Key Points: 1. External auditory exostosis (surfer’s ear) is a progressive condition of benign hyperostotic overgrowths of the external auditory canal, secondary to repetitive cold-water exposure, in which symptoms correlate to degree of exostosis. 2. Surgical intervention is the only available treatment, most commonly using the osteotome or microdrill, but these carry a risk of sensorineural hearing loss, post-operative stenosis, temporomandibular dysfunction and tympanic membrane perforation. 3. We describe the Sanu technique, an innovative method of canaloplasty with endoscopic underwater excision of exostoses using Piezoelectric saw and continuous irrigation with 1:1,000,000 adrenaline. 4. The inherent properties of the Piezoelectric saw reduce the overall risk of complications compared to otologic drill and osteotome, most notably of sensorineural hearing loss and temporomandibular joint dysfunction. 5. This novel technique is cost-equivocal and easily implemented in departments with endoscopic capabilities.

Objectives - This comprehensive study investigates the diverse bacterial species responsible for upper respiratory tract infections, their impact on different age groups, clinical diagnoses, and antibiotic resistance patterns. Design -A prospective analysis was conducted to uncover the intricate connections between various bacterial infections and their corresponding effects on a large patient population. Setting -The study’s methodology involved thorough clinical assessments to monitor respiratory diseases, culminating in the classification of bacteria and their microbial growth Participants :- . Of the 1,003 participants, 514 were found to be infected, with the 16-39 age group being the most affected. The primary clinical diagnoses included acute tonsillopharyngitis, acute tonsillitis, acute pharyngitis and acute laryngitis . Main outcome measures :- The findings underscore the respiratory system’s susceptibility to infection due to its exposure to airborne microorganisms. Results :- Analysis of 1,003 cases revealed that Streptococcus mitis had the highest infection rate across all age groups, particularly in cases of cold cough and sore throat. Other common bacteria identified were Streptococcus parasanguinis and Streptococcus sanguinis. The study aimed to assess the susceptibility of these infectious microorganisms to various medications, with Vancomycin, linezolid, and bacitracin exhibiting 100% sensitivity, while carbimoxazole displayed the highest resistance at 84%. Methicillin-resistant Staphylococcus aureus was identified as the most resistant strain, with a maximum resistance of 57.86% against all tested medications. Conclusion : This comprehensive investigation provides valuable insights into the relationship between infection and bacterial strain resistance, paving the way for the development of new therapeutic strategies.

Objectives This systematic review aims to explore and outline the anaesthetic considerations and precautions for patients with a diagnosis of hereditary haemorrhagic telangiectasia (HHT) undergoing nasal surgery. Design A search was performed across four electronic databases between the dates 1 st January 2000 and 1 st March 2024. Two independent reviewers selected articles that met the following criteria: adult patients with HHT undergoing nasal surgery; description of anaesthetic regime; English language. Case reports and reviews were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed throughout. Results and participants Nine studies were included in the analysis, comprising a total of 800 patients. Two studies described local anaesthetic (LA) only, two described general anaesthetic (GA) only, and five described cases of each. Modality of anaesthesia was dependent on type of procedure (laser therapy, endoscopic surgery, sclerotherapy, or plasma coagulation) and patient factors (including HHT disease severity, vascular anatomy, and age). Anaesthetic approaches varied, although there were similarities; for example, six studies used a topical LA, combined with a vasoconstrictor. Only one study described a GA regime. Reduction of intra-operative bleeding was highlighted across multiple studies; measures included endotracheal tube/nasal lubrication, decongestants, and controlled hypotension. Complications were generally low, with three studies, totalling 218 patients, describing procedures in-clinic with LA with no reported complications. Conclusion The literature lacks clear consensus for selecting between LA or GA, as well as evidenced regimes for both. Therefore, further research is needed to better inform the anaesthetic approach for HHT patients undergoing nasal surgery.

Objectives HPV-positive Oropharyngeal squamous cell carcinoma (OPSCC) and Head and neck carcinoma of unknown primary (HNCUP) is increasing. Despite good prognosis, recurrence rates range from 10- to 25%. Surveillance with clinical controls and imaging are not always reliable. Circulating tumour human papillomavirus DNA (ctHPV-DNA) has emerged as a potential biomarker for treatment evaluation and detection of recurrence. We aimed to investigate the correlation between ctHPV-DNA in HPV+ OPSCC/HNCUP and radiologic tumour burden. Additionally, we sought to assess whether ctHPV-DNA could serve as a tool in treatment evaluation. Design A prospective observational cohort study. Setting This multicenter study involved three otolaryngology units located in central Sweden. We utilised HPV genotype-specific assays for droplet digital PCR (ddPCR) to detect ctHPV-DNA in plasma at diagnosis and follow-up. ctHPV-DNA levels were correlated to radiological tumour burden and radiological response using Kendall Rank correlation coefficient and Kruskal Wallis test. Participants Patients with HPV+ OPSCC/HNCUP undergoing definitive (chemo)radiotherapy. Results Out of 54 patients, 51 were eligible for analyses. At baseline, ctHPV-DNA was detectable in 88%. The majority of patients with a favourable radiological evaluation according to RECIST, had a corresponding undetectable ctHPV-DNA at follow-up. The levels of ctHPV-DNA at baseline correlated with Total Tumour Volume and Nodal Volume (r τ = 0.39, p<0.01, respectively r τ =0.26, p<0.01). Conclusion ctHPV-DNA shows correlation with tumour burden. This study strengthens the role of ctHPV-DNA as a promising biomarker for diagnosing and monitoring HPV-related OPC/HNCUP. With further research on serial plasma sampling, ctHPV-DNA could complement radiological treatment evaluation in HPV+ OPSCC/HNCUP.

Objective Currently, there is no adult specific decision aid (DA) to support decision making around recurrent tonsillitis. This study intends to address this gap by piloting a prototype DA. Design Randomised clinical trial Setting Single centre trial at a tertiary otolaryngology department. Participants 43 patients were randomised to either the DA or Treatment as Usual (TAU) group. Main Outcome Measures Primary objective: To measure how patients rate the quality of their decision-making experience at the time of the decision and at follow up (SURE scale). Secondary objective: The level of decisional satisfaction at the time of the decision and at follow up; and to explore the numbers of people opting for surgery from each study condition. (SHARED tool and patient feedback) Results Quality: This study demonstrates no statistically significant difference in the degree by which patients rate the quality of their treatment decision between DA and TAU, both at baseline (P = 0.553) and follow-up (P = 0.062). Satisfaction: This study showed a statistically significant level of decisional satisfaction at the time the decision was made for Qu2 of the shared tool (U = 113, P = 0.026). No other significant difference was found between participants who received the DA and TAU. Conclusion The DA is an acceptable and useful tool which could be incorporated into the pathway for recurrent tonsillitis, helping to eliminate physician implicit bias. However, preliminary qualitative evidence from this pilot study does not suggest that inclusion of the DA improves the quality of decision making.

1) This pilot trial demonstrated utility of oral propranolol in management of epistaxis in HHT 2) Propranolol was effective in reducing the severity and frequency of nosebleeds in HHT, as measured by the epistaxis severity scale, and this improvement is mirrored by an improvement in global quality of life 3) Adverse effects were experienced by a minority of patients, with the most significant event being pitting oedema 4) Following cessation of treatment, patients demonstrated a trend of regression with worsening of epistaxis scores 5) Further investigation is justified by its favourable effects, wide availability, and minimal side effect profile

Introduction: Adenoidectomy is one of the commonest surgical procedures in children. Techniques vary, with different devices (curette, diathermy, plasma ablation, and microdebrider) and approaches (transnasal TN and transoral TO) in widespread use. A systematic review was performed to determine the efficacy, efficiency and outcomes of current techniques and approaches. Methods and analysis: A systematic review following the PRISMA guidelines was conducted. PubMed, EMBASE, The Cochrane Library, Web of Science, CINAHL were used during the literature searches. Quality assessment of included studies was performed using the Newcastle-Ottawa Scale. Results: 3185 studies were identified, 17 were included in the systematic review. 1799 patients underwent adenoidectomy, with a post-operative complication rate of 8.67% patients (n=156). Common complications identified included vomiting 2.33% (n=42); haemorrhage: primary 0.83% (n=15), secondary 0.72% (n=13) and nasal obstruction 1.55% (n=28). The microdebrider had the lowest levels of blood loss (TN 12.26 ml vs TO 12.65 ml; p=0.93) and reduced operating time (TN 6.47 mins vs TO 8.63 mins; p=0.25). Conclusion: Adenoidectomy remains a safe procedure with few post-operative complications. The microdebrider has some advantages over other techniques.

Objective Fungal infection of the external auditory canal, otomycosis, is generally a resistant mycotic infection. We designed a prospective, randomized, controlled cohort study to analyse the treatment effect of ear canal lavage on otomycosis. Methods The clinical patients were divided into two groups: an irrigation group and an irrigation + local drug treatment control group. Results From January 2022 to December 2023, a total of 102 patients treated for otomycosis were enrolled, and 98 of the patients were followed up for three months. Twenty-two of the 98 patients (22.45%) had no or minor symptoms. Other common symptoms such as pruritus, pain, hearing impairment, etc., presented solely or in combination (Table 1). Our fungal culture results revealed that, in 83 patients (84.69%) the otomycotic pathogen was Aspergillus. In the lavage group, 48 (48/52, 92.30%) patients were cured with initial treatment after three months of follow-up, two (2/52, 3.85%) patients were cured after one month but were lost to follow-up after three months, and two (2/52, 3.85%) patients failed after initial treatment, received topical miconazole ointment treatment and were eventually cured. In the irrigation + local drug control group, 48 (48/50, 96.00%) subjects responded to initial treatment without recurrent disease after three months; 2 (2/50, 4.00%) subjects were lost to follow-up. According to Fisher’s exact test, there was no significant difference between the two groups (Table 3, P = 0.258). Conclusion Both ear canal rinses and local antifungal creams are effective, and sequential treatment via both methods is reasonable.

Objectives: This study aims to examine the effects of autologous platelet-rich plasma (PRP), which increases new connective tissue synthesis and revascularization, on healing in parotid surgery wound, prevention of salivary fistula formation, drain removal time, and hospitalization in the postoperative period. Materials and Methods: Fifty-four patients who had an operation on superficial parotidectomy were randomized, and then two groups were created. PRP was gained by centrifuging the blood taken from the patients at the end of the surgery in the study group. This gained PRP was injected into the surgical site, and then the wound flap was closed by suturing. Patients were evaluated for the parameters such as the development of salivary fistula, duration of drain removal, discharge time, all other complications during the postoperative 4 weeks. Results: Drain removal time and discharge time of the PRP group cases were statistically shorter than those in the control group. The rate of development of salivary fistula according to the groups was remarkably high in the control group, but it was not statistically significant. Statistically significant correlation was found between the location of the compared tumor, and volume of material removed, and the incidence of all complications. Conclusions: PRP reduced the duration of drain removal and discharge time for those who had an operation on superficial parotidectomy. Thus, the decreased discharge time provides both reduced health costs and the risk of developing nosocomial infections. Although it was not statistically significant, a significant difference was observed in the rates of salivary fistula development.

Objective: To assess the effectiveness of auditory and visual distraction interventions on patient discomfort, pain and anxiety during office-based Otolaryngologic upper airway procedures. Data Sources: Literature searches were done through Cochrane Central Register of Controlled Trials, Lilacs, MEDLINE, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature. Review Methods: The protocol was registered in PROSPERO on August 17 th 2022, under Registration number CRD42020204354. Results: We identified 138 records; two randomized controlled trials using virtual reality as a distraction technique in adults and one in children were included. All studies had some concerns regarding risk of bias. In adults, anxiety was lower in the virtual reality group than in the standard of care, (mean difference -16.72, 95% CI -27.19 to -6.24, p=0.002, I 2=0%). There was no difference in procedure related pain between groups, (mean difference -0.28, 95% CI -1.24 to 0.68, p=0.57, I 2=10%). There was no difference in satisfaction between groups (Standardized mean difference 0.18, 95% CI -0.22 to 0.58, p = 0.37, I 2=0%). Only one Pediatric study was included hence no meta-analysis was done. Anxiety and pain were lower and satisfaction was higher in the group using virtual reality. Conclusions: The use of virtual reality distraction in addition to standard analgesia during office-based Otolaryngology upper airway procedures reduced anxiety in adults. It did not decrease pain or increase the level of patient satisfaction. In the paediatric population, there is a reported benefit for procedural anxiety, pain and satisfaction.

Background: Otorhinolaryngology traumas are common among patients with head and neck injuries. Most of this involves the facial region and to a lesser extent ear and throat. Etiology of Otorhinolaryngology trauma includes Motor traffic accidents, falls from height, assault and sports injury. Identification of this trauma by general practitioners is challenging because Otorhinolaryngology examination requires special instruments and skills. Study aim: To determine the prevalence, etiology and distribution of otorhinolaryngology trauma among patients with head and neck injury admitted at Kilimanjaro Christian Medical Center from November 2017 to May 2018. Methods: Hospital-based descriptive cross-sectional study conducted at Kilimanjaro Christian Medical Center. A total of 384 patients with head and neck injuries were included. Relevant information was collected while interviewing patients and during the physical examination was noted and data was handled with SPSS version 20 and transferred to STATA version 13 for analysis. Result. Out of 384 patients, 340 (88.5%) were male, majority 197(51.3) were aged between 21 to 40 years. Out of 384 patients 238(62%) were having Otorhinolaryngology trauma, the majority are male and are between 21 to 40 years old. Motor traffic accident was a common etiology (77.3%) in this study. The maxillofacial area was the common ORL trauma site encountered (70.3%) followed by ear trauma (17.0%) and throat 2%. Conclusion The prevalence of Otorhinolaryngology trauma among patients with head and neck injuries admitted at Kilimanjaro Christian Medical Centre is high, motor traffic accidents were the leading etiology and maxillofacial region was a common ORL trauma site encountered.

Introduction: The non-recurrent laryngeal nerve (NRLN) is a known anatomical variation of the normal recurrent laryngeal nerve (RLN). Its prevalence is estimated <1% and is prone to higher risk of iatrogenic injury. The risk of injury during thyroid surgery have been reported as variable in current literature, from 0% up to 12%. This study aimed to systematically review the incidence of NRLN injury and present the results through meta-analysis. The incidence of injury to NRLN and RLN was compared and analysed to determine its statistical significance. Methods: The PRISMA protocol was followed for an online search of prominent literatures. Studies were selected and excluded according to specific criteria. Quality assessment was performed, and data was extracted. Meta-analysis was conducted for the incidence of injury of the NRLN, and its comparison to the RLN. Results were presented in the form of a systematic review and discussed. Results: 17 studies were included in the final analysis. It was found that the pooled risk of NRLN injury was 7% and the risk ratio of injury in comparison to the RLN was 3.8, showing a statistically significant difference. Conclusion: This is the first study to report the overall risk of injury to the NRLN and found a statistically significant difference in comparison to the injury of RLN. This evidence provides grounds for future surgical guidelines to prevent injury to the NRLN. It is suggested that intra-operative nerve monitoring (IONM) should be performed in all patients found to have NRLN pre-operatively and intra-operatively.

Objective: To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data. Design: Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. Outcome Measures: Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate. Results: Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0 ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/hr (p < 0.04) with a mean difference (MD) of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (P<0.00001). LSAT improved from 87.8 ± 5.7 to 90.1 ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (P<0.0001). Conclusion: Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective, but there is heterogeneity in reported outcomes influenced by confounding factors. Key Words: Drug Induced Sleep Endoscopy; Pediatric Sleep Apnea; Tongue Surgery

ABSTRACT Objective. Our aim was to explore the relationship between vertigo symptoms and the prognosis of hearing indicators in patients with sudden sensorineural hearing loss. Data Source. Eligible studies were identified from the “PubMed”, “EMBASE”, and “Web of Science” databases from January 2000 to September 2023. Study Selection. Studies were selected from all original and retrospective or prospective studies that focused on the relationship between vertigo and hearing prognosis in patients with sudden sensorineural hearing loss. Data Extraction and Synthesis. Observational metrics for data extraction included type of study, number of subjects with or without vertigo, treatment regimen, definition of pure tone hearing thresholds, criteria for hearing improvement, treatment duration, follow-up time, and age distribution of subjects. Meta-analysis was performed using Stata 15 software. Main Outcome and Measure. Association of vertigo symptoms and the prognosis of hearing indicators in patients with sudden sensorineural hearing loss. Results.A total of 4290 patients with sudden sensorineural hearing loss were identified in 23 studies. The hearing recovery rate was 40.8% in the group with vertigo and 53.76% in the group without vertigo. Vertigo was significantly associated with poorer hearing recovery (OR = 2.13; 95% CI, 1.63-2.79; I 2 = 68.3%). Subgroup analyses revealed similar results for medication (OR=2.65; 95% CI, 1.84-3.83; I 2 = 50.8%). However, an attenuated association between vertigo and the prognosis of sudden sensorineural hearing loss was observed in the subgroups treated with drugs combined with hyperbaric chambers (OR= 1.76; 95% CI, 0.75-4.15; I 2 = 84.9%) and drugs combined with intratympanic injections (OR= 1.62; 95% CI, 1.02-2.58; I 2 = 65.6%). Conclusions and Relevance. Our study suggested that vertigo may be a negative factor in sudden sensorineural hearing loss.Based on the results of the subgroup analysis,the combined treatment regimen has better efficacy in patients with sudden sensorineural hearing loss with vertigo.

Aim of the study: Snoring is one of the main symptoms of obstructive sleep apnea syndrome (OSAS) patients. In this study, it was aimed to investigate whether snoring sound parameters can be used in pre- polysomnography (PSG) screening in patients with OSAS. Methods: All patients underwent full-night PSG test. Sound parameters were measured using the PRAAT acoustic analysis program. The relationship between these parameters and degree of OSAS, and also the relationship between snoring sound and types of OSAS were analyzed prospectively. Results: Seventy seven patients diagnosed OSAS were included the study. It was found that the shimmer scores decreased significantly from mild OSAS to severe OSAS (p=0.045). Although mean pitch scores increased from mild to severe OSAS, it was not found to be statistically significant (p=0.16). Mean pitch score was found to be significantly higher in the severe group (p=0.022). Shimmer scores were found significantly higher in REM-predominant OSAS patients than without REM-predominant OSAS patients (p=0.006). Shimmer scores were significantly higher in obese patients than in non-obese patients and in patients over 40 years of age years than under 40 years of age (p=0.032; p<0.01; respectively). The ROC analysis was performed to determine the cutoff value of mean Pitch (≥74.65) in predicting severe OSAS classification (AUC=0.69; p=0.017). Conclusion: Our results are important to show that, analysis of snoring sound with a noninvasive method of acoustic voice analysis, can be applied quickly and easily in the pre-PSG screening in especially clinically important advanced-stage OSAS cases that should be diagnosed urgently.

Objectives: The aim of this study is to report our cases of isolated frontal sinus aspergilloma (FSA), and identify key features and aspects suggestive of this pathology. Moreover, we have investigated the pathogenesis of this FSA, which has not been clearly elucidated yet. Materials and Methods: A retrospective study on cases of isolated FSA treated at the unit of Otolaryngology of the Hopital Lariboisière in Paris from 2009 to 2023 was performed. A chart review was done, Demographic and radiologic data, type of treatment with intraoperative findings, and follow-up were analyzed. Moreover, a literature review was carried out on Pubmed and Scopus using the search terms “frontal sinus aspergilloma”, “frontal sinus fungus ball” and “frontal sinus mycetoma”. Non-invasive FSA characteristics, especially the relation with surrounding bony structures were analyzed. Results: Six patients were included. The median age of the patients was 58 years old (range 25-69); 2/6 patients were female. The most common symptom was headache. All the patients underwent exclusive endoscopic sinus surgery. With regards to literature review, 17 papers have been identified reporting a total number of 30 cases of FSA. Overall, frontal sinus walls erosion was described in 47% of the cases showing a prevalence of erosive behavior of this pathology. Conclusions: FSA shows a higher incidence of bone erosion compared to other PSA. The destructive behavior of FSA could increase the risk of potential intracranial and intraorbital complications. Recognizing the radiological features of FSA, is crucial for accurate differential diagnosis with invasive forms of fungal infections and treatment planning.

Introduction Oral propranolol is a first-line treatment for infantile hemangiomas (IH). This study aims to describe the results of treating IH with propranolol only or initial propranolol therapy followed by laser therapy, surgical excision, corticosteroid therapy, or a second cycle of propranolol. Methods Our patient population included pediatric patients (<18 years of age) diagnosed with IH at Monroe Carell Junior Children’s Hospital at Vanderbilt University Medical Center between August 2009 to July 2017. Patient demographics, IH clinical features, and treatment data were extracted from the electronic medical record. Results Three hundred forty patients with IH were included in this study, with a prevalence of focal lesions (71%) and a total of 279 (82%) IH located on the head/neck. Lesions of the head had a statistically significant association with PHACE syndrome (p<0.001). Most patients initiated propanolol treatment before the age of 6 months (71%), with continuation for ≥6 months (69%). Upon discontinuation of propranolol, 14 (4%) patients required a second cycle of propranolol for regrowth. After controlling for IH location, patients with a family history of hemangiomas or cardiac abnormalities were 3.6 times more likely to need a second round of propranolol treatment (OR, 3.6; 95% Confidence Interval 1.14-11.19) (P=0.03). Conclusion The study confirms propranolol’s effectiveness and safety, reinforcing the need for early intervention and close monitoring following treatment termination to prevent regrowth. Ultimately, this research contributes to advancing the understanding and treatment of IH, aiming to optimize patient outcomes and reduce morbidity.

Objectives: This study aimed to compare patient perspectives and experiences between per-meatal and post-aural tympanoplasty techniques, focusing on scar perception, postoperative symptoms, return to work, and quality of life (QOL). Design: Retrospective comparative study. Setting: Secondary care hospital. Participants: Fifty-four patients who underwent tympanoplasty via either per-meatal or post-aural methods. Main Outcome Measures: Patient-reported scar perception, postoperative symptoms and quality of life reported using validated patient reported outcome measure- The Chronic Otitis Media Benefit Inventory (COMBI) score, patient reported return time off work. Results: Scar perception was favourable in both groups. Most patients in the post-aural group (96%) were content with their scar, while 83% of the per-meatal group patients were not bothered by the possibility of a scar behind the ear. Long term postoperative symptoms, return to work, and quality of life (QOL) measures were comparable between the two groups. The Chronic Otitis Media Benefit Inventory (COMBI) scores showed no statistically significant difference between the two surgical techniques. Conclusion: Patient experiences and outcomes were similar between per-meatal and post-aural tympanoplasty techniques. Clinicians should consider individual patient factors and expectations when choosing a surgical approach.