Journal of Laryngology and Otology最新文献

Objectives: To characterize treatment trends and facial weakness outcomes in vestibular schwannoma management using real-world data from a large US patient cohort.

Methods: This retrospective cohort analysis utilized the TriNetX US Collaborative Network. The study included 72,496 patients diagnosed with vestibular schwannoma, managed with observation, stereotactic radiosurgery or surgical treatments. Main outcome measures were demographic profiles, treatment modality utilization, facial weakness incidence and historical (2022-2025) and predicted (2025-2026) treatment trends.

Results: It showed a slight female predominance (54.35 per cent) and underrepresentation of Black and Asian patients. Observation was most common (87.6 per cent), followed by surgery (65.3 per cent) and stereotactic radiosurgery (34.7 per cent). Facial weakness rates: 4.7 per cent (observation), 9.1 per cent (stereotactic radiosurgery), 24.4 per cent (surgery). Combined treatments had higher facial weakness rates. Stereotactic radiosurgery use was stable; translabyrinthine surgery declined; posterior fossa approaches increased.

Conclusion: This comprehensive analysis highlights varying facial weakness risks across treatment modalities, disparities in the treatments and evolving treatment preferences.

Background: 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. 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.

Methods: We describe in detail the Swansea technique, an innovative method of canaloplasty with endoscopic underwater excision of exostoses using a piezoelectric saw and continuous irrigation with 1:1,000,000 adrenaline, with the results from our first 34 procedures.

Results: The inherent properties of the piezoelectric saw reduce the risk of overall complications when compared with traditional methods, whilst the surgical set-up is cost-equivocal and easily implemented in departments with endoscopic capabilities.

Conclusion: The piezoelectric saw is a promising novel technique for the treatment of external auditory exostosis.

Objectives: The aim of this study was to compare KTP (potassium titanyl phosphate) laser therapy and dextracin ear drops for treatment of chronic myringitis.

Methods: A case series involving 31 patients (18 laser group; 13 dextracin group). Primary outcomes included otorrhoea resolution, improvement in Chronic Ear Survey scores and endoscopic resolution. Secondary outcomes included hearing outcome and complications. Statistical analyses were performed using Mann-Whitney U, Wilcoxon signed-rank and Fisher's exact tests.

Results: The laser group had a higher rate of otorrhoea resolution 66.67 per cent (n = 12) vs 15.38 per cent (n = 2) (p = 0.006), showed significant improvement in symptom scores (median 31.43; p = 0.005) and medical resource use (16.67; p < 0.001) and had a significant myringitis area reduction of 31.84 per cent (p < 0.001). No significant differences were observed in Chronic Ear Survey scores and area reduction in the dextracin group. One laser-group patient developed a permanent perforation.

Conclusion: KTP laser therapy is effective for refractory chronic myringitis, offering superior symptom relief and reduced healthcare utilisation compared to topical treatment.

Background: Clinical exposure is vital in medical education, but in paediatric otolaryngology traditional bedside teaching can cause children distress and fatigue. Augmented reality technology offers a solution to enhance learning while reducing these challenges. This study evaluated the feasibility of using Microsoft HoloLens 2 augmented reality technology in clinical paediatric ENT to reduce children distress during bedside teaching.

Methods: An 18-month pilot study at Alder Hey Children's Hospital involved 109 4th-year medical students from the University of Liverpool. Students participated in virtual ward round sessions, where one student performed a clinical review using HoloLens 2, while others observed and interacted remotely. Feedback from students, patients and parents was collected verbally and via questionnaires.

Results: Overall, 69 per cent of students rated the augmented reality session as equivalent or better than traditional bedside teaching. Most students (87 per cent) had no prior experience with augmented reality, yet found it engaging and beneficial. Parent reported reduced stress for their children.

Conclusion: Augmented reality using HoloLens 2 is a promising tool for teaching clinical paediatric ENT, providing an immersive, child-friendly learning experience. While effective, high costs and technical challenges may restrict wider implementation. Future studies should explore further integration of augmented reality in medical education.

Background: Tonsillectomy is a common paediatric procedure with potential morbidity, notably post-operative pain and bleeding. One proposed factor influencing these outcomes is the surgeon's level of training.

Objective: To evaluate whether surgical training level affects short-term outcomes in paediatric tonsillectomy.

Methods: In a prospective randomised study (2019-2022), outcomes were compared in children undergoing cold dissection tonsillectomy performed by either an attending or a supervised resident. Measured outcomes included duration of analgesia use, time to resume oral intake, length of hospital stay and post-operative bleeding.

Results: A total of 115 children were included in the study, of which 60 (52.2 per cent) were operated on by residents and 55 (47.8 per cent) were operated on by attending surgeons. Baseline characteristics were similar. Operations by attending surgeons were shorter (20.4 vs 29.1 minutes), but no significant differences were found in post-operative pain, diet resumption, length of stay (1.1 days) or bleeding.

Conclusion: Supervised residents achieve comparable outcomes to attending surgeons. Surgical training level does not impact tonsillectomy outcomes under supervision.

Background: Currently, there is no guideline to support the conversion of inhaled medications to formulations suitable for patients undergoing tracheostomy or laryngectomy. This study aimed to evaluate prescribing practices and post-operative respiratory complications.

Methods: The first cycle of this cohort study (1 October 2018 to 28 February 2022) examined existing practice, while the second cycle (1 August 2023 to 31 July 2024) assessed the impact of a newly introduced prescribing tool. The primary outcomes were the proportion of patients prescribed appropriate inhaler formulation and the incidence of post-operative respiratory complications, stratified by formulation appropriateness.

Results: Our study demonstrated the tool improved appropriate formulation prescribing from 45 per cent to 60 per cent. In both cycles, patients receiving appropriate formulations had fewer post-operative respiratory complications.

Conclusion: A prescribing tool to facilitate formulation conversion was associated with improved prescribing practices and reduced complications, supporting the need for structured guidance in this high-risk population.

Objectives: One-Stop Neck Lump Clinics have gradually been implemented across the UK over the past two decades; however, long-term data reporting is sparse. This study describes data over five years of a successfully implemented One-Stop Neck Lump Clinic.

Methods: The One-Stop Neck Lump Clinic is led by ENT surgeons and a dedicated head and neck sonographer working alongside a biomedical scientist. Yearly data (2019-2024) have been collected on all patients undergoing ultrasound +/- fine-needle aspiration in the OSNLC.

Results: A total of 2198 patients were assessed over the five-year period. Fine-needle aspiration was performed in 45.0 per cent cases (n = 990), of which 134 samples were inadequate (13.5 per cent). Abnormal findings were reported in 19.9 per cent (n = 437). A "normal neck" with no pathology demonstrated was observed in 392 cases (17.8 per cent). Benign diagnoses comprised 1235 cases (56.2 per cent).

Conclusion: The OSNLC offers a streamlined pathway for rapid head and neck cancer assessment and diagnosis substantiated by long-term data.

Objective: The Association of Otolaryngologists in Training wanted to assess trainee well-being.

Methods: A survey was developed that incorporated the Copenhagen Burnout Inventory, the short Warwick-Edinburgh Mental Wellbeing Scale and the Brief Resilience Scale plus questions on working conditions.

Results: There were 190 responses and while most respondents had low or moderate levels of burnout, 15 per cent had high personal burnout and 13 per cent had high work-related burnout. The mean well-being score for respondents was lower than for the whole population mean. In addition, 39 per cent of respondents reported their mental well-being had been slightly affected in a negative way by their working environment and conditions in the last 6 months, and 26 per cent reported it being significantly affected negatively. Of these, 43 respondents reported an impact on patient safety.

Conclusion: This first-ever survey of ENT trainees in the UK identified several areas of concern, including how the working environment and conditions affect trainee well-being and impact patient safety.

Background: Button batteries are a common household item that are, unfortunately, attractive to young children. If ingested, they are corrosive and potentially fatal. Button battery ingestion is frequently unwitnessed, delaying the diagnosis. In the USA, approximately 6,000 accidental ingestions occur annually (2.2 deaths per year over a decade on average). Community awareness of this danger appears to be low.

Methods: We conducted a 22-question online questionnaire-based study to assess and raise awareness of this exceptional childhood risk.

Results: A total of 561 survey responses were analysed; 77 per cent were female, and 60 per cent were aged 30-50. Despite 87 per cent using button batteries, 65 per cent did not consider their safety, and 68 per cent found existing packaging warnings inadequate. Notably, 80 per cent recognised the potential for fatality, but 88 per cent were unaware that a spoonful of honey could delay this corrosive process.

Conclusion: Challenges persist regarding the design and marketing of button batteries and public awareness of their ingestion. Action is required to prevent further tragedies.

Objectives: To evaluate the impact of a two-week otolaryngology rotation incorporating entrustable professional activities, human factors and simulation on medical students' knowledge, perceptions and career aspirations.

Methods: The curriculum included six small-group sessions on compassion, communication, resilience, teamwork and professionalism, and three simulations: suturing, flexible nasendoscopy and grommet insertion. These were delivered alongside standard teaching. Pre- and post-rotation questionnaires assessed otolaryngology knowledge, career interest, surgical confidence and attitudes toward simulation and human factors.

Results: While students' interest in surgical careers remained unchanged, they reported improved comfort with otolaryngology knowledge, operating theatre environments and recognition of non-technical skills. Perceptions of simulation and essential surgeon qualities significantly improved.

Conclusion: Integrating entrustable professional activities, human factors education and simulation into short surgical rotations enhances both technical and non-technical skills. This approach may help address challenges in attracting students to surgery by enriching their educational experience and building confidence.