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This study aimed at measuring the magnetic field strength of commonly used types of audiological testing equipment and determine their effects on the three most commonly used programmable ventriculoperitoneal (VP) shunts to try and quantify the risk of a VP shunt being reprogrammed during audiological testing.In thisMagnetic field strength associated with transducers placed on a model of a skulls having implanted Miethke ProGAV 2.0, Medtronic Strata II and Codman Hakim programmable VP shunts was measured.The supra-aural earphones had a magnetic field strength of 14 mT at 0 mm, which dropped to 0 mT at 10 mm away from the transducer. All other equipment had a magnetic field strength of 3.5 mT or less at 0 mm. There was no instance of reprogramming of the shunts by the transducers.The findings suggest that the risk of inadvertent valve-reprogramming by the transducers is extremely small. However, care should be taken to avoid placing any of the transducers directly over the shunt.

BACKGROUND: Olfactory dysfunction is an early and sensitive marker of COVID‐19 infection. Although self‐limiting in the majority of cases, when hyposmia or anosmia persists it can have a profound effect on quality of life. Little guidance exists on the treatment of post‐COVID‐19 olfactory dysfunction, however several strategies have been proposed from the evidence relating to the treatment of post‐viral anosmia (such as medication or olfactory training). OBJECTIVES: To assess the effects (benefits and harms) of interventions that have been used, or proposed, to treat persisting olfactory dysfunction due to COVID‐19 infection. A secondary objective is to keep the evidence up‐to‐date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID‐19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA: Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID‐19 infection. Only individuals who had symptoms for at least four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Primary outcomes were the recovery of sense of smell, disease‐related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included one study with 18 participants, which compared the use of a 15‐day course of oral steroids combined with nasal irrigation (consisting of an intranasal steroid/mucolytic/decongestant solution) with no intervention. Psychophysical testing was used to assess olfactory function at baseline, 20 and 40 days. Systemic corticosteroids plus intranasal steroid/mucolytic/decongestant compared to no intervention Recovery of sense of smell was assessed after 40 days (25 days after cessation of treatment) using the Connecticut Chemosensory Clinical Research Center (CCCRC) score. This tool has a range of 0 to 100, and a score of ≥ 90 represents normal olfactory function. The evidence is very uncertain about the effect of this intervention on recovery of the sense of smell at one to three months (5/9 participants in the intervention group scored ≥ 90 compared to 0/9 in the control group; risk ratio (RR) 11.00, 95% confidence interval (CI) 0.70 to 173.66; 1 study; 18 participants; very low‐certainty evidence). Change in sense of smell was assessed using the CCCRC score at 40 days. This study reported an improvement in sense of smell in the intervention group from baseline (median improvement in CCCRC score 60, interquartile range (IQR) 40) compared to the control group (median improvement in CCCRC score 30, IQR 25) (1 study; 18 participants; very low‐certainty evidence). Serious adverse events andother adverse events were not identified in any participants of this study; however, it is unclear how these outcomes were assessed and recorded (1 study; 18 participants; very low‐certainty evidence). AUTHORS' CONCLUSIONS: There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID‐19 infection. However, we have identified other ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available. For this (first) version of the living review we identified only one study with a small sample size, which assessed systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant). However, the evidence regarding the benefits and harms from this intervention to treat persistent post‐COVID‐19 olfactory dysfunction is very uncertain.

Objectives/hypothesis This study set out to describe the progression of hearing loss in patients with neurofibromatosis type 2 (NF2), treated in a quaternary multidisciplinary clinic. It also aimed to compare hearing loss across patients grouped according to a known genetic severity score to explore its utility for prognostication. Study design Retrospective cohort study. Methods We conducted a study of 147 patients with confirmed NF2 diagnosis for a mean observational period of 10 years. Pure-tone average (PTA), optimum discriminations scores (ODS), and genotype data were collected. Patients were classified according to hearing class (American Academy of Otolaryngology), their candidacy for auditory implantation (UK National NF2 consensus) and grouped by genetic severity as: 1 = tissue mosaic, 2A = mild classic, 2B = moderate classic, and 3 = severe. Survival analysis investigated the effect of genetic severity on the age of loss of serviceable hearing. Results Genetic severity was a significant predictor of hearing outcomes such as ODS, hearing classification, and maximum annual PTA deterioration. Although the overall median age of loss of serviceable hearing was 78 years, there was significant variation according to the genetic severity; the median for severe patients was 32 years compared to a median of 80 for tissue mosaic patients. Conclusions This is the first description of long-term hearing outcomes in a clinical setting across a large heterogeneous cohort of patients with NF2. The results highlight the potential importance and benefit of considering the genetic severity score of patients when undertaking treatment decisions, as well as planning future natural history studies. Level of evidence 2c Laryngoscope, 129:974-980, 2019.

OBJECTIVES/HYPOTHESIS To determine if aspirin intake is associated with reduced growth of vestibular schwannomas (VS). To determine the prevalence of contraindications to regular aspirin in patients with VS. STUDY DESIGN Retrospective, observational case-control study. METHODS The study utilized a postal questionnaire and telephone interviews to determine aspirin exposure. Propensity score matching was used to control for age, sex, and tumor size. Cases were defined as patients with VS proven to have grown on serial magnetic resonance imaging (MRI). Controls were defined as patient with VS stable on serial MRI. Prevalence of regular aspirin use was compared in patients with growing VS versus stable VS. Absolute and relative contraindications to aspirin intake were recorded. RESULTS Six hundred fifty-three patients with VS were contacted, and responses were received by 67% (220 cases and 217 controls). The mean tumor size was 11.3 mm (9.0 mm and 13.3 mm in controls and cases, respectively). Aspirin exposure was more common in stable VS than growing VS (22.1% vs. 17.3%). However, following matching to control for covariates, aspirin was not found to be associated with VS stability (P = .475). Multiple logistic regression (analysis of variance) found tumor size to be the only factor strongly associated with tumor growth (P

​Background The clinical severity of disease in neurofibromatosis type 2 (NF2) is variable. Patients affected with a constitutional truncating NF2 mutation have severe disease, while missense mutations or mosaic mutations present with a milder attenuated phenotype. Genotype-derived natural history data are important to inform discussions on prognosis and management. Methods We have assessed NF2 clinical phenotype in 142 patients in relation to the UK NF2 Genetic Severity Score to validate its use as a clinical and research tool. Results The Genetic Severity Score showed significant correlations across 10 measures, including mean age at diagnosis, proportion of patients with bilateral vestibular schwannomas, presence of intracranial meningioma, spinal meningioma and spinal schwannoma, NF2 eye features, hearing grade, age at first radiotherapy, age at first surgery and age starting bevacizumab. In addition there was moderate but significant correlation with age at loss of useful hearing, and weak but significant correlations for mean age at death, quality of life, last optimum Speech Discrimination Score and total number of major interventions. Patients with severe disease presented at a younger age had a higher disease burden and greater requirement of intervention than patients with mild and moderate disease. Conclusions This study validates the UK NF2 Genetic Severity Score to stratify patients with NF2 for both clinical use and natural history studies.

Sudden sensorineural hearing loss (SSNHL) is a distressing condition that may lead to permanent disability with severe/profound deafness and tinnitus. While the aetiology varies, and is often idiopathic, urgent audiological assessment and management improves likelihood of hearing recovery.1 Bilateral vestibular schwannomas (VS) are a hallmark feature of neurofibromatosis type 2 (NF2) occurring in over 95% of patients.2 Up to 12% of patients with VS may present with SSNHL.3 Sudden hearing loss should be urgently assessed to determine if conductive or sensorineural using physical examination, otoscopy, tuning fork tests or audiometry. If found to be sensorineural, urgent treatment with high-dose oral and/or intratympanic steroids are indicated. It is recognised that presentation of SSNHL to an ENT specialist is often delayed, with resulting delay in treatment which may lead to reduced chance of recovery.4 The reasons for this delay in presentation are likely to be multifactorial and may include a lack of awareness among patients and clinicians for the potential of sudden hearing loss to be sensorineural and a medical emergency. This most likely occurs due to the understandable initial assumption that new-onset hearing loss is most commonly due to a conductive cause such as wax impaction or glue ear following an upper respiratory illness. However, patients with NF2 are at significant increased risk of SSNHL due to their VS and the assumption that sudden hearing loss is most likely to be conductive is not appropriate and may lead to suboptimal management and outcomes for this otological …

Facial nerve tumours are rare. The most common histological type are facial nerve schwannomas (FNS) although facial nerve haemangiomas, malignant nerve sheath tumours and 'skip' lesions from parotid malignancies, amongst others, may also occur. This chapter focuses on FNS, their presentation, diagnosis and management, but will also consider the differential diagnoses for these lesions. The main differential diagnosis of an intratemporal facial nerve schwannoma is a facial nerve haemangioma. Bony erosion may not be smooth because haemangiomas do not have a capsule. They do not usually affect multiple segments as FNS do. Haemangiomas have been described as having a 'honeycomb' appearance on imaging. FNSs are rare and usually present with disturbance of facial function, with or without audiovestibular dysfunction. Management decisions must be tailored to each patient based on existing facial and audiovestibular function and tumour location but management philosophy varies between units internationally. The primary aim of management is preservation of optimal facial function for as long as possible.

An 8-year-old girl with a history of cyclin-dependent kinase-like 5 (CDKL5) disorder was presented to the emergency department with a short history of stridor and intermittent respiratory distress following eating a biscuit. She had a background of CDKL5 disorder causing neurodevelopmental delay, including being non-verbal, and refractory epilepsy for which she had received a vagal nerve stimulator (VNS) implanted 2 years prior. On initial examination she was noted to be maintaining her oxygen saturations but with intermittent worsening of her stridor and a barking cough. There was no clear preceding history of …

Objectives:To measure the thermal properties of operative endoscopes used in otorhinolaryngological practice.Methods:A series of endoscopes of varying diameters and angulations were attached to a light source and temperature measurements taken of their shaft and tip; a measurement was also taken 5 mm in front of the endoscope tip.Results:Temperature changes took place rapidly. The amount of heat produced by the endoscopes was maximal at the tip, with larger diameter endoscopes attaining a higher temperature. Temperatures on the shaft and in front of the tip reached relatively constant temperatures independent of the type of endoscope. The maximum temperature achieved was 104.6°C for the 4 mm, 0° endoscope. Cooling occurred rapidly after the light source was switched off.Conclusion:The heat produced by some endoscopes is sufficiently great to cause thermal injury to tissues. Awareness of the temperatures produced by these endoscopes should prompt clinicians to actively cool their endoscopes during a procedure, before any thermal injury is caused.

INTRODUCTION With the increase in shift pattern work for junior doctors in the NHS, accurate handover of patient clinical information is of great importance. There is no published method that forms the gold standard of handover and there are large variations in practice. This study aims to compare the reliability of three different handover methods. PATIENTS AND METHODS We observed the handover of 12 simulated patients over five consecutive handover cycles between SHOs on a one-to-one basis. Three handover styles were used and a numerical scoring system assessed clinical information lost per handover cycle. RESULTS After five handover cycles, only 2.5% of patient information was retained using the verbal-only handover method, 85.5% was retained when using the using the verbal with note taking method and 99% was retained when a printed handout containing all patient information was used. CONCLUSIONS When patient information is handed over by the verbal only method, very few facts are retained; therefore, this method should be avoided whenever possible. Verbal handover with note taking is shown to be an effective method of handover in our study, although we accept that this is an artificial scenario and may not reflect the reality of a busy hospital. Nearly all information is retained by the printed handout method but this relies on the handout being regularly updated.

Previous studies of computed tomography (CT) and magnetic resonance imaging (MRI) before cochlear implantation have been of limited sample size, lacked statistical analysis, and been inconsistent in their conclusions. We aim to quantify the utility of CT, MRI, and their combination in order to rationalize their selection.Clinical records and radiological findings were correlated retrospectively in 158 adults and children. All underwent both CT and MRI.A total of 27.9% (95% confidence interval (CI): 21.0-35.5) of patients had a significant radiological abnormality, but these were considered critical to subsequent management in only 12.7% (7.9-18.9). All these were detected by MRI. They were missed by CT in 6.3% (3.1-11.3). In all, 6.3% also had non-critical abnormalities that were reported only on CT. Cochlear dysmorphisms were more common in children but the overall frequency of abnormalities and their detection rates did not depend on age. Omitting CT and using MRI alone are estimated to miss no critical abnormalities (95% CI: 0-2.3 %).While CT may be better at defining some abnormalities, MRI appears to be able to detect all abnormalities that are critical to patient management. Most candidates for cochlear implantation can therefore be assessed by MRI initially. CT is most likely to be helpful in those with a history of severe middle ear disease, meningitis, or dysmorphic syndromes, who should undergo both CT and MRI.

Objective: Previous studies of CT and MRI before cochlear implantation have been of limited sample size, lacked statistical analysis, and been inconsistent in their conclusions. We aim to quantify the utility of CT, MRI, and their combination in order to rationalize their selection.Method: Clinical records and radiological findings were correlated retrospectively in 158 adults and children. All underwent both CT and MRI.Results: A total of 27.9% (95% CI: 21.0 - 35.5) of patients had a significant radiological abnormality, but these were considered critical to subsequent management in only 12.7% (7.9 - 18.9). All of these were detected by MRI. They were missed by CT in 6.3% (3.1 - 11.3). A total of 6.3% also had noncritical abnormalities that were reported only on CT. Cochlear dysmorphisms were more common in children, but the overall frequency of abnormalities and their detection rates did not depend on age. Omitting CT and using MRI alone is estimated to miss no critical abnormalities (95% CI: 0 - 2.3%)....

Objective: Oncological surgical technological innovation has produced alternative hemostatic dissection techniques. Collateral tissue destruction and impact upon assessment of tumor resection margins from Harmonic and Coblation dissectors remains unknown. This study uses an ex-vivo animal model to quantify the collateral tissue destruction caused by the harmonic scalpel vs coblator wand dissection.Method: Incisions through cow tongue were made between defined parallel lines with each dissection technique. The residual tissue width was measured with vernier calipers and subtracted from the width of original tissue. A scalpel blade was used as a control.Results: The mean width of collateral tissue destruction for each modality was as follows: harmonic cutting 3.0 mm, harmonic coagulating 4.1 mm, coblation cutting 3.5 mm, harmonic cutting under tissue tension 1.2 mm.Conclusion: This study demonstrates that tissue destruction produced when using the harmonic scalpel and coblation is significant when compared ...

Epistaxis is a common problem. Most patients presenting to hospital will stop bleeding with simple first-aid measures or with nasal packing. Those who do not stop will usually require surgical management. For persistent posterior epistaxis, the sphenopalatine artery may be ligated as the artery leaves the sphenopalatine foramen to enter the nasal mucosa of the lateral wall of the nose. This may be performed endoscopically. We describe the anatomy of the area and the surgical technique. We also present a brief review of the literature on this technique.

Postlaryngectomy tracheostomal stenosis is a common complication. Stomal narrowing can be severe, requiring urgent management with dilatation of the stoma. There are numerous ways to achieve this, ranging from forcibly inserting a larger tracheostomy tube, using a graduated dilator, to surgical intervention in the form of a stomaplasty. We describe an alternative technique using a readily available cuffed tracheostomy tube.

Anticoagulation with warfarin is commonly used for prevention of thromboembolic events in patients with atrial fibrillation. Bleeding is the main side effect of anticoagulation. We report the case of a 66-year-old man who developed two spontaneous synchronous upper airway haematomas while on warfarin therapy. To our knowledge, this is the first reported case of a sublingual haematoma presenting simultaneously with supraglottic laryngeal haematomas. Upper airway haematomas are rare in the absence of a history of trauma but need to be urgently assessed due to their life-threatening potential. Clinicians should be aware of the possibility of haematomas involving the upper airway in patients on anticoagulant therapy, particularly if complaining of red flag symptoms such as acute onset dysphonia, odynophagia or airway/breathing difficulties.