Key points:Covid-19 patients are often intubated for a long time, with indication to tracheotomy, at high risk for transmitting the disease.Open surgical sub-isthmic tracheotomy above the ETT cuff should always be performed on fully paralyzed patients, to minimize the airflow and aerosolisation from alveolar space.Other technical refinements described in the paper are finalized to reduce the “no seal” time from ETT cuff deflation and cannula cuff inflation, which can become shorter than 2 seconds.Risks connected to tracheotomy in Covid-19, a conceptually extremely hazardous procedure, can be significantly reduced by rational measures and teamwork.Dear Editor,Tracheotomy, more than any other procedure, increases the risk of transmission from Covid-19 patients to operators because of aerosolisation1: a cough with an opened trachea and no seal from a cuff is the worst exposure situation.We describe our experience with tracheotomy in Covid-19, analyzing steps at risk and describing technical refinements to minimize such risk.

KEY POINTSThe COVID-19 pandemic has presented the Otolaryngology community with new challenges.Exposure to outpatient attention, endoscopic procedures and surgeries has been significantly reduced for residents worldwide.Our Otolaryngology residency program has implemented different measures to reduce residents’ exposure to high-risk infection situations.Concomitant measures have been taken to increase simulation training, and up-to-date seminars and courses for residents.Adaptation and flexibility of regular training curricula are required in order to diminish the negative impact in residents ’ education.Keywords : COVID-19, SARS-CoV-2, residents, residency education, otolaryngology.

Objectives: To evaluate whether the extent of tumor resection and free flap reconstruction influences functional outcome and complications in patients with solid malignancies of the cheek. Design and Participants: We retrospectively assessed recipient site complications and functional outcomes in 47 patients with solid malignancies of the cheek who underwent either partial (n=30; 63.8%) or full-thickness (n=17; 36.2%) cheek resection with free flap reconstruction. Setting: Retrospective, multicentric analysis Results: Full thickness resections with creation of through-and-through defects were not associated with significantly higher complication rates (70.6% vs. 46.7%; p=0.138) compared to partial defects. Recipient site complications occurred in 55.3% of patients and were noticed most likely after reconstruction of suborbital defects (69.2%; p=0.268) of which occurrence of salivary fistulae was the most common (46.2%; p=0.035). Similarly, functional outcomes including oral incompetence, ectropion, and trismus were not affected by the extent of resection (p=0.766). However, oral incompetence was higher in patients with tumors originating from oral cavity (p=0.020) and after the performance of mandibulectomy (p=0.003). Conclusions: There was no difference in functional outcome or recipient site morbidity between tumor resections resulting in full-thickness and partial defects.

Background: Parapharyngeal space tumors with complex anatomy and diverse histology and have remained a challenging phenomenon for treating physicians. Objective: Assess the factors for selection of surgical approach and association of neurological complications with tissue of origin in parapharyngeal space tumors. Type of review: Systematic review and meta-analysis of retrospective studies in accordance with PRISMA guidelines Methods: We have conducted a comprehensive web search on Pubmed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature Database (CBM) and Clinicaltrials.gov. Two researches reviewed all identified articles independently with a third reviewer for adjudication. Patient demographics and other clinicopathological characteristics were explored. Main outcome measures: Primary outcomes assessed were post-operative complications i.e. neurological and salivary, surgical approaches used and the factors used for the selection of surgical approaches. Results: The systematic review has identified 631 patients of benign parapharyngeal space tumors with neurogenic and salivary tissue histology in 13 studies with a mean age of 42.9 ± 7.76 years and a median follow-up of 40.98 ± 19.1 months. Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most common histological entities. Tumor size, location, histology, deep parotid lobe involvement and proximity to great vessels or skull base were the deciding factors in selecting the surgical approach. Factors considered to select surgical approach do not seem to have a correlation with the outcome in terms of neurological sequalae (p=0.106). Neurological deficit was observed in 48% of patients with neurogenic histology (148/310) while only 13% patients with salivary tumor developed neurological deficit. The pooled RR was 2.41 (95% CI 1.80 – 3.23, p=0.001). Conclusion: Neurologic complications are significantly associated with neurogenic benign tumors rather than surgical approach.

A document by Mohamed Ghonim . Click on the document to view its contents.

Introduction COVID 19 in particular affects the lungs causing an ARDS type picture resulting in an atypical form of ARDS whereby there is disproportionately poor oxygenation despite reasonably preserved lung compliance in the early stages 1. Experience from Italy and China suggests that nursing the patient in a prone position is potentially beneficial and can improve outcomes when carried out in the early stages of the disease1,2. This has resulted in its inclusion in several international guidelines and adoption around the world as a valid intervention for COVID 19 patients3Proning is not a new phenomenon and has been used as a treatment option for ARDS for over 20 years. It is not without complications and as well as the displacement of tubes and lines, the exacerbation of existing traumas or dehiscence of surgical wounds there are also reports of pressure necrosis secondary to prone positioning particularly of the face and nose4A cochrane review in 2015 concluded that prone ventilation was directly responsible for an increased risk of pressure sores5There is some suggestion that the pressure damage caused by proning occurs regardless of preventative measures put in place (such as foam supports and measures to relieve pressure)4But it also seems that this pressure damage is often mild and self resolving6. Regular repositioning of the head may also reduce pressure damage accordingly7Given that larger numbers of patients are likely to be proned and that proning is directly linked to pressure damage to the face and nose it would seem logical that this would represent an increase in referrals to ENT to assess this. Anecdotally this is the case in our department where we have received several such calls having never previously encountered this complication in routine practice. Although patients should be proned with the head turned to one side to avoid such pressure damage8 due to the highly unstable nature of COVID 19 patients and in some cases limited cervical spine rotation inevitably some patients will end up in positions where there nose is at risk. We present our approach to the management of these injuries borrowing from theory and practice used to manage patients having undergone rhinological procedures.

• Patients with obstructive sleep apnea (OSA) and lung disease have more prominent nocturnal hypoxemia. • Nocturnal hypoxemia in patients with impaired lung function with co-morbid OSA can enhance the possible mechanisms through which presence of OSA has been associated with adverse outcomes • Hypoxemia-, sympathetic over-activation-, increased oxidative stress-, and systemic inflammation-related to OSA may exaggerate symptoms associated with COVID-19. • It can be suggested that presence of OSA may plays a role in the severity of symptoms associated with COVID-19. • Further investigation in COVID-19 patients with previous diagnosis of OSA is warranted.

For centuries it has been humankind’s instinct to cover the mouth and nose when coughing or sneezing. Common sense would dictate this instinctively reduces the dispersion of aerosol and droplets and thus the spread of contact and airborne infections.Aerosol generating procedures (AGPs) have become a new byword for procedures that put clinicians at increased risk of contracting COVID-19. Whilst the title suggests the risk is simply in aerosols, the science is much more interesting. Droplets and aerosols are different, with the distinction between them based on size. Whilst experts disagree on the absolute size when an aerosol becomes a droplet, the general acceptance is that anything bigger than 50 microns (0.05mm) is a droplet and those smaller are aerosols.In most contagious respiratory infections, the principal transmission agents are droplets (1). This is due to the relatively high viral load in a droplet, purely due to its large size, and also the fact that large droplets have weight, and so gravity pulls them down onto surfaces that others can touch – so passing it on. This is why washing hands is so effective against droplet spread.Aerosol transmission is thought to be a much less frequent cause of transmission, mainly due to the very small viral load (given the aerosol itself is by definition very small). However, it is clearly more concerning as these very small, and therefore very light particles, can travel large distances on air currents and can be directly inhaled. That said, it is thought to only play a minor role in transmission compared to droplet spread.During the COVID-19 pandemic PHE (Public Health England) updated guidance on what it considers (AGPs) Aerosol Generating Procedures. Included within this list were examinations of the upper aerodigestive tract in ENT. Any procedure enacting air over a fluid mucosal surface therefore poses a risk of viral dispersion within both droplets and aerosol. Healthcare workers were recommended to reduce endoscopy of the nose and throat. Any essential examination had to be performed using high level PPE including an respirator (N95 or FFP3)(2).Anfinrud et al (3) graphically represented a visual reduction in aerosol production by creating light sheet from a 532-nm green LASER. Comparisons were made between a person talking with and without a cover for the mouth, in their instance, a slightly dampened wash cloth. Light flashes were recorded to evaluate the number of droplets ranging between 5-200 microns. They showed that by covering the mouth, virtually no light flashes were seen. This observation supports the well-known concept that covering the mouth does indeed reduce droplet production.On impact with smooth surfaces droplets disperse to smaller sizes and can aerosolise. Similarly impact onto soft surfaces absorbs droplets reducing their projection as well as the tendency to aerosolise (3).As the pandemic plateaus in countries across the world various strategies are to be considered to return to a new normal. This would facilitate the resumption of diagnostic services whilst maintaining the protection to healthcare workers. One suggestion is the use of facemasks to help reduce the risk of inadvertent droplet dispersion (2). Despite the ‘soft surface’ barrier masks create, in the ENT setting, facemasks obscure access to the nasal cavity thus preventing nasoendoscopy.The ‘SNAP’ (Safe Nasoendoscopic Airway Procedure) developed by endoscope-i Ltd (West Midlands, UK) is a single-use, valved endoscopic port, retrofitted to any surgical mask (Figure 1), permitting entry of a 4mm flexible and rigid endoscope to examine the naso and pharyngolarynx. The valve, a 10.9 mm cylindrical tube truncated by two opposing 45 degree inclined membranes 700 microns thick, approaches a point but terminates in a 700 micron thick and 500 micron wide plateau, creating a ‘duck bill’ formation The valves are formed using a FFF (fused filament fabrication) 3D printing technique with a Flashforge Creator Pro 3D printer. The plateau atop the valve serves to provide a reference for introducing a slit using a hardened steel razor blade that is 400 microns thin. The blade is mounted in a jig to ensure angle, penetration depth and position are controlled as it is driven through the membrane. These measures ensure that the valve opening is observably consistent and less than 50 microns. Once the SNAP is fitted to a surgical mask, any cough or sneeze generated during the procedure is caught within the mask. The valve is configured such that pressure from the patient side will serve to collapse the walls of the valve membrane thereby further sealing the slit in the valve. This seal has been in vitro tested with aerosolised fluorescein(figure 2). The 45-degree angle of the valve walls from the non-patient side similarly allows the blunt tip of the nasoendoscope to deform the valve walls with ease. The cylindrical form of the walls encourages the valve membranes to return to their original flat shape following withdrawal of the endoscope.During the COVID-19 pandemic our tertiary head and neck cancer referral centre managed 120 urgent 2ww cases. Using the Tikka et al calculator (4) 40% of referrals were redirected back to the GP. The remaining 60% either went direct for imaging or underwent endoscopy. In total 40 cases were endoscoped, 9 of which using the SNAP. All 9 cases scoped with the SNAP were completed without any adverse effect. No cough or sneeze was elicited during any of the examinations and observations between the two groups were identical. Subsequently one consultant lead FEES examination was performed under controlled conditions. Again, the procedure was completed without any complications. The patient self-remarked on the comfort of the endoscopy as a result of the stability provided by the SNAP device in the alar region the prevented inadvertent movement during the chin tuck and head turn exercises.Our observations demonstrate the SNAP device is a practical and safe tool to aid reduction in droplet dispersion whilst performing nasoendoscopy. We hope to see the inclusion of such a device in recovery guidelines by national bodies in order to facilitate the return of safe nasoendoscopy in the post COVID Pandemic era.

Facial synkinesis is the long-term sequela of facial nerve injury that can result in severe deficits in facial expression and function. It is characterized by abnormal involuntary facial movements that accompany voluntary facial expressions. The type and severity of symptoms differ from patient to patient, which makes evaluation and management complex. Given the chronicity of the disease, appropriate evaluation is paramount to effective management. This article will discuss how to effectively evaluate patients in the office and associated treatment.

Title: Cochlear anomaly with preserved hearing - A Clinical Paradox: Our Experience with Two cases

KEY POINTS1.Our population represents a common clinical scenario in which auditory profiles do not determine eligibility for further evaluation.2.Mean VOR gain in the VS group, was significantly lower on the affected side in the three canal planes.3.Refixation saccades in the affected horizontal canal had a significantly higher latency and velocity in the VS group.4. When we categorized the presence of the VIN with mastoid stimulation, we yielded sensitivities of 81.8% and specificities of 73.9% for detecting VS.5.The VIN test causes minor discomfort with high diagnostic accuracy and should be considered before referring for further imaging.

INTRODUCTION

Objective: To explore the pathogenesis of Eustachian tube dysfunction (ETD) in patients with chronic otitis media with effusion (COME) using middle ear pressure-equilibration testing. Methods: Pressure equilibration testing of ET ventilation function was carried out in 72 ears which included 51 ears of COME patients with ventilation tube (COME group) and 21 ears of patients with traumatic tympanic perforation (TP group). According to the results of the test, these ears were further divided into four types: 1. with both passive and active opening, 2. only with passive opening, 3. only with active opening, 4. without passive and active opening. Results: 85.7% ears in the TP group had both active and passive ET function while 88.2% ears in the COME group had ETD. The average frequency of ET opening (P<0.001) and the occurrence rate of pressure rebound wave (P<0.001) was significantly lower in the COME group, while the mean residual pressure after several swallowing acts (P<0.001) and the average ET opening duration (P=0.004) was significantly higher in the COME group than in the TP group. Conclusions: Relatively higher residual pressure, lower effective opening frequency, disappearance of rebound wave and longer ET opening duration indicate poor ET ventilation function and an abnormal contraction pattern of peritubular muscles of the ET in patients with COME. Our results show that ETD is prevalent in most patients with COME with various causes. Therefore, appropriate treatment methods should be adopted to ensure prompt and adequate recovery. Keywords: Eustachian tube function,pressure-equilibration test,chronic otitis media with effusion

Background: The use of immunotherapy to treat recurrent/metastatic squamous cell carcinoma of the head and neck has become a popular research topic in recent years, and many clinical trials have been carried out. Objectives: To systematically evaluate the efficacy and safety of PD-1/PD-L1 inhibitors in the treatment of recurrent/metastatic head and neck squamous cell carcinoma. Methods: We searched PubMed, Embase, Cochrane Library and other databases up to 1 November 2019 for publications reporting the use of PD-1/PD-L1 inhibitors in the treatment of squamous cell carcinoma of the head and neck. Revman 5.0 was used for combination analysis, and the overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and adverse events were determined. Results: Five articles were included. Compared with other treatment methods, this meta-analysis showed that treatment with PD-1/PD-L1 inhibitors can significantly improve OS (P < 0.0001), but there was no significant improvement in PFS or ORR. The risk of anaemia and nausea was significantly reduced by treatment with PD-1/PD-L1 inhibitors. Conclusions and Significance: Treatment with PD-1/PD-L1 inhibitors alone can improve the overall survival rate for recurrent/metastatic squamous cell carcinoma of the head and neck but there is no obvious advantage in other aspects and adverse events.

1. The age range of patients responding to the survey was 28-85 with a mean of 58\(\pm\)12 years with the duration of their disorder less than 5 years in 63% of cases. 2. Patients experience variable treatment, if at all, for post-viral olfactory loss 3. If treatment is given oral and/or intranasal steroids are typically given. 4. Several patients reported receiving imaging despite this not being clinically useful when there is a clear history and normal examination. 5. Over two thirds of patients experience parosmia and up to 5 years of the onset of the problem were still actively seeking a solution.

Keypoints and Key wordsKeypoints :Many reports suggest that odontogenic sinusitis cause critical orbital abscess with high risk of ophthalmologic sequelae due to the pathogenic potential of anaerobic bacteria.This study aimed to compare the outcomes between odontogenic sinusitis and non-odontogenic sinusitis after management of orbital abscess in an adult population.The rates of revision surgery and visual sequelae were significantly higher in the odontogenic sinusitis group.Dental etiology of the sinusitis was overlooked in four patients (24%) of the odontogenic sinusitis group. Hence, dental cause of sinusitis has to be systematically sought and treated.Key words: Abscess, Blindness, Odontogenic infection, Orbital cellulitis, Sinusitis.Ethical considerationsThe protocol was approved by the local ethics committee. All participants gave informed consent.Main TextINTRODUCTIONOrbital cellulitis is a rare acute infection of the orbit and its contents that occurs mostly in children. The main cause is sinusitis (1). It is usually classified according to Chandler’s classification based on location and severity (2). Among orbital cellulitis, abscess formation occurs in 30% of the patients (3). Associated neurological acute complications, such as empyema or cerebral abscess, are rare but life-threatening. Long-term complications can be dramatic, notably blindness and cosmetic sequelae. The treatment includes hospitalization, intravenous antibiotics and surgery. The surgical procedure can combine endoscopic endonasal approach and external approach.According to the scientific literature, only 10% of sinusitis are odontogenic (4). Some authors suggest that odontogenic sinusitis (OS) cause critical orbital abscess (5) with higher risk of ophthalmologic sequelae (6), due to the pathogenic potential of anaerobic bacteria.This study aimed to compare the outcomes between OS and non-OS after management of orbital abscess in an adult population.MATERIALS AND METHODS

Background: The total number of thyroidectomies performed worldwide both for benign and malignant disease has increased dramatically during the past few decades. Gestational hypothyroidism has deleterious effects on the fetus. Objective: The aim of this study was to assess the extent of thyroid function control among pregnant women who had previously undergone a therapeutic thyroidectomy. Methods: This retrospective cohort study included all female patients insured in the largest health maintenance organization in Israel who were pregnant between May, 2001 and September, 2012 and had a medical history of thyroid surgery. The thyroid-stimulating hormone (TSH) levels throughout the pregnancy were compared to recommended trimestral values. A multivariate analysis was performed to determine risk factors for not attaining TSH recommended range. Results: A total of 477 females with a history of thyroid surgery had given 701 births during the study period. Forty-three percent (n= 203), had thyroidal malignancy. Nearly half of the women underwent total thyroidectomy (43.4% n=207). The women’s TSH values were within the recommended range in only 60% (n= 350) of the pregnancies during the first trimester (0.1-2.5 mIU/L), in 61% (n=335) during the second trimester (0.2–3 mIU/L), and in 70% (n=338) during the third trimester (0.3–3 mIU/L). In multivariate analysis, women that underwent a total thyroidectomy due to a benign thyroid disease, were at the highest risk for not attaining target TSH levels. Conclusions: This very large cohort of pregnant women with a past history of thyroid surgery demonstrated a significant percentage of pregnancies with TSH values above the recommended range. Women that underwent a total thyroidectomy due to benign thyroid disease were at the highest risk for gestational hypothyroidism.

Key Points: • We describe a novel procedure, Endopharyngeal Ultrasound (EPhUS) and EPhUS-guided FNA • EPhUS requires an operator and an assistant, can be performed transnasal or transoral, and utilizes a Endoscopic Ultrasonography Bronchoscope • EPhUS is a safe and effective method for biopsy of deep space neck masses inaccessible to transcutaneous FNA

Objectives This large-scale case-control study aimed to explore the trace elements (Zn & Cu) and risk factors associated with tinnitus severity (mild and moderate-to-severe tinnitus). Methods The serum levels of Zn & Cu of participants were measured by inductively coupled plasma mass spectrometry (ICP-MS). The potential risk factors were analyzed by simple and multiple logistic regression analysis. Results Compared mild tinnitus with moderate-to-severe tinnitus, the serum Zn of participants had a significant difference (P=0.05), and only the age variable displayed an evident difference in main clinical characteristics analysis table (P<0.05). Under a multivariable-adjusted analysis, the potential risk factors included hearing loss (AOR: 1.704, 95% CI: 1.009-2.880), HADS-A (borderline abnormal, AOR: 2.876, 95% CI: 1.248-6.625; abnormal, AOR: 12.149, 95% CI: 2.722-54.218), AIS (slight sleep problems, AOR: 2.030, 95% CI: 1.061-3.885; probable/definite insomnia, AOR: 6.955, 95% CI: 3.669-13.185), ear-self-cleaning (<1 t/w, AOR: 2.117, 95% CI: 1.178-3.805; 3-6 t/w, AOR: 2.462, 95% CI: 1.081-5.607; ≥7 t/w, AOR: 2.472, 95% CI: 1.041-5.868), tea consumption (AOR: 1.138, 95% CI: 1.052-1.231) and sleep apnea (AOR: 1.805, 95% CI: 1.036-3.145). Next, a stratified analysis was made on these risk factors, and the results showed that the low levels of Zn were significantly associated with tinnitus severity in hearing loss group——both in “no” and “yes” subgroups (“no”, AOR: 2.588, 95% CI: 1.348-6.061; “yes”, AOR: 4.213, 95% CI: 1.106-8.430), and in HADS-A group——noly in “normal” subgroup (AOR: 2.928, 95% CI: 1.790-6.984). Conclusions Serum Zn deficiency and potential risk factors (including hearing loss, tea consumption, sleep apnea, anxiety, insomnia and ear-self-cleaning habit) were significantly correlated with tinnitus severity. Intervention with these risk factors could prevent the mild tinnitus from becoming moderate-to-severe tinnitus.

Introduction: Otitis media with effusion (OME) is the collection of fluid in the middle ear without signs or symptoms of an acute infection. It is cured by treating the cause and restoring normal eustachian tube function. By activating jaw movement and inducing frequent swallowing, chewing gum could be effective in the conservative management of OME. Objectives: To determine the recovery rate after chewing xylitol gum for the treatment of OME, and the factors associated with OME cures in adults. Materials and methods: A non-randomized, controlled trial was conducted on 30 OME patients May 2018–December 2019. The subjects chewed 2 tabs of gum for 5–10 minutes, 3 times daily, for up to 3 months. Physical and audiometric examinations were performed at 2, 6 and 12 weeks. Results: Thirty patients were enrolled. Their mean age was 55.0 ± 20.19 years. OME resolution was found in 23/43 ears (53.49%). Myringotomy was performed in 13/43 ears (30.23%). Two factors were associated with shorter resolution times. Firstly, a patient age of 40–60 years, compared with other ages (p-value = 0.030). Secondly, an initial average air-bone gap of ≤ 20 dB, compared with larger gaps (p-value = 0.027). Conclusions: Xylitol-gum chewing did not increase the overall OME resolution rate. Nonetheless, it is still a choice for OME management as it tends to shorten the resolution time, with only minor side effects being experienced by some patients. Keywords: Otitis media with effusion, otitis media, OME, xylitol chewing gum, gum chewing, xylitol gum, gum

Background: We aimed to clarify the surgical management of ectopic cervical thymus (ECT) in children. Methods: Case report and systematic review of the literature. Results: We report a case of ECT in a 10-year old girl initially misdiagnosed as branchial cyst. A systematic review of the literature (1997-2018) identified 143 paediatric patients (150 ECT) diagnosed as follows: 10 incidentally at autopsy, 107 after complete surgical excision, 33 after needle/ incisional biopsy/ imaging only. There were no reports of malignancy. Conclusions: ECT is a benign and relatively rare condition in children. ECT can be the only active thymus and careful consideration should be taken prior to its excision in young children. We recommend that ECT should be considered in the differential diagnosis of lateral neck masses in children. In cases where the exact aetiology is unclear investigation with an MRI scan of neck and thorax to avoid inappropriate surgical intervention.

IntroductionScottish Government guidelines state that 95% of patients diagnosed with cancer should begin treatment within 31 days of diagnosis and 95% of those referred with a suspicion of cancer should begin treatment within 62 days of referral (1). However, these targets currently apply to 10 major cancer groups, which excludes thyroid cancer (1). The biology of differentiated thyroid cancer (DTC) is favourable in comparison to most malignancies. However, the oncological and psychological impact of potential treatment delays in DTC is not clear. The aim of this study was to assess times from referral to diagnosis and treatment, with a focus on factors that influence times within our cancer network.

Objectives: This study aimed to investigate whether auditory steady-state response (ASSR) can be a prognostic indicator of hearing outcome in patients with sudden sensorineural hearing loss (SSNHL). Design: Prospective clinical study. Setting: Tertiary-care hospital center. Participants: Fifty-three patients with unilateral SSNHL of ≤ 90 dB HL were included. Patients with a worse ASSR threshold of ≥ 15 dB HL compared to pure-tone threshold were included in the worse ASSR (WASSR) group. Patients without a worse ASSR thresholds were included in the similar or better ASSR (SBASSR) group. Main outcome measures: Pure-tone audiometry (PTA) was gathered before and after steroid treatment. The hearing recovery was defined as a < 25 dB HL of final hearing level or a > 15 dB HL of hearing gain. Hearing outcome of SSNHL according to the ASSR grouping was evaluated. Results: Twenty-one patients were included in the WASSR group, whereas the remaining of 32 patients were included in the SBASSR group. Although WASSR and SBASSR groups had similar initial pure-tone thresholds, WASSR group had significantly worse last pure-tone thresholds compared to SBASSR group (p = 0.021). The ASSR grouping was significantly associated with the hearing recovery in univariate and multivariate logistic regression model (all p-values < 0.05) Conclusions: This study suggests that ASSR measurements can be used to predict the hearing prognosis of SSNHL.

Objectives: To investigate how surgeons interpret the ATA 2015 and BTA 2014 guidelines for low risk well differentiated thyroid cancers (LRDTCs) and how they impact patient experiences across the UK. Design: Three nationally disseminated anonymised questionnaires. Setting: A nationwide snapshot of LRDTC management. Participants: Thyroid surgeons and their respective thyroid cancer multidisciplinary teams (MDTs) and thyroid cancer patients. Main outcome measures: The outcomes of interest were how surgeons/MDTs are managing LRDTCs and patient perspectives on ‘shared-decision-making’ and their ideal surgical management for LRDTCs. Results: 74 surgeons responded. 88% utilised BTA guidelines to assess recurrence risk. Tumour size, histology, stage T3b and central nodal involvement were important for >85%, but age (>45 years) only for 50%. In T1 (2cm), Thy5 solitary nodule, 58% supported hemi-thyroidectomy (HT), with 33% for total thyroidectomy (TT). In T2 (3cm) PTC, 54% opted for TT, with 24% favouring HT. Over 90% recommended TT for any incidentally excised microscopically positive lymph nodes. In T1a(m) multifocal micro-PTC, 63% suggested HT, but with contralateral benign nodules, 66% supported TT. 40% of patients felt ‘pros and cons’ of different managements were not fully explained. 47% felt they didn’t have significant input in their management, with 53% feeling final management was clinician’s choice. 60% preferred TT, with 80% wanting to ensure there was no cancer left and avoid recurrence. 20% preferred HT, with 46% wishing to avoid lifelong thyroxine. Conclusions: There is variation in risk assessment and management of LRDTCs nationally, with contrasting views of optimum treatment between patients and clinicians. These variations in practice are affecting patient experiences nationally.