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Objective Despite advances in skull-base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery. Methods A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesized into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described. Results All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extracranial soft tissue, postoperative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR: 1.3–8.44%). Conclusions The intraoperative strategies used to prevent CSF leaks during RS VS surgery vary between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multicenter observational evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol. [ABSTRACT FROM AUTHOR]

Objectives Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesize the repair techniques and materials used in TL VS surgery to prevent CSF leaks. Design A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted. Results All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, postoperative dressings, and CSF diversion. The median postoperative incidence of CSF leaks was 6% (interquartile range: 0–10%). Conclusions This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that considers all operative stages described by our taxonomy. [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period. Objective The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use. Methods ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (noncomplicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically. Results The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively. Conclusion Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use. [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period. Objective The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use. Methods ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (noncomplicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically. Results The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively. Conclusion Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use.

This narrative review examines the role of vitamin D as a biomarker in ear disorders, including benign paroxysmal positional vertigo (BPPV), otitis media, bell's palsy, Meniere's disease, and hearing loss. PubMed, The Cochrane Library, and Google Scholar were utilized to conduct a comprehensive literature search, and findings were combined from studies from 2014 to 2024. As highlighted in this review, there is a consistent association between vitamin D deficiency and an increased risk and recurrence of disease especially in BPPV and otitis media. Its importance as a prognostic biomarker is emphasized in Bell's palsy, where higher levels of deficiencies in vitamin D are associated with higher grades of severity on the House Brackmann grading system. Vitamin D deficiency can also lead to sensorineural hearing loss due to its receptors present in the inner ear or its effect on calcium metabolism. Serum levels of vitamin D have also been shown to influence treatment outcome of sensorineural hearing loss. The role of vitamin D in Meniere's disease is unclear as no cause has been identified for the increase in endolymphatic fluid. The findings of this review emphasize the importance of serum vitamin D as a biomarker in ear disorders and advocate for more studies to be conducted to assess the importance of optimal dosing of vitamin D for the progression and outcome of these diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Hamayal et al.)

Introduction The British Association of Endocrine and Thyroid Surgeons (BAETS) published guidance in 2012 advising against day-case thyroid lobectomy due to the unpredictable risk of post-operative haematoma. Due to the increasing pressures the National Health Service (NHS) faces, a position statement was released by BAETS in 2020 highlighting their support of day-case thyroid lobectomy in specific low-risk cases with the introduction of appropriate local protocols. Objective We aimed to assess post-operative complications of thyroid lobectomy at University Hospitals Bristol and Weston NHS Trust (UHBW), a tertiary centre for Otolaryngology, to consider the feasibility and safety of day-case surgery in our unit. Methods We conducted a retrospective audit of 140 elective thyroid lobectomy cases identified in the period of January 2017 to December 2018 at UHBW. Inclusion criteria included no previous thyroid surgery or major head and neck surgery, elective thyroid lobectomy procedure only, and surgery performed at UHBW by otolaryngology or maxillofacial teams. Exclusion criteria included emergency hemithyroidectomy; hemithyroidectomy as part of another procedure; and completion thyroidectomy. Results A total of 140 elective thyroid lobectomy procedures were performed between January 2017 and December 2018. Of them, 125 cases met inclusion criteria, and 15 cases were excluded: two emergency hemithyroidectomy, three incorrect coding, four hemithyroidectomy as part of another head and neck procedure, and six completion thyroidectomy. Mean age was 51.9 years (range: 20-88 years), with 30 (24.0%) male cases and 95 (76.0%) female cases. Mean in-patient stay was 1.4 days (range: 0-19 days), and mean hours in hospital were 34 hours. Two (1.6%) cases were discharged on the same day of their operation. Post-operative complications included five (4%) cases of post-operative haematoma, four (3.2%) cases of unilateral vocal cord palsy, one (0.8%) case of pneumonia, and three (2.4%) cases of wound infections. From those cases that developed post-operative haematoma, 80% (n=4/5) developed less than 24 hours after the procedure. One (20%) case of post-operative haematoma developed on day 6 after their procedure and required readmission for re-operation. Conclusion The unpredictable nature of post-operative haematoma poses a significant risk to patients and medicolegal implications. Our findings suggest that there were no predictable risk factors amongst our patient cohort and therefore day-case thyroid lobectomy should be avoided. Further research is required to identify low-risk patients who could benefit from day-case surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Embury-Young et al.)

Introduction:  Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period. Objective  The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use. Methods  ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (noncomplicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically. Results  The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively. Conclusion  Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

The novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge. All types of elective and semi-urgent medical care and procedures have been discontinued during the pandemic to maintain the capacity to care for patients with this disease. The pandemic has had a significant impact on almost every medical field, including pediatric otolaryngology. This review highlights the impact of COVID-19 on surgical interventions and medical practices in pediatric otolaryngology owing to its direct association with ear, nose, and throat disorders, with an emphasis on immediate and potential long-term transformations in clinical practice. We reviewed several articles and scientific websites and summarized the currently available evidence and best practices for safety in the field of otolaryngology during the COVID-19 pandemic. Extensively discussed issues in pediatric otolaryngology include surgical interventions, medical practices, modes of transmission of COVID-19, personal protective equipment, and duration of exposure. Otolaryngologists should preserve their integrative medical approaches and subspecialty expertise during the COVID-19 pandemic. There has been a marked change in the approach to managing pediatric ear, nose, and throat conditions, both in the outpatient department and operating room, during the COVID-19 pandemic. The pandemic requires a great deal of flexibility and necessitates exploring new opportunities to create a safe and patient-friendly environment for children with otolaryngology problems. Many of the precautions implemented will remain necessary until a robust evidence shows the pandemic has come to an end., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Jamal et al.)