We take great pleasure in introducing this supplement dedicated to management of head neck squamous cell cancer from an unknown primary (HSCCUP).

No abstract provided as per author guidelines for Clinical Experience submissions.

Introduction: Measurements in endoscopic sinus surgery (ESS) are usually obtained with variable accuracy. We aimed to validate endoscopic multipoint integrated laser systems (EIMLS) for use in ESS, which can acquire measurements within one-hundredth of a millimetre. Methods: 4.4mm flexible endoscopic EIMLS projecting 49 laser points into the view was used to assess simulated anterior skullbase defects. Antero-posterior and lateral measurements were obtained and repeated twenty times by two surgeons. These were compared to measurements with surgical calipers. Intra and inter-observer reliability was assessed. Results: 80 measurements were obtained of simulated skullbase defects by each otolaryngology surgeon and compared to manual measurements. The mean difference shown was 0.56cm. Bland-Altman plot shows low bias (0.044) but wide 95% limits of agreement (-1.8 – 1.9). Conclusion: EIMLS allows reliable and easy to obtain measurements within a simulated ESS environment. Translation of this technology offers promise in a future clinical setting but will require further refinement to improve accuracy.

Objective Machine learning has been effective in other areas of medicine, this study aims to investigate this with regards to HNC and identify which algorithm works best to classify malignant patients. Design An observational cohort study. Setting Queen Elizabeth University Hospital. Participants Patients who were referred via the USOC pathway between January 2019 and May 2021. Main outcome measures Predicting the diagnosis of patients from three categories, benign, potential malignant and malignant, using demographics and symptoms data. Results The logistic regression-based models with a penalty term worked best on the data, ridge achieving an AUC of 0.7081. The demographic features describing living alone and recreational drug use history were the most important variables alongside the red flag symptom of a neck lump. Conclusion Further studies should aim to collect larger samples of malignant and pre-malignant patients to improve the class imbalance and increase the performance of the machine learning models.

1. The overwhelming majority of patients referred into secondary care with suspected head and neck cancer (HNC) do not have cancer (~95%). 2. During the COVID-19 pandemic telephone triage of patients with suspected HNC was necessary. During this time, a validated HNC risk-calculator, HaNC-RC-v2 (a set of symptomatology-based questions) was recommended by ENT UK to stratify patients into high or low risk of having HNC via telephone triage [(1)](#ref-0001) 3. Ufonia, a digital health company which uses an Artificial Intelligence (AI) voice assistant to automate clinical conversations via telephone, and *INSTITUTION*, were awarded an SBRI Healthcare grant to help develop an AI-delivered HNC triage telephone call. This was based on the HaNC-RC-v2 and co-created with HNC patients from the Heads2Gether charity via round-table discussions and one-to-one sessions. 4. Twenty-nine patients underwent a clinician-supervised AI-delivered HNC triage conversation as part of their standard telephone consultation. 100% of calls were completed with an average agreement of 89% between the clinician and the AI system for all symptoms asked. The technology was highly acceptable to patients with a median net promoter score (NPS) score of 8 out of 10. 5. Novel technologies involving AI automated telephone calls can be generated to remotely triage suspected HNC patients. This technology may offer an exciting opportunity to help departments triage suspected HNC referrals in an ever increasingly resource pressurised NHS.

Objectives: In recent years, with the incidence of bilateral cochlear implantation (CI) increasing, understanding the impact of CI on otolith function is of greater necessity. This study aims to investigate the development of gross motor and otolith function in patients with inner ear malformations (IEMs) by vestibular evoked myogenic potentials (VEMP). Materials and Methods: A total of 78 patients with sensorineural hearing loss (SNHL) (age 5.7±4.1 years) were divided into two groups based on the presence (IEM group, n=39) or absence (control group, n=39) of IEMs. VEMP was conducted before and 1–3 months after CI, and gross motor development assessed. Results: The mean ages of head control and independent walking were delayed in the IEM group compared with control group ( p=0.02). The preoperative cVEMP and oVEMP response rates were higher in the control groups (60% and 86.95%) than in the IEM group (57.69% and 74.35%) ( p<0.05). Additionally, abnormal cVEMP was associated with delayed acquisition of independent walking ( p=0.017). Saccular and utricular functions after CI were lost by 40% and 31.75%, respectively, in group of patients present preoperatively VEMPs waveform (n=25). Conclusions: Balance development is more reduced in patients with SNHL and IEMs than in patients without IEMs. The otolith-vestibular nerve conduction pathway can be affected by CI and lead to otolith function impairment. As such, evaluating the otolith and balance functions before CI is necessary and should be considered in clinical practice.

Objective: Vocal fold immobility (VFI) is a cause of significant morbidity and mortality in the paediatric population. Laryngoscopy is the current first-line investigation for patients with suspected VFI. Laryngeal ultrasound (LUS) has recently emerged as an alternative method of identifying VFI. Compared to laryngoscopy, LUS is less invasive, does not require anaesthesia, and can be performed by non-otolaryngologists. The primary objective of this study is to evaluate LUS as a diagnostic method for the identification of unilateral VFI in a cohort of paediatric patients in Aotearoa New Zealand (NZ). The secondary objective is to estimate the frequency of use of LUS in the paediatric population around the world. Methods: A retrospective, single-centre cohort study was performed on all paediatric patients who had undergone laryngoscopy and LUS at Starship Children’s Health between 2020 to 2023 in Auckland, NZ. An eight-question survey was also developed and distributed to better understand clinicians’ use of LUS to diagnose paediatric VFI globally. Results: Twenty-three paediatric patients met the inclusion criteria. LUS demonstrated high sensitivity (100%), specificity (63%), positive predictive value (83%), and negative predictive value (100%) for detecting unilateral VFI within our patient population. Out of the eighty-seven respondents to the survey, nearly half utilise LUS in their clinical practice in the paediatric population. The main barrier for those who do not is lack of expertise, equipment, and training. Conclusions: These findings support the use of LUS as a safe and accurate diagnostic tool for the detection of unilateral VFI. Further studies in non-surgical populations and standardised guidelines for LUS technique and reporting are required.

Objective: The aim of this investigation was to explore the potential correlation between signal intensity ratio (SIR) at internal auditory canal (IAC) bottom and hearing impairment in MD, thereby providing a foundation for further comprehension of the underlying mechanisms contributing to hearing loss. Design: Fifty patients diagnosed with unilateral definited MD were enrolled in the study. 3D-FLAIR MRI was conducted four hours after intravenous administration of gadobutrol to determine the SIR of bilateral IAC bottom. The difference of SIR of IAC bottom was assessed between affected and unaffected sides, followed by an analysis of its correlation with low-, middle-, and high-tone hearing thresholds. Additionally, correlation analysis was conducted between the degree of EH in vestibular and cochlea and the SIR on the affected side. Results: The degree of EH in MD can be clearly visualized through 3D-FLAIR MRI. The SIR on the affected side was significantly higher than that on the unaffected side (P=0.000). Furthermore, a positive correlation was observed between the SIR at the affected and low (r=0.692, P=0.000), middle (r=0.615, P=0.000) and high-tone (r=0.440, P=0.001); the SIR showed no significant correlation with cochlear (r=0.315, P=0.088) or vestibular hydrops (r=0.215, P=0.244). Conclusion: 3D-FLAIR MRI can observe the degree of EH in MD; impairment of the internal auditory barrier may be one of the factors of hearing loss in MD.