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Background Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. Aim To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care. Methods Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+ DSS) versus assessment without (− DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the “gold standard” against which the + DSS, − DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated. Results One hundred ninety-four participants (age range 25–85, mean = 57.7, SD = 16.7 years) were assigned to the + DSS (N = 100) and to the − DSS group (N = 94). The diagnosis suggested by the + DSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the − DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in the + DSS vs. the − DSS group. The standalone DSS had better diagnostic and management accuracy than the + DSS group. Conclusion There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care. Trial registration number NCT02704819 (clinicaltrials.gov).

Here, we share the first outcome of EVOTION (www.h2020evotion.eu) in the form of a data-set to inspire, encourage, and motivate a data-driven analytical approach to evidence-based healthcare policy modeling using real-world longitudinal data. The data-set includes information relating to patterns of real-world hearing aid usage and sound environment exposure. Undoubtedly, many such data-sources will be available for researchers and policy-makers in the future, and the data-set presented here can act as a first step of building and testing potential statistical models

Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. The symptoms of BPPV typically appear after angular movements of the head. BPPV leads to dizziness, nausea and imbalance. In this study, we examined a model of the semi-circular canal (SCC) with fully 3D three dimensional anatomical data from specific patient. A full Navier-Stokes equations and continuity equations are used for fluid domain with Arbitrary-Lagrangian Eulerian (ALE) formulation for mesh motion of finite element. Fluid-structure interaction for fluid coupling with cupula deformation is used. Particle tracking algorithm is implemented for particle motion. Motion of the otoconia particles which is main cause for BPPV is simulated. Velocity distribution, shear stress and force from endolymph side are presented for patient specific three SCC. We compared our numerical models with experiments with head moving and nystagmus eye tracking. Numerical simulation can give more details and understanding of the pathology of the specific patient in standard clinical diagnostic and therapy procedure for BPPV.

Understanding of the pathophysiology of hearing process and its connection with pathologic conditions which are linked with hearing loss requires an accurate description of the inner ear geometry. In this study, a semi-automated methodology for three-dimensional (3D) reconstruction of the main inner ear structures: i) scalae, ii) basilar membrane, iii) vestibule, iv) stapes and v) round window is proposed. The methodology is based on the acquisition of microCT images and the employment of appropriate image processing techniques for accurate and semi-automated reconstruction. The Level Set algorithm employed with marching cubes algorithm is the main component of the methodology. The proposed methodology outcome is a 3D representation of the inner ear structures in a geometry format which can be used for further processing for inner ear modeling.

Hearing impairment is a problem faced by many people, mostly the elderly population but occurs even in newborns. Experimental tests performed on patients give information of the level of hearing impairment and the place where the problem is located. In order to understand process of hearing and hearing impairments it would be very useful to have a look inside, but it is not possible with any experimental equipment. However, it is possible to make a virtual look inside human auditory system by development of numerical model. Using data obtained by experimental research it is possible to make sufficiently detailed model and use it to gain new knowledge that can help in understanding of hearing process and problems with hearing. In this paper one such model will be presented. The model contains mechanical and fluid elements of the middle and inner ear.

Accurate reconstruction of the inner ear is a prerequisite for the modelling and understanding of the inner ear mechanics. In this study, we present a semi-automated methodology for accurate reconstruction of the major inner ear structures (scalae, basilar membrane, stapes and semicircular canals). For this purpose, high resolution microCT images of a human specimen were used. The segmentation methodology is based on an iterative level set algorithm which provides the borders of the structures of interest. An enhanced coupled level set method which allows the simultaneous multiple image labeling without any overlapping regions has been developed for this purpose. The marching cube algorithm was applied in order to extract the surface from the segmented volume. The reconstructed geometries are then post-processed to improve the basilar membrane geometry to realistically represent physiologic dimensions. The final reconstructed model is compared to the available data from the literature. The results show that our generated inner ear structures are in good agreement with the published ones, while our approach is the most realistic in terms of the basilar membrane thickness and width reconstruction.

Objective1) Report the incidence and outcome of delayed facial nerve palsy following middle ear surgery in our department, and 2) review the medical literature.MethodsThis is a retrospective chart review study of 833 patients who were operated for chronic otitis media with cholesteatoma (572 patients), otosclerosis (192 patients), and profound hearing loss who received a cochlear implant (68 patients) since 1993.ResultsDelayed facial nerve palsy was observed in 10 patients (1.2%). In all cases, immediate postoperative facial nerve function was normal and the palsy occurred 5 to 8 days postoperatively. Facial nerve function recovered in all patients within 6 months. Assessment and management issues are discussed.ConclusionsDelayed facial nerve palsy may rarely occur following middle ear surgery and has an excellent recovery rate.

S S85 Comparisons with historical cohorts from this region shows a significant increase in the proportion of DTC (65% in the 1960s, 58% in the 1980s and 87% currently. Conclusion: The incidence of thyroid cancer in South Yorkshire is lower than many other parts of Europe. Age and gender distribution of each type is similar to published series and the causes of increased incidence are explored. http://dx.doi.org/10.1016/j.ejso.2015.08.094 19. Parathyroidectomy in Pregnancy: A single centre 10-year experience Paul C. Dent, Niyati Lobo, Susan Kirby, Neil S. Tolley, F.Fausto Palazzo Hammersmith Hospital, Imperial College Healthcare NHS Trust, UK Introduction: Primary hyperparathyroidism (PHPT) affects approximately up to 0.15% of the population with an almost 3:1 female to male ratio. However the prevalence of PHPT in women under the age of 40 is thought to be less than 4/10,000. It is suggested that PHPT in pregnancy in addition to the standard morbidity is associated with a risk of miscarriage and fetal death but best practice is not evidence based. We present our 10 year experience of parathyroidectomy performed during pregnancy. Methods: We retrospectively reviewed a prospectively maintained audit database of all cases of parathyroidectomy performed between 2005 and 2015 and identified operations performed in pregnant women. Data analysed include patient demographics, clinical features, preand post-operative biochemical studies, radiological and pathological findings, and outcome of pregnancy. Results: 932 parathyroidectomies were performed for PHPT between 2005e2015 and 12 women (aged 34.9 4.1 years) were pregnant at the time of surgery. The mean corrected calcium was 2.96 0.19 mmol/L with a PTH 16.7 10.6 pmol/L. Ultrasound localization was performed in all patients prior to surgery and 4/13 were helpful in localizing the correct parathyroid gland. Parathyroidectomy was performed with an obstetric anaesthetist. 12 patients were in the second trimester and 1 in the early third trimester (19.7 3.6 weeks). Anaesthetic time was 61.3 16.7minutes. Cure was achieved in 11 patients at first surgical intervention with no reported complications at follow up. The one patient with mild persistence/recurrence (normal corrected calcium and PTH level immediately post-operatively with an unaccommodated PTH at 6 months), had undergone a minimally invasive parathyroidectomy under LA. All foetus’ had a normal pre& post operative heart monitor. There were no immediate maternal or foetal complications and all completed their pregnancy. Conclusion: Parathyroidectomy during pregnancy is safe with obstetric anaesthesia. The absence of nuclear imaging makes four gland visualisation the approach most likely to achieve permanent cure. http://dx.doi.org/10.1016/j.ejso.2015.08.095 20.Anatomic study of the external branch of the superior laryngeal nerve. Anatomic findings and its implication in thyroid surgery Xenophon Kochilas, Konstantinos Argiris, Thanos Bibas 1 Brighton and Sussex Universities NHS Trust, UK Hippocration University Hospital Athens Greece, Honorary Reader in Otolaryngology, Ear Instituted UCL, London, UK Introduction: The External Branch of the Superior Laryngeal Nerve (EBSLN) has been described as the “neglected” in thyroid surgery. The purpose of this study was to describe the topography of the EBSL and its relationship to the adjacent anatomical structures. Material and Methods: 21 formalin-embalmed human cadavers of both sexes ranging in age from 52 to 94 (mean, 78 years) were included in this study. A total of 42 superior thyroid poles (SPT) were dissected and the exact course of the EBSLN was identified and its relationship to: i) the superior pole of the thyroid gland (SPTG) ii), the superior thyroid vessels (STV), and iii) the inferior constrictor muscle of pharynx (ICMPH) was noted. Results: The EBSLN was identified in 41 specimens (97.61%). In (19.04%) the EBSLN was crossing the STV > 1 cm above the SPTG In (54.76%) the EBSLN was crossing the STV A at 9q22.23 in a Western European cohort of patients with thyroid cancer compared to controls. Methods: DNAwas extracted from buccal swabs or whole blood of patients with differentiated non-medullary thyroid cancer by ethanol precipitation. Patients were recruited from two tertiary referral centres in Ireland and France. Cancer-free controls were recruited from the community. Genotyping was performed using Taqman-based PCR. Data was analysed using SPSS V22. Results: One hundred and eighty one cases and eighty-three controls were genotyped for the variant. The frequency of the minor allele among cases was 0.46 compared to 0.31 among controls. The genotypic odds ratio for heterozygous carriers was 2.41 (1.36e4.26, p 1⁄4 0.002), increasing to 3.56 (1.48e8.53, p 1⁄4 0.003) for rare homozygotes. Conclusion: The FOXE1 variant was identified in patients with thyroid cancer significantly more frequently than controls in both heterozygous and homozygous forms. An allele dosage effect was observed, with rare homozygous genotype conferring greater risk than heterozygotes. http://dx.doi.org/10.1016/j.ejso.2015.08.097 22. Investigating the role of polymorphism rs2910164 in mir146a in cancer predisposition Terri P. McVeigh, Patrick W. Owens, Robert Mulligan, Nicola Miller, Carole Guerin, Frederic Sebag, Denis Quill, Marcia Bell, Aoife J. Lowery, Joanne B. Weidhaas, Michael J. Kerin 1 Department of Surgery, Galway University Hospital, Galway, Ireland Department of Clinical Genetics, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland Department of Endocrine Surgery, Hopital de la Timone, Marseilles, France