Bone conduction hearing implants are a well-established method of hearing rehabilitation in children and adults. This study aimed to review any changes in provision in England.

The total number of bone conduction hearing implantations performed was analysed from 2012 to 2021 utilising Hospital Episode Statistics data for England.

The total number of procedures has increased by 58 per cent. One-stage bone conduction hearing implantations in adults accounts for the largest proportion of this increase (93 per cent of the total). The number performed in children has remained stable and accounts for 73 per cent (n = 433) of all two-stage procedures.

The data show that bone conduction hearing implant surgery is becoming increasingly popular, particularly in adults. This has correlated with the increase in availability, national recommendations and choice of devices.

To compare ultrasonography-guided drainage versus conventional surgical incision and drainage in deep neck space abscesses.

The study was pre-registered on the National Institute of Health Research Prospective Register of Systematic Reviews (CRD42023466809) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase and Central databases were searched. Primary outcomes were length of hospital stay and recurrence. Heterogeneity and bias risk were assessed, and a fixed-effects model was applied.

Of 646 screened articles, 7 studies enrolling 384 participants were included. Ultrasonography-guided drainage was associated with a significantly shorter hospital stay (mean difference = −2.31, p < 0.00001), but no statistically significant difference was noted in recurrence rate compared to incision and drainage (odds ratio = 2.02, p = 0.21). Ultrasonography-guided drainage appeared to be associated with cost savings and better cosmetic outcomes.

Ultrasonography-guided drainage was associated with a shorter hospital stay, making it a viable and perhaps more cost-effective alternative. More randomised trials with adequate outcomes reporting are recommended to optimise the available evidence.

To determine if systemic administration of low-molecular-weight heparin impacts venous compromise in loco-regional flap reconstruction for head and neck subsites.

This prospective study was conducted on patients who had developed features of venous compromise of the flap. The case group received low-molecular-weight heparin (dalteparin).

Of the 73 patients who developed venous congestion, low-molecular-weight heparin was administered in 47 patients. In the low-molecular-weight heparin subset, 23 patients had either reversal or non-progression of venous compromise (48.9 per cent). Of the patients who had no response to low-molecular-weight heparin rescue, complete necrosis was seen in 4 and partial flap necrosis was observed in 19. The corresponding numbers in the control group were 13 and 12, respectively (odds ratio 23.9, p = 0.002). Additionally, the low-molecular-weight heparin arm had a lower incidence of partial or complete flap necrosis (p = 0.002).

Low-molecular-weight heparin salvage, when instituted early, is likely to result in a significant reduction in flap-related morbidity.

This study was performed to compare the operation time, graft outcomes and complications between the endoscopic cartilage-perichondrium button technique and over-under technique for repairing large perforations.

A total of 52 chronic large perforations were randomly allocated to receive treatment using the endoscopic cartilage-perichondrium button technique (n = 26) or over-under technique (n = 26). The graft outcomes, mean operation time and post-operative complications were compared between the two groups at 12 months.

The study population consisted of 52 patients with unilateral chronic large perforations. All patients completed 12 months of follow up. The mean operation time was 32.3 ± 4.2 minutes in the button technique group and 51.6 ± 2.8 minutes in the over-underlay technique group (p < 0.01). The graft success rate at 12 months was 92.3 per cent (24 out of 26) in the button technique group and 96.2 per cent (25 out of 26) in the over-underlay group (p = 0.552).

The endoscopic cartilage-perichondrium button technique had similar graft success rates and hearing outcomes for large chronic perforations to the over-under technique, but significantly shortened the mean operation time.

This study investigates the impact of primary care utilisation of a symptom-based head and neck cancer risk calculator (Head and Neck Cancer Risk Calculator version 2) in the post-coronavirus disease 2019 period on the number of primary care referrals and cancer diagnoses.

The number of referrals from April 2019 to August 2019 and from April 2020 to July 2020 (pre-calculator) was compared with the number from the period January 2021 to August 2022 (post-calculator) using the chi-square test. The patients’ characteristics, referral urgency, triage outcome, Head and Neck Cancer Risk Calculator version 2 score and cancer diagnosis were recorded.

In total, 1110 referrals from the pre-calculator period were compared with 1559 from the post-calculator period. Patient characteristics were comparable for both cohorts. More patients were referred on the cancer pathway in the post-calculator cohort (pre-calculator patients 51.1 per cent vs post-calculator 64.0 per cent). The cancer diagnosis rate increased from 2.7 per cent in the pre-calculator cohort to 3.3 per cent in the post-calculator cohort. A lower rate of cancer diagnosis in the non-cancer pathway occurred in the cohort managed using the Head and Neck Cancer Risk Calculator version 2 (10 per cent vs 23 per cent, p = 0.10).

Head and Neck Cancer Risk Calculator version 2 demonstrated high sensitivity in cancer diagnosis. Further studies are required to improve the predictive strength of the calculator.

In Cambodia, little is known about the state of ear and hearing care, or the roles providers or key stakeholders play in delivering services.

This was an exploratory study using semi-structured qualitative interviews and a questionnaire addressed to key stakeholders to explore their perceptions and experiences in providing services to people suffering from ear disease or hearing loss in Cambodia.

Several challenges were described including a lack of hearing services to meet the demand, especially outside Phnom Penh in primary care and aural rehabilitation. Supply-side challenges include a shortage of trained professionals, facilities and resources, poor co-ordination between providers, unclear referral pathways, and long wait times.

Now is an opportune time to build on the positive trend in providing integrated care for non-communicable diseases in Cambodia, through the integration of effective ear and hearing care into primary care and strengthening the package of activities delivered at government facilities.

This study was designed to determine whether extended high-frequency audiometry was capable of better differentiating between participants with normal hearing who did or did not have subjective tinnitus.

A total of 96 study participants were enrolled: 36 patients with unilateral tinnitus, 28 patients with bilateral tinnitus and 32 volunteers as controls. All 96 participants exhibited normal audiometry findings and hearing thresholds. Extended high-frequency audiometry was used to evaluate these patients.

There were differences between the extended high-frequency hearing thresholds of affected and unaffected ears in those with unilateral tinnitus, and in the 20–29-year-old bilateral tinnitus group, at 11.2, 12.5 and 14 kHz. Unilateral tinnitus subgroups had higher extended high-frequency hearing thresholds than those in control subjects, at all extended high frequencies.

Extended high-frequency audiometry can offer additional information regarding the hearing status of patients with tinnitus who exhibit normal pure tone thresholds when analysed via conventional hearing thresholds.

Vestibular migraine is a newly recognised and debilitating condition. This article aims to provide an overview of what is known of vestibular migraine, delineating its diagnostic criteria and presenting some initial management strategies to aid ENT professionals in delivering optimal care when patients first present to the otolaryngology clinic.

Although traditionally underdiagnosed, there are now clearly defined diagnostic criteria to aid accurate diagnosis of vestibular migraine.

A detailed history and clinical examination are the cornerstone of the diagnostic process, but supportive evidence is required from appropriate audio-vestibular tests and imaging.

This is a unique condition that commonly initially presents to ENT. This article provides a summary of diagnostic and management strategies to facilitate early diagnosis and first-line treatment that can be employed in general ENT settings, which may be particularly useful given the limited availability of specialist audio-vestibular medicine and neuro-otology services.

It has been estimated that about 5 million people of those affected with otitis media have cholesteatoma, however, its pathophysiology is unclear. In this study we aimed to detect Helicobacter pylori via polymerase chain reaction and real-time polymerase chain reaction in young patients with chronic otitis media.

Patients included in our prospective cross-sectional study had middle-ear/mastoid inflammation and underwent surgical procedures. Middle-ear mucosa samples were collected, and genomic DNA was extracted for H pylori detection by polymerase chain reaction and real-time polymerase chain reaction analyses. Sociodemographic data and gastroesophageal reflux symptoms were analysed.

We included 49 patients with mean age of 12.7 ± 3.8 years. Twenty per cent of the patients were diagnosed with cholesteatoma. No increase in H pylori-amplified fluorescence was observed, indicating absence of H pylori.

Due to the absence of amplification for H pylori and the fact that albumin was amplified in all samples, we conclude that H pylori does not appear to be a causal factor.

To search for any morphological variation contributing to aetiopathogenesis and the diagnosis of benign paroxysmal positional vertigo, we measured the sizes of the semicircular canals in patients with and without benign paroxysmal positional vertigo using multidetector computed tomography.

Cranial bone computed tomography images of 30 benign paroxysmal positional vertigo patients and 30 control patients were acquired with a 128-slice computed tomography scanner and a transverse plane with a thickness of 0.67 mm. The inner diameter, height and width of the canals were measured.

The width of the anterior semicircular canals, and the width and height of the posterior semicircular canals of the affected ears in benign paroxysmal positional vertigo patients (n = 30) were significantly greater than in the control patients (n = 90; p = 0.001, p = 0.023, p = 0.003, respectively).

In benign paroxysmal positional vertigo patients, the posterior and anterior semicircular canals are longer than those in people without benign paroxysmal positional vertigo. These morphological changes may contribute to elucidating the aetiopathogenesis and be used as a radiological sign for diagnosis of benign paroxysmal positional vertigo disease.

Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).

The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.

The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.

Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.

The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.

To compare visual estimation versus ImageJ calculation of tympanic membrane perforation size in the paediatric population between clinicians of different experience.

Five images of tympanic membrane perforations in children, captured using an otoendoscope, were selected. The gold standard was the ImageJ results by one consultant otologist. Consultants, registrars and Senior House Officers or equivalent were asked to visually estimate and calculate the perforation size using ImageJ software.

The mean difference in variation from gold standard between visual estimation and ImageJ calculation was 12.16 per cent, 95 per cent CI (10.55, 13.78) p < 0.05, with ImageJ providing a more accurate estimation of perforation. Registrars were significantly more accurate at visual estimation than senior house officers. There was no statistically significant difference in ImageJ results between the different grades.

Using ImageJ software is more accurate at estimating tympanic membrane perforation size than visual assessment for all ENT clinicians regardless of experience.

This study aimed to investigate the prevalence of oropharyngeal dysphagia among institutionalised children with multiple disabilities, a topic with limited literature coverage.

The study employed a questionnaire, specifically the F-PEDI-EAT-10, to screen for dysphagia in children. Trained nurses administered the questionnaire to the participants.

The study included 117 children with multiple disabilities (51.3 per cent boys and 48.7 per cent girls) with an average age of 14 ± 4.7 years. The questionnaire revealed that 53 per cent (n = 62) of the children had a positive score and, surprisingly, 29 per cent of them (n = 18) did not have a confirmed diagnosis of oropharyngeal dysphagia. Notably, children with a positive F-PEDI-EAT-10 score had a significantly higher prevalence of pneumopathy and undernutrition compared with those with a negative score.

This study underscores the high prevalence of oropharyngeal dysphagia among children with multiple disabilities, a condition that is often underdiagnosed.

To evaluate if fusion computed tomography–diffusion-weighted magnetic resonance imaging may have a role in the pre-operative assessment of congenital middle-ear cholesteatoma.

A retrospective chart review of surgically treated congenital middle-ear cholesteatoma patients over a 2-year timespan was conducted. Pre-operative staging was performed on computed tomography and fusion computed tomography–diffusion-weighted magnetic resonance imaging based on extension of the disease according to the ChOLE classification system and the Potsic classification system. Intra-operative staging was compared to imaging findings to evaluate accuracy of the two imaging modalities in predicting congenital middle-ear cholesteatoma extent.

Computed tomography was able to correctly predict congenital middle-ear cholesteatoma extent in three out of six cases according to the ChOLE classification system, all of which were staged as Ch1a and Ch1b on pre-operative computed tomography. Cases in which computed tomography was not able correctly to determine congenital middle-ear cholesteatoma extent were staged as Ch3 on pre-operative computed tomography. Fusion scans correctly determined congenital middle-ear cholesteatoma extent in all cases according to the ChOLE classification.

Fusion computed tomography–diffusion-weighted magnetic resonance imaging may be helpful in cases of congenital middle-ear cholesteatoma where pre-operative computed tomography shows mastoid and antrum opacification, in which computed tomography alone may overestimate cholesteatoma extension beyond the level of the lateral semi-circular canal.

This study aimed to identify what proportion of middle-ear surgery patients utilise the internet for information and to characterise which resources and media formats are used and for what durations.

A single-arm, retrospective cohort study was performed using an online survey of English-speaking patients who underwent middle-ear surgery over a three-year period across two otology practices.

Of 260 invitees, 165 responded. A total of 122 used online resources: 9.8 per cent used online resources for less than 15 minutes, 27.0 per cent used them for 15 to 29 minutes, 27.0 per cent used them for 30 to 59 minutes and 36.1 per cent used them for 60 minutes or more. Of online users with complete responses (108 of 122), the most used resources (used for 12 minutes or more) were: written information (73.1 per cent); surgeons’ websites (55.6 per cent); pictures, diagrams or photos (42.6 per cent); videos (37.0 per cent); and social media (10.2 per cent).

At least 46.9 per cent of patients undergoing elective ear surgery use online resources. Most time is spent using written information, pictures, diagrams, photos and videos. Therefore, it is increasingly essential that accurate and informative resources in these formats are readily available online.

The study aimed to compare ipsilateral and contralateral electrically evoked stapedial reflex thresholds in children with a unilateral cochlear implant surgically implanted either through Veria or posterior tympanotomy approaches.

Forty-nine children using cochlear implants were studied, of whom 27 underwent the Veria approach and 22 underwent the posterior tympanotomy approach. The electrically evoked stapedius reflex thresholds were measured ipsilaterally and contralaterally by stimulating four equally spaced electrodes.

The ipsilateral electrically evoked stapedius reflex threshold was absent in all four electrodes in the children implanted using the Veria approach. However, the ipsilateral electrically evoked stapedius reflex threshold was present in 70 per cent of the children implanted using the posterior tympanotomy approach. The contralateral electrically evoked stapedius reflex threshold was present in most of the children for both surgical approaches.

The presence of the ipsilateral electrically evoked stapedius reflex threshold varies depending on the surgical technique used for cochlear implantation. However, contralateral reflexes are present in the majority of children using cochlear implants, irrespective of the surgical approach.

This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations.

A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach.

Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air–bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360).

Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations.

Tonic tensor tympani syndrome is found in a subset of tinnitus patients who experience intra-aural and peri-aural symptoms, in addition to their tinnitus, in the absence of clinically detectable pathology. As the syndrome has not been widely reported, this study aims to determine its prevalence and evaluate the effectiveness of current management.

The tinnitus management clinic records of patients over the past six years were assessed to identify tonic tensor tympani syndrome patients and track their progress based on patient-reported Tinnitus Handicap Index scores. Patients with reversible ear pathology and temporomandibular joint disorder were excluded.

It was found that 13 per cent of the tinnitus management patients fulfilled the criteria for tonic tensor tympani syndrome and 94 per cent of those who returned for follow up showed an improvement in their Tinnitus Handicap Index grades.

This study suggests that tonic tensor tympani syndrome is a significant problem among tinnitus patients and current tinnitus management strategies contribute effectively to helping such patients habituate to their symptoms.

This retrospective study aimed to establish a robust rating system for assessing post-operative outcomes in congenital aural atresia patients undergoing auricular reconstruction. The newly introduced EAR scale, a weighted grading system, not only considers anatomical landmarks but also factors such as ear alignment. In addition, the outer-ear cartilage scale and the visual analogue scale (VAS) were introduced. These scales were compared among themselves and against two established scales.

Nine raters assessed 17 eligible patients who underwent auricular reconstruction between 2001 and 2020.

The study compared inter-rater agreement among scales, with the EAR scale proving the most reliable (Krippendorff's alpha coefficient, α = 0.45), outperforming existing measures. The outer-ear cartilage scale and the VAS exhibited lower inter-rater agreement, indicating inferiority in assessing aesthetic outcomes.

The EAR scale emerged as an effective tool for evaluating post-operative outcomes in congenital aural atresia auricular reconstruction.

Persistent postural-perceptual dizziness classifies patients with chronic dizziness, often triggered by an acute episode of vestibular dysfunction or threat to balance. Unsteadiness and spatial disorientation vary in intensity but persist for over three months, exacerbated by complex visual environments.

Literature suggests diagnosis relies on a clinical history of persistent subjective dizziness and normal vestibular and neurological examination findings. Behavioural diagnostic biomarkers have been proposed, to facilitate diagnosis.

Research has focused on understanding the neural mechanisms that underpin this perceptual disorder, with imaging data supporting altered connectivity between neural brain networks that process vision, motion and emotion. Behavioural research identified the perceptual and motor responses to a heightened perception of imbalance.

Management utilises head and body motion detection, and downregulation of visual motion excitability, reducing postural hypervigilance and anxiety. Combinations of physical and cognitive therapies, with antidepressant medications, help if the condition is associated with mood disorder.