Objectives: The primary goal was to evaluate the effect of stimulus-duration on Electrogustometry (EGM) Thrasholds, to evaluate any gender-related influences and compare the above results to those after application of Taste-Strips. Design: Electrogustometry (EGM) thresholds of various stimulus duration (0.5, 1.0, 1.5, and 2.0 s) were measured in 212 non-smokers (age range: 10 – 80 years, divided into 8 age groups) without self-reported gustatory impairment. Furthermore, taste strips chemogustometry measurements in 132 participants were performed. Setting: Tertiary referral medical centre. Participants: 212 non-smokers, divided in 8 age-groups participated in the study. Main outcome measures: EGM-Thresholds and taste-strips, duration of stimuli Results: EGM-thresholds increased progressively with age and with increase in stimulus duration from 0.5 sec up to 2 sec. This pattern was consistent at all 6 anatomic areas, irrespective from gender. In contrast, in chemogustometry no differences related either to age or to gender were found. Conclusions: Age-related electrophysiological and functional gustatory decline can be better documented by EGM than using chemogustometry. This superiority of EGM was not influenced by stimulus duration; nonetheless, stimulus duration should be clearly documented in future quantitative EGM-threshold recordings, given that it may significantly influence EGM amplitude threshold measurements.

Clinical outcomes of salvage endoscopic nasopharyngectomy in recurrent nasopharyngeal carcinoma

Monitoring of anaesthetic depth has come a long way from observation of clinical signs. We report here, a useful clinical indicator of anaesthetic depth that has not been reported on before. A clinical sign, that as ENT surgeons we are often in a unique position to observe. We outline our supportive theory and respectfully highlight this to our colleagues.

Objectives: To describe volleyball-associated craniofacial injuries presenting to emergency departments (EDs) in the United States by patient demographics, injury type, anatomical location, and disposition. Design: An analysis of volleyball-related trauma was conducted using the National Electronic Injury Surveillance System (NEISS). Chi-squared testing (X2) was performed to compare categorical variables. Setting: The NEISS database collects information from approximately 100 EDs under the United States Consumer Product Safety Commission and provides data extrapolated to a nationally representative sample. Participants: The database was queried from years 2009-2018. Main outcome measures: Volleyball-related craniofacial injuries categorized by demographics (age, sex, and race), medical injury information (injury type and location), and patient disposition (observed and discharged, admitted, deceased). Results: A total of 235 volleyball-related facial traumas were recorded with an estimated 10,424 visits occurring nationally. The majority of injuries were among young adults aged 20-29 (52.3%) and was evenly distributed for men and women. Lacerations were the most frequent injury type (37.9%), while the face was the most common site of injury (41.7%). The majority of fractures involved the nose (71.4%) and amongst individuals aged 20 through 49 (90.5%). Males had significantly more lacerations than females (75.3% vs. 24.7%), whereas females had significantly more contusions/abrasions (64.5% vs. 35.5%) and concussions (72.9% vs. 27.1%). Conclusions: Volleyball-related craniofacial injuries can vary depending on patient demographics. This information can help with the development of safety and preventative measures for individuals participating in the sport.

Objective: The clinical symptoms, audiological and imaging features of unilateral cochlear nerve canal stenosis were reported. Method: The clinical data of 12 patients with unilateral cochlear nerve canal stenosis diagnosed in Beijing Friendship Hospital from January 2018 to December 2019 were analyzed retrospectively, including age of onset, clinical symptoms, signs, audiology, HRCT and MRI of temporal bone and so on. Results: Twelve patients (6 males and 6 females) were identified with unilateral cochlear nerve canal stenosis. All patients presented with hearing loss and no other complaints. Among them, 2 patients were accompanied with accessory ears and the rest had no positive signs. 11 patients had severe sensorineural hearing loss, 1 patient had normal low-frequency hearing and high-frequency hearing loss. Imaging showed that 9 patients were suspected atresia of the cochlear nerve canal, 3 patients were narrow. Conclusion: For patients with unilateral stenosis of cochlear canal, early diagnosis and intervention should be carried out as early as possible, and the healthy ears should be protected.

Objectives: Utilization of clinician-performed head and neck ultrasound among diagnostic radiologists, otolaryngologists, endocrinologists, and general surgeons, using Medicare Provider Utilization and Payment Data available through CMS.gov. Estimation of the potential impact clinician-performed ultrasounds may have on the traditional model of radiology-based ultrasound exams. Design: From 2012-2015, the files were filtered to include 4 provider types: Diagnostic Radiology (DR), Endocrinology (ENDO), General Surgery (GS), and Otolaryngology (OTO). Billable procedures are listed by HCPCS code and a filter was applied to include the following codes: 76536 Ultrasound, soft tissues of the head and neck, diagnostic; 76942 Ultrasonic guidance for needle placement; 10022 Fine needle aspiration, with imaging guidance. Setting: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File, available through the Centers for Medicare & Medicaid Services. Participants: Diagnostic Radiology (DR), Endocrinology (ENDO), General Surgery (GS), and Otolaryngology (OTO). Main outcome measures: Charges submitted, facility vs. non-facility, reimbursements, and superusers. Results and Conclusions: In 2015, OTOs submitted charges for 2.1% of all head and neck diagnostic ultrasounds (76536) performed on Medicare beneficiaries. DRs submitted more 76536 charges from 2012-2015, ENDOs to a lesser degree, and OTO and GS remained flat in charges. 10.5% of OTOs in the PUF submitted more than 100 charges apiece during 2015, as compared to a smaller proportion of radiologists (4.5%) who did so. Among surgeons in 2015, OTOs performed more diagnostic HNUS than GSs, and the percentage of OTOs performing US compared to their specialty peers was 3.5 times higher than GSs.

Aims: To correlate the HPV genotypes with recurrence of disease and malignant transformation. Methods: A prevalence cross-sectional study. The tumour tissue was isolated from the paraffin-embedded tissue (PET). The DNA was extracted from the tissue using the QiAamp DNA Mini Kit (Qiagen, Germany). Gel electrophoresis was performed to determine the presence of genomic DNA. HPV detection and genotyping were carried out using SACACE HPV High Risk and Low Risk Typing Real-TM kit (SACACE, Italy). Two different types of kits were used, that is HPV 6,11 Real-TM and HPV 16,18 Real-TM kits. Results: A total of 44 patients, 36 were male and 8 were female with a ratio of 5:1. 61.4% was Malay, 22.7% was Chinese, 11.4% Indian 4.5% other races. 15 out of 44 patients had HPV positive (34%). The recurrence rate of positive HPV infection compared to negative HPV was not statistically significant (p>0.05). There was a significant correlation of HPV 16 and 18 infection with malignant transformation (p<0.05). A high detection rate of a high-risk HPV type (67%) was observed in patients with inverted papilloma with malignant transformation. Conclusion: The prevalence of HPV in inverted papilloma is 34%. Our result supports that HPV infection is an aetiological factor in sinonasal inverted papilloma. A high-risk HPV plays a role in the oncogenesis of sinonasal inverted papilloma. Further studies should be conducted to further elaborate this relationship.

Which positive predictive value for Diffusion-Weighted Magnetic Resonance Imaging for children’s cholesteatomas? A retrospective study of 126 MRI exams

Background: Day‐case tonsillectomy (DCT) compared with inpatient tonsillectomy has increasingly become a norm for many patients undergoing elective surgeries. Unjustified stays of tonsillectomy can be avoided by day case surgery which consequently reduces treatment costs. The aim of this study was to determine the cost and effectiveness of DCT or outpatient operation in comparison with inpatient tonsillectomy. Methods: This study was a cost-effectiveness study which was performed on 300 patients. Patients were randomly divided into two groups: day case (n = 150) and inpatient (n = 150). Consequences used in model included incidence of bleeding, blood transfusion and re-operation frequency within two weeks after surgery and also the patients’ pain during 24 hours after surgery. This study was conducted from the social perspective; therefore, direct and indirect costs are included in the study. One-way sensitivity analysis was conducted to measure the uncertainty effects of the parameters. The collected data was analyzed using software Tree-Age and Excel 2016. Results: The results showed that DCT was less costly and more cost effective than the inpatient one. Mean total costs in day case and inpatient were $ 915.1 and $ 1227.9, respectively. Besides, the mean effectiveness was 0.921 and 0.914 percent, respectively. Also, one-way sensitivity analysis proved the robustness of the results of the study. Conclusion: The results showed that DCT is a cost-effective strategy and can be suggested as a good alternative for a wide range of patients after tonsillectomy. According to the result of our study, supporting day case surgery for tonsillectomy cases can significantly reduce the financial burden. Keywords: Day Case Tonsillectomy, outpatient tonsillectomy, Inpatient tonsillectomy, Cost-effectiveness analysis

Objectives To establish the prevalence of operating anxiety amongst otolaryngologists. Background Performance anxiety is a reaction to performing a task under pressure, and is linked to worse outcomes in professional sport. Awareness of the negative impact that performance anxiety can have on both surgical outcomes and the mental health of surgeons is increasing. The Royal College of Surgeons has recommended further evaluation of anxiety amongst surgeons so that we can greater understand its implications. Design The Sport Competition and Anxiety Test (SCAT) is a validated questionnaire used to assess anxiety in professional athletes. A modified version was distributed via the Association of Otolaryngologists in Training mailing list. Responses were accepted September-November 2019. Statistical analysis was carried out using SPSS. Participants Information was collected on the grade and sex of respondent. Main outcome measures Anxiety levels were calculated using SCAT guidelines. Results 106 questionnaires were returned 67M:38F (1 unspecified). 22 consultants, 72 registrars and 11 core trainees completed the questionnaire (1 unspecified). 6% of otolaryngologists were identified as having high levels of anxiety. Male trainees were less anxious than female trainees, mean score 15 vs 18 (range 10-27 vs 11-29, p<0.05). 6% of senior registrars and 9% of junior registrars had high anxiety compared to 0% consultants. Conclusion This data suggests high levels of performance anxiety exist amongst ENT surgeons. Interestingly, the highest anxiety levels were found in females and registrar level surgeons. With increasing levels of pressure and higher burn-out rates amongst surgeons, the need to understand the relationship between anxiety and surgical performance has never been so important.

Introduction and Objectives: Endoscopic ear surgery (EES) is rapidly emerging as a mainstream surgical modality, with recent literature highlighting its advantages over traditional approaches. This study tests the null hypothesis that there is no difference in direct costs of total endoscopic ear surgery and microscopic ear surgery for attic cholesteatoma in a British National Health Service District General Hospital setting. Study Design: Retrospective cost comparison Setting: district general hospital Participants: patients undergoing surgery for cholesteatoma limited to the attic, either via endoscopic or microscopic approach Cost comparison: Direct cost comparison of anaesthetic set up, surgical set up, and surgical time between total endoscopic ear surgery and microscopic ear surgery for attic cholesteatoma. Main outcome measures: Direct costs of anaesthetic set up, surgical set up, and surgical time Results: Total endoscopic ear surgery had a significant cost saving of £1419.01 per operation. Conclusion: Total endoscopic ear surgery is more cost-effective than microscopic surgery for attic cholesteatoma in a British National Health Service District General Hospital setting.

Background: The aim of this study was to compare outcomes of patients with minimal tracheal invasion undergoing shave resection to other forms of ETE in lieu of the new American Joint Committee on Cancer (AJCC) staging. Methods: All patients diagnosed with well differentiated thyroid cancer (WDTC) and ETE were analyzed. Structural recurrence was measured and compared between various forms of ETE. Results: A total of 132 patients were included in the study. Twenty-seven patients (20.4%) had strap muscle invasion, twenty-two patients (16.7%) had minimal tracheal invasion and 83 patients (62.9%) had other forms of ETE. Kaplan-Meier models for structural recurrence revealed that when combining T3b patients with T4a shave patients and comparing them to other T4a patients, the former performed better than the latter (p=0.028 for all ages; p= 0.021; for patients >55 years). Conclusions: Patients with minimal tracheal may be more correctly staged as T3b rather than T4a.

Objectives: To investigate characteristics of health-related quality of life and evaluate the association between health-related quality of life (HRQoL) and hearing among different types of chronic middle ear diseases (CMED). Design: Prospective longitudinal cohort study. Setting: Tertiary referral centre. Participants: Adult patients undergoing surgical treatment for CMED. Main outcomes measures: Pure-tone audiometry, Zurich Chronic Middle Ear Inventory (ZCMEI-21). Results: A total of 108 patients (55 females, 53 males; mean age 51.0 years [SD 15.9]) were included. CMED included COM with cholesteatoma (epitympanic [n = 39]; pars tensa [n = 7]), persistent mastoid cavity (with recurrent cholesteatoma; n = 15; without recurrent cholesteatoma, n = 10), COM without cholesteatoma (n = 22), revision ossiculoplasty for hearing restoration (n = 14), and postinflammatory meatal fibrosis (n = 1). No significant differences between pre- and postoperative air conduction pure-tone average was observed in any type of CMED. Preoperatively, mean ZCMEI-21 score showed statistically significant differences among different types of CMED (p = 0.007) with persistent mastoid cavity without cholesteatoma exhibiting the highest mean ZCMEI-21 score (34.1, SD 7.7) indicating a poor HRQoL. At a mean follow-up period of 183 days, no statistically significant differences in ZCMEI-21 scores among different types of CMED were observed (p = 0.67). Conclusion: This study objectifies differences in HRQoL among different types of CMED. In types of CMED with indication for functional surgery only, such as persistent mastoid cavity without cholesteatoma or ossiculoplasty, the worst HRQoL was observed. Yet, in these types of CMED, HRQoL guides decision for treatment. Moreover, differences in HRQoL among different types of CMED are not closely associated with hearing, but largely depend on other symptoms, such as tinnitus, discharge or vertigo.

5 KEY POINTSIn an outbreak, early healthcare personnel segregation should be considered to ensure that the provision of essential services may continue if a single team is quarantinedEstablishing a sustainable PPE usage guideline for healthcare workers early in the outbreak is of paramount importanceDesign and simulation of work processes for emergency airway creation should be considered in every otolaryngology department dealing with the COVID-19 outbreakScreening and postponement of non-urgent patient follow-ups frees up manpower and resourcesThe use of videoconferencing aids in restoring essential department activities and telemedicine may be a useful tool to explore in otolaryngology clinicsWord count: 1494

Introduction: Adenoidectomy is one of the most commonly performed operation worldwide. Most widely used approach for surgery is conventional curettage method. However, as this method is associated with high incidence of residual adenoid tissue at the end of surgery which results in recurrence of disease, a newer endoscopic microdebrider assisted approach is becoming popular these days. Though various studies have shown its efficacy in more complete removal of adenoids, its functional outcome on middle ear function remains to be explored. Objectives: To compare pre and post operative pure tone audiometric and impedance audiometric analysis following conventional and endoscopic micodebrider assisted adenoidectomy. Materials and Methods: Patients were diagnosed cases of chronic adenoiditis which were divided in groups of 25 each. Patients in first group underwent conventional curettage adenoidectomy while in second group patient underwent endoscopic microdebrider assisted adenoidectomy. Pre and postoperative pure tone and impedance audiometry were performed for all the patients and the outcomes were compared. Results: Endoscopic microdebrider assisted method resulted in better outcomes which were statistically significant as compared to the conventional curettage. Criteria such as hearing threshold (p value 0.004 at second follow up), peak pressure (p value 0.045 at first follow up), tympanogram (p value 0.016) showed that endoscopic method was better while peak compliance (P value 0.340 at first follow up) didn’t show any significant difference between the groups. Conclusion: Endoscopic microdebrider assisted method of adenoidectomy has a definite advantage of better visualization and results in more complete removal of tissue and hence results in better improvement in middle ear functions as compared to the conventional curettage.

An Unusual Clustered Series of Foreign Body Reactions to Oxidised Regenerated Cellulose in Head and Neck surgery - A Case series of four post-operative patients