MAN Ear, Nose and Throat

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Evaluating the accuracy of android applications in monitoring environmental noise levels
(Springer, 2025-03-30) Khan, Hamad; Findlay, Callum; Stevenson, Ruth-Ann; Singh, T; Walsall Healthcare NHS Trust; University Hospital Southampton NHS Foundation Trust; Ear, Nose and Throat; Medical and Dental; Khan, Hamad
Objective This study aimed to evaluate the accuracy of Android applications (apps) in measuring environmental noise levels, focusing on their potential use for occupational health assessments. Methods The top 10, highly rated, free Android apps were tested on a Samsung Galaxy A54 Smartphone (Samsung Group, Samsung Town, Seoul, South Korea) using pure tones at 100 Hz, 2000 Hz, and 4000 Hz, across four noise levels (25 dB, 40 dB, and 85 dB). Measurements were compared with a calibrated Precision Gold N09AQ environment meter (Maplin Electronics Ltd, Wath-Upon-Dearne, United Kingdom) in a controlled room. Data were analyzed using linear regression to determine R2 values for each app. Results The control meter showed the highest accuracy (R2 = 0.99). SPL Meter dB and sound Meter (KTW apps, Petaling Jaya, Selangor, Malaysia) and Sound Meter (Pony AI Inc.,Guangzhou, Guangdong, China) had the best performance (R2 = 0.98). Accuracy declined at higher noise levels, with Sound Meter (ABC Apps) showing the least accuracy (R2 = 0.85). User ratings did not correlate consistently with app performance. Conclusion Android apps offer potential as affordable noise measurement tools, with some apps demonstrating high accuracy at lower decibels. However, limitations such as reduced accuracy at higher decibels and lack of A-weighting for regulatory compliance hinder their use in professional settings. Further development and real-world testing are needed.
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.
Managing thyroid hormone replacement after total thyroidectomy : guidance for family medicine
(Medknow Publications, 2025-01-13) Ahmad, Ahmar; Mughal, Zahir; Jangan, Akash; Diakos, Emmanuel; Minhas, Satvir; Mughal, Faraz; Walsall Healthcare NHS Trust; Keele University; Ear, Nose and Throat; Medical and Dental; Ahmad, Ahmar; Mughal, Zahir; Jangan, Akash; Diakos, Emmanuel; Minhas, Satvir
Thyroid hormones are among the most prescribed medications to patients worldwide and are commonly used to treat hypothyroidism. Thyroxine is also indicated after total thyroidectomy for Graves' disease or a multinodular goitre. In this commentary, we discuss and provide guidance for family medicine and primary care clinicians on how to navigate thyroid hormone replacement in patients after total thyroidectomy for cancer.
Prevalence of synchronous bilateral/contralateral tonsil carcinoma : a systematic review and meta-analysis
(Elsevier, 2025-03-23) Charlton, Alex; Mughal, Zahir; Sharin, Florida; Sahota, Raguwinder Bindy; Mansuri, Mohammed Shaji; Mair, Manish; University Hospitals of Derby and Burton NHS Foundation Trust; Walsall Healthcare NHS Trust; University Hospitals of Leicester NHS Trust; General Surgery; Medical and Dental; Mughal, Zahir
The purpose of this systematic review and meta-analysis was to identify the prevalence of synchronous contralateral tonsil carcinoma (SCTC) amongst patients with tonsil carcinoma or head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Thirteen retrospective studies, comprising 2623 patients, were analysed, revealing an overall pooled SCTC prevalence of 4%, rising to 10% in HNSCCUP cases. HPV/p16 positivity was associated with SCTC prevalence of 3%, while HPV/p16 negativity was greater at 8%. Clinical or imaging evaluations often missed SCTC preoperatively, emphasising the importance of contralateral tonsillectomy. Morbidity varied among patients undergoing contralateral tonsillectomy. The prevalence of SCTC is significant in cases of HNSCCUP and tonsil malignancy, emphasising the importance of informed discussions regarding contralateral tonsillectomy. Tailored approaches considering individual patient and tumour characteristics are crucial, with contralateral tonsillectomy generally warranted in HNSCCUP. Further research, including prospective studies with standardised protocols, is needed to improve the understanding and management of SCTC, specifically the clinical significance of occult SCTC.
Evolving trends and future demands in ENT procedures : a nationwide 10-year analysis
(MDPI, 2024-12-23) Jangan, Akash; Minhas, Satvir; Diakos, Emmanuel; Simmons, Mark; Mughal, Zahir; Walsall Healthcare NHS Trust; Oxford University Hospitals NHS Foundation Trust; Ear, Nose and Throat; Medical and Dental; Jangan, Akash; Minhas, Satvir; Diakos, Emmanuel; Simmons, Mark
Objective: This study aims to investigate the trends in otology, rhinology, and head and neck (H&N) operations over the past decade in England. These trends will allow for predictive modelling to forecast the demand over the coming years to aid workforce and resource planning in ENT. Methods: Hospital Episode Statistics data were extracted between April 2012 and April 2023. A total of 121 otology, 114 rhinology, and 122 H&N procedure codes were included. Correlation and linear regression analyses were conducted to examine trends and produce a forecast model for the volume of operations. Results: A gradual upward trend in the volume of operations was observed in rhinology, with a positive correlation coefficient (R = 0.74). In contrast, otology (R = -0.67) and H&N (R= -0.75) showed negative trends, indicating a moderate decline in operational volumes over time. The COVID-19 pandemic significantly disrupted operating activity in rhinology and otology. To address the backlog and reach the pre-pandemic forecasted levels within the next five years, surgical capacity must increase by an additional 33,807 rhinology 25,486 otology, and 10,300 head procedures per year in England. Conclusions: This analysis highlights a need for prioritization and expansion of the ENT workforce and resources to manage the current backlog and anticipated increase in demand over the next five years.
Assessment and management of allergic rhinitis : a review and evidence-informed approach for family medicine
(Wiley, 2024-07-14) Jangan, Akash; Mughal, Zahir; Ahmad, Ahmar; Simmons, Mark; Sheikh, Aziz; Mughal, Faraz; Walsall Healthcare NHS Trust; The University of Edinburgh; Keele University; Ear, Nose and Throat; Medical and Dental; Jangan, Akash; Mughal, Zahir; Ahmad, Ahmar; Simmons, Mark
Allergic rhinitis is an inflammatory disorder affecting nasal mucosa in response to allergen exposure and is commonly assessed and managed in family medicine. In this article, we review new international guidelines on the diagnosis and management of allergic rhinitis and generate evidence-informed recommendations for family medicine doctors.
ASO Visual Abstract : primary tumour detection in Carcinoma of unknown primary with Transoral Robotic Surgery (TORS) Tongue Base Mucosectomy : a meta-analysis
(Springer, 2024-11) Gupta, Keshav Kumar; Khan, Hamad; Mughal, Zahir; De, Mriganka; Sharma, Neil; Garas, George; University Hospitals Birmingham NHS Foundation Trust; Walsall Healthcare NHS Trust; Imperial College London; Ear, Nose and Throat; Surgery; Medical and Dental; Mughal, Zahir; Gupta, Keshav Kumar; Khan, Hamad; De, Mriganka; Sharma, Neil
Background: Head and neck carcinoma of unknown primary (CUP) represents a challenging diagnostic process when standard work-up fails to identify the primary tumour site. The aim of this systematic review and meta-analysis was to evaluate the diagnostic utility and complication profile of transoral robotic surgery (TORS) tongue base mucosectomy (TBM) in the management of CUP. Patients and methods: An electronic database search was performed in the EMBASE, MEDLINE, PubMed and Cochrane databases. A meta-analysis of proportions was performed to obtain an estimate of the overall proportion for the detection and complication rates. Results: Nine studies representing 235 patients with CUP who had TORS TBM were included in the final analysis. The overall pooled tumour detection rate was 66.2% [95% confidence interval (CI) 56.1-75.8]. The incidence of tumour detection in human papilloma virus (HPV)-positive cases (81.5%, 95% CI 60.8-96.4) was significantly higher than HPV-negative cases (2.3%, 95% CI 0.00-45.7). Weighted overall complication rate was 11.4% (95% CI 7.2-16.2). The majority were grade I or II (80%) according to the Clavien-Dindo classification. Conclusions: This meta-analysis suggests TORS to be safe and effective in localising the primary tumour site in patients with CUP. While the current data supports the use of TORS in patients who are HPV positive, larger numbers of HPV-negative cases are required to determine the true diagnostic effect with TORS before any valid conclusions can be inferred in this particular subgroup. Further research should focus on high quality prospective trials with stringent methodological work-up to minimise heterogeneity and allow for more accurate statistical analysis.
Five historical innovations that have shaped modern otolaryngological surgery
(Sage, 2025-04) Patel, Ravi; Acharya, Radhika; Shah, Saumil; Desai, Chaitya; Raveshia, Dimit; Panesar, Harrypal; Patel, Neil; Mcconaghie, Greg; Cain, David Charles; Parmar, Dilen; Banerjee, Robin; Singh, Rohit; The Shrewsbury and Telford Hospital NHS Trust; The Robert Jones and Agnes Hunt Orthopaedic Hospital; University Hospitals Birmingham NHS Foundation Trust; The Princess Royal Hospital; Walsall Healthcare NHS Trust; Hull York Medical School; Ear, Nose and Throat; Critical Care; Surgery; Medical and Dental; Desai, Chaitya; Acharya, Radhika; Raveshia, Dimit
Throughout history, many innovations have contributed to the development of modern otolaryngological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern otolaryngological surgery: Operative Microscope, Hopkins Rigid Endoscope, Laryngeal Nerve monitoring, Cochlear implants and Laser surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of otolaryngological surgery and their ongoing relevance in contemporary and perioperative practice.
Blood, sweat and tonsils : bleeding after abscess tonsillectomy for quinsy - a meta-analysis
(Wiley, 2024-10) Mughal, Zahir; Gupta, Keshav Kumar; Yeo, Justin Jui Yuan; Metcalfe, Christopher; Weller, Matthew; Russells Hall Hospital; Walsall Healthcare NHS Trust; Ear, Nose and Throat; Medical and Dental; Mughal, Zahir; Gupta, Keshav Kumar; Yeo, Justin Jui Yuan; Weller, Matthew
Objective: Abscess tonsillectomy is performed during an active episode of quinsy. Apprehensions regarding an elevated bleeding risk have hindered its widespread acceptance. This study aims to assess the prevalence of post-tonsillectomy bleeding (PTB) associated with abscess tonsillectomy. Data sources: A search was performed on August 27, 2023 in Medline, Embase, PubMed, Cochrane CENTRAL, and Web of Science databases. Review methods: The systematic review was conducted in adherence to the PRISMA guidelines. Pooled PTB rate was determined using a meta-analysis of proportions. The JBI tool was used to assess the quality of the included studies. Results: Of the 525 search records, 18 studies met the eligibility criteria for final analysis. These comprised of retrospective single-center analyses. The pooled prevalence of PTB was 6.65% (95% C.I. 4.01-9.81), and the return-to-theatre rate was 2.35% (95% C.I. 1.48-3.37). There was no difference in PTB rate between unilateral and bilateral tonsillectomy. However, the bipolar technique was associated with a higher PTB rate compared to cold steel dissection. The overall quality of the body of evidence was moderate. Conclusion: Our study highlights the complications associated with abscess tonsillectomy. These findings contribute valuable insights into this potential treatment option for quinsy.
Assessing asymmetrical tonsils in children : an evidence-based review for primary care
(Royal College of General Practitioners, 2024-01-25) Mughal, Zahir; Jangan, Akash; Ahmad, Ahmar; Turner, Nick; Mughal, Faraz; Walsall Healthcare NHS Trust; Keele University; Ear, Nose and Throat; Medical and Dental; Mughal, Zahir; Jangan, Akash; Ahmad, Ahmar; Turner, Nick
No abstract available.
Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic : an international consensus
(Elsevier, 2020-06-11) Mehanna, Hisham; Hardman, John C; Shenson, Jared A; Abou-Foul, Ahmad K; Topf, Michael C; AlFalasi, Mohammad; Chan, Jason Y K; Chaturvedi, Pankaj; Chow, Velda Ling Yu; Dietz, Andreas; Fagan, Johannes J; Godballe, Christian; Golusiński, Wojciech; Homma, Akihiro; Hosal, Sefik; Iyer, N Gopalakrishna; Kerawala, Cyrus; Koh, Yoon Woo; Konney, Anna; Kowalski, Luiz P; Kraus, Dennis; Kuriakose, Moni A; Kyrodimos, Efthymios; Lai, Stephen Y; Leemans, C Rene; Lennon, Paul; Licitra, Lisa; Lou, Pei-Jen; Lyons, Bernard; Mirghani, Haitham; Nichols, Anthonny C; Paleri, Vinidh; Panizza, Benedict J; Parente Arias, Pablo; Patel, Mihir R; Piazza, Cesare; Rischin, Danny; Sanabria, Alvaro; Takes, Robert P; Thomson, David J; Uppaluri, Ravindra; Wang, Yu; Yom, Sue S; Zhu, Yi-Ming; Porceddu, Sandro V; de Almeida, John R; Simon, Chrisian; Holsinger, F Christopher; University of Birmingham; The Royal Marsden National Health Service Foundation Trust; Stanford University; Walsall Healthcare NHS Trust; United Arab Emirates University; The Chinese University of Hong Kong; Tata Memorial Hospital; University of Leipzig; University of Cape Town; University Hospital and University of Southern Denmark; Poznan University of Medical Sciences; Hokkaido University; Atilim University; National Cancer Centre and Singapore General Hospital; Yonsei University; Komfo Anokye Teaching Hospital; University of Sao Paulo; Zucker School of Medicine; Cochin Cancer Research Centre; University of Athens; University of Texas; Amsterdam University; St James's Hospital and The Royal Victoria Eye and Ear Hospital; University of Milan; National Taiwan University Hospital and College of Medicine; St Vincent's Hospital; Hôpital Européen Georges-Pompidou; University of Western Ontario; University of Queensland; Hospital Universitario Lucus Augusti; Emory University; University of Melbourne; Universidad de Antioquia-Hospital Universitario San Vicente Fundación; Radboud University Medical Center; University of Manchester; Harvard Medical School; Fudan University; University of California San Francisco; Chinese Academy of Medical Sciences and Peking Union Medical College; University Health Network, Toronto; Lausanne University Hospital; Otolaryngology; Medical and Dental; Abou-Foul, Ahmad, K
The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.
Do variations in nasal irrigation recipes and storage effect the risk of bacterial contamination? - ERRATUM
(Cambridge University Press, 2023-06-09) Whittaker, J D; Baker, E; Kumar, S; Collingwood, R; West, M; Lee, P K; Walsall Healthcare NHS Trust; University Hospital of Derby and Burton NHS Trust; University Hospital of Leicester NHS Trust; Ear, Nose and Throat; Medical and Dental; Whittaker, Joshua D.
No abstract available
Correlation between thyroid fine needle aspiration cytology and postoperative histology : a 10-year single-centre experience
(Springer, 2021-04-15) Abou-Foul, Ahmad K; Muzaffar, Jameel; Diakos, Emmanuel; Best, James E; Momtahan, Navid; Jayaram, Sharan; Royal Stoke University Hospital; University Hospitals Birmingham; Walsall Healthcare NHS Trust; Worcestershire Acute Hospitals NHS Trust; Royal Wolverhampton NHS Trust; Lancashire Teaching Hospitals NHS Foundation Trust,; Otolaryngology; Medical and Dental; Diakos, Emmanuel
Introduction Fine needle aspiration cytology (FNAC) forms part of the routine workup for suspicious thyroid nodules. Whilst cytological analysis is less precise than histological assessment, it is quick and easy to perform and may avoid the need for invasive and potentially risky surgery. Methods This retrospective study spanned a 10-year period comparing preoperative FNAC with postoperative histology results to establish the accuracy of diagnosis and malignancy rates within our population. These results were then compared to the published figures in the literature. Results The histological reports of 659 consecutive cases of thyroid surgery between 2006 and 2015 were retrieved from our hospital database. Among the 471 patients (71.5%) who underwent preoperative FNAC, the postoperative histology was reported as benign in 352 (74.7%) and malignant in 119 cases (25.3%). Papillary thyroid cancer (PTC) was the commonest histological diagnosis. Thy1 grade was reported in 165 (30%) cases, with 19.4% having a final histological diagnosis of malignancy. In the Thy2 group, 85.3% of patients had a benign final histological diagnosis, while 14.7% had malignancy (false-negative results). Malignancy was found in 89% of Thy4 and 100% of Thy5 group patients. Conclusions Rates of malignancy varied considerably from those in the published literature. Each centre should be able to quote a local malignancy rate during patient counselling. It is also prudent for all units performing thyroid diagnostics to investigate the factors that might lead to inaccuracies in reporting.
Do variations in nasal irrigation recipes and storage effect the risk of bacterial contamination?
(Cambridge University Press, 2023-07-01) Whittaker, Joshua D.; Baker, E; Kumar, S; Collingwood, R; West, M; Lee, P K; Walsall Healthcare NHS Trust; University Hospital of Derby and Burton NHS Trust; University Hospital of Leicester NHS Trust; Ear, Nose and Throat; Medical and Dental; Whittaker, Joshua D.
Three irrigation recipes (containing sodium chloride, sodium bicarbonate and sucrose) were stored at 5oC and 22oC. Further samples were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Sampling and culturing were conducted at intervals from day 0-12 to examine for bacterial presence or persistence.
Discerning a smile : the intricacies of analysis of post-neck dissection asymmetry
(Elsevier, 2022-01) Thomas, Rachael J.; Whittaker, Joshua D.; Pollock, Jonathan; Imperial College Healthcare NHS Trust; Walsall Healthcare NHS Trust; Nottingham City Hospital; Ear, Nose and Throat; Medical and Dental; Whittaker, Joshua D.
Introduction: Iatrogenic facial nerve palsy is distressing to the patient and clinician. The deformity is aesthetically displeasing, and can be functionality problematic for oral competence, dental lip trauma and speech. Furthermore such injuries have litigation implications. Marginal mandibular nerve (MMN) palsy causes an obvious asymmetrical smile. MMN is at particular risk during procedures such as rhytidoplasties, mandibular fracture, tumour resection and neck dissections. Cited causes for the high incidence are large anatomical variations, unreliable landmarks, an exposed neural course and tumour grade or nodal involvement dictating requisite nerve sacrifice. An alternative cause for post-operative asymmetry is damage to the cervical branch of the facial nerve or platysmal dysfunction due to its division. The later tends to have a transient course and recovers. Distinction between MMN palsy and palsy of the cervical branch of the facial nerve or platysma division should therefore be made. In 1979 Ellenbogen differentiated between MMN palsy and "Pseudo-paralysis of the mandibular branch of the facial nerve". Despite this, there is paucity in the literature & confusion amongst clinicians in distinguishing between these palsies, and there is little regarding these post-operative sequelae and neck dissections. Method: This article reflects on the surgical anatomy of the MMN and cervical nerve in relation to danger zones during lymphadenectomy. The authors review the anatomy of the smile. Finally, case studies are utilised to evaluate the differences between MMN palsy and its pseudo-palsy to allow clinical differentiation. Conclusion: Here we present a simple method for clinical differentiation between these two prognostically different injuries, allowing appropriate reassurance, ongoing therapy & management.

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