Dysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time.

This was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities.

This study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time (p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time (p = 0.57) or severity of dysphagia (p = 0.88).

Our dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.

A systematic review was performed to evaluate the safety and efficacy of different therapeutic interventions available for the management of isolated cricopharyngeal dysfunction.

Studies were identified using the following databases: Ovid (Medline, Embase), the Cochrane Library, PubMed and Google Scholar. An initial search identified 339 articles. All titles and abstracts were reviewed. Fifty-six relevant articles were inspected in more detail; of these, 47 were included in the qualitative analysis.

No relevant randomised trials were found. A range of case series were used to perform a qualitative analysis. Botulinum toxin A injection and cricopharyngeal dilatation were associated with a higher risk of recurrence, but appear to be more suitable in elderly and co-morbid patients. In those patients requiring formal myotomy, endoscopic approaches appear to be as effective but less morbid when compared with classical open surgery.

There is good evidence for the safety and efficacy of the different therapeutic options for isolated cricopharyngeal dysfunction. However, further studies are required to compare the efficacy of the various treatment modalities.

To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms.

A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate.

Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour.

An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.

To systematically review the literature on the occurrence of psychiatric diagnoses in a tinnitus-affected population, and correlate the presence of psychiatric disorders with tinnitus-related annoyance and severity.

A systematic review of the literature published between January 2000 and December 2012 was performed using PubMed, ISI Web of Science and SciELO databases. Original articles in English and Portuguese that focused on the diagnosis of mental disorders associated with tinnitus, especially anxiety and depression, were identified.

A total of 153 articles were found and 16 were selected. Fifteen articles showed a high prevalence of psychiatric disorders in tinnitus-affected patients, and nine showed a high correlation between the presence of a psychiatric disorder and tinnitus-related annoyance and severity.

The prevalence of psychiatric disorders, especially anxiety and depression, is high in tinnitus patients, and the presence of these disorders correlates with tinnitus-related annoyance and severity.

The coronavirus disease 2019 pandemic has necessitated almost exclusive National Health Service focus on emergency work and cancer care. There are concerns that increased hospital and community pressures will lead to decreased referrals and worse outcomes for head and neck cancer patients.

This is a retrospective review of all cases referred for suspected head and neck cancer to our institution in January and April 2020.

There was a 55 per cent decrease in referrals but diagnostic yield rose from 2.9 per cent in January to 8.06 per cent in April. In both months, 100 per cent of patients met the 31- and 62-day targets, with similar 14-day wait time success (97.83 per cent for January vs 98.33 per cent for April). Referrals for laryngopharyngeal reflux rose from 27.5 per cent to 41.9 per cent. Referrals for those aged over 60 years fell from 42 per cent to 26 per cent.

It is suggested that further research be conducted into the reasons why fewer patients were referred, particularly elderly patients, and why laryngopharyngeal reflux is so prevalent in fast-track referrals.

Cochlear implantation is the standard of care for treating severe to profound hearing loss in all age groups. There is limited data on long-term results in elderly implantees and the effect of ageing on outcomes. This study compared the stability of cochlear implantation outcome in elderly and younger patients.

A retrospective chart review of cochlear implant patients with a minimum follow up of five years was conducted.

The study included 87 patients with a mean follow up of 6.8 years. Of these, 22 patients were older than 70 years at the time of implantation. Hearing in Noise Test scores at one year after implantation were worse in the elderly: 85.3 (aged under 61 years), 80.5 (61–70 years) and 73.6 (aged over 70 years; p = 0.039). The respective scores at the last follow up were 84.8, 85.1 and 76.5 (p = 0.054). Most patients had a stable outcome during follow up. Of the elderly patients, 13.6 per cent improved and none had a reduction in score of more than 20 per cent. Similar to younger patients, elderly patients had improved Short Form 36 Health Survey scores during follow up.

Cochlear implantation improves both audiometric outcome and quality of life in elderly patients. These benefits are stable over time.

Necrotising otitis externa is increasingly being seen and treated within the UK. The aim of this study was to explore the potential cost of a cohort of patients with necrotising otitis externa presenting to a single tertiary NHS trust.

This was a retrospective study with data from 14 patients with confirmed necrotising otitis externa who were treated, monitored, discharged or who died between October 2016 and November 2018. Direct costs using the tariffs from the 2018 to 2019 financial year included in-patient stay, imaging, peripheral inserted central catheter line cost, ENT and out-patient parenteral antibiotic therapy visits and antimicrobial duration.

The mean cost of treatment per patient was £17 615 (range, £9407 to £38 230) with an extreme outlier costing more than £122 000.

Awareness and education at a primary care level and research into robust imaging to aid termination of treatment may lower costs in the future by catching pathology early and reducing treatment duration.

Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.

In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50–60 years, and univariate analysis was performed.

Elderly patients had a reduced performance status (p < 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p < 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).

Elderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.

The field of otology is increasingly at the forefront of innovation in science and medicine. The inner ear, one of the most challenging systems to study, has been rendered much more open to inquiry by recent developments in research methodology. Promising advances of potential clinical impact have occurred in recent years in biological fields such as auditory genetics, ototoxic chemoprevention and organ of Corti regeneration. The interface of the ear with digital technology to remediate hearing loss, or as a consumer device within an intelligent ecosystem of connected devices, is receiving enormous creative energy. Automation and artificial intelligence can enhance otological medical and surgical practice. Otology is poised to enter a new renaissance period, in which many previously untreatable ear diseases will yield to newly introduced therapies.

This paper speculates on the direction otology will take in the coming decades.

Making predictions about the future of otology is a risky endeavour. If the predictions are found wanting, it will likely be because of unforeseen revolutionary methods.

This study aimed to determine the prevalence of vestibular dysfunction in the Singaporean elderly and its association with presbyacusis, age and other associated risk factors.

A cross-sectional study was undertaken in a tertiary otorhinolaryngology department and the community. Healthy adults aged 40 years and above who participated in the institution's community presbyacusis screening programme were invited to participate. The main outcome measures including pure tone audiometry and vestibular assessment were obtained using a modified Clinical Test of Sensory Interaction on Balance.

The prevalence of vestibular dysfunction and presbyacusis in the study population of 216 participants was 30.1 per cent (95 per cent confidence interval, 24.0 to 36.2 per cent) and 55.6 per cent (95 per cent confidence interval, 49.0 to 62.2 per cent), respectively. The median age was 60 years (range, 40–86 years). The adjusted odds ratio for vestibular dysfunction increased by 6.2 per cent with every year of life (p < 0.05), and by 3.14 times in the presence of presbyacusis (p < 0.05). After adjusting for age and presbyacusis, diabetes (n = 30), hypertension (n = 85), hypercholesteraemia (n = 75), cardiac disease (n = 14), stroke (n = 7) and smoking (n = 55) were associated with an increased odds ratio for vestibular dysfunction which did not reach statistical significance (p > 0.05).

Vestibular dysfunction is independently associated with ageing and presbyacusis. Further research into the benefits of additional screening for vestibular dysfunction in elderly presbyacusis patients is warranted.

Evidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.

The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.

The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.

Hearing loss commonly affects quality of life in the elderly, yet is often neglected.

To investigate the impact of untreated age-related hearing loss on the quality of life of elderly individuals, and to assess the usefulness of quality of life questionnaires as screening tools for significant hearing loss.

We recruited 80 patients aged 50 years or more with untreated hearing impairment. The Short Form 36 Health Survey and the Hearing Handicap Inventory for the Elderly Screening Version questionnaire were administered.

There was no significant association between severity of hearing impairment and Short Form 36 Health Survey scores. However, dose-graded correlation was observed between severity of hearing loss and Hearing Handicap Inventory for the Elderly Screening Version questionnaire scores (p < 0.001). A score for the latter questionnaire of more than 8 was 72.8 per cent sensitive and 71.4 per cent specific in detecting clinically significant hearing loss of at least 40 dB (receiver operating characteristic = 0.83).

The Short Form 36 Health Survey, a generic measure, lacked specificity and sensitivity in detecting clinically significant hearing loss. However, significant hearing impairment was reflected in the Hearing Handicap Inventory for the Elderly Screening Version questionnaire scores, suggesting that this is a good, disease-specific screening tool. A combination of functional (i.e. the Hearing Handicap Inventory for the Elderly Screening Version questionnaire) and physiological (i.e. audiometric) assessment is recommended to investigate hearing loss in elderly individuals.

The two-week-wait head and neck cancer referral pathway was introduced by the Department of Health, and refined through National Institute for Health and Care Excellence guidelines which were updated in 2015.

A retrospective study was conducted of two-week-wait referrals to out-patient ENT from January to June 2018. The analysis included demographics, referral symptoms according to National Institute for Health and Care Excellence 2015 guidelines, cancer pick-up rates and positive predictive values.

A total of 1107 patients were referred for suspected head and neck cancer over six months, with 6 per cent diagnosed with cancer. Neck lump, persistent hoarseness and throat pain were the most common presenting symptoms. Neck lump had the highest positive predictive value, followed by oral swelling. Oral bleeding and persistent unilateral sore throat showed significant positive predictive values. Investigation for metastatic head and neck cancer of an unknown primary or the involvement of other multidisciplinary teams could hinder the achievement of a 62-day treatment target.

The cancer pick-up rate from two-week-wait referrals is only 1.5 times higher than routine referrals. The ‘red flag’ symptoms given in the 2015 National Institute for Health and Care Excellence update would benefit from further review.

Dizziness is prevalent among the elderly. However, little is known about its impact on quality of life and disability, especially in developing countries, where the number of elderly people is increasing.

This study aimed to determine the prevalence of disability, and the quality of life, among elderly persons with dizziness living in the community.

Longitudinal cohort study of dizziness among elderly persons (i.e. aged 65 years and over) residing in Yoruba-speaking areas of Nigeria.

Face-to-face interviews with respondents selected using a multi-stage, stratified area probability sampling of households. Dizziness was based on self-reporting and health-related quality of life was measured using the brief version of the World Health Organization quality of life assessment.

Dizziness was reported and confirmed in 318/1281 elderly respondents, a prevalence of 24.8 per cent. Respondents comprised 197 (61.9 per cent) women and 121 (38.1 per cent) men. Thirty-nine respondents (12.3 per cent) were aged 65–69 years, 91 (28.6 per cent) 70–74 years, 66 (20.8 per cent) 75–79 years and 122 (38.4 per cent) ≥80 years. The prevalence of disability in activities of daily living was 29.56 per cent, and that of disability in instrumental activities of daily living 10.1 per cent. The influence of gender was not significant. The prevalence of disability in activities of daily living (p = 0.00) and in instrumental activities of daily living (p = 0.00) increased significantly with age. Univariate analysis revealed that disability in activities of daily living (p = 0.00), disability in instrumental activities of daily living (p = 0.01), poor family interaction (p = 0.00), poor community involvement (p = 0.00), overall poor health (p = 0.00), current depression (p = 0.01), and difficulty with sedentary (p = 0.00) and vigorous (p = 0.00) activities were significantly more common among elderly respondents with dizziness, compared with non-dizzy elderly respondents. In contrast, cognitive impairment (p = 0.05) was not significantly correlated. The probabilities of the occurrence of difficulty with vigorous or sedentary mobility in our elderly respondents were 2.6 and 1.9, respectively, compared with non-dizzy elderly respondents. Similarly, the probabilities of the occurrence of disability in activities of daily living, current depression and dementia were 1.6 each. Logistic regression analyses for age, sex, medical conditions and presence of disability confirmed that dizziness was significantly associated with worsened cognition. Similarly, dizziness was significantly associated with reduced total quality of life (p = 0.00), and also with reductions in the physical (p = 0.00), psychological (p = 0.00) and environmental (p = 0.00) domains of the research instrument.

Among elderly people with dizziness, there was a high prevalence of significant disability requiring assistance. In addition, dizziness alone significantly reduced these individual's overall total quality of life, and their quality of life as regards physical, psychological and environmental parameters. This information will assist policy planning for the elderly.

As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.

During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.

Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.

To assess the influence of presbylarynx and presbycusis on Voice Handicap Index and emotional status.

A case–control, prospective, observational, cross-sectional study was conducted of patients aged 65 years or older referred to an otorhinolaryngology department from January to September 2020. Presbycusis was assessed by pure tone and vocal audiometry. Each subject underwent fibre-optic videolaryngoscopy with stroboscopy, and presbylarynx was considered when two or more of the following endoscopic findings were identified: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed two questionnaires: Voice Handicap Index and Geriatric Depression Scale (short-form).

The studied population included 174 White European subjects, with a mean age of 73.99 years, of whom 22.8 per cent presented both presbylarynx and presbycusis. Multivariate linear regression revealed that only presence and severity of presbylarynx had an influence on Voice Handicap Index-30 scores. However, both spindle-shaped glottal gap and presbycusis influenced Geriatric Depression Scale scores.

Presbylarynx has a strong association with the impact of voice on quality of life. Presbylarynx and presbycusis seem to have a cumulative effect on emotional status.

Epistaxis is a common emergency presentation to ENT. The ‘Epistaxis 2016: national audit of management’ collected prospective data over a 30-day audit window in 113 centres. A 30-day all-cause mortality rate of 3.4 per cent was identified. This study examines in more detail the subgroup of patients who died during the audit period.

There were 985 eligible patients identified. Of these, 33 patients died within the audit period. World Health Organization bleeding score, Modified Early Warning System score, haemostasis time, source of referral, co-morbidities and cause of death were investigated from the dataset.

Patients who died were more likely to come from a ward environment, have co-existing cardiovascular disease, diabetes or a bleeding diathesis, be on antithrombotic medication, or have received a blood transfusion. Patients did not die from exsanguination.

Epistaxis may be seen as a general marker of poor health and a poor prognostic sign.

Treatment for advanced laryngeal cancer includes surgery, and/or chemoradiotherapy or radiotherapy. Each of these treatments results in major changes to the swallowing mechanism. Dysphagia is strongly correlated with poorer quality of life. A good understanding of outcomes is needed for well-informed treatment decisions.

This study reports on patients' swallowing outcomes following surgical and non-surgical treatments based on the results of three different swallowing tests. A total of 123 data sets were collected in out-patient clinics across two hospitals in North East England.

There were no significant differences between treatment groups for patient-reported swallowing outcomes or swallowing performance. However, patients who had undergone chemoradiotherapy or radiotherapy (with or without laryngectomy) had significantly more diet restrictions than other groups.

Long-term dysphagia is a common outcome of treatment for advanced laryngeal cancer. Patients treated with chemoradiotherapy and laryngectomy reported the worst overall outcomes. More longitudinal prospective research with large treatment groups is needed to investigate swallowing outcomes following different treatment methods.