Objectives: This rapid review aims to evaluate the impact of the COVID-19 pandemic on incidence of head and neck cancer (HNC) and stage distribution at diagnosis. Design: Rapid Review and Meta-analysis Participants: comparative data for new HNC patients between a pre-pandemic cohort (before March 2020) and a pandemic cohort (after March 2020 during the lockdown period). Main Outcomes Measured: data on tumour stage, incidence, referral pathway (number of new patient referrals) or workload levels (number of HNC treatments). Data on stage were summarised as odds ratios (OR) with 95% confidence intervals (CI), data related to changes in numbers of diagnoses, referrals and workload levels were summarised as a narrative synthesis. Results: 31 reports were included in this review. Individually 16 out of 23 studies did not show a significant impact on stage relative to the pre-pandemic period. However, the meta-analysis revealed that patients diagnosed with HNC during the pandemic were 16% more likely to have nodal involvement (OR=1.16; 95% CI 1.00–1.35), 17% more likely to have a late overall stage (OR=1.17; 95% CI 1.01–1.36), and 32% more likely to present with advanced tumour extent (T3 and T4 stage) (OR=1.32; 95% CI 1.08–1.62). Data on incidence was extremely limited and not currently sufficient to assess trends in burden of disease. Conclusions: This review indicates that during the COVID-19 pandemic there was upstaging of HNC at diagnosis, suggesting the provision of care to HNC patients was significantly affected.

Introduction Healthcare is responsible for 5.4% of greenhouse gas emissions in the UK. Emissions in surgery is a relatively unexplored area; in particular, this hasn’t yet been looked at as a whole in ENT in the UK. Aims Quantify the amount of greenhouse gas (GHG) emission from a tonsillectomy and assess the proportion of each source’s contribution. Method Operational data from tonsillectomies performed at a large university teaching hospital in the UK were gathered and converted to global warming potential using established conversion factors and data from existing healthcare-focused carbon footprint studies. The domains considered were waste, pharmaceuticals, surgical instrument decontamination, transportation, consumables use and utilities. This study used a process-based carbon footprint approach based on the “Greenhouse Gas Protocol: Product Life Cycle Accounting and Reporting Standard”. Results The carbon footprint of a typical case was 41 kgCO2e which is equivalent to driving a car for approximately 150 miles. Consumables were responsible for 17% of this; 14% came from transport, 5.4% from decontamination, 4.8% from pharmaceuticals and 4% from waste. However, the largest GHG was from utilities, of which heating, ventilation and air conditioning was the overwhelming contributor. Conclusion While the largest sources of GHG emissions require hospital-wide initiatives, there are aspects of consumables and waste streams we can improve on in ENT surgery. These include the use of disposable vs reusable instruments as well as increased availability and use of recycling waste streams in theatres. Additionally, this study provides a template that can be applied to other ENT procedures.

Background Peritonsillar abscess is a common clinical problem. Management involves drainage of the abscess and administration of antibiotics. The choice of antibiotic is related to the polymicrobial growth of aspirate cultures, leading to prescriptions of co-amoxiclav, or metronidazole in addition to phenoxymethylpenicillin. However there is little evidence to support this. Objectives The aim of this review was to assess clinical effectiveness of phenoxymethylpenicillin vs phenoxymethylpenicillin plus anaerobic cover in the management of peritonsillar abscess. Design/Setting A systematic review of literature and clinical trial databases in accordance with the PRISMA 2020 statement. Studies were screened for eligibility by two independent reviewers. Main outcome measure Three studies were included, two comparing oral penicillin to oral penicillin plus metronidazole, one comparing IM/oral penicillin to IM/oral sulbactam-ampicillin. Clinical outcomes were assessed in all, including recurrence rate, symptom improvement and duration of pyrexia. Results There was no significant difference in any clinical outcome across all studies between the two groups. One study found a significant increase in diarrhoea and vomiting as a side effect in the group receiving metronidazole plus penicillin compared to penicillin alone (p=0.01). Conclusion On reviewing the literature, no significant clinical benefit has been demonstrated in the addition of either metronidazole or more broad-spectrum antibiotic cover compared to oral penicillin monotherapy for peritonsillar abscess when combined with incision and drainage protocols. Moreover, unnecessary broad-spectrum antibiotics contribute to increased side effects, costs, and antimicrobial resistance.