The Association of Otolaryngologists in Training wanted to assess trainee well-being.

A survey was developed that incorporated the Copenhagen Burnout Inventory, the short Warwick–Edinburgh Mental Wellbeing Scale and the Brief Resilience Scale plus questions on working conditions.

There were 190 responses and while most respondents had low or moderate levels of burnout, 15 per cent had high personal burnout and 13 per cent had high work-related burnout. The mean well-being score for respondents was lower than for the whole population mean. In addition, 39 per cent of respondents reported their mental well-being had been slightly affected in a negative way by their working environment and conditions in the last 6 months, and 26 per cent reported it being significantly affected negatively. Of these, 43 respondents reported an impact on patient safety.

This first-ever survey of ENT trainees in the UK identified several areas of concern, including how the working environment and conditions affect trainee well-being and impact patient safety.

The objective of the study was to determine the effect of tranexamic acid in ear surgeries on duration of surgery, intra-operative blood loss, visibility and mean arterial pressure (MAP).

A systematic review and meta-analysis were conducted following the 2020 PRISMA guidelines. Five databases were used (PubMed, Cochrane, Scopus, Web of Science and Embase). A search yielded 73 articles: 31 were duplicates and 42 were screened for by two authors. A standardised mean difference (SMD) was calculated to measure the effect size across studies.

The search yielded five final studies with ear procedures including tympanoplasty, atticotomy, mastoidectomy, ossiculoplasty, stapedotomy, tympanotomy and microscopic modified radical mastoidectomy. Tranexamic acid reduced duration of surgery (standardised mean difference = -3.82; p = 0.38), intra-operative blood loss (standardised mean difference = -19.64; p < 0.05) and mean arterial pressure (standardised mean difference = -2.88; p < 0.05).

This meta-analysis demonstrated that tranexamic acid reduced bleeding and mean arterial pressure that were both statistically significant, while the reduction in duration of surgery was statistically insignificant. All studies reported better visibility.

Clinical trials provide valuable treatment insights but often fail to represent real-world outcomes. This is particularly true for advanced laryngeal cancer patients, who face significant co-morbidities and socioeconomic challenges. This study evaluates whether outcomes from research datasets in The Cancer Imaging Archive reflect real-world survival in a regional cohort from North-East England.

This retrospective analysis compares outcomes between The Cancer Imaging Archive (n = 198) and North-East England (n = 222) cohorts. Demographics, treatment modalities and five-year disease-specific survival were assessed via Kaplan–Meier curves and Cox regression.

North-East England had a lower five-year disease-specific survival (59.2 per cent vs. 76.9 per cent; p = 0.0018) and was characterised by greater co-morbidity burden and upfront surgery with adjuvant therapy (51 per cent), whereas The Cancer Imaging Archive patients received upfront chemoradiotherapy (53 per cent) or radiotherapy alone (41 per cent).

The poorer real-world outcomes reflect the challenges of generalising research data to heterogeneous populations. Bridging the gap between research efficacy and real-world effectiveness is critical to delivering equitable care for advanced laryngeal cancer.

The Association of Otolaryngologists in Training wanted to assess the experiences of bullying, harassment and raising concerns in their otolaryngology posts.

An online survey of otolaryngology trainees, with 190 responses out of 350 targeted, included questions on bullying and harassment.

Many respondents had experienced or witnessed a range of bullying, harassment and sexual harassment behaviours, including: unrealistic expectations about workload, responsibilities or level of competence; inadequate or absent supervision; and undervaluing someone’s contribution (in their presence or otherwise). However, very few (5 per cent or less) had reported them. Twenty-one per cent would not feel confident in reporting bullying/harassment or sexual harassment problems, and 40 per cent do not feel safe raising concerns. Just 10 per cent said the existing reporting mechanisms are sufficient.

A number of initiatives have been introduced recently in the UK to address bullying and harassment within the medical workplace, but there is still potential for further development.

Investigate the impact of surgical method on hearing outcomes and complication rates after otosclerosis surgery.

Records of patients more than 18 years old who underwent otosclerosis surgery were reviewed to identify prosthesis type, surgical approach, post-operative dizziness, overnight admissions and hearing outcomes.

A total of 132 stapedotomies were performed with McGee pistons and 144 stapedectomies were performed using ribbon loops. No sensorineural hearing loss was noted with both techniques. Stapedotomy patients had a statistically larger improvement in speech reception thresholds, but there was no significant difference in air–bone gap closure between the two methods. 3.7 per cent of stapedotomy patients experienced post-operative dizziness, which was not significantly different the 7.6 per cent dizzy after stapedectomy (p = 0.2037). Diazepam was prescribed for dizziness in 90.9 per cent (10/11) of dizzy patients with ribbon loops and 0 per cent of those (0/5) with McGee pistons (p = 0.0018).

Both approaches yielded similarly good air–bone gap closure and were found to be safe and effective with low post-operative dizziness.

The inner ear is a complex sensory organ with finely balanced physiology; disrupting this may cause hearing changes or vestibular symptoms. Pregnancy involves multiple significant reversible alterations in physiological state. This study reviews literature on the inner ear in pregnancy.

The review was pre-registered on the PROSPERO database CRD42023446898. Robust searches were conducted by two independent researchers according to the PRISMA 2020 guideline.

A total of 69 studies were filtered into the final analysis. Consistent evidence of subclinical hearing loss in pregnancy was identified, which resolved following childbirth. Auditory processing is affected by pregnancy. Vestibular dysfunction may contribute to pregnancy nausea. Sudden sensorineural hearing loss does not occur more frequently in pregnancy.

This review summarises evidence for reversible and irreversible changes to hearing and vestibular function in pregnancy and pregnancy-related conditions, reviewing aetiological theories and offering insight to audiovestibular physiology and explaining audiovestibular symptoms in the pregnant patient.

This study aimed to compare the outcome of the standard trans-cervical approach and modified trans-cervical approach regarding cosmesis and complications outcomes in a tertiary hospital in Nigeria.

In this study, 25 patients with submandibular salivary gland lesions adjudged not to be malignant neoplasia were included. They were randomised into the two groups by balloting method.

Twelve (48 per cent) patients had the traditional transcervical approach while 13 (52per cent) had the modified approach. There was no statistically significant difference between the groups in terms of general complication, transient paresthesia and wound infection (p > 0.05). The presence of a non-visible scar was reported in almost 85 per cent of patients in the modified trans-cervical approach group compared to 50 per cent in the standard trans-cervical approach group.

Though by observation the modified trans-cervical approach was superior to the standard trans-cervical approach, the differences were statistically insignificant.

To evaluate the impact of a two-week otolaryngology rotation incorporating entrustable professional activities, human factors and simulation on medical students’ knowledge, perceptions and career aspirations.

The curriculum included six small-group sessions on compassion, communication, resilience, teamwork and professionalism, and three simulations: suturing, flexible nasendoscopy and grommet insertion. These were delivered alongside standard teaching. Pre- and post-rotation questionnaires assessed otolaryngology knowledge, career interest, surgical confidence and attitudes toward simulation and human factors.

While students’ interest in surgical careers remained unchanged, they reported improved comfort with otolaryngology knowledge, operating theatre environments and recognition of non-technical skills. Perceptions of simulation and essential surgeon qualities significantly improved.

Integrating entrustable professional activities, human factors education and simulation into short surgical rotations enhances both technical and non-technical skills. This approach may help address challenges in attracting students to surgery by enriching their educational experience and building confidence.

Rosai–Dorfman disease is a rare histiocytic disorder typically presenting with cervical lymphadenopathy. Sinonasal involvement is uncommon and presents diagnostic and therapeutic challenges. This scoping review synthesises literature on the clinical presentation, diagnosis, management and outcomes of sinonasal Rosai–Dorfman disease.

We systematically searched PubMed, Scopus and Embase. Articles were screened using Endnote. Studies reporting sinonasal Rosai–Dorfman disease were included. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR (Scoping Review) guidelines.

Thirty studies comprising 36 patients were included. Common symptoms were nasal obstruction (80.6 per cent) and epistaxis (41.7 per cent). Computed tomography (75 per cent) and magnetic resonance imaging (36.1 per cent) were primary imaging modalities. Histopathology showed emperipolesis (66.7 per cent), S-100 (69.4 per cent) and CD68 (47.2 per cent) positivity. Management was mainly surgical (72.2 per cent), with corticosteroids (44.4 per cent), radiotherapy (5.6 per cent) and chemotherapy (5.6 per cent) used less frequently. Outcomes included complete resolution (38.9 per cent), stable disease (38.9 per cent) and recurrence (16.7 per cent).

Diagnosis relies on histopathology and imaging. Surgical procedures, often with corticosteroids, remain the primary treatment. Future research should guide diagnostic and treatment protocols.

Necrotising otitis externa is a serious infective condition with significant risk of complications and a profound impact on patients’ quality of life.

A quantitative descriptive study was undertaken using epidemiological data from the National Health Service Hospital Episode Statistics database and other national databases. Data correlating with reported cases 2002-2024 were compiled and analysed.

The national incidence of necrotising otitis externa has demonstrated a sustained increase 2002-2024. The 30 per cent incidence drop during the coronavirus disease 2019 pandemic may be attributable to reduced exposure to risk factors, reduced contact between susceptible patients and health professionals and pandemic-related deaths of at-risk populations. There remains a strong correlation between growths in necrotising otitis externa incidence, the ageing population and national incidence of diabetes mellitus. These are all projected to continue to rise. Antibiotic resistance is not a significant contributing factor.

This study demonstrates several significant trends, offering a strong foundation for deeper exploration in future studies.

Few studies have investigated stapedotomy using 1470 nm diode laser, and the present article contributes with clinical experience.

A retrospective analysis was conducted to investigate hearing performance of 22 patients undergoing 1470 nm diode laser-assisted primary stapedotomy.

In 8/22 cases, accidental breaches to the inner ear by the laser and in 14/22 cases the stapedotomy was performed as planned only by drill. Air–bone gap and loss of sensorineural hearing were low and with no significant differences for groups at follow-up. No patients with breaches by laser reported new or worse tinnitus.

Accidental breaches in the stapes footplate using this diode laser did not appear to equate with inner ear damage within this limited cohort. Hearing outcomes were not significantly affected. These findings should be interpreted with caution. Further studies evaluating this laser wavelength in stapedotomy is required.

To evaluate the experiences and perspectives of otolaryngology residents regarding current parental leave (PL) practices, incorporating insights from both male and female trainees to assess institutional policies and support mechanisms.

A 43-item anonymous survey was distributed to 125 ACGME-accredited otolaryngology residency programs, yielding responses from 105 residents (response rate: 29%). Data were analyzed using descriptive statistics and thematic analysis to evaluate perceptions of PL policies, barriers to leave, and postpartum support.

Most respondents were female (57%) and married (77%), with an average age of 30 years. Only 26% were aware of the American Board of Otolaryngology’s 8-week PL policy. Female residents typically took 4-6 weeks of leave, while male residents took none. Concerns about program strain (29%) and lack of lactation support (60%) were significant barriers. Despite this, most respondents felt supported by co-residents and faculty.

Otolaryngology residents reported dissatisfaction with PL policies, inadequate lactation support, and poor awareness of institutional guidelines. Addressing these issues is critical to fostering a supportive environment for residents pursuing parenthood during training.

The virtues of the scapular tip free flap for reconstruction of complex midface oncologic defects have been claimed by many. To obtain optimal functional and aesthetic results, precise positioning of the free flap used for reconstruction is paramount.

Four cases illustrate our approach to midface reconstruction with angular branch-based scapular tip flaps. A standard surgical navigation device was used both to plan bone cuts for the oncologic resection and to optimise the positioning of the flap.

Case 1 illustrates the usefulness of navigation for reconstruction of total palato-septectomy defects, using a horizontally positioned flap. Optimal neo-palate height, alignment of the anterior nasal spine and nasal projection were obtained. For cases 2–4, vertical inset of the flap yielded optimal midface projection and orbital floor position.

Surgical navigation systems are useful adjuncts for midface reconstruction.

Squamous cell carcinoma of the external auditory canal is rare, with bilateral cases even rarer. We report the management of a patient with bilateral external auditory canal squamous cell carcinoma related to radiotherapy and immunosuppression.

A 47-year-old woman with a history of radiotherapy 14 years prior and renal transplantation 6 years prior presented with bilateral external auditory canal squamous cell carcinoma. Squamous cell carcinoma was excised with a purely surgical approach. The two operations included a tympanic membrane graft to preserve hearing on the left side. The patient remains disease-free six months post-op. She uses a bone-conduction hearing aid to good effect on the right side and has mild hearing loss on the left. The operative areas have healed well.

The patient’s previous radiotherapy and immunosuppression may have contributed to her bilateral external auditory canal squamous cell carcinoma. Preventative positron emission tomography scans have the potential to identify second malignancies early, allowing more conservative treatment plans.

We report the surgical outcomes and functional results in a pediatric population following the use of the laryngotracheal LT-moldR prosthesis to treat complex glottic and subglottic stenosis.

A retrospective observational study in children following open and endoscopic surgical treatment for LT stenosis.

Among 46 patients, 91% received LT-mold during an open surgery and 9% had it following an endoscopic procedure. 93% patients were successfully decannulated and 80% needed stent placement for longer than 2 months. Mean time to decannulation was 229 days. Currently, 83% patients have normal breathing, 67% patients have normal voice or mild dysphonia and swallowing outcomes have remained similar in the pre- and post-operative period.

The LT-mold provided an adequate airway stenting, enabling decannulation in most patients with advanced grades of laryngotracheal stenosis. Duration of stenting and time to decannulation showed no correlation with the grade of stenosis or patient comorbidities. Functional results were optimal.

The aim of this study was to investigate the association between the Healthy Eating Index 2015 scores and hearing loss.

This study utilized cross-sectional data from individuals aged over 20 years (n = 5171) who participated in the National Health and Nutrition Examination Survey from 1999 to 2012 and 2015 to 2018. We collected information on their hearing, Healthy Eating Index 2015 scores and several other important covariates using multivariate regression analyses.

After adjusting for potential confounders, when hearing loss was defined as greater than or equal to 20 dB, the odds ratio for low-frequency hearing loss and high-frequency hearing loss was 0.99 (95 per cent confidence interval: 0.98–0.99; p < 0.001) and 0.99 (95 per cent confidence interval: 0.98–1; p = 0.006), respectively. When hearing loss was defined as greater than 25 dB, the odds ratio for low-frequency hearing loss and speech-frequency band hearing loss was 0.98 (95 per cent confidence interval: 0.98–0.99; p < 0.001) and 0.99 (95 per cent confidence interval: 0.98–1; p = 0.008), respectively.

In American adults, Healthy Eating Index scores are associated with hearing loss.

A range of chronic ear complaints may be attributed to Eustachian tube dysfunction. Eustachian tube dysfunction secondary to a deviated nasal septum has been described in several clinical studies, with symptomatic improvement demonstrated following septoplasty. However, uncertainty exists as to the size of the effect and consistency between studies.

Electronic searches were carried out of Pubmed, Embase and the Cochrane Library for adult patients with complaints of nasal obstruction and/or impairment and/or complaints of ear fullness undergoing nasal surgery.

Seven studies met the inclusion criteria. Studies evaluated the effect of nasal surgery on Eustachian tube dysfunction using a variety of outcomes, including Eustachian tube function tests, the Eustachian Tube Dysfunction Questionnaire-7, tympanometry and Nasal Obstruction Symptom Evaluation scores. The results demonstrated the positive impact of nasal surgery on various outcomes related to Eustachian tube dysfunction.

Nasal surgery has been demonstrated to have promising results as a therapeutic option for patients with Eustachian tube dysfunction and a deviated nasal septum, offering significant symptom relief and improved quality of life. Through the integration of the treatment of nasal symptoms in the management of Eustachian tube dysfunction, clinicians can adopt a comprehensive approach to addressing the underlying pathologies contributing to Eustachian tube dysfunction.

This study aimed to evaluate if there is a role for hypoglossal nerve stimulation outside the original Stimulation Therapy for Apnea Reduction (STAR) trial criteria.

This review was conducted using PubMed, Embase and Cochrane Library databases.

Hypoglossal nerve stimulation led to improved outcomes in individuals who fell outside the STAR trial criteria for apnoea-hypopnoea index and body mass index. However, this improvement did not extend to patients with complete concentric palatal collapse or those with a significant central apnoea component.

Hypoglossal nerve stimulation can be effective in patients outside the original STAR trial criteria for certain parameters. Further research is needed to refine patient selection criteria for optimal outcomes.