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Objective: To evaluate the prevalence and other characteristics of author self-citations in six Turkey-originated general otorhinolaryngology (ORL) journals of Turkish ORL literature. Methods: A total of 970 articles published in six Turkey-originated general ORL journals (ENT Updates, Journal of Ear Nose Throat and Head Neck Surgery, KBB-Forum, Praxis of Otorhinolaryngology, The Turkish Journal of Ear Nose and Throat, and Turkish Archives of Otorhinolaryngology) in 2016-2020 were analyzed for author self-citations. The association between author self-citations and journal types, study types, study topics, country of origin, and compatibility with the topic were also evaluated. Results: There were 265 author self-citations (0.273 per article) which corresponded to 1.36% of all citations. There was no significant difference between the journal types, study topics, and origin of the studies in terms of mean self-citation values per study, whereas case reports had significantly lower self-citations than review and original investigations. There were three citations (1.1%) that were irrelevant to the study topic. Conclusion: To the best of our knowledge, this is the first study that investigated the practice of author self-citation in Turkish ORL literature. Author self-citation rate in the Turkish-originated general ORL journals was found remarkably lower than the medical literature, whereas the self-citations were found compatible with the study topic to a very large extent. Members of the scientific community including authors, readers, and journal editors should be cautious regarding the unethical practices of self-citations.

Unanticipated complications of ENT surgeries may have profound functional and esthetic consequences for patients. Herein, we provide a broad overview of postoperative complications after ENT surgery, illustrating their unique nature, impact, and principles of management. The discussion is organized by subspecialty to highlight the great anatomic complexity of the head and neck and the importance of critical neurovascular and sensory structures that make ENT an impactful, yet challenging surgical specialty.

Objectives. Sarcoidosis is a multisystemic inflammatory disease with extrathoracic manifestations, most commonly affecting the young and middle-aged, female and black populations. Diagnosis usually requires evidence of non-caseating granulomata and, when treated, prognosis is usually favourable. We aim to establish the incidence, clinical features and optimal treatment of ENT manifestations of this disease. Design. We performed a review of the literature to determine the evidence-base supporting this. Results. ENT manifestations are present in 10-15% of patients with sarcoidosis, often as a presenting feature, and require vigilance for swift recognition and coordinated additional treatment specific to the organ. Laryngeal sarcoidosis presents with difficulty in breathing, dysphonia and cough, and may be treated by Speech and Language Therapy (SLT) or intralesional injection, dilatation or tissue reduction. Nasal disease presents with crusting, rhinitis, nasal obstruction and anosmia, usually without sinus involvement. It is treated by topical nasal or intralesional treatments but may also require endoscopic sinus surgery, laser treatment or even nasal reconstruction. Otological disease is uncommon but includes audiovestibular symptoms, both sensorineural and conductive hearing loss, and skin lesions. Conclusions. The consequences of ENT manifestations of sarcoidosis can be uncomfortable, disabling and even life threatening. Effective management strategies require good diagnostic skills and use of specific therapies combined with established treatments such as corticosteroids. Comparisons of treatment outcomes are needed to establish best practice in this area.

Purpose: Early evidence supports the safety and efficiency of extended scope speech-language pathology (SLP) clinics designed to manage low risk ear nose and throat (ENT) outpatient referrals, howe...

Problem description Otorhinolaryngology services are not available in all hospitals and atraumatic epistaxis is a common presentation to Emergency Departments (ED). Not all ED staff are experienced in managing epistaxis and there appeared to be a high rate of re-bleeding after treatment provided. We aimed to improve outcome for ED patients presenting with atraumatic epistaxis and staff conditions by creating a Departmental pathway outlining a management plan and ensuring all equipment needed was readily available. Methods A retrospective 6-month audit was done to assess current management and re-bleed percentage rates post nasal packing. A team was assembled, stocked a trolley, created an Atraumatic epistaxis ED pathway and promoted its use by staff. Repeated Plan-Do-Study-Act cycles were undertaken. Chosen measures were (1) Reduced re-bleed rates post nasal packing from initial audit levels; (2) Increased nasal packing duration; (3) Improved qualitative feedback by ED doctors (4) 100% E.N.T. trolley stock. Results Audit showed minimal use of vasoconstrictor spray, a 7-hour mean nasal pack duration, a re-bleed rate post nasal packing of 39% and staff reports of difficulties accessing items required. After introduction of the E.N.T. trolley, there was positive staff feedback regarding improved availability of treatment items and full stocking of the trolley was achieved after repeated cycles. Following introduction of the Epistaxis pathway and staff education, average re-bleed rates post nasal packing dropped* from 39% to 20% in the first cycle; 21% in the third cycle; 25% in the fourth cycle and 14% in the fifth cycle- (*Isolated re-bleed average of 40% observed in the second cycle). Mean nasal packing duration increased from 7 h to 9, 10, 10, 12 and 8 h in the 2-monthly cycles successively. Conclusion The project's aims of improving epistaxis patients' outcomes and improved convenience for ED staff were achieved.

Anushree Kucheria,1 Johan Bastianpillai,2 Shaharyar Khan,3 Vikas Acharya4 1Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Berkshire, UK; 2Northwick Park Hospital, London North west University Healthcare NHS Trust, London, UK; 3London North west University Healthcare NHS Trust, London, UK; 4Department of ENT Surgery, Northwick Park Hospital, London North west University Healthcare NHS Trust, London, UKCorrespondence: Anushree Kucheria Email anushreekuch@gmail.comIntroduction: General practitioners (GPs) encounter many adult and paediatric patients presenting with ear, nose and throat (ENT) complaints. There is a paucity of learning opportunities to develop knowledge and skills in ENT at undergraduate and postgraduate level. GP trainees starting an ENT rotation have very little prior experience, and therefore we recognise a need for an introduction through a focused induction programme. The aim of this study was to understand whether a GP trainee focussed induction programme can improve the confidence of these doctors in managing emergency hospital presentations in ENT.Methods: An ENT-focussed induction program was created: a didactic teaching program, shadowing period and supervised on-calls. Five GP trainees completed the induction programme. Questionnaires assessed the GP trainees’ confidence in managing common emergency presentations and performing common procedures before and after the induction program. For comparison, questionnaires were given to seven GP trainees who did not complete induction program before starting the rotation and 2 weeks subsequently.Results: With no induction in place, the mean increase in confidence was by 0.81. In comparison, the GP trainees who did complete the induction program had a mean increase in confidence by 1.2. The induction program had a dramatic increase in confidence in ENT-specific skills which would not have been experienced in other specialties such as flexible nasal endoscopy, post-tonsillectomy bleeding, neck sepsis, stridor and periorbital cellulitis.Limitations: A small cohort of participants in one hospital were included, thus affecting the reliability of the results.Conclusion: There was a greater level in confidence in managing ENT presentations of those who completed the induction program, and we recommend a similar structured programme for GP trainees who rotate in ENT. This may have wider implications in fostering interest in postgraduate degrees in ENT and improving the quality of primary care management of ENT complaints.Keywords: otolaryngology, ENT, general practitioner trainees, induction programs, confidence

The majority of the tissues and organs that fall into the area of expertise of ear, nose and throat (ENT) specialists are adjacent to the orbit, and therefore to the globe. As a result of this contiguity, ENT diseases can spread to the orbit and present with various orbital complications. While these complications can be mild, they can also manifest as severe morbidities that lead to permanent loss of vision. In addition, ENT diseases can also spread to the cranium as well as the orbit, and lead to severe intracranial complications that may result in mortality. Such intracranial complications may also manifest with findings in an ophthalmological examination, as many cranial nerves (CNs) are also associated with the orbital structures. This is why ENT specialists commonly encounter ophthalmological findings as a result of both the orbital and cranial complications of infectious ENT diseases. In addition, ophthalmological examination findings are useful for diagnosis, as some infectious agents can cause a common infection both in the ocular and head-neck region.

Objective: To evaluate the clinical efficacy of topical nasal Pomegranate Fruit Extract (PFE) for Chronic Rhinitis (CR), Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP), and Chronic Rhinosinusitis without Nasal Polyposis (CRSsNP). Methods: Prospective, double-blinded, randomized study including 111 consecutive patients, between April 2012 and January 2017, afflicted by CRSwNP, CRSsNP, and CR. Patients from each group were randomly assigned to either PFE treatment or placebo twice daily for 30 days. Therapeutic efficacy was assessed by Ear Nose and Throat, blood and tomographic examinations, and the SNOT-20 questionnaire. Results: CR patients treated with PFE suffered significantly less from thick nasal discharge, difficulty falling asleep, reduced productivity, reduced concentration, and sadness ( P = .004, P = .02, P = .03, P = .007 and P = .02, respectively). Conclusions: Topical nasal PFE was found to have some benefits for CR patients, however, not for CRS with or without Nasal Polyposis.

Otorhinolaryngology is a vast domain that requires the aid of many resources for optimal performance. The medical devices utilized in this branch share common problems, such as the formation of biofilms. These structured communities of microbes encased in a 3D matrix can develop antimicrobial resistance (AMR), thus making it a problem with challenging solutions. Therefore, it is of concern the introduction in the medical practice involving biomaterials for ear, nose and throat (ENT) devices, such as implants for the trachea (stents), ear (cochlear implants), and voice recovery (voice prosthetics). The surface of these materials must be biocompatible and limit the development of biofilm while still promoting regeneration. In this respect, several surface modification techniques and functionalization procedures can be utilized to facilitate the success of the implants and ensure a long time of use. On this note, this review provides information on the intricate underlying mechanisms of biofilm formation, the large specter of implants and prosthetics that are susceptible to microbial colonization and subsequently related infections. Specifically, the discussion is particularized on biofilm development on ENT devices, ways to reduce it, and recent approaches that have emerged in this field.

In this special issue of the Ear Nose and Throat (ENT) journal entitled Lasers in Otolaryngology, we attempted to cover and accommodate different experiences from around the globe on both established and some not so well-known techniques and indications for Lasers in most ENT subspecialties. Despite the COVID 19 pandemic, authors from all over the world have expressed their interest in publishing their Laser experiences with ENT journal and for this we are very grateful.

Aims: Many procedures in ear, nose, and throat (ENT) day surgery are carried out under local anesthesia in Finland, whereas many other countries use general anesthesia. We investigated overstay and readmission rates in local and general anesthesia at Helsinki University Hospital. Material and Methods: We conducted a retrospective study on ENT (n = 1011) day surgery patients within a 3-month period using the hospital’s surgery database to collect data pertaining to anesthesia, overstays, readmissions, and contacts within 30 days of surgery. Objectives: We examined the effect of American Society of Anesthesiologists (ASA) class, age, sex, type of procedure, and anesthesia type on overstay, contact, and readmission rates. Results: A multivariable logistic regression model included ASA class, age, sex, type of procedure, and anesthesia (local vs general). Sex, age, and type of procedure had an effect on the outcomes of overstay, readmission, or contact. With general anesthesia, 3.2% (n = 23) had an overstay or readmission compared to 1.4% (n = 4) after local anesthesia. This was mainly explained by the number of study outcomes in tonsillar surgery that was performed only in general anesthesia. Conclusions: Day surgery could be done safely using local anesthesia, as the number of study outcomes was no greater than in general anesthesia. Sex, type of procedure, and age affected the rate of study outcomes, but ASA class and anesthesia form did not. Our overstay, contact, and readmission rates are on the same level, or lower, than in international studies.

Objective Foreign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions. Methods From April 2009 to March 2014, 94,479 patients visited the Chuo Emergency Clinic (CEC) in Osaka, which is a local emergency center for Osaka prefecture in Japan. Among them, 3229 patients with throat FBs, 577 children (0–15 years of age) with ear FBs, and 1999 children (0–15 years of age) with nose FBs were enrolled into the present study. Monthly trends in the number of throat FBs were examined in relation to fish eating customs. The monthly average of the daily ratio of pediatric patients with ear or nose FBs to the total number of patients were examined in relation to weather parameters using a database of the Japan Meteorological Agency. Results The incidence of throat FBs was significantly higher in July and January ( p 0.05, analyzed by ANOVA and Tukey–Kramer test), presumably because Japanese people have more chances to eat fish in these months due to the traditional fish-eating customs. There was also a significant correlation between the number of pediatric patients with ear and nose FBs and the bad weather parameters including daily rainfall (r = 0.76, p = 0.0043; r = 0.57, p = 0.050, respectively, analyzed by the Pearson product-moment correlation coefficient). This is because children would spend longer time inside on rainy days, which increases the chance of putting a small toy part in the ear and nose. Conclusions FBs in throat and ear/nose occurred more frequently in the specific periods to eat fish and rainy days, respectively. Therefore, public announcement on the risk of occurrence of FBs based on sociocultural and geographical data is helpful to prevent FBs.

Background and Objectives: Otolaryngologists usually encounter foreign bodies pediatricians, and preliminary care physicians. In this study,determining the prevalence of foreign body types in the ear, nose, and throat is the goal.Methods: This study is a descriptive-analytic kind of study based on hospital information that was taken from patients with foreign bodies in ear, throat, and nose referred to ENT Emergency Department of Imam Khomeini Hospital in Ahvazduring 1396 and 1397.Registered hospital records are used to determine the number of patients with foreign bodies in the ear, throat, and nose. Also, Socio-demographic data were collected prospectively using a pre-designed questionnaire. Descriptive and analytical statistical methods (using SPSS version 22.0) were used to input and analyze data collected from 4257 patients. Conclusion: Foreign bodies in the ears, nose, or throat are frequent in the emergency services of otorhinolaryngology (ENT). The most common site of FB accommodation is in the Throat. FB of the ear, nose, and throat should be handled properly to avoid complications.

Introduction Amidst another wave of COVID-19, the alarming number of cases per day in India has affected the healthcare system and professionals tremendously. As the disease burden continues to increase, ear, nose, and throat (ENT) specialists remain at high risk of exposure to this aerosol borne virus. This requires the creation and regulation of protocols for conducting routine clinical practice, especially by ENT specialists.Objectives To review the available literature and to propose strategies and recommendations for ENT practitioners to conduct their regular practice amidst this pandemic.Data synthesis A systematic review of the available literature on ENT practice during the COVID-19 pandemic was done. Out of the many protocols proposed in various studies, the most practical and feasible ones that could be adopted by practicing ENT doctors/ surgeons in the long run were selected. Adequate precautions and use of high level of personal protective equipment (PPE) is required to be adopted by all practicing ENT doctors. Use of teleconsultation has been promoted as it limits face-to-face exposure. Proper guidelines should be followed for both emergency and elective surgeries. Endoscopy can be used as a safe and useful tool for ENT examination.Conclusion As practicing otorhinolaryngologists, it is of utmost importance that we take all necessary precautions and adopt safety measures in our clinical practice while conducting out patient department (OPD) consultations, operative procedures, and emergency care to protect our patients, ourselves, and other healthcare staff during this time.

Objectives: Epistaxis is the second most common referral to the Ear nose and throat (ENT) department. Frailty, a marker for biological vulnerability, has been shown to increase the risk of haemorrhage, but its impact in epistaxis patients is unknown. We aim to establish the impact of Clinical Frailty score, as well as other established risk factors for epistaxis, on the likelihood of admission in patients presenting to secondary care with epistaxis. Design: Retrospective cohort study Setting: University hospital Otolaryngology department Participants: Adult patients presenting to hospital with epistaxis between March 2019 and March 2020. Main outcome measures: We compare the clinical frailty score of patients admitted with epistaxis to those patients seen and treated same day. Results: 299 epistaxis presentations were identified, of which 122 (30.8%) required admission for further management. Clinical frailty score of ≥4 had an increased odds for admission (OR 3.15 (95% CI:1.94 – 5.16), p

Background: Foreign body in ENT refers to an object which settles within head orifices which includes theear, nose, or throat.Aim: Compare the incidence of various Foreign Bodies in the Ear, Nose and Throat and the type of anesthesiarequired for removal in alramadi teaching hospital.Method: This cross-sectional study was conducted on 100 patients who presented with complaints of foreignbody insertion/impactionor ingestion in ear or nose or throat in alramadi teaching hospital.Results: These cases comprised of 64 (64%) males & 36 (36%) females having male: female ratio= 1.77:1. Out of all patients 56 (56%) presented with ear foreign bodies, 33 patients (33%) presented with nasalcavity foreign bodies, 11 patients (11%) presented with the throat (oropharyngeal/hypopharyngeal) foreignbodies. General anesthesia was required in 8 cases (8%) while the rest removed by senior house officersunder supervision by ENT specialists or Consultants without GA.Conclusion: Foreign bodies considered an important challenge to otolaryngologist especially in childrenwho represented the most commonly affected age.

Objectives/Hypothesis: Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology. Study Design: DELPHI survey. Methods: Twenty-seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained. Results: The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high-definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ-specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre- and postoperative videos in voice surgery and preoperative drawings and photos of scars in plastic surgery, as well as the ventilation method in airway surgery. Conclusions: International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery. Level of Evidence: 5 Laryngoscope, 131:E732–E737, 2021.

Objective This study was undertaken to identify the proportion of referrals to Oral and Maxillofacial surgeons amongst Australian general medical practitioners (GP’s) for common head and neck surgical scenarios. Methods A questionnaire presenting 34 common clinical surgical scenarios involving the head and neck region, as well as a descriptive component identifying reasons/barriers to referral was sent out through newsletter e-publications targeting general practitioners. The main outcome measures were identification of the preferred specialty referral (Ear Nose and Throat, Plastic, Oral & Maxillofacial (OMS) or General surgery) for each of the clinical scenarios provided. Results 90 GP’s participated with eligible responses. The majority of dento-alveolar surgery and facial trauma was referred to OMS. In cases of oral pathology, the referral rate to OMS was mixed (mean ∼57%). Regarding facial cosmetics, the majority of respondents chose Plastic Surgery for referrals (94.4%), and ENT surgery for the management of obstructive sleep apnoea (90%). Conclusions The responses of this survey indicate an adequate awareness of the core fields in OMS (trauma, dento-alveolar). Less awareness appears to be present of the expanding role of OMS in the areas of pathology and cosmetic and OSA surgery. Medical education may play a role in expanding these perceptions.

Aims: Facial candling is one of the traditional treatments that is claimed to be able to help in curing or reducing various allergy and inflammation conditions such as allergic rhinitis. We aimed to explore the perceptions of participants with allergic rhinitis toward their disease conditions and facial candling treatment. Materials and Methods: The study used a qualitative exploratory design, comprising 12 in-depth interviews. A semi-structured topic guide was used to explore all relevant aspects of the topic, which were audio recorded, transcribed verbatim. All the interviews were conducted in a few beauty salons in purposively selected city areas in the state of Kedah, Malaysia. Results: Of the 12 patients, seven (58%) reported a positive experience of facial candling treatment, with improvement in the condition of their allergic rhinitis. Specific themes about the experience of facial candling treatment that were identified within the transcript data included knowledge about facial candling, options for disease treatment, effectiveness of facial candling, sources of information, comparison, application of treatment, treatment budget, and safety. The major strength lies in the fact that reasons for using facial candling were uncovered from the perspectives of people with allergic rhinitis through the in-depth interviews. Conclusions: The motives of these participants for using facial candling are mainly due to cultural influence and its low cost of treatment. There were mixed responses from the participants about the usefulness of facial candling. Most of the respondents had not assessed the safety of prolonged use of facial candling and regarded it as a safe procedure as this has been practiced for generations.

Peritonsillar abscess (PTA) is one of the most commonly seen ear nose and throat (ENT) emergencies. The most catastrophic complication that may occur due to surgical treatment of PTA is injury of internal carotid artery. The aim of this study is to determine distance and angle between PTA with ICA; and to prevent possible complications.A total of 34 adult patients with PTA were enrolled in this study. Neck computed tomographies of the patients with PTA were evaluated by a radiologist. The distance between PTA and ICA (DIP), and contralateral tonsil side and ICA (DIT) were measured and compared with each other. Also angle between PTA and ICA (AIP) was examined.This study contained 20 (58.8%) males and 14 (41.2%) females with a mean age of 32.20 ± 12.75 years (range 18-60 years). Mean DIP and DIT scores were 13.39 ± 3.7 mm (min: 5.32, max: 19.07) and 9.61 ± 3.17 mm (min: 4.95, max: 16.35) respectively, and the difference was statistically significant (p0.05). Mean distance between anterior border of PTA and ICA was 36.18 ± 6.42 mm (min: 17.12 max: 47.43). The AIP was 33.40 ± 2.29° (min: 30.10° and max: 40.71°). According to risk classification system, the 28 (82.4%) patients constituted low risk, and 6 (%17.6) patients constituted moderate risk.According to the distance between the PTA and ICA, the risk of ICA injury was found to be mild and moderate in PTA patients. It is crucial for the surgeon to pay attention to the depth and angle of the incision during drainage of the abscess.

With today's technological advances in outpatient surgery, anesthetic technique does not differ significantly between inpatient and outpatient settings. It is important to decide which setting is most appropriate for the patient based on the surgeon's ability, the patient's comorbidities, the facility resources, and the staff who will provide care for the patient. Matching all of the above can lead to good outcomes, less complications, and a good patient experience.

Ear, nose and throat problems are very common in Primary Care settings. Numerous studies have reported that Primary Care physicians feel dissatisfied with their performance and insufficient training to diagnose and manage these problems. The objective of this study was to assess the competency in diagnosis and management of prevalent ear, nose and throat problems in medical residents of Family Medicine, Internal Medicine and Pediatrics at a University Hospital in Buenos Aires, Argentina, using an Objective Structured Clinical Examination. The participants were 25 residents of Pediatrics (7), Internal Medicine (10) and Family Medicine (8). Residents of Family Medicine and Pediatrics showed better performance than residents of Internal Medicine. Residents of Primary Care demonstrated dissimilar competencies in the management of prevalent ear, nose and throat problems. Areas of common improvement opportunities were detected for the three groups, which provided direction and motivation in future learnings in both knowledge and skills.

The tools described in this article are verified to be Greco-Roman medical and surgical instruments for the eye, ear, nose, and throat. They include three myrtle leaf-shaped scalpels, three ear spoons, a "Q-tip," a forceps, a needle, and two arrow-pointed scalpels. One of the arrow-pointed scalpels is nearly identical to a Juerger keratome, suggesting that in Roman times, cataracts were extracted, not just "couched" into the posterior chamber. The description presented here goes beyond traditional archeological claims, because as a head and neck surgeon, I evaluated these instruments from a surgeon's point of view. For example, nonsurgeon medical historians have claimed the myrtle leaf-shaped items were used as handles or for blunt dissection, which I feel is mistaken. Review of the literature reveals the Greco-Roman surgeons were doing tonsillectomies, tracheotomies, and cataract extractions, and recognized that swimming in dirty water could cause ear infection. However, it is clear that with poor or no anesthesia, the pain from blunt dissection would have been intolerable, and unnecessary tissue planes would have been opened increasing wound infection risks. Therefore, there would have been no need for the myrtle leaf-shaped blade if it were just a handle. Laryngoscope, 2016 127:354-358, 2017.

Introduction A large number of patients present in Otolaryngology clinics with vague upper gastro intestinal symptoms, some potentially originating from the oesophagus. In the United Kingdom there is no consensus for investigation protocols. The concern is that diagnosis of early oesophageal malignancy can be delayed with detrimental effects to the prognosis of the patient. The aim of this paper is to attempt to establish the impact of Ear Nose and Throat (ENT) work up in the diagnostic pathway of these patients. Methods Retrospective analysis of case notes of newly diagnosed oesophageal carcinoma over a 15 month period. Results Sixty five patients with a new diagnosis of oesophageal carcinoma were identified from the upper GI cancer network. A cohort of 7 patients was initially referred to ENT with related symptoms. Delays occurred at different stages during the course of their diagnostic pathways. Only 2 patients were diagnosed from ENT prior to referral to upper GI. Conclusion We support the creation of one stop clinics incorporating the use of transnasal oesophagoscopy. The current literature is discussed.

Objectives To study the compliance of ear, nose, and throat (ENT) physicians to the American Association Otolaryngology-Head - Neck Surgery (AAO-HNS) clinical practice guidelines (CPG) for tinnitus and to identify the disparity of both diagnosis and management options in the absence of a local protocol for the management of adult tinnitus. Materials and methods A voluntary and anonymous questionnaire was emailed in a Google spread-out sheet format to all practicing ENT physicians across the country (n=370). Overall, 126 ENT physicians responded to the questionnaire (34% of the physicians to whom the questionnaire was sent). Results Medical history focuses on tinnitus characteristics and otological signs, and symptoms are often queried (80%-98%). Physicians routinely perform an otoscopic examination, whereas other relevant possible physical findings, such as temporomandibular joint disorders or neck trauma, are less frequently examined. Treating physicians have the most frequent recourse to sound therapy and cognitive behavioral therapy in accordance with AAO-HNS CPG. Conclusion The publication of the AAO-HNS CPG for tinnitus is important, permitting a common approach for the diagnosis and management of primary tinnitus (PT). A diagnosis and management scheme that takes into consideration both the AAO-HNS CPG for tinnitus as well as physician diagnosis and management paradigms is suggested.

Introduction: Many specialist waitlists in Australian hospitals are long. One reason anecdotally reported for this is poor alignment of referrals with current recommended guidelines. This paper reports the findings of an audit undertaken in 2017 for ear, nose and throat (ENT) surgeon referrals submitted by primary health centres within Cape York, Australia. Materials and methods: 54 long-wait ENT referrals were reviewed against referral criteria for ENT presentations using the Clinical Prioritization Criteria (CPC) and two routinely applied clinical primary health care guidelines; with findings reported alongside patient demography. Results: All of the long wait ENT referrals in the sample were for remote living Indigenous Australians, most were children (93%). One fifth of referrals fulfilled all referral criteria and were appropriate (22%); one third required further informaiton to support the referral, either audiology or clinical history (30%); and half were inappropriate referrals (48%). Conclusion: Although many referral submissions did not adhere to CPC or routine guidelines, this audit enabled the identification of improvements to the referral system including the development of a checklist and flow-chart, plus patient information resources aimed at improving patient adherence. A case can be made for a new service delivery model that provides ongoing primary health education and facilitates improved ENT access. These strategies may improve ENT referral quality and decongest current ENT specialist waitlists, while offering improved primary health care management of ear presentations.

Contrary to general and obstetric populations, where difficult airway is widely studied and well documented, it requires further research in elective and emergency ear, nose and throat (ENT) surgeries. American Society of Anesthesiologists (ASA) has published practice guidelines for the management of difficult airway, which help us deal with it perioperatively. All patients posted for ENT surgeries with difficult airway should be evaluated preoperatively and the strategy for management of difficult intubation as well as extubation chalked out. In the event, that the primary approach fails, the secondary plan should always be clear preoperatively, to reduce morbidity and mortality. How to cite this article Baldwa NM. Anticipated Difficult Airway in Ear, Nose and Throat Procedures. Int J Otorhinolaryngol Clin 2015;7(1):10-16.

Ear, nose and throat (ENT) emergency procedures demand significant anesthetic challenges. Variety of emergency conditions like deep neck space infections (Ludwig's angina, retropharyngeal, parapharyngeal abscess), acute onset of stridor, epiglottitis, laryngotracheobronchitis, inhaled foreign bodies, facial injuries, etc. are a challenge to both the surgeon and the anesthesiologist and communication and cooperation is vital. Priority in emergency is to clear and secure the airway and consider requirement of ‘shared airway’. Preferred anesthesia and airway technique include awake flexible fiberoptic (FOB) guided intubation in cooperative patients’ and an inhalational induction in uncooperative patient or tracheostomy. Anticipation, vigilance, readiness for difficult intubation, emergency tracheostomy and team work is essential while managing ENT emergency procedures. How to cite this article Harde M, Bawankar T, Bhadade R. Ear, Nose and Throat Emergencies and Anesthesia. Int J Otorhinolaryngol Clin 2015;7(1):28-34.

Summary Objective This study investigated the efficiency of the DoctorVox Voice Therapy Technique using high back-pressure on mutational falsetto. Study Design A total of 21 men with mutational falsetto and 25 age-matched healthy men were included. All patients received DoctorVox voice therapy using the doctorVOX device with high back-pressure. Ear nose and throat examination, videolaryngostroboscopy, and acoustic (SPL, mean F0, first three formants, jitter%, shimmer%, and NHR) and electroglottographic analysis (Closed Quotient and Contact Index) were performed at pretreatment, and at 1 and 6 months after treatment. The VHI-10 and the GRBAS scales were used for perceptual voice evaluation. Results Compared with the pretreatment values, the first and sixth month values after treatment demonstrated a significant decrease inVHI-10, GRBAS, F0, F1, F2, F3, Jitt %, Shimm %, NHR, and contact index and a significant increase in closed quotient among MF patients. In the sixth month after treatment, VHI-10, jitt%, and NHR parameters were significantly lower than those of the first month. The first-month data for VHI-10, jitt%, and NHR values was significantly higher than that of the control group, while there was no significant difference between the sixth-month data and that of the control group. Conclusions The DoctorVox Voice Therapy Technique is highly effective in mutational falsetto treatment. At the first session, the patients reach a lower fundamental frequency in the chest register; by the 1 month after treatment, they have a normal pitch at speaking. The improvement in perturbation measures may continue for 6 months. Patients should be followed up regularly for at least 6 months after treatment to obtain optimum treatment outcomes.

Objective To evaluate the effectiveness of crenotherapy on the olfactory performance of elderly patients with chronic rhinosinusitis (CRS). Study Design A longitudinal case-control study of a cohort of elderly patients affected by CRS and olfactory dysfunction assessed with the Sniffin' Sticks (Burghart Medical Technology, Wedel, Germany) (SS) olfactory test. Methods One hundred and thirty-seven elderly subjects with CRS were divided into two groups. The investigational arm (n = 69) underwent crenotherapy with hyperthermal water, rich in mineral salts, and the control group (n = 68) underwent NaCl 0.9% both for 12 days. At baseline and at 1 and 6 months after treatment, both groups underwent ear nose and throat assessment and SS. Self-report questionnaires were administered at baseline to evaluate the patients' own olfactory response, and after treatment to evaluate their degree tolerability. Olfactory performance was then evaluated in elderly subjects with hyposmia without CRS (n = 40) and in younger subjects with both hyposmia and CRS (n = 40). Results No adverse reactions were reported after crenotherapy. The SS total score showed that crenotherapy induced a statistically significant improvement in the olfactory function of both the elderly and the younger subjects with hyposmia and CRS. By contrast, no improvement was observed in the control arm and in the elderly with hyposmia without CRS. All subjects showed a good degree of tolerability. Conclusions We demonstrated that crenotherapy effectively improves olfactory function in elderly patients with CRS. Finally, our study suggests that crenotherapy represents a safe therapeutic strategy for the treatment of CRS and olfactory dysfunction in the elderly. Level of Evidence 3B. Laryngoscope, 125:1529–1534, 2015

Management of the pregnant surgical patient is challenging. The surgical procedure is usually postponed until the postpartum period, although this may not be possible in emergency situations. This article highlights the optimal management of the pregnant woman requiring ear nose and throat surgery.

Introduction For Otorhinolaryngologist, removal of Foreign Bodies (FB) from the ear, nose and throat is one of the common emergency procedures done. Most of the cases especially of the ear and nose can be managed without General Anaesthesia (GA). But in some cases GA may be needed. There are very few studies that address the scenario of ear, nose and throat foreign body that required GA for its removal and the complications associated with it. Aim This study was conducted with the aim to study the patient's profile, types and distribution of FB removed under GA, and the associated complications. Materials and methods The present study is a hospital based retrospective, cross-sectional study conducted in the Department of Otorhinolaryngology in association with Department of Anaesthesiology and Critical Care in North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India from year 2009 to 2014. Information was collected from indoor patient file and operation record book. Those patients where foreign body was not found after examination under GA were excluded. Results A total of 112 cases of foreign body in ear, nose and throat removed under GA were selected. There was variation of age from youngest case being 11 months to 74 years with a slight male predominance. Two third of the patients belonged to paediatric age group. Most of the FB were inanimate with high number of inorganic type found in majority. Foreign body in food passage was found in most cases. Coin and meat bone were the common FB in children and adults respectively. We found no complications related to removal of foreign body from the food passage and nose. But some complications were seen in foreign body of ear and tracheo-bronchial tree. Conclusion Ear, nose and throat FB that required GA were seen in all age groups. FB of food passage constitute the majority. Type of foreign body varies between children and adults. In children most common types were related to toys and their part and food materials. In adults, food materials were most common.

Hintergrund Die haufigsten Standardeingriffe in der HNO-Heilkunde werden entsprechend internationalen Kriterien als „clean-contaminated“ eingestuft, entsprechend gibt es in der Regel keine verbindlichen Empfehlungen zur perioperativen antibiotischen Prophylaxe (pAP). Der Nutzen einer derartigen pAP ist fur diese Eingriffe unklar. Ziel der Arbeit war die Evaluation der Effekte einer pAP bei ausgewahlten Standardeingriffen.

Background: This study aims to map the coverage of Ear, Nose and Throat (ENT) outreach clinics in New South Wales (NSW) over a 5-year period [2012–2016]. It also aims to determine the extent of engagement in outreach work among NSW and ACT-based ENT surgeons over this period. Methods: Online and telephone survey of ENT surgeons practising in NSW and ACT conducted between December 2016 and May 2017. The survey was designed to identify the location, frequency and the number of ENT surgeons providing outreach services in NSW. A secondary outcome of the survey was the current and future rates of participation in outreach projects by NSW and ACT-based ENT surgeons. Results: Eighteen surgeons provided at least one ENT outreach service in NSW between 2012 and 2016. The average yearly commitment was 5.5 days (SD 4.2 days). Eighteen distinct towns in NSW received an outreach service. In the majority of cases, a visiting surgeon provided outreach services to the same town for at least three consecutive years. Surgeons who obtained their Fellowship of the Royal Australasian College of Surgeons (FRACS) after 2005 had the highest interest in future participation. Conclusions: Approximately 1 in 5 NSW and ACT-based ENT surgeons perform outreach activities. The data suggests that many remote and rural towns within NSW are not receiving outreach services. Better coordination of services and a commitment to regular and well-constructed outreach programs could redress this imbalance. The expressed intention to become involved in future outreach programs, particularly among the younger surgeons, needs to be encouraged and supported for this to be realised.

Introduction A foreign body (FB) is an object or substance foreign to the location where it is found. FBs in the ear, nose, and throat are a common problem frequently encountered in both children and adults.Objective To analyze FBs in terms of type, site, age, and gender distribution and method of removal.Methods A retrospective study was performed in a tertiary care hospital in the central part of Nepal. The study period was from June 2013 to May 2014. The information was obtained from hospital record books.Results A total of 134 patients had FBs in the ear, nose, or throat; 94 were males and 40 were females. Of the 134 patients, 70 (52.23% ) had FB in the ear, 28 (20.89% ) in the nose, and 36 (26.86% ) in the throat. The FB was animate (living) in 28 (40% ) patients with FB in the ear and 1 (3.5% ) patient with FB in the nose, but the FB was inanimate (nonliving) in any patient with FB in the throat, in 42 (60% ) patients with FB in the ear FB, and in 27 (96.4% ) patients with FB of the nose. The FB was removed with or without local anaesthesia (LA) in 98 (73.13% ) patients, and only 36 patients (26.86% ) required general anaesthesia (GA). The most common age group affected was Conclusion FBs in the ear and nose were found more frequently in children, and the throat was the most common site of FB in adults and elderly people. Most of the FBs can be easily removed in emergency room or outpatient department.

Virtual reality has been introduced to the medical field and it is now used in medical education as an alternative high fidelity simulator. The major components to successful learning that has contributed to the efficacy of the virtual reality system are the ability to provide repetitive practice under controlled environment, self-directed learning and proved construct validity. This review evaluated the validity and the efficacy of current virtual reality systems in ear, nose and throat surgery.

Olfactory dysfunction is a common disorder, especially in elderly people. From the etiological point of view a differentiation is made between sinunasal, traumatic and non-sinunasal causes of dysosmia. Olfactory disorders are often observed in neurodegenerative diseases, especially in patients with Parkinson's disease or Alzheimer's disease. Apart from an extensive medical history important diagnostic tools are a complete ear nose and throat (ENT) examination including nasal endoscopy and olfactory testing, for example, with "sniffin' sticks". For diagnostic purposes modern imaging procedures, such as magnetic resonance imaging (MRI) are becoming more and more important. For testing children, olfactory testing needs to be adapted and depending on the etiology, olfactory training, antiphlogistic and surgical procedures are the most promising therapeutic approaches. In cases of intracranial causes of dysosmia neurosurgeons should know and respect the anatomical structures of the olfactory signal pathway, not least for the long-term prognosis.

Introduction : Medical teachers needs to innovate different strategic in order to increase the attention and interest of the students in “minor” subjects like otolaryngology (ORL) / ear nose and throat (ENT). One helpful approach could be using a “short questionnaire” handout containing probable questions from the topic of didactic lecture. Material and methods: Sixth semester lectures of ORL/ ENT were divided in two groups. For “group A” lectures students were provided with “short questionnaire” handouts before lecture. The hand out were containing of MCQs, BAQs, SAQs. For “group B” lectures no handouts were provided. At the end of lecture short test was done. Scores were calculated and compared. Results: When students were provided with “short questionnaire handouts” they perform well. We suggest “short questionnaire” definitely helps in increasing attention of the students to the lecture. In addition it also helps in increasing self directed learning by them particularly for minor subjects, to which they pay less attention.

// Daria A. Gaykalova 1 , Veronika Zizkova 1, 2 , Theresa Guo 1 , Ilse Tiscareno 1 , Yingying Wei 3, 10 , Rajita Vatapalli 1, 4 , Patrick T. Hennessey 1, 5 , Julie Ahn 1 , Ludmila Danilova 3, 11 , Zubair Khan 1 , Justin A. Bishop 1, 6 , J. Silvio Gutkind 7 , Wayne M. Koch 1 , William H. Westra 1, 6 , Elana J. Fertig 3 , Michael F. Ochs 3, 8 , Joseph A. Califano 1, 9 1 Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA 2 Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic 3 Division of Oncology Biostatistics, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA 4 Department of Urology, Northwestern University, Chicago, Illinois, USA 5 Department of Otolaryngology, Mid-Michigan Ear Nose and Throat, East Lansing, Michigan, USA 6 Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA 7 Department of Pharmacology, UC San Diego Moores Cancer Center, La Jolla, California, USA 8 Department of Mathematics and Statistics, The College of New Jersey, Ewing, New Jersey, USA 9 Department of Surgery, UC San Diego, Moores Cancer Center, La Jolla, California, USA 10 Department of Statistics, The Chinese University of Hong Kong, NT, Shatin, Hong Kong 11 Laboratory of Systems Biology and Computational Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia Correspondence to: Joseph A. Califano, email: jcalifano@ucsd.edu Daria A. Gaykalova, email: dgaykal1@jhmi.edu Keywords: HNSCC, DTX1, expression, methylation, integration Received: September 07, 2016 Accepted: January 16, 2017 Published: January 27, 2017 ABSTRACT Over a half million new cases of Head and Neck Squamous Cell Carcinoma (HNSCC) are diagnosed annually worldwide, however, 5 year overall survival is only 50% for HNSCC patients. Recently, high throughput technologies have accelerated the genome-wide characterization of HNSCC. However, comprehensive pipelines with statistical algorithms that account for HNSCC biology and perform independent confirmatory and functional validation of candidates are needed to identify the most biologically relevant genes. We applied outlier statistics to high throughput gene expression data, and identified 76 top-scoring candidates with significant differential expression in tumors compared to normal tissues. We identified 15 epigenetically regulated candidates by focusing on a subset of the genes with a negative correlation between gene expression and promoter methylation. Differential expression and methylation of 3 selected candidates ( BANK1 , BIN2 , and DTX1 ) were confirmed in an independent HNSCC cohorts from Johns Hopkins and TCGA (The Cancer Genome Atlas). We further performed functional evaluation of NOTCH regulator, DTX1 , which was downregulated by promoter hypermethylation in tumors, and demonstrated that decreased expression of DTX1 in HNSCC tumors maybe associated with NOTCH pathway activation and increased migration potential.

Contributing reviewers The editors of BMC Ear, Nose and Throat Disorders would like to thank all our reviewers who have contributed to the journal in Volume 15 (2015).

To study the incidence of various foreign bodies in patients of different age and sex, attending E.N.T. Department, a retrospective review was done in Department of E.N.T., Burdwan Medical College and Hospital, Burdwan. About 334 patients with foreign body in ENT region presented to Department of E.N.T., Burdwan Medical College and Hospital from October 2008 to September 2010 were included in the study. Foreign body in ENT region is a common problem frequently encountered in both children and adults. Their accurate diagnosis and management without any complications is often challenging.

In den vergangenen Jahren hat die Refluxerkrankung an Bedeutung gewonnen, da eine Vielzahl von Erkrankungen und Symptomen des oberen Aerodigestivtrakts mit ihr in Verbindung gebracht werden. Es muss dabei der extraosophageale Reflux (EER) vom klassischen gastroosophagealen Reflux (GERD) abgegrenzt werden. Zur Diagnostik des EER stehen verschiedene Verfahren zur Verfugung. Neben der Berucksichtigung typischer Refluxsymptome und typischer Schleimhautveranderungen im Pharynx und Larynx kann eine Saurebelastung des oberen Osophagus, des Kehlkopfs und des Larynx auch mit verschiedenen pH-Metrie-Systemen gemessen werden. Zudem hat sich mittlerweile auch die transnasale flexible Osophagoskopie, nicht zuletzt wegen der Moglichkeit, refluxbedingte Schleimhautveranderungen zu erkennen, mancherorts in der Refluxdiagnostik etabliert. Im folgenden Beitrag werden diese Moglichkeiten vor dem Hintergrund der eigenen Erfahrung und des internationalen Schrifttums beschrieben.