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OBJECTIVES There are no hearing protection regulations in place for passengers using public transport, such as the London Underground. In light of this, we sought to examine sound pressure levels experienced by regular users of the London Underground. METHODS Sound pressure levels (A-weighted decibels: dBA) were taken on moving London Underground carriages between Euston and South Wimbledon on the Northern Line, and between Euston and Vauxhall on the Victoria Line, during 2006 and 2018. In addition, carriage sound pressure levels travelling within Zone 1 of the London Underground were tested in 2019. Three experimental and three technical repeats were undertaken using a hand-held calibrated multi-function sound level meter. RESULTS Passengers are routinely and consistently subjected to sound pressure levels exceeding 80 dBA, with levels sometimes reaching over 100 dBA. CONCLUSION This study is unique within the literature, with no published studies outlining exposure levels for London Underground passengers. It provides evidence of elevated noise exposure to passengers, consistently along large stretches of the London Underground, over a prolonged study period (2006-2019). KEY WORDS Sensorineural hearing losssound pressureexposureLondonundergroundtube. LEVEL OF EVIDENCE N/A Laryngoscope, 2020.

Introduction: A stronger evidence level is needed to confirm the benefits and limits of laparoscopic hemihepatectomies. Methods: Laparoscopic and open hemihepatectomies from nine European referral centers were compared after propensity score matching (right and left hemihepatectomies separately, and benign and malignant diseases sub-analyses). Results: Five hundred and forty-five laparoscopic hemihepatectomies were compared with 545 open. Laparoscopy was associated with reduced blood loss (P < 0.001), postoperative stay (P&nbsp

Mucoepidermoid variant of thyroid carcinoma is a rare and complex disease. Securing a diagnosis and formulating an evidence-based treatment plan is challenging. A case report of a patient with the dual pathology of a composite mucoepidermoid carcinoma of the thyroid and a follicular variant of papillary thyroid carcinoma with malignant metastasis is presented in this article. We discuss the challenges in diagnosis, prognostic factors and management of this rare presentation by reviewing current literature.

Mastoiditis caused by mycobacterium tuberculosis (TB) has an extremely low incidence in paediatric patients and intracranial complications are even rarer. We report the case of a 2-year-old Caucasian male who presented to a tertiary ENT centre with a left sided mastoid swelling and drowsiness after having been treated unsuccessfully for unresolving ear pain and discharge for 6 weeks. He was subsequently found to have mastoiditis with intracranial complications caused by mycobacterium TB. This report aims to increase awareness of TB as a potential cause of chronic unresolving ear pain in the paediatric age group, as well as the importance of multidisciplinary team management.

Introduction The impact of unilateral vocal fold palsy (UVFP) on quality of life cannot be underestimated. Management may be complicated by difficulty in determining prognosis. Currently, there is no standardized management pathway for UVFP. Surgery is considered when speech and language therapy has not been successful or when there is significant aspiration and dysphonia. Surgical options for UVFP include injection laryngoplasty, thyroplasty and laryngeal reinnervation. Methods We report the case of a 6-year-old girl with a left UVFP sustained following PDA ligation. She suffered significant voice issues, aspiration and intermittent stridor limiting activities. Following multidisciplinary team reassessment including videofluoroscopy and perceptual and objective voice measures, laryngotracheobronchoscopy (LTB) and laryngeal electromyography (LEMG) with injection of Radiesse into the left vocal fold was undertaken. Consequently, she underwent non-selective laryngeal reinnervation with the aim of providing a permanent solution by the formation of an anastomosis between the ansa cervicalis and the main stump of the recurrent laryngeal nerve (RLN) resulting in improved muscle tone. Results LEMG indicated no spontaneous recovery. The laryngeal injection allowed for temporary improvement of voice and feeding. Consequently non-selective left laryngeal reinnervation using ansa cervicalis and repeat vocal cord injection was performed. Twelve months following surgery her voice remain greatly improved and there are no feeding issues or aspiration. Conclusion In this case so far the use of LEMG and laryngeal reinnervation has proved successful. Non-selective laryngeal reinnervation techniques for UVFP may provide a permanent solution and should be considered in children as a management option in suitable cases.

We describe a case of a craniofacial dermoid cyst in a 16-month boy treated at our tertiary referral centre. The patient presented with a soft tissue swelling in the mid forehead extending down to the glabella. Computed tomography and magnetic resonance imaging scans demonstrated a peripherally enhancing cystic lesion with a defect in the underlying frontal bone. The clinical and imaging features were suggestive of a dermoid cyst with intracranial extension. The cyst became infected pre-operatively and this episode was managed by aspiration and antibiotics. Definitive management was by excision of the extra and intra-cranial components of the lesion via a bifrontal craniotomy. The presentation, investigations and management of this lesion is discussed.

Background: Pareto analysis is the cornerstone of most businesses improvement strategies around the world. It has been used in healthcare as part of quality improvement endeavours. Pager activity can be used as a surrogate to assess the sources and frequency of demands on junior doctor resources. Thus our aim is to analyse and improve the allocation of junior doctor resources through the study of pager calls using the Pareto principle.Methods: Retrospective observational study examining pager calls to Ear, Nose & Throat junior doctor/residents at the University Hospital Southampton, a tertiary referral centre on the south coast of the United Kingdom. A Pareto principle analysis was undertaken, assessing whether the majority of activity stems from a minority of sources. Results: In total, 2853 pager calls were included, averaging 31 pages a day over a three-month period. Highest daily page activity occurred at 11 am and 2 pm. Data conformed to the Pareto principle; 80% of activity came from 22% of sources, with the paediatric department providing the highest demand.Conclusions: Analysis of pager frequency data has shown confirmation to the Pareto principle, identifying that the majority of calls to the junior doctor/resident originate from a limited number of departments/locations. Such analysis has allowed a restructuring of resources, to better streamline departmental efficiency. A broader appreciation and adoption of Pareto analysis within the healthcare sector would enable improved resource allocation, in an era of limited healthcare budgets.