Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement.

An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed.

The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education.

The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.

To evaluate the utility of pre-operative transtympanic electrically evoked auditory brainstem responses and post-operative neural response telemetry in auditory neuropathy spectrum disorder patients.

Four auditory neuropathy spectrum disorder patients who had undergone cochlear implantation and used it for more than one year were studied. All four patients underwent pre-operative transtympanic electrically evoked auditory brainstem response testing, intra-operative and post-operative (at 3, 6 and 12 months after switch-on) neural response telemetry, and out-patient cochlear implant electrically evoked auditory brainstem response testing (at 12 months).

Patients with better waveforms on transtympanic electrically evoked auditory brainstem response testing showed superior performance after one year of implant use. Neural response telemetry and electrically evoked auditory brainstem response measures improved in all patients.

Inferences related to cochlear implantation outcomes can be based on the waveform of transtympanic electrically evoked auditory brainstem responses. Robust transtympanic electrically evoked auditory brainstem responses suggest better performance. Improvements in electrically evoked auditory brainstem responses and neural response telemetry over time indicate that electrical stimulation is favourable in auditory neuropathy spectrum disorder patients. These measures provide an objective way to monitor changes and progress in auditory pathways following cochlear implantation.

This study aimed to analyse if there were any associations between patulous Eustachian tube occurrence and climatic factors and seasonality.

The correlation between the monthly average number of patients diagnosed with patulous Eustachian tube and climatic factors in Seoul, Korea, from January 2010 to December 2016, was statistically analysed using national data sets.

The relative risk for patulous Eustachian tube occurrence according to season was significantly higher in summer and autumn, and lower in winter than in spring (relative risk (95 per cent confidence interval): 1.334 (1.267–1.404), 1.219 (1.157–1.285) and 0.889 (0.840–0.941) for summer, autumn and winter, respectively). Temperature, atmospheric pressure and relative humidity had a moderate positive (r = 0.648), negative (r = –0.601) and positive (r = 0.492) correlation with the number of patulous Eustachian tube cases, respectively.

The number of patulous Eustachian tube cases was highest in summer and increased in proportion to changes in temperature and humidity, which could be due to physiological changes caused by climatic factors or diet trends.

To report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature.

A retrospective case series was conducted of all patients undergoing parotidectomy for chronic parotid sialadenitis at our institution between 2009 and 2018.

Eighteen superficial parotidectomies were performed, resulting in complete symptom resolution in 17 patients. There was only one recurrence, of a milder form of the disease, requiring no specific treatment. Eight temporary post-operative facial nerve palsies and one permanent palsy occurred. Further complications included post-operative wound haematoma, seroma, Frey's syndrome, neuropathic pain and wound infection.

Superficial parotidectomy is sufficient to control patient symptoms, avoiding the increased morbidity associated with near-total parotidectomy. The literature does not point to a clear difference in either the incidence of recurrence or the risk of a facial nerve palsy between the two procedures. Furthermore, the symptoms attributed to recurrence are often not severe enough to warrant salvage near-total parotidectomy.

To investigate the effects of nasal irrigation with sodium hyaluronate and surfactant solutions on mucociliary clearance time in patients with mild persistent allergic rhinitis.

A total of 120 patients diagnosed with mild persistent allergic rhinitis were enrolled in this prospective study. The patients were allocated randomly to the surfactant, sodium hyaluronate or isotonic saline (as a control) nasal irrigation group. The mucociliary clearance times and improvements in mucociliary clearance times were compared.

Improvements in mean mucociliary clearance time were significantly greater in the surfactant and sodium hyaluronate groups than in the control group (p < 0.01). The mean post-treatment mucociliary clearance time of the surfactant group was significantly lower than that of the control (p < 0.001) and sodium hyaluronate groups (p = 0.03).

Surfactant and sodium hyaluronate nasal irrigation solutions may both be used as adjunctive treatments for allergic rhinitis. Surfactant nasal irrigation resulted in better mucociliary clearance times.

Foreign bodies in the ear, nose and throat commonly necessitate emergency department visits.

This retrospective study was conducted on emergency department visits from January 2010 to December 2019 to determine characteristics and clinical prognoses of ENT patients. Patients were divided into three groups according to foreign-body entry route; patient characteristics and clinical findings were compared between groups.

Of 676 142 emergency department visits, 10 454 were because of ENT-related foreign bodies. The mean (± standard deviation) age of subjects was 24.0 (± 23.4) years, and 5176 patients were male (49.5 per cent). The most common entry route was the mouth (74.5 per cent). Most patients (97.1 per cent) were discharged after emergency treatment. Intensive care and in-hospital mortality occurred only in the mouth group.

Clinical findings differ depending on foreign-body entry route. After emergency treatment, most patients were discharged; some cases presented serious complications.

The extent of surgery, the type of device used and head position may influence nasal irrigation. The aim of this study was to determine the effectiveness of topical irrigant delivery to the paranasal sinuses according to these factors.

Four cadaveric heads underwent four stepwise endoscopic dissections. Irrigations were evaluated after every stage using different delivery devices (squeeze-bottle, gravity-dependent device and syringe) in two head positions (nose-to-sink and vertex down). Irrigant penetration into each sinus was estimated using a four-point scale.

A significant positive effect of surgery was demonstrated for each sinus as well as for the delivery device. High-volume irrigant devices are more effective, and the head position plays a significant role in irrigant distribution to the frontal sinus.

This study further confirms the efficacy of high-volume irrigant devices. A vertex down position during the irrigation could improve delivery to the frontal sinus, and the widening of the ostia increases irrigant access to the sinuses.

This study aimed to examine the association between caloric asymmetry and response to treatment in patients with vestibular migraine.

Dizziness Handicap Inventory scores were compared between patients with less than and more than 25 per cent asymmetry (using Cohen effect size) in a cohort of definite vestibular migraine patients who underwent caloric testing between August 2016 and March 2019.

A total of 31 patients (mean age: 48.7 ± 20.0 years; mean follow up: 9.1 ± 8.1 months) were included. Mean caloric asymmetry was 15.1 ± 15.6 per cent, with 6 (19.4 per cent) patients having asymmetry more than 25 per cent. Overall, patients experienced significant improvement in Dizziness Handicap Inventory total (d = 0.623 (95 per cent confidence interval, 0.007, 1.216)), emotional domain (d = 0.635 (95 per cent confidence interval, 0.019, 1.229)) and functional domain (d = 0.769 (95 per cent confidence interval, 0.143, 1.367)) but not physical domain (d = 0.227 (95 per cent confidence interval, −0.370, 0.815)) scores. Patients with more than 25 per cent asymmetry had no significant improvement in Dizziness Handicap Inventory scores, whereas those with less than 25 per cent asymmetry had significant improvement in Dizziness Handicap Inventory functional domain scores only (d = 0.636 (95 per cent confidence interval, 0.004, 1.244)).

Vestibular migraine patients with peripheral vestibular weakness on caloric testing may be less likely to improve after treatment compared with those without.

Treatment of coronavirus disease 2019 infection can result in immunosuppression. Rhino-orbital-cerebral mucormycosis is a frequent co-infection, even after recovery.

An ambispective interventional study was conducted of 41 coronavirus patients with rhino-orbital-cerebral mucormycosis at a tertiary care centre from March to May 2021.

There were 28 males and 13 females with a mean age of 48.2 years (range, 21–68 years). Twelve had long-standing diabetes mellitus and 28 had been recently diagnosed. Thirty-six had received systemic corticosteroids for coronavirus disease 2019. Nasal signs were present in 95 per cent of patients, ophthalmic symptoms and signs in 87 per cent, palatal necrosis in 46.3 per cent, facial signs in 24.3 per cent, nerve palsies in 60.9 per cent, and intracranial involvement in 21.9 per cent. Treatment with amphotericin B was based on clinical features and co-morbidities. Endonasal debridement was performed in 51.2 per cent of patients, total maxillectomy in 14.6 per cent and orbital exenteration in 9.7 per cent. At the last follow up, 37 patients (90.24 per cent) were on antifungal therapy; 4 (9.75 per cent) did not survive.

Early detection may improve survival. Follow up of high-risk patients after coronavirus disease 2019 infection is paramount.

Laryngopharyngeal reflux symptoms assessed with the reflux symptom index can overlap with non-allergic rhinitis symptoms. This study aims to explore the association between the reflux symptom index and nasal symptoms in non-allergic rhinitis patients.

A cross-sectional study was conducted on consecutive adults with non-allergic rhinitis. The reflux symptom index (score of more than 13 = laryngopharyngeal reflux) and nasal symptoms (categorised as mild (total score of 0–3), moderate (4–7) or severe (8–12)) were assessed.

The study included 227 participants (aged 58.64 ± 12.39 years, 59.5 per cent female). The reflux symptom index scores increased with total nasal symptom scores (mild vs moderate vs severe, 8.61 ± 6.27 vs 12.94 ± 7.4 vs 16.40 ± 8.10; p < 0.01). Logistic regression indicated that laryngopharyngeal reflux is more likely in patients with severe nose block (odds ratio 5.47 (95 per cent confidence interval = 2.16–13.87); p < 0.01).

Laryngopharyngeal reflux symptoms are associated with nasal symptom severity, and nasal symptoms should be primarily treated. Those with predominant nose block and laryngopharyngeal reflux symptoms are more likely to have laryngopharyngeal reflux.

This study aimed to evaluate the association between serum D-dimer, ferritin and vitamin D levels, and dysgeusia symptoms, in patients with coronavirus disease 2019.

The present study was conducted with the medical records of 300 patients positive for coronavirus disease 2019, hospitalised between 28 March and 15 August 2020. The patients were divided into two groups regarding the presence or absence of dysgeusia symptoms.

Fever and sore throat rates, and the mean D-dimer level, were considerably higher in the dysgeusia group than in the non-dysgeusia group (32.1 vs 21.6 per cent, p = 0.04; 43.6 vs 20.7 per cent, p < 0.001; and 0.54 ± 0.32 vs 0.49 ± 0.51 mg/l FEU, p = 0.008, respectively). The mean age was significantly lower in the dysgeusia group than in the non-dysgeusia group (42.83 ± 12.31 vs 50.51 ± 13.67 years, p < 0.001).

Younger age, fever and shortness of breath could be observed in patients with dysgeusia symptoms. In addition, the D-dimer level was significantly higher in the dysgeusia group.

Chronic rhinosinusitis is associated with altered mucociliary clearance and olfaction. The study aimed to analyse the reversibility of impairment and endoscopic factors predicting changes in mucociliary clearance and olfactory parameters.

This prospective study included patients undergoing functional endoscopic sinus surgery for medically refractory chronic rhinosinusitis. Pre- and post-operative measurements of mucociliary clearance, olfactory thresholds, and identification scores were recorded.

Of the 96 patients, 65.6 per cent had polyposis and 80.2 per cent underwent primary surgery. Improvements in mucociliary clearance and olfaction scores were seen in all patients, with greater reversibility of impairment in patients with polyposis and in those who underwent revision surgery. The presence of polyps correlated significantly with changes in mucociliary clearance and olfaction.

The study highlights improvements in mucociliary clearance, olfactory thresholds and identification scores after functional endoscopic sinus surgery in chronic rhinosinusitis with or without nasal polyposis, as well as for primary and revision surgeries. Adequate post-operative care and prevention of polyps recurrence help to improve mucociliary clearance and olfaction scores.

Fear of contracting coronavirus disease 2019 may be the latest addition to the barriers to clinic attendance. This study aimed to examine the impact of coronavirus disease 2019 and other variables on non-attendance rate at an out-patient clinic.

Clinic attendance at the Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, New Zealand, was assessed. For each appointment, the impact of coronavirus disease 2019 and other variables on non-attendance rate were analysed.

In total, 1963 appointments were scheduled, with 194 non-attendances (9.9 per cent). Patients who had their appointments confirmed beforehand were 10.0 times more likely to attend their appointment. Sex, socioeconomic status, ethnicity and age were found to impact non-attendance rate.

In New Zealand, coronavirus disease 2019 does not appear to be a barrier to out-patient clinic appointment attendance. The patient's age, sex, ethnicity, socioeconomic status and prior appointment confirmation were found to influence clinic attendance.

Utilisation of the Head and Neck Cancer Risk Calculator version 2 has been recommended during the coronavirus disease 2019 pandemic for the assessment of head and neck cancer referrals. As limited data were available, this study was conducted to analyse the use of the Head and Neck Cancer Risk Calculator version 2 in clinical practice.

Patients undergoing telephone triage in a two-week wait referral clinic were included. Data were collected and analysed using appropriate methods.

Sixty-four patients in the study were risk-stratified into low-risk (51.6 per cent, 33 of 64), moderate-risk (14.1 per cent, 9 of 64) and high-risk (34.4 per cent, 22 of 64) groups. Of the patients, 53.1 per cent (34 of 64) avoided an urgent hospital visit, and 96.9 per cent (62 of 64) were cancer free, while 3.1 per cent (2 of 64) were found to have a head and neck malignancy. The sensitivity, specificity, negative predictive value and accuracy were 50.00 per cent, 66.13 per cent, 99.92 per cent and 66.11 per cent, respectively.

It is reasonable to use the calculator for triaging purposes, but it must always be accompanied by a meticulous clinical thought process.

This study aimed to evaluate and compare cases of simultaneous and consecutive bilateral cochlear implantation from the perspective of the duration of anaesthesia, surgical complications and hospitalisation.

Fifty patients with simultaneous bilateral cochlear implantation (group 1) and 47 patients with consecutive bilateral cochlear implantation (group 2) were included in this study. The two groups were compared in terms of the duration of anaesthesia, the duration of surgery, radiological findings, the complications and the post-operative hospitalisation time.

Group 1 had a significantly shorter operation time than group 2 (p < 0.01). The mean total operation time was 189 minutes in group 1. In group 2, the mean operation times for the first and second surgery were 134 minutes and 136 minutes, respectively, and the total operation time for both surgical procedures in group 2 was 270 minutes. The duration of post-operative hospitalisation of the patients in group 1 was significantly shorter than the total post-operative hospitalisation after both operations for the patients in group 2 (p < 0.01).

In conclusion, if there is no anatomical problem that may lead to a prolonged operation time or any risk regarding anaesthesia, simultaneous bilateral cochlear implantation can be performed safely.

This study aimed to measure the duration and recovery rate of olfactory loss in patients complaining of recent smell loss as their prominent symptom during the coronavirus disease 2019 outbreak.

This was a prospective telephone follow-up observational study of 243 participants who completed an online survey that started on 12 March 2020.

After a mean of 5.5 months from the loss of smell onset, 98.3 per cent of participants reported improvement with a 71.2 per cent complete recovery rate after a median of 21 days. The chance of complete recovery significantly decreased after 131 days from the onset of loss of smell (100 per cent sensitive and 97.7 per cent specific). Younger age and isolated smell loss were associated with a rapid recovery, whereas accompanying rhinological and gastrointestinal symptoms were associated with longer loss of smell duration.

Smell loss, occurring as a prominent symptom during the coronavirus disease 2019 pandemic, showed a favourable outcome. However, after 5.5 months from the onset, around 10 per cent of participants still complained of moderate or severe hyposmia.

Odontogenic sinusitis is an underdiagnosed entity and is one cause of failure of conventional treatments of sinusitis. Unfortunately, there is no consensus so far on the best management protocol. This retrospective study aimed to suggest a practical management protocol that can reduce misdiagnosis and improve treatment outcomes.

The study included 74 patients with confirmed odontogenic sinusitis who were diagnosed and treated over 10 years (2010–2019). The patient data were recorded and analysed.

Dental pain was reported in only 31.1 per cent of patients. Fifty-six patients (75.7 per cent) had received dental treatment during the last year, but only 13 (23.1 per cent) reported it. Dental pathology was missed on initial computed tomography evaluation in 24 patients (32.4 per cent). Forty-one patients (55.4 per cent) were successfully treated by dental procedures and antibiotics. Fourteen patients needed functional endoscopic sinus surgery in addition to dental procedures.

Successful management of odontogenic sinusitis requires good communication between rhinologists, radiologists and dentists. Dental treatment should be the logical first step in the treatment protocol, unless otherwise indicated.

Visual-vestibular mismatch patients experience persistent postural and perceptual dizziness. Previous studies have shown the benefit of vestibular rehabilitation for visual desensitisation using gaze stabilisation exercises and optokinetic stimulation. This study assessed the benefit of customised vestibular rehabilitation with visual desensitisation and virtual reality based therapy rehabilitation in the management of patients with persistent postural-perceptual dizziness.

This retrospective study included 100 patients with Situational Characteristic Questionnaire scores of more than 0.9. All patients received virtual reality based therapy along with usual vestibular rehabilitation using gaze stabilisation exercises with a plain background followed by graded visual stimulation and optokinetic digital video disc stimulation. Patients’ symptoms were assessed before and after vestibular rehabilitation using the Situational Characteristic Questionnaire, Generalised Anxiety Disorder Assessment-7, Nijmegen Questionnaire and Dizziness Handicap Inventory.

There were statistically significant improvements in Situational Characteristic Questionnaire scores, Nijmegen Questionnaire scores and Dizziness Handicap Inventory total score. However, there was a statistically insignificant difference in Generalised Anxiety Disorder Assessment-7 scores. There was a significant positive correlation between post-rehabilitation Situational Characteristic Questionnaire scores and other questionnaire results.

Incorporating virtual reality based therapy with customised vestibular rehabilitation exercises results in significant improvement in persistent postural-perceptual dizziness related symptoms.

To report intensive care unit admission outcomes for head and neck cancer patients.

A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units.

There were 10 721 head and neck cancer patients, with a median age of 64 years (71.6 per cent male). Of admissions, 76.4 per cent were in public hospitals, 96.9 per cent were post-operative and 43.6 per cent required mechanical ventilation. Annual head and neck cancer admissions increased from 2000 to 2015 (from 348 to 1132 patients), but the overall proportion of intensive care unit admissions remained constant. In-hospital mortality was 2.7 per cent, and intensive care unit mortality was 0.7 per cent. The in-hospital mortality risk decreased three-fold (p < 0.001).

Head and neck cancer patients had low mortality in the intensive care unit and in hospital. Risk of dying decreased despite more intensive care unit admissions. This is the first large-scale cohort study quantifying intensive care unit utilisation by head and neck cancer patients. It informs future work investigating alternatives to the intensive care unit for these patients.

Antibiotics are the mainstay of therapy for acute exacerbation of chronic rhinosinusitis. However, no treatment guidelines exist. Most clinicians follow the recommendations for acute bacterial rhinosinusitis, usually caused by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis, and treat with amoxicillin or amoxicillin-clavulanate.

Medical data of 810 patients who had undergone endoscopic sinus surgery were analysed retrospectively. The results of bacterial cultures and treatment course were assessed in 152 patients who presented with acute exacerbation of chronic rhinosinusitis within 6 months of endoscopic sinus surgery.

The most common bacterial species present were Staphylococcus aureus (36 per cent), Pseudomonas aeruginosa (13 per cent) and Escherichia coli (11 per cent). Most of the isolates showed resistance or intermediate sensitivity to amoxicillin-clavulanate. Targeted antibiotic therapy was significantly more effective than empiric therapy (71 per cent versus 42 per cent). The most effective antibiotics were fluoroquinolones.

Acute exacerbation of chronic rhinosinusitis shows different microbiology than acute bacterial rhinosinusitis and requires a different therapeutic approach. It is optimally treated with culture-directed antibiotic therapy.