The field of ENT surgery is one of the most varied specialties, with numerous subspecialties and continuing divergence. With this evolution there comes, however, a risk that specialists become de-skilled in certain areas. In the case of ENT emergencies, this can be particularly dangerous.

Current guidance from relevant UK professional membership bodies regarding emergency surgery provision was inspected and a literature search was performed to identify studies relating to management of ENT emergencies in the context of increasing subspecialisation.

The specialty currently has provisions in place to ensure timely, appropriate and safe management of emergencies, in the form of guidelines and emergency clinics; however, there is scope for improvement of the system.

Management of the pharyngeal pouch has evolved enormously since the first description by Ludlow in 1764 and the first case series by Zenker and Von Ziemssen in 1877. With the introduction of antibiotics, and the advancement of surgical technique with the advent of endoscopic surgery and lasers, current management is vastly different to that in the nineteenth century.

This paper traces the history of pharyngeal pouch management, and discusses the various treatment options and opinions recorded during the nineteenth and twentieth centuries, comparing these with techniques popular today.

Pharyngeal pouch surgery has been associated with significant morbidity, both because of the elderly age of patients typically affected by the condition and because of the surgery itself and potential post-operative complications encountered. The historical development of pharyngeal pouch management and the understanding of pharyngeal pouch pathophysiology are discussed.

To systematically search for studies reporting outcomes for adenoidectomy alone as a treatment for paediatric obstructive sleep apnoea and use the data to perform a meta-analysis.

Nine databases, including PubMed and Medline, were systematically searched through to 1 April 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed.

A total of 1032 articles were screened and 126 full texts were reviewed. Three paediatric studies (47 patients) reported outcomes. Overall, apnoea–hypopnoea index values decreased from 18.1 ± 16.8 to 3.1 ± 5.5 events per hour (28 patients). Random-effects modelling demonstrated a mean difference of −14.43 events per hour (I2 = 23 per cent (low inconsistency)). The apnoea–hypopnoea index standardised mean difference was −1.14 (large magnitude of effect). The largest reduction in apnoea–hypopnoea index was observed in children aged less than 12 months (reduction of 56.6−94.9 per cent). Lowest oxygen saturation values improved from 80.0 ± 9.5 to 85.5 ± 6.0 per cent (13 children).

Adenoidectomy alone has improved obstructive sleep apnoea in children, especially in those aged less than 12 months; however, given the low number of studies, isolated adenoidectomy remains an area for additional research.

This study was undertaken to determine the optimum approach to screening for head and neck cancer based on international experiences.

To determine whether or not head and neck cancer is suitable for screening, and, if so, what the ideal approach should be.

An electronic search of online databases up to and including May 2014 was conducted. Key search terms included ‘head and neck’, ‘cancer’, ‘screening’, ‘larynx’, ‘oropharynx’ and ‘oral’.

Subset analysis of high-risk cohorts showed statistically significant improvements in early detection of head and neck cancer via screening.

Current levels of public awareness regarding head and neck cancers are suboptimal, despite increased incidence and mortality. Scheduled and opportunistic screening, coupled with efforts to enhance education and health behaviour modification, are highly recommended for pre-defined, high-risk, targeted populations. This can enable early detection and therefore improve morbidity and mortality.

A systematic review was performed to evaluate the safety and efficacy of different therapeutic interventions available for the management of isolated cricopharyngeal dysfunction.

Studies were identified using the following databases: Ovid (Medline, Embase), the Cochrane Library, PubMed and Google Scholar. An initial search identified 339 articles. All titles and abstracts were reviewed. Fifty-six relevant articles were inspected in more detail; of these, 47 were included in the qualitative analysis.

No relevant randomised trials were found. A range of case series were used to perform a qualitative analysis. Botulinum toxin A injection and cricopharyngeal dilatation were associated with a higher risk of recurrence, but appear to be more suitable in elderly and co-morbid patients. In those patients requiring formal myotomy, endoscopic approaches appear to be as effective but less morbid when compared with classical open surgery.

There is good evidence for the safety and efficacy of the different therapeutic options for isolated cricopharyngeal dysfunction. However, further studies are required to compare the efficacy of the various treatment modalities.

This literature review analysed facial nerve management strategies in jugular paraganglioma surgery and discusses the tumour resection rate and the facial nerve outcome associated with each technique.

A retrospective review of PubMed and Medline articles on the surgical treatments for jugular paraganglioma was performed. Tumour resection rates and post-operative facial nerve function after non-rerouting, short anterior rerouting and long anterior rerouting approaches were evaluated for each article.

A total of 15 studies involving a total of 688 patients were included. Post-operative facial nerve function was similar after non-rerouting and short anterior rerouting approaches (p = 0.169); however, both of these techniques had significantly better post-operative facial nerve outcomes compared with long anterior rerouting (p < 0.001 and p = 0.001, respectively). The total tumour removal rate was significantly higher for long anterior rerouting than with the non-rerouting approach (p = 0.016). There was no difference in total tumour removal rate between the long and short anterior rerouting approaches (p = 0.067) and between the short anterior rerouting and non-rerouting approaches (p = 0.867).

No strict guidelines for facial nerve management in jugular paraganglioma resection are available. Although long anterior rerouting provides the best tumour exposure along with a low morbidity rate, case-by-case selection of the surgical approach is recommended.

The frequency with which a scientific article is cited by other studies is one way to measure its academic influence.

A comprehensive search was performed to identify journal articles in the otorhinolaryngology subject category of the 2013 Journal Citation Report Science Edition over the last 30 years (1985–2014). The 100 most cited articles were reviewed and basic information including the publication year, country of origin, source journal, article type and research field was collected.

The 100 most cited articles were published in 15 of the 44 otorhinolaryngology journals. The number of citations per article ranged between 208 and 1559. The leading research field was otology and neurotology (n = 50), followed by rhinology (n = 23) and head and neck surgery (n = 11). Most papers originated in the USA (n = 64).

The possibility of an article being cited is influenced by the publication language, country of origin and source journal.

Three cases of internal carotid artery aneurysm affecting the distal cervical segment were retrospectively reviewed.

Two patients underwent open surgical repair requiring petrous segment exposure for bypass of the affected segment using a Fisch type A lateral skull base approach. The third patient underwent endovascular stenting.

There were no cerebrovascular complications post-operatively. Both open repair patients experienced temporary lower cranial nerve palsies. One required facial nerve grafting. All patients had patent grafts at follow up. The stent graft patient had a small endoleak at six months.

Endovascular and open approaches both have advantages and disadvantages. Treatment needs to be tailored to the lesion and the patient. An open surgical approach is difficult but well established. Endovascular treatment of these lesions is a relatively recent technique, and new cases need to be continually reported with a view to attaining long-term data.

To determine if there is gender or laterality predilection in patients with semicircular canal dehiscence syndrome.

A multi-institutional chart review was performed to identify patients diagnosed with semicircular canal dehiscence between 2000 and 2015. A systematic literature search was conducted using PubMed to further identify patients with semicircular canal dehiscence. Age, gender and laterality data were collected. Statistical analysis was performed to evaluate for gender or laterality preponderance.

A total of 682 patients with semicircular canal dehiscence were identified by literature and chart review. Mean age of diagnosis was 49.75 years (standard deviation = 15.33). Semicircular canal dehiscence was associated with a statistically significant female predominance (chi-square = 7.185, p = 0.007); the female-to-male ratio was 1.2 to 1. Left-sided semicircular canal dehiscence was most common, followed by right-sided then bilateral (chi-square = 23.457, p < 0.001).

Semicircular canal dehiscence syndrome is most commonly left-sided and exhibits a female predominance. This may be secondary to morphological cerebral hemisphere asymmetries in both sexes and a predilection of women to seek more medical care than men.

To determine the effectiveness of augmentation surgery using polydimethylsiloxane elastomer injection for the management of patulous eustachian tube.

All patients were treated with eustachian tube injection augmentation performed via a combined transnasal-transoral endoscopic approach. Clinical presentation, volume of injection, complications and initial response were all prospectively recorded. Longer-term follow up was conducted through structured telephone interviews using previously described patient-reported outcome measures.

Overall, 8 of 11 patients (73 per cent) derived complete or significant symptom improvement; 1 patient had significant improvements but was dissatisfied, and in 2 patients the symptoms were unchanged. The eight satisfied patients showed improvement in their quality-of-life scores.

This study describes an effective treatment option for patulous eustachian tube. Unlike many prior published reports, previously described patient-reported outcome measures were utilised in order to allow more direct comparison.

To review reports of adenoid cystic carcinomas arising in the head and neck area outside of the major salivary glands, in order to enhance the care of patients with these unusual neoplasms.

An international team of head and neck surgeons, pathologists, oncologists and radiation oncologists was assembled to explore the published experience and their own working experience of the diagnosis and treatment of adenoid cystic carcinomas arising in the vicinity of the sinonasal tract, nasopharynx, lacrimal glands and external auditory canal.

The behaviour of adenoid cystic carcinoma arising in head and neck sites exclusive of the major salivary glands parallels that of tumours with a similar histology arising in the major salivary glands – these are relentless, progressive tumours, associated with high rates of mortality. Of 774 patients reviewed, at least 41 (5.3 per cent) developed documented regional node metastases.

The relatively low overall incidence of nodal metastases in adenoid cystic carcinomas arising in the head and neck region outside of the major salivary glands suggests that routine elective regional lymph node dissection might not be indicated in most patients with these tumours.

This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre.

A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties.

Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery.

ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.

In cochlear implantation, there are two crucial factors promoting hearing preservation: an atraumatic surgical approach and selection of an electrode that does not damage cochlear structures. This study aimed to evaluate hearing preservation in children implanted with the Nucleus Slim Straight (CI422) electrode.

Nineteen children aged 6–18 years, with partial deafness, were implanted using the 6-step Skarzynski procedure. Electrode insertion depth was 20–25 mm. Hearing status was assessed with pure tone audiometry before surgery, and at 1, 5, 9, 12 and 24 months after surgery. Electrode placement was confirmed with computed tomography.

Mean hearing preservation in the study group at activation of the cochlear implant was 73 per cent (standard deviation = 37 per cent). After 24 months, it was 67 per cent (standard deviation = 45 per cent). On a categorical scale, hearing preservation was possible in 100 per cent of cases.

Hearing preservation in children implanted with the Nucleus CI422 slim, straight electrode is possible even with 25 mm insertion depth, although the recommended insertion depth is 20 mm. A round window approach using a soft, straight electrode is most conducive to hearing preservation.

• • Recent evidence synthesis from National Institute for Health and Care Excellence suggests that the following brief interventions for smoking cessation work should be used:

  • ○ Ask smokers how interested they are in quitting (R)

  • ○ If they want to stop, refer them to an intensive support service such as National Health Service Stop Smoking Services (R)

  • ○ If they are unwilling or unable to accept a referral, offer a stop smoking aid, e.g. pharmacotherapy. (R)

• • Brief interventions are effective for hazardous and harmful drinking. (R)

• • Specialist interventions are effective in people with alcohol dependence. (R)

• • Most people with alcohol dependence can undergo medically assisted withdrawal safely at home, after risk assessment. (R)

• • Management of leukoplakia is not informed by high-level evidence but consensus supports targeted use of biopsy and histopathological assessment. (R)

• • The management of biopsy proven dysplastic lesions favours:

  • ○ advice to reduce known environmental carcinogens such as tobacco and alcohol (R)

  • ○ surgical excision when the size of the lesions and the patient's function allows (R)

  • ○ long-term surveillance. (R)

• • Fanconi anaemia patients should:

  • ○ be followed up in a multidisciplinary specialist Fanconi anaemia clinic (G)

  • ○ have quarterly screening for head and neck squamous cell carcinoma and an aggressive biopsy policy (G)

  • ○ receive prophylactic vaccination against high risk human papilloma virus (G)

  • ○ receive treatment for head and neck squamous cell carcinoma with surgery alone where possible. (G)

This study aimed to undertake a systematic review of the literature about pre-operative counselling for laryngectomy patients, identify its practice and patient and (where possible) carer perceptions.

A search strategy was formulated using a concept map and a Population, Intervention, Comparative Interaction and Outcomes (‘PICO’) schema. All publications from 1975 to 2015 reporting pre-operative counselling of laryngectomy patients were included. Papers were retrieved and critiqued, and those included were assigned a level of evidence (according to the Joanna Briggs Institute schema).

Of the 56 papers retrieved, 21 were included in the review. The literature is limited: studies demonstrate bias and are of poor methodological quality. There are clear, persistent reports by patients and carers of shortfalls in clinical practice.

Studies on pre-operative counselling for laryngectomees are flawed in design and represent weak levels of evidence. Pre-operative counselling has not been operationalised, resulting in differing paradigms being examined. Aggregation of data and/or results is not possible and the veracity of many studies is questioned.

There have been recent advances in our appreciation of the functional complementarity of the upper and lower airways. The unified airway begins at the nose: rather than acting merely as a conduit for air to the lungs, the nose and nasal cavity perform an important role in filtering, humidification and immune surveillance.

The physiological and pathological responses of the nasal cavity to exercise and regular training are examined in this narrative review, with specific reference to the relation of nasal health to quality of life, lower airway health and upper respiratory tract infections. Relevant literature is examined and placed in clinical context.

There is considerable published evidence to support nasal dysfunction associated with exercise, and a link to lower airway dysfunction. Evidence also supports the role of upper and lower airway dysfunction in the development of upper respiratory tract infection symptoms.

Nasal dysfunction in exercise may be a source of considerable morbidity to the regular exerciser, and further research into exercise-induced rhinitis is recommended.

To investigate rhinology-related malpractice claims with the aim of optimising safe practice.

The database of the National Institute of Forensic Medicine was reviewed. In total, 241 otorhinolaryngology malpractice case reports dating from 2005 to 2012 were evaluated, and 83 malpractice cases related to rhinology treatments were separated.

There was no significant difference between the number of male (n = 42) and female (n = 41) claimants. The mean patient age was 32.07 ± 10.53 years (range, 10–75 years). Seventy-nine cases involved surgical treatment in rhinology. The most common complaints were: unsatisfactory cosmetic results (n = 30), optic nerve injury (n = 10), septal perforation (n = 9) and intracranial penetration (n = 4). Malpractice was detected in 21 cases (25.3 per cent). No delinquency was found in 62 cases (74.7 per cent).

Physicians should be aware of legal consequences related to rhinology practice. Further study is needed on this topic, as well as interdisciplinary collaboration, to ensure best practices and to avoid litigation.