There is little consensus on how best to manage head and neck cancer with palliative intent. Predicting outcome is difficult and reported survival varies. The present study sought to delineate local practice and outcomes in patients treated with palliative intent.

The clinical records of all head and neck cancer patients treated with palliative intent presenting between 2015 and 2016 to our multidisciplinary team were reviewed.

Eighty-four patients (21.5 per cent) were treated with palliative intent. All had squamous cell carcinoma. Mean survival time was 151 days (standard deviation = 121.1; range, 8–536 days). Of the patients, 83.3 per cent had a palliative care referral; 74.1 per cent had a hospice referral. Patients received a variety of interventions, and there was an associated complication in 8.2 per cent. The mean number of days spent in hospital for interventions was 11.9 days (standard deviation = 12.5; range, 0–41 days).

Different interventions are used to manage head and neck cancer patients with palliative intent, and these may be associated with significant morbidity. Survival time is variable, often several months; thus, any treatment must take into account morbidity in conjunction with the patient's wishes.

The aim of this study was to examine whether melatonin is involved in the pathogenesis of nasal polyposis.

This study included 29 patients with nasal polyposis and undergoing functional endoscopic sinus surgery. As a control group, 26 patients who had been operated on for a deviated nasal septum and concha bullosa were enrolled. Samples were taken from the nasal polyp tissue and from the resected middle concha bullosa mucosa of the control group. Serum samples were taken from all patients.

It was found that the tissue and serum melatonin levels in the nasal polyp group were significantly lower compared with the tissue and serum melatonin levels in the control group.

In nasal polyposis, the melatonin level in the serum and tissue is lower than in individuals without polyposis. This deficiency may play a role in the pathogenesis of nasal polyposis.

This study aimed to examine nasal mucociliary clearance time in patients with Helicobacter pylori infection.

Fifty patients who were newly diagnosed with H pylori infection using gastric biopsy in the gastroenterology out-patient clinic, and 50 age- and gender-matched healthy adults who were admitted to the otorhinolaryngology out-patient clinic, were included in this study. After an otorhinolaryngological examination (anterior rhinoscopy and nasal endoscopic examination), the nasal mucociliary clearance time of each subject was calculated using the saccharine test.

The mean mucociliary clearance time was 06:29 ± 3:31 minutes (range, 00:55–15:19 minutes) in the control group and 10:12 ± 06:09 minutes (range, 01:28–32:00 minutes) in the study group. Comparisons of the two groups revealed a statistically significant difference (p = 0.002).

Nasal mucociliary clearance time was significantly increased in patients with H pylori infection. The results suggest that H pylori infection may have an unfavourable effect on nasal mucociliary clearance.

Paediatric hearing loss rates in Ghana are currently unknown.

A cross-sectional study was conducted in peri-urban Kumasi, Ghana; children (aged 3–15 years) were recruited from randomly selected households. Selected children underwent otoscopic examination prior to in-community pure tone screening using the portable ShoeBox audiometer. The LittlEars auditory questionnaire was also administered to caregivers and parents.

Data were collected from 387 children. After conditioning, 362 children were screened using monaural pure tones presented at 25 dB. Twenty-five children could not be conditioned to behavioural audiometric screening. Eight children were referred based on audiometric screening results. Of those, four were identified as having hearing loss. Four children scored less than the maximum mark of 35 on the LittleEars questionnaire. Of those, three had hearing loss as identified through pure tone screening. The predominant physical finding on otoscopy was ear canal cerumen impaction.

Paediatric hearing loss is prevalent in Ghana, and should be treated as a public health problem warranting further evaluation and epidemiology characterisation.

To evaluate the impact of platelet-rich fibrin therapy in tympanoplasty type 1 surgery on graft survival and frequency-specific hearing outcomes.

Patients who underwent tympanoplasty type 1 surgery were randomised into temporal fascia graft alone (n = 55) and temporal fascia graft plus platelet-rich fibrin therapy (n = 36) groups. Graft survival and hearing outcomes were recorded.

Graft survival rates were significantly higher in the temporal fascia graft plus platelet-rich fibrin therapy group than in the temporal fascia graft alone group at one (100.0 vs 85.5 per cent, p = 0.020), three (97.2 vs 80.0 per cent, p = 0.024) and six months post-operatively (94.4 vs 74.5 per cent, p = 0.031). The difference in hearing gain between groups was not significant.

Our findings revealed that the use of a platelet-rich fibrin plus temporal fascia graft for type 1 tympanoplasty was associated with more favourable post-operative outcomes than the use of temporal fascia alone, both in terms of tympanic membrane healing and graft survival; hearing restoration outcomes were similar.

To evaluate the significance of patients’ ability to recognise symptoms that signify recurrence.

A retrospective analysis was conducted in Norway of demographic, clinical and follow-up data for patients with laryngeal carcinoma considered free of disease following treatment. The study included clinical data from 732 patients with glottic tumours and 249 patients with supraglottic tumours who were considered cured of disease. Data on the site, time and type of recurrence (symptomatic or asymptomatic) were retrieved.

Recurrence was observed in 127 patients with glottic tumours and 71 with supraglottic tumours. A total of 103 glottic recurrences and 53 supraglottic recurrences were symptomatic. For patients with glottic carcinoma, recurrence detection through symptoms was associated with a favourable post-salvage survival rate compared with asymptomatic recurrences (p = 0.003).

A patient's ability to self-detect ‘red flag’ symptoms and self-initiate visits represents a previously ignored prognostic factor, and may rationalise follow up and improve survival.

This retrospective case series examined the outcomes of surgeon-performed intubation using the anterior commissure rigid laryngoscope and bougie in adults with a difficult airway, including awake patients.

This study comprised a series of adult patients who underwent surgeon-performed intubation over a 10-year period. They were identified by a records search for the Current Procedural Terminology (‘CPT’) code 31500 – ‘intubation by surgeon’.

Forty-nine intubations performed in the operating theatre were reviewed. Intubation performed by the surgeon using the rigid anterior commissure laryngoscope was successful in 47 of the cases (96 per cent). Over half of the patients had experienced failed intubation attempts with other methods by other providers prior to the surgeon performing direct laryngoscopy. Twenty intubations were performed without paralytics and with the patient awake.

In properly selected adults who need an urgent, secure airway in the operating theatre, surgeon-performed anterior commissure laryngoscopic intubation using a bougie should be considered a safe, reliable procedure. In most cases, this procedure can be performed in selected patients whilst awake, with sedation.

To examine the relationship between the therapeutic effect of intratympanic methylprednisolone perfusion and histone acetylation in refractory sudden sensorineural hearing loss.

Thirty-four refractory sudden sensorineural hearing loss patients were enrolled and treated with intratympanic methylprednisolone perfusion. Pure tone average, acetylated histone H3, acetylated histone H4 and histone deacetylase 2 (HDAC2) were measured in peripheral blood mononuclear cells before and after intratympanic methylprednisolone perfusion. Sixteen healthy volunteers were recruited to obtain normal reference values.

Pure tone average in sudden sensorineural hearing loss patients improved from 84.14 ± 13.54 dB to 73.56 ± 18.45 dB after intratympanic methylprednisolone perfusion. Up-regulations in HDAC2 protein level, and down-regulations in histone H3 and H4 acetylation were observed in the intratympanic methylprednisolone perfusion sensitive group (pure tone average gain of 15 dB or more), while no significant changes were observed in the intratympanic methylprednisolone perfusion insensitive group (pure tone average gain of less than 15 dB).

Intratympanic methylprednisolone perfusion can improve hearing in a considerable number of refractory sudden sensorineural hearing loss patients. The therapeutic effect is closely related to reduced histone acetylation.

Pharyngeal pouch surgical treatments can be carried out via an endoscopic or open approach. Injection of botulinum toxin into the cricopharyngeus was first described as an alternative treatment to the more invasive surgical procedures performed for cricopharyngeal dysfunction. It has not been previously described as a treatment option for pharyngeal pouch.

To compare operative time, average stay, complication rates and symptom control between endoscopic laser diverticulotomy, botulinum toxin injection and open procedures for pharyngeal pouch patients.

The medical records for 66 pharyngeal pouch procedures, carried out on 47 patients treated between 2011 and 2017, were identified and reviewed.

The mean operative time was 21 minutes for botulinum toxin injection, 38 for endoscopic laser diverticulotomy and 104 for open surgery. The mean hospital stay was 0.6 days for botulinum toxin injection, 4.7 for endoscopic laser diverticulotomy and 4 for open surgery. The improvement in Reflux Symptom Index scores was statistically significant for both endoscopic laser diverticulotomy and botulinum toxin injection. Botulinum toxin injection had a 0 per cent complication rate.

Botulinum toxin injection is a safe and effective treatment for pharyngeal pouch.

To explore the use of fluorescence lifetime imaging microscopy in thyroid tissues, and to investigate how different thyroid lesions affect fluorescence lifetime.

Fluorescence lifetime measurements were taken of fresh frozen thyroid surgical specimens stained with fluorescein isothiocyanate tagged anti-thyroglobulin monoclonal antibodies.

The mean fluorescence lifetime measurements in 12 patients – 3 with multinodular goitre, 4 with follicular adenoma, 4 with papillary thyroid carcinoma and 1 with follicular carcinoma – were 3.16 ns (range, 2.66–3.52 ns), 3.75 ns (range, 2.99–4.57 ns), 2.97 ns (range, 2.57–3.21 ns) and 3.61 ns, respectively. The fluorescence lifetime of follicular adenoma patients was higher than that of papillary thyroid carcinoma patients by 26 per cent (p = 0.058). The fluorescence lifetime in the follicular carcinoma patient was similar to the follicular adenoma group, but higher than in the papillary thyroid carcinoma group by 22 per cent (p = 0.01).

Fluorescence lifetime measurements varied in different thyroid pathologies, possibly because of tissue-scale structural influences.

To assess published reports of oncological surgical success rates in patients who underwent transoral laser supraglottic surgery and robotic surgery for supraglottic cancer.

A systematic review of the literature was conducted and a meta-analysis of published data was performed. PubMed, Sage, Medline and Cochrane data sources were investigated. Overall survival rates, disease-specific survival rates, additional treatments and recurrence rates were investigated to determine the success of the surgical procedures.

The meta-analysis included 24 studies; 1617 studies were excluded. There were no statistically significant differences between the transoral laser supraglottic surgery and transoral robotic supraglottic surgery groups in terms of overall survival (77.0 per cent and 82.4 per cent respectively) and disease-specific survival (75.8 per cent and 87.0 per cent respectively). There was recurrence in 164 out of 832 patients (19.7 per cent) in the transoral laser supraglottic surgery group and in only 6 out of 66 patients (9 per cent) in the transoral robotic supraglottic surgery group.

Transoral laser surgery and robotic surgery appear to have comparable and acceptable oncological success rates.

To report device failures, audiological signs and other reasons for revision cochlear implant surgery, and discuss indications for revision surgery.

Revision procedures between November 1997 and August 2017 were retrospectively analysed. Over 20 years, 2181 cochlear implant operations were performed, and 114 patients underwent 127 revision operations.

The revision rate was 4.67 per cent. The full insertion rate for revision cochlear implant surgery was 88.2 per cent. The most frequent reasons for revision surgery were: device failure (59 per cent), wound breakdown (9.4 per cent) and electrode malposition (8.7 per cent). The device failure rate was: 2.78 per cent for Advanced Bionics, 1.82 per cent for Cochlear and 5.25 per cent for Med-El systems. The number of active electrodes was significantly increased only for Med-El devices after revision surgery. The most common complaints among 61 patients were: gradually decreased auditory performance, sudden internal device shutdown and headaches.

The most common reason for revision surgery was device failure. Patients should be evaluated for device failure in cases of: no hearing despite appropriate follow up, side effects such as facial nerve stimulation, and rejection of speech processor use in paediatrics. After revision surgery, most patients have successful outcomes.

To evaluate clinical characteristics of tympanosclerosis and to investigate the predictive value of clinical evaluation in diagnosing the ossicular chain status in tympanosclerosis.

The study included 166 ears operated on for chronic otitis media. Age, gender, duration of symptoms and history of ear drainage were recorded from the patient's file. Details of ossicular mobility were obtained from the operation records.

There was no difference in age or disease duration between ears with chronic otitis media with or without tympanosclerosis. The ears with chronic otitis media without tympanosclerosis had a higher rate of middle-ear suppuration compared to those with tympanosclerosis (p < 0.001). In chronic otitis media with tympanosclerosis, the ears with a mobile ossicular chain had a higher rate of active drainage in their clinical history compared to ears with a fixed ossicular chain (p = 0.026). Stapes fixation was present mostly in dry ears with tympanosclerosis (p = 0.005).

Chronic otitis media with tympanosclerosis is characterised by the long-term absence of suppurations. The probability of having a fixed ossicular chain or stapes was higher in tympanosclerosis cases with no ear drainage.

Zenker's diverticulum is a pharyngoesophageal outpouching of mucosa and submucosa through Killian's dehiscence.

To investigate the propensity for Zenker's diverticulum to occur on the left side by examining muscle thickness in Killian's dehiscence, and to explore correlations between muscle thickness, sex, height and age.

The study included 109 Caucasian cadavers, 52 male and 57 female. The mean thickest and thinnest measurements of left medial, left lateral, right medial and right lateral aspects of Killian's dehiscence were calculated. The paired student's t-test was used to determine significance.

The average left muscle layer was significantly thinner than the right muscle layer, in both medial and lateral aspects. Furthermore, medial muscle thickness was significantly thinner than its respective lateral aspect for both the left and right sides. No correlations were found between muscle thickness and cadavers’ sex, length or stature, or age.

There was a significant difference in muscle thickness between the left and right sides of Killian's dehiscence. The findings suggest there is a reason why Zenker's diverticulum occurs predominantly on the left side. The study also showed a significant difference in muscle thickness between the medial and lateral aspects of Killian's triangle.

To investigate the effects of surgical treatment for nasal obstruction on sexual functions, regardless of the condition causing the nasal obstruction.

Of 238 patients identified with nasal obstruction, 57 complained of erectile dysfunction and were included in the analysis. Patients underwent septoplasty, functional endoscopic sinus surgery, concha bullosa excision or radiofrequency ablation of the inferior turbinates, depending on their obstruction-causing disease. Pre- and post-operative evaluation of perceived nasal obstruction was performed using the Nasal Obstruction Symptom Evaluation questionnaire. Pre- and post-operative assessment of sexual functions was performed using the International Index of Erectile Function.

Mean post-operative scores for erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall sexual satisfaction were significantly higher compared to the pre-operative scores (p = 0.022, p = 0.036, p = 0.033, p = 0.016 and p = 0.029, respectively).

Surgical treatment of nasal obstruction by septoplasty, endoscopic sinus surgery, concha bullosa excision or radiofrequency can significantly improve sexual performance.

This study aimed to determine the distance between the most anterior part of the anterior nasal spine and the posterior septal angle.

Sinus computed tomography images from February to April 2016 were retrospectively analysed. Scans from adult Caucasians were included. Those with evidence of previous surgery, large slices or poor quality were excluded. The distance between the posterior septal angle and the most anterior part of the anterior nasal spine was measured digitally by two independent raters.

Of 122 scans, 100 met the inclusion criteria (49 males and 51 females; mean age of 52.5 years). The mean distance measured was 5.13 mm (standard deviation = 1.24 mm, range = 1.85–8.00 mm). Measurements between male and female patients were not significantly different (t=0.450, p=0.654, 95 per cent confidence interval = -0.382 to 0.606).

There is variability in the distance between the anterior nasal spine and the posterior septal angle. Surgeons should observe this relationship intra-operatively to avoid instability and unintended aesthetic changes.

This study compared the complications and functional outcomes of patients with oral tongue cancer who had undergone reconstruction using a submental island flap or a radial forearm free flap.

Of the 54 patients, 29 underwent reconstruction with a submental island flap and 25 patients with a radial forearm free flap. The complications and outcomes of speech and swallowing were evaluated.

In the submental island flap group, all the flaps were successfully transferred with no donor site complications. In the radial forearm free flap group, partial skin graft loss and arm function restriction were recorded. Mean operative time and duration of hospital stay were significantly shorter in the submental island flap group. Speech and swallowing function were comparable between the two groups. There was no significant difference in locoregional recurrence between the groups.

The submental island flap is reliable and is suitable for oral tongue reconstruction. It has a lower complication incidence when compared to the radial forearm free flap, while maintaining speech and swallowing function.

The completion of a laser safety course remains a core surgical curriculum requirement for otolaryngologists training in the UK. This project aimed to develop a comprehensive laser safety course utilising both technical and non-technical skills simulation.

Otolaryngology trainees and consultants from the West of Scotland Deanery attended a 1-day course comprising lectures, two high-fidelity simulation scenarios and a technical simulation of safe laser use in practice.

The course, and in particular the use of simulation training, received excellent feedback from otolaryngology trainees and consultants who participated. Both simulation scenarios were validated for future use in laser simulation.

The course has been recognised as a laser safety course sufficient for the otolaryngology Certificate of Completion of Training. To the authors’ knowledge, this article represents the first description of using in situ non-technical skills simulation training for teaching laser use in otolaryngology.

Transoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10.

Primary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments.

Voice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression.

Age and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.