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Objectives COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.Design Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.Setting UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.Participants The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measures Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.Results The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.Conclusions Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.Trial registration number The study is registered with ClinicalTrials.Gov (NCT04572438).

A study published in Clinical Otolaryngology compares the use of the VITOM-3D exoscope and the traditional operating microscope for major ear surgery. The study finds that the exoscope can be a viable alternative, with similar outcomes in terms of complications, graft status, audiometric results, and cholesteatoma recurrence. However, it is important to carefully select cases for the exoscope and note that it is not compatible with KTP lasers. The study provides valuable insights into the use of this technology in otolaryngology, but further research is needed to address its limitations and fully understand its potential. [Extracted from the article]

ObjectiveEvidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE.Study designCOS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition.SettingStakeholders from the United Kingdom.Subjects and methodsComprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition.ResultsCandidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'.ConclusionThe development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

Objective: Review the effectiveness of surgical and non‐surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. Design: Narrative review. Setting: ENT and otology services worldwide. Participants: Patients with non‐cholesteatoma tympanic membrane retractions. Main Ouctome measure: Changes in retraction (progression or resolution, or development of a known sequela such as perforation). Results: Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. Conclusion: Few high‐quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hearing loss and its consequences is increasing as the elderly population grows. As the guidelines for cochlear implantation (CI) expand, the number of elderly CI recipients is also increasing. We report complication rates, survival duration, and audiological outcomes for CI recipients aged 80 years and over and discuss the cost utility of CI in this age group. Methods: A retrospective cohort study was undertaken of all CI recipients (126 cases), aged 80 years and over at the time of their surgery, implanted at our institution (Cambridge University Hospitals) during a period from January 1, 2001, to March 31, 2019. Data on survival at 1, 3, and 5 years post-implantation, post-operative complications and functional hearing outcomes including audiometric and speech discrimination outcomes (Bamford-Kowal-Bench sentence test) have been reported. Results: The mean age at implantation was 84 years. The mean audiometric score improved from 108 dB HL to 28 dB HL post-implantation. The mean Bamford-Kowal-Bench score improved from 14% to 66% and 73% at 2 and 12 months post-implantation, respectively. The complication rate was 15.3%. The survival probability at 1 year post-implantation was 0.95 for females and 0.93 for males, at 3 years was 0.89 for females and 0.81 for males, and at 5 years was 0.74 for females and 0.54 for males. Conclusion: CI is safe and well-tolerated in this age group and elderly patients gain similar audiometric and functional benefit as found for younger age groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have shown high rates (47–72%) of self-reported work-related musculoskeletal disorders (WRMDs) in surgeons of the head and neck. Physical requirements in the workplace, individual factors (e.g. poor posture, obesity) and psychosocial factors have been identified as risk factors. Establishing biomechanical risk factors may help prevent further development of WRMDs in this population. OBJECTIVE: The purpose of this critical review was to source studies that identified the biomechanical risk factors for WRMDs in this surgical sub-specialty. METHODS: Searches were conducted of Medline, CINAHL, and AMED databases from 1980 until September 2018. RESULTS: A total of 182 article were identified. Exclusion criteria lead to 163 full-text articles being screened, generating a total of 6 articles for review. The aims of the included studies varied significantly. Surgeons spend the majority of operating time in static, asymmetrical positions. Surgical loupes/headlamps significantly increased cervical spine loading. Articulated surgical arm supports provided optimal ergonomic conditions. Performing surgical operations with the surgeon in standing or sitting had no effect on task performance or demand. Physical fatigue was also measured in both positions. CONCLUSIONS: A combination of equipment-based and patient/surgeon position-based factors predispose surgeons to biomechanical risk factors. Studies of greater methodological quality are required. [ABSTRACT FROM AUTHOR]

Background: Advances in endoscopic technology have allowed transnasal oesophagoscopy to be used for a variety of diagnostic and therapeutic procedures. Method: A review of the literature was carried out to look into the extended role of transnasal oesophagoscopy within otolaryngology, using the Embase, Cinahl and Medline databases. Results: There were 16 studies showing that transnasal oesophagoscopy is safe and cost effective and can be used for removal of foreign bodies, tracheoesophageal puncture, laser laryngeal surgery and balloon dilatation. Conclusion: This study presents a summary of the literature showing that transnasal oesophagoscopy can be used as a safe and cost-effective alternative or adjunct to traditional rigid endoscopes for therapeutic procedures. [ABSTRACT FROM AUTHOR]

Introduction: OFBO is a common occurrence in the emergency setting. Endoscopic removal via rigid or flexible oesophagoscopy is only performed following failure to pass the obstruction after a period of observation and medical management. Despite recommendations from the ESGE, there is currently a lack of high-quality evidence to support the diagnostic work-up of these patients. Purpose: The purpose of this single centre study was to assess the outcome and follow-up of this population over a 5-year period. We retrospectively collected data regarding all patients undergoing emergency oesophagoscopy between 2012-2017 and recorded their outcomes and subsequent follow-up. Results: We found that only 33% of patients had diagnostic investigations performed post-operatively and oesophageal pathology was detected in 44% of those investigated. Eosinophilic oesophagitis was the most common diagnosis and OGD was more likely to detect pathology compared to other modalities. Conclusion: Our study suggests that our findings could have been higher had all our patients underwent further investigation. Therefore, we would recommend a diagnostic work-up in all patients following a discussion of the risks associated with an endoscopic examination. We thoroughly support further large-scale collaborative research which can shed better light of evidence on the topic. [ABSTRACT FROM AUTHOR]

Objectives: Vestibular schwannomas (VS) are rare benign tumours of the vestibular nerve that cause hearing loss. Management strategies include watchful waiting, radiotherapy or surgical resection. Historically, the presence of retrocochlear disease has been considered to be a contra-indication to cochlear implantation (CI). The aim of this systematic review is to assess hearing rehabilitation outcomes for CI recipients with VS, either sporadic or associated with neurofibromatosis type 2, whose tumours have been managed with either observation or radiotherapy.Methods: PubMed, Embase, and Cochrane Library databases were searched from inception through to November 2018. 50 cases from 12 studies met the inclusion criteria. Patient demographics, VS characteristics, management strategy, pre-CI hearing status, electrical promontory stimulation testing, post-CI hearing status and speech perception scores, functional benefits and follow-up length are reported.Results: Radiotherapy and observation groups had similar patient demographics in terms of age at CI, tumour size and duration of deafness. Following CI, 64% and 60% of patients in the radiotherapy and observation groups achieved open-set speech perception, respectively. Pure tone average thresholds (33 vs. 39 dB) and speech scores were also comparable between both groups.Conclusion: Ipsilateral CI in patients with VS that have not been surgically resected can provide beneficial hearing rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Objective of review: Surgical site infections are a recognised complication of cochlear implant (CI) surgery with significant morbidity. Our aim was to search for the optimum prevention and management strategy to deal with this issue. Type of review: Systematic review. Search strategy: A systematic literature search was undertaken from the databases of Embase, CINAHL, MEDLINE®, Web of Science, Scopus and Cochrane Library according to the predefined inclusion and exclusion criteria. Evaluation method: All relevant titles, abstracts and full‐text articles were reviewed by two authors who resolved any differences by discussion and consultation with senior authors. Results: Fourteen articles were included in our review. The overall quality of evidence was low with the vast majority of the studies being retrospective case series and expert opinions. No randomised controlled trials were noted. We found consistent reports that intraoperative prophylactic antibiotics should be given to all patients undergoing CI and that the vast majority of CI wound infections had grown Staphylococcal spp. or Pseudomonas spp. Conclusion: Our review has not identified any reliable or reproducible strategies to prevent and deal with wound infections after CI. We strongly encourage further research within this field and would suggest that a consensus of opinions from a multidisciplinary panel of experts may be a pragmatic way forward as an effective guide. [ABSTRACT FROM AUTHOR]

Musculoskeletal pain is a common occupational hazard experienced by surgeons. Ear, nose and throat (ENT) surgeons are predisposed to neck and back pain due to regular prolonged microscopic work. We conducted a prospective pilot study to investigate the effects of sustained microscopic work on the neck and back, its correlation to surgical experience and to assess the benefits of a prototype postural support chair (PSC) amongst 10 male, ENT clinicians. We used a subjective measure of time to fatigue and pain for the neck and back as well as objective readings from a surface electromyogram (sEMG). We found that an increase in surgical experience correlated with the time taken to experience fatigue and pain in the neck and back. This was corroborated by our sEMG findings. The PSC significantly delayed the sensations in the neck and also eliminated the difference seen amongst the varying seniority of clinicians. [ABSTRACT FROM AUTHOR]

Objective: Microscopic surgery is currently considered the 'gold standard' for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic. Method: Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively. Results: Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training. Conclusion: The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery. [ABSTRACT FROM AUTHOR]

The article discusses a study focusing on improving the efficacy of positron-emission tomography-computed tomography (PET-CT) imaging in head and neck squamous cell carcinoma (HNSCC). Topics discussed include the recurrence of HNSCC; the comparison of disease staging with PET-CT and CT magnetic resonance imaging (MRI); and the limitations of PET-CT.

Examples include a high-riding and/or dehiscent jugular bulb and a jugular bulb diverticulum. Given the close relationship of the jugular bulb with the hypotympanum, a high-riding or dehiscent jugular bulb can also complicate middle ear surgery, with injury leading to potentially serious bleeding. Keypoints Given the close relationship of the jugular bulb with the hypotympanum, a high-riding or dehiscent jugular bulb can complicate middle ear surgery, with injury leading to potentially serious bleeding. [Extracted from the article]

Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew Candida albicans. She was subsequently treated with long-term antifungals and antibiotics, and eventually recovered with good effect. The diagnostic dilemma and the empirical treatment of such a rare case are discussed. [ABSTRACT FROM AUTHOR]

Background: Careers in medicine are embarked on by people with various personalities, with highly strung and motivated characters usually drawn to surgery. This study was conducted to identify the personality types of ENT surgeons in comparison to a control group of foundation doctors. Method: A validated personality questionnaire was distributed to ENT specialty trainees and two cohorts of foundation doctors between October 2013 and November 2015. The questionnaires were scored and individuals were categorised as having either type A or type B personalities. Results: Response rates were 90 per cent (26 out of 29) for ENT specialty trainees and 76 per cent (79 out of 104) for foundation doctors. There was a significantly higher proportion of type A personalities in the ENT specialty trainees compared to the foundation doctors (18 out of 26 ENT specialty trainees vs 32 out of 79 foundation doctors; p = 0.01, chi-square = 6.4708). There were no associations between personality type and grade, gender or subspecialty of interest. Conclusion: ENT surgeons are more likely to be of type A personality in comparison to foundation doctors. This could be a reflection of the recruitment process into the specialty or a characteristic of individuals that get drawn to ENT. [ABSTRACT FROM AUTHOR]

Background: Sharps injuries are a common occupational hazard amongst surgeons. Limited work has been conducted on their effects within the ENT community. Methods: A literature review was performed and a survey on sharps injuries was distributed to the entire membership of ENT-UK electronically. Results: The literature review revealed 3 studies, with 2 of them performed more than 20 years ago. A total of 323 completed questionnaires were returned (24 per cent response rate). Of the respondents, 26.6 per cent reported having experienced sharps injuries. There was no statistical difference between the occurrence of sharps injuries and the grade, length of time spent in the specialty or subspecialty of respondents. Only 33.7 per cent of afflicted clinicians reported all their injuries as per local institutional policies. No seroconversions were reported. Conclusion: The study found poor evidence on sharps injuries amongst ENT surgeons, and low reporting rates that were comparable to other studies conducted in the UK. This highlights the need for further research and increasing awareness on sharps injuries regulations within the specialty. [ABSTRACT FROM AUTHOR]

Objective:Surgeons are exposed to a variety of occupational risks, including work-related musculoskeletal disorders. This study investigated the prevalence of these latter disorders amongst UK ENT surgeons and compared this with the existing literature.Methods:A survey containing questions on work-related musculoskeletal disorders was distributed to the entire membership of ENT-UK electronically, with the assistance of its Survey Guardian. A literature review on the subject was then performed.Results:A total of 323 completed questionnaires were received (a 24 per cent response rate). Work-related musculoskeletal disorders had been experienced by 47.4 per cent of respondents. There were no statistical differences between the occurrence of work-related musculoskeletal disorders and: grade, length of time spent in the specialty or the subspecialty of respondents. Eighty-five per cent of affected surgeons sought treatment, with 22.9 per cent taking time off work and six surgeons retiring early. The literature review only identified five related studies.Conclusion:Despite the scarcity of studies, work-related musculoskeletal disorders are common amongst ENT surgeons in the UK. Such disparity highlights the need for more research and appropriate ergonomic intervention within the specialty. [ABSTRACT FROM AUTHOR]

Background: Around 1.1 million people suffer from occupational health diseases in the UK. Work-related conditions reported by doctors include mental health disorders, musculoskeletal problems and skin disorders. Aims: To investigate the prevalence of occupational illness in UK doctors from different specialties. Methods: A literature search conducted on PubMed, EMBASE, MEDLINE® and Health Management Information Consortium (HMIC) identified relevant research about doctors between the years 1990 and 2013. Results: Seventy-two papers were identified. The majority of studies were cross-sectional with no randomized controlled trials or meta-analyses found. Mental health issues including burnout were widely reported and were attributed to greater job constraints, managerial issues, difficulty with clinical cases and lack of job satisfaction. Substance abuse in doctors was reported to be a risk of maladaptive coping mechanisms and was associated with early retirement. Surgeons were reported as being at greatest risk of needle-stick injuries and musculoskeletal pain. Orthopaedic surgeons were reported to be at risk of noise-induced hearing loss as a result of the use of air-powered and electric drills. There was limited research found concerning contact dermatitis and work-related malignancies amongst doctors in the UK. Conclusions: Our literature review found research on UK doctors for a variety of work-related illnesses with the prevalence varying depending on both specialty and seniority. This could have adverse effects both on the individual and the provision of patient care. Further studies are required to investigate the epidemiology of noise-induced hearing loss, nosocomial infections, skin-related disorders and workrelated malignancies. [ABSTRACT FROM AUTHOR]

Plants from Gynura family was used in this study, namely, Gynura procumbens and Gynura bicolor. Gynura procumbens is well known for its various medicinal properties such as antihyperglycaemic, antihyperlipidaemic, and antiulcerogenic; meanwhile, G. bicolor remains unexploited. Several nonenzymatic antioxidants methods were utilized to study the antioxidant capacity, which include ferric reducing antioxidant power (FRAP), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay, total flavonoid content, total phenolic content, and ascorbic acid content determination. DPPH assay reveals G. procumbens shoot as the lowest (66.885%) and G. procumbens root as the highest (93.499%) DPPH radical inhibitor. In FRAP assay, reducing power was not detected in G. procumbens leaf callus (0.000 TEAC mg/g FW) whereby G. procumbens root exhibits the highest (1.103 TEAC mg/g FW) ferric reducing power. Total phenolic content and total flavonoid content exhibited similar trend for both the intact plants analysed. In all antioxidant assays, G. procumbens callus culture exhibits very low antioxidant activity. However, G. procumbens root exhibited highest phenolic content, flavonoid content, and ascorbic acid content with 4.957 TEAC mg/g FW, 543.529 QE µg/g FW, and 54.723 µg/g FW, respectively. This study reveals that G. procumbens root extract is a good source of natural antioxidant. [ABSTRACT FROM AUTHOR]

Amongst the myriad of problems that patients with severe neurodisability encounter is that of recurrent airway obstructions and intractable aspiration pneumonias due to dysfunction of the protective mechanism of the larynx. Here, we describe the use of total laryngectomy as a surgical option for these patients. Case was 24 year old male with severe cerebral palsy suffering from recurrent episodes of airway obstruction and aspiration pneumonia. In the severely disabled patient with recurrent aspiration pneumonias, total laryngectomy may present as a viable option, especially in those patients who have been previously incapable of effective verbal communication. [ABSTRACT FROM AUTHOR]