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Publication Epistaxis management quality improvement project(Cambridge University Press, 2020-06-29) Ojha, Shilpa; Cheung, Linnea; Clark, Matthew; Galm, Tira; Ojha, Shilpa; Cheung, Linnea; Clark, Matthew; Galm, Tira; Medical and DentalNo abstract availablePublication Sudden sensorineural hearing loss and bedside phone testing: a guide for primary care(Royal College of General Practitioners, 2020-02-20) Ojha, Shilpa; Henderson, Arthur; Bennett, Warren; Clark, Matthew; Ojha, Shilpa; Clark, Matthew; Medical and DentalNo abstract availablePublication A Systematic Review of Interventions for Balance Dysfunction in Patients With Vestibular Schwannoma(Lippincott, Williams & Wilkins, 2020-03) Ojha, Shilpa; Clamp, Philip; Ojha, Shilpa; Medical and DentalObjective: Dizziness is a major contributing factor to poor quality of life for patients with vestibular schwannoma (acoustic neuroma). We wished to review the literature on interventions for balance dysfunction in these patients. Data Sources: A systematic literature review was performed identifying studies that measured balance function before and after treatment for vestibular schwannoma. Data sources include Medline (1950–present), EMBASE (1974–present), Cochrane Library (issue 3, 2008), NHS Centre of reviews and dissemination, Clinical Evidence, Cochrane central register of controlled trial, and CINAHL. Study Selection: A minimum follow-up of 6 months was required, to estimate long-term balance function. Eight articles were identified, including five studies with surgical intervention, two studies with stereotactic radiotherapy, and one comparing the two. Study design was generally poor with a high risk of bias. These studies all utilized the Dizziness Handicap Inventory (DHI) as a measure of pre- and postintervention balance function. Data Extraction: Results showed that overall DHI scores are not statistically affected by intervention irrespective of modality (surgery or stereotactic radiotherapy). Patients selected with severe dizziness, who undergo surgery, improved postoperatively. No other studies for severe dizziness were noted for comparison. Conclusions: Age, sex, and tumor size have no statistically significant effect on DHI outcomes, and no evidence to suggest which treatment modality has better dizziness related outcomes. No specific treatment modality was superior in terms of long-term balance function. Patients with severe dizziness may benefit from surgery, although no comparator studies were identified.Publication Test, test, test - a complication of testing for coronavirus disease 2019 with nasal swabs(Cambridge University Press, 2020-07-28) Mughal, Zahir; Luff, Ed; Okonkwo, Okechukwu; Hall, Charlie; Mughal, Zahir; Luff, Ed; Okonkwo, Okechukwu; Hall, Charlie; Medical and DentalBackground: Coronavirus disease 2019, a highly transmissible respiratory infection, has created a public health crisis of global magnitude. The mainstay of diagnostic testing for coronavirus disease 2019 is molecular polymerase chain reaction testing of a respiratory specimen, obtained with a viral swab. As the incidence of new cases of coronavirus disease 2019 increases exponentially, the use of viral swabs to collect nasopharyngeal specimens is anticipated to increase drastically. Case report: This paper draws attention to a complication of viral swab testing in the nasopharynx and describes the premature engagement of a viral swab breakpoint, resulting in impaction in the nasal cavity. Conclusion: This case highlights a possible design flaw of the viral swab when used to collect nasopharyngeal specimens, which then requires an aerosol-generating procedure in a high-risk patient to be performed. The paper outlines a safe technique of nasal foreign body removal in a suspected coronavirus disease 2019 patient and suggests alternative testing materials.Publication Telephone triage is effective in identifying nasal fractures that require manipulation(Wiley, 2021-02-07) Mughal, Zahir; Iniowurai, Deinma; Clark, Matthew; Mughal, Zahir; Iniowurai, Deinma; Clark, Matthew; Medical and DentalNo abstract availablePublication Delayed Facial Nerve Palsy Following Otological Surgery: Systematic Review and Narrative Synthesis(Cambridge University Press, 2025-08-29) Walters, Ben; Patel, Sanjay; Kim, Valerie; Walijee, Hussein; Walijee, Hussein; Medical and DentalNo abstract availablePublication Acute paediatric mastoiditis in the UK before and during the COVID-19 pandemic: A national observational study(Wiley, 2021-11-03) Smith, Matthew; Jones, Gareth; Hardman, John; Nichani, Jaya; Khwaja, Sadie; Bruce, Iain; Rea, Peter; Jones, Gareth; Medical and DentalObjectives: To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK. Design: National retrospective and prospective audit. Setting: 48 UK secondary care ENT departments. Participants: Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis. Main outcome measures: Cases were divided into Period 1 (01/11/19-15/03/20), before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1 and 2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical). Results: 286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in December 2020-Febraury 2021. Patient age differed between periods 1 and 2 (3.2 vs 4.7 years respectively, p < 0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period, 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% vs 24.3%, p = 0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2. Conclusion: The COVID-19 pandemic led to a significant change in the presentation and case mix of acute paediatric mastoiditis in the UK.Publication Internal vascular channel architecture in human auditory ossicles(Wiley, 2022-03-31) Manoharan, Shivani; Gray, Roger; Hamilton, John; Mason, Matthew; Hamilton, John; Medical and DentalThe vascular supply of the human auditory ossicles has long been of anatomical and clinical interest. While the external blood supply has been well-described, there is only limited information available regarding the internal vascular architecture of the ossicles, and there has been little comparison of this between individuals. Based on high-resolution micro-CT scans, we made reconstructions of the internal vascular channels and cavities in 12 sets of ossicles from elderly donors. Despite considerable individual variation, a common basic pattern was identified. The presence of channels within the stapes footplate was confirmed. The long process of the incus and neck of the stapes showed signs of bony erosion in all specimens examined. More severe erosion was associated with interruption of some or all of the main internal vascular channels which normally pass down the incudal long process; internal excavation of the proximal process could interrupt vascular channels in ossicles which did not appear to be badly damaged from exterior inspection. An awareness of this possibility may be helpful for surgical procedures that compromise the mucosal blood supply. We also calculated ossicular densities, finding that the malleus tends to be denser than the incus. This is mainly due to a lower proportion of vascular channels and cavities within the malleus.Publication Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative(Biomed Central, 2022-07-11) Hardman, John; Harrington, Kevin; Roques, Tom; Sood, Sanjai; Jose, Jemy; Lester, Shane; Pracy, Paul; Simo, Ricard; Repanos, Costa; Stafford, Frank; Jennings, Chris; Winter, Stuart; Wheatly, Hugh; Homer, Jarrod; Kumar, B. Nirmal; Paleri, Vinidh; Wheatly, Hugh; Medical and DentalBackground: Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. Methods: A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. Results: Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached 'strong agreement' (n = 25, 2, 0 for each round, respectively), a single statement achieved 'agreement' only (round 3), and 'no agreement' could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. Conclusions: The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.Publication Applications of Artificial Intelligence in Temporal Bone Imaging: Advances and Future Challenges(Springer Nature, 2023-09-02) Petsiou, Dioni-Pinelopi; Martinos, Anastasios; Spinos, Dimitrios; Spinos, Dimitrios; Medical and DentalThe applications of artificial intelligence (AI) in temporal bone (TB) imaging have gained significant attention in recent years, revolutionizing the field of otolaryngology and radiology. Accurate interpretation of imaging features of TB conditions plays a crucial role in diagnosing and treating a range of ear-related pathologies, including middle and inner ear diseases, otosclerosis, and vestibular schwannomas. According to multiple clinical studies published in the literature, AI-powered algorithms have demonstrated exceptional proficiency in interpreting imaging findings, not only saving time for physicians but also enhancing diagnostic accuracy by reducing human error. Although several challenges remain in routinely relying on AI applications, the collaboration between AI and healthcare professionals holds the key to better patient outcomes and significantly improved patient care. This overview delivers a comprehensive update on the advances of AI in the field of TB imaging, summarizes recent evidence provided by clinical studies, and discusses future insights and challenges in the widespread integration of AI in clinical practice.Publication Surgical arrest of post-tonsillectomy haemorrhage: hospital episode statistics 2016–2022(Royal College of Surgeons of England, 2024-05-24) Heining, Christopher; Clark, Matthew; Clark, Matthew; Medical and DentalIntroduction Return to theatre for arrest of post-tonsillectomy haemorrhage represents a significant complication of a commonly performed Ear, Nose and Throat procedure. We used Hospital Episode Statistics data to quantify this risk. This method has been used previously for data from 2002–2004 and again for 2010–2016. In this article, coblation tonsillectomy was considered separately as it had not been analysed in previous studies. Methods We used Hospital Episode Statistics data provided by the Department of Health to determine the risk of return to theatre for patients undergoing tonsillectomy between 2016 and 2022. Adults and children were analysed separately. Results Between 1 April 2016 and 30 April 2022, 179,172 tonsillectomies were performed (not including coblation tonsillectomy), 4,311 (2.41%) of which returned to theatre for control of postoperative bleeding. In children, 1.16% returned to theatre, whereas in adults, 3.80% returned (p<0.05). When including coblation tonsillectomy, the return to theatre rate was 0.82% in children, 3.46% in adults and 1.92% overall. Conclusions This study shows that adults remain more than three times more likely than children to require a return to theatre for arrest of haemorrhage following tonsillectomy. The rates of post-tonsillectomy haemorrhage decrease when coblation tonsillectomies are added to the analysis. The rate of return to theatre for post-tonsillectomy haemorrhage seems to have stabilised compared with previous work carried out. The authors recommend further work to assess the complication rate of tonsillectomy in the UK and to compare coblation tonsillectomy with other techniques.Publication Investigations for Suspected Head and Neck Squamous Cell Carcinoma of Unknown Primary (HNSCCUP): A National Cohort Study(Wiley, 2025-01-08) Hardman, John; Constable, James; Williamson, Andrew; Dobbs, Sian; Hogan, Christopher; Hulse, Kate; Khosla, Shivun; Milinis, Kristijonas; Tudor-Green, Ben; Paleri, Vinidh; INEGRATE (The ENT Trainee Research Network); Constable, James; Medical and DentalObjectives Head and neck squamous cell carcinoma from unknown primary (HNSCCUP) is a rare and challenging condition. This study aimed to investigate the diagnostic pathways of suspected HNSCCUP patients in the United Kingdom. Methods A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT (PET-CT) within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients with no primary site on examination and no previous head and neck cancer were eligible. Results Data for 965 patients were received from 57 centres; 68.5% were HPV-related disease. Three investigation cycles were observed: ultrasound with biopsy, cross-sectional imaging (MRI and/or CT) and PET-CT, at median times of 17, 29.5 and 46 days from referral. No primary was identified on PET-CT in 49.8% (n = 478/960). Diagnostic tonsillectomy was performed in 58.2% (n = 278/478) and tongue base mucosectomy (TBM) in 21.7% (n = 104/479). Ipsilateral tonsillectomy carried the highest diagnostic yield (18.7%, n = 52/278), followed by TBM (15.4%, n = 16/104). Contralateral tonsillectomy, performed in 49.0% (n = 234/478), carried the lowest yield (0.9%, n = 2/234). PET-CT with concurrent MRI was associated with higher primary site detection than PET-CT with concurrent CT (p = 0.003). A minority of patients undergoing treatment with curative intent received first-definitive-treatment within 62 days of referral (15.2%, n = 77/505, median 92 days, IQR: 71–117). Conclusions Most patients experienced a protracted diagnostic pathway and waited over 3 months for definitive treatment. Earlier PET-CT with concurrent MRI may expedite diagnosis. TBM appears more productive than contralateral tonsillectomy for primary site detection.Publication Comparing tonsillectomy vs tonsil biopsy in the diagnosis of palatine tonsil squamous cell carcinoma – a retrospective analysis of subsequent resection margins(Cambridge University Press, 2025-04-08) Heining, Christopher; Constable, James; Dale, Oliver; Constable, James; Medical and DentalNo abstract availablePublication The Otolaryngology Consultant Workforce in England:A Survey Update and Future Repercussions(Wiley, 2024-05-25) Nieto, Hannah; Lee, Jonathan; Hall, Charlie; McDermott, Ann-Louise; Hall, Charlie; Medical and DentalIntroduction: Effective medical staffing is pivotal for a successful healthcare system, demanding strategic planning to ensure a high-quality service. Although the UK's doctor to population ratio has improved over time, it remains below global averages. The COVID-19 pandemic has exacerbated existing challenges, resulting in an unprecedented NHS waiting list with Ear, Nose, and Throat (ENT) surgeries ranking third highest in waiting times amongst all specialties. Methods: This study utilized a national jotform survey to gather data from ENTUK members, primarily focusing on consultant staffing within ENT departments across the UK. Additional information collected encompassed registration status, part-time roles, gender, vacancies, locum roles, associate specialists, registrars and other junior doctors, and advanced nurse practitioners. When survey responses were inadequate, direct communication was established with departmental consultants or secretaries, followed by Freedom of Information requests as necessary. All data were compiled using Microsoft Excel. Results: Among the 65 responses to the ENTUK survey, 53 individual trusts were identified. These included 41 English acute trusts, with supplementary participation from Scotland, Wales, and Northern Ireland. Data from 749 consultants across 115 English acute trusts were collected in combination with a Freedom of Information request. Conclusion: Despite an increased number of ENT consultants, the persistence of unfilled posts coincides with mounting waiting lists. The pandemic's effects, including early retirements and part-time roles, emphasise the urgency of expanding training positions to counterbalance these shifts. Local and national interventions are essential to fortify and diversify the ENT workforce through a variety of strategies.Publication Sick-leave duration after elective day case surgery in ENT: Is it affected by the type of employment?(Elsevier, 2023-11-03) Heining, Christopher; Ishii, Hiro; Cheung, Linnea; Clark, Matthew; Clark, Matthew; Medical and DentalBackground: Many ENT day-case procedures are performed on otherwise healthy individuals in employment. We hypothesised patients' type of employment may affect the amount of time taken off work following such procedures. We aimed to disprove the hypothesis that there is no difference in time taken off between employees and self-employed individuals. Materials and methods: We prospectively collected data on working adult patients undertaking elective day-case procedures at our department. Collected information included basic patient demographics and type of employment. A telephone call was made to collect data on actual period of time taken off work, 5-6 weeks later. Results: 23% of patients were self-employed, the rest were employees. 92% of self-employed patients received no pay during their time off. This compared with 10% of employed patients receiving no pay. 77% of employed patients received full pay. Although mean time taken off work was less if the patient was self-employed (9.5 days vs 10.63), this was not found to be statistically significant. Discussion and conclusion: Our study demonstrates time off work following day-case ENT procedures places a higher financial burden on self-employed patients. This should inform patient counselling prior to operations. We demonstrated no statistically significant difference in time off work post-surgery between the 2 groups. There was a possible trend towards less time off in self-employed individuals and we speculate that further research with more patients may demonstrate a statistically significant difference in time off work. Perhaps most importantly is for doctors to consider how long an individual needs off after a given procedure, after taking account of their individual patient needs, rather than defaulting to a standard 2-weeks.Publication Delivering a net zero National Health Service: where does otorhinolaryngology – head and neck surgery stand?(Cambridge University Press, 2023-10-05) Spinos, Dimitrios; Doshi, Jayesh; Garas, George; Spinos, Dimitrios; Medical and DentalObjective: The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. Method: Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. Results: The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. Conclusion: Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.Publication A retrospective database analysis of pediatric parathyroidectomies from the United Kingdom registry of endocrine and Thyroid Surgeons(Wiley, 2024-10-15) Embury-Young, Ysabelle; Brennan, Laura; Jackson, Samuel; Aspinall, Sebastian; Stechman, Michael; Balasubramanian, Sabapathy; Kim, Dae; Ishii, Hiro; Embury-Young, Ysabelle; Medical and DentalIntroduction The United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) holds the largest database of pediatric parathyroidectomy cases globally. There are currently no quoted acceptable cure or complication rates in the literature. Methods This retrospective database analysis evaluates the efficacy and safety of targeted parathyroidectomy (tPTx) and bilateral neck exploration (BNE) in first-time parathyroidectomy for pediatric primary hyperparathyroidism (PHPT) through analysis of the UKRETS database (1995–2022). Pre-, intra- and postoperative outcomes were assessed and analyzed. Results 168 cases underwent parathyroidectomy; 25 (15%) familial and 143 (85%) sporadic PHPT. 69% were female with a mean age of 10 years (Range 0–17). BNE was the most common operative approach (61%; n = 103/168). The most frequently used imaging modality was US (80%; n = 135/168). Mean number of glands excised in familial cases was three compared to one gland in sporadic cases (p < 0.05). Familial cases had a significantly higher rate of postoperative hypocalcemia (32% vs. 9%, p < 0.05) and all were BNE. Cure rate was 96.9% (n = 127/131), with differences in cure rates that did not reach statistical significance (sporadic 98.2% vs. familial 90.5%, p = 0.06). Preoperative localization (image-positive or negative) made no difference to cure rates in either familial (90% vs. 91%, p = 0.94) or sporadic (97.5% vs. 100%, p = 0.4) cases. Conclusions This analysis demonstrates that first-time pediatric parathyroidectomy for PHPT is safe and effective. Familial cases have a higher rate of postoperative hypocalcemia; therefore, parents should be informed of this when consented. Targeted parathyroidectomy is safe and effective in both sporadic and familial cases, as long as there is positive preoperative imaging.