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AbstractBackgroundAimsMethodsResultsConclusionRecurrence rate of necrotising otitis externa (NOE) after treatment is 15-20%. This is mainly due to a lack of reliable clinical indicator for the resolution of disease.We aim to assess the predictability of the otalgia, otorrhoea and C-reactive protein (CRP) levels in a large cohort of sixty-two patients for treatment outcome.Consecutive patients treated for NOE in our Nottingham tertiary ENT referral unit were retrospectively reviewed from January 2017 to June 2020. Diagnoses were made based on clinical findings and imaging. Good response to treatment was defined as those who required treatment of not longer than the standard six weeks of systemic antibiotics.Average age at presentation was 78.4 years. 75.8% of patients were male. 62.9% had diabetes. Ten patients received more than the standard six weeks of systemic antibiotics. Complications from disease progression included cranial nerve neuropathies (14.5%), meningitis (3.2%), and sigmoid sinus thrombosis (3.2%). Two patients had recurrent or persistent NOE and died while on treatment. Delays in normalization of CRP (p = 0.015) and resolution of otorrhoea (p = 0.014) were associated with an increased need for prolonged antibiotic treatment.Normalisation of CRP and resolution of otorrhea can assist in identifying patients who will likely benefit from a prolonged course of systemic antibiotics. [ABSTRACT FROM AUTHOR]

Objective: Thyroid hormone under‐replacement and over‐replacement are associated with adverse health outcomes. This systematic review aimed to evaluate the extent of thyroid hormone replacement adequacy for patients with known hypothyroidism in real‐word settings, excluding those receiving thyroid hormone suppressive therapy as thyroid cancer treatment. Design: Four electronic databases (Embase [Ovid], Medline [Ovid], PubMed and SCOPUS) were searched for published and unpublished observational studies until 12 December 2022. The results of the studies were meta‐analysed to calculate pooled prevalence estimates for thyroid hormone supplementation adequacy, over‐replacement and under‐replacement. Quality assessment of studies was performed using the Joanna‐Briggs appraisal tool for prevalence studies. Results: Seven studies with a total of 4230 patients were eligible for quantitative synthesis. The pooled prevalence estimates of adequate thyroid replacement, over‐replacement and under‐replacement were 0.55 (95% confidence interval [CI]: 0.49–0.60, p =.001), 0.20 (95% CI: 0.14–0.27, p =.001) and 0.24 (95% CI: 0.13–0.36, p =.001), respectively. Four studies subclassified hypothyroidism and hyperthyroidism into overt and subclinical. The pooled prevalence of overt and subclinical hyperthyroidism was 0.04 (95% CI: 0.00–0.11, p =.01) and 0.17 (95% CI: 0.09–0.27 p =.001), respectively. For overt and subclinical hypothyroidism, the pooled prevalence was 0.02 (95% CI: 0.01–0.03, p =.001) and 0.20 (95% CI: 0.12–0.29, p =.001), respectively. Conclusions: On average, approximately half of patients with hypothyroidism are only treated to target euthyroidism. In real‐world practice, a significant number of patients are over‐treated or under‐treated, leading to adverse healthcare outcomes. It is imperative that more effective thyroid monitoring strategies be implemented, with an emphasis on primary care thyroid function monitoring, to minimise inappropriate thyroid replacement treatments and optimise healthcare outcomes at a population level. [ABSTRACT FROM AUTHOR]

Objective: We undertook a systematic review of the literature with meta‐analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base and the outcomes of their repair. Data Sources: A Systematic Review of English Articles using MEDLINE, EMBASE, and Cochrane Library. Review Methods: The research algorithm included the following keywords: "spontaneous CSF leak," "lateral skull base," "temporal bone," "meningocele," "encephalocele," and "otorrhea." We also manually searched the references of included studies, to identify possible studies missed during our literature search. Results: More than two‐thirds of the patients were female (69.2%) and often were obese (mean BMI 36.5 kg/m2) with a mean age of 57. Most common presenting symptoms were otorrhea and hearing loss. Most authors did not report a routine use of a post‐operative lumbar drain. Most patients had a single skull base defect and encephaloceles prolapsing through, across obese and non‐obese groups. Median length of stay in hospital was 3.2 days, and the majority of patients did not have any recurrence during their follow‐up (89.6%), which was not affected by obesity. Conclusion: Obesity does not affect length of hospital stay or recurrence rate following surgical repair of lateral skull base sCSF leaks. Surgical repair is a safe and viable approach in the management of obese patients with sCSF leaks in the temporal bone. Level of Evidence: NA Laryngoscope, 134:2012–2018, 2024 [ABSTRACT FROM AUTHOR]

Objective: 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. [ABSTRACT FROM AUTHOR]

Objective: The human temporal bone comprises more than 30 identifiable anatomical components. With the demand for precise image interpretation in this complex region, the utilization of artificial intelligence (AI) applications is steadily increasing. This systematic review aims to highlight the current role of AI in temporal bone imaging., Data Sources: A Systematic Review of English Publications searching MEDLINE (PubMed), COCHRANE Library, and EMBASE., Review Methods: The search algorithm employed consisted of key items such as 'artificial intelligence,' 'machine learning,' 'deep learning,' 'neural network,' 'temporal bone,' and 'vestibular schwannoma.' Additionally, manual retrieval was conducted to capture any studies potentially missed in our initial search. All abstracts and full texts were screened based on our inclusion and exclusion criteria., Results: A total of 72 studies were included. 95.8% were retrospective and 88.9% were based on internal databases. Approximately two-thirds involved an AI-to-human comparison. Computed tomography (CT) was the imaging modality in 54.2% of the studies, with vestibular schwannoma (VS) being the most frequent study item (37.5%). Fifty-eight out of 72 articles employed neural networks, with 72.2% using various types of convolutional neural network models. Quality assessment of the included publications yielded a mean score of 13.6 ± 2.5 on a 20-point scale based on the CONSORT-AI extension., Conclusion: Current research data highlight AI's potential in enhancing diagnostic accuracy with faster results and decreased performance errors compared to those of clinicians, thus improving patient care. However, the shortcomings of the existing research, often marked by heterogeneity and variable quality, underscore the need for more standardized methodological approaches to ensure the consistency and reliability of future data., Level of Evidence: NA Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)