiyapillai, Mirusanthan; Seymour, Kay; Sharma, Sunil; Siau, Richard; Singh, Arvind; Stapleton, Emma; Stephenson, Kate; Stynes, Gill; Subramanian, Bharathi; Summerfield, Neil; Swords, Chloe; Trinidade, Aaron; Tse, Antonia; Twumasi, Emmanuel; Ubhi, Harmony; Unadkat, Samit; Vijendren, Ananth; Wasson, Joe; Watson, Glen; Williams, Glennis; Wilson, Janet; Yao, Alexander; Youssef, Ahmed; Lloyd, Simon K W; Tysome, James R; Ear, Nose and Throat; Medical and Dental; Doshi, Jayesh; Javed, Faisal
Objective: Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Setting: Stakeholders from the United Kingdom. Subjects and methods: Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. Results: Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. Conclusion: The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.
A novel capacitive cochlear implant electrode array sensing system to discriminate failure patterns.
(Lippincott Williams & Wilkins, 2021-06-01) Hou, Lei; Du, Xinli; Boulgouris, Nikolaos; Coulson, Chris; Irving, Richard; Begg, Philip; Brett, Peter; Ear, Nose and Throat; Medical and Dental; Coulson, Christopher; Irving, Richard
Objectives: The research is to propose a sensing system to ensure the electrode array being correctly placed inside the cochlea. Instead of applying extra sensors to the array, the capacitive information from multiple points of the array is gathered and analyzed to determine the state and behavior of the electrode array. Methods: The sensing system measures electrode bipolar capacitances between multiple pairs of electrodes during the insertion. The principal component analysis (PCA) method is then applied to analysis the recorded data to discriminate insertion patterns. Results: In total, 384 capacitance profiles from electrode pair (1, 2), and electrode pair (15, 16) were analyzed and compared. In an account of both the electrode pairs, the threshold distance was examined to be d = 1.99 at the average comparison type. The experiment results showed the success rate is over 80% to identify buckling during the insertion on a 2D cochlear model. Conclusion: This early-stage investigation shows great potential compared with the current practice, which does not provide any feedback to surgeons. The system demonstrates the feasibility of a sensing method for auto-reoccupation electrodes behavior, and it will help surgeons to avoid misplacement of the electrode array inside the cochlea.
Anosmia: an evidence-based approach to diagnosis and management in primary care.
(Royal College of General Practitioners, 2021-02-25) Deutsch, Peter G; Evans, Catherine; Wahid, Nur Wahidah; Amlani, Aakash D; Khanna, Aman; Ear, Nose and Throat; Medical and Dental; Amlani, Aakash; Khanna, Aman
No abstract available
Clinical findings in symptomatic patients with radiologically isolated sphenoid sinus disease : a systematic review and meta-analysis
(Wiley, 2025-07) Mughal, Zahir; Gupta, Keshav Kumar; Jolly, Karan; Beech, Thomas; Minhas, Satvir; Turner, Nicholas; Walsall Healthcare NHS Trust; University Hospitals Birmingham NHS Foundation Trust; Ear, Nose and Throat; Medical and Dental; Mughal, Zahir; Minhas, Satvir; Turner, Nicholas; Jolly, Karan; Beech, Thomas
Objective: To explore the clinical presentations of isolated sphenoid sinus disease (ISSD). Setting and design: A literature search was conducted on 23 December 2023 across electronic databases including Medline, Embase, Web of Science, and Cochrane. We performed a meta-analysis of proportions using a random-effects model to determine the prevalence of clinical findings in patients who presented with symptoms and had ISSD on radiological imaging. Sensitivity and subgroup analyses were employed to investigate sources of heterogeneity. The PRISMA guideline was followed. Participants: This study included patients with clinically significant isolated sphenoid sinus opacification on cross-sectional imaging. Main outcome measure: The pooled prevalence of clinical symptoms and signs. Results: A total of 18 studies met the eligibility criteria, encompassing over 1000 patients. The prevailing symptoms were headache in 67.9% (95% CI 62.9-72.7), nasal symptoms 29.7% (95% CI 25.2-34.4), and visual disturbance 14.0% (95% CI 9.3-19.3). Subgroup analysis revealed a significant difference between neoplastic and inflammatory diagnoses concerning the development of visual symptoms (38.3% versus 15.5%, p = 0.0005). A negative nasendoscopic examination was found in 52.0% (95% CI 41.0-62.8) of cases. Conclusions: Headache emerged as the primary symptom of ISSD, followed by nasal and visual symptoms. Nasendoscopy had a high false negative rate, highlighting its limitation in assessing this condition. Our study highlights the key clinical findings associated with ISSD, which may indicate the need for imaging.
Effect of cochlear implantation on air conduction and bone conduction elicited vestibular evoked myogenic potentials-a scoping review.
(MDPI AG, 2024-11-20) Ayas, Muhammed; Muzaffar, Jameel; Phillips, Veronica; Smith, Mathew E; Borsetto, Daniele; Bance, Manohar L; ENT; Medical and Dental; Muzaffar, Jameel
Background/Objectives: Cochlear implantation (CI) is an effective intervention for individuals with severe to profound hearing loss; however, it may impact vestibular function due to its proximity to related anatomical structures. Vestibular evoked myogenic potentials (VEMPs) assess the function of the saccule and utricle, critical components of the vestibular system. This review examines CI's impact on air conduction (AC) and bone conduction (BC) VEMP responses. Methods: A scoping review was conducted following PRISMA guidelines, using databases such as Medline, Embase, Cochrane Library, Scopus, and ProQuest Dissertations. Studies reporting on AC and/or BC-VEMP in CI recipients were included. Data extraction focused on VEMP response rates, amplitudes, and latencies pre- and post-CI. Risk of bias/quality assessment was performed using the Newcastle-Ottawa Scale. Results: Out of 961 studies identified, 4 met the inclusion criteria, encompassing a total of 245 CI-implanted ears. Results indicated that AC-VEMP responses were often reduced or absent post-CI, reflecting the influence of surgical changes in the middle ear mechanics rather than otolith dysfunction. In contrast, BC-VEMP responses were more consistently preserved, suggesting that BC stimuli bypass the middle ear and more accurately delineate otolith function. Variations in VEMP outcomes were noted depending on the surgical approach and individual patient factors. Conclusions: CI impacts vestibular function as measured by VEMP, with AC-VEMP showing greater susceptibility to postoperative changes compared to BC-VEMP. The presence of preserved BC-VEMP alongside absent AC-VEMP underscores the need to differentiate between these measures in assessing vestibular function.
The sinus surgery completeness score: a radiological assessment of the extent of endoscopic sinus surgery
(Springer International, 2024-12-04) Gupta, Keshav Kumar; Okhovat, Saleh; Sharma, Rishi; Lim, Alison; Beech, Thomas; McClelland, Lisha; Janjua, Arif; Jolly, Karan; University Hospitals Birmingham NHS Trust; Queen Elizabeth University Hospital, Glasgow; Addenbrookes Hospital; Vancouver General Hospital; Surgery; Ear Nose and Throat; Medical and Dental; Gupta, Keshav; Beech, Tom; McClelland, Lisha; Jolly, Karan
Purpose: Chronic rhinosinusitis (CRS) often requires endoscopic sinus surgery (ESS) for symptom control. However, there is currently a high reported revision rate. The introduction of biologics offers an alternative treatment, but patient criteria are ambiguous, particularly regarding the definition of "previous ESS." This study aims to introduce the Sinus Surgery Completeness Score (SSCS) to help evaluate the extent of ESS as well as evaluate the extent of sinus surgery in the study cohort. Methods: The SSCS was developed by expert rhinologists and anterior skull base surgeons and applied to computed tomography (CT) sinus scans of 41 CRS patients who underwent previous ESS. Inter-rater reliability was assessed, and statistical analysis was performed to correlate SSCS scores with Lund-Mackay (LM) and Sinonasal Outcome Test-22 (SNOT-22) scores. Results: The SSCS demonstrated strong inter-rater reliability (Fleiss Kappa score 0.857). The mean time to complete the SCSS was 2.7 min. Most patients had incomplete surgery with a mean SCSS of 7.40 (total 24) with no patients achieving a maximum score. The maxillary sinus was the most dissected subunit, with frontal and sphenoid sinuses being the least. Weak negative correlations were observed between the SSCS and LM and SNOT-22 scores. Conclusions: The SSCS is a useful tool for assessing the completeness of sinus surgery, offering a standardized approach to evaluating surgical outcomes. While further research is needed to elucidate the relationship between surgical completeness and patient outcomes, the SSCS holds promise in guiding patient management including informing decisions regarding eligibility for biologic therapy.
Efficacy of nonmedicated middle meatal packing after endoscopic sinus surgery: a systematic review
(John Wiley & Sons, 2024-03-21) Iftikhar, Haissan; Abbasi, Ammaar M A; Mustafa, Khawaja; Das, Jai K; Javer, Amin R; University Hospitals Birmingham NHS Foundation Trust; Aga Khan University; Aga Khan University Medical College; St. Paul's Sinus Center; Ear Nose and Throat; Medical and Dental; Iftikhar, Haissan
Objectives: This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods: We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL, and Clinicaltrials.org and included randomized controlled trials in the English language only. We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool (version 2). We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment, Development and Evaluation. Results: Our search identified 390 articles of which four met our eligibility criteria. A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils. At 4 weeks of follow-up, there was no difference in the risk of synechia formation on either the packed side or the unpacked side, with a relative risk (RR) of 0.77 (95% confidence interval [CI]: 0.48-1.25). Similarly, no difference was seen at either 8-12 weeks of follow-up, with an RR of 0.68 (95% CI: 0.42-1.20). Nasal congestion was reported to be less on the packed side on the follow-up in one of the trials. Conclusions: Our systematic review, with limited evidence, indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long-term sequelae.
Relationship between clinical features and the arc and length of dehiscence in SCDS: a single center review of 42 cases
(Lippincott Williams & Wilkins, 2021-10-25) Darr, Adnan; Thomas, Charlotte; Rainsbury, James; Banga, Rupan; Irving, Richard; Chavda, Swarupsinh; University Hospitals Birmingham NHS Foundation Trust; University Hospitals Plymouth NHS Foundation Trust; Ear Nose and Throat; Imaging; Admin and Clerical; Medical and Dental; Banga, Rupan; irving, Richard; Chavda, Sawrupsinh
Introduction: Superior canal dehiscence syndrome (SCDS) is a rare disorder characterized by an array of audiovestibular symptoms due to a dehiscence of bone overlying the superior semicircular canal (SSC). In the presence of debilitating symptoms, surgical management, to plug or resurface the SCC is performed. Although computed tomography (CT) may overestimate the size or presence of a dehiscence due to a partial volume effect, it remains an invaluable diagnostic tool. Objectives: To assess for correlation between the arc and length of dehiscence and clinical symptomology. Method: A single-center, single-operator retrospective analysis of 42 patients who underwent trans mastoid plugging of SCC with confirmed radiological dehiscence of their SSC between January 2008 and July 2019 was undertaken. Patients were assessed based on seven predefined clinical symptoms. Length and arc of dehiscence's were evaluated by means of high resolution (0.5 mm) CT (HRCT), using multiplanar reconstruction (MPR). Receiver operating characteristics (ROC), and more specifically the area under the ROC curve (AUROC) were used to assess for statistical significance. Results: Our results demonstrate overall very little correlation between the arc and size of the dehiscence and symptoms. The only statistically significant correlation we found was between length of dehiscence and the presence of aural fullness. Conclusion: SCDS is a debilitating condition with an array of symptoms on presentation. While dehiscence length demonstrated a correlation with aural fullness, no other symptomology in patients with radiologically evident SCDS demonstrated a statistically significant correlation either against the length or arc of dehiscence.
Artificial Intelligence in Temporal Bone Imaging: A Systematic Review
(Wiley-Blackwell, 2024-10-01) Spinos, Dimitrios; Martinos, Anastasios; Petsiou, Dioni-Pinelopi; Mistry, Nina; Garas, George; Ear, Nose and Throat; Medical and Dental; Spinos, Dimitrios
Objective: The human temporal bone comprises more than 30 identifiable anatomical components. With the demand for precise image interpretation in this complex region, the utilization of artificial intelligence (AI) applications is steadily increasing. This systematic review aims to highlight the current role of AI in temporal bone imaging. Data sources: A Systematic Review of English Publications searching MEDLINE (PubMed), COCHRANE Library, and EMBASE. Review methods: The search algorithm employed consisted of key items such as 'artificial intelligence,' 'machine learning,' 'deep learning,' 'neural network,' 'temporal bone,' and 'vestibular schwannoma.' Additionally, manual retrieval was conducted to capture any studies potentially missed in our initial search. All abstracts and full texts were screened based on our inclusion and exclusion criteria. Results: A total of 72 studies were included. 95.8% were retrospective and 88.9% were based on internal databases. Approximately two-thirds involved an AI-to-human comparison. Computed tomography (CT) was the imaging modality in 54.2% of the studies, with vestibular schwannoma (VS) being the most frequent study item (37.5%). Fifty-eight out of 72 articles employed neural networks, with 72.2% using various types of convolutional neural network models. Quality assessment of the included publications yielded a mean score of 13.6 ± 2.5 on a 20-point scale based on the CONSORT-AI extension. Conclusion: Current research data highlight AI's potential in enhancing diagnostic accuracy with faster results and decreased performance errors compared to those of clinicians, thus improving patient care. However, the shortcomings of the existing research, often marked by heterogeneity and variable quality, underscore the need for more standardized methodological approaches to ensure the consistency and reliability of future data.
Face and content validation of artificial temporal bone dissection for otolaryngology training
(Headley Brothers, 2024-10-25) Kurichiyil, Shadia Hashim; Whittaker, Joshua D; Dalton, C Lucy
No abstract available.
Ambulatory management of common ENT emergencies - what's the evidence?
(Cambridge University Press, 2021-02-17) Heining, C J; Amlani, A; Doshi, J; Ear Nose and Throat; Ear Nose and Throat; Medical and Dental; Amlani, Aakash; Doshi, Jayesh
Objectives: The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. Methods: A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. Results: Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. Conclusion: In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.
A rare case of nasal gout.
(BMJ Publishing Group, 2020-10-30) Richards, Emma; Watts, Emma; McClelland, Lisha; Ear, Nose, and Throat; Medical and Dental; Richards, Emma; Watts, Emma; McClelland, Lisha
Gout is an increasingly common metabolic disorder worldwide. Classical presentation is with acute attacks of arthritis affecting the first metatarsophalangeal joint. With disease progression, tophi may also appear. We present an unusual case of nasal gout in a 55-year-old man who was referred to the Ear, Nose and Throat department with irregularity over the nasal bones and episodic pain. We discuss the work up, diagnosis and management of this case and review the limited literature on this topic
The effectiveness and safety of intrathecal fluorescein in the management of cerebrospinal fluid leaks.
(Sage Publications, 2021-06-01) Jolly, Karan; Gupta, Keshav Kumar; Banota, Abishek; Ahmed, Shahzada K; Ear, Nose, and Throat; Medical and Dental; Jolly, Karan; Ahmed, Shahzada K
Background: Cerebrospinal fluid (CSF) leaks can be associated with significant morbidity such as meningitis. Surgical management has proven effective, with endoscopic approaches having become the gold standard due to success rates >90%. Inability to localise the leak site prior to surgery is associated with surgical failure. The use of intrathecal fluorescein (IF) to localise CSF fistulae sites was first demonstrated in 1960. Despite this, its use in this context is unlicensed. Objective: Evaluate the safety and efficacy of IF use in the management of CSF leak repairs in our centre. Methods: All patients who underwent endoscopic repair of CSF fistula by a single surgeon where IF was used between January 2010 - September 2019 at a single-centre (tertiary skull base referral unit in the United Kingdom) were retrospectively analysed. Primary outcome measures were localisation of CSF fistula with IF (efficacy) and peri-operative complications likely to be attributable to IF (safety). Results: There were 55 patients included (60 procedures) with a positive localisation rate of 90.0% with IF. The overall peri-operative complication rate was 8.3% (n = 5). It is likely that none were related to IF use. However, three complications may be linked giving a complication rate potentially related to IF of 5.0%. There were no peri-operative mortalities. Conclusion: Many studies have demonstrated IF to be safe at low doses (<50mg) with a high sensitivity, specificity and positive predicative value. Our results demonstrate that the use of IF in our centre is safe and effective at identifying CSF fistulae. While we have reported some complications in our cohort, these were unlikely to be directly attributable IF use. We have described no serious complications such as seizures, limb weakness or death. We believe this study adds to the growing body of evidence that IF use in the management CSF fistula repairs is safe and effective.
Three-dimensional printed instruments used in a Septoplasty: a new paradigm in surgery.
(Wiley, 2021-06-23) Zaidi, Syed; Naik, Paresh; Ahmed, Shahzada; Doctors; Ear, Nose, and Throat; Medical and Dental; Zaidi, Syed; Ahmed, Shahzada
Objective: Three-dimensional (3D) printing has been rapidly adopted by different surgical disciplines. It has shown itself to have improved outcomes in education, pre-operative planning, and reconstruction. However, using 3D printing to create surgical instruments is a niche within the literature that has not yet been fully explored. The authors present a study in which it is hypothesized that 3D printing surgical instruments can be utilized successfully within ENT surgery. Methods: As one of the most common ENT operations worldwide, a septoplasty was chosen as the procedure to provide proof of concept. For the septoplasty, five instruments were printed: a scalpel handle, needle holders, toothed forceps, a Cottle/Freer elevator, and a Killian's speculum. The entire set took 224 minutes on average to print, weighed 36 g, and only used approximately 86 pence ($1.20 USD) worth of polylactic acid plastic to create. Results: All steps in performing a septoplasty on a human cadaver with the 3D printed tools were possible and were undertaken successfully. This yielded a similar outcome to using stainless steel with the added benefit of there being a large reduction in cost and the ability for rapid customization according to the surgeon's preferences. Conclusion: As technology and mainstream interest in 3D printing develops, the availability of more precise Computer-Aided Design software will allow for more complex designs of tools to be created. Currently, 3D printing has been shown to be a promising method from which future surgical tools can be fashioned to meet the complex, dynamic demands of surgery.
Quality of life and symptom assessment in paraesophageal hernias: a systematic literature review of reporting standards.
(Oxford University Press, 2021-01-13) Patel, Nikhil M; Puri, Aiysha; Sounderajah, Viknesh; Ferri, Lorenzo; Griffiths, Ewen; Low, Donald; Maynard, Nick; Mueller, Carmen; Pera, Manuel; van Berge Henegouwen, Mark I; Watson, David I; Zaninotto, Giovanni; Hanna, George B; Markar, Sheraz R; Imperial College London; McGill University Health Centre, Montreal; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Virginia Mason Medical Center, Seattle; Oxford University Hospitals NHS Foundation Trust; University Hospital del Mar; Hospital del Mar Medical Research Institute (IMIM); University Medical Center Amsterdam; Flinders Medical Centre; Karolinska Institutet; Gastrointestinal Surgery; Medical and Dental; Griffiths, Ewen
Background: Paraesophageal hernias (PEH) present with a range of symptoms affecting physical and mental health. This systematic review aims to assess the quality of reporting standards for patients with PEH, identify the most frequently used quality of life (QOL) and symptom severity assessment tools in PEH and to ascertain additional symptoms reported by these patients not captured by these tools. Methods: A systematic literature review according to PRISMA protocols was carried out following a literature search of MEDLINE, Embase and Cochrane databases for studies published between January 1960 and May 2020. Published abstracts from conference proceedings were included. Data on QOL tools used and reported symptoms were extracted. Results: This review included 220 studies reporting on 28 353 patients. A total of 46 different QOL and symptom severity tools were used across all studies, and 89 different symptoms were reported. The most frequently utilized QOL tool was the Gastro-Esophageal Reflux Disease-Health related quality of life questionnaire symptom severity instrument (47.7%), 57.2% of studies utilized more than 2 QOL tools and 'dysphagia' was the most frequently reported symptom, in 55.0% of studies. Notably, respiratory and cardiovascular symptoms, although less common than GI symptoms, were reported and included 'dyspnea' reported in 35 studies (15.9%). Conclusions: There lacks a QOL assessment tool that captures the range of symptoms associated with PEH. Reporting standards for this cohort must be improved to compare patient outcomes before and after surgery. Further investigations must seek to develop a PEH specific tool, that encompasses the relative importance of symptoms when considering surgical intervention and assessing symptomatic improvement following surgery.
Prognostic indicators in clinically node-negative malignant primary salivary tumours of the parotid: a multicentre experience
(Elsevier, 2021-11-03) Fussey, Jonathan; Tomasoni, Michele; Tirelli, Giancarlo; Giordano, Leone; Galli, Andrea; Colangeli, Roberta; Cazzador, Diego; Tofanelli, Margherita; da Mosto, Maria Cristina; Bianchini, Chiara; Pelucchi, Stefano; Ubayasiri, Kishan; Elsayed, Mahmoud; Long, Patrick; Saratziotis, Athanasios; Hajiioannou, Jiannis; Piazza, Cesare; Deganello, Alberto; Lombardi, Davide; Nicolai, Piero; Pracy, Paul; Sharma, Neil; Nankivell, Paul; Borsetto, Daniele; Boscolo-Rizzo, Paolo; University Hospitals Birmingham NHS Foundation Trust; University of Brescia; University of Trieste; IRCCS Ospedale San Raffaele; University of Padova; University Hospital of Ferrara; University Hospitals Nottingham; General University Hospital of Larissa; Cambridge University Hospitals; Ear Nose and Throat; Admin and Clerical; Medical and Dental; Fussey, Jonathan; Pracy, Paul; Sharma, Neil; Nankivell, Paul
Objectives: Nodal metastasis is an important prognosticator in primary parotid cancers. The management of the clinically node-negative neck is an area lacking consensus. This study investigates the occult nodal metastasis rate, and prognostic indicators in primary parotid cancers. Materials and methods: We performed a multicentre retrospective case note review of patients diagnosed and treated surgically with curative intent between 1997 and 2020. Demographic, clinic-pathological and follow-up data was recorded. Results: After exclusions, 334 patients were included for analysis, with a median follow-up of 48 months. The overall rate of occult lymph node metastasis amongst patients undergoing elective neck dissection was 22.4%, with older age, high-grade and more advanced primary tumours being associated with higher rates. On multivariable analysis, age ≥ 60 years (HR = 2.69, p = 0.004), high-grade tumours (HR = 2.70, p = 0.005) and advanced primary tumours (pT3-4, HR = 2.06, p = 0.038) were associated with worse overall survival. Occult nodal metastasis on final pathology was associated with a close-to-significant reduction in regional recurrence free survival (HR = 3.18, p = 0.076). Conclusion: This large series confirms the significant occult lymph node metastasis rate in primary parotid cancer, and demonstrates the importance of primary histology, tumour grade and stage in predicting survival outcome. This data supports the use of elective neck dissection in patients with high-risk tumours.

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