To evaluate the functional magnetic resonance imaging changes in the olfactory structures of coronavirus disease 2019 patients experiencing olfactory dysfunction.

This study included patients aged 25–65 years who presented with a sudden loss of smell, confirmed coronavirus disease 2019 infection, and persistent olfactory dysfunction for a minimum of 2 months without any treatment.

Irrespective of the side of brain activation, the analysis of the cumulative maximum diameter of the activation zones revealed significantly lower activation in the upper frontal lobe (p = 0.037) and basal ganglia (p = 0.023) in olfactory dysfunction patients. Irrespective of the side of activation, the analysis of the number of activation points demonstrated significantly lower activation in the upper frontal lobe (p = 0.036) and basal ganglia (p = 0.009) in olfactory dysfunction patients.

Patients with coronavirus-triggered olfactory dysfunction exhibited lower activity in their basal ganglia and upper frontal lobe.

Otolaryngologists perform bilateral myringotomy and tube placement for surgical management for otitis media with effusion. This retrospective study aimed to address the extent to which the coronavirus disease 2019 pandemic and season impact the number of bilateral myringotomy and tube placement procedures performed at a tertiary care centre.

A total of 1248 charts of children who underwent bilateral myringotomy and tube placement from January 2018 through February 2021 were reviewed.

The cohort included 41.6 per cent females and 58.4 per cent males, with 63.7 per cent having private insurance. The median age at surgery was 2.6 years. The spring season had the most bilateral myringotomy and tube placement procedures per week. The number of bilateral myringotomy and tube placement procedures performed per week after the onset of the coronavirus disease 2019 pandemic was significantly lower compared to the years prior. There was no difference in number of intra-operative effusions pre-pandemic versus after the pandemic onset.

This study sheds light on the impact of the coronavirus disease 2019 pandemic and seasonality on the rates of tympanostomy tube procedures, vital for understanding the temporality of ear infections.

The aim of this study is to identify the prognostic factors that may have an effect on the outcome of post-coronavirus disease 2019 acute invasive fungal sinusitis in order to help optimise diagnosis and management.

This retrospective study involved 60 patients with post-coronavirus disease 2019 acute invasive fungal sinusitis. We identified and studied several factors that may have an effect on the prognosis. These factors included patient-related factors, disease-related factors, and treatment-related factors.

Comorbidities especially renal impairment, previous intensive care unit admission, skin involvement, and intracranial spread of infection are associated with significantly poorer outcomes. Early aggressive surgical debridement is an independent factor associated with better prognosis.

Identifying prognostic factors may have a role in prevention of invasive fungal sinusitis, predicting prognosis, and tailoring patient-specific treatment protocols.

PTEN hamartoma tumour syndrome (PHTS) comprises a group of genetic disorders with varied clinical presentations, including macrocephaly, developmental delay, and increased cancer susceptibility. Recent reports have highlighted the occurrence of tonsil-related issues in PHTS.

Clinical data focusing on tonsil-related pathology and tonsillectomy details (indications, histology and post-operative complications) were collected from 53 patients with PHTS.

Tonsil issues affected 58 per cent of the cohort, with 43 per cent requiring tonsillectomy. Primary indications for tonsillectomy included obstructive sleep apnoea (43 per cent), recurrent tonsillitis (17 per cent) and other causes (17 per cent). Tonsil-related problems were observed both before (45 per cent) and after (55 per cent) PHTS. Tonsillectomy with adenoidectomy was the predominant surgical intervention performed (87 per cent), spanning a broad age range (1–27 years old).

Our findings highlight the complex nature of PHTS and its association with tonsil-related pathology, demonstrating its relevance for ENT surgeons. Early recognition and intervention are pivotal for managing sleep apnoea and the associated health problems.

This study investigated the frequency of ear canal protection use and looked at its influence on external auditory exostosis severity and knowledge about external auditory exostosis among windsurfers and kitesurfers on the German coast.

This retrospective cross-sectional study interviewed 130 windsurfers and kitesurfers along the German coast on knowledge of external auditory exostosis, exposure time, use of neoprene hoods and earplugs, and otological complaints. Participants underwent bilateral video-otoscopic examination.

Knowledge of external auditory exostosis was ‘good’ or ‘excellent’ in 78 of 130 (60 per cent) individuals and ‘poor’ or non-existent in 52 of 130 (40 per cent) individuals. Knowledge was positively correlated with hours of exposure, otological complaints and frequency of ear canal protection use. A significant negative influence of neoprene hood use on external auditory exostosis severity was shown.

The positive effect of external auditory exostosis knowledge on the frequency of ear canal protection and the reduction of external auditory exostosis risk implies a need for health education on this topic.

To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development.

A retrospective cohort study was conducted with data collected from a medical record audit. Over the study duration, the primary contact physiotherapist completed initial appointments with patients; follow-up appointments were subsequently conducted by medical staff.

There was a 46 per cent reduction in patients with suggested vestibulopathy requiring an ENT medical review. This reduction could hypothetically increase to 71 per cent with follow-up primary contact physiotherapist appointments. Improvements in the service delivery model and a primary contact physiotherapist arranging diagnostic assessments could improve waitlist times and facilitate better utilisation of medical staff time.

The primary contact physiotherapist can help in the management of patients with suspected vestibulopathy on an ENT waitlist. This is achieved through: a reduction of patients requiring ENT review, improvements to waitlist time and improved utilisation of medical specialists’ time.

Non-dissolvable nasal packs (Rapid Rhino and Merocel) are widely used in secondary healthcare centres for the control of epistaxis, with some side effects.

A prospective, observational cohort study was conducted of adults who required Rapid Rhino or Merocel packing for acute epistaxis management in a large healthcare centre between March 2020 and 2021. A validated modified version of the 22-item Sino-Nasal Outcome Test was used.

A total of 80 adults requiring non-dissolvable packs were recruited. Seventy per cent of patients had Rapid Rhino packs inserted. Embarrassment was greater in patients who used Rapid Rhino than Merocel. Merocel packs had a significantly higher mean pain score on removal compared to Rapid Rhino. There was no correlation between rebleed rate and type of nasal pack used.

Non-dissolvable Rapid Rhino and Merocel nasal packs have similar efficacy in controlling epistaxis. Rapid Rhino packs are more embarrassing for patients in comparison to Merocel packs, but are less painful to remove.

This study aimed to analyse clinical and radiological features (phenotypes) to predict revision risk after functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps.

Phenotype characteristics of the patients with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery were analysed retrospectively.

The rates of asthma, aspirin sensitivity, smoking and a positive prick test result were significantly higher in revision functional endoscopic sinus surgery cases (p < 0.001, 0.001, < 0.001 and < 0.001, respectively). Multivariate analysis demonstrated that only gender, pre-operative nasal steroid use, pre-operative systemic steroid use, intra-operative systemic steroid use and smoking were significant risk factors for revision functional endoscopic sinus surgery (p = 0.034, 0.001, 0.010, 0.007 and 0.001, respectively). In addition, only eosinophilia and aspirin sensitivity were significant risk factors for multiple revision functional endoscopic sinus surgery procedures (p = 0.043 and 0.005, odds ratio = 2.4 and 5.2).

Beyond the endotype of chronic rhinosinusitis with nasal polyps, defining clinical and radiological factors enables a valid prediction of patients at high risk of revision functional endoscopic sinus surgery.

For over a century, circumferential pharyngoesophageal junction reconstruction posed significant surgical challenges. This review aims to provide a narrative history of pharyngoesophageal junction reconstruction from early surgical innovations to the advent of modern free-flap procedures.

The review encompasses three segments: (1) local and/or locoregional flaps, (2) visceral transposition flaps, and (3) free-tissue transfer, focusing on the interplay between pharyngoesophageal junction reconstruction and prevalent surgical trends.

Before 1960, Mikulicz-Radecki's flaps and the Wookey technique prevailed for circumferential pharyngoesophageal junction reconstruction. Gastric pull-up and colonic interposition were favoured visceral techniques in the 1960s–1990s. Concurrently, deltopectoral and pectoralis major flaps were the preferred cutaneous methods. Free flaps (radial forearm, anterolateral thigh) revolutionised reconstructions in the late 1980s, yet gastric pull-up and free jejunal transfer remain in selective use.

Numerous pharyngoesophageal junction reconstructive methods have been trialled in the last century. Despite significant advancements in free-flap reconstruction, some older methods are still in use for challenging clinical situations.

Maximum phonation time is a simple test used to assess glottic competency. Our objective was to evaluate any correlation between maximum phonation time and spasmodic dysphonia as adductor spasmodic dysphonia and abductor spasmodic dysphonia have an adductor and abductor overdrive, respectively.

A 3-year data-review was performed for patients diagnosed with adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia. Maximum phonation time was noted on the first visit and compared with a control group.

Average maximum phonation time in adductor spasmodic dysphonia, abductor spasmodic dysphonia and control group was 25 seconds, 9 seconds and 16 seconds. A significant difference was found for adductor spasmodic dysphonia and abductor spasmodic dysphonia. A receiver operating characteristic curve analysis between adductor spasmodic dysphonia and control groups showed a positive predictive value of 81.3 per cent, negative predictive value of 83.9 per cent, sensitivity of 79.6 per cent and specificity of 85.2 per cent. Level of evidence = 4.

We recommend that maximum phonation time be added to the diagnostic armamentarium of spasmodic dysphonia. This correlation between maximum phonation time and spasmodic dysphonia has not been previously published.

To report a single-centre experience in the endoscopic carbon dioxide laser-assisted approach to glomus tympanicum tumours.

A retrospective case review was conducted of patients diagnosed with class A1 to B1 glomus tympanicum tumours who underwent exclusive transcanal endoscopic carbon dioxide laser surgery.

Seven patients fulfilled the inclusion criteria. All patients (100 per cent) were women, with a mean age of 65.4 years (standard deviation, 13.6). There were five A2 tumours, one A1 tumour and one B1 tumour. One patient presented with a delayed tympanic membrane perforation needing myringoplasty on follow up. There were no substantial post-operative complications. The mean hospitalisation time was 9.5 hours (standard deviation, 9.8). The mean follow-up period was 32.7 months (standard deviation, 13.1), with all cases having resolution of pulsatile tinnitus and no tumour recurrence.

The study provides further evidence on the safety and efficacy of endoscopic carbon dioxide laser surgery as a minimally invasive technique for treating early-stage glomus tympanicum tumours.

This study aimed to quantitatively investigate airborne particle load in the operating room during endoscopic or microscopic epitympanectomy or mastoidectomy.

In the transcanal endoscopic ear surgery group, drilling was performed underwater. A particle counter was used to measure the particle load before, during and after drilling during transcanal endoscopic ear surgery or microscopic ear surgery. The device counted the numbers of airborne particles of 0.3, 0.5 or 1.0 μm in diameter.

The particle load during drilling was significantly higher in the microscopic ear surgery group (n = 5) than in the transcanal endoscopic ear surgery group (n = 11) for all particle sizes (p < 0.01). In the transcanal endoscopic ear surgery group, no significant differences among the particle load observed before, during and after drilling were seen for any of the particle sizes.

Bone dissection carries a lower risk of airborne infection if it is performed using the endoscopic underwater drilling technique.

To evaluate four dimensions of fatigue, including subjective fatigue severity, concentration problems, reduced motivation, and activity in patients with single-sided deafness.

Following audiological assessment, the Checklist Individual Strength scale and Montreal Cognitive Assessment were performed on 41 adults with single-sided deafness and 41 sex-matched adults with normal bilateral hearing in the study group and control group, respectively. Subjective fatigue severity, concentration, motivation, activity level and cognitive performance were analysed between and within groups.

Individuals with single-sided deafness exhibited reduced concentration and motivation; however, their activity level was average. Subjective fatigue symptoms were more prevalent in individuals with single-sided deafness than in control participants. The concentration problem was related to decreased cognitive performance.

This study revealed negative somatic consequences of single-sided deafness. Self-perceived fatigue is likely underestimated in this population due to the limited studies reported in the literature. Further studies should focus on counselling, follow up and hearing rehabilitation concerning ameliorating fatigue.

The purpose of this study is to analyse the effect of half canal wall down tympanomastoidectomy in the treatment of chronic otitis media or cholesteatoma.

In this retrospective study, the half canal wall down tympanomastoidectomy technique was used at our hospital for chronic otitis media or cholesteatoma removal in 265 adult patients, representing 271 operated ears, with an average follow-up time of 8.4 years.

The post-operative cavities were slightly wider and straighter in 91.9 per cent of the ears. Fifteen per cent of the patients needed cavity cleaning every six months, 25 per cent of them needed cavity cleaning every year and 60 per cent of the patients had a self-cleaning cavity. Only one patient with a cleft palate experienced cholesteatoma recurrence in the mesotympanum.

The half canal wall down tympanomastoidectomy technique showed a low-recurrence rate and satisfying operative cavities. The half canal wall down tympanomastoidectomy technique is a good choice for middle ear surgery.

Frontal sinus stents have been introduced to reduce frontal sinus re-stenosis after surgery and to improve outcomes.

This study was a retrospective analysis of 19 patients who had endoscopic sinus surgery with approach to the frontal sinus and insertion of a soft sinus stent.

The frontal recess was patent in 78.9 per cent and stenosed in 21.1 per cent of patients; no completely closed recesses were observed. Mean follow up was 20.7 months, and time period of stenting was 9.8 months on average; complications were observed in 47.4 per cent of the patients, with post-operative sinonasal infection being the most common.

In the authors’ experience, indications for frontal sinus stenting include recalcitrant chronic rhinosinusitis after multiple functional endoscopic sinus surgeries (especially in chronic rhinosinusitis with nasal polyps), patients with history of important craniofacial surgery or trauma, and recurrent mucoceles. The stent was overall well tolerated as only minor complications were observed. Close clinical follow up is mandatory.

Balance dysfunction and vestibular conditions are major problems requiring significant resources. There is significant national and international variation in management pathways for such patients.

This paper outlines a collaborative project run by the ENT department and two vestibular rehabilitation trained physiotherapists to establish a clinic to manage patients referred to ENT with vestibular and/or balance complaints. As part of a six-month pilot, two physiotherapy-led balance clinics were provided per week.

A total of 159 new patients were seen, with only 15 needing ENT consultant input. This led to the successful creation of substantive posts; the clinic has seen 698 patients in its first two years.

Patient outcomes and experience have been positive, and accompanied by reduced waiting and in-service times. The authors discuss some of the pitfalls, challenges and opportunities of developing this type of clinic.

To analyse variations in the n-butanol threshold and odour identification scores of the Connecticut Chemosensory Clinical Research Centre test in various grades of olfactory dysfunction and in different nasal conditions leading to olfactory loss.

Retrospective observational study.

All grades of olfactory dysfunction were predominantly noted among males. In chronic rhinosinusitis, anosmia or severe hyposmia was seen in 87.5 per cent of patients without polyps in comparison with 68 per cent of patients with polyps. In addition, 90 per cent of patients with atrophic rhinitis and post-traumatic loss had anosmia, but only 30.7 per cent of patients with allergic rhinitis had anosmia. Pepper was the most affected smell for all the nasal diseases except atrophic rhinitis, in which asafoetida and baby powder smells were affected more.

In most inflammatory sinonasal conditions, odour identification is relatively preserved even when the threshold is maximally affected. In patients with comparable olfactory dysfunction based on the Connecticut Chemosensory Clinical Research Centre test score, a relatively preserved suprathreshold odour identification score may predict better prognosis.