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ObjectiveWork-related musculoskeletal disorders in ENT surgeons are common and detrimental, yet few are aware of preventative measures. We evaluate the evidence for interventions to prevent work-related musculoskeletal disorders in ENT surgeons.MethodA systematic search of databases up to 8 June 2021 was performed using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and predetermined inclusion criteria.ResultsSeven prospective cohort studies and 2 case series were identified (51 participants). Interventions included novel equipment (n= 3), patient positioning (n= 2), clinician positioning (n= 3) and operative technique (n= 1). Five studies reported Rapid Upper Limb Assessment scores as outcome measures of strain. Strain decreased when adopting a favourable operating posture, using a supportive chair and keeping patients supine for clinic procedures.ConclusionA small number of low-quality studies were identified. Modifiable risk factors exist, and ergonomic education may help prevent work-related musculoskeletal disorders. Further studies with longer term follow up are required.

A 25-year-old man presented to the emergency department reporting a 6-hour history of progressive neck swelling associated with a single episode of chest pain. He had no significant medical history. He initially denied any illicit drug use. On examination, the neck was visibly distended with palpable crepitus that extended to the upper torso. Cardiorespiratory examination was otherwise unremarkable. He was systemically well and routine observations were normal. The ECG showed widespread concave ST elevation suggestive of pericarditis. The chest radiograph demonstrated pneumomediastinum. A CT scan of the neck and thorax revealed widespread surgical emphysema along the thoracic wall, extending through the mediastinum, upwards into the neck involving both superficial and deep compartments (figure 1 …

Fibro-osseous dysplasia is a developmental non familial, benign anomaly of bone development occurring in single or multiple bones, characterised by the replacement of normal bone by fibro-osseous tissue. We describe the case of a fourteen year old boy, which illustrates many of the difficulties confronting surgeons dealing with this uncommon condition. Complete surgical excision was required, before a definitive histological diagnosis could be established. We report the clinical, radiological and pathological features of this unusual case. We review the pathology of the condition and discuss the approaches to surgical management.

Laser Doppler flowmetry was used to assess cochlear blood flow (CBF) in the hydropic ear in four experiments. 1) The increase in CBF elicited by local electrical stimulation of the cochlea in the hydropic ear was compared to that observed in normal controls. The magnitude of the evoked CBF change was reduced by approximately 30% in the hydropic ear compared to the normal ear. 2) The reduction in CBF evoked by direct electrical stimulation of the superior cervical ganglion was reduced by approximately one third in the hydropic ear compared to a normal ear. 3) Rhythmic (flux motion or vasomotion) variations in CBF, observed in association with lower blood pressure and thought to extend the autoregulatory range in an organ system, were reduced or eliminated in the hydropic ear. 4) The autoregulatory response to a decreased perfusion pressure, produced by decreased cardiac output, was clearly reduced relative to control in the hydropic ear. These findings represent the first report of significant CBF changes with hydrops. They are consistent with reports of increased sensitivity of the hydropic ear to trauma and stress and may be relevant considerations in the treatment of hydrops in humans.

Background: Particle repositioning procedures give consistent results for the treatment of benign positional paroxysmal vertigo (BPPV). However, little consideration has been given to the possibilities of bilateral disease. Objective/Hypothesis: To report contralateral symptoms and signs suggestive of revealed or incipient BPPV as a complication of Epley maneuver. Study Design: A prospective cohort of 198 cases over a period of 11 years. Results: Ten (5.0%) developed contralateral symptoms and signs suggestive of revealed or incipient posterior canal BPPV within 2 weeks of treatment. Conclusion: This novel observation has not been previously described and may influence the strategy for future management of patients with BPPV. Particle repositioning maneuvers for the previously asymptomatic contralateral ear may need to be considered in a subset of patients with posterior canal BPPV who suffer contralateral symptoms after undergoing treatment for the original ear.