Post-Laryngectomy Voice Prosthesis Changes by Speech-Language Pathologists: Our Experience.

Objective: To propose a scoring system based on laryngoscopic characteristics for the differential diagnosis of benign and malignant vocal cord leukoplakia. Design: Retrospective study. Setting: Tertiary hospitals Participants: Laryngoscopic images from 200 cases of vocal cord leukoplakia were retrospectively analyzed. The morphologies of vocal cord leukoplakia under laryngoscopy were evaluated by two laryngologists. Main outcome measures: The laryngoscopic signs of benign and malignant vocal cord leukoplakia were compared, and statistically significant features were assigned and accumulated to establish the leukoplakia finding score (LFS). Results: A total of five indicators (size, thickness, texture, hyperemia, and anterior commissure involvement) associated with malignant vocal cord leukoplakia were included to construct the LFS, with a possible range of 0–10 points. The diagnosis of malignant vocal cord leukoplakia as a score of ≥6 points was the most efficient. The sensitivity, specificity, and accuracy of the LFS were 93.8%, 83.6%, and 86.0%, respectively. The consistency in the LFS obtained by different laryngologists was strong (kappa=0.809). Conclusion: This scoring system based on laryngoscopic characteristics has high diagnostic value for distinguishing benign and malignant vocal cord leukoplakia.

Objectives: Tinnitus is a sensation of ringing in the ears in the absence of any physical source in the environment. 15-25% of adults experience some form of tinnitus. A common cause of tinnitus is noise, head injury, ototoxic substances, as well as disorders of blood and blood vessels. Vascular causes include: head - neck tumours, turbulent blood flow, problems with blood supply and inner ear cell damage. The aspect of rheology in terms of tinnitus has not been described yet. Participants: Twelve patients with tinnitus, aged 30 to 74 years. Main outcome measures: The subjects all underwent audiological and neurological evaluation. Rheological properties of whole blood and plasma were assessed as well. The Quemada model was used to describe the variability of red blood cells shape, as well as their tendency to form aggregates. Results: Reduced whole blood viscosity in the low shear rate range is observed in the studied patient group. Conclusion: On the basis of the experimental study, statistically different results of hemorheological measurements were observed in the evaluated group in comparison to a reference group

Dear Sir,With great interest we read the article by Godbehere et al on vincristine (VCR)-induced vocal cord paralysis (VI-VCP) in pediatric patients.1 The subject is clinically relevant and the authors provide a practical algorithm for diagnosing and treating VI-VCP. We strongly support early ENT referral following stridor in children to assess for potentially life-threatening complications of VCR administration.2 Our recently published case report and literature review (in Dutch) have found similar type and onset of symptoms.1-2In a recent review (published in Dutch literature, see Table 1 ) we summarized 22 studies including 45 patients, and we, remarkably, found some data that were slightly contrasting with findings of Godbehere et al. 1 First, we found that 11 out of 45 children between 5 and 17 years of age presented with VI-VCP, which suggests that airway obstruction might also affect older children following VCR administration. For example, one 16-year-old and one 17-year-old child needed ICU management and intubation respectively following VCR treatment. Six of the seven cases (85%) described by Godbehere et al 1 presented with bilateral vocal cord paralysis, which suggests that this is more common than unilateral paralysis. In contrast, we found that 26 out of the 35 cases (74%) that reported laterality presented with bilateral vocal cord paralysis. VI-VCP laterality was not reported in 11 cases, which could further affect this prevalence. Report of relatively more unilateral paralysis could consequently result in lower (overall) indication of invasive airway management.Remarkably, in contrast to Godbehere et al 1 we found that dose reduction resulted in reversion of paralysis in four cases. Complete cessation of therapy might therefore not be needed in all cases (contrasting findings of Godbehere et al 1. In addition, we retrieved six cases that showed partial recovery and even two cases showing no recovery.We also found (Table 1 ) that respiratory support is not always needed to facilitate VCR continuation: 10 children with bilateral vocal cord palsy received VCR dose reduction and did not need invasive airway management. One 7-year-old child with bilateral vocal cord palsy even continued VCR at full dose. Finally, we found 3 cases receiving tracheostomy as airway management, but still required discontinuation of VCR treatment, indicating that invasive airway management does not always facilitate continuation of VCR treatment.In conclusion, we agree with Godbehere et al 1that awareness of this potentially life-threatening complication is essential. Maybe our Table 1 could facilitate implementation of treatment decision (trees) in patients suffering from VI-VCP.References :Godbehere J, Payne J, Thevasagayam R. Vocal cord paralysis secondary to vincristine treatment in children: A case series of seven children and literature review. Clin. Otolaryngol. 2021;46:1114-1118.J.E. Swartz, H.P.H. Hundscheid, H. Bruijnzeel, et al . Vincristine-induced vocal cord paralysis: a rare but potentially life-threatening complication, Ned Tijdschr Oncol 2021;18:16-21.

BACKGROUND: Post-operative management of chronic rhinosinusitis is very crucial for outcomes following surgery, Normal saline nasal irrigation and steroid spray form the standard treatment of care in this period. However nasal irrigation may not be adequate and spary is usually started after 2wks of surgery which in any case does not deliver optimum dosage of drug to the paranasal sinus mucosa. Budesonide nasal irrigation in a high-volume low-pressure system could be the solution for a better outcome. METHODS: A double blinded randomized control trial with 88 patients in 2 groups of 44 each received normal saline or Budesonide nasal irrigation (0.5mg in 200ml) twice daily. Patients were followed up at 2 weeks post-operatively and 3 months, a SNOT 22 and Lund Kennedy Endoscopic scores were assessed for subjective and objective assessment. Subset analysis of only CRS patients (55) were done, and results presented. RESULTS: Patient reported subjective score at 3 months post operatively, SNOT22 was significantly (p<0.0001) improved with the use of Budesonide irrigation (26.69+/-2.92) as compared to Normal saline (30.54+/-2.81) and objective assessment score, LKES was significantly(p=0.0031) better in Budesonide group (4.06+0.74) in comparison to Normal saline in the saline (4.50+0.67)respectively. The mean scores 3 months post op visit was significantly lower for both subjective SNOT(p<0.001) and objective score LKES (p<0.0001) in Budesonide groups. CONCLUSION: Budesonide nasal irrigation with positive pressure high volume device has better patient benefits and wound healing when compared to normal saline irrigation in the post-operative management of chronic rhinosinusitis.

Objectives Dizziness has a lifetime prevalence of 17 – 30%. These symptoms have multiple aetiologies and can be difficult to diagnose in a routine ENT clinic. Several units have established multi-disciplinary ‘Dizzy Clinics’ to standardise the management of complex patients. We have developed a multi-disciplinary ‘Dizzy Clinic’ comprising clinicians and allied healthcare professionals, which incorporates a telephone triage service. Our service has been radically changed to triage patients to either a rapid access 30-minute BPPV clinic, or a 1-hour complex balance clinic and this study assesses the efficacy of our new model. Methods We conducted a retrospective audit of 124 patients referred to ‘generic’ ENT clinics for dizziness in 2019. This data was used to implement a new service where patients would receive a telephone triage before progressing to a multi-disciplinary clinic comprising audiologists, physiotherapists, and ENT surgeons. We prospectively re-audited 151 patients referred to this service in 2021. Results 40% of patients referred with dizziness in 2019 did not require a face-to-face appointment for an assessment of their dizziness. A telephone triage introduced to our ‘Dizzy Clinic’ streamed only 35.8% of referrals to a face-to-face appointment. 90% of face-to-face appointments from the ‘Dizzy Clinic’ were performed by a non-ENT surgeon. The ‘Dizzy Clinic’ showed more thorough and improved examinations compared to the previous cycle, and 60% were discharged from the ‘Dizzy Clinic’ after their first assessment, compared to 61% in the previous cycle. Conclusions Our ‘Dizzy Clinic’ effectively triages patients and enables a multi-disciplinary team to contribute to the management of dizzy patients.

Objective: Tonsillectomy is one of the most common surgeries worldwide, mostly indicated for recurrent throat infections and sleep-disordered breathing. The most significant complication is post-tonsillectomy bleeding. Although several risk factors for post-tonsillectomy bleeding in adults have been described, the role of post-operative pain as a risk factor for hemorrhage has not been described in this patient population. Design: Retrospective cohort study of adult patients (18 years and older) who underwent tonsillectomy in a tertiary referral center. Multi-variable logistic regression model was used to test correlation between the independent variables and post-tonsillectomy bleeding. Results: 305 patients (male to female ratio 1:1) with a mean age of 30.5 years old (18-82, ± 12). Mean body mass index was 26.6 (16-42, ±5) and 13% of patients were current smokers. Post-tonsillectomy pain on post-operative day 1 and 2 was associated with increased risk of bleeding (adjusted odds ratio 2.18, 95% confidence interval 1.73-2.44). Other factors that were associated with increased risk of post-tonsillectomy bleeding were male sex, young age (18-30 years old), smoking, recurrent throat infections as an indication for surgery and the usage of hot technique (p < 0.05). Conclusions: Increased post-operative pain following tonsillectomy is associated with increased risk of bleeding in adults. Other factors such as younger age group, males, smoking, previous throat infections and using hot dissection technique are also associated with risk of post-tonsillectomy bleeding. Further studies should explore the effect of strict pain control regimens on post-tonsillectomy bleeding in adults.

Objectives: Allergic fungal rhinosinusitis (AFRS) has unique clinical symptoms, radiology, and histopathological patterns. It is easy to be misdiagnosed because of the low detection rate of fungi. The purpose of this study was to improve the diagnostic rate by analyzing these data of the clinical, radiology and pathological of AFRS. Methods: The data of patients with chronic rhinosinusitis (CRS) treated in the Department of Otolaryngology-Head and neck surgery of the First Affiliated Hospital of University of Science and technology of China (USTC) from January 2015 to December 2020 were analyzed. The discharged patients diagnosed with AFRS and the suspected cases in the description of radiology or surgical records were reviewed, combined with specific immunoglobulin E (IgE) examination, they were divided into three groups: AFRS, suspected AFRS and fungal ball sinusitis (FBS). The age, gender, eosinophils and basophils in peripheral blood, total serum IgE, invasion of sinuses, bone erosion, computed tomographic (CT) Lund-Mackay score, whether accompanied with allergic rhinitis, asthma, and olfactory hypothyroidism were all analyzed. Results: 631 patients with non-invasive fungal sinusitis were treated in the past 6 years. 29 cases of AFRS, 69 cases of suspected AFRS and 533 cases of FBS. A total of 98 confirmed and suspected AFRS cases were identified, with an average age of 34.3 years. 79 cases of multiple paranasal sinus invasion and 55 cases of bilateral paranasal sinuses. 25 cases with bone erosion. There were no significant differences in age, eosinophils percentage, basophils percentage, total serum IgE, CT Lund-Mackay score, combined with allergic rhinitis, asthma and hypoolfactory between AFRS and suspected AFRS. However, significant differences were observed in the above indicators between AFRS or confirmed AFRS and FBS. Conclusion: AFRS may be misdiagnosed due to the low detection of fungi. Clinical, laboratory, radiology and histopathological need to focus on improving the detection rate of fungi in AFRS. In order to reduce the recurrence of the disease, we can consider the diagnosis of AFRS for patients with clinical, radiology and immunological characteristics consistent with AFRS but without fungal etiology

Background: Our centre has favoured primary surgery over chemoradiotherapy(CRT) for specific advanced laryngeal cancer patients with large volume tumours, airway compromise, significant dysphagia and T4 disease. Some reports suggest surgery is associated with higher oncological control than organ-preservation strategies. This study reports the survival outcomes for a modern, high-volume head and neck centre favouring surgical management approaches. Methods: Patient data was collated retrospectively over a 7-year period from a tertiary head and neck specialty centre. Kaplan-Meier survival analysis and the Cox-proportional hazards model were employed for survival analyses. Results: The study population included 121 patients with T3(n=76) or T4(n=45) laryngeal cancer with a mean follow-up of 2.9 years. 104(86.0%) patients were treated with curative intent. Of which, 14(11.6%) received radiotherapy, 40(33.1%) received chemoradiotherapy (CRT), 19(15.7%) underwent surgery alone and 31(25.6%) underwent surgery with adjuvant therapy. In the cohort treated with curative intent, the 2-year and 5-year estimated disease-specific survival was 77.9% and 64.1% respectively. CRT had the highest 2-year DSS(92.5%), followed by surgery with adjuvant therapy(81.8%), RT alone(75%) and surgery alone(72.4%). Prognostic factors identified for disease-specific survival included age, tumour subsite and treatment modality. Conclusion: For a centre favouring primary surgery for certain advanced laryngeal cancers, the DSS appears no higher than published literature. The DSS following CRT is encouraging and we postulate that more of our patients may have benefitted from this treatment. To truly enhance survival, future research needs to move away from identifying treatment superiority and focus on precision medicine to define treatment pathways in this disease.

Introduction Paediatric tonsillectomy performed for sleep disordered breathing or recurrent tonsillitis and the effects on a child’s quality of life symptoms while waiting for surgery in an Australian public health system have not previously been investigated. This study investigated parental perceptions of the effects of tonsillectomy on their child’s quality of life while awaiting tonsillectomy and following surgery. Design, Setting and Participants An observational study was undertaken at a tertiary Australian hospital. Parents of paediatric patients (2 to 16 years of age) listed for tonsillectomy completed a validated quality of life questionnaire (T—14 Paediatric Throat Disorders Outcome Test) at the initial consultation, on day of surgery, 6 weeks post-operatively and 6 months post-operatively. T-14 scores were compared using the Related-Samples Wilcoxon Signed Rank Test. Results Parents of 167 children participated in this study. There was a median wait time of 174 days (IQR 108 – 347) from the initial consultation until the day of surgery, with no significant change in median T-14 scores (35 [IQR 22 - 42] vs 36 [IQR 22 - 42]; n= 63; p > 0.05). There was a significant decrease from pre-operative T-14 scores to 6 weeks post-operatively (33.5 [IQR 22 - 42] vs 2 [IQR 0 - 5]; n = 160; p < 0.001), and this was sustained with a minor improvement at 6 months post-operatively (6-week 2 [IQR 0 - 5] vs 6-month 0 [IQR 0 - 2]; n = 148; p < 0.001). Conclusion Paediatric tonsillectomy improves the patient’s quality of life as perceived by their parents with a sustained benefit in the long term. There is no improvement to the patient’s quality of life while awaiting tonsillectomy, thus patient welfare can be improved through reducing waiting times for surgery.

Background Olfactory dysfunction (OD) is a common but underreported problem that can significantly impact a patient’s quality of life. Dysfunction is prevalent in over 5% of the adult population and can be broadly categorised into conductive and sensorineural causes. Magnetic Resonance Imaging (MRI) can form part of the diagnostic work up, although its exact role is often debated. Objectives The aim of this study was to evaluate the value of MRI in managing patients with OD. Design/ Method A retrospective analysis of the records of patients presenting to national smell and taste clinic over a five-year period was performed. Variables included demographics, endoscopic findings, final diagnosis, psychophysical smell test and MRI results. Results A total of 409 patients underwent clinical assessment and smell testing for OD, of which 172 patients (42%) had MRI scans performed. The age range of patients was 10 to 93 years. Imaging in younger age-groups was associated with a higher rate of positive findings, however identifiable causes for OD were recorded across the range. MRI provided both diagnostic and prognostic information in those with idiopathic, traumatic, and congenital causes of OD. For example, MRI provided information on the extent or absence of traumatic gliosis in those with a head trauma history allowing further treatment and prognosis. Conclusion We recommend the adjunct use of MRI in patients with a clear history and examination findings of head injury, congenital cases and in apparent idiopathic cases. MRI should be requested to compliment clinical findings with a view to aiding decision-making on treatment and prognosis independent of patient’s age.

Objectives High incidence of laryngo-tracheobronchial symptoms was reported in Chinese patients with relapsing polychondritis (RP)，but it is either misdiagnosed or delayed in diagnosis during the early stage. Characteristics of RP patients with laryngo-tracheobronchial involvement were summarized in this study to increase awareness of this disease. Design, Setting and Participants Sixty RP patients with laryngo-tracheobronchial involvement hospitalized in Beijing Tongren Hospital were analyzed retrospectively. Results A total of 31 males and 29 females were included in the study with an average age of 37.3+16.7 years. The median delay between onset and diagnosis was 12.5 months (range, 1 to 156 months). The rate of misdiagnosis was as high as 60%. The most common initial respiratory symptom was hoarseness (23/60, 38.3%), followed by dyspnea (11/60, 18.3%) and cough (9/60, 15.0%). The most common accumulated respiratory symptom was dyspnea (53/60, 88.3%), followed by hoarseness (52/60, 86.7%) and cough (35/60, 58.3%). Subglottic stenosis was observed in 51 cases (85.0%). Congested, swollen vocal cords and arypiglottic folds, which looked like acute laryngitis, were observed in 41 cases (68.3%) and 30 cases (50.0%) respectively. Cricoid cartilage was the most easily involved laryngeal cartilage on CT (39/60, 65.0%). Conclusions In RP patients with laryngotracheobronchial involvement, cricoid cartilage is the most easily involved airway cartilage. In cases of recurrent laryngitis and subglottic stenosis without clear cause, RP should be a candidate diagnosis. Key words Polychondritis, Relapsing; Larynx; Trachea; Bronchi; Cartilage

Safety and Feasibility of Hypnosis-induced Sleep Endoscopy in Obstructive Sleep Apnea Patients: Our Experience.

Objective: This study evaluates the benefits and limitations of selected modalities of digital image enhancement in detection of cholesteatoma remnants during endoscopic ear surgery (EES) and compares their usefulness in recognizing residual disease. Study Design: Cross-sectional study Setting: Tertiary referral hospital Methods: A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image enhancing modalities (clara, spectra A, spectra B), were generated. Fifty-one experienced ear surgeons participated in the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. Results Clara showed the highest accuracy in cholesteatoma detection, followed by spectra A and lastly spectra B. In contrast, spectra B showed the highest sensitivity and clara the highest specificity, while spectra A was placed in the middle for both values. Using the spectra B modality, most responses agreed across the two time points,. Ear surgeons assessed the usefulness, as well as preference among image modalities in the following order: clara, spectra B, spectra A. Conclusion The suitability of image enhancement techniques for application in EES could be shown. Clara can be considered the state-of-art technique throughout the procedure and has subjectively been evaluated best by surgeons. Due to its high sensitivity, spectra B is recommended regarding the final check after resection to prevent cholesteatoma residuals.

Methotrexate is a chemotherapeutic and anti-inflammatory agent used in cancers, hematologic and rheumatologic diseases, binding to Dihydrofolate Reductase (DHFR) as a competitive inhibitor, modulating inflammation by inhibition of transmethylation reactions.1,2 Life threatening hypersensitivity reactions (HSRs) have been reported with methotrexate. 3,4,5 Alternative treatments result in suboptimal outcomes/ death due to cancer progression. Drug desensitization enables patients to continue treatment, preventing anaphylaxis by inducing a temporary tolerance.3 We report a case of a child with Acute B-cell Lymphoblastic Leukemia who successfully tolerated methotrexate desensitization, and subsequently weaned to a weekly oral challenge. He is now taking weekly methotrexate without any reactions.

Background: A James Lind Alliance Priority Setting Partnership (JLAPSP) was established by Fifth Sense together with UEA to identify the top 10 research questions in the field of smell and taste disorders in the United Kingdom. Methods: After steering group was established, an electronic survey was disseminated to all stakeholders (patients, healthcare professionals, family, carers, researchers) to determine the list of questions. After removing out-of-scope responses, the remainder were consolidated to create summary questions. A literature search was conducted to remove already answered questions. A second survey was used to determine the top questions that formed the subject of final debate at a workshop attended by clinicians and patients to determine the top 10 priorities. Results: The 665 respondents to the initial survey provided 1698 research questions. Thirteen were out-of-scope and removed; remaining 1685 were then consolidated to form 147 summary questions. Following literature search and discussion with the steering group, 37 questions remained for the second survey, which 235 people responded. The top ten priorities agreed in the workshop covered themes of improved understanding of pathophysiologlogy, improving health services, and managing long-term effects of smell/taste disorders. The most important research question agreed was “How can we further our understanding of the mechanism of disease in the nerve pathways that affect smell and taste disorders, including where parosmia and phantosmia exist.” Conclusions: We report the top 10 research priorities in smell and taste disorders. These priorities will now empower researchers to secure research funding and provide the basis of the Fifth Sense research hub.

Introduction Surgical trainees have to achieve a set level of operative competence under the timeframe set by the intercollegiate surgical curriculum. The operating theatre as the primary learning environment needs to be conductive to achieve successful training. In this project, we developed and validated a 27-item questionnaire which aims to evaluate the training experience of higher surgical trainees in the operating theatre. Methods Initial questionnaire was developed by reviewing existing instruments. The questionnaire was then modified in a focus group to explore themes perceived to be important to training. The modified questionnaire was sent out to obtain the content validity index (CVI) of each item. Lastly, the final version was disseminated and Cronbach’s alpha was derived to measure the internal consistency of the questionnaire. Results The Initial version of 33 questions was modified in focus group into a 29-item 4-point Likert scale questionnaire covering three areas. 14 responses were received from higher surgical trainee and consultants to determine the CVI. 27 out of 29 items reached the threshold index of 0.87. Finally, the 27-item questionnaire achieved a Cronbach’s alpha of 0.88 from 17 responses. Discussion The Cronbach’s coefficient of 0.89 in the resultant questionnaire is comparable to other existing medical education evaluation tools, which indicates a high internal consistency. Our validated questionnaire can be utilized to identify areas that needs to be improved as perceived by higher surgical trainees and to improve their training experience in theatre.

Key points instead of abstract as per author guidelines: • Chyle leaks (CLs) following neck dissection for metastatic head and neck malignancy are infrequent but represent a serious complication, with an incidence of 1-2.5%. • CL is associated with significant morbidity including metabolic imbalance, immunosuppression, dehydration, poor wound healing and prolonged length of hospital stay. • A protocolised approach to the management of CL post neck dissections is highlighted for expedient patient management. • Thoracic duct (TD) ligation using video-assisted thoracoscopic surgery (VATS) is an effective method of treating moderate (500-1000ml/24 hours) to high-volume CL (>1000ml/24 hours) not responding to medical therapy. • VATS TD ligation is a safe procedure to treat CL. It has a low morbidity compared to other surgical techniques (neck re-exploration or open thoracotomy).

Objective: This study aimed to develop deep learning (DL) models for differentiating between eosinophilic chronic rhinosinusitis (ECRS) and non-eosinophilic chronic rhinosinusitis (NECRS) on preoperative computed tomography (CT). Methods: A total of 878 chronic rhinosinusitis (CRS) patients undergoing nasal endoscopic surgery were included. Axial spiral CT images were pre-processed and used to build the dataset. Two semantic segmentation models based on U-net and Deeplabv3 were trained to segment sinus area in CT images. All patient images were segmented using the better-performing segmentation model and used for training and validation of the transferred efficientnet_b0, resnet50, inception_resnet_v2, and Xception neural networks. Additionally, we evaluated the performances of the models trained using each image and each patient as a unit. The precision of each model was assessed based on the receiver operating characteristic curve. Further, we analyzed the confusion matrix, accuracy, and interpretability of each model. Results: The Dice coefficients of U-net and Deeplabv3 were 0.953 and 0.961, respectively. The average area under the curve and mean accuracy values of the four networks were 0.848 and 0.762 for models trained using a single image as a unit, while the corresponding values for models trained using each patient as a unit were 0.853 and 0.893, respectively. The generated Grad-Cams showed good interpretability. Conclusion: Combining semantic segmentation with classification networks could effectively distinguish between patients with ECRS and NECRS based on preoperative sinus CT images. Furthermore, labeling each patient to build a dataset for classification may be more reliable than labeling each medical image.

Aims: We compared the prognostic utility of sentinel node biopsy (SNB) and elective neck dissection (END) in patients with early (T1–2) oral cavity squamous cell carcinoma (OSCC) and clinically N0 necks. Methods: We searched the PubMed, SCOPUS, Embase, Web of Science, and Cochrane library databases up to March 2022. The hazard ratios (HRs), Kaplan–Meier curves, p-values, and survival outcomes were extracted, along with all study characteristics. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results: Twelve studies involving 10,583 patients were finally included. We found no significant differences in overall survival (OS) (HR = 1.1226; 95% confidence interval [CI]: 0.9263; 1.3604), disease-free survival (DFS) (HR = 1.0797; 95% CI: 0.8765; 1.3300) or disease-specific survival (DSS) (HR = 0.8652; 95% CI: 0.6531; 1.1462) between the two groups. Heterogeneity was not detected in pooled OS, DFS, and DSS analyses (all I2 < 50). In subgroup analyses by follow-up period (3, 5, and 10 years), SNB and END had similar prognostic value. Conclusions: We found no significant difference in OS, DFS, or DSS between patients with early OSCC and clinical N0 necks evaluated via SNB and END, suggesting that SNB might be a valuable alternative to END for the management of early stage clinically node-negative OSCC.

Key Points 1. During the COVID-19 pandemic, NHS cancer referral guidance recommended a move from face-to-face clinics to telephone appointment. In this study, we reviewed the safety of telephone clinic for urgent 2-week wait cancer referrals. 2. In the 7 months study period during the COVID-19 pandemic, 1062 urgent 2-week wait cancer referrals were received in our regional head and neck specialist unit, reflecting a 7.3% decline compared to pre-pandemic data. 3. At 6-months follow-up, 98 (9.2%) patients received a new diagnosis of malignancy. 95 of them received their diagnoses promptly after their initial telephone clinic, whereas 3 patients received a delayed diagnosis. 4. There is a late diagnosis rate of 0.28% but we discussed in our cases that late diagnosis does not inevitably lead to worse clinical outcome or harm. 5. Telephone clinics will likely remain in some capacity after the pandemic, while telephone clinics are pragmatic means to maintain patient flow during the pandemic, they could result in risk of late diagnosis.

Objectives To examine the methods and infrastructure necessary to establish a national Ménière’s disease registry Design Observational study. Four NHS Trusts and four independent hospitals or clinics, within three distinct urban and rural regions within the UK (“Blinded for review”). Participants Patients with Ménière’s disease. Main outcome measures Data related to the number of participants recruited, method of recruitment, participant demographics, completeness of data, and proportion of participants with bilateral disease. Results 411 participants were recruited into this study, 263 from NHS Trusts, and 148 from independent hospitals or clinics. Online recruitment was used for 73% participants and 27% were recruited via paper. 57% of participants were female and 96% of participants were white. There was no clear advantage to data completeness from either online or postal data collection. Around 20% of participants had audiological evidence of bilateral Ménière’s disease. Conclusion This feasibility study has demonstrated that hundreds of participants with Ménière’s disease can be successfully recruited to enter data into a large data collection platform. It is hoped that this initial feasibility study will pave the way for expansion of the registry to answer fundamental and complex questions alike, regarding the nature of Ménière’s disease.

Objectives: To explore the effect of intranasal administration of rh-bFGF on postoperative chronic rhinosinusitis with nasal polyps(CRSwNP) patients. Design: A prospective, randomized, controlled, double-blinded trial. Setting and Participants: 75 hospitalized patients who met the criteria of primary bilateral CRSwNP were enrolled from March 2020 to January 2021. Main outcome measures: Visual analogue scale, 22 item Sino-Nasal Outcome Test ,Lund-Kennedy system, and Scanning electron microscopy and Quantitative real-time PCR. Results: 75 patients with CRSwNP were randomly divided into three groups, and 72 patients completed the 1-month medication regimen and 1 year follow-up. Rh-bFGF nasal spray and drop application reduced general nasal VAS scores within two weeks after ESS compared to the control group. In contrast, only rh-bFGF nasal drops reduced SNOT-22 scores at 2 weeks and 1 year compared to the control group. A significant reduction in the endoscopic L-K score was observed in the rh-bFGF nasal spray and drop group compared to the control group. This is primarily because rh-bFGF promotes cilia growth in the nasal mucosal epithelium after the operation, as illustrated by scanning electron microscopy and expression of CP110, Tap73 and Foxj1 mRNA. For eosinophilic CRSwNP, the general VAS score of rh-bFGF nasal drops was more obviously reduced compared to the control group after ESS. A similar trend was observed for L-K score. Conclusions: Rh-bFGF nasal-drops and sprays can quickly and effectively relieve postoperative symptoms and improve long-term prognosis of patients with CRSwNP. Moreover, rh-bFGF nasal-drops are also an effective method for postoperative patients with eosinophilic CRSwNP.

Recurrence after conservative resection of pleomorphic adenoma is a rare and late phenomenon that poses a difficult management problem. All recurrences at 6 years after capsular dissection were detected clinically (recurrence rate 3.2%). Magnetic resonance imaging failed to detect early occult recurrences after conservative surgery and thus a “single shot” imaging modality for follow up is not recommended. Regular ultrasound and magnetic resonance imaging have been used after surgery for early detection of a recurrence. The pickup rate is low so the additional cost and effort of radiological surveillance is not justified. Follow up after parotid surgery for pleomorphic adenoma remains clinical. There may be a benefit in regular surveillance imaging of high risk patients (prior enucleation or resection after recurrence).