Abstract Objectives: This study aimed to make cochlear implant settings of adult individuals using cochlear implants remotely via tele -fitting and to evaluate patients’ benefit from amplification during the COVID 19 pandemic process. Methods: In this study, 51 adult subjects with Turkey’s postlingual cochlear implant users from four different cities participated remotely via computer connection. After the cochlear implant fitting of all the participants was made with a remote computer connection, all participants were filled in the online the Speech Spatial Quality of Questionnaire (SSQ12), Speech Hearing Questionnaire, Satisfaction with Amplification in Daily Life questionnaire (SADL), Short Form-36 quality of life questionnaires (SF36). The patients’ data before and after using a hearing aid were scanned back and compared with the data from the COVID 19 pandemic process. Results: There was a statistically significant increase in the SSQ12 score at least 6 months after using a cochlear implant. The pre-implantation SADL overall score and the positive effect scores were statistically lower than the post-implantation. A statistically significant difference was observed between our data and normative values of the role limitations due to physical functions, role limitations due to emotional problems, mental health, energy / vitality, and pain of the SF36. Conclusions: The observation of a positive increase in the online questionnaire showed the benefit of teleology in patients even in adverse situations such as the COVID 19 pandemic process. These findings are significant as they will provide useful information for audiologists to evaluate remote service delivery options and prepare internet-based tele-fitting applications.

ABSTRACT Objective We assessed the prevalence, clinical characteristics, and severity of respiratory tract and ear symptoms among Finnish Non-steroidal anti-inflammatory drug (NSAID) exacerbated respirato-ry disease (N-ERD) patients. Design A retrospective cross-sectional questionnaire study. Setting A university tertiary care center. Participants A total of 232 patients with both asthmatic and polypoid ICD-10 diagnoses treated at our universi-ty tertiary care center between January 2016 and May 2017 were identified by an electronic patient record search. The patient charts were manually reviewed and 102 patients with speci-fied symptoms on NSAID exposure, in addition to asthma and nasal polyposis diagnosis, were considered potential N-ERD patients. The patients received a questionnaire with an informed consent form, and the 66 patients who responded and confirmed diagnoses of asthma, nasal polyposis, and acetylsalicylic acid (ASA) or NSAID intolerance were included. Results The first diagnosis received was asthma, followed by NSAID intolerance and nasal polyposis, when evaluated by mean age of contracting the condition. When evaluating individual patients, there was considerable variation in the order and timing of the separate conditions. The majority of the patients received all three diagnoses within a few years’ time. The diagnostics and treat-ment of N-ERD patients seemed to only partially follow the international guidelines. The propor-tion of N-ERD patients with recurrent or chronic middle ear infection was 18%. Patient-reported disease control was good in asthma, but only mediocre in nasal polyposis and ear symptoms. As many as 14% reported a positive family history of N-ERD. Conclusions Structured cross-department diagnostics and care could benefit N-ERD patients in Finland. Rhi-nological and aural symptoms seem to affect a patient’s quality of life more than asthma. The high proportion of familial cases warrants further studies. Keywords: Asthma, Aspirin-Induced, Nasal Polyps, Aspirin, NSAIDs, Heredity, Ear, Middle, Fin-land

5 Key points: • As an aerosol-generating procedure (AGP), tracheostomy poses significant viral transmissions risks to health care workers • The decision about tracheostomy method and optimal setting depends on a multitude of local factors with no available studies to suggest the superior option • We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic • A key approach in performing an effective bedside tracheostomy is to ensure that the procedure is standardised and performed by highly experienced surgeons, anaesthetist and scrub team. • Our experience with bedside open tracheostomy demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.

Objective:Hearing loss is a prevalent disease with free field voice test (FFVT) being a common hearing test performed.FFVT has its own disadvantage as a screening tool as there is no standardization of speech among examiners.We aim to invent mobile-app based hearing screening using Flutter-Dart programming language that mimics findings of FFVT.The app is termed as Free field click test (FFCT).Our aim is to compare sensitivity&specificity of FFCT and FFVT with Pure Tone audiogram (PTA). Methods:This is an open-labelled randomized controlled trial. This study was conducted at the (removed for blind peer review) from December-March 2020. 50 patients from 18-80 years old with complaint of hearing loss were recruited.These patients were randomly assigned into two groups; FFVT&FFCT which were compared with PTA.Categorical data were analyzed with Chi-square test,non-categorical data were calculated with Student t-test for statistical significance. Results:Results were calculated based on degree of hearing loss against PTA.FFCT‘s rate of detection of hearing loss was significant for all degrees of hearing loss with p-values of <0.05. FFVT’s detection rate was only significant to normal hearing, moderate & severe hearing loss. FFCT had higher sensitivity of 94.1% for normal hearing compared to 52% for FFVT.FFVT had higher specificity but with a marginal difference only.A higher rate of accuracy (94%) and strength of the correlation (0.97) were obtained for FFCT than FFVT. Conclusion:FFCT is a more sensitive&accurate tool than FFVT in detecting hearing thresholds. It proves to be an ideal tool to screen hearing loss and is convenient in times of social distancing during COVID-19 pandemic now.

Objectives The objectives of this study are to describe the incidence and age range of presentation of lateral neck cysts, to evaluate a management algorithm for adults presenting with lateral neck cystic lesions and to report the age incidence at which malignant cystic lesions in the neck have clinically presented as lateral neck cysts. Design A retrospective review of histologically diagnosed branchial cysts between 1995 and 2014 at a single centre. Setting Oxford University Hospitals NHS Foundation Trust. Participants A single senior head and neck pathologist and the ENT head and neck team. Main outcome measures Does a dedicated pathway help to identify malignancy in lateral neck cysts earlier in the diagnostic pathway? Results When using a random investigative pathway the sensitivity in distinguishing malignant from non-malignant was 93%, specificity 12% with a PPV of 83% and NPV 28%. When using a defined investigative protocol, the sensitivity was 94%, specificity 67%, PPV of 85% and NPV 86%. Conclusions This study conveys that using a structed pathway when working up patients with a lateral neck cyst results in a greater sensitivity, specificity, PPV and NPV in distinguishing malignancy compared to an unstructured workup. Key points 1) Establishing a lateral neck cyst as a benign structure is a diagnosis of exclusion 2) There is no established protocol for this pathway. 3) The need for a diagnostic pathway is important given the impact of COVID-19 4) The diagnostic challenge is differentiating benign from malignant 5) For lateral neck cysts a cut off age of 35 may not be appropriate

Tonsillectomy is the most common surgery in children. Post-tonsillectomy pain is universal and associated with considerable morbidity. Dipyrone is banned in some countries and the analgesic most commonly used in others. Evidence of the effectiveness of dipyrone in postoperative analgesia of tonsillectomy are scarce. Serious adverse effects such as agranulocytosis and anaphylaxis are rare and their incidence varies in different populations.

Background: Flexible nasendoscopy is the principle method of assessment of vocal cord movement. As this procedure is inherently subjective it may be that it is not possible for clinicians to grade degree of vocal cord movement reliably. Aim: The aim of this study was to assess the accuracy and consistency of grading of vocal cord movement viewed via flexible nasendoscopy. Design: Prospective video analysis study. Methods: Thirty flexible nasendoscopy videos, without sound or clinical information, were assessed by 6 consultant Head and Neck surgeons. They were asked to assess and grade right and left vocal cord movement independently, based on a 5-category scale. This process was repeated three times at separate time intervals. Agreement and reliability were assessed. Participants: 6 consultant head and neck surgeons. Results: The mean overall percentage of observed inter-rater agreement was 67.7% (SD 1.9) with the 5-categories scale, increasing to 91.4% ( SD 1.9) when a 3-category scale was derived. The mean overall percentage of observed intra-rater agreement was 78.3% (SD 9.7) for 5 categories, increasing to 93.1% (SD 3.3) for 3 categories. Discriminating vocal cord motion using the 5-category scale is less reliable (k= 0.52) than with the 3-category scale (k = 0.68). Conclusion: This study demonstrates quantitatively that it is challenging to accurately and consistently grade subtle differences of vocal cord movement as proven by lesser agreement and reliability when using a 5 point scale instead of a 3 point scale. It highlights the need to have an objective measure to help in the assessment of vocal cord movement.

Objectives: To assess droplet splatter around the surgical field and surgeon during simulated Coblation tonsil surgery to better inform on mitigation strategies and evaluate choice of personal protective equipment. Design: Observational study Setting: Operation theatre suite at a tertiary hospital Participants: Life size head model was used to simulate tonsil surgery using fluorescein-soaked strawberries to mimic tonsils Main outcome measures: The Coblation wand was activated over the strawberries for 5 minutes. This was repeated 5 times with 2 surgeons (total of 10 data sets). The presence of droplet around the surgical field and anatomical subsites on the surgeon was assessed in binary fashion: present or not present. The results were collated as frequency of droplet detection and illustrated as a heatmap; 0 = white, 1-2 = yellow, 3-4 = orange and 5 = red. Results: Fluorescein droplets were detected in all four quadrants of the surgical field. The frequency of splatter was greatest in the upper (nearest to surgeon) and lower quadrants. There were detectable splatter droplets on the surgeon; most frequently occurring on the hands followed by the forearm. Droplets were also detected on the visor, neck, and chest albeit less frequently. However, none were detected on the upper arms. Conclusion: Droplet splatter can be detected in the immediate surgical field as well as on the surgeon. Although wearing a face visor does not prevent splatter on the surgical mask or around the eyes, it should be considered when undertaking tonsil surgery as well as a properly fitted goggle.

KEY POINTS: - Our goal was to indentify the most common and most influential postoperative reasons causing persistent ABG. Our focus was concentrated on the mechanical dysfunctions in the middle ear, with special regard to postoperative fibrosis formation. - Periprosthetic adhesion formation was seen in 64% of the cases, and it was the primary cause behind the unsatisfactory hearing result in 32% of all cases - There was no significant difference in the level of persistent ABGs across groups of fibrosis and surgical failure after primary surgery - Periprosthetic fibrosis is the most common reason for compromised audiological outcomes after stapedotomy, and has the same negative effect on ABG development as any other surgical failure, while the revision could be more challenging in these cases - The use of the most atraumatic surgical technique and preservation of intact intratympanic mucosa is a key factor during middle ear surgery.

Objectives; To investigate spray technique and compliance among patients using steroid nasal spray. Design: Patient-reported survey Setting; Single centre study- a tertiary care hospital Participants: 100 participants (1 excluded) Main outcome measures 1) Nasal spray technique 2) Patient compliance Results: Out of 99 participants included in this study only one patient used steroid nose spray with a completely correct spray technique. Only 40% of patients received guidance instructions from the prescriber about the spray technique. 70% of patients reported using their spray regularly while 14% and 16% reported using mostly and sometimes respectively. 53% of patients were found using the correct dosage of the spray while 34% of patients were using incorrect dose and 13% cases dosage was unknown. Conclusions: Wrong spray technique is extremely common and can be easily corrected. Patient compliance can also be improved further. This survey emphasizes the importance of giving written and verbal instructions about the use of spray to the patients. We recommend following the written instructions for the use of steroid nasal spray from “British Society for Allergy and Clinical Immunology” or/and video tutorial from “asthma.org.uk- how to use nasal spray”

Objectives: The expression of CD3, CD4, CD8, PD-1 and PD-L1 in mucosal malignant melanoma tumors was analyzed by immunohistochemical staining. The aim was to explore the characteristics of malignant melanoma in head and neck and its correlation with the expression of these factors, to further our understanding of the disease. Design:Retrospective clinical study. Setting: Otorhinolaryngology unit of a tertiary hospital. Participants: 36 patients underwent immunohistochemical staining. Main outcome measures: In total, 24 patients underwent immunohistochemical staining of CD4, CD8, PD-1, and PD-L1, and 12 patients underwent CD3 immunohistochemical staining. Results: There was no significant difference between the expression of CD3, CD4, or CD8 and the general clinical features of mucosal melanoma. However, (1) the high rate of expression of CD8 was significantly different in different lesion locations: 85.71% in the nasal cavity/sinus/nasal cavity and sinus, and 66.67% in the nasopharynx; (2) the expression of PD-L1 was statistically significantly correlated with the combined expression of CD4, CD8 and CD4/CD8 (r = 0.451, P < 0.05); (3) the median progression-free survival times of patients with high and low expression CD4 were 24 months and 4 months, respectively, and those of patients with high and low expression of CD8 were 24 months and 6 months, respectively. Conclusions: The correlation between the expression of CD8 and PD-L1 suggests the role of tumor infiltrating lymphocytes in anti-tumor immunity and their possible use as immunotherapy markers. In addition, the expression of CD4 and CD8 in tumor tissue may play a guiding role in the prognosis of patients.

Objectives: Despite advances in the surgical treatment of parotid duct stenosis, it remains a surgical challenge. This study aimed to analyze the surgical outcomes of sialendoscopy combined with transoral sialodochoplasty for the treatment of patients with parotid duct stenosis with megaduct in parotid glands. Design: Retrospective cohort study Setting: Academic tertiary medical center Participants: This study included 13 patients with chronic obstructive sialadenitis caused by type 2 parotid duct stenosis who underwent sialendoscopy with transoral sialodochoplasty. Main Outcomes and Measures: All patients completed a three-point Likert-type rating scale 3 months postoperatively. Radiologic evaluation using magnetic resonance (MR) sialography was performed to evaluate megaduct diameter. Thirteen glands underwent sialendoscopy combined with transoral sialodochoplasty. Results: At 3 months after surgery, six (46.2%) glands showed complete resolution, and seven (53.8%) showed partial resolution of obstructive symptoms. Megaduct diameter between pre- and postoperative MR sialography significantly decreased after transoral sialodochoplasty (8.05 ± 2.675 vs. 4.15 ± 2.400, P = 0.028). Saliva excretion was improved after the transoral sialodochoplasty, as the distal ducts were visualized with sialagogues postoperatively. Conclusions: Type 2 parotid duct stenosis can be successfully treated with sialendoscopy combined with sialodochoplasty. In cases of large megaduct, transoral sialodochoplasty appears to offer benefits of reducing the diameter of dilated megaducts and improving salivary outflow.

Objectives; To investigate spray technique and compliance among patients using steroid nasal spray. Design: Patient-reported survey Setting; Single centre study- a tertiary care hospital Participants: 100 participants (1 excluded) Main outcome measures 1) Nasal spray technique 2) Patient compliance Results: Out of 99 participants included in this study only one patient used steroid nose spray with a completely correct spray technique. Only 40% of patients received guidance instructions from the prescriber about the spray technique. 70% of patients reported using their spray regularly while 14% and 16% reported using mostly and sometimes respectively. 53% of patients were found using the correct dosage of the spray while 34% of patients were using incorrect dose and 13% cases dosage was unknown. Conclusions: Wrong spray technique is extremely common and can be easily corrected. Patient compliance can also be improved further. This survey emphasizes the importance of giving written and verbal instructions about the use of spray to the patients. We recommend following the written instructions for the use of steroid nasal spray from “British Society for Allergy and Clinical Immunology” or/and video tutorial from “asthma.org.uk- how to use nasal spray”

Introduction: Intranasal steroid injections were once routinely performed for refractory allergy patients worldwide. Due to concerns about visual complications, the procedure is very rarely performed today. Nonetheless, many studies evaluating the technique advocate for its use. Methods: A narrative review of the history of intranasal steroid injections was performed. Additionally, the analogous experiences of non-otolaryngology providers with steroid injection treatments were assessed. Results: Many non-otolaryngology providers have had similar, devastating thromboembolic complications from particulate steroid injections. In other fields, a switch to non-particulate steroid formulations (e.g. dexamethasone) appears to avoid the risk of thromboembolic events entirely without sacrificing effectiveness. Conclusion: The otolaryngologists’ aversion to intranasal injection treatments may not be evidence-based. Intranasal injection treatments with non-particulate steroids as well as other medications merit consideration.

Introduction; This review discusses how nasal congestion may have benefits as a mechanism of defence against respiratory viruses. Methods; A literature research was conducted on respiratory viruses and nasal congestion, following a recently published review on how temperature sensitivity is important for the success of common respiratory viruses. Results; The literature reported that common respiratory viruses are temperature sensitive and replicate well at the cooler temperatures of the upper airways (32oC), but replication is restricted at body temperature (37oC). The amplitude of the phases of congestion and decongestion associated with the nasal cycle was increased on infection with respiratory viruses and this caused unilateral nasal congestion and obstruction. Nasal congestion and obstruction increase nasal mucosal temperature towards 37oC and therefore restricted the replication of respiratory viruses. Conclusion; Nasal congestion associated with the nasal cycle may act as a mechanism of respiratory defence against infection with respiratory viruses

Abstract Purpose: Explore the effect of resection of different parts of the maxilla on the prognosis of patients with nasal malignant tumors and promote its clinical selection of nasal endoscopic maxillectomy. Methods: The clinical data of patients with maxillary sinus tumors who underwent endoscopic maxillary resection from January 2013 to May 2020 were analyzed retrospectively and the surgical methods, tumor margin, recurrence and complications are summarized. Results: Among 30 patients (all available follow-up; mean: 17.8 months, range: 2–64 months; pT: T1–T4a), 17 (56.6%) underwent partial maxillary resection, nine (30.0%) total resection, two (6.7%) subtotal resection and two (6.7%) extended resection. There was no significant difference (Log Rank; P > 0.05) in the recurrence rate between endoscopic-assisted maxillectomy and trans-facial surgery. Conclusions: According to the range of tumor lesions and the possible base, different parts of the maxillary sinus can be removed selectively assisted by endoscopy. With the application of endoscopic-assisted maxillectomy, the function can be preserved as far as possible without increasing complications or recurrence rate, and the surgical field of view will be exposed more clearly.

Objectives: Given some of the shared organic and psychogenic pathophysiologic mechanisms in tinnitus and erectile dysfunction (ED), we hypothesized that newly-onset tinnitus may be associated with ED. This study aims to explore the relationship between these two medical conditions using a nationwide population-based database. Design: A case-control study Setting: Taiwan Participants: We retrieved data from Taiwan’s National Health Insurance Dataset, 19,329 patients with ED and 19,329 propensity score-matched patients without ED (controls). Main outcome measures: The diagnosis date was the date of the first ED claim for ED, which was the index date for cases. We defined the date of the control patient’s first utilization of ambulatory care during the index year of their matched case as their index date. Tinnitus during a one-year period before the index date was the exposure of interest. Results: Of the 38,658 sampled patients, 1247 (3.23%) had been diagnosed with tinnitus within the year prior to the index date, 792 (4.10%) among cases and 455 (2.35%) among controls. Multiple logistic regression analysis showed that cases were more likely to have had a prior tinnitus diagnosis compared to controls (OR=1.772; 95% CI=1.577-1.992; p<0.001). After adjusting for co-morbid medical disorders and social economic factors, cases were more likely than controls to have a prior diagnosis of tinnitus (OR=1.779, 95% CI=1.582-2.001, p<0.001). Conclusions: This investigation detected a novel association between ED and newly-onset tinnitus. Physicians should be alert to the possibility of developing ED in patients treated for tinnitus.

Key Points: • Tranexamic acid is an antifibrinolytic agent that has been used in variety of operations to reduce blood loss. • Post thyroidectomy haematoma can be life threatening, therefore multiple methods are used to reduce the risk of bleeding. • Tranexamic acid was given intra-operatively to 106 patients undergoing thyroid surgery. • Patients who received tranexamic acid had no return to theatre for post-operative haematoma (p=0.041). • There were no adverse events reported related to the administration of tranexamic acid.

Objective: To describe our experience of dealing with pharyngocutaneous fistulas (PCF) following total laryngectomy. Design: Retrospective cohort Setting: Tertiary referral center Participants: All patients undergoing total laryngectomy at the [removed for blind peer review] over the 10 year period January 2008 to December 2017. Main outcome measures: Incidence of PCF; treatment of PCF (conservative versus operative), closure success rate; time to closure; delay in adjuvant radiotherapy; increased the need of future neopharyngeal dilatations; overall survival. Results: A total of 242 patients (199 males, 43 females) were analysed. One hundred and fifteen patients underwent primary laryngectomy, 102 salvage laryngectomy and 25 functional laryngectomy. Seventy five of 242(31%) patients had a PCF. This was managed conservatively in 36/75 (48%) and operatively in 39/75 (52%) . Hospital length of stay was significantly longer in the PCF group (OR 2.38, p=<0.001). 5 year overall survival was 44% in the no PCF versus 24% in the PCF group, OR 1.7, p=0.001. PCF was not correlated with delay to adjuvant radiotherapy or the risk of neopharyngeal dilatation. Conclusions: Despite efforts to identify risk factors and take preventive measures, PCF remains an all to frequent complication of total laryngectomy. PCF leads to increased morbidity and significantly worse overall survival. The increased mortality is not a result of a delay in adjuvant radiotherapy.

Aims: This article describes the report of a rare case of fungal ball in the frontal sinus in an adult male and discuss about the variables of this condition related to the patient. Additionally, this study aims to identify the state of the art of fungal ball in paranasal sinuses, especially in the frontal sinus. Method: We performed a literature review on fungal ball in the paranasal sinuses and described a rare case of fungal ball in the frontal sinus, which is listed as the paranasal sinus most rarely affected by fungal ball. Result: All reported cases of fungus ball in the frontal sinus affected male patients, contrary to the common prevalence of females in fungal ball of the other paranasal sinuses. Of the total of 8 patients with fungal ball in the frontal sinus reported, 40% had unilateral disease and 60% bilateral, also contrary to the incidence data of the other paranasal sinuses, with unilateral prevalence. However, with the present study, this index changes, with 50% unilateral and 50% bilateral in frontal sinus involvement. The average age of cases reported in the frontal sinus is 65.29 years, with a minimum age of 61.16 and a maximum of 69 years. As for the etiologic agent, Aspergillus sp., the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming this prevalence data from other studies. Conclusion: Despite being a low incidence entity, frontal sinus fungal ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments. We hope to contribute to the knowledge of this presentation as a differential diagnosis and reinforce the importance of thorough clinical investigation.

Objectives: Cochlear implantation can restore access to sound and speech understanding in subjects with substantial hearing loss where acoustic hearing aids do not. The Health Utilities Index Mark III (HUI3) is commonly used to measure health utility across all types of intervention and is sensitive to changes in hearing. In the current study we analysed for factors predicting clinically important gains in HUI3 scores in adult Nucleus cochlear implant recipients, implanted in a single centre. Design: Retrospective analysis of data collected in an observational study. Demographic and other baseline parameters were analysed for their association with gains in HUI3 scores. Participants: One-hundred and thirty-seven adult recipients of Nucleus cochlear implants who had at least one-year follow-up. Main Outcome Measures: HUI3 scores and speech, spatial, quality (SSQ) scale scores were collected at baseline before device activation and one-year after. Difference scores were computed. Clinically important gain was defined as 0.1 point on the HUI3 scale. Results: Baseline telephone use and baseline HUI3 hearing, speech and emotion attribute levels were significantly associated with clinically important gains in HUI3 scores. However, SSQ scores increased significantly with or without clinically important gains in HUI3 scores. Conclusion: Those subjects who were unable to use the telephone prior to cochlear implantation were one-and-a-half times more likely to obtain a clinically important gain in health utility. Those subjects who were unhappy, or experienced difficulties communicating with strangers were twice or more likely to obtain a clinically important gain in HUI3 scores compared to those who did not.

Objective The purpose of this investigation was to compare the efficacy of an automatic speech recognition (ASR) system and traditional methods for evaluating speech intelligibility in children with hearing loss. Design Observational Research Outcome Setting Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, China Participants Ninety- four children aged 30 to 180 months with hearing loss who used hearing aids or cochlear implants prior to the examination and children with hearing loss who had congenital microtia. Main outcome measures Speech intelligibility evaluation，include the speech intelligibility score of traditional evaluation and automatic speech recognition system. Results For the speech intelligibility evaluation in the 94 children, the ASR system yielded speech intelligibility scores ranging from 0 to 100 (mean 64.3±31.1), and the traditional method yielded speech intelligibility scores ranging from 0 to 100 (mean 81.5±24.4. The correlation between the results of the traditional method and those of the ASR system was 0.895 (p <0.001). Conclusion Speech intelligibility evaluation for children with hearing loss in the clinic can be performed using the ASR system. This method can increase the precision, objectivity, and efficacy of speech intelligibility assessments.

Objective: This study aimed to investigate the outcome of adults with benign paroxysmal positional vertigo(BPPV)secondary to sudden sensorineural hearing loss(SSNHL). Methods: A retrospective study was conducted in patients with evidence of idiopathic BPPV or SSNHL with BPPV . All participants were identified and categorized by using the Dix-Hallpike test and roll test, followed by canalith repositioning procedures (CRPs) that were repeated 2 to 3 times. Assessment of the outcome was conducted one-hour and one-week post-CRPs, respectively. Results Six-four adults with BPPV secondary to SSNHL and 328 adults with idiopathic BPPV were included. The posterior canal was the most affected in both groups. At one-hour posttreatment, the cured rate of the BPPV with SSNHL group was 45.31%, which was significantly lower than that of the i-BPPV group (94.82%, P<0.01). At one-week posttreatment, the cured rate of the BPPV with SSNHL group was 66.67%,which was significantly lower than that of the i-BPPV group (98.78%, P<0.01). Conclusions BPPV with SSNHL was associated with poorer outcomes than i-BPPV in the short term.

En-bloc clearance of malignant deep lobe parotid tumours involving the stylomandibular tunnel and parapharyngeal space is challenging in view of the limited surgical access and the critical structures that are located in close proximity The technique that we describe is a combined transmandibular-transmastoid approach that allows complete en-bloc resection of the deep parotid lobe and stylomandibular tunnel with a lateral temporal bone resection and a marginal mandibulectomy This approach provides good exposure of the critical structures and allows for a safe en-bloc resection and good oncological margins This clinical scenario is common in Australia, due to the high incidence of cutaneous squamous cell carcinoma involving the parotid gland, either through direct invasion or lymphatic spread In this article we explain step-by-step how to perform these resections to allow potential cure in patients with very locally advanced disease