Osteomyelitis of the frontal bone is a rare but devastating complication of frontal sinusitis. Treatment involves aggressive surgery to remove all sequestra in combination with long-term antibiotic therapy. However, systemic antibiotics may struggle to penetrate any remaining infection in devascularised areas, and the morbidity associated with surgical resection of some areas of the skull base is too high. In contrast, locally implanted antibiotics provide a reliable, high concentration of treatment to these areas while also minimising potential systemic side effects. The clinical application of tobramycin beads has primarily been used in orthopaedics as an adjunct to the treatment of tibial osteomyelitis or prosthetic joint infection.

To the best of the authors' knowledge, the two cases discussed here represent the first use of tobramycin antibiotic beads in frontal sinus osteomyelitis secondary to chronic rhinosinusitis.

These cases show promising use of tobramycin beads in recalcitrant frontal osteomyelitis.

This study aimed to establish a model for predicting the three-year survival status of patients with hypopharyngeal squamous cell carcinoma using artificial intelligence algorithms.

Data from 295 patients with hypopharyngeal squamous cell carcinoma were analysed retrospectively. Training sets comprised 70 per cent of the data and test sets the remaining 30 per cent. A total of 22 clinical parameters were included as training features. In total, 12 different types of machine learning algorithms were used for model construction. Accuracy, sensitivity, specificity, area under the receiver operating characteristic curve and Cohen's kappa co-efficient were used to evaluate model performance.

The XGBoost algorithm achieved the best model performance. Accuracy, sensitivity, specificity, area under the receiver operating characteristic curve and kappa value of the model were 80.9 per cent, 92.6 per cent, 62.9 per cent, 77.7 per cent and 58.1 per cent, respectively.

This study successfully identified a machine learning model for predicting three-year survival status for patients with hypopharyngeal squamous cell carcinoma that can offer a new prognostic evaluation method for the clinical treatment of these patients.

ENT is underrepresented in the curriculum, and this has been compounded by coronavirus disease 2019. Recent restructures have removed ENT placements from the curriculum. This lack of exposure needs to be addressed, and increased use of online learning represents an opportunity to facilitate this. This study aimed to evaluate whether online learning can effectively deliver undergraduate ENT teaching.

An online ENT module was created; content was structured on the Sheffield Medical School curriculum. Pre- and post-module tests and 5-point Likert scales were used to assess student knowledge and confidence, respectively.

A total of 115 participants were recruited. Test scores improved by 29 per cent (p < 0.001) and confidence by 66 per cent. Anatomy and ENT conditions demonstrated significant improvement in confidence, with a lower confidence score for examination.

This study showed improved knowledge and confidence, whilst highlighting greater efficacy in content over practical skills teaching. Online learning is a validated educational tool; however, it should not be used as a replacement but as an adjunct to supplement learning.

To identify the clinical characteristics, treatment, and prognosis of relapsing polychondritis patients with airway involvement.

Twenty-eight patients with relapsing polychondritis, hospitalised in the First Hospital of Shanxi Medical University between April 2011 and April 2021, were retrospectively analysed.

Fifty per cent of relapsing polychondritis patients with airway involvement had a lower risk of ear and ocular involvement. Relapsing polychondritis patients with airway involvement had a longer time-to-diagnosis (p < 0.001), a poorer outcome following glucocorticoid combined with immunosuppressant treatment (p = 0.004), and a higher recurrence rate than those without airway involvement (p = 0.004). The rates of positive findings on chest computed tomography and bronchoscopy in relapsing polychondritis patients with airway involvement were 88.9 per cent and 85.7 per cent, respectively. Laryngoscopy analysis showed that 66.7 per cent of relapsing polychondritis patients had varying degrees of mucosal lesions.

For relapsing polychondritis patients with airway involvement, drug treatment should be combined with local airway management.

Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages.

This paper describes a modification, and discusses its pros and cons.

The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline.

Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.

Tracheal stenosis can be difficult to manage. Dilatation can relieve acute symptoms, avoid emergency tracheostomy and may be curative, but traditional dilators risk injury and obstruction in an already critical airway. This paper describes a novel technique for conducting tracheobronchial dilatation with a non-occlusive balloon through a supraglottic airway device, performed under endoscopic guidance.

A supraglottic airway device is placed whilst the patient is under total intravenous anaesthesia with mechanical ventilation. Using a multiport airway adaptor, inspection is performed by flexible endoscopy and a guidewire is placed through the stenosis. A non-occlusive balloon is advanced over the guidewire and positioned using the endoscope reinserted through the second adaptor port. Ventilation can thus be continued throughout dilatation under vision.

This technique has revolutionised our approach to tracheal dilatation in our institution. It avoids tracheostomy, and can be safely and reliably performed by junior staff in the emergency setting after adequate training.

UK guidelines advocate ‘one-stop’ neck lump assessment for cancer referrals. This paper reports the pilot of a novel pre-clinic ultrasound pathway, presents outcomes, and discusses strengths and limitations in the context of the coronavirus disease 2019 pandemic.

Two-week-wait cancer referral patients with a neck lump were allocated a pre-clinic ultrasound scan followed by a clinic appointment. Demographic, patient journey and outcome data were collected and analysed.

Ninety-nine patients underwent ultrasound assessment with or without biopsy on average 8 days following referral. Patients were followed up on average 14.1 days (range, 2–26 days) after initial referral. At the first clinic appointment, 45 patients were discharged, 10 were scheduled for surgery, 12 were diagnosed with cancer, 6 were referred to another specialty and cancer was excluded in 19 patients. Retrospectively, four ultrasounds were performed unnecessarily.

Pre-clinic ultrasound scanning is an alternative to the one-stop neck lump pathway. This study demonstrates fewer clinic visits, faster diagnosis and a low proportion of unnecessary scans, whilst minimising face-to-face consultations and aerosol-generating procedures.

To evaluate the safety and biocompatibility of bone wax as an implant material for medialisation laryngoplasty in a large animal model.

Three Dorper-cross ewes underwent type I thyroplasty of the right vocal fold with bone wax. The animals were monitored for four weeks for general wellbeing. The animals were euthanised and the larynges harvested. Histological evaluation was performed to assess for adverse tissue reaction and biocompatibility.

The mean (± standard deviation) amount of bone wax implanted was 0.49 g (± 0.12 g). No adverse events were reported. Ex vivo vibration was present on high-speed imaging for all medialised vocal folds. Histology demonstrated implanted paraffin embedded within the thyroarytenoid muscle with no evidence of resorption, a minimal inflammatory infiltrate, and a thin fibrotic capsule.

The results of this investigation suggest that bone wax may be a safe and efficacious implant material for medialisation laryngoplasty. Further studies are necessary to assess its long-term safety and efficacy.

This study evaluated audiological outcomes of stapedotomy using two different techniques, vein graft interposition and vein graft surround, for sealing the stapes fenestra.

A retrospective study of 130 patients who underwent stapedotomy for otosclerosis was performed. A total of 84 patients underwent the vein graft surround procedure and 46 underwent the vein graft interposition procedure. Post-operative hearing outcome was compared between them.

A total of 55 of 130 patients had a post-operative air–bone gap of less than 10 dB. A total of 57 patients had an air–bone gap within 20 dB. The average air–bone gap was 13.16 dB at 3 months with a mean improvement of 22.06 dB (11.98 dB for vein graft interposition and 13.80 dB for vein graft surround; p = 0.79).

There was no significant difference in hearing outcome between the two techniques. The vein graft interposition technique is preferred for large fenestra or stapedectomy cases and in cerebrospinal fluid gusher cases. The vein graft surround technique is easier to perform and preferred in small fenestra stapedotomy.

Some chronic rhinosinusitis with nasal polyps patients undergo revision surgery at some point following initial functional endoscopic sinus surgery. This review aimed to identify the predictive factors for recurrence of nasal polyps requiring oral corticosteroids or revision surgery in chronic rhinosinusitis with nasal polyps following functional endoscopic sinus surgery.

A retrospective analysis of 221 patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps in a tertiary rhinology centre, between January 2015 and December 2018, was undertaken.

Forty-four (21.6 per cent) patients underwent medical polypectomy, 19 (9 per cent) underwent revision surgery and 51 (24.3 per cent) underwent combined polypectomy during the mean follow-up time of 5.3 years. Patients aged less than 55 years of age, with a history of previous functional endoscopic sinus surgery, peripheral blood eosinophil counts of 300 cells/μl or higher, a Lund–Mackay score of more than 17 and concomitant aspirin-exacerbated respiratory disease had significantly increased odds for medical polypectomy, revision surgery and combined polypectomy.

Knowing these predictive factors, clinicians can better identify patients with an increased likelihood of severe polyp recurrence and therefore arrange closer follow-up to optimise therapy.

Nasolacrimal duct obstruction is the most common cause of epiphora in children. Management has classically focused on probing and syringing followed by stent insertion and dacryocystorhinostomy either externally or endonasally. This study aimed to assess the effectiveness and safety of these procedures.

This was a retrospective analysis of the outcomes of all patients under the age of 16 who have undergone a surgical lacrimal intervention for nasolacrimal duct obstruction under general anaesthetic over a 10-year period. Outcomes included success rates and complications.

A total of 432 patients were identified. Primary probe and syringing had a success rate of 83 per cent. Primary endonasal dacryocystorhinostomy had a success rate of 71 per cent, and revision surgery had a success rate of 82 per cent.

Endonasal dacryocystorhinostomy is an effective and safe technique for the treatment of epiphora, and this study has provided a suggested protocol for management of patients presenting with epiphora.

Cholesteatomas present a high risk for residual and recurrent disease, and the surveillance of post-operative patients can be challenging. Diffusion-weighted magnetic resonance imaging is becoming the preferred method for investigating recidivism; however, false positive imaging findings increase the risk of patients undergoing unnecessary second look surgery.

This study reports two patients with false positive diffusion restriction associated with cartilage grafts that mimicked cholesteatoma and resulted in second look surgery with no disease found at operation. This study also discusses the related medical literature, including potential causes of abnormal diffusion restriction and methods to negate this.

Caution should be exercised when considering second look surgery in the presence of a cartilage graft and a high confidence of disease clearance. A multi-disciplinary approach is recommended for the operating surgeon to review the images with a radiologist.

The operating theatre, as the primary learning environment for surgeons, needs to be conducive to achieve successful training. A validated 27-item questionnaire aimed at evaluating the training experience of higher surgical trainees in the operating theatre was developed.

The initial questionnaire was developed using a literature review and a focus group. Items were validated with content validity index (CVI) and Cronbach's alpha.

The initial version of 33 questions was modified in the focus group into a 29-item 4-point Likert scale questionnaire covering 3 areas. Of these 29 items, 27 reached the threshold CVI of 0.87, and they achieved a Cronbach's alpha of 0.89 from 17 responses.

The quantitative validations in the instrument are comparable to other existing medical education evaluation tools. Aspects of non-technical skills and human factors were featured heavily and perceived to be important for learning in the operating theatre.

Thraconian fish (weever fish) are poisonous fish found mostly in the eastern Mediterranean region, but also in the eastern Atlantic Ocean, the North Sea and European coastal areas. Greater weever fish belong to the Trachinus draco family; these fish have spines on their dorsal fins and gill covers that secrete a high dose of dracotoxin venom.

This paper reports a 35-year-old female who presented with widespread body aches, respiratory distress and hoarseness following a greater weever attack. It discusses respiratory distress and other findings that occur after a greater weever attack in rare otolaryngological emergency cases.

While greater weever fish are more likely to attack limbs such as arms and legs, patients stung on the neck who develop respiratory distress are considered an ENT emergency.

Aneurysmal bone cysts are expansile benign lesions associated with compressive destruction and obscure pathogenesis. The most common sites of temporal bone involvement are the petrous apex, squamous portions and mastoid.

This paper reports a right temporal aneurysmal bone cyst in a 51-year-old man who presented clinically with facial palsy, and hearing loss and impaired vestibular function. Magnetic resonance imaging and computed tomography findings were consistent with a diagnosis of aneurysmal bone cyst. Inter-operative findings showed that the lesion had caused compressive damage to the internal auditory canal. Following surgical excision, the patient experienced vertigo, indicating recovery of vestibular function. Follow-up imaging revealed complete resection without clinical recurrence.

To our knowledge, this is the first report of aneurysmal bone cyst invasion of the inner auditory canal. Our clinical experience indicates that vestibular nerve damage recovery is relatively uncommon. This case report will hopefully inform future studies.

This case report discusses a successful emergency Lichtenberger lateralisation procedure after immediate bilateral laryngeal immobility, occurring after total thyroidectomy.

A 63-year-old female with right-sided vocal fold paralysis due to compression by a multinodular thyroid goitre underwent total thyroidectomy, which resulted in immediate post-operative bilateral vocal fold immobility. The patient had acute-onset post-operative dyspnoea, was promptly re-intubated, and an emergency lateralisation Lichtenberger suture was placed over the right vocal fold and fixated on the outer surface of the neck.

After two weeks, her right vocal fold recovered first, with the suture still in place. At four weeks, both vocal folds regained function and the suture was extracted.

The take-away message is that an emergency lateralisation suture may be a viable option in maintaining airway patency, while allowing for normal deglutition, in patients who would otherwise be candidates for prolonged intubation, posterior cordotomy, medial arytenoidectomy or tracheostomy.

In severe refractory epistaxis, the anterior ethmoidal artery may need to be ligated. Previously described endonasal or transorbital approaches are not always effective, or they have suboptimal aesthetic outcomes. This paper describes a safe and effective surgical technique, with a consistent landmark allowing quick identification.

A transcaruncular incision is made, oriented medially in the direction of the medial orbital wall towards the level of the nasion. Once onto bone, a subperiosteal plane is developed and an endoscope is used to dissect posteriorly at the level of the nasion, until the anterior ethmoidal artery is identified, and subsequently ligated.

The nasion is an easy, constant landmark to use for ligation of the anterior ethmoidal artery in refractory epistaxis. The traditional method of identifying the anterior ethmoidal artery is not applicable or constant enough for use during the transorbital approach. The described technique avoids injury to surrounding structures and has a satisfactory aesthetic outcome.

Oropharyngeal dysphagia is caused by difficulty in bolus preparation and transport from the mouth to the oesophagus; this may result in malnutrition and aspiration pneumonia. It has a high prevalence in head and neck cancer patients. The objective of this study is to reduce these complications using a new protocol of diagnosis and evaluation of oropharyngeal dysphagia.

This is a prospective study developed in a secondary hospital. All patients diagnosed with head and neck cancer in 2021 and 2022 are subjected to this protocol: an oropharyngeal dysphagia screening test, a swallowing-related quality of life questionnaire and a flexible endoscopic evaluation of swallow.

A total of 72 evaluations are reported using this protocol, before and after cancer treatment, and only 1 presents with aspiration pneumonia.

Using this protocol, the incidence of aspiration pneumonia can be reduced, and diet recommendations can be given earlier in order to maintain a patient's nutritional requirements.

Subtotal petrosectomy for chronic suppurative otitis media requires obliteration of the mastoid cavity and middle ear. Usually, abdominal fat is used for this purpose. However, infection is a risk of using fat, which might require revision surgery. The use of S53P4 bioactive glass with antibacterial properties seems an attractive alternative.

Two patients with a history of chronic suppurative otitis media, complicated by profound perceptive hearing loss, had already been surgically treated, and were thereafter extensively treated conservatively. Because of recurrent chronic otorrhoea and pain, subtotal petrosectomy with obliteration of the cavity with S53P4 bioactive glass was performed.

Follow-up duration was 84 months and 18 months, respectively. No complications occurred peri-operatively. A dry ear was obtained and no late adverse events were observed.

S53P4 bioactive glass is feasible to use for obliteration after subtotal petrosectomy. Elimination of chronic suppurative otitis media can be achieved with this technique. The bioactive glass granules might be an attractive alternative to abdominal fat, which has a risk of infection.