Clinical Otolaryngology 2020-11-22

SerenoCemTM granules: a retrospective analysis of 43 patients and identification of a subset with progressive erosion

\nFabrizio Bandino, \nBruno Kenway, \nMichail Chatzimichalis\n

Publicatie 22-11-2020


AbstractSerenoCemTM granules (Corinthian Surgical Limited – Nottingham) were introduced in 1999 and withdrawn from the market in 2016 after identification of possible bone reabsorption. Harrison et al. first published their findings in 2017 highlighting high rates of bony erosion, with many patients asymptomatic; a recent 2 year follow up study1 by the same Group has not identified any patients with progressive erosion on interval CT scans.

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Timing and volume of information produced for the Otolaryngologist during the COVID‐19 pandemic in the UK. A review of the volume of online literature.

\nCristina Cernei, \nManu K Shrivastava, \nWilliam Colquhoun‐Flannery, \nStuart C Winter\n

Publicatie 21-11-2020


AbstractBackgroundThe SARS‐CoV‐2 was first reported in December 2019 in Wuhan, China and has been declared a pandemic in March 2020. COVID‐19 has caused unprecedented and lasting biopsychosocial effects worldwide. All healthcare professionals have faced life threatening risks by attending their daily jobs. The daily emergence of advice and guidelines was necessary to ensure the safety of patients and staff. To this effect, all elective services came to a halt to preserve hospitals’ capacity for dealing with the sickest. This retrospective, descriptive review aims to assess the volume and timing of the advice released specifically relevant to UK ENT specialists.MethodsTwo separate searches were performed. One involved online advice published in English by international, national and ENT‐specific organisations between the 1st of January to the 31st of May. The date, title, source, type of advice and link to the advice were recorded in Excel. The resources were analysed per week of publication. A second separate search for peer‐reviewed publications was conducted using PubMed Central and Cochrane databases.FindingsCOVID‐19 related guidance was considered, of which 175were identified. 52/175 (29.7%) articles were published by international organisations. 56/175 (32%) were produced by national organisations and 67/175 (38.28%) were produced by ENT specific organisations. The peak guidance production took place in the third and fourth week of March (16/03/2020‐ 29/03/2020) with 72/175 publications. Of these, 27/70 came from the international category, 17/70 from national bodies and 26/70 from ENT‐specific organisations. 13,863 total publications relating to COVID‐19 were found using PubMed and Cochrane search strategies; 76% were relevant to ENT.ConclusionThe challenges faced by ENT relate to the unprecedented, sudden and daily changes to clinical practice. Multiple bodies interpreted the guidance, giving an opportunity for confusion and delay in treatments for patients. Implementing a system with clear lines of communication and dissemination of information will improve our response to future pandemic events whilst maintaining a commercial awareness to better use the human and financial resources of an already financially restricted NHS.

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The use of ultrasound‐guided preoperative colloidal charcoal injection in the surgical management of recurrent differentiated thyroid cancer—A pilot study in 3 patients

\nAli Eker Moustafa, \nFrederick Robert Green, \nSheila Fraser, \nSriram Vaidyanathan, \nJames W Moor\n

Publicatie 21-11-2020


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The frequency of lymph node metastases by neck level in p16 positive oropharyngeal squamous cell carcinoma

\nFrederick R. Green, \nAli E. Moustafa, \nPreetha Chengot, \nAmit Prasai, \nJames W. Moor\n

Publicatie 18-11-2020


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Survival and treatment outcome of head and neck cancer patients with pulmonary oligo‐metastases

\nInes Lardinois, \nDidier Dequanter, \nJérôme R. Lechien, \nCyril Bouland, \nRokneddine Javadian, \nAlexandra Rodriguez, \nIsabelle Loeb, \nFabrice Journe, \nSven Saussez\n

Publicatie 15-11-2020


AbstractObjectivesThe purpose of this study is to determine the outcome of head and neck squamous cell carcinoma (HNSCC) patients developing lung metastasis.DesignRetrospective studyParticipantsHNSCC patients with lung metastasis treated between 2001 and 2018 were included .Mean outcomes mesuresStatistical analyses described the relationship between patient survival, treatment efficacy and pulmonary metastasis occurrence.ResultsOne hundred HNSCC patients were included in the study. The median overall survival (OS) was 21 months. The median recurrence‐free survival (RFS) was seven months. Patient survival with only lung metastases was significantly longer compared to patients with lung metastases and lymph nodes involvement or other metastases. Moreover, patients with a single metastasis had longer post‐RFS and OS than patients with multiple metastases. The local control of metastasis was better when patients presented only lung metastases, and it was more effective in single metastasis. The surgery allowed better metastases local control than supportive care or radio and/or chemotherapy. In case of specific therapy, pulmonary resection was associated with a longer post‐RFS and a longer OS compared to supportive care or radio and/or chemotherapy.ConclusionsWe confirmed, in the current study, the significant survival benefit for HNSCC patients treated by surgery for their pulmonary metastasis. While treatment of multiple metastases required palliative chemotherapy or best supportive care in most of the cases, specific surgical treatment in selected HNSCC patients should be considered.

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The changing face of tonsillectomy

\nMat Daniel, \nJames Tysome\n

Publicatie 14-11-2020


AbstractTonsillectomy is one of the commonest surgical procedures in children, and the subject of much debate and political discourse. Whilst historically recurrent tonsillitis has been the main indication, there has been a shift towards surgery for obstructive sleep apnoea (OSA) in recent years. For recurrent tonsillitis, indications for surgery are now well researched, accepted, and enforced at commissioning level. In the case of OSA, the evidence base for patient selection and management is perhaps not as robust.

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Longitudinal economic analysis of Bonebridge 601 versus percutaneous bone‐anchored hearing devices over a 5‐year follow‐up period

\nNikul Amin, \nAndrew Jonathan Soulby, \nDaniele Borsetto, \nIrumee Pai\n

Publicatie 12-11-2020


AbstractObjectivesPercutaneous bone‐anchored hearing devices (pBAHDs) are the most commonly used bone conduction implants (BCI). Concerns surround the long‐term complications, notably skin‐related, in patients with percutaneous abutments. The active transcutaneous BCI Bonebridge system can help avoid some of these pitfalls but is often considered a second‐line option due to various factors including perceived increased overall costs.DesignLongitudinal economic analysis of Bonebridge BCI 601 versus pBAHD over a 5‐year follow‐up period.SettingA specialist hearing implant centre.ParticipantsAdult patients (≥16 years) with conductive hearing loss, mixed hearing loss or single‐sided deafness, who received a Bonebridge or pBAHD implant between 1/7/2013 and 1/12/2018 with a minimum 12‐month follow‐up.Main outcome measuresWe compared the mean costs per implanted patient for both implants at 1, 3 and 5 years postoperative time points. Clinical effectiveness was evaluated using objective and patient‐reported outcome measures.ResultsThe mean total cost per patient of Bonebridge was significantly higher than pBAHD at 1‐year post‐implantation (£8512 standard deviation SD £715 vs £5590 SD £1394, P < .001); however, by 5‐years post‐implantation this difference was no longer statistically significant (£12 453 SD £2159 vs £12 575 SD £3854, P > .05). The overall cost convergence was mainly accounted for by the increased long‐term complications, revision surgery rates and higher cost of the pBAHD external processor compared to Bonebridge.ConclusionsLong‐term costs of Bonebridge to healthcare providers are comparable to pBAHDs, whilst offering lower complication rates, comparable audiological benefit and patient satisfaction. Bonebridge should be considered as a first‐line BCI option in appropriate cases.

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Efficacy of toluidine blue in the diagnosis and screening of oral cancer and pre‐cancer: A systematic review and meta‐analysis

\nDo Hyun Kim, \nEun A. Song, \nSung Won Kim, \nSe Hwan Hwang\n

Publicatie 12-11-2020


AbstractAimsThe accuracy of toluidine blue (TB) and chemiluminescence for diagnosing oral cancer and pre‐cancer was evaluated.MethodsTwo authors (working independently) comprehensively reviewed six databases (PubMed, Cochrane database, Embase, Web of Science, SCOPUS and Google Scholar) from their dates of inception until March 2020. Oral mucosal disorder, as detected by TB, was compared with that detected by chemiluminescence. True‐positive, true‐negative, false‐positive and false‐negative data were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). The extent of interrater agreement was also assessed.ResultsTwenty‐nine prospective and retrospective studies were included. The diagnostic odds ratio (DOR) of TB was 7.017 (95% confidence interval CI, 4.544; 10.836). The area under the summary receiver operating characteristic curve was 0.766. The correlation between the sensitivity and the false‐positive rate was 0.196, indicating the absence of heterogeneity. TB exhibited moderate interrater reliability (0.6777; 95% CI, 0.43; 0.7455). Compared with chemiluminescence, as used in nine studies, TB had a lower sensitivity (0.659 vs 0.841), but a higher specificity (0.809 vs 0.345), negative predictive value (0.766 vs 0.690) and DOR (10.565 vs 5.203). Compared with clinical examination, as used in four studies, TB method had a higher sensitivity (0.891 vs 0.891), specificity (0.739 vs 0.634), negative predictive value (0.920 vs 0.714) and DOR (28.491 vs 8.526). Subgroup analysis showed that screening for severe dysplasia or more severe disease was significantly more sensitive, but less specific, than screening for all dysplasias.ConclusionsAlthough the diagnostic accuracy of TB in the diagnostic work‐up of oral cancer and pre‐cancer was higher than that of clinical examination, it was not high enough for TB to reliably be used alone. Instead, it should be combined with chemiluminescence or other diagnostic tools.

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The implications of variations in nasal irrigation recipes in the United Kingdom

\nJoshua D Whittaker, \nTimothy Reynolds, \nPatrick K Lee\n

Publicatie 11-11-2020


AbstractObjectiveThis study aims to investigate the variations in publicly available nasal irrigation recipes published in the United Kingdom (UK).DesignInternet searches used to identify eligible nasal irrigation recipes. These were then examined for their physical and biochemical properties, through theoretical calculations and experimental measurement.SettingRecipes produced by healthcare providers or official national bodies in the UK.ParticipantsNo human participants.Main outcome measuresSolution osmolality (classified into hypo‐, iso‐ and hyper‐tonic), acidity (pH) and specific gravity.Results13 unique recipes were identified from 17 sources. Osmolality ranged from 166.2 to 1492.2 mosmol/kg in volumes ranging from 142 to 1136 mls (isotonic range 275‐295 mosmol/kg). Specific gravity ranged from 1.006 to 1.034. pH ranged from 7.74 to 8.11. No recipe produced a solution with isotonic properties. The majority produced hypertonic irrigations.ConclusionsMost publicly available nasal irrigation recipes produce hypertonic solutions but there is great variability in the osmolality and volume. UK organisations should take action to review published recipes to bring these into alignment with latest guidelines (recommending against hypertonic saline use) and reduce variability in patient interpretations.

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Role of specific IgE on staphylococcal enterotoxin B in chronic rhinosinusitis severity

\nSuk Won Chang, \nJeong Jin Park, \nChi Sang Hwang, \nJae Sung Nam, \nJong‐Gyun Ha, \nWasan F. Almarzouq, \nChang‐Hoon Kim, \nJoo‐Heon Yoon, \nHyung‐Ju Cho\n

Publicatie 10-11-2020


AbstractObjectiveTo investigate the clinical significance of specific IgE‐staphylococcal enterotoxin B (IgE‐SEB) in CRS (chronic rhinosinusitis).DesignRetrospective analysis of patients who were positive for specific IgE‐staphylococcal enterotoxin B.SettingTertiary rhinology clinic.ParticipantsA total of 965 patients who were tested for specific IgE‐staphylococcal enterotoxin B from December 2016 to December 2017Main outcome measuresWe retrospectively reviewed the records of 965 patients who were tested for specific IgE‐staphylococcal enterotoxin B from December 2016 to December 2017. Patient demographics, titre specific IgE to staphylococcal enterotoxin B levels, MAST, serologic test, and medical records were reviewed.ResultsIgE‐SEB (KU/L) was higher in CRS patients than Non‐CRS patients (0.13±0.37 vs 0.08±0.22, respectively; p‐value: 0.044), and the IgE‐SEB (+, ≥0.35) rate was also higher (10.06% vs 4.46%, respectively; p‐value: 0.030). IgE‐SEB (KU/L) was higher in the CRS group than in the fungal sinusitis group (0.13±0.37 vs 0.03±0.05, respectively; p‐value: <0.001), and the IgE‐SEB (+, ≥0.35) rate was also higher (10.06% vs 0 %, respectively; p‐value: 0.015). Between the CRSsNP (chronic rhinosinusitis without nasal polyps) and CRSwNP (chronic rhinosinusitis with nasal polyps) groups, there were no differences in IgE‐SEB (KU/L) or IgE‐SEB (+) rates. IgE‐SEB positivity was not associated with the presence of polyps, concomitant asthma, or postoperative recurrence. As the values of IgE‐SEB(KU/L) and the IgE‐SEB (+,>0.1) rate increased, the CRS severity also increased.ConclusionsIgE‐SEB showed a positive correlation with Lund‐Mackay CT severity score, but not with postoperative recurrence or nasal polyps. Further studies are needed to obtain clear evidence that IgE‐SEB can be considered as an independent CRS endotype.

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Awake endoscopic assessment of the upper airway during tidal breathing: Definition of anatomical features and comparison with drug‐induced sleep endoscopy

\nEli Van de Perck, \nAnneclaire V. Vroegop, \nSara Op de Beeck, \nMarijke Dieltjens, \nAnnelies E. Verbruggen, \nPaul H. Van de Heyning, \nMarc J. Braem, \nOlivier M. Vanderveken\n

Publicatie 10-11-2020


AbstractObjectivesAwake nasopharyngoscopy is routinely performed in the assessment of patients who require treatment for sleep‐disordered breathing (SDB). However, the applicability and accuracy of Müllers manoeuvre, the main evaluation method for this purpose, are disputable. The current study aimed to introduce an alternative method for awake nasopharyngoscopy in patients with SDB.DesignWe defined qualitative anatomical features during tidal breathing at the levels of the soft palate, oropharynx, tongue base, epiglottis and hypopharynx, and compared these awake features to the sites and patterns of collapse as observed during drug‐induced sleep endoscopy (DISE).SettingTertiary care academic centre.ParticipantsSeventy‐three patients diagnosed with SDB.Main outcome measuresThe primary outcome measure was the Kendalls tau correlation coefficient (τ) between observations during awake nasopharyngoscopy and DISE. Kappa‐statistics (κ) were calculated to assess the agreement on awake endoscopic features with a second observer.ResultsIn contrast to epiglottis shape, the modified Cormack‐Lehane scale was significantly associated with epiglottis collapse during DISE (P < .0001; τ = .45). Other upper airway features that were correlated with DISE collapse were the position of the soft palate (P = .007; τ = .29), crowding of the oropharynx (P = .026; τ = .32) and a posteriorly located tongue base (P = .046; τ = .32). Interobserver agreement of endoscopic features during tidal breathing was moderate (0.60 ≤ κ < 0.80).ConclusionThe current study introduces a comprehensive and reliable assessment method for awake nasopharyngoscopy based on anatomical features that are compatible with DISE collapse patterns.

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An enhanced recovery programme improves the comfort and outcomes in children with obstructive sleep apnoea undergoing adenotonsillectomy: A retrospective historical control study

\nYu Zhang, \nDawei Liu, \nXiumei Chen, \nJiahai Ma, \nXicheng Song\n

Publicatie 07-11-2020


AbstractObjectiveTo explore the effects of an enhanced recovery after surgery (ERAS) programme on postoperative rehabilitation in children with obstructive sleep apnoea (OSA) during the perioperative period of adenotonsillectomy.DesignA retrospective historical control study.SettingService improvement project.ParticipantsThe study included 394 children with OSA (207 males, 187 females; age range, 2.5 years to 14 years) who underwent adenotonsillectomy.Main outcome measuresThe children who had undergone adenoidal ablation and bilateral tonsillectomy were divided into an ERAS group (208 patients) treated with the combined optimisation measures and a control group (186 patients) treated with traditional measures during the perioperative period. The postoperative incidence of complications, pain scores, anxiety scores and postoperative diets in the two groups were assessed.ResultsPatients in the ERAS group had significantly a lower overall complication rate and incidence of fever for 2 weeks of follow‐up when compared to patients in the control group through the application of perioperative optimisation measures. Furthermore, patients in the ERAS group had less post‐surgical pain, had better dietary intake at days 1, 3 and 7 after surgery and had lower preoperative anxiety scores after admission education and while waiting in the operation room.ConclusionThe ERAS programme consisting of combined optimisation measures can reduce physical and psychological trauma during the perioperative period of adenotonsillectomy performed for children with OSA.

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Development of a model to predict vestibular schwannoma growth: An opportunity to introduce new wait and scan strategies

\nMayke A. Hentschel, \nGerjon Hannink, \nStefan C. A. Steens, \nJef J. S. Mulder, \nMaroeska M. Rovers, \nHenricus P. M. Kunst\n

Publicatie 06-11-2020


AbstractObjectivesTo develop a prediction model to predict vestibular schwannoma (VS) growth for patients in a wait and scan (W&S) strategy.DesignRetrospective cohort study.SettingTertiary hospital (Radboud university medical center, Nijmegen, the Netherlands).ParticipantsPatients with unilateral VS, entering a W&S strategy and at least one follow‐up MRI available. Data on demographics, symptoms, audiometry and MRI characteristics at time of diagnosis were collected from medical records.Main outcome measuresFollowing multiple imputation, a multivariable Cox regression model was used to select variables, using VS growth (≥2 mm) as outcome. Decision curve analyses (DCA) were performed to compare the model to the current strategy.ResultsOf 1217 analysed VS patients, 653 (53.7%) showed growth during follow‐up. Balance complaints (HR 1.57 (95% CI: 1.31‐1.88)) and tinnitus complaints in the affected ear (HR 1.36 (95% CI: 1.15‐1.61)), Koos grade (Koos 1 is reference, Koos 2 HR 1.03 (95% CI: 0.80‐1.31), Koos 3 HR 1.55 (95% CI: 1.16‐2.06), Koos 4 HR 2.18 (95% CI: 1.60‐2.96)), time since onset of symptoms (IQR HR 0.83 (95% CI: 0.77‐0.88) and intrameatal diameter on MRI (IQR HR 1.67 (95% CI: 1.42‐1.96)) were selected as significant predictors. The models discrimination (Harrells C) was 0.69 (95% CI: 0.67‐0.71), and calibration was good. DCA showed that the model has a higher net benefit than the current strategy for probabilities of VS growth of >12%, 15% and 21% for the first consecutive 3 years, respectively.ConclusionsPatients with balance and tinnitus complaints, a higher Koos grade, short duration of symptoms and a larger intrameatal diameter at time of diagnosis have a higher probability of future VS growth. After external validation, this model may be used to inform patients about their prognosis, individualise the W&S strategy and improve (cost‐)effectiveness.

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In‐scalp incision technique for cochlear implantation

\nHisashi Sugimoto, \nMiyako Hatano, \nTomokazu Yoshizaki\n

Publicatie 03-11-2020


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The role of nasal congestion as a defence against respiratory viruses

\nRonald Eccles\n

Publicatie 01-11-2020


AbstractIntroductionThis review discusses how nasal congestion may have benefits as a mechanism of defence against respiratory viruses.MethodsA literature research was conducted on respiratory viruses and nasal congestion, following a recently published review on how temperature sensitivity is important for the success of common respiratory viruses.ResultsThe literature reported that common respiratory viruses are temperature sensitive and replicate well at the cooler temperatures of the upper airways (32°C), but replication is restricted at body temperature (37°C). The amplitude of the phases of congestion and decongestion associated with the nasal cycle was increased on infection with respiratory viruses and this caused unilateral nasal congestion and obstruction. Nasal congestion and obstruction increase nasal mucosal temperature towards 37°C and therefore restricted the replication of respiratory viruses.ConclusionNasal congestion associated with the nasal cycle may act as a mechanism of respiratory defence against infection with respiratory viruses.

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Predictors of OSA following adenotonsillectomy in children with trisomy 21

\nDiogo Raposo, \nMarco Menezes, \nJoão Rito, \nMafalda Trindade‐Soares, \nCristina Adónis, \nHelena Cristina Loureiro, \nFilipe Freire\n

Publicatie 31-10-2020


AbstractObjectivesGiven that 30%‐50% of children with trisomy 21 have persistent obstructive sleep apnoea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA severity after adenotonsillectomy.DesignRetrospective study.SettingSecondary care hospital.ParticipantsRetrospective review of 32 children with the diagnosis of trisomy 21 and OSA by polysomnography who underwent adenotonsillectomy, from January 2010 to December 2018.Main outcome and measureNon‐parametric analysis was used to compare pre‐ and postoperative factors, and regression was used to model persistent OSA and OSA severity.ResultsThirty‐two children were included (17 males, median age 10.00 ± 8.00 years, median body mass index z‐score 0.89 ± 1.25). Overall, adenotonsillectomy resulted in a significant improvement in median obstructive apnoea‐hypopnoea index (oAHI) from 7.5 ± 8.95 to 4.40 ± 4.38 events per hour (P < .001) and in median OSA‐18 score from 85.00 ± 12.00 to 61.00 ± 37.75 (P < .001). Persistent OSA was found in 56.25% of the children. Univariate regression suggests that postoperative OSA‐18 score was associated with persistent OSA after adenotonsillectomy. Preoperative oAHI, preoperative oxygen desaturation index, pre‐ and postoperative OSA‐18 scores correlated with OSA severity after adenotonsillectomy. However, in a multivariate model only the postoperative OSA‐18 score correlated with OSA severity after adenotonsillectomy.ConclusionsAlthough adenotonsillectomy results in a significant improvement of OSA in children with trisomy 21, more than half of the children had persistent OSA. The postoperative OSA‐18 score was associated both with persistent OSA and OSA severity after adenotonsillectomy.

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Adults with inflammatory bowel disease are at a greater risk of developing chronic rhinosinusitis: A nationwide population‐based study

\nYu‐Hsuan Lin, \nCheng Li Lin, \nChia‐Hung Kao\n

Publicatie 21-10-2020


AbstractBackgroundBoth inflammatory bowel disease (IBD) and chronic rhinosinusitis (CRS) are characterised by dysregulated immune responses. Though previous studies have demonstrated the coexistence of IBD and CRS, investigations of their association using large sets of epidemiologic data are lacking.MethodsWe examined IBD and the subsequent risk of CRS in a nationwide setting. For 1 January 2000 to 31 December 2010, we identified in the National Health Insurance Dataset of Taiwan a total of 8313 patients over the age of 20 years with IBD. We randomly extracted 33 252 cases without IBD to create a comparison group matching patients by age, sex and index year. Cumulative incidences were obtained using the Kaplan‐Meier method, and we calculated risk estimates for the development of CRS using the Cox proportional hazards model.ResultsIn 295 007 person‐years, we identified 521 (1.25%) cases of IBD. The IBD cohort had a 1.26‐fold (95% confidence interval CI, 1.17‐1.35) greater risk of developing CRS than the comparison group; for ulcerative colitis, it was 1.73‐fold (95% CI, 1.48‐2.05) and for Crohns disease it was 1.20‐fold (95% CI = 1.11‐1.29). Subsequent analysis stratified by age revealed that the risk was highest among the population with IBD aged 50 to 64 years (adjusted hazard ratio = 1.37; 95% CI, 1.18‐1.59). A follow‐up‐specific analysis demonstrated that the risk appeared to be highest with a follow‐up duration of less than 2 years.ConclusionThe present analysis indicates that personal history of IBD, especially the phenotype ulcerative colitis, is associated with increased risk of subsequent CRS.

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Rhinology in the COVID‐19 era: Our experience from a rhinology tertiary referral hospital and implications for future practice

\nJennifer C. Magill, \nSamit Unadkat, \nElizabeth Bullock, \nMark S. Ferguson, \nCatherine Rennie, \nWilliam E. Grant, \nHesham A. Saleh\n

Publicatie 21-10-2020


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A prospective multicentre external validation study of the Liverpool Peritonsillar abscess Score (LPS) with a no‐examination COVID‐19 modification

\nDavid Selwyn, \nDing Yang, \nElliot Heward, \nAshwin Kerai, \nElinor Thompson, \nAbulgasem Shommakhi, \nScott Faulkner, \nRichard Siau, \nHussein Walijee, \nTom Hampton, \nDorota Chudek, \nSupriya Singhera, \nWaqas Din, \nAndrew S. Lau\n

Publicatie 20-10-2020


AbstractObjectivesOur primary aim was to validate the Liverpool Peritonsillar abscess Score (LPS) externally in a new patient cohort. Our secondary aim was to modify the LPS in the light of the COVID‐19 pandemic to produce a no‐examination variant for use in this instance.DesignProspective multicentre external validation study.SettingSix different secondary care institutions across the United Kingdom.ParticipantsPatients over 16 years old who were referred to ENT with any uncomplicated sore throat such a tonsillitis or peritonsillar abscess (PTA).Main outcome measuresSensitivity, specificity, positive predictive value and negative predictive value for both the original LPS model and the modified model for COVID‐19.ResultsThe LPS model had sensitivity and specificity calculated at 98% and 79%, respectively. The LPS has a high negative predictive value (NPV) of 99%. The positive predictive value (PPV) was slightly lower at 63%. Receiver operating characteristic (ROC) curve, including the area under the curve (AUROC), was 0.888 which indicates very good accuracy.ConclusionsExternal validation of the LPS against an independent geographically diverse population yields high NPV. This may support non‐specialist colleagues who may have concerns about mis‐diagnosing a PTA. The COVID‐19 modification of the LPS has a similar NPV, which may be of use where routine oral examination is to be avoided during the COVID‐19 pandemic.

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Identifying factors associated with spontaneous restoration of hearing in children with otitis media with effusion

\nLowri Edwards, \nRebecca Cannings‐John, \nChristopher Butler, \nNick Francis\n

Publicatie 20-10-2020


AbstractObjectivesTo identify predictors of acceptable hearing at 5 weeks, 6 and 12 months in children with bilateral otitis media with effusion (OME).Design and settingSecondary analysis of OSTRICH data, conducted in hospital ear, nose and throat (ENT) and paediatric audiology and audiovestibular medicine departments across Wales and England.ParticipantsThe OSTRICH study included 389 children aged 2‐8 years with bilateral hearing loss attributable toOME for at least 3 months.Main outcome measuresBaseline, 5‐week, 6‐ and 12‐month audiology measurements were collected and logistic regression models used to identify pre‐randomisation baseline variables that predicted return of acceptable hearing, which was defined as less than or equal to 20 dB hearing loss averaged within the frequencies of 0.5, 1, 2 and 4 kHz in at least one ear in children assessed by pure tone audiometry, ear‐specific insert visual reinforcement audiometry or ear‐specific play audiometry less than or equal to 25 dB hearing loss averaged within the frequencies of 0.5, 1, 2 and 4 kHz in children assessed by sound‐field visual reinforcement audiometry or sound‐field performance/play audiometry, based on national guidelines.ResultsLess severe baseline hearing loss across both ears most consistently predicted acceptable hearing at 5 weeks (adjusted odds ratio aOR 0.91, 95% CI 0.87‐0.95), 6 months (0.94 0.90‐0.98) and 12 months (0.93 0.89‐0.97). Negative history of atopy (2.05 1.16‐3.61), never using hearing aids (aOR 2.16 1.04‐4.48), and being male (1.75 1.02‐2.99) were significant at 6 months, but not at 12 months. Symptom duration was a predictor at 5 weeks, but not at 6 or 12 months.ConclusionsMilder baseline hearing loss most consistently predicts acceptable hearing at 5 weeks, 6 and 12 months in children with chronic OME. Negative history of atopy, never using hearing aids, and male gender are associated with better prognosis. These predictors can be used to identify children that may not require treatment.

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Lithuanian version of nasolacrimal duct obstruction symptom scoring questionnaire. Cross‐cultural adaptation and validation. Short‐ and long‐term results

\nTomas Jakštas, \nTomas Balsevičius, \nSaulius Vaitkus, \nEvaldas Padervinskis\n

Publicatie 19-10-2020


AbstractObjectivesThe objective of this study was to perform translation, cross‐cultural adaptation and validation of the Lithuanian version of specific nasolacrimal duct obstruction symptom scoring (NLDO‐SS) questionnaire and to evaluate short‐ and long‐term results of endoscopic endonasal dacryocystorhinostomy (EN‐DCRS) procedure.Design, Setting, ParticipantsPermission for questionnaire translation, cross‐cultural adaptation and validation was obtained from the authors of the original questionnaire. Translation, validation and cross‐cultural adaptation were carried out according to generally accepted methodology. Validation study of the Lithuanian version of NLDO‐SS (L‐NLDO‐SS) was performed, and short‐ and long‐term results of EN‐DCRS procedure were evaluated according to symptoms. In total, 44 patients were evaluated 2 weeks before the surgical intervention, a day before the surgery and 41 patients 2 months after the surgery, and again 10 months later.Main outcome measuresWe analysed the internal consistency and test‐retest reliability of the L‐NLDO‐SS questionnaire. Cronbachs alpha was used to represent and evaluate internal consistency for ordinal responses. Validity was assessed by comparing scores between a control group of volunteers without NLDO and the NLDO group using Mann‐Whitney test. To test the limiting score on which the sensitivity and specificity curves cross in identifying patients with NLDO, receiver operating characteristic (ROC) curve analysis was used. The pre‐ and post‐operative scores were compared using the paired t‐test.ResultsThe results showed an acceptable internal consistency of L‐NLDO‐SS questionnaire, with Cronbachs alpha—.73 in the initial test group and .71 in the retest group. Pearsons correlation coefficient was .94 (P < .001), revealing good correlation between the initial scores and the retest scores. Our sample of healthy individuals had a mean L‐NLDO‐SS score of 11.42 (±12.69) points, and patients being scheduled for EN‐DCRS had a mean L‐NLDO‐SS score of 27.45 (±9.81) points. Post‐operatively mean L‐NLDO‐SS scores improved from 27.45 (±9.81) points to 4.45 (±6.29) points in the short term and to 5.83 (±4.17) in the long term, demonstrating the statistically significant responsiveness of the instrument over both timescales.ConclusionsLithuanian version of NLDO‐SS questionnaire is a valid instrument for assessing patients with NLDO in the Lithuanian population. It demonstrated good internal consistency, reproducibility, validity and responsiveness.

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Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography

\nNikul Amin, \nAbigail Walker, \nIsam Alobid, \nShahram Anari, \nFlorian Bast, \nRajiv K. Bhalla, \nRussell Cathcart, \nPhilip G. Harries, \nIain Hathorn, \nCarl M. Philpott, \nYujay Ramakrishnan, \nBenjamin Stew, \nPavol Surda, \nFiona Ting, \nClaire Hopkins\n

Publicatie 19-10-2020


AbstractObjectivesConebeam computed tomography (CBCT) imaging is commonly requested by dental implant surgeons, preoperatively, for patients being considered for dental implants. Incidental maxillary sinus findings often result in otolaryngology (ENT) referral for further assessment.CBCT findings include transient and benign mucosal changes that may not require any intervention and therefore unnecessarily delay implant surgery.We aim to define appropriateness criteria for ESS in the management of adult dental implant patients with incidental maxillary sinus findings on CBCT and provide guidance to both dental implant and ENT surgeons.DesignThe RAND/UCLA appropriateness methodology was used to develop and define the appropriateness criteria.SettingA virtual panel of 13 international experts in ESS.ParticipantsThe expert panel completed two rounds of a modified Delphi ranking process for nine clinical scenarios, considering various factors affecting decision‐making processes.Main outcome measuresTo define appropriateness criteria for ESS in adult dental implant patients who have incidental maxillary sinus findings on CBCT.ResultsPatients with clinical symptoms and endoscopic findings of chronic rhinosinusitis together with an obstructed ostiomeatal complex (OMC) and concentric mucosal thickening of the ipsilateral maxillary sinus or pansinusitis were deemed appropriate candidates for ESS prior to their dental implant. ESS was not appropriate in asymptomatic patients with a patent OMC and mucosal thickening isolated to floor of the ipsilateral maxillary sinus.For uncertain scenarios, further discussion between dental implant and ENT surgeon should be considered.ConclusionsThis study has developed and reported a list of appropriateness criteria to offer ESS in adult dental implant patients with incidental maxillary sinus findings on CBCT.

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Emergency airway training: “Who are you going to FONA?”

\nSanjana Bhalla, \nIssa Beegun, \nChris Hogan, \nZaid Awad, \nNeil Tolley\n

Publicatie 19-10-2020


AbstractObjectivesTo demonstrate face and content validity of a home‐made simulation model as a training tool for front of neck access (FONA) procedures.DesignThis was a prospective evaluation study, in which experienced otolaryngologists and trainees were recruited to complete 3 tasks using our FONA model.SettingThe study was completed during regular simulation training days and international conferences.ParticipantsA total of 52 participants completed the questionnaire and were included in the study; 25 were experts and 27 were trainees.Main outcome measuresAll participants completed a validated 15‐item questionnaire using a 5‐point likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task‐specific content (TSC) and curriculum applicability (CTR).ResultsThere were no statistically significant differences between the groups ratings for FV, GC, TSC or CTR (P = .76, .13, .4 and .67, respectively). The model achieved a median FV of 4 (IQR 4‐5) with the agreement of experienced and trainee groups (68.9% and 92%, respectively). The median GC validity score was 5 (IQR 4‐5) with the agreement of 87.6% and 98.4% in respected groups. The model achieved a median TSC of 4.8 (IQR 4‐5) with the agreement of 54.5% and 99% in respected groups. The median CTR score was 5 (IQR 4‐5) with the agreement of 54.4% and 100% in respected groups.ConclusionOur home‐made FONA model achieved face and content validity for training and is safe and affordable for teaching basic front of neck access skills to otolaryngology trainees.

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Preradiation tooth extraction and jaw osteoradionecrosis: Nationwide population‐based retrospective study in Taiwan

\nPei‐Hsun Liao, \nChi‐Hsiang Chu, \nPei‐Ling Tang, \nPei‐Chen Wu, \nTsu‐Jen Kuo\n

Publicatie 19-10-2020


AbstractObjectiveRadiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national healthcare database, we reviewed the contraindications and analysed other risk factors for ORNJ.DesignA retrospective cohort study.SettingBy using Taiwans National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1‐21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included. The patients were divided into two groups according to the time of tooth extraction before the index day: 1‐7 days and 8‐21 days.ParticipantsTaiwanese patients with head and neck cancer.Main Outcomes MeasureUnivariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ.ResultsThe overall incidence of ORNJ in the included patients was 1.03% (mean follow‐up duration, 4.07 ± 3.01 years; range, 1.00‐13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio HR =0.734; P = .312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488) and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all P < .001).ConclusionIn a mean follow‐up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7‐21 days before RT.

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Comparative cohort study of volumetric modulated arc therapy for squamous cell cancer of unknown primary in the head and neck—Involved neck only versus mucosal irradiation

\nWai‐Yan Poon, \nMaureen Thomson, \nPhilip McLoone, \nChristina Wilson, \nRobin Crosbie, \nStefano Schipani, \nDerek Grose, \nAllan James, \nCarolynn Lamb, \nMohammed Rizwanullah, \nFrances Campbell, \nFiona Easton, \nClaire Paterson\n

Publicatie 19-10-2020


AbstractObjectivesTarget volumes for irradiation remain ill‐defined for squamous cell cancer of unknown primary in the head and neck (SCCUP). The aim of this study was to compare involved neck only (INO) radiotherapy (RT) with irradiating involved neck plus potential mucosal primary sites and contralateral neck (MUC) in patients diagnosed and treated with modern diagnostics and techniques.DesignThis is a retrospective cohort study. Patients with a diagnosis of SCCUP with unilateral neck disease were included.ResultsThirty patients were identified. All underwent FDG PET‐CT. 47% of patients had HPV‐positive SCC. 20 patients received RT to INO, 10 patients to MUC, all with volumetric modulated arc therapy (VMAT). A significantly lower dose for each organ at risk was delivered in INO‐treated patients, with mean dose to contralateral parotid gland 57% less. The proportion of patients with late grade 2 or worse xerostomia was higher in MUC patients. The incidence of grade 2‐3 mucositis (89% vs 45%) and grade 3 or worse dysphagia (50% vs 10%) was higher in MUC patients. Median follow‐up was 31 months. No mucosal primaries emerged. Progression‐free survival at 2 years was 74.7% for INO patients, 70% in the MUC group. Overall survival at 2 years was 79.7% in the INO group and 70% in the MUC patients.ConclusionINO radiotherapy for patients with SCCUP of the head and neck is a safe treatment strategy resulting in clinically significant lower RT doses to OARS. Acute and late toxicities are reduced without detriment to patient survival.

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Prospective anatomical study to determine the site of insertion of recurrent laryngeal nerve into the larynx

\nJames X. Wu, \nMartin Hanson, \nShivangi Lohia, \nHao Li, \nLaura Wang, \nAshok R. Shaha, \nIan Ganly\n

Publicatie 19-10-2020


AbstractObjectivesDetermine whether the insertion site of the recurrent laryngeal nerve (RLN) occurs at a predictable distance from the midline trachea, to help guide safe dissection during thyroid surgery.DesignProspective clinical trial. At the inferior edge of the cricoid cartilage, we measured the distance from mildline trachea to the RLN insertion site.SettingSingle institution.Participants50 consecutive patients undergoing thyroid surgery.Main outcome measuresDistance from midline trachea to laryngeal insertion of RLN.ResultsThe study population included 36 women and 14 men, with 72 total nerves measured. The average distance‐to‐midline + standard deviation (range) of the RLN was 20.7 + 2.3 (17‐26) mm in women compared to 26.3 + 2.1 (22‐32) mm in men.ConclusionThe insertion point of the RLN into the larynx at the level of inferior border of the cricoid cartilage can be reliably predicted, to facilitate early identification of the RLN during thyroid surgery.

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Surgiflo® may have a potential impact on the healing process in cricotracheal resection anastomosis

\nAhmed Musaad Abd El‐Fattah, \nHisham Atef Ebada, \nAli Tawfik\n

Publicatie 19-10-2020


AbstractObjectivesTo evaluate the role of thrombin‐based haemostatic agent Surgiflo® (Ethicon) in improving the outcome of cricotracheal resection anastomosis.DesignRandomised controlled clinical trial.SettingOtorhinolaryngology Department, Mansoura University Hospitals, Egypt.ParticipantsThis study included 55 patients with grade III and IV subglottic and/or cervical tracheal stenosis, who underwent cricotracheal resection anastomosis. Patients were randomly assigned into two groups: Surgiflo group (n = 20) and control group (n = 35). In Surgiflo patients, Surgiflo® was applied at the end of surgery over the whole operative field including the line of airway anastomosis with the purpose of adequate haemostasis and enhancing healing of the anastomosis.Main outcome measuresThe success rate and the incidence of complications in both groups were compared.ResultsAt the end of treatment, decannulation rate was 95% (19/20) in the Surgiflo groups and 82.8% (29/35) in the control group. The overall incidence of complications was significantly lower in the Surgiflo group (P = .021). Need for further surgical airway interventions in the form of repeated dilatation, granulation tissue removal or performing a tracheotomy was reported in 22.9% (8/35) of control group patients, in comparison with 5% (1/20) in Surgiflo group.ConclusionDirect Surgiflo® application in the operative field enhances the anastomotic healing, decreases the incidence of anastomotic complications and subsequently improves the outcome. It can be recommended as an adjuvant to surgery in patients undergoing cricotracheal resection anastomosis.

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Locoregional control, progression‐free survival and morbidity rates in N3 head and neck cancer patients with low primary tumour burden: A 301‐patient study

\nFlorent Carsuzaa, \nXavier Dufour, \nPhilippe Gorphe, \nChristian Righini, \nAlain Cosmidis, \nMaximilien Rogé, \nErwan De Mones, \nStéphanie Servagi Vernat, \nDenis Tonnerre, \nSylvain Morinière, \nAmaury Dugas, \nOlivier Malard, \nFrançois Pasquier, \nSébastien Vergez, \nUlrike Schick, \nMichael Gérard, \nJulia Salleron, \nJuliette Thariat\n

Publicatie 19-10-2020


AbstractObjectivesIn patients with N3 head and neck squamous cell carcinoma (HNSCC), N3 disease is associated with high regional relapse and metastatic risks. Patients with resectable N3 disease have better prognosis although their metastatic risk may be similar as in patients with unresectable disease. Neoadjuvant chemotherapy has been associated with lower metastatic rates, but N3 patients may die of rapid locoregional progression. We assessed outcomes with the three modalities in patients with low primary burden to better assess the specific prognosis of N3 disease.MethodsThis retrospective multicentric study included T0‐2 N3 HNSCC patients. Outcomes and morbidity in upfront neck dissection (uND) vs non‐surgical groups were analysed and oncological outcomes and morbidity compared between patients undergoing chemoradiation or neoadjuvant chemotherapy in patients with initially unresectable N3 nodes.ResultsOf 301 patients, 142 (47%) underwent uND, 68 (23%) neoadjuvant chemotherapy and 91 (30%) chemoradiation. The 24‐ and 60‐month incidence of locoregional relapse was 23.2% 18.3%; 28.4% and 27.4% 21.8%; 33.3%; it was lower in patients undergoing uND (P = .006). In patients with non‐surgical treatments, success rates were 57.8% 49.4%; 66.3% after chemoradiation and 38.1% 29.6%; 46.7% after neoadjuvant chemotherapy (P = .001). Overall morbidity was more frequent in patients undergoing uND (68.8%) (P < .001).ConclusionuND improved locoregional control but increased morbidity and showed no survival benefit. Success rates were better after chemoradiation versus neoadjuvant chemotherapy. Neoadjuvant chemotherapy did not reduce metastatic rates but non‐responders to chemoradiation had poor PFS and survival rate, suggesting that predictive criteria are warranted.

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Polysomnography in children with obstructive sleep apnoea and neurocognitive disorders

\nArvind Chandrakantan, \nDeep Patel, \nMica Glaun, \nDeepak Mehta, \nMary F. Musso, \nAmee Patel, \nAdam C. Adler\n

Publicatie 19-10-2020


AbstractObjectiveThe neurocognitive associations in paediatric obstructive sleep apnoea (OSA) are well known; however, whether polysomnographic features can predict these associations is unknown. Therefore, the primary objective of this study was to compare common polysomnographic parameters in children with OSA in the presence and absence of neurocognitive dysfunction.MethodsPolysomnography data for children ages 3‐6 years with mild‐moderate OSA who as defined by AHI between 5 and 10 were analysed from a single sleep centre at a tertiary paediatric hospital from January 2016 to December 2018. The following parameters were identified: arousals per hour, percentage of time asleep, apnoea‐hypopnoea index (AHI), oxygen desaturation nadir during sleeps, baseline oxygen saturation during sleep, time spent with SpO2 less than 90%, maximum transcutaneous CO2, per cent of the total sleep time spent with TcCO2 greater than 50 mmHg, age, body mass index (BMI), gender and type of disability in the neurocognitive dysfunction group. Neurocognitive diagnoses were recorded. Those with syndromic comorbidities were excluded. The study cohort was then compared to a cohort of 200 subjects with OSA and no neurocognitive disorders matched for age, gender and BMI. A paired column analysis by chi‐squared analysis was then undertaken between the two groups.ResultsA total of 200 children were identified (126 males and 74 females) in the neurocognitive dysfunction group (OSA with neurocognitive dysfunction) and compared with 200 children in the control group (OSA without neurocognitive dysfunction) (113 males and 87 females). There were no statistical differences between groups.ConclusionCommonly used polysomnographic indices are not predictive of neurocognitive dysfunction in paediatric OSA.

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Outcomes of a multidisciplinary Ear, Nose and Throat Allied Health Primary Contact outpatient assessment service

\nChristopher L. Payten, \nJennifer Eakin, \nTamsin Smith, \nVicky Stewart, \nCatherine J. Madill, \nKelly A. Weir\n

Publicatie 19-10-2020


AbstractBackgroundTraditionally, patients are seen by an ear, nose and throat (ENT) surgeon prior to allied health referral for treatment of swallowing, voice, hearing and dizziness. Wait‐times for ENT consultations often exceed those clinically recommended. We evaluated the service impact of five allied health primary contact clinics (AHPC‐ENT) on wait‐times and access to treatment.SettingA metropolitan Australian University Hospital Outpatient ENT Department.ParticipantsWe created five AHPC‐ENT pathways (dysphonia, dysphagia, vestibular, adult and paediatric audiology) for low‐acuity patients referred to ENT with symptoms of dysphonia, dysphagia, dizziness and hearing loss.Main outcome measuresUsing multiple regression analysis, we compared waiting times in the 24‐month pre‐ and 12‐month post‐implementation of the AHPC‐ENT service. In addition, we measured the number of patients requiring specialist ENT intervention after assessment in the AHPC‐ENT, adverse events and evaluation of service delivery costs.ResultsSeven hundred and thirty‐eight patients were seen in the AHPC‐ENT over the first 12 months of implementation (dysphagia, 66; dysphonia, 153; vestibular, 151; retro‐cochlear, 60; and paediatric glue ear, 308). All pathways significantly reduced the waiting times for patients by an average of 277 days, compared with usual care. The majority of patients were able to be discharged without ongoing ENT intervention (72% dysphagia; 81% dysphonia; 74% vestibular; 53% retro‐cochlear; and 32% paediatric glue ear). No adverse events were recorded.ConclusionsThe AHPC‐ENT improved waiting times for assessment and access to treatment. Future research on cost‐effectiveness and diagnostic agreement between AHPs and ENT clinicians would provide further confidence in the model.

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Acknowledging personal biases in otolaryngology manuscript selection

\nWilliam James Moss\n

Publicatie 19-10-2020


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Letter to the Editor in reference to: Interspecialty referral of oesophagogastric and pharyngolaryngeal cancers delays diagnosis and reduces patient survival: A matched case‐control study

\nJohn E. Fenton\n

Publicatie 19-10-2020


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Floseal: A novel application technique for the treatment of challenging epistaxis

\nQuentin Bonduelle, \nTimothy C Biggs, \nFabian Sipaul\n

Publicatie 19-10-2020


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Endopharyngeal Ultrasound: description of a novel technique to overcome a common diagnostic dilemma in a patient with a deep neck space mass

\nTaha Mur, \nOsamu Sakai, \nLauren Tracy, \nKei Suzuki, \nDaniel Faden\n

Publicatie 19-10-2020


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Our experience of the increased rates of post‐tonsillectomy haemorrhage in 1538 children with pre‐operative infective symptoms or signs

\nJames Johnston, \nAaron Vergeer, \nNatasha Donaldson, \nSubhaschandra Shetty, \nMurali Mahadevan\n

Publicatie 19-10-2020


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Letter to editor: A systematic review of the incidence of thyroid carcinoma in patients undergoing thyroidectomy for thyrotoxicosis

\nOvie Edafe, \nSabapathy P. Balasubramanian\n

Publicatie 19-10-2020


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Management of cN0 low‐grade mucoepidermoid carcinomas of salivary glands: Prospective multicentre study of 152 cases of the French Network of Rare Head and Neck Tumors (REFCOR)

\nLaurie Saloner Dahan, \nRoch Giorgi, \nRenaud Garrel, \nLudovic Le Taillandier de Gabory, \nValérie Costes‐Martineau, \nPhilippe Herman, \nGilles Poissonnet, \nOlivier Mauvais, \nOlivier Malard, \nSébastien Vergez, \nEmmanuelle Uro‐Coste, \nBéatrix Barry, \nChristine Bach, \nDominique Chevalier, \nFrancois Mouawad, \nJean‐Claude Merol, \nVianney Bastit, \nJuliette Thariat, \nLaurent Gilain, \nXavier Dufour, \nChristian‐Adrien Righini, \nPatrick Dessi, \nJustin Michel, \nThomas Radulesco, \nCaroline Even, \nBertrand Baujat, \nNicolas Fakhry\n

Publicatie 19-10-2020


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How many patients will be eligible for cochlear implantation (CI) on audiological grounds, once the new 2019 NICE guidance takes effect? Evaluation of audiological data for the population of East Kent to estimate cochlear implantation eligibility based on NICE 2019 guidance (TA566) and NICE 2009 guidance (TA166)

\nRobert Grounds, \nEleojo Miachi, \nTina Beckham, \nCodruta Neumann, \nJoseph Wasson\n

Publicatie 19-10-2020


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Clinical outcome of exclusive endoscopic tympanoplasty with porcine small intestine submucosa in 72 patients

\nChin‐Kuo Chen, \nLi‐Chun Hsieh\n

Publicatie 19-10-2020


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Concurrent chemoradiotherapy with low‐dose weekly platinum agent for head and neck carcinoma

\nMasayuki Kitano, \nTsuyoshi Kojima, \nYusuke Okanoue, \nShintaro Fujimura, \nSeiji Oyagi, \nKazuhiko Shoji, \nRyusuke Hori\n

Publicatie 19-10-2020


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Drainless head and neck surgery: A retrospective review of 156 procedures (thyroidectomy, parotidectomy and neck dissections in a tertiary setting)

\nEleanor J. Crossley, \nTimothy C. Biggs, \nMandar Jog, \nKonstantinos Marinakis, \nFabian Sipaul, \nPhillip Brown, \nTahwinder Singh\n

Publicatie 19-10-2020


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Issue Information

Publicatie 19-10-2020


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Retraction: Increased maternal serum placental growth hormone variant in pregnancies complicated by otosclerosis

Publicatie 19-10-2020


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Is loss of sense of smell a diagnostic marker in COVID‐19: A systematic review and meta‐analysis

\nJohn Rocke, \nClaire Hopkins, \nCarl Philpott, \nNirmal Kumar\n

Publicatie 19-10-2020


AbstractAimsTo systematically review the currently available evidence investigating the association between olfactory dysfunction (OD) and the novel coronavirus (COVID‐19). To analyse the prevalence of OD in patients who have tested positive on polymerase chain reaction (PCR) for COVID‐19. To perform a meta‐analysis of patients presenting with olfactory dysfunction, during the pandemic, and to investigate the positive predictive value for a COVID‐19‐positive result in this population. To assess whether olfactory dysfunction could be used as a diagnostic marker for COVID‐19 positivity and aid public health approaches in tackling the current outbreak.MethodsWe systematically searched MedLine (PubMed), Embase, Health Management Information Consortium (HMIC), Medrxiv, the Cochrane Library, the Cochrane COVID‐19 Study Register, NIHR Dissemination centre, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify the current published evidence which associates coronaviridae or similar RNA viruses with anosmia. The initial search identified 157 articles. A total of 145 papers were excluded following application of our exclusion criteria. The 12 remaining articles that presented evidence on the association between COVID‐19 and olfactory dysfunction were critically analysed.ResultsOlfactory dysfunction has been shown to be the strongest predictor of COVID‐19 positivity when compared to other symptoms in logistic regression analysis. In patients who had tested positive for COVID‐19, there was a prevalence of 62% of OD. In populations of patients who are currently reporting OD, there is a positive predictive value of 61% for a positive COVID‐19 result.ConclusionOur review has shown that there is already significant evidence which demonstrates an association between OD and the novel coronavirus—COVID‐19. It is unclear if this finding is unique to this coronavirus as individual viral phenotypes rarely present in such concentrated large numbers. We have demonstrated that OD is comparatively more predictive for COVID‐19 positivity compared to other associated symptoms. We recommend that people who develop OD during the pandemic should be self‐isolate and this guidance should be adopted internationally to prevent transmission.

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Post‐Treatment Head and Neck Cancer Care: National Audit and Analysis of Current Practice in the United Kingdom

\nINTEGRATE (UK ENT Trainee Research Network), \nMatthew Ellis, \nGeorge Garas, \nJohn Hardman, \nMaha Khan, \nHisham Mehanna, \nMatthew E. Smith, \nTheofano Tikka, \nKishan Ubayasiri, \nRichard Williams, \nG. Garas, \nJ. Hardman, \nM. Khan, \nH. Mehanna, \nM.E. Smith, \nT. Tikka, \nK. Ubayasiri, \nR. Williams, \nC. Swords, \nG. Wilson, \nR. Hone, \nR. Siau, \nT. Hampton, \nO. Mclaren, \nJ. Fleming, \nT. Biggs, \nJ. Fussey, \nM. Farr, \nR. Steven, \nD. Yiannakis, \nJ. Adams, \nB. Wright, \nK. Davies, \nD. Dick, \nM. Adams, \nH Jones, \nT. Myuran, \nS. Goh, \nM. Dowling, \nJ. Sinnott, \nA. Hardy, \nE. Halliday, \nJ. Virk, \nF. Ahmed, \nJ. Walton, \nB. van Beugen, \nN. Hope, \nM. Edmond, \nK. Lau, \nT. Ahmed, \nD. Nair, \nK. Varadharajan, \nD. Lin, \nL. Ferguson, \nS. Mahalingam, \nY. Kamhieh, \nM. Afiq Slim, \nT. Tornari, \nA. Abdel‐Rahim, \nK. Hutson, \nA. Millington, \nT. Moorhouse, \nE. Farrar, \nS. Doumas, \nU. Kamel, \nP. Coyle, \nD. McAnerney, \nO. Mirza, \nD. Leopard, \nT. Saunders, \nL. McMurran, \nL. Johnstone, \nT. Oremule, \nJ. Bates, \nA. Iacovidou, \nN. Upile, \nR. Chessman, \nR. Mcleod, \nT. Milner, \nR. Cheong, \nA. Gaunt, \nK. To, \nA. Tse, \nD Yap, \nE Noon, \nM Cresswell, \nA.S. Mallick, \nW. Crookes, \nC. Corner, \nN. Walker, \nR. Ricks, \nS. Healy, \nW. Kendall, \nG Fragkiadakis, \nK. Conroy, \nA. Pervez, \nN. Caton, \nR. Balakumar, \nC. Smith, \nA. Waters, \nR Advani, \nM. Shaker, \nE. Schecter, \nZW Liu, \nK. Karamali, \nS. Alvi, \nB. Cosway, \nD. Thorley, \nM. Williams, \nP. Bijoor, \nB. Anwar, \nN. Hamilton, \nG. Moghul, \nS. Ansari, \nN. Mahon, \nS. Hey, \nH. Lancer, \nR. Ghedia, \nS. Dewhurst, \nM. Cherko, \nA. Carter, \nD. Pennell\n

Publicatie 18-10-2020


AbstractObjectivesWe aimed to audit current United Kingdom (UK) practice of Head and Neck Cancer (HNC) post‐treatment surveillance against national guidelines and determine the outcomes of these practices in detecting recurrence.DesignNational cross‐sectional study of current HNC surveillance practice.SettingUK HNC outpatient departments.ParticipantsHNC patients reviewed for post‐treatment surveillance.Main outcome measuresCompliance with UK multidisciplinary guidelines and rates of cancer recurrence detection by time, clinic type and symptoms.ResultsData were analysed from 5,123 consultations across 89 UK centres. 30% of consultations were in dedicated multidisciplinary clinics, with input from allied health professionals (AHPs) available on the day in 23% of all consultations. Recurrence was suspected in 344 consultations and investigated with MRI in 29.6% (n = 102) and PET‐CT in 14.2% (n = 49). Patient education regarding recurrence symptoms, and smoking and alcohol advice, was provided in 20.4%, 6.2% and 5.3% of cases, respectively. Rates of recurrence detected were 35% in expedited appointments and 5.2% in planned follow‐ups (P = .0001). Of the expedited appointments, 63% were initiated by patients and 37% by clinicians. Recurrence was higher in those with new symptoms (7.1% versus 2.2%). The strongest predictors of recurrence were dyspnoea (positive predictive value (PPV)=16.2%), neck pain (PPV = 10.4%) and mouth/throat pain (PPV = 9.2%).ConclusionsDedicated multidisciplinary clinics comprise a minority of consultations for HNC surveillance in the UK, with low availability of AHPs. PET‐CT and MRI were underutilised for the investigation of suspected recurrence. There may be scope for greater emphasis on patient education and consequent patient‐initiated symptom‐driven follow‐up.

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Efficacy of argon‐helium cryoablation and its effects on immune function of patients with neck malignant tumours

\nZheng Zheng, \nYingchun Zhao, \nYonghui An, \nNa Li, \nChangwen Bo, \nWenhua Ma, \nYing Guo, \nChangpeng Zou, \nBo Tian, \nSujing Zhang\n

Publicatie 15-10-2020


AbstractObjectivesOur study aimed to investigate the clinical efficacy of argon‐helium cryoablation and its effects on the immune function of patients with neck malignant tumours.DesignRetrospective study.SettingSingle‐institution academic tertiary care centre.MethodsTotally, 180 patients harbouring head and neck malignant tumours were divided into the argon‐helium cryoablation group (n = 150) and the radiotherapy group (n = 50). The efficacy of the two groups was compared, and the immune function was observed.ResultsThe short‐term clinical effect of the argon‐helium cryoablation group was significantly higher than that of the radiotherapy group (P < .05). After treatment, the CD3+, CD4+, CD8+ and CD4+/CD8+ of the argon‐helium cryoablation group were significantly better than those of the radiotherapy group (P < .001). The results of TNF‐α, IL‐1 β and CRP in the argon‐helium cryoablation group were significantly better than that in the radiotherapy group (P < .001).ConclusionArgon‐helium cryoablation could effectively improve the immune function, 5‐year survival rate and local remission rate.

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A low fidelity Peritonsillar Abscess Drainage Simulator—Our experience of feedback from 117 trainees

\nDorota Alicja Chudek, \nImogen Wilson, \nEmma Hogg, \nHannah Emerson, \nElliot Heward, \nDing Yang, \nDavid Selwyn, \nAndrew S. Lau\n

Publicatie 09-10-2020


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Sublingual immunotherapy vs placebo in the management of grass pollen‐induced allergic rhinitis in adults: A systematic review and meta‐analysis

\nDominika Boldovjáková, \nSara Cordoni, \nCraig John Fraser, \nAimee Beth Love, \nLorna Patrick, \nGary James Ramsay, \nAaron Stephen James Ferguson, \nAnas Gomati, \nBhaskar Ram\n

Publicatie 09-10-2020


AbstractIntroductionAllergic rhinitis (AR) is a common inflammatory condition of the nasal mucosa affecting approximately 20% of the population worldwide. Current therapies include intranasal antihistamines, corticosteroids, subcutaneous and sublingual immunotherapy (SLIT). This review and meta‐analysis assess the efficacy of SLIT in the management of grass pollen‐induced AR in adults.MethodsOvid EMBASE, Ovid EBM Reviews, Cochrane Central Register of Controlled Trials, Ovid MedLine and PubMed were searched using the following terms: ‘sublingual immunotherapy’, ‘SLIT’, ‘rhinitis’, ‘allergic rhinitis’, ‘rhinosinusitis’ and ‘rhino‐conjunctivitis’. All included studies were double‐blind, placebo‐controlled and randomised trials. Primary outcome was symptom score and secondary outcome included quality of life and safety profile. Meta‐analysis of symptom improvement was carried out.ResultsSix studies were identified with 979 subjects randomly allocated to SLIT and 992 to a placebo control. All studies reported an improvement in symptoms with SLIT, with five reaching statistical significance (P < .05). Four studies reported statistically significant improvement in quality of life (P < .05). Oral pruritus was the most common adverse event reported. The overall risk of bias was high in 50% of the studies.ConclusionsSublingual immunotherapy was a safe and effective treatment for grass pollen‐induced AR in adults, and therefore, consideration should be given to its use for moderate‐to‐severe disease in the UK‐wide population.

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Quantitative comparison of endoscopically assisted endonasal, sublabial and transorbital transmaxillary approaches to the anterolateral skull base

\nBon‐Jour Lin, \nDa‐Tong Ju, \nTzu‐Hsien Hsu, \nYi‐An Chen, \nTzu‐Tsao Chung, \nWei‐Hsiu Liu, \nDueng‐Yuan Hueng, \nYuan‐Hao Chen, \nChung‐Ching Hsia, \nHsin‐I Ma, \nMing‐Ying Liu, \nChi‐Tun Tang\n

Publicatie 08-10-2020


AbstractObjectivesThe aim of this anatomical study is to make quantitative comparison among three endoscopic approaches, encompassing contralateral endonasal transseptal transmaxillary transpterygoid approach (contralateral EEA), endoscopic sublabial transmaxillary transalisphenoid (Caldwell‐Luc) approach and endoscopic transorbital transmaxillary approach through inferior orbital fissure (ETOA), to the anterolateral skull base for assisting preoperative planning.Design & ParticipantsAnatomical dissections were performed in four adult cadaveric heads bilaterally using three endoscopic transmaxillary approaches described above.SettingSkull Base Laboratory at the National Defense Medical Center.Main outcome measuresThe area of exposure, angles of attack and depth of surgical corridor of each approach were measured and obtained for statistical comparison.ResultsThe ETOA had significantly larger exposure over middle cranial fossa (731.40 ± 80.08 mm2) than contralateral EEA (266.60 ± 46.74 mm2) and Caldwell‐Luc approach (468.40 ± 59.67 mm2). In comparison with contralateral EEA and Caldwell‐Luc approach, the ETOA offered significantly greater angles of attack and shorter depth of surgical corridor (P < .05 for all comparisons).ConclusionsThe ETOA is the superior choice for target lesion occupying multiple compartments with its epicentre located in the middle cranial fossa or superior portion of infratemporal fossa.

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Subtotal functional sialoadenectomy vs four‐duct ligation for the treatment of drooling in neurologically impaired children: Long‐term follow‐up

\nFrancesco De Peppo, \nRomina Caccamo, \nMaria Carmen Garganese, \nEmanuela Ceriati, \nPaola Marchetti, \nOttavio Domenico Adorisio, \nAntonella Cerchiari, \nSonia Battaglia\n

Publicatie 08-10-2020


AbstractObjectivesThe best surgical option to treat drooling in neurodisabilities is still under debate. The aim of this study was to describe the technique of subtotal functional sialoadenectomy (SFS) (ie four‐duct ligation (4‐DL) together with bilateral sublingual gland excision) and its long‐term outcomes, in comparison with 4‐DL.DesignRetrospective observational cohort study.SettingUnit of Pediatric Surgery of Bambino Gesù Childrens Hospital (Rome).ParticipantsSeventy‐five patients surgically treated for drooling between 2002 and 2012, with at least five years of follow‐up, divided into two groups: 4‐DL group (19 patients) underwent four‐duct ligation, and SFS group (56 patients) underwent subtotal functional sialoadenectomy.Main outcome measuresPrimary end points were the evaluation of drooling improvement after surgery (parameters: Drooling Severity and Frequency Scale, DSFS; no of bibs/day; no of shirts/day; no of pneumonia/year; use of antidrooling drugs) and the comparison between two different surgical techniques.ResultsMedian age at surgery was 10 years (1‐35). Long‐term outcomes showed significant improvement in DSFS and in no of shirts/day in both groups. Significantly better results were found in the SFS group than in the 4‐DL group as far as DSFS (P value .045), no of bibs/day (P value .041), no of shirts/day (P value .032) are concerned. Reoperation rate for recurrence was 42% in the 4‐DL group and 0% in the SFS group (P value < .0001). Six patients (8%; 2 in the 4‐DL group and 4 in the SFS group) experienced perioperative complications, while 4 patients (5%; 2 in the 4‐DL group and 2 in the SFS group) recorded long‐term complications, with no difference between groups neither need for surgical treatment. No surgery‐related mortality was recorded.ConclusionsIn our experience, subtotal functional sialoadenectomy ensured significantly greater long‐term effects than four‐duct ligation for drooling treatment in neurologically impaired child, with equal complication rate.

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Quality‐of‐life changes following three‐dimensional printing of prosthesis for large nasal septal perforations—Our experience of 13 patients

\nGaurav S. Medikeri, \nGrace C. Khong, \nSarah Fleming, \nTaran Malhotra, \nSamuel C. Leong\n

Publicatie 04-10-2020


AbstractNasal septal perforations can be caused by a number of aetiology including intra‐nasal drug abuse, trauma and iatrogenic causes.

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Otorhinolaryngology litigation in England: 727 clinical negligence cases against the National Health Service

\nAnnakan Victor Navaratnam, \nAhmad Hariri, \nCherrie Ho, \nJohn T Machin, \nTim WR Briggs, \nAndrew Marshall\n

Publicatie 02-10-2020


AbstractIntroductionLitigation against the National Health Service (NHS) in England is rising. The aim of this study was to determine the incidence and characteristics of otorhinolaryngology clinical negligence claims in England.MethodsA retrospective review was undertaken of all clinical negligence claims in England held by NHS Resolution relating to otorhinolaryngology between April 2013 and April 2018. Analysis was performed using information for cause, patient injury and claim cost. Where claim information was adequately detailed, the authors categorised claims by subspecialty, diagnosis and surgery.ResultsA total number of 727 claims were identified with an estimated potential cost of £108 million. Out of these, 463 were closed claims. Including open claim reserves, the mean cost of a claim was £148 923. Head and neck surgery was the subspecialty with the highest number of claims (n = 313, 43%) and highest cost (£51.5 million) followed by otology (n = 171, £24.5 million) and rhinology (n = 171, £13.6 million). Over half of claims were associated with an operation (n = 429, 59%) where mastoid surgery (n = 46) and endoscopic sinus surgery (n = 46) were equally associated with the greatest number of claims. The most frequent causes for clinical negligence claims included failure or delay to diagnose (n = 178, 25%), failure or delay to treat (n = 136, 19%), intra‐operative complications (n = 130, 18%) and failure of the consent process (n = 107, 15%).DiscussionClinical negligence claims in otorhinolaryngology are related to several different components of patient management and are not limited to postoperative complications. This study highlights the importance of robust pathways in out‐patient diagnostics and the consenting process in order to deliver better patient care and reduce the impact of litigation.Keywordsinformed consent, malpractice, clinical negligence claims, litigation, otolaryngology

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Manuka honey versus saline sinus irrigation in the treatment of cystic fibrosis‐associated chronic rhinosinusitis: A randomised pilot trial

\nVictoria S. Lee, \nIan M. Humphreys, \nPatricia L. Purcell, \nGreg E. Davis\n

Publicatie 02-10-2020


AbstractObjectivesManuka honey attacks biofilms, which contribute to bacterial persistence in cystic fibrosis sinusitis. The primary objective was to determine feasibility of investigating manuka honey as an irrigation treatment for cystic fibrosis sinusitis and secondarily to assess the treatments preliminary effectiveness.DesignProspective, single‐blinded (clinician only), randomised, parallel two‐arm pilot trial.SettingTertiary rhinology clinic.ParticipantsSubjects had recalcitrant cystic fibrosis sinusitis and previous sinus surgery. They received manuka honey or saline sinus irrigations twice daily for 30 days.Main Outcome MeasuresMain outcomes were recruitment/retention rates and tolerability. Preliminary effectiveness was assessed based on quality‐of‐life Sinonasal Outcome Test‐22 and Lund‐Kennedy endoscopic change scores and post‐treatment culture negativity.ResultsOver 10 months, 13 subjects were enrolled, and 77% (10/13) were included in the analysis. Manuka honey irrigations were well‐tolerated. The quality‐of‐life change score was clinically significant for manuka honey (−9 −14,−6) but not saline (−5 −9,−1), although the difference was not statistically significant (P = .29). Lund‐Kennedy endoscopic change score was significantly better for manuka honey (−3 −5,−3) versus saline (0 0,0) (P = .006). There was no difference in post‐treatment culture negativity between manuka honey (1/5, 20%) and saline (0/5, 0%) (P = 1.00).ConclusionsManuka honey irrigations were well tolerated, and retention rates were high. Preliminary data showed that manuka honey achieved a clinically important difference in quality‐of‐life score and a significantly better endoscopic outcome. Microbiological control was difficult to achieve. A future definitive trial would require multi‐institutional recruitment.

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Revised 15‐item Glasgow Benefit Inventory with five factors based on analysis of a large population study of medical and surgical otorhinolaryngological interventions

\nGeorge G. Browning, \nHaytham Kubba, \nWilliam M. Whitmer\n

Publicatie 29-09-2020


AbstractObjectivesTo review, using confirmatory factor analysis, the widely used 18‐question Glasgow Benefit Inventory GBI that has three factors. Thereafter to develop, using exploratory factor analysis, a more coherent, revised version of the GBI.DesignConfirmatory and exploratory factor analysis of a large national GBI data set of ORL interventions.SettingAdult otorhinolaryngology outpatient clinics in six University Hospital departments.ParticipantsOne thousand nine hundred eighty adult patients who had complete GBI data and who underwent an active (medical or surgical) intervention, out of the total data set of 9005 patients from the original Scottish ENT Outcome Study SENTOS.ResultsOne of the 18 questions was discarded from the data base because it was not answered by 8% of respondents. Two of the original factors remained (Physical Health, renamed General Health, and Social Support, renamed Support). The General factor was split into three new factors (Quality of Life, Self‐Confidence and Social Involvement). The three new factors were found to give additional information regarding the area of benefit.This reduced number of questions does not make any material difference to the results of the >196 existing GBI papers in the literature.ConclusionA 15‐question GBI with five factors is provided that is more explanatory of the areas of benefit.

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Three‐dimensional printing to compare endoscopic endonasal surgical approaches: A technical note

\nValentin Favier, \nYaser Najaf, \nArnaud Damecourt, \nGérard Subsol, \nGuillaume Captier, \nJulien Boetto, \nLouis Crampette\n

Publicatie 27-09-2020


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Regenerative efficacy of fibroblast growth factor for the treatment of aged vocal fold: From animal model to clinical application

\nMyung Jin Ban, \nSeung Chul Lee, \nJae Hong Park, \nKi Nam Park, \nHee Kyung Kim, \nSeung Won Lee\n

Publicatie 24-09-2020


AbstractObjectivesWe assessed fibroblast growth factor (FGF) regenerative efficacy in an aged vocal fold rat model and confirmed it in a prospective clinical trial.Design, setting, and participantsFor animal experiments, 48 Sprague‐Dawley rats were divided into two groups: 24 six‐month‐olds (young group) and 24 twenty‐four‐month‐olds (old group). FGF was injected once a week thrice into the left vocal fold of the old group, dividing them into two sub‐groups (injected left and uninjected right). Additionally, we conducted a prospective clinical trial for 38 patients with aged atrophic vocal fold.Main outcome measuresA month post‐injection, excised larynx from the three groups was subjected to comparative histopathological (ratio of relative lamina propria to total vocal fold) and mRNA expression analysis (of procollagen I, hyaluronic acid synthase (HAS)‐2 and matrix metalloproteinase (MMP)‐2) by real‐time PCR. We performed perceptual, stroboscopic, acoustic aerodynamic test and Voice Handicap Index survey prior to and 1, 6 and 12 months after FGF injection.ResultsIn rats, the relative lamina propria ratio increased after FGF injection. Procollagen I mRNA level decreased, whereas that of HAS‐2 and MMP‐2 increased significantly in the injected compared to the uninjected old group. Enrolled patients showed improved subjective and objective voice parameters after FGF injection, and these were maintained for a year. Potential side effects were not observed.ConclusionsAnimal experiments and prospective clinical trial suggest that FGF injection to vocal fold can significantly improve voice quality until one year, without complications, and is effective for aged atrophic vocal fold treatment.

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Management of new onset loss of sense of smell during the COVID‐19 pandemic ‐ BRS Consensus Guidelines

\nClaire Hopkins, \nMikkel Alanin, \nCarl Philpott, \nPhil Harries, \nKatherine Whitcroft, \nAli Qureishi, \nShahram Anari, \nYujay Ramakrishnan, \nAnshul Sama, \nElgan Davies, \nBen Stew, \nSimon Gane, \nSean Carrie, \nIain Hathorn, \nRaj Bhalla, \nChrissi Kelly, \nNina Hill, \nDuncan Boak, \nB. Nirmal Kumar\n

Publicatie 24-09-2020


AbstractObjectivesThe primary aim of the study is to provide recommendations for the investigation and management of patients with new onset loss of sense of smell during the COVID‐19 pandemic.DesignAfter undertaking a literature review, we used the RAND/UCLA methodology with a multi‐step process to reach consensus about treatment options, onward referral, and imaging.Setting and participantsAn expert panel consisting of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists.Main outcome measuresThe panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset loss of sense of smell during the COVID‐19 pandemic. Using a 9‐point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean.ResultsConsensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A drops. Alpha‐lipoic acid was not recommended, olfactory training was recommended for all patients with persistent loss of sense of smell of more than 2 weeks duration, and oral steroids, steroid rinses, and omega 3 supplements may be considered on an individual basis. Recommendations regarding the need for referral and investigation have been made.ConclusionThis study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID‐19‐related loss of sense of smell. The guideline may evolve as our experience of COVID‐19 develops.

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Analysis of reflux as the aetiology of laryngeal dysplasia progression through a matched case‐control study

\nWei Gu, \nYan‐Yan Niu, \nWen‐Ze Wang, \nZhi‐Yong Liang, \nXiao‐Feng Jin, \nHong Huo, \nJian Wang\n

Publicatie 24-09-2020


AbstractObjectivesLaryngeal dysplasia (LD) is a precancerous lesion of the larynx. In this study, the laryngeal tissue of patients with laryngeal dysplasia was taken as the research object, and the aetiology of reflux was analysed.MethodPatients with laryngeal dysplasia after surgery were selected as our subjects. The levels of pepsin, enterokinase and bilirubin in laryngeal tissue samples of the two groups were detected by immunohistochemical method.ResultsThe OR values (95% CI) of pepsin, enterokinase and bilirubin were 0.67 (0.19‐2.36), 0.80 (0.22‐2.98) and 1.33 (0.30‐5.96), respectively, in the univariate analysis. Besides, in the multivariate analysis, the OR values (95% CI) of pepsin, enterokinase and bilirubin were 0.57 (0.14‐2.30), 0.73 (0.18‐2.92) and 1.40 (0.30‐6.53), respectively.ConclusionLarger sample size should be applied to prospective studies on whether reflux is a risk factor for laryngeal cancer.

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Olfactory changes after endoscopic sinus surgery for chronic rhinosinusitis: A meta‐analysis

\nRui Zhao, \nKai Chen, \nYuedi Tang\n

Publicatie 23-09-2020


AbstractBackgroundEndoscopic sinus surgery (ESS) is an important treatment modality for chronic rhinosinusitis (CRS). However, its effect on olfaction remains controversial.Objective of reviewTo assess the olfactory impact of ESS in patients with CRS.Type of reviewA meta‐analysis.Search strategyA systematic literature search in the PubMed, EMBASE and Cochrane Library databases was conducted to identify studies that assessed change in olfaction after ESS in patients with CRS. Search terms were related to paranasal sinus diseases, smell and endoscopy.Evaluation methodThe extracted data included authors, publication year, study type, age, sex, diagnostic criteria, surgical mode, sample size, follow‐up time, olfaction measurement tool and outcome. We analysed the olfactory changes as continuous variables.ResultsThirty‐five studies including 3164 patients with CRS were eligible for the meta‐analysis. Among patients having CRS with nasal polyps, olfactory dysfunction improved, as assessed by the Sniffin Sticks total score (P = .000), Sniffin Sticks discrimination score (P = .023), Sniffin Sticks identification score (P = .005), University of Pennsylvania Smell Identification Test (P = .046) and Visual Analogue Scale (P = .000). However, the threshold score of the Sniffin Sticks test did not improve significantly (P = .361). Olfactory dysfunction did not improve in patients having CRS without nasal polyps according to the University of Pennsylvania Smell Identification Test (P = .404). In non‐classified CRS patients, improvement in olfactory dysfunction was observed according to the University of Pennsylvania Smell Identification Test (P = .000), Visual Analogue Scale (P = .001) and Questionnaire of Olfactory Disorders‐Negative Statements (P = .001). However, there were no significant improvements according to the Brief Smell Identification Test (P = .325), Sniffin Sticks threshold score (P = .160) and Sniffin Sticks identification score (P = .079).ConclusionEndoscopic sinus surgery may be beneficial for improvement in olfactory conditions in patients with CRS. Further thorough and comprehensive studies need to be conducted.

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HPV genotype is a prognosticator for recurrence of respiratory papillomatosis in children

\nRodrigo L. Nogueira, \nDaniel S. Küpper, \nCaroline M. Bonfim, \nDavi C. Aragon, \nThiago A. Damico, \nCarolina S. Miura, \nIvna M. Passos, \nMaurício L. Nogueira, \nPaula Rahal, \nFabiana C. P. Valera\n

Publicatie 22-09-2020


AbstractObjectivesThis study aimed to compare the prognosis according to age, genotype or human papillomavirus (HPV) variant in patients with recurrent respiratory papillomatosis (RRP).DesignNon‐concurrent cohort.ParticipantsForty one patients with RRP.SettingTertiary referral hospital.Main Outcome MeasuresDisease severity was defined by the number of surgeries performed, and Derkay score at surgeries, obtained from medical records. HPV was detected and genotyped, and HPV‐6 variants were also assessed.ResultsFifteen (36.58%) individuals belonged to the juvenile RRP group (JoRRP, less than 18 years), while 26 patients (63.41%) were allocated at the adult group (AoRRP, equal or more than 18 years). JoRRP patients needed, in average, a higher number of surgeries to control the disease than AoRRP patients (mean difference: 3.36). Also, JoRRP patients showed a higher Derkay score at each surgery (mean difference: 3.76). There was no significant difference in the number of surgeries when we compared patients infected with HPV‐6 or HPV‐11, neither in accordance to HPV‐6 variants. Patients with HPV‐11 presented a higher mean Derkay score at surgery than those with HPV‐6 (mean difference: 4.39); when co‐variated by age, we observed that this difference occurred only among JoRRP patients (mean difference: 6.15).ConclusionsAge of onset of RRP has an important impact on number of surgeries to control disease. Patients with JoRRP and HPV‐11 tend to present worse Derkay score at each surgery. HPV genotype among adults and HPV‐6 variants had no impact on the outcome of the disease.

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Using post‐operative trend in C‐reactive protein to predict fistula in neopharyngeal repairs following laryngectomy and pharyngectomy surgery in fifty‐five patients

\nEdwin Halliday, \nAjith George\n

Publicatie 22-09-2020


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Audiological Performance in Children with Inner Ear Malformations Before and After Cochlear Implantation: A Cohort Study of 274 Patients

\nHilal Burcu Ozkan, \nBetul Cicek Cinar, \nEsra Yucel, \nGonca Sennaroglu, \nLevent Sennaroglu\n

Publicatie 22-09-2020


AbstractBackground and ObjectiveInner ear malformations (IEMs) are common in children with hearing loss. The different types of IEMs form a unique subgroup of cochlear implant (CI) candidates. We aimed to evaluate the auditory perception outcomes of CI in children with different types of IEMs and compare them with CI users without IEMs.MethodsThe study included 274 CI users with and without IEMs as two groups (n = 137, each). Both groups’ chronological age at implantation and duration of CI usage was matched (± 8 months). All subjects were evaluated pre‐operatively and post‐operatively by the Lings sound test and the auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), closed‐set Pattern Perception Test (PPT) and open‐set Sentence Recognition Test (SRT). Besides, children with IEMs were assessed for language development.ResultsProgress in the IEMs’ group differed according to the type of ear anomaly. CI users with enlarged vestibular aqueduct had the highest scores, while users with common cavity had the lowest. Children with IEMs performed well on the closed‐set test while having difficulty with the open‐set test.ConclusionCochlear implantation outcomes are favourable in IEMs’ patients with a cochlear nerve visible on magnetic resonance imaging. Our results indicate that it is critical to take the anatomical differences into account during follow‐up and rehabilitation programmes. Each CI user should be evaluated according to his or her individual needs.

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Impact of bile acids on the severity of laryngo‐pharyngeal reflux

\nEugenio De Corso, \nSilvia Baroni, \nGiampiero Salonna, \nMichele Marchese, \nMarilena Graziadio, \nGIovanni Di Cintio, \nGaetano Paludetti, \nGuido Costamagna, \nJacopo Galli\n

Publicatie 17-09-2020


AbstractObjectivesThe primary end point of this study was to evaluate the impact of bile acids on severity of laryngo‐pharyngeal reflux (LPR) and the possible correlation with esophagitis and upper airway malignancies. The second end point was to evaluate if salivary bile acids and molecules other than pepsin might serve as diagnostic biomarkers of LPR.DesignObservational prospective comparative study.SettingOtorhinolaryngology unit of a tertiary hospital.ParticipantsSixty‐two consecutive adult outpatients suspected of LPR.Main outcome measuresBile acids, bilirubin and pepsinogen I‐II were measured in saliva. Patients underwent pH metry and based on the results of bile acids were subdivided as acid, mixed and alkaline LPR.ResultsSignificantly higher Reflux Findings Score (RFS) and Reflux Symptoms Index (RSI) were seen in patients with alkaline and mixed LPR compared to acid LPR. Salivary bile acids >1 µmol/L seem to be a reliable indicator of the severity of LPR. Compared to those without, patients with esophagitis or a history of upper airway malignancy have high concentrations of bile acids in saliva. Among the molecules studied, bile acids were the most suitable for diagnosis of LPR, with a sensitivity of 86% and a positive predictive value of 80.7%.ConclusionsOur data suggest that high concentrations of bile acids are associated with higher values of RSI and RFS in LPR as well as a higher risk of esophagitis and history of upper airway malignancies. We finally observed that bile acids provided the best biometric parameters for diagnosis of LPR among the molecules tested.

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Video laryngoscope‐guided (GlideScope®) injection of botulinum toxin in laryngectomy patients with limited neck extension

\nYadsan Devabalan, \nAkshat Malik, \nMargaret Coffey, \nPeter Clarke\n

Publicatie 17-09-2020


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Long‐term outcomes of juvenile‐onset recurrent respiratory papillomatosis

\nYang Xiao, \nXianxiang Zhang, \nLijing Ma, \nJun Wang\n

Publicatie 17-09-2020


AbstractObjectiveTo investigate the adult outcomes of children with juvenile‐onset recurrent respiratory papillomatosis via long‐term follow‐up.Study DesignRetrospective study.SettingBeijing Tongren Hospital.ParticipantsThe study includes 121 patients with recurrent respiratory papillomatosis.Main outcome and measureWe followed up respiratory papillomatosis patients aged least 14 years and analysed their clinical features based on recurrence‐free time.ResultsIn total, 112 (92.6%) patients underwent three or more operations. The age at initial operation was 4.3 ± 2.9 years; 47.9% (58/121) experienced recurrence and underwent surgical treatment after age 14. At follow‐up, 5% (6/121) had died, 41.3% (50/121) had been recurrence‐free for 5 years or more (cured group), and 53.7% (65/121) had recurrence in the past 5 years (recurrent group). The age at the last operation was 9.2 ± 4.6 years in the cured group. The overall operation frequency was higher in the recurrence group than in the cured group (17.8 ± 11.9 vs 8.7 ± 6.5). Additionally, the human papillomavirus (HPV) infection and tracheal dissemination rates were higher in the recurrence group than in the cured group (90.8% 59/65 vs 54.0% 27/50 and 26.2% 17/65 vs 10% 5/50, respectively).ConclusionThe mortality rate for juvenile‐onset recurrent respiratory papillomatosis is 5%. Approximately 50% of children experience recurrence and require repeated operations in adulthood. No significant difference in sex, age at initial operation or adjuvant therapy between the cured and recurrent groups was observed; however, significant between‐group differences were found in overall operation frequency, aggressive disease, tracheal dissemination of papilloma, and HPV infection.

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Treating twenty‐five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase®): A case series

\nShayan Shahidi, \nAbdul Nassimizadeh, \nChris Coulson\n

Publicatie 17-09-2020


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Targeted skull base biopsies in the management of central skull base osteomyelitis

\nRegi Thomas\n

Publicatie 17-09-2020


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The validity of the Acoustic Breathiness Index in the evaluation of breathy voice quality: A Meta‐Analysis

\nBen Barsties v. Latoszek, \nGeun‐Hyo Kim, \nJonathan Delgado Hernández, \nKiyohito Hosokawa, \nMarina Englert, \nKatrin Neumann, \nSvetlana Hetjens\n

Publicatie 17-09-2020


AbstractBackgroundThe evaluation of voice quality with acoustic measurements is useful to objectify the diagnostic process. Particularly, breathiness was highly evaluated and the Acoustic Breathiness Index (ABI) might have promising features.Objective of reviewThe goal of the present meta‐analysis is to quantify, from existing cross‐validation studies, the evidence for the diagnostic accuracy of ABI, including its sensitivity and specificity.Type of reviewMeta‐analysis.Search strategyWe searched in MEDLINE, Google Scholar and Science Citation Index, and as manual search for the term Acoustic Breathiness Index from inception to February 2020.Studies were included that used equal proportion of continuous speech and sustained vowel segments, a recording hardware with a sufficient standard for voice signal analyses, the software Praat for signal processing and the customised Praat script, and two groups of subjects (vocally healthy and voice‐disordered). Furthermore, the diagnostic accuracy of ABI was measured.Evaluation methodThe primary outcome variable was ABI. The score ranged from 0 to 10 with varying thresholds according to different languages to determine the absence or presence of breathiness.A meta‐analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses of diagnostic test accuracy study guidelines. Data were extracted, and the risk of bias was assessed using the QUADAS‐2 tool. The pooled sensitivity and specificity of ABI were determined using a summary receiver operating characteristic (SROC) approach to calculate also a weighted threshold value of ABI with its sensitivity and specificity.ResultsA total of 34 unique citations were screened, and 10 full‐text articles were reviewed, including six studies. In total, 3603 voice samples were considered for further analysis separating into 467 vocally healthy and 3136 voice‐disordered voice samples. The pooled sensitivity was 0.84 (95% CI, 0.83‐0.85), and the pooled specificity was 0.92 (95% CI, 0.89‐0.94). The area under the curve of the SROC curve of this analysis showed an excellent value of 0.94. The weighted ABI threshold was determined at 3.40 (sensitivity: 0.86, 95% CI, 0.84‐0.87.; specificity: 0.90, 95% CI 0.88‐0.92).ConclusionsThe results confirm the ABI as robust and valid objective measure for evaluating breathiness.

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Pan‐Scotland tonsillectomy outcomes: A national cross‐sectional study

\nThomas D. Milner, \nOmar Hilmi, \nJohn Marshall, \nKenneth MacKenzie\n

Publicatie 16-09-2020


AbstractObjectivesThe aim of this study was to assess the current post‐tonsillectomy haemorrhage and return to theatre rates in Scotland.DesignNational cross‐sectional study.Participants and settingTonsillectomy outcomes data were collated for all NHS patients undergoing tonsillectomy in Scotland between 1998‐2002 and 2013‐2017.Main outcome measuresUsing Information Services Division (ISD) Scotland retrospective data, 30‐day re‐admission and 30‐day return to theatre rates allowed an assessment of post‐tonsillectomy haemorrhage rates. Data were validated through comparison with an audit conducted in NHS Greater Glasgow & Clyde between 2015 and 2016.ResultsTonsillectomy was performed in 27 819 patients between 1998 and 2002, and 23 184 patients between 2013 and 2017. 30‐day re‐admission rates increased considerably between the 1998‐2002 and 2013‐2017 cohorts, from 4.7% to 12.1% in paediatric patients, and 9.8%‐19.9% in adult patients. Similarly, 30‐day “return to theatre rates” increased between the two cohorts, from 1.2% to 1.7% in paediatric patients, and 3.6%‐4.9% in adult patients. Re‐admission and return to theatre rates were similar across Health Boards for both adult and paediatric tonsillectomies in each cohort.ConclusionsCurrent 30‐day re‐admission and return to theatre rates are significantly higher than the majority of reported series to date. The rising rate of tonsillectomy haemorrhage between cohorts is likely to be multifactorial, possibly reflecting an underestimation of previous rates and the changing profile of the tonsillectomy patient. A detailed audit of current practice is needed to investigate these tonsillectomy outcomes, which are similar across all Health Boards in Scotland. Of most significance are the implications for accurate patient consent and non‐elective ENT service provision.

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Trends in tonsillectomy surgery in children in Scotland 2000‐2018

\nHaytham Kubba, \nLaura S. Downie\n

Publicatie 16-09-2020


AbstractBackgroundTonsillectomy is one of the most common surgical procedures in children but indications and surgical practice change over time.ObjectivesWe aimed to identify trends in tonsillectomy procedures in children, in particular the number of procedures performed, the age of child undergoing tonsillectomy and the type of hospital in which the surgery was performed.DesignReview of Scottish Morbidity Records data (SMR01) which are routinely collected after everyday case procedure or overnight stay in all Scottish NHS hospitals.SettingAll NHS hospitals in all 14 Scottish health boards.ParticipantsAll children (0‐16 years) undergoing tonsillectomy, 2000‐2018.Main outcome measuresNumber of tonsillectomy procedures; rate of tonsillectomy per 1000 children in the population; number of children aged 0‐2 years and 3‐4 years undergoing tonsillectomy; health board in which the surgery occurred; diagnostic coding for these episodes; length of stay and readmission within 30 days of surgery.ResultsDuring 2000‐2018, there were 50,208 tonsillectomies performed in children in Scotland (mean 2642/year). The number of tonsillectomies per year remained constant (R = 0.322, P = .178) but tonsillectomies performed in children 0‐2 years rose from 0.41 to 1.56 per 1000 (R = 0.912, P < .001), and 3‐4 years from 3.06 to 6.93 per 1000 (R = 0.864, P < .001). The proportion of all childrens tonsillectomies performed up to age 4 rose from 20.6% to 35.9% and up to age 2 from 2.4% to 8.1%. All specialist childrens hospitals showed a significant increase in surgery in very young children.ConclusionsTonsillectomy rates remained static between 2000 and 2018, despite a falling population. More tonsillectomies are now performed for obstructive sleep apnoea, at a young age and in regional childrens hospitals. This has important implications for the workload of these specialist hospitals.

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Pathognomonic ultrasonic images of congenital pyriform sinus fistula in Children

\nChe‐Yi Lin, \nTzu‐Yu Hsiao, \nWei‐Chung Hsu\n

Publicatie 14-09-2020


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The role of upper GI flexible endoscopy in management of large pharyngeal pouches

\nSamyukta Ravisankar, \nSomayyeh Shahsavari, \nJaiganesh Manickavasagam, \nSamit Majumdar, \nPradeep Patil\n

Publicatie 13-09-2020


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Identification of putative laryngeal and pharyngeal lichen planus lesions: An endoscopic preliminary evaluation in 16 patients

"\nAntonio M. Bulfamante, \nUmberto DAgostino Fiorenza, \nPaolo Castellarin, \nCarlotta Pipolo, \nGiancarlo Cacioppo, \nGiovanni Felisati, \nAlberto M. Saibene\n"

Publicatie 09-09-2020


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New findings in a retrospective study on the efficacy of precision sound therapy of 156 tinnitus: “Drift” of tinnitus sites

\nPiao Xu, \nQiongping Lin, \nDafei Li, \nJingya Yang, \nHaiyan Zhao, \nShanshan Zhang, \nGuangyong Tian\n

Publicatie 25-08-2020


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