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Introduction\ud \ud Otitis media is an umbrella term for middle ear inflammation; ranging from acute infection to chronic mucosal disease. It is a leading cause of antimicrobial therapy prescriptions and surgery in children. Despite this, treatments have changed little in over 50 years. Research has been limited by the lack of physiological models of middle ear epithelium.\ud \ud \ud Methods\ud \ud We develop a novel human middle ear epithelial culture using an air-liquid interface (ALI) system; akin to the healthy ventilated middle ear in vivo. We validate this using immunohistochemistry, immunofluorescence, scanning and transmission electron microscopy, and membrane conductance studies. We also utilize this model to perform a pilot challenge of middle ear epithelial cells with SARS-CoV-2.\ud \ud \ud Results\ud \ud We demonstrate that human middle ear epithelial cells cultured at an ALI undergo mucociliary differentiation to produce diverse epithelial subtypes including basal (p63+), goblet (MUC5AC+, MUC5B+), and ciliated (FOXJ1+) cells. Mature ciliagenesis is visualized and tight junction formation is shown with electron microscopy, and confirmed by membrane conductance. Together, these demonstrate this model reflects the complex epithelial cell types which exist in vivo. Following SARS-CoV-2 challenge, human middle ear epithelium shows positive viral uptake, as measured by polymerase chain reaction and immunohistochemistry.\ud \ud \ud Conclusion\ud \ud We describe a novel physiological system to study the human middle ear. This can be utilized for translational research into middle ear diseases. We also demonstrate, for the first time under controlled conditions, that human middle ear epithelium is susceptible to SARS-CoV-2 infection, which has important clinical implications for safe otological surgery.\ud \ud \ud Level of Evidence\ud \ud NA.

Background: Idiopathic pseudotumour (IP) is a non-specific, non-neoplastic, inflammatory process without identifiable local or systemic causes. IP in the head and neck region present diagnostic and management issues. Methodology: Retrospective case series and literature review. Results: We describe clinical history, examination, laboratory investigations and image findings of three patients, all males who presented with facial pain and ophthalmoplegia. Scans revealed lesions in the pterygopalatine fossa. The diagnosis of idiopathic pseudotumour was confirmed by histopathology. We discuss their treatment pathways and prognosis. Conclusions: Idiopathic pseudotumours in the head and neck region especially those involving anterior skull base are rare. Understanding their presentation and characteristics might help an unsuspecting otorhinolaryngologist in the diagnosis and treatment of these lesions.

BackgroundMastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined.MethodA retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017.ResultsFifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0–27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred.ConclusionA detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions.

The aim of this report was to review the recent literature related to the assessment and management of obstructive sleep apnea (OSA) in children under the age of 2 years. Adenotonsillectomy (AT) indications are changing, with a greater proportion of younger children undergoing AT for OSA. Medical therapies may be an alternative to AT in mild-moderate OSA cases; however, further research is needed. Coblation® intracapsular tonsillectomy may confer benefits in reduced post-operative pain and hemorrhage. Recent concerns regarding the safety of general anesthesia in young children are an important area for further investigation. There is a paucity of literature related to OSA in children younger than 2 years. Recent large-scale trials have actively excluded children from this age group and there are no planned studies of this specific population. These children represent a distinct population with differing etiologies, presentations, investigations, and management consideration.

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the elderly. This has been identified as a risk factor in falls. Falls are the leading cause of disability and the leading cause of death from injury among people over 75 in the UK. Methods: We assessed the effect of BPPV treatment on falls in an elderly population by retrospectively reviewing one unit’s experience of BPPV management over an 8-year period from June 2008 to June 2016. We specifically assessed patients who were referred for the primary reason of falls and were aged over 65 years. These patients were evaluated and treated with particle repositioning maneuvers if their positional tests were positive. The frequency of falls prior to their visit and at 6-month clinic follow-up were reviewed. Results: The total number of falls in the cohort reduced significantly ( P < .0001) after the procedure, from 128 to 46 falls (64% reduction). Associated comorbidities were also evaluated in this group. Conclusion: A prompt and effective treatment of BPPV is prudent to prevent devastating falls in older people in our communities.

Objective Gastro-oesophageal reflux disease is thought to be a risk factor for head and neck malignancies. Bile acids are one of the principle components of gastric refluxate and have previously been implicated in the development of oesophageal and bowel malignancies. There is clear evidence that bile acids reflux into the laryngopharynx. Despite this, the carcinogenic properties of bile acids in this area are yet to be fully identified. We therefore investigated the potential role of bile acids in pharyngeal malignancy, through the highly conserved process of epithelial–mesenchymal transition (EMT). EMT occurs in invasion and metastasis and is a central process in the development of epithelial carcinoma. Design Translational research study. Methods Human hypopharyngeal squamous carcinoma FaDu cells were challenged with primary (cholic or chenodeoxycholic) and secondary (deoxycholic or lithocholic) bile acids. EMT-relevant proteins TGF-β1 and MMP-9 were measured in the cell culture supernates at 48 h via ELISA. Cell viability was confirmed >95% via CellTiter-Blue assay. Results Significantly greater concentrations of TGF-β1 were measured in the culture supernates of cells treated with cholic acid, deoxycholic acid and chenodeoxycholic acid. MMP-9 levels were increased in deoxycholic acid and lithocolic acid stimulations when compared to control (P < 0.05). Conclusion This is the first demonstration that bile acids induce TGF-β1 and MMP-9 in pharyngeal cells. TGF-β1 is considered a master switch for EMT, while MMP-9 is a part of the EMT proteome which degrades basement membranes. This implies a potential role for bile acids in pharyngeal carcinogenesis through the mechanism of EMT and suggests potential novel therapeutic targets.

There is limited guidance available to clinicians regarding the management of antithrombotic therapy during epistaxis, whilst there has been an increase in the use of anticoagulation and antiplatelet therapy. In addition, the introduction of direct oral anticoagulants (DOACs), such as dabigatran and rivaroxaban, over the last decade has significantly increased the complexity of managing the anticoagulated epistaxis patient. We undertook a systemic literature review investigating potential management strategies for each class of anti-thrombotic therapy during epistaxis. A PubMED and Cochrane Library search was performed on 10/03/16 using, but not limited to, the search terms epistaxis, nosebleed, nose bleeding, nasal haemorrhage, nasal bleeding AND each of the following search terms: antithrombotic, anticoagulant, antiplatelet, aspirin, clopidogrel, warfarin, dabigatran, rivaroxaban, apixaban and tranexamic acid. This yielded 3815 results, of which 29 were considered relevant. Other sources such as national and international guidelines related to the management of anti-thrombotics were also utilised. We present the findings related to the management of each class of anti-thrombotic therapy during epistaxis. Overall we found a lack of evidence regarding this topic and further high quality research is needed. This is an area growing in complexity and the support of colleagues in Haematology and Cardiology is increasingly important.

BackgroundMastoiditis is an otological emergency, and cross-sectional imaging has a role in the diagnosis of complications and surgical planning. Advances in imaging technology are becoming increasingly sophisticated and, by the same token, the ability to accurately interpret findings is essential.MethodsThis paper reviews common and rare complications of mastoiditis using case-led examples. A radiologist-derived systematic checklist is proposed, to assist the ENT surgeon with interpreting cross-sectional imaging in emergency mastoiditis cases when the opinion of a head and neck radiologist may be difficult to obtain.ResultsA 16-point checklist (the ‘mastoid 16’) was used on a case-led basis to review the radiological features of both common and rare complications of mastoiditis; this is complemented with imaging examples.ConclusionAcute mastoiditis has a range of serious complications that may be amenable to treatment, once diagnosed using appropriate imaging. The proposed checklist provides a systematic approach to identifying complications of mastoiditis.

Objective of review Acute otitis media (AOM) is the largest cause of antimicrobial prescriptions amongst children in developed countries. Excessive and inappropriate prescribing is known to drive antimicrobial resistance, but less is known of antimicrobial resistance in AOM-associated bacteria. Type of review & search strategy We conducted a systematic review and meta-analysis of bacterial prevalence and antimicrobial resistance in studies of paediatric AOM identified from Ovid Medline, Embase and the Cochrane library. Results From 48 unique studies, 15,871 samples were included. Only 0.67 (CI 0.63–0.71) of all ear samples grew a bacterial pathogen. The most common bacterial causes of AOM in children were Streptococcus pneumoniae 0.30 (CI 0.27–0.32), Haemophilus influenza 0.23 (CI 0.20–0.26), and Moraxella catarrhalis 0.05 (CI 0.04–0.06). Resistance patterns varied amongst organisms and antimicrobial agents. The pooled proportion of bacterial culture-positive episodes of AOM that could be effectively treated with amoxicillin was 0.85 (CI 0.76–0.94), erythromycin was 0.64 (0.48–0.78) and amoxicillin-clavulanate was 0.95 (CI 0.85–0.98). Conclusion We have demonstrated the bacteriology and antimicrobial resistance patterns of AOM. Of samples which grew bacteria, on average approximately 15% of isolates demonstrated resistance to amoxicillin; a typical first-line agent. Greater understanding of local bacteriology and resistance patterns is needed to enable improved antimicrobial stewardship.

Objective Paediatric solid organ transplantation is an increasingly successful treatment. Improved survival is paralleled by increased secondary complications of immunosuppression, including post-transplant lymphoproliferative disease (PTLD). PTLD frequently presents in Waldeyer's lymphatic ring. Adenotonsillar hypertrophy (ATH) is common in children, however in children after transplant, ATH may indicate PTLD. We review the literature on ATH and the role of adenotonsillectomy in children after transplantation. Methods A comprehensive literature search was performed on the 26 th September 2017 of Ovid Medline (1996–September 2017), Embase (1996–2017) and EBM reviews (Cochrane database of systematic reviews 2005–September 20 th 2017). Results were limited to English language publications within the last 20 years. Abstracts were screened for relevance to PTLD and ATH in the paediatric solid organ transplantation population. Screening of the bibliographies identified further articles. Results 85 unique articles were screened to yield 18 relevant publications. 10 were retrospective studies and 8 were prospective studies. Conclusion In children, we report a PTLD incidence of up to 15%, with up to 63% of cases presenting in the head and neck. Histological examination of adenotonsillectomy specimens found PTLD in a mean 5.7% (range 0–39%). We found a lack of prospective studies into this topic and further high quality research is needed. Clinical assessment of ATH in children after transplantation and when to perform a diagnostic adenotonsillectomy remains challenging. Children with ATH warrant prompt further investigation and support from colleagues in transplantation and oncology is required.

Background:Recently, there has been increased emphasis on the development and application of patient-reported outcome measures. This drive to assess the impact of illness or interventions, from the patient's perspective, has resulted in a greater number of available questionnaires. The importance of selecting an appropriate patient-reported outcome measure is specifically emphasised in the paediatric population. The literature on patient-reported outcome measures used in paediatric otolaryngology was reviewed.Methods:A comprehensive literature search was conducted using the databases Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo, using the terms: ‘health assessment questionnaire’, ‘structured questionnaire’, ‘questionnaire’, ‘patient reported outcome measures’, ‘PROM’, ‘quality of life’ or ‘survey’, and ‘children’ or ‘otolaryngology’. The search was limited to English-language articles published between 1996 and 2016.Results:The search yielded 656 articles, of which 63 were considered relevant. This included general paediatric patient-reported outcome measures applied to otolaryngology, and paediatric otolaryngology disease-specific patient-reported outcome measures.Conclusion:A large collection of patient-reported outcome measures are described in the paediatric otolaryngology literature. Greater standardisation of the patient-reported outcome measures used in paediatric otolaryngology would assist in pooling of data and increase the validation of tools used.

Objective:This study aimed to compare the efficacy of diode laser, coblation and cold dissection tonsillectomy in paediatric patients.Methods:A total of 120 patients aged 10–15 years with recurrent tonsillitis were recruited. Participants were prospectively randomised to diode laser, coblation or cold dissection tonsillectomy. Operative time and blood loss were recorded. Pain was recorded on a Wong–Baker FACES®pain scale.Results:The operative time (10 ± 0.99 minutes), blood loss (20 ± 0.85 ml) and pain were significantly lower with coblation tonsillectomy than with cold dissection tonsillectomy (20 ± 1.0 minutes and 30 ± 1.0 ml;p= 0.0001) and diode laser tonsillectomy (15 ± 0.83 minutes and 25 ± 0.83 ml;p= 0.0001). Diode laser tonsillectomy had a shorter operative time (p= 0.0001) and less blood loss (p= 0.001) compared with cold dissection tonsillectomy. However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with the cold dissection (p= 0.042) and coblation (p= 0.04) tonsillectomy groups.Conclusion:Both coblation and diode laser tonsillectomy are associated with significantly reduced blood loss and shorter operative times compared with cold dissection tonsillectomy. However, we advocate coblation tonsillectomy because of the lower post-operative pain scores compared with diode laser and cold dissection tonsillectomy.

Background:Olfactory dysfunction is a common condition that may in some cases require imaging to investigate a potential underlying cause.Objectives:This review describes the anatomy of normal olfaction and illustrates the pathological substrates of olfactory dysfunction amenable to imaging.

Objectives/Hypothesis The association between extraesophageal reflux (EER) and symptoms of gastroesophageal reflux disease (GERD) is inadequately understood. We used the Comprehensive Reflux Symptom Scale (CReSS) to evaluate EER and reflux-symptom prevalence in gastroenterology and otolaryngology outpatients and symptom awareness among UK gastroenterologists. Study Design Cross-sectional cohort survey. Methods Six hundred thirty-nine participants were surveyed: 103 controls, 359 patients undergoing esophagogastroduodenoscopy (EGD), and 177 otolaryngology clinic patients with throat symptoms. Participants completed the CReSS questionnaire. The study was undertaken in the Endoscopy Unit and the Department of Otolaryngology–Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom. Registered members of the British Gastroenterology Society were asked to rate how frequently reflux patients might complain of each CReSS item. Results The median CReSS total in volunteers (4) was significantly lower (P 15% of ENT patients and 28% of EGD patients. Three major, robust CReSS factors: esophageal, pharyngeal, and upper airway emerged. Of 259 gastroenterologists, >20% scored 8 of the 34 symptoms as never being reported by reflux patients. Conclusions Endorsement of each EER CReSS item by 28% to 58% of patients with endoscopic evidence of GERD supports the Montreal consensus on an EER-GERD continuum. Gastroenterologists vary considerably in their appreciation of EER symptom relevance. The advantages of CReSS include standardized, comprehensive capture of patient experience; discriminant validity of ENT and GERD patients from volunteers; and discrete esophageal, pharyngeal, and upper airway subscales. Level of Evidence 4 Laryngoscope, 125:424–430, 2015

Objective:To investigate throat-related quality of life in peritonsillar abscess sufferers.Method:The adult tonsil outcome inventory questionnaire, which is a validated throat-related quality of life tool, was administered to individuals who had recently suffered a peritonsillar abscess and to control subjects.Results:The mean inventory score was significantly higher (reflecting poorer throat-related quality of life) in peritonsillar abscess sufferers (n = 55, mean score 25.8 out of 100) than in age- and gender-matched controls (n = 55, mean score 8.7) (p Conclusion:Peritonsillar abscess had a significant impact on throat-related quality of life. In many, peritonsillar abscess represented an acute episode on a background of chronic throat problems. For optimal management, notably the place and timing of tonsillectomy, this impact should be taken into account. The adult tonsil outcome inventory is an ideal tool for use in clinical practice.

Objectives/Hypothesis: A literature review regarding the use of laryngopharyngeal mucosal signs in diagnosing laryngopharyngeal reflux (LPR). Study Design: Literature review. Methods: A search of MEDLINE in February 2012 using the terms laryngopharyngeal reflux, laryngitis, mucosa, appearances, and signs (English language only). Results: One or more laryngopharyngeal mucosal signs associated with LPR were identified in 64% to 93% of healthy volunteers (3% >5 signs) and in 17% to 85% of gastroesophageal reflux disease sufferers (Reflux Finding Score [RFS] >7 in 24%). Reinke's edema, pseudosulcus, ventricular obliteration, vocal cord nodules, and granulomas have in some, but not all studies, been shown to be more prevalent in those with pH-proven pharyngeal reflux. Pseudosulcus, interarytenoid thickening, and Reinke's edema were more prevalent in those symptomatic of LPR than those not. The use of multiple mucosal signs may improve detection of reflux sufferers from asymptomatic controls. The RFS has a sensitivity and specificity of 87.8% and 37.5%, respectively, for picking up pH-proven pharyngeal reflux individuals. Inter- and intrarater reliability for identifying signs is fair to good in most studies. Conclusions: The limited evidence for each mucosal finding should be considered in making the diagnosis of LPR. Further quality research in to mucosal findings in LPR is needed.

Anosmia is present in approximately 1% of the population and can have a significant impact on quality of life 1. In contrast to acquired anosmia, congenital anosmia is a relatively rare condition characterized by a complete lack of olfactory perception and the aplasia or hypoplasia of the olfactory bulb. Kallmann syndrome (congenital hypogonadotropic hypogonadism and anosmia) is the best known condition assoicated with congenital anosmia 2,3. Kallmann Syndrome has a prevalence of around 1 in 8000, and is five times more common in men than women 2,3. This article is protected by copyright. All rights reserved.

Background:Despite the patient numbers and scope of ENT surgery, it is under-represented in most undergraduate medical curricula.Method:An online questionnaire was e-mailed, at National Health Service trust level, to 3544 newly qualified doctors from 30 UK medical schools. Undergraduate ENT exposure, confidence and educational value were measured on a Likert scale.Results:We received 444 eligible responses. The mean undergraduate ENT exposure was 3.4 days of pre-clinical teaching plus 5.0 days of ENT departmental experience. However, 15.8 per cent of respondents reported no formal departmental ENT experience, and 65.8 per cent would have liked further undergraduate experience. Teaching modalities with a lower perceived educational value were generally offered more frequently than those with a higher perceived educational value. Graduates felt significantly less confident with ENT history-taking, examination and management, compared with their cardiology clinical competencies (p Conclusion:These results highlight the lack of UK ENT undergraduate education, and the significant effect this has on junior doctors’ clinical confidence. In addition, commonly used teaching methods may not be optimally effective.

Clin. Otolaryngol. 2011, 36, 45–50 Objectives: To generate consensus amongst faculty members regarding follow-up practice for well-defined clinical scenarios using a Delphi exercise and to identify whether disseminating the consensus guidelines changed follow-up practice. Study Design: Generation of consensus using a Delphi exercise and an audit of follow-up practice before and after dissemination of the resultant guidelines. Setting: The department of Otorhinolaryngology-Head and Neck Surgery at the Freeman Hospital, Newcastle upon Tyne, UK. Participants and methods: Panel members for this exercise included 11 consultants and two associate specialists and one co-ordinator. We identified clinical scenarios where ≥80% agreement existed that routine follow-up appointments should not be made and subsequently disseminated guidelines widely to all medical staff. The follow-up rates for the scenarios where consensus existed regarding follow-up practice were audited from clinic letters before and after the guidelines were disseminated. Main outcome measures: Agreement on scenarios where routine follow-up appointments should not be made was assessed using a Likert scale (1–5). Results: Of 13 faculty members, 12 responded to rounds one and two, and 11 responded to round three. The Delphi exercise identified 18 clinical scenarios where there was ≥80% agreement on patients not routinely being followed up. Comparison of the follow-up practice prior to and after the Delphi exercise identified a reduction in follow-up for all 18 scenarios of 48%. Conclusion: Consensus regarding routine follow-up can be reached by using the Delphi process in ENT practice. This can translate into a real change in clinical practice. Furthermore, this process could be applied for consensus building in other related areas.

Background:FloSeal, a locally applied haemostatic agent, has been shown to be effective in a variety of clinical situations. This study investigated its potential benefits in the management of epistaxis.Methods:The outcomes of a series of patients with epistaxis presenting to one ENT unit, over a two-month period, were compared. Patients were either treated with FloSeal or traditional epistaxis management techniques. Success of FloSeal was classed as complete haemostasis after its application, without the need for further interventions and no readmission with epistaxis within 7 days.Results:Our study comprised 101 adults, with a mean age of 70 years (range, 22–98 years). The overall success rate for FloSeal was 14 per cent (5 out of 36 cases). It was successful in 66 per cent of anterior epistaxis cases (2 out of 3) and in only 9 per cent of posterior epistaxis cases (3 out of 33). There was a significantly higher failure rate of FloSeal compared with nasal packing in posterior epistaxis (p < 0.001).Conclusion:Our findings suggest that FloSeal has a limited role in the management of epistaxis.

Background:Isolated olfactory dysfunction is a common complaint; the vast majority of cases are benign and untreatable. A common dilemma is whether to image the olfactory tract of affected patients.Methods:A case review of 100 consecutive patients who underwent magnetic resonance imaging for the primary complaint of olfactory dysfunction was performed. Patients with a diagnosis of chronic rhinosinusitis, with or without nasal polyps, were excluded.Results:Magnetic resonance imaging abnormalities that were considered clinically relevant to the presentation of olfactory dysfunction were found in only seven patients (7 per cent). Of these, only one patient (1 per cent) had an abnormality found that altered their clinical management. A comparison of the findings for children (less than 16 years old,n = 5) with those for adults (equal to or more than 16 years old,n = 95) revealed that 4 per cent of adults scanned had olfactory-related pathology diagnosed, as opposed to 60 per cent of children.Conclusion:Cross-sectional imaging may not be necessary in most patients with olfactory dysfunction. Imaging adds little to the patient history and clinical examination findings.

Objectives We aimed to assess self-report and perceptual voice outcomes in patients undergoing local anaesthetic injection laryngoplasty in our outpatient clinic. Design Prospective case series. Setting Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle-upon-Tyne, UK. Participants Sixty-eight patients underwent local anaesthetic injection laryngoplasty in the outpatient clinic over the 2-year study period. Main outcome measure Voice Performance Questionnaire (patient-rated), and perceptual voice analysis (observer-rated) Grade, Roughness, Breathiness, Aesthenia and Strain scores were recorded before and 2 weeks after injection laryngoplasty. Results Fifty-seven patients had sufficient pre- and post-procedure data to be included in the analysis. These included 32 men and 25 women, age range 26–97 years. Of the remaining patients, they were excluded due to failed procedure (n = 3), too unwell to proceed (n = 1), died before follow-up was complete (n = 3) and incomplete data (n = 4). The median Voice Performance Questionnaire score improved from 42 to 21; (P

Objective: The incidence of quinsy is rising in the UK for reasons which are unclear. There were >7000 hospital diagnosed episodes last year in England alone. Some suggest a link to the decline in elective tonsillectomy. Our aim was to compare chronic throat symptoms in quinsy patients and controls.Method: The validated 16-item Tonsillectomy Outcome Inventory (TOI-16) was used to compare the impact of throat symptoms over the previous 6 months in 119 controls (no quinsy history) and 55 contactable (by telephone) quinsy patients (34M, 21F), who had an average experience of 1.4 (range 0-4) quinsies. Analysis was in SPSS.Results: The TOI-16 Cronbach’s α = .92, indicating high internal consistency. The mean 6-month overall throat impact scores in quinsy patients (21.0) were significantly greater than that in volunteers (10.9 P < .05). The post-quinsy interval had only modest effect on the overall mean score. Younger people had higher scores in both groups. On item-by-item analysis, quinsy patients recorded si...

Objective: Diagnosis and management of EER remains controversial. We have validated a reliable Comprehensive Reflux Symptom Scale (CReSS) incorporating 34 possible symptoms of EER and gastroesophageal reflux disease (GERD). We aimed to compare CReSS in healthy volunteers, throat clinic attenders, and a heterogeneous group referred for upper gastrointestinal (GI) endoscopy.Method: The CReSS was administered to 532 participants: 103 healthy volunteers, mean age 55 years, 39% male, 15% smokers; 175 throat clinic attenders, mean age 56 years, 37% male, 11% smokers; and 254 attenders for GI endoscopy, mean age 58 years, 41% male, 14% smokers. Regular recent antacid use was recorded.Results: The mean CReSS total was 6.5 (SD 8.14) in volunteers, significantly lower (P < .001) than in throat 32.19 (SD 22.37) or GI patients 39.67 (SD 26.14). CReSS totals were independent of age. All items were endorsed by at least 17% of throat patients, 30% of GI patients. The top symptoms in throat patients were throat clearing,...