Background: Parotidectomy is commonly performed as an inpatient procedure due to drain insertion. However recent evidence suggests that drainless outpatient parotidectomy is a safe option with comparable postoperative complication and hospital readmission rates to inpatient parotidectomies. Objective: Patient satisfaction on outpatient parotidectomy is unclear and this study aims to report patients’ perspective and satisfaction on drainless outpatient parotidectomy. Design, participants and outcome measures: Anonymous Core questionnaire for the assessment of Patient Satisfaction’ (COPS) for general Day care (COPS-D) questionnaire survey was completed by patients who underwent drainless same day parotidectomy at Ninewells Hospital, Dundee from June 2018 to October 2020. Patient satisfaction on different aspects of their outpatient parotidectomy journey (e.g. pre-admission, admission on ward, in-theatre experience, nursing care, pain control and overall satisfaction) were scored using a five-point Likert scale. Results: A total of 31 drainless outpatient parotidectomies were performed and 28 patients completed the patient satisfaction survey. The majority of patients were highly satisfied (i.e. scored 5/5) with their preadmission visit (79.5%), admission on the ward (84.5%), operating room experience (96.4%), nursing care (83.9%), medical care (87.5%), information received (75.0%), autonomy (79.8%) and discharge and after care (61.9%). Despite preferring drainless parotidectomy, 16/28 (57.1%) patients either stayed for less than 23 hours or preferred to stay overnight in the hospital for non-surgical reasons. Conclusion: Outpatient parotidectomy is well received by patients and the majority preferred drainless parotidectomy over inpatient parotidectomy with drains. Careful consideration should be given when selecting patients for day case parotidectomy.

Objective : This study aims to compare the potential sinus distribution between high-volume nasal irrigation and nasal spray in chronic rhinosinusitis patients who have not undergone sinus surgery. Design and Setting : A randomized clinical study was conducted at the Otolaryngology-Head & Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University.Participants : 40 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Thirty-eight patients met the inclusion criteria and were randomly assigned to receive nasal irrigation or nasal spray mixed with fluorescein sodium preoperatively. Main outcome measures : The primary outcome was the mean difference in the staining score of fluorescein in all sinuses between the two groups. Results : The total staining score of fluorescein in all sinuses via nasal irrigation was statistically more significant than the score via nasal spray, with a mean difference score of 2.90, 95%CI: 1.22-4.58, p-value 0.001. The most significantly affected sinuses were specific to the maxillary and anterior ethmoid sinuses, whereas the frontal and sphenoid sinuses had the slightest solution distribution from both techniques. Conclusion : Nasal irrigation is a potential route to deliver drugs into the sinus in unoperated CRS patients. However, it is not considered a superior method to nasal spray at the most challenging anatomical areas, i.e., the frontal and sphenoid sinuses. Keywords : Corticosteroid use, Endoscopic sinus surgery, Irrigations, Topical therapy for chronic rhinosinusitis, Medical therapy for chronic rhinosinusitis, Nasal polyp, Nasal spray, Chronic rhinosinusitis

Objective: To evaluate whether prolonged operative time is negatively associated with post-operative complications and length of stay in patients undergoing microvascular free flap reconstruction for complex head and neck defects. Methods: 342 consecutive patients undergoing microvascular reconstruction for head and neck defects between 2017-2019 at a single institution were evaluated. Operative outcomes and operative time were compared whilst controlling for patient and treatment related factors. Results: Mean operative time was 551 minutes and length of stay was 16.2 days. An 11% increase in the risk of a post-operative complication was observed for every additional hour of operative time (OR 1.11, 95%CI 1.03 – 1.21, p=0.011) after adjusting for patient and treatment factors. A cut-off of 9 hours yielded a 92% increase in complications on either side of this (OR 1.92, 95%CI 1.18 – 3.13, p=0.009). Increased operative time was also associated with increased length of stay and return to theatres, but not medical complications. Conclusion: Prolonged operative time is significantly associated with increase surgical complications, length of stay and return to theatres when performing microvascular reconstructive surgery for head and neck defects. Keywords : free flap, microsurgery, operative time, length of hospital stay, complication rate, head and neck surgery Key points : 1. This study analyzed a contemporary cohort over a relatively short period where outcomes can reliably be recorded and verified 2. This is the first Australian study that demonstrated operative time as it relates to surgical technique, comparing pedicled and free flaps and also stratified by flap type, oncological resection, or comorbidity 3. Operations more than 9 hours duration were associated with an 89% increase in the odds of developing a surgical complication 4. Prolonged operative time was also significantly associated with length of stay and return to theatres 5. Future studies are needed to investigate associations with each component of operative time element separately in a multi institutional design

Introduction Otoscopy is a key clinical skill which following the introduction of the Medical Licensing Assessment all newly qualified doctors in the United Kingdom will be required to be able to perform independently. At present there is no consensus on a standardised method for objectively assessing otoscopy skills. Methods Prospective mixed methods study comparing face, content and construct validity of three different platforms for otoscopy skills assessment, using a traditional otoscope with manikin, digital otoscope (Tympahealth) with manikin, and traditional otoscope with a low-cost model ear (SimEar). Skills were assessed using a standardised mark scheme, and five expert assessors and twelve participants who rotated through three Objective Structured Clinical Examination (OSCE) stations representing each model. Assessors numerically ranked validity of each model, and participated in a semi-structured interview of opinion. Results Each platform differed in face, construct and content validity scores, with no one platform consistently outperforming others. Three main themes were identified during thematic analysis of expert assessor interviews: ability to assess what is seen, anatomical reality, and ease of use. The low-cost model showed greatest potential, where modification to include a silicone ear could lead to high validity with marginal increase in cost. Conclusion Several modalities for assessing otoscopy skills exist, each with advantages and disadvantages. Modifications to a low-cost model, for use with either a traditional or digital otoscope, could prove to be the best model.

Purpose of this study was to observe if there was any increase in epistaxis admissions to hospital after the introduction of routine population wide nasal swabbing. This study looked at difference in epistaxis admissions from 2020 and 2021 across the 9 NHS Trusts in the Southwest.This study found that there were less hospital admissions in 2021 due to epistaxis. This could be due to the widespread fear amongst the populace at the time of attending hospital due risk of COVID-19 and of overburdening the hospital. Patient's that did present to ED may have received more effective epistaxis management with biodegradable nasal pacs and topical haemostatic matrices. However there are many confounding factors, thus it is important to avoid over interpretation of the data.

Aim Approximately 5% 1 of all mucosal head and neck (H&N) squamous cell cancers (SCC) arise from the hypopharynx. 1 Patients with hypopharyngeal SCC (HPSCC) tend to have a poor prognosis compared with other subsites with reported 5-year survival of 27% in the UK.2 Most patients (80%) have stage III/IV disease at presentation.3 There are very few HPSCC-specific studies and this subsite is not well represented in more general H&N SCC trials. Thus, deciding the best treatment plan is difficult and relies on the expertise of an experienced multi-disciplinary team (MDT).4 Patient fitness for treatment complicates matters further. The incidence of H&N cancer increases with age and is closely correlated with deprivation.1 The aim of this series was to review outcomes of patients with HPSCC in our cancer network. Method This retrospective study included all patients with a histological or radiological diagnosis of HPSCC made from August 2016 to August 2018. They were identified from the cancer network MDT database. Subsites included pyriform fossa, post cricoid and posterior pharyngeal wall. Data including patient demographics, treatment details, toxicity and disease control were extracted from case records. Results 118 patients were evaluable. 8 (6.7%) patients had a radiological diagnosis, the remainder were biopsy proven HPSCC. The probability of survival at 24 months was higher in patients of good performance status (PS 0-1: 41.7%, 95% CI 29.7-53.2% Vs. PS ≥2: 27.5%, 95% CI 13.9-43.0%). Patients aged >70 years had a lower probability of survival at 24 months compared to those <70 (<70yrs 44.5%, 95% CI 27.1 – 55.9% Vs ≥70yrs 24.4%, 95% CI 12.6 – 38.3). 57 (48.3%) of the 118 patients were treated with radical intent, of which 19 (33%) died at time of follow-up. 14 of these deaths were cancer related. The median time from primary surgery to adjuvant RT was 17 weeks. Conclusion Most patients with HPSCC present with locally advanced disease and are unsuitable for active anti-cancer treatment. For those treated radically the pattern of treatment failure is loco-regional. A multimodality approach for locally advanced disease with surgery and radiotherapy appears to be advantageous in terms of survival.

Key Points  Transoral resection for oral cavity and oropharyngeal cancer has become popular.  Transoral conventional interrupt knot tying suturing for oral/oropharyngeal defect often requires time.  Transoral barbed knotless continuous suture could reduce operation time with a comparable complication rate.  Knotless barbed suture provides appropriate tension and secure closure with multiple anchors.  Transoral barbed knotless suture is particularly advantageous in deep and narrow areas.

Data Availability StatementThe data that support the findings of this study are available from the corresponding author upon reasonable request.

Background Vertigo can have a negative impact on the quality of life of patients. Mobile health apps have the potential to promote autonomy, and improve symptoms through self-management and vestibular rehabilitation exercises. This study aimed to systematically evaluate the quality of apps for vertigo using the published literature and smartphone stores. Design A systematic review of the literature, utilising Embase, Medline, Cochrane and clinicaltrials.org, and Apple and Google Play Stores were used to identify mobile device apps relating to vertigo. Apps were evaluated for characteristics, content, healthcare involvement and quality using the Mobile App Rating Score (MARS) system (a standardised tool for assessing app quality). Results The literature search identified no eligible articles. The app search identified and evaluated 32 eligible apps. Four main categories of apps were identified: exercise provision, information provision, symptom monitoring and assessment. Six apps included healthcare professionals in their development. MARS scoring ranged between 1.8 and 4.05 (maximum 5), with only 25% of apps scoring the minimum acceptability score of 3. The highest scoring apps were those providing rehabilitation exercises and symptom monitoring. Conclusion There is great potential in the use of mobile apps to help monitor and manage vertigo. This article demonstrates that despite numerous readily available vertigo apps, few are of an acceptable standard. There is scope for apps to improve. We propose involving health professionals and patients in their development to ensure high quality evidence-based information and evaluating their efficacy through future patient-centred trials.

The results of the investigation of the exact nature of the mechanisms that ensure the organism's survival in the face of the pathogen's pathological effects reveal those severe co-occurring manifestations that are temporally linked to a pathogen, such as those which appear in COVID-19 patients, to be manifestations of different diseases which are brought about through the same pathway under the influence of different causes which include the pathogen. Since the single pathway through which all of such diseases, which have the same "immunological nature," are brought about must be blocked for the attenuation of the influence of the pathogen to bring about the remission of the disease it causes, such diseases will undergo simultaneous remission when conditions permit immune mechanisms to attenuate the causative influences of the pathogen. Therefore, when conditions do not permit immune mechanisms to attenuate the influence under which any of the diseases in the same "immunological spectrum" as the disease the pathogen causes is produced through the pathway, the manifestations of such diseases that are linked with the pathogen will persist despite treatments that reduce pathogen load and the pathogen will appear to be resistant to treatment. These results throw light on the different immunological phenomena which include those that inspired variolation and vaccination, remissions that are temporally linked with infection, the multiorgan manifestations that are seen in COVID-19 as well as long COVID.

Introduction- Necrotising fasciitis is a rapidly progressive disease with high morbidity and mortality. Head and neck necrotising fasciitis is a rare clinical entity but may be admitted under an ENT specialist team. An understanding of the presenting features and the need for prompt management is imperative. Case Series-We present a series of patients admitted to hospitals across Greater Glasgow, United Kingdom under Otoloryngology and Maxillofacial surgical teams with head and neck necrotising fasciitis over an 8-year time period. Discussion-8 patients were identified in this case series. We highlight the clinical features, patient demographics and operative courses of this patient group. We highlight the need to recognise peri-ocular necrotising fasciitis, especially in the paediatric population which has not been discussed in the otolaryngology literature previously.

A document by Patrick Reeves. Click on the document to view its contents.

Abstract Objectives: An association between COVID-19 and anosmia has been demonstrated worldwide. Calcium cations play an essential role in odor transmission, including feedback inhibition. Therefore, it is suggested that reducing intranasal free calcium cations with topical chelating agent pentasodium diethylenetriamine pentaacetate may improve olfactory function in patients with anosmia post COVID-19 infection. Design: Prospective controlled clinical trial to test use of pentasodium diethylenetriamine pentaacetate for post COVID-19 olfactory loss. Setting: ENT Department (Institution blinded for review). Participants: Sixty-six adult patients with history of confirmed COVID-19 and olfactory dysfunction persisted more than 90 days after SARS-CoV-2 negative testing were included. Main outcome measures: Participants were divided into 2 equal groups receiving nasal spray containing either 0.9% sodium chloride or 2% pentasodium diethylenetriamine pentaacetate. Olfactory function was assessed before treatment and 1 month later using the Sniffin’ Sticks test. A carbon paste ion-selective electrode was developed for quantitative analysis of calcium cation concentrations in nasal mucus before treatment and 1 month later. Results: After treatment with pentasodium diethylenetriamine pentaacetate, there was a significant improvement from functional anosmia to hyposmia compared with sodium chloride. In addition, the decrease of calcium concentration was recorded after treatment with pentasodium diethylenetriamine pentaacetate compared with sodium chloride. Conclusion: Based on the results of the proposed study, topical use of pentasodium diethylenetriamine pentaacetate may be a useful therapy for olfactory dysfunction after COVID-19.

Key Points 1. This study reports clinical outcome data on 76 patients with platinum-resistant recurrent or metastatic head and neck squamous carcinoma treated with nivolumab, making it the largest published single centre case series of its kind. 2. Radiotherapy was administered alongside systemic therapy with nivolumab, defined as radiotherapy within 8 weeks of prior systemic therapy, in 16 of 76 patients (21%). 3. Nivolumab was continued following radiotherapy completion due to ongoing clinical benefit from the drug in 9 of 16 patients (56%). 4. Durable complete response following radio-immunotherapy was seen in 2 of the 9 patients (22%) who continued nivolumab subsequent to radiotherapy. 5. Indications for radiotherapy included symptom control (3 of 9), oligoprogression (5 of 9) and incomplete response (1 of 9).

Background The incidence of thyroid cancer is increasing globally due to the increase in detection of subclinical, low volume papillary thyroid microcarcinomas (PTMC) (<1cm). Several international groups have recommended an active surveillance approach for this low-risk disease. In contrast to many other countries, the UK’s approach to thyroid nodules is to avoid detection of incidental lesions where appropriate. Objective This study aims to establish the proportion of patients with thyroid cancer in the UK that would benefit from active surveillance. Design, participants, and outcome measures: Individuals with PTMC in NHS Lothian from 2009-2020 were reviewed from a local thyroid cancer database. The mode of detection of PTMC and proportion of patients who might benefit from active surveillance were established. Results From 651 individuals with differentiated thyroid cancer managed over 12-year period, 185 individuals with PTMC were identified (28.4%). The majority of PTMC 151/185 (81.6%) were either diagnosed post-operatively following thyroidectomy for benign disease or with nodal disease. Only 24 individuals with PTMC were identified following palpable thyroid nodule, incidental finding on imaging and surveillance screening. Therefore, when the indication for surgery was considered, only 24/651 (3.7%) patients were identified pre-operatively and would therefore be realistic candidates for active surveillance. Conclusion Less than 4% of patients with thyroid cancer in the UK would be appropriate for active surveillance. Rather than developing programs to deal with this minority of patients, focus should be maintained on minimizing detection of these low-risk cases.

Introduction: A large proportion of patients with infectious mononucleosis (IM) have abnormal liver function tests (LFT) at presentation. There is no guideline regarding the management and follow-up of these patients. Some patients also have abdominal ultrasound due to deranged LFT, the need for this practice is unclear. The aim of this systematic review was to evaluate the evidence base on LFT assessment in IM, time to resolution of derangement, and the role of abdominal ultrasound. Methods: A systematic search of PubMed, EMBASE and the Cochrane library was done. Two authors independently screened records for eligibility using pre-defined criteria. We included both adult and paediatric populations. Quality assessment of included studies was done. Results: A total of 3924 patients were included from 32 studies. A combination of typical clinical features, heterophile antibodies and EBV-specific antibodies were used to ascertain diagnosis. The following proportion of patients had abnormal LFTs: AST (57%); ALT (62%); ALP (65%); Bilirubin (16%); GGT (41%). Reported median (i.q.r.) time to resolution of LFT was 8 (6–12) weeks. Maximum time to resolution was >6 months. Clinical hepatomegaly and splenomegaly were found in 35% and 44% of patients respectively. Enlarged liver and spleen on ultrasound were seen in 16/29 (55%) and 38/38 (100%) of patients respectively. There were no reports of decompensated liver disease. Conclusion: Derangement in LFTs can persist over six months from initial presentation in IM. However, this is self-limiting. The evidence suggests serial liver function assessments and ultrasound abdomen are not required in immunocompetent patients with subclinical derangement in LFTs.

Abstract Background This study aimed to evaluate whether changes in practice and patient behaviour due to the covid-19 pandemic impacted the presentation, management, and outcomes of patients with deep neck space infections (DNSI). Design Retrospective cohort study including all adults presenting to the otolaryngology department at a tertiary UK centre with a DNSI during the first 12 months of the covid-19 pandemic (n = 27), and those from the previous 12 month period (n = 26). Patients with peritonsillar abscess which did not involve deep neck spaces radiologically were excluded. Results The covid-19 pandemic cohort tended to present later after onset of symptoms (5.96 days vs 3.25 days, p = 0.0277), have abscess formation rather than inflammation only (77.8% vs 34.6%, p < 0.01), and develop complications (33.3% vs 7.7%, p = 0.0394). Not reaching statistical significance, the covid-19 pandemic cohort also had larger volume abscess (25.18cm3 vs 14.5cm3, p = 0.291), longer hospital stay (14.48 days vs 6.35 days, p = 0.114), and longer intensive care stay (7.88 days vs 1.78 days, p = 0.0992). Non-significant changes were noted in management, with the covid-19 pandemic cohort being seven times more likely to undergo tracheostomy (25.9% vs 3.8%, p = 0.0504), and more likely to undergo transcervical drainage (37% vs 19.2%, p = 0.224) and hot tonsillectomy (11.1% vs 0%, p = 0.236). Conclusion This study demonstrates the covid-19 pandemic led to delayed presentation and more severe infection, requiring more radical management in patients with DNSI.

Comment on: Burden of central nervous system complications in sickle cell disease: A systematic review and meta-analysis R. Grant Steen, PhD103 Van Doren PlaceChapel Hill, NC 27517G_Steen_MediCC@yahoo.comDear Editor;I read with interest a recent paper in Pediatric Blood & Cancer(1), about cognitive impairment in children with sickle cell disease (SCD). I’m always grateful to have my work cited, especially since our paper is almost 20 years old (2).However, it seems that Lee et al . have gone to great lengths to mischaracterize our work. They write (pg. 5) that, “SCI [silent cerebral infarct] and absence of SCI/CVA [cerebrovascular accident] were verified by review of brain MRIs in all studies except Ghafuri et al . and Steen et al . In these studies, absence of SCI/CVA was defined as no mention of cerebral infarcts in the subject’s medical records.” Also on pg. 5, they write that, “An alternative analysis was conducted excluding studies with insufficient definition of overt stroke and/or SCI based on clinical opinion (Ghafuriet al . and Steen et al .)”. I cannot speak for Ghafuriet al , but we did a careful review of MRI findings for every single patient in our study, as is necessary for a paper in theAmerican Journal of Neuroradiology . This should be pellucidly clear because the title of our paper is, “Cognitive Impairment in Children with Hemoglobin SS Sickle Cell Disease: Relationship to MR Imaging Findings and Hematocrit ”. All our SCD patients were evaluated by at least two neuroradiologists, and patients thought to be abnormal were evaluated by a third neuroradiologist blinded as to previous findings (2). One wonders what other errors may be present in Leeet al (1).Fortunately, this mischaracterization of our work did not lead to incorrect conclusions (1). A comparison of Table 1 to Supplementary Table 6, in which our paper and Ghafuri et al were deleted from analysis, shows that none of the major findings were changed much by deleting these papers (1). I agree with most conclusions in Lee et al .; in fact, I would go further. In uncited work from St. Jude Children’s Research Hospital, we found that children with SCD can suffer cognitive impairment even in the absence of MRI evidence of brain injury (3). We tested a hypothesis that children with SCD who are completely normal by MRI can still be cognitively impaired, as predicted by a model of diffuse brain injury. A total of 54 patients with hemoglobin SS (average age 10.9 years ± 2.9 years SD) were examined with the Wechsler Intelligence Scale for Children-III (WISC-III) and were randomly matched by age, race, and gender to healthy children from the Wechsler normative database. Patients were also imaged at 1.5 Tesla with standard imaging sequences. Among 30 patients judged normal by MRI, there were substantial deficits in Wechsler Full-Scale IQ, Verbal IQ, and Performance IQ (all P < 0.01), when compared to African-American controls. The patient Wechsler Full-Scale IQ was 12.9 points lower than that of matched controls and decreased as a function of age (P = 0.014). These findings strongly suggest that there is diffuse brain injury in SCD patients, perhaps associated with chronic hypoxia (3).

A PRIMARILY CLINICIAN’S RESPONSIBILITY

Objectives: To design a Spanish questionnaire to assess quality of life in chronic obstructive sialadenitis (COS), named CSOC and assess its reliability, validity and feasibility. Design: A prospective, multicentre, observational study Settings: Salivary Gland Disorder and Sialendoscopy Unit, University Tertiary Hospital. Participants: Patients with diagnosis of COS and indication for sialendoscopy were included in the study. Main outcome measures: The item generation process included a review of published data as well as interviews with patients. An expert panel then tested the content validity of the instrument and the construct validity was tested in 120 patients. Patients completed a self-administered CSOC questionnaire, a Short Form-36 and a Visual Analogue Scale. Feasibility, reliability, internal consistency, construct validity and responsiveness were assessed. Results: All the patients found the instrument understandable. Cronbach α coefficient was high (0.85). The time required to fill out was 5.7 and 4.5 minutes for pre and postsialendoscopy CSOC respectively. Cronbach α coefficient was very high for both pre and postsialendoscopy CSOC (0.90 and 0.94 respectively). The correlation with the SF-36 dimensions was negative and positive with the VAS. The mean score of CSOC was 28.6 and 7.98 for pre and postsialendoscopy Conclusions: The CSOC questionnaire is understandable, feasible, reliable and representative of quality of life in COS. Keywords: sialadenitis, QOL, questionnaire, validation, sialendoscopy

1) Results of ossiculoplasty via trans-canal endoscopic (TEES) route is comparable to that of the traditional microscopic approach 2) There was no difference in complications or secondary outcomes such as tympanic membrane residual perforation or ear discharge between these groups 3) Both groups achieved an air-bone gap of less that 20dB in more than 70% of the cases 4) In our experience there was no difference in outcomes based on ossiculoplasty material such as cartilage, titanium prosthesis or autologous grafts such as incus. 5) Eroded stapes superstructure is does not preclude getting improvements in ABG of less than 20dB, but larger studies with longer follow ups might be useful.

A document by Yen-Hui Lee. Click on the document to view its contents.

Abstract Objectives To explore the long-term efficacy and possible mechanism of endolymphatic sac decompression (ESD) in the treatment of Meniere’s disease(MD) by electrocochleography. Design Prospective cohort study. Setting “Blinded for review” Participants A total of 85 patients with MD who underwent unilateral ESD between June 2015 and November 2019 at“Blinded for review”were enrolled. Main outcome measures The Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), pure tone audiometry, and electrocochleography were used for assessment. The mean follow-up time was 26 months (range: 7–60 months). Results The number of vertigo episodes was significantly reduced following ESD compared to before the surgery (P<0.005), and all patients achieved complete or basic control of vertigo as evidenced by a decrease in DHI score (P<0.005). THI scores of patients with tinnitus were also lower after as compared to before ESD (P<0.005), whereas no significant change in average hearing threshold of the affected side was observed (P>0.05). The cochlear summating potential (SP)/auditory nerve action potential (AP) area ratio in the electrocochleogram of the affected side was negatively correlated with DHI score (rs=−0.159, P=0.0074). Conclusions ESD achieved effective long-term control of vertigo in MD patients and improved the associated tinnitus without any obvious damage to hearing. Electrocochleography was useful for postoperative monitoring; the SP/AP area ratio of the affected side was closely related to the improvement of postoperative vertigo, possibly reflecting greater relief of pressure in the endolymphatic sac. Keypoints •ESD provided long-term control of vertigo in MD patients and improved the accompanying tinnitus without obviously damaging hearing. •ECochG is useful for monitoring the postoperative outcome of ESD. •The SP/AP area ratio of the affected side was closely related to the improvement of postoperative vertigo. •The endolymphatic sac is a “decompression reservoir” of the membranous labyrinth. •ESD may provide space for expansion of the endolymphatic sac and relieve pressure within the membranous labyrinth caused by endolymphatic hydrops, thereby reducing the risk of sac rupture and restoring pressure balance to reduce the sensation of vertigo.

Objective: The aim of this study was to evaluate the audiological performance of the ADHEAR system and to compare it with a softband BAHA system in adults with middle ear disease. Study Design: Prospective, single-subject, repeated-measures study Setting: Monocentric study Participants: In 23 patients with mild to moderate isolated conductive or combined hearing loss (CHL) the ADHEAR system was tested, where 12 of them were outside of the ADHEAR indication. In ten patients, testing was performed with the ADHEAR system and a softband BAHA system. A control group consisted of 10 patients with bilateral artificial occluded ear canal. Main outcome measures: Air and bone conduction thresholds and free-field monosyllable speech intelligibility thresholds in quiet and in noise were measured and evaluated in an unaided situation and aided situation. Furthermore, an ADHEAR questionnaire was assessed. Results: In patients with a middle ear disease compared to the unaided situation, the aided situations with the ADHEAR system and the softband BAHA system led to a significant improvement of speech intelligibility in quiet and in noise. In terms of the ADHEAR questionnaire, using the ADHEAR system patients reported about an improvement in sound localization, sound quality and speech intelligibility. Conclusions: The results show that patients with middle ear disease can benefit from the ADHEAR system, even if their hearing loss is outside of its indication. Outside the indication criteria of the ADHEAR system, it can be an option.