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.

To evaluate risk factors for poor prognosis in vocal fold leukoplakia.

Clinical data were collected for 344 patients with vocal fold leukoplakia who received surgical treatment in our otolaryngology department from October 2010 to June 2019. Univariate and multivariate logistic regression analyses of the relevant factors were conducted.

Among the 344 patients, 98 exhibited recurrence and 30 underwent a malignant change. Multivariate logistic regression analysis showed that size of the lesion (p = 0.03, odds ratio = 2.14), form of the lesion under white light (p < 0.001), surgical method (p < 0.001, odds ratio = 0.28) and pathological type (p < 0.001) were independent factors that affected the recurrence of vocal fold leukoplakia. In both univariate and multivariate analyses, the sole independent risk factor for malignant transformation of vocal fold leukoplakia was pathological type (p < 0.001).

The outlook for vocal fold leukoplakia depends on several clinical factors, especially pathological type. The more severe the pathological type, the more likely it is to recur or become cancerous.

Nasal obstruction and congestion can occur because of turbinate and septal variations with or without rhinitis. A combined treatment for nasal obstruction and congestion was examined retrospectively in cases where the nasal swell body was addressed with inferior turbinectomy, with or without posterior nasal nerve ablation.

A 940 nm laser was utilised for contact (nasal swell body, septum and inferior turbinate) and non-contact (posterior nasal nerve) ablation. Total Nasal Symptoms Score, visual analogue scale pain score, complications and procedure location (office vs operating theatre) were recorded.

All 242 patients underwent nasal swell body reduction with inferior turbinate reduction, and 150 had posterior nasal nerve ablation also. No laser complications were observed. An 80 per cent reduction in medication usage was noted. Total Nasal Symptoms Score decreased by 73 per cent; rhinorrhoea and congestion scores decreased by 54 per cent and 81 per cent respectively. Crusting, epistaxis and infections were minimal, and resolved within two weeks.

Nasal swell body with inferior turbinate reduction, with or without posterior nasal nerve ablation, is a new method of treating nasal obstruction and congestion. Laser posterior nasal nerve ablation can be utilised as a complementary tool to deliver anatomical obstruction relief.

Heat from transoral laser microsurgery can cause tissue shrinkage, impacting the surgical margin. This study aimed to compare shrinkage between cold steel and carbon dioxide laser resections of laryngeal lesions.

A European Laryngological Society type II resection was performed on 10 mm ‘lesions’ marked on both the true and false folds of fresh-frozen human larynxes; specifically, laser resection was performed on the right side and cold steel resection on the left side.

Twenty-eight larynxes were included. Tissue shrinkage was significantly higher in laser resection (35–45 per cent) compared to cold steel resection (8–14 per cent) (p < 0.0001). In most cases, there was no significant difference in shrinkage between true and false fold sites.

This study demonstrates that specimen shrinkage is significantly higher in laser resections. This shrinkage will affect the size of the surgical margin; surgeons and pathologists should be aware of this when considering positive and close margins.

Retraction pockets are collapsed segments of the tympanic membrane. Their formation is associated with a disruption in middle-ear ventilation pathways, leading to the loss of organised collagen of the tympanic membrane. There are several approaches in treating retraction pockets, which aim either to improve ventilation or repair the retraction pockets themselves.

A review of the literature regarding the classification and associated management of retraction pockets was conducted, using Medline and Cochrane Library databases, with the addition of our institution's experience in undertaking novel techniques.

All the current classification systems fail to guide treatment or prognosticate the disease. Commonly, an initial conservative approach is suggested for early stages, with no clear indication regarding when a surgical solution should be offered. There are conflicting data concerning the effectiveness of these treatments in terms of disease prevention, recurrence and hearing outcomes.

Minimally invasive approaches utilising novel techniques may be key to reducing peri-operative morbidity and improving the overall patient experience.

Current evidence suggests there is no difference between endoscopic laser surgery and radiotherapy with regards to oncological outcomes of early laryngeal cancer. Patient management may therefore be directed towards voice and quality of life outcomes. This systematic review compares functional outcomes with respect to voice character, swallowing outcomes and quality of life for endoscopic laser surgery versus radiotherapy for T1 and T2 stage laryngeal carcinoma.

Search terminology was designed by both authors and used in Cochrane, PubMed and Web of Science databases. Studies of adult patients treated for primary T1 and T2 laryngeal squamous cell carcinoma utilising one objective (validated) measure of quality of life, swallowing or voice were included.

Initial searches identified 1767 studies. After inclusion and exclusion criteria were applied, 42 studies were identified for full-text review.

This review concluded that neither treatment is clearly advantageous. Future research should be composed of further prospective studies that use a standardised assessment regime to allow valid comparison.

To statistically analyse the hearing thresholds of two cohorts undergoing stapedotomy for otosclerosis with two different prostheses.

A retrospective study was conducted comparing NiTiBOND (n = 53) and Nitinol (n = 38) prostheses.

Average follow-up duration was 4.1 years for NiTiBOND and 4.4 years for Nitinol prostheses. The post-operative air–bone gap was 10 dB or less, indicating clinical success. The p-values for differences between (1) pre- and post-operative values in the NiTiBOND group, (2) pre- and post-operative values in the Nitinol group, (3) pre-operative values and (4) post-operative values in the two groups were: air–bone gap – p < 0.001, p < 0.001, p = 0.631 and p = 0.647; four-frequency bone conduction threshold – p = 0.076, p = 0.129, p < 0.001 and p = 0.005; four-frequency air conduction threshold – p < 0.001, p < 0.001, p = 0.043 and p = 0.041; three-frequency (1, 2 and 4 kHz) bone conduction threshold pre-operatively – p = 0.639, p = 0.495, p = 0.001 and p = 0.01; and air conduction threshold at 4 kHz: – p < 0.001, p < 0.001, p = 0.03 and p = 0.058.

Post-operative audiological outcomes for NiTiBOND and Nitinol were comparable.

Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures.

A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018.

Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373).

Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.

Acquired anterior glottic web poses a significant challenge to laryngologists given its propensity to recur following treatment, and there are a wide variety of described techniques.

A systematic review of the medical literature was undertaken in order to identify all articles pertaining to the management of acquired anterior glottic web.

Thirteen studies meeting the inclusion criteria were identified and analysed. All were retrospective series, with varying surgical techniques and outcome measures. Only two studies reported on the use of topical mitomycin C.

Mucosal graft techniques and keel placement appear to improve success rates, but both carry risks and disadvantages. Based on the available evidence, the use of topical agents such as mitomycin C cannot be recommended in the management of acquired anterior glottic web.

The completion of a laser safety course remains a core surgical curriculum requirement for otolaryngologists training in the UK. This project aimed to develop a comprehensive laser safety course utilising both technical and non-technical skills simulation.

Otolaryngology trainees and consultants from the West of Scotland Deanery attended a 1-day course comprising lectures, two high-fidelity simulation scenarios and a technical simulation of safe laser use in practice.

The course, and in particular the use of simulation training, received excellent feedback from otolaryngology trainees and consultants who participated. Both simulation scenarios were validated for future use in laser simulation.

The course has been recognised as a laser safety course sufficient for the otolaryngology Certificate of Completion of Training. To the authors’ knowledge, this article represents the first description of using in situ non-technical skills simulation training for teaching laser use in otolaryngology.

To assess published reports of oncological surgical success rates in patients who underwent transoral laser supraglottic surgery and robotic surgery for supraglottic cancer.

A systematic review of the literature was conducted and a meta-analysis of published data was performed. PubMed, Sage, Medline and Cochrane data sources were investigated. Overall survival rates, disease-specific survival rates, additional treatments and recurrence rates were investigated to determine the success of the surgical procedures.

The meta-analysis included 24 studies; 1617 studies were excluded. There were no statistically significant differences between the transoral laser supraglottic surgery and transoral robotic supraglottic surgery groups in terms of overall survival (77.0 per cent and 82.4 per cent respectively) and disease-specific survival (75.8 per cent and 87.0 per cent respectively). There was recurrence in 164 out of 832 patients (19.7 per cent) in the transoral laser supraglottic surgery group and in only 6 out of 66 patients (9 per cent) in the transoral robotic supraglottic surgery group.

Transoral laser surgery and robotic surgery appear to have comparable and acceptable oncological success rates.