Objective: Transoral robotic surgery (TORS) for oropharyngeal cancer was introduced to ensure better functional preservation with less morbidity. However, long-term functional outcomes, especially speech and swallowing outcomes, have not been thoroughly investigated. This study aimed to evaluate the long-term functional swallowing and speech outcomes after transoral robotic surgery for oropharyngeal cancer. Methods We studied 41 patients with oropharyngeal squamous cell carcinoma who underwent TORS between January 2010 and December 2018. Tongue mobility, maximal phonation time, articulation, verbal diadochokinesis, reading speed, and modified barium swallowing tests were performed between two and three years after TORS to analyze the long-term functional speech and swallowing outcomes. Results: The mean patient age was 57.7 ± 9.9 years, and the male to female ratio was 34:7. The most common subsite was the palatine tonsil (73.2%), followed by the base of tongue (22.0%). Forty patients (97.6%) underwent concomitant neck dissection, and 36 patients (87.8%) received adjuvant radiation or chemoradiation therapy. Tongue mobility, maximum phonation time, articulation, verbal diadochokinesis, and reading speed were not different from those of the normal population. Modified barium swallowing outcomes were acceptable in most patients; however, one patient (2.4%) was dependent on a percutaneous endoscopic gastrostomy tube. None of the patients required a permanent tracheostomy. Conclusions: Long-term speech and swallowing functions after TORS were acceptable in most patients with oropharyngeal cancer. TORS is an excellent treatment modality for oropharyngeal cancer in terms of functional outcomes.

Background: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for many ENT operations including endoscopic sinus surgery (ESS). We aimed to investigate the safety of ESS in England. Methods: This was an observational, secondary analysis of administrative data. Participants were all patients in England undergoing elective ESS procedure aged ≥ 17 years during for the five years from 1st April 2014 to 31st March 2019. The exposure variable was day-case or overnight stay. The primary outcome was emergency readmission within 30 days post-discharge. Results: Data were available for 49,223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 100% to 20.6%. Rates of day-case surgery increased from 64.0% in 2014/15 to 78.7% in 2018/19. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). For secondary outcomes measures, there was no evidence of poorer outcomes for day-case patients. Outcomes for patients operated on in trusts with ≥80% day-case rates compared to patients operated on in trusts with <50% rates of day-case surgery were similar. Conclusions: ESS can safely be performed as day-case surgery at current rates. There is a potential to increase rates of day-case ESS in England, especially in departments that currently have low rates of day-case ESS.

Abstract Objectives The aim of this study was to evaluate whether adding an extra perichondrium patch to enhance the cartilage graft during endoscopic myringoplasty can improve the healing rate and post-operative hearing of patients with poor prognostic factors (eustachian tube dysfunction, large perforations, subtotal perforations and marginal perforations). Methods This retrospective study analyzed a total of 80 patients (40 females and 40 males, median age of 40.55 years) who had received an extra patch during endoscopic cartilage myringoplasty. Patients were followed up for six months. Healing rates, complications, preoperative and postoperative pure-tone average (PTA) and air-bone gap (ABG) were analyzed. Results At six months follow-up, the healing rate of tympanic membrane was 100% (80/80). The mean preoperative pure-tone average (PTA)（43.18± 14.57 dB HL）significantly decreased (27.08±9.36 dB HL) six months after the operation (P=0.002). Similarly, the mean preoperative ABG（19.05±5.72 dB HL）reduced to（9.36±3.75 dB HL） (P=0.0019) at sixth month. Major complications were not observed during follow-up. Conclusions The usage of an extra patch during endoscopic cartilage myringoplasty for large, subtotal and marginal tympanic membrane perforations achieved a high healing rate and a statistically significant hearing gain with low incidence of complications.

Abstract Objective: To determine whether Betahistine dihydrochloride is effective in treating primary tinnitus in adults. Design: Intention-to-treat, randomized, triple-blinding, monocentric clinical trial Setting: Botucatu Medical School – State University of São Paulo (Unesp) in Brazil. Participants: 62 adults with primary tinnitus for at least six months (both sexes), and a Tinnitus Handicap Inventory score above 18 were randomized in two equal study groups: betahistine (24 mg of oral betahistine 12/12hs for 90 days), control group (a matched placebo). Main outcomes measures: Primary outcome measure - change in Tinnitus Handicap Inventory score; secondary outcome - Clinical Global Impression Improvement and participants’ perceived improvement after the intervention. Results: Participants had a median age (interquartile range) of 54 (48 to 60) years, with a balanced number of men and women. There was no significant difference in Tinnitus Handicap Inventory change before and after treatment between the study group and control (median difference of -2 points; 95% CI, -8 to 6 points); the Tinnitus Handicap Inventory after intervention was a median (interquartile range) of 4 (-4 to 14) lower in the betahistine group, and a median (interquartile range) of 2 (-6 to 10) lower in the placebo group. The secondary endpoint, covariate adjustment, and per-protocol analysis provided similar results, and side effects were without difference between both groups. Conclusion: Betahistine was ineffective when compared to the placebo in the treatment of the primary tinnitus .

Objectives Chronic rhinosinusitis is a heterogenous disease with variation in the endotypes of nasal polyps, with type 2 inflammation being more prevalent in Caucasian populations and papers describing as many as 5 different types of inflammation in Chinese populations. We aim to describe the variation in endotypes for patients with chronic rhinosinusitis with nasal polyposis in our unique multiracial population, together with associated demographic and clinical biomarkers. Design: Retrospective analysis Setting and Participants: Demographic, clinical and structured histopathological data of 67 patients who underwent sinus surgery for nasal polyposis by a single surgeon in Singapore General Hospital were evaluated. Results: In our population, 46.2% had eosinophil-predominant disease, and 53.7% had lymphoplasmacytic disease, with no significant demographic differences between the 2 populations. There were significantly higher peripheral eosinophil levels in patients with eosinophil predominant inflammation on tissue histology (absolute eosinophil count 0.69 ± 0.17 x 109) vs lymphoplasmacytic disease (0.22 ± 0.09 x 109) (p = 0.00). Structured histopathological reporting revealed that patients with eosinophilic disease tended to have more severe inflammation and basement membrane thickening, though this did not reach statistical significance. Conclusion: Understanding the underlying inflammatory patterns of patients with nasal polyposis paves the way to personalised therapy and better prognostication of disease. Our population is shown to have a slight preponderance toward lymphoplasmacytic disease, especially amongst the Chinese majority. Serum eosinophilia and the presence of asthma seems to correlate well with tissue eosinophilia, which can potentially be utilised as a marker of type 2 inflammatory disease.

Objectives: To evaluate the risk of sensorineural hearing loss (SNHL) after mastoidectomy in patients with acute mastoiditis (AM) and compare patients who received surgical versus conservative treatment. Methods: A retrospective cohort study of medical records of all patients who were diagnosed with AM at Soroka medical center between the years 2005-2020 and had an available hearing test. Data included demographics, clinical characteristic, comorbidities, and a pure tune audiometry conducted in our institution after recovery. Hearing loss (HL) was defined as a decrease of 15 dB or more in a given frequency. HL was categorized as mild (25-40 dB decrease), moderate (41-70) or severe (71db<). Frequencies range was categorized as Low (<500 Hz), middle (501-2000 HZ) or high (>2001) pitch. We divided the patients to two groups; patients who received conservative treatment and patients who underwent surgery. Results: A total of 24 patients met the inclusion/exclusion criteria, 12 underwent surgery (mean age 20.2 m) and 12 received conservative treatment (mean age 20.1 m). A definite CHL of 10 to 20 dB could be diagnosed in 3 of the 5 patients in each group, who had bone conduction thresholds measured. SNHL was not observed in any of the patients old enough to have bone conduction tested Conclusions: This is the first study to examine HL of children following AM. From our limited study it seems that the disease itself as well as mastoidectomy is not a risk factor for developing SNHL later in life.

Objectives To summarise current practices in the diagnosis and management of Deep Neck Space Infections (DNSIs) To inform future studies in developing a framework in the management of DNSIs Design This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with 2 independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach. Setting Secondary or Tertiary Care centres that undertook management of Deep Neck Space Infections. Participants All adult patients with a deep neck space infection. Main outcome measures The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs. Results 60 studies were reviewed. 31 studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single RCT all other studies were observational (n=25) or case series (n=36). CT was used to diagnose DNSI in 78% of patients, Mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration. Qualitative analysis identified 7 major themes were identified on DNSI. Conclusion There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.

BACKGROUND: Intraoperative MRI (iMRI) is a definitive technology in neurosurgery that has been used effectively to maximize outcomes for transsphenoidal resection of pituitary tumors. IMRI has been seen to provide optimal visualization of surrounding vital neurovascular structures and has helped surgeons achieve gross total resection. The use of iMRI in the community hospital setting has not been documented in the current literature as of yet. OBJECTIVE: This study aims to provide insight into the experiences of iMRI use in a community hospital setting and add to the growing literature of iMRi use for transsphenoidal resection of pituitary tumors. METHODS: A retrospective review of 56 patients who underwent iMRI guided transsphenoidal pituitary tumor resection at Northwestern Medicine Central Dupage Hospital (from November 2011 to April 2018) was performed. RESULTS: Gross total resection was found in 67% (n=37) of patients who underwent iMRI. 33% (n=19) did not achieve gross total resection of their pituitary mass. IMRi was used exactly one time during the case in 96% (n=54) of patients. IMRi was used more than once during the case in 4% (n=2) of patients. Post operative tumor residual was found in 32% (n=6) of patients who had available post-operative MRI studies (n=19). CONCLUSIONS: Our study shows that iMRI can be useful in a community hospital setting to achieve gross total resection during transsphenoidal pituitary tumor resection. It also demonstrates the ability and need to utilize iMRI only one time during a case which lends itself to operative efficiency.

Objective: To explore the audiological characteristics of infant auditory neuropathy (AN) patients with cochlear microphonic (CM) recorded but no otoacoustic emission (OAE) response and clinically reduce the rate of missed diagnosis of AN. Design: Retrospective clinical study of medical data from 2003 to 2020. Setting: Otolaryngology head and neck surgery clinical hearing center. Participants: Eighteen infant AN patients with CM present and distortion product otoacoustic emission (DPOAE) absent in both ears were OAE absent group. Forty-four infant AN patients with CM and DPOAE present in both ears were OAE present group. Main outcome measures: Audiological characteristics. Results: 1. The age of onset in OAE absent group was 0.9 (0.02) years old, which was less than 1.11 (1.63) years old in OAE present group (P=0.041). 2. The CM threshold of OAE absent group was 80 (10) dB nHL, which was significantly higher (P<0.001) than OAE present group. CM amplitude were smaller (P<0.05), and CM duration were shorter (P<0.05) in OAE absent group. 3. The thresholds of auditory steady-state response (ASSR) at 0.5, 1, 2 and 4 kHz were 94 (10), 94 (10), 87 (20) and 81 (10) dB HL cg respectively in OAE absent group, which were higher than those in OAE present group (P<0.01). Conclusions: Infant AN patients with CM present and OAE absent showed earlier onset, worse hearing level and worse CM performance. The influencing factors and value of CM in AN patients still need to be explored in the future.

Objectives: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. Design: Retrospective cohort study. Setting: UK secondary/tertiary referral unit. Participants: New adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, reviewed in either a face-to-face or telephone clinic. Main outcome measures: Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. Results: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (2 <0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts respectively (p<0.001). Conclusion: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem, however further research is required.

Objectives: The purpose of this study was to compare the incidences of common upper airway infections and their complications, and of antibiotic prescription rates during 2020, when the COVID-19 pandemic struck, and the previous year. Study design: Retrospective national register study Setting/source population: The Swedish population in 2019 and 2020. Methods: The Swedish Board of Health and Welfare statistics data base, which includes all out- and inpatient diagnoses in specialised care was used to retrieve the number of otitis media, rhinosinusitis, pharyngotonsillitis, acute mastoiditis and peritonsillar abscess diagnoses in various age groups during 2019 and 2020. The number of prescriptions of oral antibiotics used to treat upper airway infections was collected from the Swedish E-Health Authority, which covers all prescriptions in Sweden. Population data were retrieved from Statistics Sweden. Results: There was strong evidence of a substantial decrease (approximately 40%) in otitis media, rhinosinusitis and pharyngotonsillitis cases in the population as a whole in 2020 compared to 2019. For otitis media, the decrease was most pronounced among children, whereas rhinosinusitis and pharyngotonsillitis incidence decreased to a similar extent in adults, as well. Furthermore, there was equally strong evidence that acute mastoiditis decreased by 40% in children and adolescents and that peritonsillitis in adults decreased by 24%. The decrease in infections was accompanied by a corresponding decrease in antibiotic prescriptions. Conclusion: The social distancing measures introduced during 2020 were followed by a significant decrease in upper airway infections and antibiotic prescriptions.

Characteristic of Sound Localisation of Unilateral Microtia and Atresia with and without a Non-surgical Bone Conduction Device

B-cell acute lymphoblastic leukemia (B-ALL) is the most common leukemia in the pediatric population, caused by a malignant clonal proliferation of B lymphoid progenitor cells. Identifying new molecular markers related to B-cell development is helpful for investing the pathogenesis of B-ALL, and is potentially important for clinical prognosis. We found that B cells showed the highest expression of glutaminyl-tRNA amidotransferase subunit QRSL1 (QRSL1) compared with other cells during the differentiation and development of hematopoietic stem cells and the expression of QRSL1 also gradually increases with the development of human fetal B-cell. Moreover, QRSL1 expression was higher in the tissues and cell lines extracted from patients with B-ALL than in corresponding control tissues. In the TARGET cohort, EFS and OS decreased in B-ALL with high expression of QRSL1, suggesting that QRSL1 was an independent prognostic factor. And high QRSL1 expression is associated with more bone marrow sites of relapse and TCF3-PBX1 gene fusions. Then analyzing the gene expression of the TCF3-PBX1 gene fusion subgroup, the significantly different gene expression between the QRSL1 low group and QRSL1 high group exhibited enrichment in cell development, suggesting that QRSL1 may participate in leukemic cell development in childhood B-ALL. Therefore, QRSL1 may be a molecule related to B cell development and is associated with molecular subtypes of B-ALL. The high expression of QRSL1 is associated with poor prognosis in patients with B-ALL, showing its potential as a prognostic marker of B-ALL leukemia.

Abstract BACKGROUND: Meniere’s disease (MD) involves cochlear and vestibular symptoms, but the underlying cause remains unclear. Findings predominantly show a low-to-mid-tone hearing impairment, and it is not possible to predict hearing improvement after an attack. OBJECTIVE: To examine whether improvement in hearing in definite MD (DMD) patients could be predicted using inner ear contrast magnetic resonance imaging (IEC-MRI) and pure tone audiometry (PTA) at the time of an attack. METHODS: Between April 2020 and March 2022, seven DMD outpatients were enrolled based on the Bárány Society DMD criteria. Patients were divided into two groups: a low-tone hearing loss (LTL) group and a low-to-mid-tone hearing loss (LMTL) group. Hearing improvement rates were examined. We also examined whether endolymphatic hydrops and hearing improvement were related. RESULTS: Endolymphatic hydrops was found in two of four LTL cases. One of three LMTL cases had prominent lymphedema. All LTL patients showed hearing improvements. Only one LMTL patient showed hearing improvement. Endolymphatic hydrops did not correlate with hearing improvement. CONCLUSIONS: It is not possible to estimate hearing improvement using IEC-MRI. PTA showed that LTL had a better hearing prognosis than LMTL. Therefore, it is possible to estimate hearing improvement using PTA.

Introduction: Obstructive foreign bodies of the pharynx are a relatively rare but dangerous emergency in ENT practice. Objective: To investigate cases of pharyngeal obstructive foreign bodies in the ENT by studying its epidemiological, diagnostic and therapeutic aspects. Method: a cross-sectional prospective study of 6 years from January 2015 to December 2020 was carried out in the ENT and cervico-facial surgery department. Results: we recorded 34 cases of pharyngeal obstruction by foreign bodies. The patients were aged 3 months to 39 years and the sex ratio was 1.83. The age group ranged between 3 month and 3 years was the most represented with 47.06% cases. The respiratory distress (52.94%) and dysphagia (70.59%) were the main cause of consultation in the ENT. Most Foreign bodies were toys and bottle caps in respectively 52.93% and 29.41% cases. The topography was predominantly hypopharyngeal (82.35%). The extraction was endoscopic (64.70%) and chairside (35.29%), with a favorable outcome in 97.06% of cases. Conclusion: pharyngeal obstructive foreign bodies constitutes an absolute ENT emergency, the prevention of which is based on rigorous surveillance of preschool children.

Title: A prospective study comparing Itraconazole and systemic steroids as an adjunct to topical steroids in the post-operative management of Allergic fungal rhinosinusitis ABSTRACT Objectives The objective of this study was to compare the efficacy of Itraconazole and systemic steroids as an adjuvant to topical steroids in post-operative patients with Allergic Fungal Rhinosinusitis (AFRS) using both subjective and objective outcome measurements. Methods A prospective comparative study was conducted in a tertiary care center on 60 patients diagnosed with AFRS. Patients with chronic systemic illness and those undergoing revision surgery were excluded. Post-operative patients were divided into two groups of 30 each which received Itraconazole 400 mg OD or Methylprednisolone in tapering doses over six weeks. The outcomes were measured at the end of 6 weeks -Kupferberg endoscopic staging, Absolute Eosinophilic Count (AEC), Serum Immunoglobulin (IgE), and Sino Nasal Outcome Test - 20 scores. Results Our study showed no statistical significance in outcomes between the two groups treated with Itraconazole and Methylprednisolone regarding recurrence, AEC, IgE, and Quality of Life Assessment (p<0.01). Conclusion Itraconazole was comparable to Methylprednisolone in preventing disease recurrence in the post-operative management of AFRS. It may be a viable alternative to replacing systemic steroids where the latter may be contraindicated. Itraconazole given at a dose of 400 mg once daily for six weeks was a safe dose. Keywords: Allergic Fungal Rhinosinusitis, Itraconazole, endoscopy, Quality of Life, Methylprednisolone Key points: • Itraconazole was comparable to systemic steroid (Methylprednisolone) in preventing disease recurrence in the post-operative management of AFRS. • It may be a viable alternative to replacing systemic steroids where the latter may be contraindicated. • Itraconazole given at a dose of 400 mg once daily for six weeks was a safe dose. • Recurrence may be treated safely with Itraconazole than with steroids. • The course may be repeated in case of recurrence with close monitoring.

Objectives: The aim of this study was to investigate whether the prevalence of group 2 innate lymphoid cells (ILC2s) in sinonasal tissues or in peripheral blood is associated with the postoperative outcome in chronic rhinosinusitis (CRS) patients. Design: A cross-sectional study of CRS patients undergoing endoscopic sinus surgery (ESS). Setting: The Department of Otorhinolaryngology-Head and Neck Surgery at Shiga University of Medical Science Hospital. Participants: Eleven patients with eosinophilic CRS (eCRS) and ten patients with non-eCRS were recruited. Main outcome measures: We examined the ILC2 prevalence in sinonasal tissues and in peripheral blood before and after ESS. Lund-Mackay computed tomography (LMK-CT) scores were used to evaluate the postoperative outcomes; cases with more than 50% improvement were categorized into the good outcome group, and cases with less than 50% improvement were categorized into the poor outcome group. Results: The ILC2 prevalence in sinonasal tissues was correlated with that in preoperative blood in the eCRS and non-eCRS patients. The ILC2 prevalence in sinonasal tissues and in preoperative blood was not correlated with the pre- or postoperative LMK-CT scores. Postoperatively, the ILC2 prevalence in blood was decreased in the eCRS and non-eCRS patients, and the decrease was associated with the good outcome group, but not the poor outcome group. Conclusion: The decreased ILC2 prevalence in blood may be related to good postoperative outcomes after ESS in eCRS and non-eCRS patients.

Objectives: Barium studies are routinely requested to investigate a range of conditions, however, its efficacy for several conditions is unclear. Alongside findings from our audit in a district general hospital, we aim to review current literature on the use of barium swallow as an investigation for pharyngeal pouch, globus pharyngeus, tertiary peristalsis and oesophageal malignancy in adults. Methods: A systematic literature search was conducted on three databases for papers published in English in the last ten years. Following screening, six studies were included for pharyngeal pouch, five studies were included for globus pharyngeus, seven studies were included for tertiary peristalsis, and thirteen studies were included for oesophageal malignancy. Results: Barium swallow is a useful and important investigation in diagnosing pharyngeal pouch and can be useful to investigate oesophageal dysmotility in tertiary peristalsis. Globus pharyngeus patients do not clinically benefit from undergoing barium swallow. Oesophagogastroduodenoscopy (OGD) should remain as first line in diagnosing oesophageal malignancies. Conclusion: Barium swallow should be used to investigate pharyngeal pouch and tertiary peristalsis, but not used as the main investigation for globus pharyngeus or oesophageal malignancy. There is a need to develop further guidelines for investigations requested for dysphagia.

Abstract Background: Currently, the most common surgical modalities used for recurrent respiratory papillomatosis resection are microdebrider, CO2 laser, and KTP laser. However, complication rates vary among different surgical modalities and have been controversial in different studies. Objective of review: This study systematically reviews the available studies which reported intraoperative and postoperative complications, aiming to compare the safety of microdebrider, CO2 laser, and KTP laser. Type of review: Meta-analysis. Search strategy: Seven electronic databases (PubMed/MEDLINE, EMBASE[Ovid], Scopus, Cochrane Library, and Web of Science) were searched from inception through April 28th,2022. Randomized controlled, prospective or retrospective observational studies that recorded the complications of three different surgical modalities for recurrent respiratory papillomatosis resection were included in the meta-analysis. Evaluation method: Outcomes of interest were intraoperative and postoperative complications, and complication rate was calculated to evaluate the safety of surgical methods. Results: Twenty different studies was included in quantitative synthesis. Only one study compared outcomes of those three kinds of treatment modalities simultaneously, two studies compared microdebrider and CO2 laser, and the remaining studies focused on only one of three treatments. The weighted average complication rate for microdebrider was 0.03(95% confidence interval [CI] 0.00-0.21), n = 6, for CO2 laser treatment was 0.16 (95% confidence interval [CI] 0.09-0.25), n = 14，and for KTP laser treatment was 0.04 (95% CI 0.00-0.14), n =4. Conclusion：The limited evidence demonstrated that CO2 lasers in the surgical treatment of RRP may lead to more surgical complications, and microdebrider and KTP lasers may be safer. However, the heterogeneous data limits any strong comparison of outcomes of different treatment of laryngeal papillomas. Future randomised controlled trials that directly compare the safety of different surgical modalities are needed.

Objective Examine the characteristics of recent head and neck oncology (H&N) fellowship graduates and assess their current perceptions of career alignment and satisfaction. Methods H&N fellowship graduates from American Head & Neck Society (AHNS)-accredited programs between 2015 to 2020 were surveyed. Two-sample t-tests and analysis of variance tests were used to determine the effect of respondents’ demographics, fellowship characteristics, career preferences, and current practice on their degree of career alignment with expectations and overall job satisfaction. Results Fifty-eight fellowship graduates completed the cross-sectional survey. Fifty-two of all respondents (89.7%) primarily preferred an academic job, of whom 5 (9.6%) went into private practice. Respondents in private practice, those treating general Otolaryngology patients, or those who do not work with residents demonstrated significantly poorer job alignment and career satisfaction compared to those in academic medicine, those only treating H&N patients, or those working with residents, respectively. Discussion The number of desirable academic positions each year may be insufficient for graduating fellows. By setting realistic career expectations, planning for a mixed scope of practice, and integrating resident involvement into private practice groups, H&N providers may ultimately find more fulfillment in their work. These findings could be valuable to fellowship programs in designing training and to future H&N fellows in their career planning. Further studies with higher power would be warranted to identify other indicators of H&N career satisfaction and ways to reduce physician burnout.

Background: Head and neck cancer (HNC) have a considerable mortality and morbidity rate. Surgery is one of the most effective treatments, however it may compromise the independence of patients after its performance. The Rehabilitation Nurse (RN) intervention is essential for recovery. Objective: To compare the dependence degree between patients who underwent RN intervention versus general health care after HNC surgery. Methods: Patients submitted to different types of HNC surgery, were divided into two groups intervention by the RN versus general health care, the outcome was the Barthel Index Discharge categorized as dichotomic to assess the patient independence at discharge and their differences calculated by statistical analysis. To analyze the effect of the RN intervention on dependence, a Poisson regression model was used, adjusting the confounding factors Initial Barthel Index and Age in the variable Barthel Index Discharge>91. Results: In middle/late postoperative period, in the group with RN intervention (n=79) the hospitalization time was reduced by 4.29 days versus general health care (n=72). At discharge, the Barthel Index (p<0.005) improved significantly in the RN intervention group compared to the general health care group. The intervention of the RN after surgery had a positive effect on the functional capacity of the patients, after adjusting the confounding factors (RR:1.47; 95%CI[1.02; 2.12]). Conclusion: The RN intervention is an added value in the independence of the patient submitted to HNC surgery. It is an innovative study in patient after diagnosis HNC, showing that intervention of RN through rehabilitation programs allows independence after his surgery. 5 succinct Key points: Independence of the patient submitted to HNC surgery; early rehabilitation in postoperative period; rehabilitation nursing programs; self-care optimization; regression model.

Objectives To assess the efficacy and implementation of an epistaxis symptom diary in the management of a child with de-novo HHT type 1. HHT is a cause of chronic, severe epistaxis which can lead to significant physical and psychogical morbidity. We propose that the use of symptom diaries can reduce associated patient morbidity and aid physicians in treatment planning. Participants We discuss an independently developed symptom diary for a 10-year-old girl with HHT, Patient x (“xxx”), and its subsequent impact. Including its uses for surgical and medical treatment planning. Design A patient developed epistaxis symptom diary was designed to including nosebleed timing and side of onset, estimated severity, exacerbating / trigger factors and use of medications. A phenomenological qualitative approach was taken to assessing the impact of the diary on “xxx’s” physical and psychological wellbeing. Setting “xxx’s” diary is a novel symptom diary for patients with of chronic epistaxis and HHT which can improve patient engagement with treatment, foster lifestyle changes, and aid clinicians in promoting tailored patient-centred care. Main outcome measures “xxx’s” diary has proved to be an extremely useful tool for patient xxx, her parents and her ENT team, having improved both her physical and psychological wellbeing. Results and Conclusions We would recommend detailed symptom monitoring for all patients with severe epistaxis and HHT and suggest “xxx’s” diary as a template for this.

Introduction. Branchial cleft anomalies (BCA) can occur as sinuses, fistulas or cysts. They arise from the first, second, third or fourth pharyngeal cleft due to non-fusion or subinvolution. Mostly, located in Robbin’s neck-level II, BCA clinically present as a painless compressible swelling, cutaneous draining sinus, or fistula. Surgical treatment is the gold standard to prevent recurrence, though the necessity of ipsilateral tonsillectomy is discussed. Study Design. We conducted a retrospective comparative cohort study. Setting. Monocentric. Methods. In retrospect, data was collected from patients, that were admitted with the diagnosis BCA between 2006 and 2020 in an academic tertiary care center. Main outcome measures. 160 patients met inclusion criteria, the data was further evaluated, the focus was set on the occurrence of recurrence with or without tonsillectomy. Results. Recurrence of BCA was observed in 2 out of 160 surgically treated patients (1,25%), one of them with simultaneous tonsillectomy, the other without. Conclusion. A statistically significant difference in the recurrence-rate between these two groups (with/without tonsillectomy) could not be shown. The performance of an ipsilateral simultaneous tonsillectomy in the surgical workup of BCA cannot be recommended at the basis of our data.

Objectives: To determine the patient and treatment characteristics associated with delay in post-operative radiation therapy (PORT) for patients treated surgically for head and neck squamous cell cancer (HNSCC) at our institution. Design: Single institution retrospective review Setting: Tertiary care academic medical center Participants: Patients treated surgically for HNSCC that underwent PORT between 2013-2016 Main outcomes measures: Time from surgery to initiation of PORT. Results: 140 patients met inclusion criteria. A majority did not start radiotherapy within six weeks. Factors associated with a delayed initiation of PORT included length of stay >8 days, 30-day readmission, no adjuvant chemotherapy, post-operative complications, and fragmented care. Conclusion: A majority of patients did not initiate PORT within the guideline-recommended 6 weeks. Modifiable risks factors that delay initiation of PORT were identified.