The T-graft is a new tool in the armament of structural rhinoplasty. The graft makes it easy to create a well- balanced nasal framework both for beginners and more experienced rhinoplastic surgeons. Due to its multifunctional character the T-graft allows the surgeon to control nasal length as well as nasal tip projection and -rotation. The T-graft is indicated in many anatomical features like in patients with a short nose or heavy soft tissue envelope, but also in patients with under projection of the nasal tip, under- or over-rotation of the nasal tip and deviations of the caudal nasal septum.

Objectives: To assess the feasibility of using Image1 S™ endoscopic enhancement system for discrimination of the vascular patterns in laryngeal lesions. Design: Forty patients presenting with benign, dysplastic and malign laryngeal lesions were examined with Image1 S system. The vascular patterns were classified by a group of the authors/ according to the ELS guideline, as perpendicular or longitudinal, in all lesions. Endoscopic images of the vascular patterns are evaluated through an online survey by a group of otolaryngologists with different levels of clinical expertise. The qualitative evaluation of the vascular patterns in two groups were compared to investigate the consistency. The relationship between the vascular patterns and the pathological results was statistically analyzed. Results: Eleven patient presented with benign, 13 patients with dysplastic and 16 patients with malignant pathology. The vascular patterns were longitudinal in 9 lesions, perpendicular in 28 lesions and undetectable in 3 lesions. The relevance between the vascularization pattern and the pathological diagnosis was found to be significant (χ2= 20.30, p < 0,001). The qualitative evaluation of the vascular patterns by the two groups of observers was significantly close to each other (=0.63). The survey also showed that spectral modes producing high contrast images were preferred by 81,9% of the participants over white light images. Conclusion: This study demonstrated the usefulness and feasibility of Image1 S endoscopic enhancement system to predict the diagnosis from vascular changes in laryngeal lesions.

Background: To describe how parents and families of children with cancer evaluate the benefits and risks of using social media (SM) and how they navigate disagreements between oncologists’ advice and information found on SM. Procedure: Parents of children who had been previously diagnosed with cancer, and who had used SM for a purpose related to that child’s health were recruited through SM sites and nonprofit organizations across the U.S. and were invited to complete questionnaires about their experiences using SM; a subset of participants also completed a follow-up in-depth interview. Open-ended responses and interviews were analyzed using thematic analysis. Results: 90 parents completed written questionnaires; 21 completed follow-up interviews. 70% described experiencing a situation in which information shared on SM conflicted with information provided by their child’s oncologist. Although 86% discussed it with the oncologist and 70% described the response as positive, 78% retained negative feelings about the experience. Openness to discussing SM, honesty, transparency and humility regarding the limits of medicine, and shared decision-making regarding information found on SM were connected with reported trust in the oncologist. Conclusions: Parents offered valuable insights regarding their experiences navigating SM, including 8 recommendations for how pediatricians might approach discussing parental SM use. Future studies will evaluate the utility of these recommendations for pediatric clinicians.

Guidelines state there is no Abstract for Correspondence: Our Experience

Objectives. Sarcoidosis is a multisystemic inflammatory disease with extrathoracic manifestations, most commonly affecting the young and middle-aged, female and black populations. Diagnosis usually requires evidence of non-caseating granulomata and, when treated, prognosis is usually favourable. We aim to establish the incidence, clinical features and optimal treatment of ENT manifestations of this disease. Design. We performed a review of the literature to determine the evidence-base supporting this. Results. ENT manifestations are present in 10-15% of patients with sarcoidosis, often as a presenting feature, and require vigilance for swift recognition and coordinated additional treatment specific to the organ. Laryngeal sarcoidosis presents with difficulty in breathing, dysphonia and cough, and may be treated by Speech and Language Therapy (SLT) or intralesional injection, dilatation or tissue reduction. Nasal disease presents with crusting, rhinitis, nasal obstruction and anosmia, usually without sinus involvement. It is treated by topical nasal or intralesional treatments but may also require endoscopic sinus surgery, laser treatment or even nasal reconstruction. Otological disease is uncommon but includes audiovestibular symptoms, both sensorineural and conductive hearing loss, and skin lesions. Conclusions. The consequences of ENT manifestations of sarcoidosis can be uncomfortable, disabling and even life threatening. Effective management strategies require good diagnostic skills and use of specific therapies combined with established treatments such as corticosteroids. Comparisons of treatment outcomes are needed to establish best practice in this area.

Objectives: Maxillary sinus fungal balls (MSFBs) mostly occur in older individuals and demonstrate female predominance. Early diagnosis is important to avoid treatment delays. This study aimed to elucidate the differences in clinical and imaging presentation of MSFB with and without intralesional hyperdensity (IH). Design and setting: This was a retrospective review in a tertiary medical center. We retrospectively identified 588 patients underwent endoscopic sinus surgery procedures for MSFB between 2005 and 2018. The clinical characteristics and computed tomography (CT) findings including the presence of complete or partial opacification, IH, and odontogenic pathology were reviewed. Participants: 588 MSFB patients Results: Patients with unilateral MSFB had a mean age of 57.4 years and demonstrated female predominance (64.63%). The overall female-to-male ratio was highest at 51-60 years (2.02) and rose to 2.60 in MSFB with IH only. Compared to those with IH, MSFB without IH was significantly more common in males (OR = 2.496; P < .0001), in those with diabetes mellitus (DM) (OR = 2.094; P = .010) and adjacent maxillary odontogenic pathology (OR = 1.697; P = .030). Complete opacification on CT was less common in MSFB without IH (OR = 0.617; P = .025). Conclusion: The highest female-to-male ratio for MSFB at 51-60 years corresponded to the age of menopause. Patients with MSFB without IH were more likely to have DM, no female predominance, adjacent maxillary odontogenic pathology, and partial opacification of the sinus, compared to those with IH. These clinical features may aid earlier identification of MSFB without IH.

Abstract Objectives: In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post-procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit’s complication rates. Design: Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8-month period between November 2019 and July 2020. Patients were assessed pre-operatively for pre-existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anesthetic and surgical teams, and complications were recorded on patient interview in recovery. Setting: Tertiary adult airway service for predominantly benign pathology. Results: Adequate surgical views were obtained in 149/150 procedures. BMI and limitations to chin and neck movement had mild positive correlations with more difficult views in their own rights, but did not correlate with a statistically significant increase in complications. There was a negative correlation between age and interincisor gap (p=0.014), and wider mouth opening correlated with a lower incidence of sore throat (p=0.023). Macroglossia showed a statistically significant positive correlation with tongue symptoms (p=1.611x10-8). Conclusion: In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. Patient-reported neck and chin movement were found to correlate well with the surgical view obtained. The most common complication of SL is temporary sore throat and there remain recognized risks of temporary tongue and dental symptoms.

Objectives: Allergic rhinitis ( AR) has been recently increasing in prevalence, and traditional treatment strategies sometimes show limited effectiveness for patients with intractable AR. Botulinum toxin type A (BTX-A) is among the increasingly used alternative treatment options. This study was conducted aiming at clinical assessment of the effect of combined septal and turbinate injection of BTX-A for management of uncontrolled AR. Design and setting: A single-arm pilot study enrolled 40 patients having moderate to severe uncontrolled AR were recruited in between October 2018 and August 2019. Each patient received 45 units of BTX-A injected in 3 fixed points of each side of the nose: inferior turbinate (15IU), middle turbinate (15IU) and nasal septum (15IU). All patients were evaluated in terms of nasal hypersecretions, congestion and sneezing with visual analogue scale prior to treatment and at weeks 1, 2, 4, 8 and 12 during the follow-up period. Results: Throughout the 12 weeks follow-up period, a significant difference in the degree of nasal hypersecretions could be identified before and after BTX-A injection. Sneezing differed significantly only in the first 4 weeks while nasal congestion did not differ significantly, before and after BTX-A injection. BTX-A was well tolerated by the patients, with no serious adverse or systemic effects. Conclusion: Combined septal and turbinate injection of BTX-A, in patients with uncontrolled AR, may be a long-lasting therapeutic option for the treatment of nasal hypersecretions, but not as effective as for sneezing and nasal congestion.

Management of nutritional needs is of paramount importance in cancer patients and nasogastric feeding is the most common method. Nasal cavity being a richly innervated region, is also a hallway for the exposure of the same to external environment. Any trauma or pressure to these nerve endings result in unilateral headache mimicking Sluder’s neuralgia. Nasogastric tube may irritate the nasal mucosa and exert pressure on the nasal turbinates. We believe that the persistent headache in patients with NG tube is distinctly significant that it interferes with the physical comfort of patient. It also influences the sleep patterns, thereby causing repercussions in the emotional well-being. Head and neck oncologists being the primary clinicians, it is imperative to consider the Sluder’s neuralgia in patients with nasogastric tube feeding. This mandates a prospective study to describe the clinical features and the treatment of ‘NGT neuralgia’.

OBJECTİVE: To investigate the bispectral index values of normal sleep stages PATİENTS and METHOD: Simultaneous polysomnography and bispectral index recordings of 21 patients who underwent polysomnography for diagnosis of obstructive sleep apnea were analyzed for determining the BIS values of normal sleep stages. RESULTS: BIS values are found sensitive in reflecting the various stages of natural sleep except for REM and stage N2. REM and stage N2 BIS values were close to each other. CONCLUSION: BIS is sensitive for the evaluation of the stages of natural sleep and BIS values decreases as the sleep stages becomes deeper

Abstract: Objective: Sacrificing the auricle has severe postoperative impacts on patients with temporal bone malignancy who have undergone en bloc temporal bone resection. The auricular complications following en bloc temporal bone resection remain unclear. Therefore, this study aimed to examine auricular complications following en bloc temporal bone resection and reveal the associated risk factors. Study Design: Case series with chart review. Setting: Single tertiary care medical center Participants: Our study includes all cases who underwent en bloc temporal bone resection with preserved auricle for temporal bone malignancy from January 1993 to July 2020. The resulting dataset contained 64 patients during the review period. Main outcome measures: We examined the relationship of auricular complications with surgical procedures and patient profiles. Results: Three of 64 cases (4.7%) showed postoperative auricular complication. The cause in all three cases was venous congestion. Postoperative bloodletting to relieve the congestion effectively salvaged the auricle in two of these cases. Insufficient bloodletting to relieve the auricular congestion in the remaining case led to auricular necrosis. Pre-/infra-auricular lymph node dissection is correlated with auricular complications with statistical significance. Conclusions: Temporal bone resection causes auricular congestion due to vascular insufficiency, particularly insufficient venous outflow. An immediate and continuous application of bloodletting can improve venous drainage after temporal bone resection to prevent auricle necrosis.

Title: Intratympanic gentamicin injection in Ménière’s disease: our twelve years’ experience and outcomes. Objective: The aim of our study is to evaluate the effectiveness of intratympanic gentamicin injection(ITG) on vertigo control with reduced doses and its hearing effects. Study design: Retrospective study Materials and Method: The study was conducted at our Otolaryngology Department of AORN “S.G. Moscati” between January 2005 and January 2015 on 72 patients with disabling unilateral Meniere’s disease treated with ITG. We use 0.2-0.3 mL of gentamicin sulfate at a concentration of 40mg/ml, injected into the affected ear through the posterior-inferior quadrant of the tympanic membrane. The procedure was carried out for three following days. Main outcome measures: vertigo control and hearing threshold changes after ITG treatment. Results: In the 98.6% of the patients (n=71) the ITG produced the full remission of the vertiginous symptoms. In the 91.6% of cases(n=66) a single treatment (three consequent injections) was sufficient to control vertigo, in the 5.5% of cases (n=4) two treatments were necessary to control vertigo and in the 1.3% of patients(n=1) three treatments were necessary to control vertigo. In no case we have had hearing loss after ITG procedure. The pre-treatment pure tone average was 48 db. The post-treatment pure tone average was 49.2 db. This difference was no statistical difference. Conclusion: In this study we reported high vertigo control, long follow-up and no case of significant hearing worsening. We consider the three injections in the following three days with low doses of gentamicin a safe and valid treatment for Meniere’s disease. Keyword : Meniere’s disease, intratympanic gentamicin injection, vertigo control, hearing worsening, aminoglycoside ototoxicity.

Background: To assess the efficacy and prognosis of computed tomography (CT)-guided 125I radioactive seeds implantation brachytherapy (RSI-BT) for recurrent nasopharyngeal carcinoma (NPC) after external beam radiotherapy (EBRT). Methods: Thirty-one patients with recurrent NPC (forty-one lesions) after EBRT from February 2003 to January 2019 were enrolled in this retrospective study. The work-follow of CT-guidance RSI-BT was: indication selection, patient set-up and immobilization on CT couch, CT-simulation, preoperative planning, prescription doses (PD) definition of 110-160Gy, seed implantation, postoperative dosimetric evaluation and postoperative follow-up. Median radioactivity of RSI was 0.43 (range 0.22-0.79, average 0.61) mCi. Median actuarial number of 125I seeds was 24 (range 3-83, average 37). Median value of post-operative D90 was 118.5 (range 62.4-246, average 136.2) Gy. Local control (LC) and overall survival (OS) were investigated for their relationship with the prognosis. The adverse events were evaluated by the Radiation Therapy Oncology Group (RTOG) classification criteria. Results: Median follow-up was 41.9 (range 2.1-60.2, average 44.1) months. Median LC was 35.8 (range 2.1-60.2, average 34.9) months. LC at 1-, 3- and 5-year was 71.3%, 41.9% and 27.9%, respectively. Median OS was 22.6 (range 2.1~60.2, average 27.1) months. OS at 1-, 3- and 5-years was 57.7%, 23.8% and 11.9%, respectively. Univariate analysis suggested that sex (P=0.037) and frequency of previous EBRT (P=0.001) were prognostic factors influencing LC. Moreover, univariate analysis also suggested that frequency of previous EBRT (P=0.012) was prognostic factors influencing OS. Prevalence of side effects (≥grade 3) was 6.5%. Conclusion: 125I RSI-BT was a safe and feasible salvage treatment for recurrent NPC after EBRT. Key words: recurrent nasopharyngeal carcinoma; External beam radiotherapy; 125I seed implantation brachytherapy; overall survival; local control; side effects.

Objectives: In this study, we designed a new technique for open septal reduction using a polydioxanone (PDS) plate and compared it with closed reduction. Design, Setting, Participants: This study included nineteen consecutive patients with nasoseptal fracture: ten receiving open reduction with a PDS plate (PDS group) and nine undergoing closed reduction (CR group). Open septal reduction was performed after closed reduction for nasal bone fracture. A mucoperichondrial flap was unilaterally elevated, and the deviated septal cartilage was reduced. The PDS plate was inserted horizontally above the vomerine suture. Surgical outcome was analyzed with three-dimensional volumetry and with a quality-of-life scale for nasal obstruction (NOSE scale). Results: Complications included one case of septal perforation in the CR group and one case of PDS exposure and septal hematoma in the PDS group. In the 3D volumetric analysis of the PDS group, the median value of the nasal cavity change significantly differed between 1.14 mL (interquartile range; 0.46 to 2.4) at the preoperative CT scan and 0.33 mL (interquartile range; -0.22 to 1.29) at the postoperative CT scan (**p = 0.0039). The NOSE scale revealed significant improvement in nasal obstruction postsurgically (median value, 42.5 to 7.5; *p = 0.0139) in the PDS group. Conclusion: PDS plates potentially present a new concept of open septal reduction in terms of septal reinforcement compared with the subtractive approach of open septal reduction.

Objective: Novel Coronavirus disease is a new infectious agent of the respiratory tract characterized by a severe acute respiratory syndrome. For this disease, there are limited data with regard to the clinical characteristics of the patients and prognostic factors. Study Design: Retrospective Cohort Setting: Secondary Referral Center Methods: We collected data from 213 patients who were hospitalized into COVID-19 isolation with positive PCR test results. We recorded various patient values, including blood test results. We also noted age, gender, additional diseases, duration of discharge, whether they live or die, whether they smoke, and their radiological staging. Results: In CT imaging with a staging of maximum 4 points and minimum 0 points, the mean value resulted in 1.95. The average radiological stage of the dead patients group was reported as 2.56. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). The number of smokers was 14 (6.5%). Of the 26 patients who died, 3 were smokers and 23 were non-smokers. Conclusion: 14 of the patients in the study were smokers (6.5%). One in four people in Turkey is a smoker, while in COVID-19 isolation service only a 6.5% rate of smoking was observed. That supports the theory that smoking hasn’t negative impact on COVID-19 development. The average radiological stage was reported as 2.56 in the dead patients’s group. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). It seems that an elevated radiological stage is a predictor of death. Keywords: Covid-19, SARS-CoV-2, smoking, computed tomography, predictor factors. Key points: to learn relations between smoking and covid-19, effect of Ct stages on the disease severity, effect of blood analysis on Covid-19, the parameters in deaths of Covid-19, ratio of smoking in Covid-19 inpatients

Objective: To compare some characteristics of two subgroups of tinnitus, noise-induced tinnitus and age-related tinnitus. Design: An online survey from the Iowa Tinnitus Website was reviewed. The participants were divided into two subgroups according to their reported cause of tinnitus—noise or aging. Their answers to the questions about loudness, qualities, worsening and reducing factors of tinnitus were analyzed. Study sample: There were 16 patients of age-related tinnitus and 147 of noise-induced tinnitus. Results: Two groups did not differ significantly in loudness (U = 887.5, p > 0.05), qualities (X2 = 1.164, p > 0.05) or reducing factors (X2 = 1.984, p > 0.05). Ringing/whistling was the most common quality of both age-related (37.5%) and noise-induced tinnitus (51.7%). 42.9% of participants of noise-induced tinnitus and 31.3% of age-related tinnitus felt that nothing made tinnitus better. The main worsening factors for noise-induced tinnitus included being in a noisy place (44.2%) and lack of sleep (42.9%) , which differed from the age-related group (X2 = 6.169, p < 0.05). Conclusions: There was a great deal of overlap between two subgroups, with some differences in worsening factors, including noise environment and lack of sleep. This is an important ‘red flag’ in counseling, and should be considered by doctors when choosing therapy.

Objectives The association between diagonal ear lobe crease (DELC) and cardiovascular disease was first suggested in 1973 although some studies have attributed this to confounding cardiovascular factors. This review looked to see if there is a significant association between DELC and angiography-confirmed coronary artery disease (CAD) independent of other risk factors. Design Systematic review and meta-analysis of selected studies using the PRISMA checklist. Setting 12 different hospitals with angiography in eight countries. Participants 4960 adult patients undergoing coronary angiography. Main Outcome Measures • Presence/absence of diagonal ear lobe crease • Diagnostic Odds Ratio • Sensitivity/Specificity Results 12 studies were included in the meta-analysis. Findings from our study suggest: • Patients with DELC have a 4x increased likelihood of having CAD (OR 4.61 P<0.00001). • The relationship between DELC and CAD was independent of age and all other conventional cardiovascular risk factors. • Bilateral DELC has a stronger association with CAD than unilateral DELC. • Presence of DELC has insufficient sensitivity / specificity to be used as a diagnostic test for cardiovascular disease but instead should be used as a risk marker. Conclusions We found that DELC is associated with CAD independently of other known cardiovascular risk factors including age. Histology studies indicate that atherosclerosis is causing DELC and patients with DELC appear to have an increased risk of CAD. It has insufficient sensitivity or specificity to be used as a diagnostic test but should be used as a valuable risk marker to be aware of whilst examining ears.

• The UK National Institute for Health and Care Excellence has estimated a 70% increase in demand resulting from the 2019 modification to cochlear implant criteria • We modelled the projected increase using our large database of pure tone audiometry results, and adjusted for frailty as a marker of risk of general anaesthesia • Our results suggest an overall 79% increase in demand, with most of this for adult implantation, and in particular for those over the age of 65 • Our findings are important for those planning delivery of cochlear implant services

Intro Allergic rhinitis（AR） is a common condition which can significantly impair quality of life. This study aimed to illustrate the efficacy and safety of sublingual immunotherapy (SLIT) on pollen AR patients. Methods Four electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were searched from their inception until September 2019. Two reviewers （FLF and CLJ） independently extracted the data. The Cochrane’s Risk of Bias tool was used to assess the quality of included studies. The outcomes of study were calculated by MD or SMD with 95%CI. A meta-analysis was performed using RevMan 5.3 software. Results In this systematic review, a total of 8 articles were included, involving 785 participants. The quality of the included studies ranged from low to moderate. The results of the meta-analysis showed that compared with placebo, a significant reduction of nasal symptoms were observed on SLIT (MD = −0.84, 95% CI = −1.47 to −0.22, P < 0.05), IgE (SMD =0.46, 95% CI = 0.16 to 0.76, P < 0.05); No significant effect on medication scores (MD = −0.41, 95% CI = −0.89 to 0.07, P =0.10). No serious adverse events were reported, and symptoms of adverse events were reported more frequently in the gastrointestinal symptoms. Conclusion SLIT can effectively relieve rhinitis symptoms and decrease the level of specific-IgE for pollen allergic rhinitis patients and the safety was verified. But due to the low quality of studies, more high-quality randomized trials are needed to provide stronger evidence of the conclusion.

Introduction: Referrals for OE have increased but the reasons for this remain unclear. We characterise referrals to inform primary secondary care interface improvements. Methods: Questionnaire study from dedicated consultant-led research clinic for OE referrals. Results: 62 patients responded; 63% female, mean age 54 years. One was excluded (not OE). Most had multiple primary care visits before referral (average 4 GP; 2 practice nurse). 60% had received oral antibiotics (16% multiple classes). 18% had never had ear drops. 39% were not advised to keep ears dry. 21% had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. <10% had narrow canals. 36% had active discharge but <7% needed a wick. Conclusion: OE occurs most commonly in women - often with associated risk factors. Lifestyle advice and ototopical drops are frequently overlooked; instead often inappropriately treated with oral antibiotics. Most ear were anatomically normal and community aural care clinics may have a role in reducing referrals.

Objectives: This study evaluated the characteristics of reflux in patients with laryngopharyngeal reflux (LPR) refractory to proton pump inhibitor (PPI) therapy using the 24-h multichannel intraluminal impedance (MII)-pH monitoring. Design: Prospective cohort study. Setting: A tertiary care otolaryngology clinic. Participants: Patients with suspected LPR underwent 24-hour MII-pH monitoring and were prescribed high-dose PPI twice daily. One-hundred and eight patients followed up for at least 2 months were enrolled. Main outcome measures: Patients with suspected LPR showing more than one proximal reflux episode were considered to have LPR. Patients with LPR showing ≥50% decrease in the follow-up reflux symptom index (RSI) score compared to the pre-treatment RSI score during treatment periods were defined as responders; others were defined as non-responders. Various parameters in the 24-h MII-pH monitoring between non-responders and responders with LPR were compared using Student’s t-test. Results: Of 108 patients with suspected LPR, 80 were diagnosed with LPR. Patients with LPR were categorized as non-responders (n = 19) and responders (n = 61). Proximal all reflux time and proximal longest reflux time in MII parameters were significantly higher in responders than in non-responders (p = 0.0040 and 0.0216, respectively). The proximal all reflux time >0.000517% was a better cut-off value to predict responders with LPR compared to the proximal longest reflux time >0.61 min (sensitivity + specificity: 1.317 vs. 1.291). Conclusions: The proximal all reflux time can be helpful to predict the response to PPI therapy and establish a personalized therapeutic scheme in patients with LPR.

Key points: • Intraoral, sublabial, and transnasal endoscopic approachs are used to manage odontogenic maxillary cysts. • Transnasal endoscopic approach includes inferior meatal antrostomy, middle meatal antrostomy, and endoscopic medial maxillectomy approach. • Trans-antral endoscopic assisted excision of odontogenic maxillary cyst approach have the advantage of direct lesion access of the sublabial approach as well as the advantages of better illumination, magnification, and small access of endoscopic approach. • The trans-antral endoscopic assisted approach co-morbitity seems to be the least comparing to the benefit of complete excision of the cyst within its entire wall in all the cases with minimal injury of the unaffected maxillary sinus mucosa as well as avoidance of injury of any nearby structure if there is defect in the sinus wall.

Objectives: Otorhinolaryngological conditions seem to be more frequent in children with Eosinophilic Esophagitis (EoE), including allergic rhinitis, but, to our best knowledge, there are no studies showing if the frequency of these conditions is superior in children with EoE. The aim of this study is to determine whether otorhinolaryngological manifestations are more prevalent in these children. Design: Case control study Setting: Tertiary referral Paediatric Hospital of Lisbon, Portugal. Participants: Children with EoE (cases) and children diagnosed with allergic rhinitis but not diagnosed with EoE or other eosinophilic disorders (controls). Main outcome measures: Complete otorhinolaryngological evaluation of children under an observation protocol with questions about ear, nose and throat symptoms, and previous medical history; physical examination and the CARAT kids questionnaire to evaluate the level of control of children’s rhinitis. Results: This study included 45 children. The study group consisted of 15 children diagnosed with EoE and the control group consisted of 30 cases with allergic rhinitis. Both groups included 6 to 17 years old children. There were no differences concerning gender, age, total CARAT kids score or CARAT kids score for questions for upper and lower respiratory tract (p>0.05). When otorhinolaryngological symptoms were analysed separately there were no statistically significant differences between case and control groups (p>0.05), except for dysphagia (p=0,036) which was more prevalent in the case group. There were no significant differences related to the number of symptoms reported, frequency of asthma, otorhinolaryngological surgeries in the past, drug allergies, and documented hearing loss (p>0.05). There were no significant differences in laryngopharyngeal changes seen as markers for laryngopharyngeal reflux between both groups (p>0.05). Conclusions: Apparently, otorhinolaryngological conditions are not more prevalent in children diagnosed with EoE, but future larger studies are needed to confirm our findings. Yet, Otorhinolaryngologists must be aware of this condition since early referral of children with symptoms related to EoE such as dysphagia and atopy to a Gastroenterology appointment can speed up diagnosis and treatment, potentially reducing long-term sequelae.

Abstract Introduction: One stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is quick diagnosis and early management while simultaneously improving patient experience. Objectives: To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to number of appointments required for formulating management plan and number of ‘one stop’ visits. Design: Retrospective observational study Setting: Regional Head and Neck Cancer Center (Secondary care hospital) Participants: Patients referred by General practitioner with symptoms of neck lump Main outcome measures: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in number of appointments, one stop visits, requirement of Ultrasound and efficiency of Fine needle aspiration. Results and Conclusions: Improved efficacy of OSNLC was noted as patients seen in clinic required lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic.