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Background/Objectives: Cochlear implantation (CI) is an effective intervention for individuals with severe to profound hearing loss; however, it may impact vestibular function due to its proximity to related anatomical structures. Vestibular evoked myogenic potentials (VEMPs) assess the function of the saccule and utricle, critical components of the vestibular system. This review examines CI's impact on air conduction (AC) and bone conduction (BC) VEMP responses. Methods: A scoping review was conducted following PRISMA guidelines, using databases such as Medline, Embase, Cochrane Library, Scopus, and ProQuest Dissertations. Studies reporting on AC and/or BC-VEMP in CI recipients were included. Data extraction focused on VEMP response rates, amplitudes, and latencies pre- and post-CI. Risk of bias/quality assessment was performed using the Newcastle–Ottawa Scale. Results: Out of 961 studies identified, 4 met the inclusion criteria, encompassing a total of 245 CI-implanted ears. Results indicated that AC-VEMP responses were often reduced or absent post-CI, reflecting the influence of surgical changes in the middle ear mechanics rather than otolith dysfunction. In contrast, BC-VEMP responses were more consistently preserved, suggesting that BC stimuli bypass the middle ear and more accurately delineate otolith function. Variations in VEMP outcomes were noted depending on the surgical approach and individual patient factors. Conclusions: CI impacts vestibular function as measured by VEMP, with AC-VEMP showing greater susceptibility to postoperative changes compared to BC-VEMP. The presence of preserved BC-VEMP alongside absent AC-VEMP underscores the need to differentiate between these measures in assessing vestibular function. [ABSTRACT FROM AUTHOR]

Background: Extrusion of electrodes outside the cochlea and tip fold overs may lead to suboptimal outcomes in cochlear implant (CI) recipients. Intraoperative measures such as Trans-Impedance Matrix (TIM) measurements may enable clinicians to identify electrode malposition and direct surgeons to correctly place the electrode array during surgery. Objectives: To assess the current literature on the effectiveness of TIM measurements in identifying extracochlear electrodes and tip fold overs. Methods: A scoping review of studies on TIM-based measurements were carried out using the Databases-Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Eleven full texts articles met the inclusion criteria. Only human studies pertaining to TIM as a tool used in CI were included in the review. Further, patient characteristics, electrode design, and TIM measurement outcomes were reported. Results: TIM measurements were available for 550 implanted ears with the subjects age ranged between 9 months to 89 years. Abnormal TIM measurements were reported for 6.55% (36). Tip fold over was detected in 3.64% (20) of the cases, extracochlear electrodes in 1.45% (8), and 1.45% (8) were reported as buckling. Slim-modiolar electrode array designs were more common (54.71%) than pre-curved (23.34%) or lateral wall (21.95%) electrode array. Abnormal cochlear anatomy was reported for five ears (0.89%), with normal cochlear anatomy for all other patients. Conclusion: TIM measurement is a promising tool for the intraoperative detection of electrode malposition. TIM measurement has a potential to replace intraoperative imaging in future. Though, TIM measurement is in its early stages of clinical utility, intuitive normative data sets coupled with standardised criteria for detection of abnormal electrode positioning would enhance its sensitivity. [ABSTRACT FROM AUTHOR]

Device activation typically occurs four weeks post cochlear implant surgery. Emerging evidence suggests earlier activation is feasible and beneficial, giving patients quicker access to sound and rehabilitation. Assess current literature for effects of early cochlear implant activation. Electronic searches of Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Studies investigating any aspect of early activation were included for review. From 15 studies, 625 patients received early activation, compared with 243 patients in the control groups. Early activation was considered as within 7 days post-operatively with 12 studies reporting within 1 day post-operatively, compared with standard activation of 9-46 days post-operatively in the control group. Some studies indicated earlier low levels of impedance in the early activation group. Magnet strength adjustment or off-ear processor wear was often recommended within the early activation cohort. Complication rates were low in both groups. Early activation improved patient satisfaction and anxiety levels without detriment to speech recognition or rehabilitation. Early cochlear implant activation is feasible and allows patients with no contraindications, earlier access to auditory perception and rehabilitation and reduces anxiety linked to delay in activation. Further evidence is required to monitor long-term effects of early activation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore how teleaudiology is perceived by Australian-based hearing health care stakeholders (clients, clinicians, students, academics, and industry partners) to inform future teleaudiology implementation. Method: Five cross-sectional online surveys were adopted, and a total of 366 stakeholders responded (173 clients, 110 clinicians, 58 students, 19 academics, and six industry partners). Results: Results show that 55% of clients and over 90% of clinicians, students, academics, and industry partners knew what teleaudiology was. Experience in teleaudiology appointments was shared by 85% of clinicians and 7% of clients. Moreover, 98% of clients were not offered any teleaudiology appointments. Teleaudiology apps were used by 66% of clinicians and 26% of clients. Both clients and clinicians acknowledged the benefits of teleaudiology including convenience and accessibility and identified drawbacks, such as loss of personal interaction and communication difficulty. About 80% of students and academics reported inclusion of teleaudiology within their universities' curriculum but only to a limited extent. Low teleaudiology uptake rates in placement clinics, as well as insufficient funding and staffing, were suggested as barriers to learning and teaching teleaudiology. Industry partners were generally confident in training clinicians to use teleaudiology products and teaching students on teleaudiology, but only one industry partner had been invited by universities for teaching purposes. Conclusions: Low teleaudiology use and reserved attitudes toward widespread teleaudiology implementation were observed among clients. Clinicians, students, academics, and industry partners generally displayed positive attitudes toward teleaudiology use. Increasing awareness of teleaudiology services and collaboration between stakeholders are crucial in promoting teleaudiology uptake. [ABSTRACT FROM AUTHOR]

Introduction: Penetrating Neck Injuries (PNIs) affected 3.2% of trauma patients attending US and UK deployed medical treatment facilities (MTFs) during the Iraq and Afghanistan conflicts. Injured military personnel requiring aeromedical evacuation for such injuries were managed at the Royal Centre for Defence Medicine (RCDM), Birmingham, UK. The aim of this paper was to review the management of PNI in both deployed MTFs and when evacuated back to the UK.Patients and Methods: A retrospective case note review was performed of all military patients who sustained PNI whilst on deployment overseas, and who were subsequently evacuated to RCDM between March 2003 and December 2014.Results: Forty casualties who sustained PNI were identified, of which 28/40 (70%) sustained injury from explosive fragmentation, and 11/40 (28%) from gunshot wounds. Hard signs of PNI were present in 3/40 (7.5%) patients, soft signs in 14/40 (35%), no signs in 12/40 (30%), and unknown signs in 11/40 (28%) patients. Computed tomography angiography (CTA) was used in 39/40 (98%) patients, and was effective at ruling out significant injury, with 100% (29/29) of casualties with a negative CTA not developing vascular or aerodigestive injury. There were 9/29 (31%) patients who had surgical neck exploration despite both a negative CTA and absence of hard signs of PNI. There were 12/40 (30%) patients who required operative intervention at RCDM.Conclusion: UK military surgeons in Role 3 MTFs had a low threshold for surgical exploration, even in the absence of CT findings or hard signs. This was likely due to the high-energy mechanisms responsible for military PNI, in addition to the limited availability of equipment and clinical expertise in visualising the larynx. [ABSTRACT FROM AUTHOR]

BACKGROUND: Congenital cholesteatomas account for just up to 5% of all cholesteatomas and most commonly arise in the petrous apex and middle ear. Congenital cholesteatomas arising in the mastoid are rare and typically present late. METHODS: In this study, we report a case series of 3 cases managed in our department between 2006 and 2021 and present a summary of the current literature. RESULTS: Congenital cholesteatomas arising in the mastoid is a rare finding and even among reported cases, not all are clearly mastoid in origin. Their location allows for considerable growth before symptoms develop. Pain and localized swelling in the temporal area are the most common presenting symptoms which can lead to diagnostic challenges. Our cases show that although surgery is often appropriate, conservative management may be suitable in certain situations. CONCLUSION: Congenital cholesteatoma of mastoid origin is rare and can present a diagnostic challenge. Greater awareness is important to facilitate early detection. A high index of suspicion is needed in those presenting with retro-auricular pain and swelling in the context of a normal ontological examination. [ABSTRACT FROM AUTHOR]

Objectives: To report the experience of civilian penetrating neck trauma (PNT) at a UK level I trauma centre, propose an initial management algorithm and assess the degree of correlation between clinical signs of injury, operative findings and radiological reports. Design: Retrospective case note review. Setting: UK level I trauma centre April 2012–November 2017. Participants: Three hundred ten cases of PNT were drawn from electronic patient records. Data were extracted on hard and soft signs of vascular or aerodigestive tract injury, clinical management, radiological imaging and patient outcomes. Main outcome measures: Patient demographics, mechanism of injury, morbidity and mortality. The correlation between clinical signs, and radiological reports to internal injury on surgical exploration. Results: Two hundred seventy‐one (87.4%) male and 39 (13.6%) female patients with a mean age of 36 years (16–87) were identified. The most common causes of injury were assault 171 (55.2%) and deliberate self‐harm 118 (38%). A knife was the most common instrument 240 (77.4%). Past psychiatric history was noted in 119 (38.4%), and 60 (19.4%) were intoxicated. 50% were definitively managed in theatre with a negative exploration rate of 38%, and 50% were managed in ED. Pre‐operative radiological reports correlated with operative reports in 62% of cases with venous injury the most common positive and negative finding. Multivariate correlation was r = 0.89, p = 0.045, between hard signs plus positive radiology findings and internal injury on neck exploration. Conclusions: Management of PNT by clinical and radiological signs is safe and effective, and can be streamlined by a decision‐making algorithm as proposed here. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review describes and evaluates the current literature on remote otological assessment using video-otoscopy with regards to reliability and potential applications. Methods: Systematic review was conducted in accordance with the PRISMA statement. There was heterogeneity of included studies, so a descriptive analysis was undertaken. Results: Seventeen studies were included for analysis conducted across a variety of healthcare settings. Overall, there was a trend towards acquisition of adequate images for diagnosis by non-otolaryngology-specialist facilitators with reasonable agreement between asynchronous images and controls; however, there was significant variation between the studies. Conclusion: Remote otological assessment using video-otoscopy shows potential as a safe and effective method for detecting the presence of ear disease in a wide range of healthcare settings. Barriers to the acquisition of adequate images include the presence of obstructing cerumen, and strategies to deal with this should be considered. Further work is required to evaluate endoscope-based systems to assess whether they will allow the acquisition of higher quality images. [ABSTRACT FROM AUTHOR]

Background: The middle ear is a complex anatomical space which is difficult to interpret from two-dimensional imagery. Appropriate surgical knowledge of the area is required to operate, yet current anatomical teaching methods are costly and hard to access for the trainee. Methods: A papercraft 3D design involving anatomical elements added separately to a model was designed, and then peer-validated by medical students and junior doctors. Preliminary quantitative assessment was performed using an anatomical labelling questionnaire, with six students given a lecture to act as a control. Qualitative feedback was also gathered. Results: 18 participants were recruited for the study. A total of 12 models were constructed by 6 medical students and 6 junior doctors. 6 medical students received a lecture only. Qualitative feedback was positive and suggested the model improved knowledge and was useful, yet timing and complexity were issues. Students scored, on average, 37% higher after completing the model, with junior doctors also improving anatomical knowledge, though these differences were not significant (p > 0.05). Conclusions: In this initial investigation, the model was shown to be an engaging way to learn anatomy, with the tactile and active nature of the process cited as benefits. Construction of the model improved anatomical knowledge to a greater extent than a classical lecture in this study, though this difference was not significant. Further design iterations are required to improve practical utility in the teaching environment, as well as a larger study. [ABSTRACT FROM AUTHOR]

Keywords: BAHA; osseo-integrated implants; outcomes; research EN BAHA osseo-integrated implants outcomes research 846 849 4 06/23/21 20210701 NES 210701 Key points Linear incision with soft tissue preservation surgery is a commonly performed method of implanting bone-anchored hearing implants (BAHI). Fourteen patients were excluded who had revision tissue preservation surgery after undergoing soft tissue reduction surgery in their previous operation. One patient (skin thickness 10mm) required tissue reduction surgery after initial tissue preservation as even when the 12mm abutment was tried this was not satisfactory. Percutaneous bone-anchored hearing implant surgery: linear incision technique with tissue preservation versus linear incision technique with tissue reduction. [Extracted from the article]

Background: We present our 9-year consecutive case series of skull base chordomas and chondrosarcomas from a UK tertiary referral centre, discussing treatments offered and outcomes. This was carried out to improve understanding around current treatment and to better inform the management of future patients. Methods: Consecutive case series over a 9-year period (2007–2016). Retrospective data analysis from the electronic skull base multidisciplinary team database and the digital patient records at a UK tertiary referral centre Results: Twenty-four patients were identified (11 chordomas, 13 chondrosarcomas, mean age 52). Nineteen had proton beam therapy (PBT) postoperatively; two had intensity-modulated radiotherapy; two had no further treatment. One patient was lost to follow-up. All chordomas were resected via a transnasal endoscopic approach. Of the 19 patients undergoing resection with PBT, 13 were disease free at latest follow-up, and six patients had local recurrence, of which two died (mean follow up 7.4 years). Of the three patients treated with surgery then IMRT/TomoTherapy, one died 4 years post-treatment, and the other two are alive after 4 and 5 years of follow-up respectively. Of the two patients treated with surgery alone, one was lost to follow-up, and the other is alive after more than 8 years. Chondrosarcoma 5-year survival was 91.6%, and chordoma 4-year survival was 75%. Conclusion: Skull base chordomas and chondrosarcomas can be challenging to resect, and most cases require adjuvant therapy to achieve control. Where complete resection is not possible, it is critical to undertake sufficient resection to permit high-dose radiation. [ABSTRACT FROM AUTHOR]

Establish outcomes following cochlear implantation (CI) in patients with Jervell and Lange-Nielsen Syndrome (JLNS). Methods Systematic review and narrative synthesis. Databases searched on Medline, Pubmed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement. Searches identified 63 abstracts and 19 full texts. Of these, 9 studies met inclusion criteria reporting outcomes in 66 patients with at least 72 implants. Hearing outcomes were generally good. Mortality secondary to cardiac complications within the follow up period occurred in at least five cases (7.6%), though three of these were thought to be unrelated to surgery. Potentially dangerous arrhythmias without associated morbidity were also noted in at least five patients. The methodological quality of included studies was modest, predominantly consisting of case reports and non-controlled case series with small numbers of patients. All studies were OCEBM grade IV. One study contributed 41/66 patients (62%). Hearing outcomes following CI in JLNS are generally good with the majority of patients experiencing useful hearing improvement. Significant peri-operative cardiac risks exist and should be discussed with the patient and family during pre-operative counselling and prompt thorough investigation, pre-operative optimisation and peri-operative monitoring. [ABSTRACT FROM AUTHOR]

Purpose: The advent of endoscopic otosurgery provides reduced tissue destruction with theoretically improved views, yet a quantification of the difference of exposure between microscopic and endoscopic approaches has not yet been performed in human specimens. The objective of this study was to assess the difference in views of cadaveric tympanic membranes when inspected with operating microscopes or endoscopes. Methods: A circular graduated disc was inserted into eight cadaveric external ear canals to rest against the tympanic membrane. Three independent observers assessed the maximum possible observable radius of the graduated disc in each ear using a 0° endoscope and a surgical microscope in superior, inferior, posterior, and anterior directions. Results: The endoscope was able to view a significantly larger mean maximum visible radius than the microscope in posterior, superior, anterior, and inferior directions. This represented a mean gain in observable distance of 19.18%. There was a smaller variation in mean maximum visible radius than the microscope. Conclusion: The wider field of view in an endoscope compared to a microscope implies reduced surgical tissue damage is needed to provide sufficient operative exposure. Enhanced views of the attic were demonstrated by the endoscope, further indicating utility in cholesteatoma observation and surgery. [ABSTRACT FROM AUTHOR]

Lenalidomide maintenance following autologous stem cell transplant (ASCT) is considered the standard of care for eligible patients with multiple myeloma (MM). A recent meta-analysis has provided additional evidence that lenalidomide maintenance is associated with a higher incidence of second primary malignancies, including both hematologic and solid malignancies. Acute lymphoblastic leukemia (ALL) as a second primary malignancy is rarely described in the literature. Herein, we describe two patients with MM treated with induction therapy, ASCT, and lenalidomide maintenance that experienced cytopenias while on maintenance. ALL was unexpectedly diagnosed on bone marrow biopsy. One patient was diagnosed on routine biopsy performed as part of requirements of the clinical trial. Both patients had B-cell ALL, without known poor risk cytogenetics, and were managed with standard induction therapies resulting in complete remission. We also reviewed the literature for similar cases of secondary ALL (sALL) in MM patients exposed to immunomodulatory drugs (IMiDs). In conclusion, persistent cytopenias in responding MM patients receiving IMiDs maintenance should be an indication for bone marrow biopsy. Patients develop sALL after median of 32.5 months (range, 20–84) from being on lenalidomide or thalidomide maintenance, often presenting with cytopenias, display low tolerance to chemotherapy, but remission can often be achieved. [ABSTRACT FROM AUTHOR]

Coblation is one of the more recent techniques for tonsillectomy; however, it remains unclear whether it exhibits any benefit or increased risk when compared to other techniques. This review provides an updated assessment of coblation tonsillectomy and how it compares to other tonsillectomy techniques. Systematic review and descriptive analysis of published literature. Electronic searches of MEDLINE, EMBASE, Web of Science and the Cochrane Database were performed. We included all randomized control trials comparing coblation tonsillectomy (not 'tonsillotomy') with any other tonsillectomy technique. Studies were excluded if tonsils, rather than individuals, were randomized. 16 eligible studies were identified, including a total of 567 patients, both adults and children. Coblation was compared with a variety of other tonsillectomy techniques. Outcomes included pain, primary and secondary haemorrhage, intraoperative bleeding and operation time. Postoperative pain was the primary outcome in most studies. There was a trend towards less pain in the coblation group in seven of the included studies. More recent studies appeared to fare more favourably in terms of pain outcomes and operating time. The coblation technique appears to be comparable with other commonly employed techniques for tonsillectomy; however, there is still no strong evidence to suggest that it possesses any definitive benefits. Findings would advocate further work being done through carefully designed randomised control trials, which compare coblation with cold dissection as the 'gold standard' and place an emphasis on reducing the amount of adjuvant electrocautery used so as to maximise the benefits of coblation and the lower temperature it generates. [ABSTRACT FROM AUTHOR]

Human evaluation and judgement may include errors that can have disastrous results. Within medicine and healthcare there has been slow progress towards major changes in safety. Healthcare lags behind other specialised industries, such as aviation and nuclear power, where there have been significant improvements in overall safety, especially in reducing risk of errors. Following several high profile cases in the USA during the 1990s, a report titled 'To Err Is Human: Building a Safer Health System' was published. The report extrapolated that in the USA approximately 50,000 to 100,000 patients may die each year as a result of medical errors. Traditionally otolaryngology has always been regarded as a 'safe specialty'. A study in the USA in 2004 inferred that there may be 2600 cases of major morbidity and 165 deaths within the specialty. MEDLINE via PubMed interface was searched for English language articles published between 2000 and 2012. Each combined two or three of the keywords noted earlier. Limitations are related to several generic topics within patient safety in otolaryngology. Other areas covered have been current relevant topics due to recent interest or new advances in technology. There has been a heightened awareness within the healthcare community of patient safety; it has become a major priority. Focus has shifted from apportioning blame to prevention of the errors and implementation of patient safety mechanisms in healthcare delivery. Type of Errors can be divided into errors due to action and errors due to knowledge or planning. In healthcare there are several factors that may influence adverse events and patient safety. Although technology may improve patient safety, it also introduces new sources of error. The ability to work with people allows for the increase in safety netting. Team working has been shown to have a beneficial effect on patient safety. Any field of work involving human decision-making will always have a risk of error. Within Otolaryngology, although patient safety has evolved along similar themes as other surgical specialties; there are several specific high-risk areas. Medical error is a common problem and its human cost is of immense importance. Steps to reduce such errors require the identification of high-risk practice within a complex healthcare system. The commitment to patient safety and quality improvement in medicine depend on personal responsibility and professional accountability. [ABSTRACT FROM AUTHOR]

Background: Otitis externa is a condition causing inflammation of the outer ear canal, which presents with itching, discharge and pain. Most cases of acute otitis externa are caused by bacterial infection and are thus treated with antibiotics. This systematic review and meta‐analysis of randomised controlled trials aims to assess the effectiveness of topical non‐antibiotic treatments compared to topical antibiotic treatment for the treatment of acute otitis externa. Methods: Systematic review and meta‐analysis databases searched: Cochrane Library including ClinicalTrials.gov; MEDLINE; World Health Organisation International Clinical Trials Registry Platform and Web of Science to identify randomised clinical trials evaluating topical antibiotics and topical non‐antibiotic agents in adults and children with acute otitis externa. Non‐antibiotic therapeutics for comparison with topical antibiotics included antiseptics, steroids, non‐pharmaceuticals and astringents. Results: Seventeen trials were eligible for inclusion, with 10 combined in meta‐analysis. Data could be pooled comparing antiseptic and steroid monotherapies with topical antibiotic agents. There were no significant differences in cure rates in any pairwise comparisons. Individually, the majority of studies favoured topical antiseptics or steroids over antibiotics, however these differences were not significant when pooled in meta‐analysis. Conclusion: Antiseptic, steroid and antibiotic monotherapies are all effective for the management of acute otitis externa. There is insufficient evidence to suggest that topical antiseptic or steroid agents are superior or inferior to topical antibiotics. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the type, content, accessibility and quality of information available via the internet for patients with head and neck cancer. The Google search engine was used to generate lists of the first 100 websites for general head and neck cancer and the first ten for head and neck cancers by anatomical location (160 total). Websites were evaluated with the validated DISCERN and LIDA instruments, the SMOG (Simple measure of gobbledygook) readability score and against the JAMA (Journal of the American Medical Association) criteria. 40 of the 160 websites ranked by Google were suitable for analysis. Seven websites (17.5 %) partially or fully achieved all four JAMA benchmarks and only one (2.5 %) site achieved none. 28 (70 %) included reference to quality of life factors. Correlations were identified between Google site rank and all four of our appraisal tools; LIDA (−0.966, p = 0.006), JAMA (−5.93, p = 0.028), DISCERN (−0.568, p = 0.037) and SMOG (4.678, p = 0.04). Google site rank and both government run sites (−35.38, p = 0.034) and sites run by universities or hospitals (−27.32, p = 0.016) also showed an association. Comparing our observations with those of Riordain in 2008, there has been little improvement in the quality of head and neck cancer information available online over this time. Given the variability in quality of information online, patients would benefit from being directed to reliable websites by clinicians [ABSTRACT FROM AUTHOR]

Waldenström's macroglobulinemia (WM) is increasingly being associated with amyloidosis particularly of the amyloid light-chain variety. We report on one of the few cases of WM associated with serum amyloid A protein (AA) amyloidosis. Autologous stem cell transplant (ASCT) is now being increasingly used for the treatment of amyloidosis, but most studies are small case series. Traditionally AA amyloid is associated with connective tissue disorders and periodic fever syndromes and has been treated by addressing the underlying condition. We present the first case of serum amyloid A being treated with melphalan-based ASCT to deal with the underlying WM and thereby control the amyloid, thus demonstrating the viability of this novel approach for the treatment of this disorder. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: This study aims to gain in-depth feedback on patient perceptions of remote assessment in otology, to better inform the development of a telemedicine pathway for new otology referrals. Methods: A qualitative descriptive approach was employed to analyse semi-structured interviews from 14 patients seen in a routine otology clinic. Results: Patients were generally accepting of the proposed telemedicine pathway. Key themes included maintaining quality of care, adequate training for facilitators, reducing waiting times, appropriate actioning of clinic outcomes and anxiety surrounding the use of technology. Conclusions: Our proposed telemedicine pathway for new otology referrals is acceptable to patients, provided there is no compromise in the standard of their care versus a traditional pathway. These results further our understanding of remote assessment in otology from the patient perspective and may help to inform the development of such pathways outside of our centre. [ABSTRACT FROM AUTHOR]

Background: Effective management of cerebrospinal fluid (CSF) leaks can reduce significant associated morbidity. Intrathecal fluorescein (IF) may be a valuable intra-operative adjunct to localise leak sites. Recent reports have demonstrated low doses of IF to be safe, however, no internationally accepted dose of IF has been agreed.Objective: To assess the efficacy and safety of IF used in the endoscopic management of anterior skull base CSF fistulae.Methods: A systematic review and descriptive analysis were performed of all published data in accordance to PRISMA guidelines.Results: There were 18 included articles giving a total of 335 procedures where IF was used. Doses of IF ranged from 10mg - 150mg. IF positively identified the site of CSF fistula in 88.7% of cases (n = 297). There was a total of 25 reported peri-operative complications in all included studies (7.5%) with 5.1% (n = 17) potentially related to IF use. Of these, the complication rate was 3.9% at low IF doses (<50mg) and 80.0% at higher doses (≥50mg).Conclusion: Our review demonstrates that IF is effective at localising CSF fistulae with most significant complications being related to doses ≥50mg. We therefore propose that there is a potential for the licensing of IF in this field. Doses <50mg have consistently been shown to be safe while still maintaining effective localisation rates. Based on the most common doses used in this group, we recommend utilisation of a dosing below 50mg, with the most frequent range being between 10-30mg. [ABSTRACT FROM AUTHOR]

Simple Summary: Even with recent advances, there are urgent needs for novel therapies to improve overall survival and decrease toxicities in the management of head and neck squamous cell carcinoma (HNSCC). This article reviews historical data to provide a context and highlights recent data in understanding of epidemiology and pathophysiology and supporting changes in treatments of HNSCC, particularly in patients with recurrent and/or metastatic disease. For use of immune checkpoint modulators such as programmed cell death protein 1 (PD-1) inhibitors, potential predictive biomarkers of clinical benefits are also summarized. In addition, this article reviews currently ongoing clinical trials and provides a perspective on future research directions. Head and neck squamous cell carcinoma (HNSCC) is the most common cancer arising in the head and neck region. The most common risk factors are smoking, excessive drinking, and human papillomavirus (HPV) infection. While the overall incidence of smoking is decreasing, the incidence of HPV-related HNSCC is increasing in the United States and Western Europe, which led to a shift in understanding of the pathophysiology, treatment, and prognosis of this disease. The outcomes for non-metastatic HNSCC remains very encouraging and continues to improve. Advances in radiation technology and techniques, better organ preserving surgical options, and multidisciplinary treatment modalities have improved cure rates for locally advanced HNSCC patients. The treatment of metastatic disease, however, remains an area of need. The advancement of immune checkpoint inhibitors has provided significantly better outcomes, but only a small proportion of patients obtain benefits. Most recurrent and/or metastatic HNSCC patients continue to have poor survival. This has led to the vigorous investigation of new biomarkers and biomarker-based therapies. Novel therapeutic options including adaptive cellular therapy and therapeutic vaccines are also on the horizon. In this review, we highlight the latest advances in the field of HNSCC and the future direction of research. [ABSTRACT FROM AUTHOR]

Background: Cochlear implantation (CI) has proven to be a highly effective method for rehabilitating individuals with severe to profound hearing loss. However, challenges persist, particularly in cases where CI failure necessitates re-implantation. This study aims to address the gap in understanding the knowledge and practices of audiologists in the UK regarding cochlear re-implantation through a comprehensive questionnaire survey. Methods: A bespoke questionnaire was distributed to audiologists working with CI across the UK. The survey, which included multiple-choice items, open-text responses, and visual analogue scales, was made accessible via an online link shared through professional bodies, email groups, and social media platforms. Results: The survey received 27 responses, predominantly from female audiologists (71.4%), with significant representation from London (28.6%) and the East of England (21.4%). A majority of respondents had over 16 years of CI experience (35.7%) and held a master's degree (60.7%). Key reasons for CI re-implantation included electrode failure (82.1%) and hermetic seal failure (60.7%). While respondents showed strong confidence in counselling (88.8%) and managing re-implanted devices (84.6%), there was a noted variation in opinions regarding the need for additional training in intraoperative measures. Conclusion: This survey highlights the current practices and training needs of UK audiologists in CI re-implantation. This underscores the importance of targeted training to fill knowledge gaps and improve clinical care during CI re-implantation, ultimately enhancing outcomes for both audiologists and CI recipients. [ABSTRACT FROM AUTHOR]

Background: Pharmacologic immunosuppression regimes are commonly employed in stem cell clinical trials to mitigate host immune rejection and promote survival and viability of transplanted cells. Immunosuppression and cell survival has been extensively studied in retinal and spinal tissues. The applicability of stem cell therapy is rapidly expanding to other sensory organs such as the ear and hearing. As regenerative therapy is directed to new areas, a greater understanding of immunosuppression strategies and their efficacy is required to facilitate translation to organ-specific biologic microenvironments. Objective: This systematic review appraises the current literature regarding immunosuppression strategies employed in stem cell trials of retinal and neural cells. Methods: This systematic review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included studies presenting data on neural or retinal cells as part of an in-human clinical trial that detailed the immunosuppression regime used. Exclusion criteria included non-English language studies, animal studies, review articles, case reports, editorials, and letters. The databases Medline, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to February 2024. Risk of bias was evaluated using the ROBINS-I tool. Results: Eighteen articles fit the inclusion criteria. Nine articles concerned retinal cells, 5 concerned spinal cord injury, and 4 concerned amyotrophic lateral sclerosis. A multi-drug and short-term immunosuppression regime were commonly employed in the identified studies. Detected immune responses in treated patients were rare. Common immunosuppression paradigms included tacrolimus, mycophenolate mofetil and tapering doses of steroids. Local immunosuppression with steroids was employed in some studies concerning retinal diseases. Discussion: A short-term course of systemic immunosuppression seemed efficacious for most included studies, with some showing grafted cells viable months to years after immunosuppression had stopped. Longer-term follow-up is required to see if this remains the case. Side effects related to immunosuppression were uncommon. [ABSTRACT FROM AUTHOR]

Objectives: As the population ages and implantation criteria are relaxed, more patients with complex comorbidities are becoming eligible for cochlear implantation (CI). These patients have higher risks associated with general anesthesia. This systematic review assesses outcomes and complications following CI under local anesthetic to examine utility for patients deemed not suitable or at high risk for general anesthesia. Methods: A systematic review and meta‐analysis performed according to the 2020 PRISMA guidelines. Databases searched were MEDLINE, PubMed, EMBASE, CINAHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. There were no limitations on year of publication or language. Results: Then, 132 unique were identified. After screening abstracts and full texts for eligibility criteria a total of 18 articles were included. In the nine studies where audiological data were reported, all patients demonstrated improvement in audiological outcomes following implantation under local anesthetic (LA). Only minor complications of transient vertigo, wound infection, facial nerve paralysis, confusion, and tinnitus were reported but all were transient. Meta‐analysis showed surgical time was significantly shorter under LA. Conclusions: CI under LA is safe for patients with comorbidities which preclude them from general anesthesia, with minimal complications and an improved cost‐effectiveness profile. However, larger scale, robust trials are required to assess this further. [ABSTRACT FROM AUTHOR]

Highlights from the article: Corrigendum to "Outcomes of Programmed Cell Death Protein 1 (PD-1) and Programmed Death-Ligand 1 (PD-L1) Inhibitor Therapy in HIV Patients with Advanced Cancer" In the article titled "Outcomes of Programmed Cell Death Protein 1 (PD-1) and Programmed Death-Ligand 1(PD-L1) Inhibitor Therapy in HIV Patients with Advanced Cancer" [1], Drs. Jameel Muzaffar, Ahmad M. Haider, and Marjorie Adams Curry were missing from the authors' list.

Highlights from the article: Corrigendum to "Acute Lymphoblastic Leukemia following Lenalidomide Maintenance for Multiple Myeloma: Two Cases with Unexpected Presentation and Good Prognostic Features" In the article titled "Acute Lymphoblastic Leukemia following Lenalidomide Maintenance for Multiple Myeloma: Two Cases with Unexpected Presentation and Good Prognostic Features" [1], the first name of the third author was given incorrectly as Hermant. 1 Khan A. M., Muzaffar J., Murthy H., Wingard J. R., Moreb J. S., Acute lymphoblastic leukemia following lenalidomide maintenance for multiple myeloma: two cases with unexpected presentation and good prognostic features, Case Reports in Hematology, 2018, 2018, 5, 9052314, 10.1155/2018/9052314.

Cochlear implants are crucial for addressing severe-to-profound hearing loss, with the success of the procedure requiring careful electrode placement. This scoping review synthesizes the findings from 125 studies examining the factors influencing insertion forces (IFs) and intracochlear pressure (IP), which are crucial for optimizing implantation techniques and enhancing patient outcomes. The review highlights the impact of variables, including insertion depth, speed, and the use of robotic assistance on IFs and IP. Results indicate that higher insertion speeds generally increase IFs and IP in artificial models, a pattern not consistently observed in cadaveric studies due to variations in methodology and sample size. The study also explores the observed minimal impact of robotic assistance on reducing IFs compared to manual methods. Importantly, this review underscores the need for a standardized approach in cochlear implant research to address inconsistencies and improve clinical practices aimed at preserving hearing during implantation. [ABSTRACT FROM AUTHOR]

Objectives: To establish audiological and other outcomes following cochlear implantation in humans and animals with eluting electrodes. Methods: Systematic review and narrative synthesis. Databases searched (April 2023): MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and Web of Science. Studies reporting outcomes in either humans or animals following cochlear implantation with a drugeluting electrode were included. No limits were placed on language or year of publication. Risk of bias assessment was performed on all included studies using either the Brazzelli or Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) assessment tools. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results: Searches identified 146 abstracts and 108 full texts. Of these, 18 studies met the inclusion criteria, reporting outcomes in 523 animals (17 studies) and 24 humans (1 study). Eluting electrodes included dexamethasone (16 studies), aracytine (1 study), nicotinamide adenine dinucleotide (1 study), the growth factors insulinlike growth factor 1 (IGF1) and hepatocyte growth factor (HGF) (1 study), and neurotrophin-3 (1 study). All included studies compare outcomes following implantation with an eluting electrode with a control non-eluting electrode. In the majority of studies, audiological outcomes (e.g., auditory brainstem response threshold) were superior following implantation with an eluting electrode compared with a standard electrode. Most studies which investigated post-implantation impedance reported lower impedance following implantation with an eluting electrode. The influence of eluting electrodes on other reported outcomes (including post-implantation cochlear fibrosis and the survival of hair cells and spiral ganglion neurons) was more varied across the included studies. Conclusions: Eluting electrodes have shown promise in animal studies in preserving residual hearing following cochlear implantation and in reducing impedance, though data from human studies remain lacking. Further in-human studies will be required to determine the clinical usefulness of drug-eluting cochlear implants as a future treatment for sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: Determine the prevalence of otological symptoms and tympanic membrane perforation, healing rates of tympanic membrane perforation with surgical and conservative management, and hearing function in civilian victims of terrorist explosions. Methods: A systematic review was conducted with searches on Medline, Embase, EMCare and CINAHL for publications between the 1st January 1945 and 26th May 2023. Studies with quantitative data addressing our aims were included. This review is registered with PROSPERO: CRD42020166768. Among 2611 studies screened, 18 studies comprising prospective and retrospective cohort studies were included. Results: The percentage of eardrums perforated in patients admitted to hospital, under ENT follow up and attending the emergency department is 69.0% (CI 55.5–80.5%), 38.7% (CI 19.0–63.0%, I2 0.715%) and 21.0% (CI 11.9–34.3%, I2 0.718%) respectively. Perforated eardrums heal spontaneously in 62.9% (CI 50.4–73.8%, I2 0.687%) of cases and in 88.8% (CI 75.9–96.3%, I2 0.500%) of cases after surgery. Common symptoms present within one month of bombings are tinnitus 84.7% (CI 70.0–92.9%, I2 0.506%), hearing loss 83.0% (CI 64.5–92.9%, I2 0.505%) and ear fullness 59.7% (CI 13.4–93.4%, I2 0.719). Symptomatic status between one and six months commonly include no symptoms 57.5% (CI 46.0–68.3%), hearing loss 35.4% (CI 21.8–51.8%, I2 0.673%) and tinnitus 15.6% (CI 4.9–40.0%, I2 0.500%). Within one month of bombings, the most common hearing abnormality is sensorineural hearing loss affecting 26.9% (CI 16.9–40.1%, I2 0.689%) of ears 43.5% (CI 33.4–54.2%, I2 0.500) of people. Conclusion: Tympanic membrane perforation, subjective hearing loss, tinnitus, ear fullness and sensorineural hearing loss are common sequelae of civilian terrorist explosions. [ABSTRACT FROM AUTHOR]

Background: Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. Methods and findings: A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. Conclusions: The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process. In this multi-centre UK wide study including >6000 participants, Chloe Swords and co-workers explore referral patterns for cochlear implantation vary across the UK according to ethnicity and socioeconomics. Author summary: Why was this study done?: • This study was undertaken to investigate referral patterns for cochlear implantation among patients meeting pure tone audiometric threshold criteria in Great Britain and to identify if socioeconomic or ethnic disparities effect the likelihood of referral. What did the researchers do and find?: • Researchers conducted an observational study across 36 secondary care Otolaryngology and Audiology units in Great Britain, focusing on adults who met pure tone audiometric threshold criteria for cochlear implant assessment. • Of 6,171 included adults identified, 36% were informed of their potential eligibility for a cochlear implant, but only 9% were actually referred for assessment. • Referral likelihood was lower for those in more deprived areas, living in London, of male sex, or older age. • Ethnic minorities, particularly of Asian or black backgrounds, were also less likely to be informed about their eligibility. What do these findings mean?: • These data suggest that the majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are not being referred appropriately for cochlear implant assessments, indicating significant disparities in patient management based on socioeconomic status, ethnicity, and sex. • These disparities suggest a need for targeted efforts to improve referral rates among underrepresented groups and to ensure all patients are informed of their treatment options. • Further research is required to understand and address these disparities, with initiatives to ensure informed decision-making, educate healthcare providers, and explore reasons for declining cochlear implant assessments, especially among older ethnic minority groups. • Study limitations include its observational retrospective nature, potential inaccuracies in the reporting of sex and gender, and the impact of the COVID-19 pandemic on referral protocols. [ABSTRACT FROM AUTHOR]

Objectives: To assess outcomes following cochlear implantation (CI) in patients with hearing loss secondary to primary or secondary autoimmune inner ear disease (AIED). Methods: A systematic review and narrative synthesis was completed according to PRISMA guidelines. Databases searched included MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Collection, and ClinicalTrials.gov. No limits were placed on year of publication or language. Results: A total of 551 studies were identified, of which 29 were included after removal of duplicates, and screening the title, abstract, and full text. All except one study were OCEBM grade IV. 114 of 115 patients displayed improvement in hearing following cochlear implantation. With implant use, roughly a third of these patients had hearing that improved over time, a third improved and plateaued, and a third remained stable. There was no additional risk of perioperative complications found in AIED patients compared what is generally accepted in general cochlear implantation, although two episodes of device failure after 6 months were noted, and four patients with secondary AIED displayed poor initial audiological outcomes. Conclusion: CI in both primary and secondary AIED provides marked improvement in hearing. Early CI may be a valid management option, provide long‐lasting hearing in patients and reduce the side effects of long‐term systemic immunosuppressants. However, patients should be counseled residual hearing may be lost if there is cochlear ossification or fibrosis which may make implant insertion more traumatic. Level of Evidence: NA. Autoimmune inner ear disease is characterised by bilateral, assymetrical, progressive (or fluctuating) hearing loss that develops over weeks to months and is steroid responsive. Cochlear implantation has been suggested as a useful intervention in this group when medical management fails, however there is limited data in the literature. This review aims to systematically review all available evidence of post‐cochlear implantation hearing outcomes in patients with autoimmune inner ear disease to assess its benefit. [ABSTRACT FROM AUTHOR]

This study's aim was to establish outcomes following cochlear implantation (CI) in patients with mitochondrial disorders associated with deafness. Systematic review and narrative synthesis. Databases searched: Medline, EMBASE, Web of Science, COCHRANE, and ClinicalTrials.gov. No limits on language or year of publication. Review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Searches identified 437 abstracts and 37 full text articles, of which 11 studies met the inclusion criteria reporting outcomes in a total of 17 patients. All implants achieved good hearing outcomes, and follow-up ranged between 1 week and 12 months. The methodological quality of the included studies was sufficient, scoring grades 3 to 4 using the Oxford Centre for Evidence Based Medicine grading system. All studies were retrospective and consisted of case reviews and case reports. All cases of CI showed positive outcomes in speech perception and detection. There is some qualitative evidence to suggest improvement in quality of life and satisfaction postoperatively. There was very limited information available on secondary outcomes such as surgical complications, quality of life, and method of cochlear implant insertion. The small sample size of our patient cohort and quality of studies suggests a need for large-scale studies with more robust methodology to assess the effectiveness of CI. There is a need for studies that assess other factors to be considered when counseling patients about cochlear implants, such as adverse events, surgical complications, and long-term benefits. [ABSTRACT FROM AUTHOR]

This study aimed to establish outcomes following cochlear implantation (CI) in patients with superficial siderosis (SS). MEDLINE, Embase, Web of Science, Cochrane, and ClinicalTrials.gov databases were searched for this systematic review. No limits were placed on the language or the year of publication. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of a total of 46 studies, 19 studies met the inclusion criteria reporting outcomes in 38 patients. Of the 44 implants, 23 implants (52.27%) had good hearing outcomes at the last follow-up, 9 (20.45%) were initially beneficial for the patient, but then the performance deteriorated (4 of which were re-implanted), and 12 (27.27%) were not beneficial for the patient. All studies were classified as grade 4 studies using the Oxford Centre for Evidence-Based Medicine (OCEBM) grading system, being retrospective in nature and consisting of case reports and noncontrolled case series with a small number of patients. Of the 44 implants, 32 (72.73%) showed improved hearing outcomes following CI for SS at some point in time, of which 23 (52.2%) implants showed sustained benefit at the last follow-up (average follow-up time was 21.97 months). It is difficult to predict the longevity of benefit owing to the progressive nature of the disease or the patients in whom it may be beneficial, as the preoperative investigations inadequately predict benefit. Preimplantation and postimplantation counseling with the patient and their family regarding the potential limited benefit and eventual parallel decline with the neurological disease are crucial, along with thorough clinical investigations. [ABSTRACT FROM AUTHOR]

Summarise outcomes following cochlear implantation (CI) in patients with post-meningitis deafness. Systematic review and narrative synthesis. Databases searched: Medline, Pubmed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Studies with a minimum of 20 individuals with post-meningitis deafness were included. Review conducted in accordance with the PRISMA statement. Searches identified 906 abstracts and 291 full texts. Of these, 19 studies met the inclusion criteria, reporting outcomes in 610 patients with 650 implants. Audiological outcomes improved across all studies following cochlear implantation. 7 studies demonstrated a statistically significant difference between pre and post-CI outcomes. Patients with no cochlear ossification, full electrode insertion, shorter duration of deafness and no neurological sequelae generally appeared to perform best. A total of 31 minor and 19 major complications were reported, with 15 cases of reimplantation. The methodological quality of the included studies was sufficient, predominantly consisting of cohort studies. 15 studies were OCEBM grade III and 4 studies were OCEBM grade IV. All studies had a minimum of 20 individuals with post-meningitic deafness and used multi-channel cochlear implant devices. Audiological outcomes following cochlear implantation in meningitis are satisfactory, providing functional levels of speech perception and intelligibility. Improvement in hearing is dependent on the amount of cochlear ossification, duration of deafness prior to implantation, electrode insertion depth and presence of neurological sequalae. Cochlear implantation in meningitis patients can be challenging due to the presence of ossification and inaccuracies of pre-operative imaging. Therefore, early and bilateral implantation is recommended in all patients with post-meningitis hearing loss to improve the likelihood of full electrode insertion. [ABSTRACT FROM AUTHOR]

To establish outcomes following cochlear implantation (CI) in patients with postsynaptic auditory neuropathy (AN). Systematic review and narrative synthesis. Databases searched: MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement. Searches identified 98 studies in total, of which 14 met the inclusion criteria reporting outcomes in 25 patients with at least 28 CIs. Of these, 4 studies focused on Charcot-Marie-Tooth disease (CMT), 3 on Brown- Vialetto-Van-Laere syndrome (BVVL), 2 on Friedreich Ataxia (FRDA), 2 on Syndromic dominant optic atrophy (DOA+), 2 on Cerebellar ataxia - areflexia - pes cavus - optic atrophy - sensorineural hearing loss (CAPOS) syndrome, and 1 on Deafness-dystonia-optic neuronopathy (DDON) syndrome. All studies were Oxford Centre for Evidence Based Medicine (OCEBM) grade IV. Overall trend was towards good post-CI outcomes with 22 of the total 25 patients displaying modest to significant benefit. Hearing outcomes following CI in postsynaptic ANs are variable but generally good with patients showing improvements in hearing thresholds and speech perception. In the future, development of a clearer stratification system into pre, post, and central AN would have clinical and academic benefits. Further research is required to understand AN pathophysiology and develop better diagnostic tools for more accurate identification of lesion sites. Multicenter longitudinal studies with standardized comprehensive outcome measures including health-related quality of life data will be key in establishing a better understanding of short and long-term post-CI outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study is a systematic review of the literature which seeks to evaluate auditory and quality of life (QOL) outcomes of cochlear implantation in patients with Usher syndrome. Methods: Systematic review of studies indexed in Medline via PubMed, Ovid EMBASE, Web of Science, CENTRAL and clinicaltrials.gov was performed up to March 9th 2022, conducted in accordance with the PRISMA statement. Patient demographics, comorbidity, details of cochlear implantation, auditory, and QOL outcomes were extracted and summarized. Results: 33 studies reported over 217 cochlear implants in 187 patients with Usher syndrome, comprising subtypes 1 (56 patients), 2 (9 patients), 3 (23 patients), and not specified (99 patients). Auditory outcomes included improved sound detection, speech perception, and speech intelligibility. QOL outcomes were reported for 75 patients, with benefit reported in the majority. Conclusions: Many patients with Usher syndrome develop improved auditory outcomes after cochlear implantation with early implantation being an important factor. [ABSTRACT FROM AUTHOR]

Tinnitus is a common health condition, affecting approximately 15% of the UK population. The tinnitus treatment with the strongest evidence base is Cognitive Behavioural Therapy (CBT), with standard tinnitus therapy typically augmented with education, relaxation and other techniques. Availability of CBT and conventional tinnitus therapy more broadly is limited for tinnitus sufferers. The DEFINE trial aims to assess whether smartphone-delivered tinnitus therapy, the Oto app, is as effective as current standard care, one-to-one therapist-delivered tinnitus treatment for the treatment of tinnitus in adults. The trial is registered in the ISRCTN Registry: ISRCTN99577932. DEFINE is an open-label, non-inferiority, prospective, parallel design, randomised-controlled trial. Recruitment, interventions and assessments will be remote, enabling UK-wide participant involvement. 198 participants aged 18 years or more will be recruited via social media advertisement or via primary care physicians. A screening process will identify those with tinnitus that impacts health-related quality of life, and following consent smartphone-based audiometry will be performed. Randomisation 1:1 to the Oto app or one-to-one therapist-led tinnitus therapy will be performed centrally by computer, matching groups for age, sex and hearing level. Following participant allocation, the Oto app will be provided for immediate use, or a one-to-one remote therapy appointment booked to occur within approximately 1 week, with up to 6 sessions delivered. Participant outcomes will be collected at 4,12, 26 and 52 weeks via questionnaire and phone call. The primary outcome is the change in Tinnitus Functional Index (TFI) total score measured at 26 weeks following allocation. Adverse events will be recorded. A health economic evaluation in the form of a cost-utility analysis will be performed using data from participant submitted EuroQol 5D-5L and Health Utilities Index Mark 3 scores and resource use data. Trial results will be made publicly available, including a plain English summary. [ABSTRACT FROM AUTHOR]

Objectives: To assess outcomes associated with photobiomodulation therapy (PBMT) for hearing loss in human and animal studies. Design: Systematic review and narrative synthesis in accordance with PRISMA guidelines. Setting: Data bases searched: MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov and Web of Science. No limits were placed on language or year of publication. Review conducted in accordance with the PRISMA 2020 statement. Participants: All human and animal subjects treated with PBMT for hearing loss. Main outcome measures: Pre‐ and post‐PBMT audio metric outcomes. Results: Searches identified 122 abstracts and 49 full text articles. Of these, 17 studies met the inclusion criteria, reporting outcomes in 327 animals (11 studies), 30 humans (1 study), and 40 animal specimens (5 studies). PBMT parameters included 6 different wavelengths: 908 nm (1 study), 810 nm (1 study), 532 & 635 nm (1 study), 830 nm (3 studies), 808 nm (11 studies). The duration ranged from 4 to 60 minutes in a session, and the follow‐up ranged from 5–28 days. Outcomes improved significantly when wavelengths within the range of 800–830 nm were used, and with greater duration of PBMT exposure. Included studies predominantly consisted of non‐randomized controlled trials (10 studies). Conclusions: Hearing outcomes following PBMT appear to be superior to no PBMT for subjects with hearing loss, although higher level evidence is required to verify this. PBMT enables concentrated, focused delivery of light therapy to the inner ear through a non‐invasive manner with minimal side effects. As a result of heterogeneity in reporting PBMT parameters and outcomes across the included studies, direct comparison is challenging. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 42-year-old female with a long-standing history of migraine headaches and no other medical history. She had a six hour history of worsening headache and palpitations progressing to altered sensorium. She also had a two-week history of poorly controlled migraine for which she had been taking Fioricet in addition to her usual home medications. She was found to have complete heart block with a ventricular escape rhythm of 34 beats per minute.

Patients with locoregional recurrence of squamous cell carcinoma of the head and neck (SCCHN) have relatively poor outcomes; therefore, stereotactic body radiation therapy (SBRT) has been investigated for this patient population. We performed a phase 1 clinical trial to establish a maximum tolerated dose of SBRT with concurrent cisplatin in previously irradiated locoregional SCCHN. Patients with recurrent SCCHN who had previously undergone radiation therapy to doses ≥45 Gy to the area of recurrence ≥6 months before enrollment and who were not surgical candidates or refused surgery were eligible. SBRT was delivered every other day for 5 fractions. Starting dose level was 6 Gy × 5 fractions, followed by 7 Gy × 5 fractions and 8 Gy × 5 fractions. Chemotherapy consisted of cisplatin given before every SBRT fraction at a dose of 15 mg/m2. Patients were monitored for dose-limiting toxicities (DLT) that occurred within 3 months from the start of SBRT. Secondary endpoints included locoregional failure, distant metastasis, and overall survival. Twenty patients were enrolled, with 18 patients evaluable for endpoints. One patient at dose level 1 (30 Gy) died of unknown causes 2 weeks following completion of treatment. Therefore, an additional 3 patients were accrued to the 30-Gy dose level, with no further DLTs observed. Three patients were then accrued at dose level 2 (35 Gy) and 9 patients at dose level 3 (40 Gy) without DLTs. At a median follow-up of 9.5 months, cumulative incidence of locoregional failure at 2 years was 61% (95% confidence interval [CI], 12%-66%), cumulative incidence of distant metastasis was 11% (95% CI, 74%-100%) at 2 years, and overall survival was 22% (95% CI, 9%-53%) at 2 years. Concurrent cisplatin and reirradiation with an SBRT dose of ≤40 Gy was safe and feasible in patients with locoregionally recurrent or second primary SCCHN. [ABSTRACT FROM AUTHOR]

To investigate the effects of COVID-19 on individuals with tinnitus and their views to guide future tinnitus care. A mixed-methods cross-sectional research design. An online survey was completed by 365 individuals with tinnitus from Australia and other countries. Tinnitus was reported to be more bothersome during the pandemic by 36% of respondents, whereas 59% reported no change and 5% reported less bothersome tinnitus. Nearly half of the respondents had received COVID-19 vaccination(s) and 12% of them reported more bothersome tinnitus while 2% developed tinnitus post-vaccination. Australian respondents spent less time in self-isolation or quarantine and saw fewer change in in-person social contact than respondents from other countries. More than 70% of respondents thought that tinnitus care services were insufficient both before and during the pandemic. Regarding their opinions on how to improve tinnitus care in the future, five themes including alleviation of condition, government policies, reduced barriers, self- and public-awareness, and hearing devices were identified. A majority of respondents did not perceive any change in tinnitus perception and one-third of respondents had worsened tinnitus during the pandemic. To improve tinnitus care, better awareness and more accessible resources and management are crucial. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aims to establish the expected hearing and speech outcomes following cochlear implantation (CI) in patients with profound congenital deafness secondary to Waardenburg syndrome (WS). Methods: A systematic review of the literature and narrative synthesis was performed in accordance with the PRISMA statement. Databases searched: Medline, Pubmed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov. No limits were placed on language or year of publication. Results: Searches identified 186 abstracts and full texts. Of these, 16 studies met inclusion criteria reporting outcomes in 179 patients and at least 194 implants. Hearing outcomes of those receiving cochlear implantation were generally good. Five studies included genetic analysis of one or more of the participants. A total of 11 peri/post‐operative complications were reported. The methodological quality of included studies was modest, mainly comprising noncontrolled case series with small cohort size. All studies were OCEBM grade III–IV. Conclusion: Cochlear implantation in congenitally deafened children with Waardenburg Syndrome is a well‐established intervention as a method of auditory rehabilitation. Due to the uncommon nature of the condition, there is a lack of large‐scale high‐quality studies examining the use of cochlear implantation in this patient group. However, overall outcomes following implantation are positive with the majority of patients demonstrating improved audiometry, speech perception and speech intelligibility supporting its use in appropriately selected cases. [ABSTRACT FROM AUTHOR]

Background: Intraoperative and postoperative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intraoperative and postoperative bleeding, however reported results are variable. Objectives: To determine the safety and efficacy of TXA use in H&N surgery. Methods: Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey, and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of postoperative drain or return to theatre rate for postoperative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for randomised controlled trials and Newcastle–Ottawa Scale tool for non‐randomised studies. Results: Sixteen studies were identified (114 407 patients). Eight studies evaluated TXA in major H&N surgery and eight studies in tonsillectomy. Primary outcomes were reduction in intraoperative or postoperative bleeding. Secondary outcomes included the duration of postoperative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intraoperative blood loss in tonsillectomy. However, the effect on posttonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intraoperative bleeding in major H&N procedures. Postoperative drainage volumes were significantly reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases. Conclusion: TXA use is safe in H&N patients. Whilst sufficient evidence exists to support the use of TXA in tonsillectomy, insufficient evidence exists to recommend use in major H&N surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. Methods: Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. Results: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ2 < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001). Conclusions: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem; however, further research is required. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe considerations for developing supportive care interventions targeted to head and neck cancer (HNC) survivors. Methods: One‐time semi‐structured interviews (N = 33) were conducted with HNC survivors who had recently finished treatment (n = 20) and HNC providers (e.g., physicians, nurses; n = 13). Interviews were transcribed verbatim and coded using inductive applied thematic analysis techniques to identify themes. Results: HNC survivors (75% male; M = 61 years old) and providers (54% physicians; 62% female) were unanimously supportive of developing HNC‐specific supportive care interventions. Participants described potential benefits of offering interventions at various points throughout the HNC treatment and survivorship trajectory rather than at a single critical time. Many participants preferred group‐based interventions because of the high value of peer‐support. Others described how group interventions may not be appropriate for all HNC survivors due to risks for negative social comparisons and exacerbated anxiety. Participants suggested topics that should be addressed in HNC‐specific interventions including education about acute and long‐term side effects, symptom management, nutritional support, relationship/social role changes, grief/loss, and fear of recurrence. Conclusions: HNC‐specific supportive care interventions are critically needed, as survivors experience persistent symptoms and distinct psychosocial concerns that impact quality of life. Findings from this study can inform the development of supportive care interventions targeted to the unique psychosocial concerns of HNC survivors. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic has drastically changed cancer care delivery strategies. Patients with locally advanced head and neck cancer (LA-HNC) may be particularly affected by the COVID-19 pandemic, as they often undergo treatments that require daily clinic visits (e.g., radiation therapy). The goal of this study was to characterize the lived experience of LA-HNC patients and their healthcare providers during the COVID-19 pandemic. Methods: LA-HNC patients who completed a full course of chemotherapy and radiation therapy during the COVID19 pandemic (N = 20) and LA-HNC healthcare providers (N = 13) participated in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed for qualitative themes. Results: The COVID-19 pandemic had a significant impact on patients' overall quality of life and health care. Results were organized in four main themes: (1) increased psychological distress; (2) exacerbated social isolation; (3) added stress in clinic for patients and providers; and (4) delays in health care. Conclusions: Findings highlight myriad ways LA-HNC patients and providers have been affected by the COVID-19 pandemic. Results can inform the development of supportive interventions to assist LA-HNC in managing COVID-19-related stress and unmet needs related to social isolation and in-clinic support. [ABSTRACT FROM AUTHOR]

Objective: Establish anatomical considerations, audiological outcomes, and optimal management in patients with branchiootic/branchiootorenal syndrome (BO/BOR). Methods: Databases reviewed: Medline, Pubmed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov. Clinical or radiological studies of patients with BOR syndrome describing either the audiological profile or anatomical changes were included. Articles in which BOR syndrome was associated with other syndromes, and those that were focused only on general and genetic aspects of BOR syndrome were excluded. Articles were assessed using Oxford Centre for Evidence‐Based Medicine (OCEBM) grading system and the Brazzelli risk of bias tool for nonrandomized studies. Results: Searches identified 379 articles. Of these, 64 studies met the inclusion criteria, reporting outcomes in 482 patients from at least 95 families. In 308 patients, hearing loss was categorized as sensorineural (29%), conductive (20%), and mixed (51%). Hearing outcomes were variable in terms of onset, pattern, and severity; ranging from mild to profound deafness. One hundred sixty‐nine patients presented with inner ear anomalies, 145 had middle, and 151 had external ear abnormalities. In 44 studies, 58 ear operations were described. Mixed outcomes were reported in patients managed with hearing aids or middle ear surgery; however, successful cochlear implantation was described in all five cases. Conclusion: The anatomical and audiological profiles of patients with BO/BOR are variable. A range of surgical procedures were described, however lacked objective outcome measures. Given the range of anatomical variants, management decisions should be made on an individual basis including full audiological and radiological assessment. Level of evidence: NA. [ABSTRACT FROM AUTHOR]