The fragility index represents the minimum number of patients required to convert an outcome from statistically significant to insignificant. This report assesses the fragility index of head and neck cancer randomised, controlled trials.

Studies were extracted from PubMed/Medline, Scopus, Embase and Cochrane databases.

Overall, 123 randomised, controlled trials were included. The sample size and fragility index medians (interquartile ranges) were 103 (56–213) and 2 (0–5), respectively. The fragility index exceeded the number of patients lost to follow up in 42.3 per cent (n = 52) of studies. A higher fragility index correlated with higher sample size (r = 0.514, p < 0.001), number of events (r = 0.449, p < 0.001) and statistical significance via p-value (r = −0.367, p < 0.001).

Head and neck cancer randomised, controlled trials demonstrated low fragility index values, in which statistically significant results could be nullified by altering the outcomes of just two patients, on average. Future head and neck oncology randomised, controlled trials should report the fragility index in order to provide insight into statistical robustness.

Recurrent respiratory papillomatosis is a benign manifestation of human papillomavirus types 6 and 11 in the respiratory tract. Disease is recurrent, and factors predicting these recurrences and severity of disease are incompletely characterised. This retrospective cohort study examined the relationship of immunosuppression with recurrent respiratory papillomatosis morbidity.

A retrospective cohort of 97 adult patients with recurrent respiratory papillomatosis treated at a tertiary referral centre from 2005 to 2020 was conducted. Measures assessed included inter-surgical interval, Voice Handicap Index (‘VHI-10’) and anatomical Derkay scores.

Bivariate analyses comparing average inter-surgical interval, Voice Handicap Index and Derkay scores in immunosuppressed and healthy patients were insignificant. When controlling for diabetes mellitus and comparing immunosuppressed to healthy patients, inter-surgical interval and Voice Handicap Index change were insignificant (p = 0.458 and p = 0.465, respectively).

Recurrent respiratory papillomatosis morbidity for immunosuppressed patients did not significantly differ from that of immunocompetent patients.

There is limited evidence or agreement on the benefit, duration and frequency of post-operative surveillance neck ultrasound in patients with differentiated thyroid cancer treated with hemithyroidectomy alone. This study's primary aim was to assess the benefit of neck ultrasound in this situation, with a secondary aim to assess the detection of malignancy in the contralateral lobe in patients undergoing completion surgery.

A retrospective observational study was conducted involving patients who had differentiated thyroid cancer found at diagnostic hemithyroidectomy between 1 December 2013 and 31 December 2016.

Of 105 patients, 74 underwent completion thyroidectomy. Thirty-five per cent of these patients had malignancy identified in the contralateral lobe, the majority were unsuspected sonographically. Of 31 hemithyroidectomy patients, 1 had a nodule classified as ‘U3’ (indeterminate) at the first ultrasound surveillance, ultimately identified as incidental papillary microcarcinomas on completion thyroidectomy. There was no other disease recurrence or malignancy at a median of 3.8 years’ follow up.

The findings indicate a limited role for ultrasound follow up of patients with differentiated thyroid cancer treated with hemithyroidectomy alone.

Image enhancement systems are important diagnostic tools in the detection of laryngeal pathologies. This study aimed to compare three different image enhancement systems: professional image enhancement technology, Image1 S and narrow-band imaging.

Using the three systems, 100 patients with laryngeal lesions were investigated using a flexible and a 30° rigid endoscope. The lesions were diagnosed by three experts and classified using the Ni classification. The findings were compared.

Lesions classified as ‘benign’ were histopathologically confirmed in 50 per cent of patients, malignant lesions were confirmed in 41 per cent and recurrent respiratory papillomatosis were confirmed in 9 per cent. There was no significant difference between the experts’ assessments of each image enhancement system.

The three systems give comparable results in the detection of laryngeal lesions. With two additional systems, more users can perform image-enhanced endoscopy, resulting in a broadly available tool that can help to improve oncological assessment.

In this study, we reviewed the post-operative complications in parotidectomy and its association with various patient, tumour and surgical factors.

All parotidectomies performed in our regional unit between 2013 to 2020 were identified. Electronic medical record and clinic letters were reviewed for any post-operative complications. A logistical regression model was applied on data collected on twelve patient factors, three tumour factors and four surgical factors.

379 cases of parotidectomy were identified in the eight-year study period. 55% (n = 210) were documented with nine types of post-operative complications. This study identified age >80 (odds ratio = 1.89, p = 0.018), active smoker (odds ratio = 0.94, p = 0.018), total parotidectomy approach (odds ratio = 1.77, p = 0.012), longer operation time (odds ratio = 0.006, p = 0.015) and hypertension (odds ratio = 1.23, p = 0.019) were associated with a higher risk of facial nerve palsy. Predictive factors were also identified for auricular nerve numbness and Frey syndrome.

This study revealed the incidences and potential predictors of post-operative complications in parotidectomy. Notably, the grade of operator (consultants/ registrars) had no effect on the possibility of adverse outcome, reflecting patient safety was not compromised for training. These findings can be used in patient counselling and guide treatment options to minimise post-operative complications.

Advanced laryngeal cancers are clinically complex; there is a paucity of modern decision-making models to guide tumour-specific management. This pilot study aims to identify computed tomography-based radiomic features that may predict survival and enhance prognostication.

Pre-biopsy, contrast-enhanced computed tomography scans were assembled from a retrospective cohort (n = 72) with advanced laryngeal cancers (T3 and T4). The LIFEx software was used for radiomic feature extraction. Two features: shape compacity (irregularity of tumour volume) and grey-level zone length matrix – grey-level non-uniformity (tumour heterogeneity) were selected via least absolute shrinkage and selection operator-based Cox regression and explored for prognostic potential.

A greater shape compacity (hazard ratio 2.89) and grey-level zone length matrix – grey-level non-uniformity (hazard ratio 1.64) were significantly associated with worse 5-year disease-specific survival (p < 0.05). Cox regression models yielded a superior C-index when incorporating radiomic features (0.759) versus clinicopathological variables alone (0.655).

Two radiomic features were identified as independent prognostic biomarkers. A multi-centre prospective study is necessary for further exploration. Integrated radiomic models may refine the treatment of advanced laryngeal cancers.

This study aimed to investigate the presence of implicit bias among ENT surgeons and explore the impact of the results of the Implicit Association Test on the surgeons’ behaviour towards patients.

Seven ENT surgeons who were not black, Asian or minority ethnic were asked to complete the Race Implicit Association Test. The surgeons also completed a survey about their perceptions of their implicit biases and the impact of the Race Implicit Association Test results on their behaviour towards patients.

The mean Race Implicit Association Test score for the ENT surgeons suggested a slight bias that favoured white over black people. Furthermore, 42 per cent of the surgeons thought that they had hidden or unconscious racial bias, 42 per cent said they would change their behaviour towards patients after receiving these results and 85 per cent thought that the Race Implicit Association Test was helpful for appraisal purposes.

The results suggest that ENT surgeons who are not black, Asian or minority ethnic may have implicit biases towards black patients. These findings highlight the need for interventions to reduce implicit bias among ENT surgeons and improve healthcare outcomes for marginalised populations.

To propose a scoring system based on laryngoscopic characteristics for the differential diagnosis of benign and malignant vocal fold leukoplakia.

Laryngoscopic images from 200 vocal fold leukoplakia cases were retrospectively analysed. The laryngoscopic signs of benign and malignant vocal fold leukoplakia were compared, and statistically significant features were assigned and accumulated to establish the leukoplakia finding score.

A total of five indicators associated with malignant vocal fold leukoplakia were included to construct the leukoplakia finding score, with a possible range of 0–10 points. A score of 6 points or more was indicative of a diagnosis of malignant vocal fold leukoplakia. The sensitivity, specificity and accuracy values of the leukoplakia finding score were 93.8 per cent, 83.6 per cent and 86.0 per cent, respectively. The consistency in the leukoplakia finding score obtained by different laryngologists was strong (kappa = 0.809).

This scoring system based on laryngoscopic characteristics has high diagnostic value for distinguishing benign and malignant vocal fold leukoplakia.

The aim of this communication was to introduce a novel combined image (magnetic resonance and computed tomography-guided and sialendoscopy-assisted transoral approach for the treatment of a parotid duct stenosis with megaduct.

A 46-year-old woman was referred to our department for recurrent infections of the right parotid gland following unsuccessful multiple transoral surgical approaches for a Stensen's duct stricture with megaduct. An image (magnetic resonance and computed tomography)-guided and sialendoscopy-assisted transoral sialodochoplasty was planned and performed.

No complications occurred. The patient was discharged 2 days after surgery. No more swelling or infections occurred. The patient is currently symptom-free after a follow up of 11 months.

Although imaging navigation means more technical effort and costs, this novel approach can be considered a viable surgical opportunity for distal and mid-third parotid duct stenosis with concomitant megaduct, particularly in cases of persistent inflammation or iatrogenic scars due to previous surgery.

Otolaryngology (ENT) plays a crucial role in healthcare, yet undergraduate education in the United Kingdom has historically not reflected this. This study aimed to assess the delivery of ENT education, focusing on teaching methods, clinical placements, and assessment practices.

An online questionnaire was distributed to medical students. Data were collected via Qualtrics from 5 August 2023 to 17 October 2023.

Forty medical schools were involved. Thirty-seven schools had compulsory ENT teaching however 20 per cent lack an ENT placement. Clinical placements varied, with an average length of 7.3 days. Assessment of ENT knowledge included Objective, Structures, Clinical Examination stations (90 per cent) and written exams (80 per cent).

The study highlights persistent gaps in ENT education. Deficiencies in clinical exposure and lack of alignment with national guidelines indicate the need for improvement. As the Medical Licensing Assessment approaches, standardising assessments may address disparities but should be accompanied by comprehensive changes in teaching methods and placements.

Electrothermal bipolar vessel sealing devices are electrosurgical devices that seal tissues and blood vessels up to 7 mm in diameter. This paper discusses our experience using electrothermal bipolar vessel sealing devices in transoral head and neck surgery.

Electrothermal bipolar vessel sealing devices were used in five patients with lesions of varying size and type within the pharyngo-larynx. These were treated transorally by the otolaryngology department at the Royal Adelaide Hospital. Either the Medtronic LigaSure or BiZact devices were used for transoral resection, debulking or division of these lesions.

Electrothermal bipolar vessel sealing devices were considered helpful in four out of the five cases. Success was dependent on suitable transoral access. A single unsuccessful case reflected the LigaSure jaw's inability to engage a large tumour effectively.

Electrothermal bipolar vessel sealing devices can be safely deployed transorally to treat lesions of the upper aero-digestive tract in selected patients. Further studies investigating additional indications would broaden applications of this approach.

Developing skills in rigid endoscopy poses challenges to the surgical trainee. This study investigates whether a modified manikin can improve the technical skill of junior operators by providing direct quantitative feedback.

A force-sensing pad was incorporated into the oral cavity of a life support manikin. Junior trainees and senior otolaryngologists were invited to perform rigid endoscopy and received real-time feedback from the force sensor during the procedure.

There was a significant inverse correlation between operator seniority and the weight applied to the oral cavity (p < 0.0001). All junior trainee operators applied less weight after five attempts (346 ± 90.95 g) compared to their first attempt (464 ± 85.79 g). This gave a statistically significant decrease of 118 g (standard deviation = 107.27 g, p = 0.007) when quantitative feedback was provided to learning operators.

This low-cost, simple model allows trainees to rehearse a high-risk procedure in a safe environment and adjust their operative technique.

This pilot study aimed to assess the feasibility of using a high-definition intra-operative exoscope in teaching septorhinoplasty.

The exoscope was used in septorhinoplasty cases with different trainers and trainees. A high-definition screen displayed real-time, magnified images. Post-procedure, a questionnaire was completed by trainer and trainees, assessing the feasibility, safety and content validity of the exoscope as a septorhinoplasty training tool.

Trainees and trainers assigned favourable ratings to all aspects of the exoscope as a training tool, particularly with regard to teaching anatomy and improving visualisation.

The exoscope is a potentially effective training tool in septorhinoplasty, and is especially useful in improving visualisation, without restricting the operator. Annotatable intra-operative photographs and videos allow trainees to study cases outside of the operating theatre environment. The use of an exoscope for septorhinoplasty in the UK may facilitate increased hands-on involvement earlier in training than is currently typical.

Out-patient channelled endoscopic local anaesthetic biopsy reduces the time to diagnosis and wider use may improve cancer pathway times. This study aimed to assess the practice of ENT surgeons using channelled local anaesthetic biopsy.

A survey was distributed nationally, containing questions about out-patient local anaesthetic biopsy.

In total, 58 responses were returned; only 12 per cent of respondents (n = 7) used general anaesthetic biopsy. The advantages of local anaesthetic biopsy were: the avoidance of general anaesthetic for patients with poor performance scores (95 per cent, n = 55) and faster cancer pathway times (91 per cent, n = 53). Disadvantages were: clinics running late (29 per cent, n = 17) and complications (24 per cent, n = 14). The main barrier to using local anaesthetic was access to channelled flexible endoscopy (38 per cent, n = 22), with 43 per cent (n = 25) reporting they were not using out-patient channelled endoscopes but would be interested in using them.

Surgeons are interested in using channelled endoscopic local anaesthetic biopsy, but they are limited by access to equipment. Increased use of channelled endoscopes may improve national cancer pathway times and avoid challenging general anaesthetics.

To analyse the comparative clinical outcomes and clinicopathological significance of vocal fold leukoplakia lesions treated by appearance classification and traditional methods.

A total of 1442 vocal fold leukoplakia patients were enrolled. Group A patients were treated according to appearance classification and Group B patients were treated according to traditional methods.

In Group A, 24.4, 14.9 and 60.6 per cent of patients had grade I, II and III dysplasia, respectively. Grade I dysplasia (63.4 per cent) was more than twice as frequent in Group B patients than in Group A patients, while grade II dysplasia (20.4 per cent) and grade III dysplasia (16.2 per cent) were significantly less frequent in Group B patients than in Group A patients (p = 0.000). There was a significant correlation between vocal fold leukoplakia appearance and the degree of dysplasia (p = 0.000). The recurrence and malignant transformation rates (17.6 and 31 per cent, respectively) in Group B were significantly greater than those in Group A (10.8 and 25.9 per cent, respectively) (p = 0.000).

Vocal fold leukoplakia appearance classification is useful for guiding treatment decision-making and could help to improve therapeutic accuracy.

This paper reports the innovative use of a modified nasopharyngeal airway device as a temporary stent in patients with laryngotracheal stenosis. It also discusses the technique of endoscopic stent placement, and our experience in terms of the indications and suitability.

The nasopharyngeal airway device was modified to use as an airway stent by trimming it to the desired length. Next, the stent was inserted endoscopically and anchored using a novel approach.

The surgery was performed successfully without complications. The patients had full use of their voice while the stent was in situ. No significant granulation tissue was observed.

This paper demonstrates the feasibility of using a nasopharyngeal airway device as a temporary stent to prevent restenosis in cases where the patients have a strong demand for phonation. The modified nasopharyngeal airway device is potentially very promising, but cases must be selected carefully to avoid compromising efficacy and safety.