Up to 60 per cent of patients with enlarged vestibular aqueduct syndrome experience sudden hearing loss. This review analyses treatment options and outcomes when sudden hearing loss occurs.

Embase, Ovid MEDLINE and Web of Science databases were the data sources. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. The number of patients, episodes, treatments, baseline hearing and change in hearing thresholds after intervention and return to baseline were extracted.

The final analysis included 60 episodes of hearing loss from 11 studies, from a search of 1,064 studies. The treatment groups were: 1, no treatment; 2, systemic steroids; 3, salvage hyperbaric oxygen therapy in steroid partial or non-responders. The hearing improvement across the groups was 9.1 per cent, 50 per cent and 89.5 per cent, respectively.

Enlarged vestibular aqueduct patients with sudden hearing loss may first be treated with systemic steroids. Salvage hyperbaric oxygen therapy can be considered in steroid non-responders to improve further chances of recovery.

This study aimed to determine the safety of selective cyclooxygenase 2 inhibitors in tonsillectomy patients.

A systematic review of the literature was undertaken in August 2024 (updated March 2025) using Joanna Briggs Institute systematic review and critical appraisal methodology. Study outcomes were bleeding incidence, analgesic efficacy and adverse effects. Eligible comparators were non–cyclooxygenase-2-selective non-steroidal anti-inflammatory drugs or placebo.

Fifteen studies were included for meta-analysis, 14 of which were randomised control trials. The studies were overall of good quality. There was no increased risk of bleeding with selective cyclooxygenase 2 inhibitors (odds ratio = 1.27; 95 per cent confidence interval: 0.51 to 3.16; p = 0.61). They were more effective than placebo in providing analgesia (odds ratio = -1.22; 95 per cent confidence interval, -2.12 to -0.33; Z = 2.67; p = 0.007; I2 = 84 per cent).

Selective cyclooxygenase 2 inhibitors do not cause an increase in bleeding risk for tonsillectomy patients. There is insufficient evidence to compare their safety and efficacy to non-selective non-steroidal anti-inflammatory drugs such as ibuprofen.

This study aimed to synthesise existing systematic reviews to determine the true long-term recurrence rate of cholesteatoma following primary surgery and to evaluate the comparative effectiveness of surgical approaches (canal wall up vs canal wall down ) and adjunctive procedures on disease recidivism.

A systematic search of PubMed, Scopus and OpenAlex identified 23 studies (predominantly systematic reviews and meta-analyses) encompassing 12,819 patients with an equal to or greater than 12 months’ follow-up and clearly defined recurrence, evaluating canal wall up, canal wall down, mastoid obliteration and endoscopic assistance.

Recurrence increased from 7 per cent at 12 months to 39 per cent at 15 years. Canal wall down showed lower recurrence than canal wall up. Mastoid obliteration (odds ratio, 0.33–0.45) and endoscopic techniques (risk ratio, 0.48–0.68) reduced recidivism and residual disease. Age and staged surgery increased risk, whereas planned second-look surgery was protective.

Cholesteatoma recurrence is strongly time-dependent. Combining appropriate surgical techniques with mastoid obliteration, endoscopic assistance and long-term surveillance improves long-term disease control.

Evaluating the effectiveness of intra-operative nerve monitoring and stimulation in preventing spinal accessory nerve and marginal mandibular nerve injuries during neck dissection.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review methodology was used to map and summarise current literature. Online PubMed/MEDLINE searches and manual screening identified relevant studies for inclusion.

Seven studies met the inclusion criteria. Six addressed the spinal accessory nerve and one the marginal mandibular nerve. No randomised controlled trials were identified. The evidence tentatively supports the use of intra-operative neurophysiological monitoring in reducing spinal accessory nerve and marginal mandibular nerve palsy rates during neck dissection. Intra-operative neurophysiological monitoring modalities varied across studies, from continuous neuromonitoring to handheld nerve stimulation and nerve mapping. Monitoring criteria and outcome definitions differed across studies.

The evidence base for intra-operative neurophysiological monitoring of standard accessory nerve and marginal mandibular nerve during neck dissection remains methodologically heterogeneous. Standardised protocols, prospective controlled studies and dedicated marginal mandibular nerve monitoring studies are required before routine implementation can be recommended.

The purpose of this single-centre retrospective study was to determine the long-term outcomes of the BIA400 and Ponto Wide, in terms of implant stability, soft tissue reactions, skin thickening and implant loss.

Adults who had the BIA400 or Ponto Wide implanted between January 2013 and December 2023 and had at least two follow-up appointments were included, leading to a cohort of 93 BIA400 and 114 Ponto Wide implants.

Significantly more soft tissue reactions with a Holgers Scale score of 1 or greater (p = 0.003), adverse soft tissue reactions of Holgers Scale score of 2 or greater (p = 0.018), skin thickening (p < 0.001) and skin thickening requiring treatment (p ≤ 0.001) occurred in the BIA400 group. No difference in implant stability was found. One BIA400 implant (1.1 per cent) and three Ponto Wide implants (2.7 per cent) were lost.

Both implants have excellent implant stability and similar implant survival rates. The Ponto Wide has favourable outcomes in terms of (adverse) soft tissue reaction and skin thickening (requiring treatment).

Tinnitus is a common and potentially distressing symptom associated with chronic ear disease. Its burden in patients with chronic suppurative otitis media in low-resource settings is not well characterised.

A cross-sectional study was conducted during an ear surgery camp in Nepal. One hundred patients with chronic suppurative otitis media completed the validated Nepali Tinnitus Handicap Inventory. Severity was categorised using established grading systems. Associations between sex and severity were assessed using chi-squared analysis.

Nepali Tinnitus Handicap Inventory scores ranged from 0 to 94. Overall, 62 per cent of patients reported moderate or worse tinnitus, and 36 per cent reported severe or catastrophic symptoms. Female patients demonstrated a greater burden, with a higher proportion in severe and catastrophic categories. This difference was statistically significant (χ2 = 11.05; df = 4; p = 0.026).

Patients undergoing surgery for chronic suppurative otitis media experience a substantial and under-recognised tinnitus burden. Routine assessment may support more comprehensive, patient-centred care.

Increased use of personal listening devices such as headphones and earphones can lead to noise-induced hearing loss, especially with prolonged use and high volume. This study aimed to assess hearing status among medical trainees and its relationship with unsafe personal listening device usage.

Cross-sectional study was conducted among 177 medical trainees at a medical college in Western Rajasthan. An online questionnaire assessed personal listening device usage patterns, and hearing status was evaluated.

Most preferred in-the-ear personal listening devices (78 per cent) at moderately loud volume (61.6 per cent) for more than 1 hour daily (58.2 per cent). Although 54.2 per cent reported slight hearing loss in at least one ear, no significant association was found between hearing loss and personal listening device type, volume or duration. However, hearing loss was significantly higher in males than females.

Contrary to earlier studies, no significant relationship was observed between personal listening device usage patterns and hearing loss, highlighting the need for larger studies using standardised sound exposure assessments.

This study aimed to assess long-term audiological outcomes in 465 primary myringoplasties and evaluate factors influencing surgical success.

A retrospective analysis was conducted on 442 patients (465 procedures) between 2001 and 2024. Outcomes were evaluated based on perforation location and surgical period.

Mean air–bone gap improved from 19.1 dB to 9.8 dB post-operatively. Air–bone gap closure less than 10 dB was achieved in 53 per cent of patients. Posterior perforations yielded significantly better outcomes (8.7 dB vs. 10.2 dB; p = 0.0226).

A residual air–bone gap of 8–12 dB is common despite anatomical success. Accurate reporting must include long-term data and high-frequency (4 kHz) analysis.

The vestibulo-ocular reflex is essential for maintaining visual stability during head movements. Individual neurophysiological characteristics, such as hand dominance, may influence vestibular responses through hemispheric lateralisation. This study aimed to investigate the effect of hand dominance on functional vestibulo-ocular reflex performance using the Functional Head Impulse Test.

Fifty-eight healthy volunteers were classified as right- or left-handed using the Edinburgh Handedness Inventory. Functional Head Impulse Test reading scores were obtained during passive rightward and leftward head impulses at acceleration levels of 4000, 5000 and 6000°/s2.

No significant differences were observed between right- and left-handed individuals during rightward head movements. In contrast, during leftward head movements, right-handed individuals demonstrated significantly higher Functional Head Impulse Test scores at 4000 and 6000°/s2, as well as higher total reading scores.

Hand dominance influences functional vestibulo-ocular performance, particularly during leftward head impulses. Considering hand dominance in the interpretation of Functional Head Impulse Test results may enhance the accuracy and individualisation of vestibular assessments.

Persistent otologic infections are common, yet microbiological data from primary care clinics remain limited. This study characterised culture findings in patients with persistent otologic symptoms.

We conducted a retrospective case series at a primary care clinic in South Korea. Ear discharge cultures were reviewed in patients with symptoms lasting longer than one month and prior exposure to ototopical and/or systemic antibiotics.

Twenty-seven specimens from 24 patients were analysed. Otitis externa accounted for 92.6 per cent of cases. Staphylococcus aureus was the most common isolate, including methicillin-susceptible (48.1 per cent) and methicillin-resistant strains (11.1 per cent), with frequent fluoroquinolone non-susceptibility. Pseudomonas aeruginosa was identified in 14.8 per cent of specimens. Bacterial–fungal co-isolation occurred in 48.1 per cent, most commonly involving Candida species. Culture findings led to treatment modification in 29.6 per cent of specimens.

Selective ear discharge cultures may help guide management in primary care patients with persistent symptoms and prior antimicrobial exposure.

Axillary lymph node metastases represent a rare and under-recognised pattern of disease progression in laryngeal squamous cell carcinoma, with limited data regarding their timing and clinical significance.

We retrospectively reviewed all patients treated for advanced-stage laryngeal squamous cell carcinoma at two tertiary medical centres between 2017–2022, identifying cases that subsequently developed axillary lymph node metastases.

Five patients (3.6 per cent) developed axillary lymph node metastases, all following total laryngectomy, four after salvage surgery for recurrent disease. Mean interval from surgery to axillary lymph node metastases diagnosis was 9.9 ± 4.2 months. All tumours were moderately to poorly differentiated, and axillary involvement was frequently associated with mediastinal nodal disease. All patients received systemic therapy, including chemotherapy and/or immunotherapy, and three died of disease during follow-up.

Axillary lymph node metastases occurred within a relatively narrow time window after total laryngectomy, suggesting a non-random metastatic pattern. Awareness of this pathway is important for post-laryngectomy surveillance and interpretation of follow-up imaging.

To investigate pain, discomfort, tolerance and complications during 24-hour multichannel intraluminal impedance-pH monitoring.

A prospective observational study at an academic out-patient clinic including 55 patients undergoing 24-hour multichannel intraluminal impedance-pH monitoring. Patient experience was measured using self-reported questionnaires at four time points: pre-insertion, post-insertion, before sleep and post-procedure. Anxiety, pain, discomfort, tolerance and other symptoms were assessed using visual analogue scale (VAS) scores. After treatment, the decision regret scale survey was administered.

Anxiety decreased after catheter insertion. Discomfort peaked immediately after insertion and declined over time, while intolerance remained relatively stable. Foreign body sensation showed the highest VAS score. The proportion of participants unwilling to undergo the examination again was high, but patients tended to have a positive perception of 24-hour multichannel intraluminal impedance-pH monitoring after treatment.

Although 24-hour multichannel intraluminal impedance-pH monitoring has been reported to be uncomfortable and difficult to tolerate, most patients were satisfied with their decision to undergo the test.

Surgical site infection is a major cause of morbidity. Standard pre-operative nasal decolonisation depends on patient-led, multiday topical antibiotics, which suffer from poor adherence and contribute to antimicrobial resistance. Clinician-delivered nasal photodisinfection offers an immediate, non-antibiotic alternative.

A single-centre before-and-after service evaluation compared surgical site infection outcomes before and after implementation of a pre-operative nasal photodisinfection protocol in adults undergoing endoscopic anterior skull base surgery. The primary outcome was 30-day surgical site infection; secondary outcomes were post-operative meningitis and excess bed-stay.

Two hundred patients were included (105 standard; 95 photodisinfection). Surgical site infection occurred in 15 patients (14.6 per cent) with standard care versus 3 (3.2 per cent) after photodisinfection, an absolute risk reduction of 11.4 per cent (95 per cent CI 3.7–19.1; p = 0.0059). Meningitis occurred in five standard-care patients and none after photodisinfection. Compliance was 100 per cent, with no adverse events.

Photodisinfection was associated with substantially reduced surgical site infection.

There is increasing demand for high-quality anatomy teaching for medical undergraduates. This study investigates medical students’ perspectives on using virtual reality to learn laryngeal anatomy.

Thirty-six Year 4 university teaching hospital medical students participated in a virtual reality laryngeal anatomy learning experience (Oculus Quest 2® headsets). Students interacted with a VR model and completed a confidential feedback survey assessing their virtual reality exposure, learning environment, perceived usefulness and willingness to use virtual reality in future training.

A total of 75 per cent of students had minimal prior virtual reality exposure. Despite this, 69.5 per cent agreed that virtual reality helped them learn the anatomy better than traditional lectures; 76.1 per cent believed virtual reality enhanced their learning; and 80 per cent expressed willingness to use virtual reality in their training. High satisfaction was reported regarding the learning environment, with 97.2 per cent feeling comfortable and engaged.

Virtual reality is a useful adjunct to laryngeal anatomy education, providing an interactive, engaging and resource-efficient adjunct to traditional methods.

This study aimed to compare the environmental and financial impact of cochlear implantation performed with and without general anaesthesia.

Two cochlear implant procedures performed on the same day by the same surgical and anaesthetic teams were prospectively evaluated: one under total intravenous anaesthesia with bispectral index monitoring, and one under local anaesthesia with propofol sedation. Anaesthetic drugs, consumables, equipment, electricity use and procedural duration were recorded. Financial costs were estimated using procurement data and national formularies. Carbon dioxide equivalent emissions were calculated using published conversion factors.

Local anaesthesia was associated with lower cost (£59 vs. £179) and lower carbon footprint (2.85 vs. 5.28 kg carbon dioxide equivalent). Procedural duration was similar between pathways (71 vs. 74 minutes).

Cochlear implantation without general anaesthesia may reduce environmental and financial cost without prolonging procedural duration. Anaesthetic pathway selection represents a modifiable determinant of resource use in otological practice.

Angiosarcoma is a rare malignant vascular tumour. Its occurrence in the nasal cavity is uncommon, and septal cases are particularly rare. Because symptoms are often non-specific, nasal septal angiosarcoma may initially mimic benign vascular lesion and delay diagnosis.

We report a 46-year-old woman with recurrent epistaxis and nasal obstruction. Nasal endoscopy and excisional biopsy were performed, with histopathology and immunohistochemistry.

Endoscopy revealed a 1.0 × 0.5 cm mass on the anterior septum. The lesion appeared completely excised on gross inspection; however, histopathology demonstrated infiltrative margins with residual tumour at the resection edges. Microscopy showed irregular vascular channels, pleomorphic endothelial cells, high mitotic activity and focal necrosis. Immunohistochemistry confirmed endothelial differentiation. No cartilage invasion was identified on histology.

This case highlights the diagnostic challenge of nasal septal angiosarcoma and the emphasises the importance of early biopsy, histopathological confirmation and multidisciplinary management.

Necrotising otitis externa is a severe, potentially life-threatening infection of the external auditory canal and skull base, first formally described by Chandler in 1968. However, historical literature suggests that its clinical features were recognised long before this, without conceptual unification.

A narrative historical review was undertaken using primary and secondary sources, including early otological texts, case reports and modern literature.

Descriptions consistent with necrotising otitis externa appear as early as the nineteenth century, with recurrent observations of severe otitis externa, temporal bone involvement and systemic vulnerability. These remained fragmented across diagnostic categories until the mid-twentieth century. Chandler’s work represents a transition from clinical observation to conceptual recognition, providing a unifying framework that enabled consistent diagnosis, comparison and subsequent study of the condition.

The evolution of necrotising otitis externa reflects a process of progressive recognition, offering insight into ongoing challenges in defining and studying the disease in contemporary clinical practice.

To compare unilateral vs bilateral hot tonsillectomy in managing peri-tonsillar abscesses.

Literature review in Medline and other database sources, and critical analysis of data.

Management options for peri-tonsillar abscesses range from intravenous antibiotics alone or needle aspiration for small collections to incision and drainage or abscess tonsillectomy for larger ones. Regarding the latter, there is no clear consensus in the literature on favouring unilateral over bilateral excision.

Conventional wisdom would suggest that operating on acutely inflamed tissue may increase the risk of bleeding due to engorged vessels and tissue friability. The potentially lower rate of post-operative haemorrhage in unilateral abscess tonsillectomy should be weighed against a potentially lower risk of future episodes in bilateral excisions. Furthermore, the improved efficiency of unilateral abscess tonsillectomy in terms of healthcare resource utilisation and operative time should be evaluated in the context of routinely performed interval contralateral tonsillectomies, potentially affecting operating theatre planning.