To investigate the usefulness of copeptin and S100B levels in the differentiation of central and peripheral vertigo.

Ninety patients were included in the study. Copeptin and S100B levels were measured using the enzyme-linked immunosorbent assay method.

The time between symptom onset and presentation to the emergency department was longer in the patients diagnosed with central vertigo. S100B and copeptin levels were significantly higher in central vertigo patients. The confirmed cut-off value was 17 for the S100B level and 1.65 for the copeptin level.

Quick and reliable differentiation between central and peripheral vertigo is important to reduce the length of hospital stay of patients in the emergency department, and for patient comfort. S100B and copeptin levels are potential biomarkers in the differential diagnosis of central vertigo and peripheral vertigo for patients whose aetiology of vertigo cannot be differentially diagnosed with history-taking and physical examination.

This prospective study aimed to evaluate possible diagnostic delays in head and neck squamous cell carcinoma recurrences due to the changed follow-up protocol during the coronavirus disease 2019 pandemic.

The follow-up appointments of head and neck squamous cell carcinoma patients treated more than one year prior to the pandemic were changed to telephone appointments in order to reduce physical visits to the hospital. All contacts, reasons for contact and recurrent cancers were recorded.

There were 17 recurrences during a seven-month study period among 178 patients treated in the previous year (10 per cent); 14 of these recurrences occurred in patients whose treatment had ended less than one year previously and 3 occurred more than one year after treatment had ended. There was no delay in diagnoses of recurrent tumours or treatment despite reduced visits because of the coronavirus disease 2019 pandemic.

According to our analyses, no delay was caused in the diagnoses of recurrent diseases. Follow up by telephone or telemedicine can be considered as part of the follow-up protocol one year after the treatment of head and neck squamous cell carcinoma when necessary.

The extent of surgery, the type of device used and head position may influence nasal irrigation. The aim of this study was to determine the effectiveness of topical irrigant delivery to the paranasal sinuses according to these factors.

Four cadaveric heads underwent four stepwise endoscopic dissections. Irrigations were evaluated after every stage using different delivery devices (squeeze-bottle, gravity-dependent device and syringe) in two head positions (nose-to-sink and vertex down). Irrigant penetration into each sinus was estimated using a four-point scale.

A significant positive effect of surgery was demonstrated for each sinus as well as for the delivery device. High-volume irrigant devices are more effective, and the head position plays a significant role in irrigant distribution to the frontal sinus.

This study further confirms the efficacy of high-volume irrigant devices. A vertex down position during the irrigation could improve delivery to the frontal sinus, and the widening of the ostia increases irrigant access to the sinuses.

The global pandemic of coronavirus disease 2019 has necessitated changes to ‘usual’ ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis.

A literature review was performed, searching all available online databases and resources. The Medical Subject Headings ‘tonsillitis’, ‘pharyngotonsillitis’, ‘quinsy’, ‘peritonsillar abscess’ and ‘epistaxis’ were used. Papers discussing out-patient management were reviewed by the authors.

Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described.

In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.

This study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell carcinoma.

This study was a systematic review in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed until January 2018; pertinent studies were screened. Quality of evidence was assessed using the grading of recommendation, assessment, development and evaluation working group system.

Eight articles were chosen that reported on 437 patients with external auditory carcinoma. The 5-year overall survival rate was 53.0 per cent. The pooled proportion of survivors at 5 years for T1 tumours was 88.4 per cent and for T2 tumours was 88.6 per cent. For the combined population of T1 and T2 cancer patients, it was 84.5 per cent. For T3 and T4 tumours, it was 53.3 per cent and 26.8 per cent, respectively, whereas for T3 and T4 tumours combined, it was 40.4 per cent. Individual analysis of 61 patients with presence of cervical nodes showed a poor survival rate.

From this review, there was not any significant difference found in the survival outcome between T1 and T2 tumours. A practical classification incorporating nodal status that accurately stratifies patients was proposed.

To evaluate otorhinolaryngological manifestations of coronavirus disease 2019 infection and the time required for their resolution.

A prospective analysis was conducted of coronavirus disease 2019 patients presenting from 1 April 2020 to 30 July 2020. The otorhinolaryngological manifestations were evaluated based on patient history. The time required for symptom resolution was evaluated separately for intensive care unit and non-intensive care unit patients.

A total of 600 patients were included in the study; 13.3 per cent required the intensive care unit and 2.2 per cent expired. The otorhinolaryngological manifestations were: sore throat (88 per cent), fever (78.8 per cent), anosmia or hyposmia (63.6 per cent), ageusia or hypogeusia (63.5 per cent), rhinorrhoea (51.3 per cent), nasal obstruction (33.5 per cent), sneezing (30.3 per cent), and breathing difficulty (18.6 per cent). The time required for symptom resolution was longest for breathing difficulty (23.6 days for intensive care unit and 8.2 days for non-intensive care unit patients).

Otorhinolaryngological symptoms are one of the main presentations of coronavirus disease 2019 infection. The increased prevalence of medical co-morbidities in patients requiring intensive care unit and in deceased patients is also highlighted.

The coronavirus disease 2019 pandemic has posed a new challenge for medical educators worldwide. While teaching and learning shifted online, assessment posed a roadblock. A pilot study was performed to check the feasibility and acceptability of online open-book examination.

A pilot study was carried out on sixth semester (fourth year) students. An online open-book examination was conducted on an ENT topic, and feedback was obtained using a pre-validated questionnaire. Two teachers scored and collated the answers, and the marks were averaged for each candidate.

Ninety-eight students appeared for the examination: 21.4 per cent failed and 78.6 per cent passed. Eight students scored above 75 per cent correct. Only 55 students volunteered to give feedback; most agreed that the best advantage of this assessment was that it was stress-free. The disadvantage most complained of was network connectivity issues.

Online open-book examination has the potential to be the new normal in the present circumstances and beyond.

Platinum-based chemotherapy drugs are associated with substantial ototoxicity. The hearing of children treated with these drugs should be closely monitored.

A questionnaire was sent out to the 19 audiology departments associated with national paediatric cancer specialist centres in the UK looking at current practice in ototoxicity monitoring.

Responses were received from 17 of 19 centres (89 per cent). All offered some form of audiometric monitoring service. Extended high-frequency testing (9–20 kHz) was only utilised by 7 services (29 per cent). A majority of respondents were reluctant to consider self-test devices in paediatric ototoxicity monitoring (n = 9; 53 per cent). Provision of long-term audiological follow up is sporadic with only 4 (23 per cent) respondents keeping all children with normal hearing under review once treatment is completed.

While some good practice in paediatric ototoxicity was identified, opportunities exist to improve clinical practice and protocols, promote multidisciplinary team working and to utilise technologies such as extended high frequency and self-test audiometry.

Manifestations of the coronavirus disease 2019 in ENT include sore throat, rhinorrhoea, anosmia and dysgeusia. Whether coronavirus disease 2019 causes otitis media is not known.

To assess the presence of otitis media in a series of patients with confirmed coronavirus disease 2019 and ENT symptoms.

The study included patients with coronavirus disease 2019, confirmed on polymerase chain reaction assay, who had otological (e.g. otalgia, otorrhoea, hearing loss) or other ENT (e.g. anosmia, dysgeusia) manifestations of coronavirus disease 2019, in two tertiary referral hospitals in Iran. Patients were excluded if they had a background of otological problems including previous acute otitis media, chronic otitis media, otological surgery, and trauma or radiotherapy to the head and neck.

Otitis media was found in eight patients with coronavirus disease 2019 and no background of otological problems. Six patients had middle-ear effusion, three had typical signs of acute otitis media, and one had a tympanic membrane perforation. Most patients had hearing loss; conductive hearing loss and mild sensorineural hearing loss at high frequencies were the underlying mechanisms.

Otitis media should be considered a manifestation or associated symptom of coronavirus disease 2019 during the current pandemic.

This study aimed to evaluate the outcome of granular myringitis treatment of 1 per cent diluted vinegar ear drops or 1 per cent chloramphenicol ear drops and to assess the side effects of 1 per cent diluted vinegar.

Twenty-four patients aged over 18 years and diagnosed with granular myringitis grade I or II within 90 days of symptom onset were included. Patients were equally randomised into either the 1 per cent diluted vinegar group or the 1 per cent chloramphenicol group. Outcome of treatment and side effects were compared between groups. The main outcome measure was completely epithelialised tympanic membrane at the eight-week period.

Eleven of 12 patients treated with 1 per cent diluted vinegar had complete recovery. In the 1 per cent chloramphenicol group, 8 of 12 patients recovered. The difference between groups was not statistically significant (p = 0.156). The observed side effects of diluted vinegar included dizziness and mild external auditory canal irritation.

One per cent diluted vinegar is an interesting option for granular myringitis. Other comparative advantages of 1 per cent diluted vinegar include its low price and no induction of antimicrobial resistance.

Since the start of the coronavirus disease 2019 pandemic, transnasal humidified rapid-insufflation ventilatory exchange (‘THRIVE’) has been classified as a high-risk aerosol-generating procedure and is strongly discouraged, despite a lack of conclusive evidence on its safety.

This study aimed to investigate the safety of transnasal humidified rapid-insufflation ventilatory exchange usage and its impact on staff members. A prospective study was conducted on all transnasal humidified rapid-insufflation ventilatory exchange cases performed in our unit between March and July 2020.

During the study period, 18 patients with a variety of airway pathologies were successfully managed with transnasal humidified rapid-insufflation ventilatory exchange. For each case, 7–10 staff members were present. Appropriate personal protective equipment protocols were strictly implemented and adhered to. None of the staff involved reported symptoms or tested positive for coronavirus disease 2019, up to at least a month following their exposure to transnasal humidified rapid-insufflation ventilatory exchange.

With strictly correct personal protective equipment use, transnasal humidified rapid-insufflation ventilatory exchange can be safely employed for carefully selected patients in the current pandemic, without jeopardising the health and safety of the ENT and anaesthetic workforce.

This study sought to determine the conditions that still present to ENT despite government advice to avoid unnecessary travel. It also assessed the impact of social distancing on pathologies presenting to ENT and reviewed the usefulness of telephone consultations in semi-urgent presentations.

A retrospective review was conducted of 97 instances of patient care carried out in the rapid access ENT clinic at a large district general hospital.

Otitis externa and foreign bodies represented 25 per cent and 13 per cent of consultations respectively. Tonsillitis and peritonsillar abscess were uncommon, representing 6 per cent of total consultations. Telephone appointments represented only 28 per cent of total consultations; however, they appeared to reduce the number of physical appointments required.

Otitis externa and foreign bodies continue to be common during the pandemic. Social distancing measures reduced the number of tonsillitis and quinsy presentations. Telephone consultations are effective for certain urgent presentations to ENT, most noticeably nasal trauma and follow up of non-serious pathologies.

To demonstrate the feasibility of continuing cochlear implantation during the coronavirus disease 2019 crisis and to report on trends of referrals via the neonatal hearing screening programme.

A prospective case series was conducted on children who underwent cochlear implantation during the coronavirus disease 2019 crisis in the UK and a sample of referrals via the neonatal hearing screening programme. A step-by-step description of peri-operative management is included.

Regionally, between February and May 2020, 106 babies were referred via the neonatal hearing screening programme to paediatric audiology. Eleven children were operated on during the coronavirus disease 2019 study period. None of the 11 children developed coronavirus symptoms.

It is widely recognised that the demands of managing the current pandemic may compromise screening, clinical assessment and elective surgery. Time-sensitive issues such as cancer management have gained prominence, but a similar need exists for timely paediatric cochlear implantation.

Implantation in the paediatric population during the coronavirus disease 2019 pandemic is feasible with careful planning.

This study aimed to evaluate the association between serum D-dimer, ferritin and vitamin D levels, and dysgeusia symptoms, in patients with coronavirus disease 2019.

The present study was conducted with the medical records of 300 patients positive for coronavirus disease 2019, hospitalised between 28 March and 15 August 2020. The patients were divided into two groups regarding the presence or absence of dysgeusia symptoms.

Fever and sore throat rates, and the mean D-dimer level, were considerably higher in the dysgeusia group than in the non-dysgeusia group (32.1 vs 21.6 per cent, p = 0.04; 43.6 vs 20.7 per cent, p < 0.001; and 0.54 ± 0.32 vs 0.49 ± 0.51 mg/l FEU, p = 0.008, respectively). The mean age was significantly lower in the dysgeusia group than in the non-dysgeusia group (42.83 ± 12.31 vs 50.51 ± 13.67 years, p < 0.001).

Younger age, fever and shortness of breath could be observed in patients with dysgeusia symptoms. In addition, the D-dimer level was significantly higher in the dysgeusia group.

Microlaryngoscopy is an aerosol-generating procedure. This paper presents a novel approach for better protecting staff during microlaryngoscopy.

A clear plastic microscope drape is attached to the objective lens. Instead of using the drape to cover the microscope, it is pulled down to cover the patient's head and torso. The holes designated for the binoculars of the microscope are used for the surgeon hands, forming protective clear plastic sleeves.

The proposed technique, which is simple, relatively inexpensive and technically feasible for any hospital to perform during microlaryngoscopy procedures, can increase safety and minimise droplet and aerosol exposure in the operating theatre.

Tonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years. These procedures were the first for which unwarranted regional variation was discovered, in 1938. Indications for these procedures have become stricter over time, which might have reduced regional practice variation.

This paper presents a historical review on practice variation in paediatric tonsillectomy and adenoidectomy rates. Data on publication year, region, level of variation, methodology and outcomes were collected.

Twenty-one articles on practice variation in paediatric tonsil surgery were included, with data from 12 different countries. Significant variation was found throughout the years, although a greater than 10-fold variation was observed only in the earliest publications.

No evidence has yet been found that better indications for tonsillectomy and adenoidectomy have reduced practice variation. International efforts are needed to reconsider why we are still unable to tackle this variation.

Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the ‘Southampton Tent’ and ‘OtoTent’.

To evaluate the use of a novel drape ‘tent’ that has advantages over established ‘tent’ designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field.

During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape ‘tent’. Use of this drape ‘tent’ had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.

Olfactory dysfunction represents one of the most frequent symptoms of coronavirus disease 2019, affecting about 70 per cent of patients. However, the pathogenesis of the olfactory dysfunction in coronavirus disease 2019 has not yet been elucidated.

This report presents the radiological and histopathological findings of a patient who presented with anosmia persisting for more than three months after infection with severe acute respiratory syndrome coronavirus-2.

The biopsy demonstrated significant disruption of the olfactory epithelium. This shifts the focus away from invasion of the olfactory bulb and encourages further studies of treatments targeted at the surface epithelium.

The coronavirus disease 2019 pandemic has led to the birth of videoconference multidisciplinary teams, which are now commonplace. This remote way of deciding care demands a new set of rules to ensure the quality of the complex decisions that are made for the patient group needing multidisciplinary care. Videoconference multidisciplinary teams bring with them novel forms of distraction that are under-appreciated and can impair decision-making.

A practical checklist was generated as applied to videoconference multidisciplinary teams using the principles of human factors awareness and recognition.

Some of the strategies that should be adopted to minimise errors arising from human factors are: information technology support, a suitable environment to dial in, a global checklist employed prior to the videoconference, visible participants, avoiding distractions from other sources (e.g. e-mail, mobile phone), a videoconference sign-out and rapid dissemination of the outcomes sheet.

This article presents a framework that uses human factors principles applied in this setting, which will contribute to enhanced patient safety, team working and a reduction in medical errors.

Coronavirus disease 2019 was declared a pandemic on 11th March 2020. All non-urgent surgical procedures have been postponed indefinitely. The British Association of Head and Neck Oncology state that only those with treatable head and neck cancer unsuitable for alternative treatment should undergo surgery. This paper details our management of a patient who tested positive for severe acute respiratory syndrome coronavirus-2 days before curative surgery for laryngeal cancer.

By following British Association of Head and Neck Oncology guidance, a 49-year-old male scheduled for total laryngectomy and bilateral neck dissection for a T3 transglottic squamous cell cancer was pre-operatively identified as an asymptomatic carrier of severe acute respiratory syndrome coronavirus-2. Following 14-day isolation and laboratory proven viral clearance, he underwent successful major surgery. He was managed throughout the peri- and post-operative phases without complications or adverse effects on staff.

With careful planning, previous coronavirus disease 2019 positive status should not prevent an individual from undergoing successful total laryngectomy and bilateral neck dissection in a safe and timely manner during the pandemic.