Work-related musculoskeletal disorders in ENT surgeons are common and detrimental, yet few are aware of preventative measures. We evaluate the evidence for interventions to prevent work-related musculoskeletal disorders in ENT surgeons.

A systematic search of databases up to 8 June 2021 was performed using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and predetermined inclusion criteria.

Seven prospective cohort studies and 2 case series were identified (51 participants). Interventions included novel equipment (n = 3), patient positioning (n = 2), clinician positioning (n = 3) and operative technique (n = 1). Five studies reported Rapid Upper Limb Assessment scores as outcome measures of strain. Strain decreased when adopting a favourable operating posture, using a supportive chair and keeping patients supine for clinic procedures.

A small number of low-quality studies were identified. Modifiable risk factors exist, and ergonomic education may help prevent work-related musculoskeletal disorders. Further studies with longer term follow up are required.

Despite crossing at the isocentre, misaligned laser beams may cause significant positioning problems.

The jig proposed here is to be used in addition to the quality assurance procedures employed with linacs and deals with possible misalignments of transverse lasers.

It is an inverted T construction with a two-sided rectangular, slightly transparent mirror set vertical on a piece of glass serving as its base. The device is carried by a horizontally set spirit-level surface and placed on the couch-top so that the sagittal laser passes through the vertical mirror’s plane. Then the therapy couch is translated along the Y direction until a laser beam shines on the corresponding side of the semi-transparent mirror. This spot is marked and is normally the linac’s isocentre set through an independent procedure employing a rotating plate. If the laser had been set properly, then its beam should be reflecting back on its source. If not, the alignment can be corrected by rotating and/or translating the laser holder until it does that. At the same time, it should be ensured that the beam does not wander away from the isocentre spot on the mirror. When both are achieved, the beam ends up perpendicular to the linac’s axis of rotation, while passing through the isocentre. The procedure can be repeated for the opposite laser.

The jig was simple to construct and has been found quite useful in practice. The accuracy of patient positioning will be restricted only by the size of the laser beam’s cross-section.

This study aimed to describe total volume and cross-sectional area measurement changes in obstructive sleep apnoea patients associated with a supine versus an upright position.

A retrospective chart review of patients who underwent cone beam computed tomography in upright and supine positions was performed, and the images were analysed.

Five obstructive sleep apnoea patients (all male) underwent both upright and supine cone beam computed tomography imaging. Mean age was 35.0 ± 9.3 years, mean body mass index was 28.1 ± 2.7 kg/m2 and mean apnoea–hypopnoea index was 39.3 ± 23.0 per hour. The airway was smaller when patients were in a supine compared with an upright position, as reflected by decreases in the following airway measurements: total volume; posterior nasal spine, uvula tip, retrolingual and tongue base (not significant) cross-sectional areas; and site of the minimum cross-sectional area (of the overall airway). Total airway volume decreased by 32.6 per cent and cross-sectional area measurements decreased between 32.3 and 75.9 per cent when patients were in a supine position.

In this case series, the airway of obstructive sleep apnoea patients was significantly smaller when patients were in a supine compared with an upright position.

This study describes the clinical features of up-beating vertical nystagmus observed during the seated–supine positional (straight head-hanging) test in patients with benign paroxysmal positional vertigo.

A total of 190 patients with benign paroxysmal positional vertigo symptoms who had presented between 2009 and 2012 were enrolled for this retrospective case series. Twelve patients with positional up-beating vertical nystagmus, as confirmed by video-nystagmography during the seated–supine positional test, were selected.

The incidence and duration of symptoms of multiple canal benign paroxysmal positional vertigo were significantly lower compared with the other types of benign paroxysmal positional vertigo (p = 0.029 and p = 0.048 respectively). Trauma was the leading aetiological factor in those patients (p = 0.012). The average number of therapeutic manoeuvres required for the relief of symptoms in patients with multiple canal involvement was significantly higher than in the other groups (p = 0.041).

In patients with benign paroxysmal positional vertigo, the presence of vertical up-beating nystagmus while lying down is a unique peripheral sign and could indicate multiple canal involvement. Therefore, the seated–supine positional test should always be included in the test battery.

Geometric uncertainties limit the accuracy of three-dimensional conformal radiotherapy treatments. This study aims to evaluate typical random and systematic set-up errors and analyse the impact of no action level (NAL) correction protocol on systematic set-up errors and clinical target volume (CTV)–planning target volume (PTV) margins.

A total 668 pairs of orthogonal electronic portal images were compared with digitally reconstructed radiographs from computed tomography planning scans for 100 patients consecutively treated during 2011. Patients were divided into groups depending on the treated anatomical region. Patient-specific and population random and systematic set-up errors were calculated. Impact of application of NAL correction protocol on systematic set-up errors and CTV–PTV expansions were evaluated.

Population set-up errors resulted from about 1 mm in head and neck to 2–3 mm in prostate, rectum, lung, breast and gynaecological districts. Patient-specific systematic set-up errors were higher for breast and gynaecological districts and application of NAL correction protocol gave significant reductions, even higher than 30%. Calculated CTV–PTV margins ranged from 10 mm on left–right direction for prostate to 20 mm on superior–inferior direction for lung.

Set-up errors resulted reasonably controlled and application of NAL correction protocol could further improve the level of accuracy. However, the NAL application alone did not seem to add any substantial benefit on CTV–PTV total margins without the adoption of corrective strategies to reduce other important uncertainties limiting accuracy of three-dimensional conformal radiotherapy.