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

Background Vertigo can have a negative impact on the quality of life of patients. Mobile health apps have the potential to promote autonomy, and improve symptoms through self-management and vestibular rehabilitation exercises. This study aimed to systematically evaluate the quality of apps for vertigo using the published literature and smartphone stores. Design A systematic review of the literature, utilising Embase, Medline, Cochrane and clinicaltrials.org, and Apple and Google Play Stores were used to identify mobile device apps relating to vertigo. Apps were evaluated for characteristics, content, healthcare involvement and quality using the Mobile App Rating Score (MARS) system (a standardised tool for assessing app quality). Results The literature search identified no eligible articles. The app search identified and evaluated 32 eligible apps. Four main categories of apps were identified: exercise provision, information provision, symptom monitoring and assessment. Six apps included healthcare professionals in their development. MARS scoring ranged between 1.8 and 4.05 (maximum 5), with only 25% of apps scoring the minimum acceptability score of 3. The highest scoring apps were those providing rehabilitation exercises and symptom monitoring. Conclusion There is great potential in the use of mobile apps to help monitor and manage vertigo. This article demonstrates that despite numerous readily available vertigo apps, few are of an acceptable standard. There is scope for apps to improve. We propose involving health professionals and patients in their development to ensure high quality evidence-based information and evaluating their efficacy through future patient-centred trials.

Objectives To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK. Design National retrospective and prospective audit Setting 48 UK secondary care ENT departments Participants Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis. Main outcome measures Cases were divided into: Period 1 (01/11/19-15/03/20) before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1&2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical). Results 286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in Dec 2020-Feb 2021. Patient age differed between period 1&2 (3.2 Vs 4.7 years respectively, p<0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% Vs 24.3%, p=0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2. Conclusion The COVID-19 pandemic led to a significant change in the presentation and case-mix of acute paediatric mastoiditis in the UK.