Contemporary trends can be revealed in an enquiry of presentations at a surgical symposium.

AIMS: Ascertain whether a demographic analysis of the archives of an annual national meeting head and neck section could reflect contemporary issues in our specialty and compare the results with available analysis from other ORL-HNS meetings. MATERIALS AND METHODS: A review of all accepted abstracts of Sylvester O'Halloran Symposium-H&N section, from 2005 to 2020. RESULTS: ORL-HNS was responsible for 77% of the accepted abstracts. Presentations on H&N Malignancy were predominantly from ORL-HNS (84%), while Thyroid presentations were divided with General Surgery (45%). Medical students have appeared in recent years and produced 4% of papers at the last meeting while more junior presenters are participating with an increasing female preponderance (ranging from 7 to 53%). The overall publication rate was 27%, where male authors had a rate of 28% and females 22%. Similar papers published subsequent to the relevant meeting were identified from other institutions in 40% of presentations. CONCLUSION: This review of presentations at a surgical meeting provides an insight into contemporary issues involving our specialty and lays down markers or challenges for organisers and presenters alike. Presentations on H&N Malignancy have become almost exclusively ORL-HNS, while Thyroid presentations are becoming more valorised to General Surgery and Facial Plastics with our colleagues in Plastic Surgery and Maxillofacial. Our publication rate of 27% is similar to other ORL-HNS meetings. Approximately 10% are published over 5 years after the meeting but presenters should endeavour to publish earlier as others may usurp publication in up to 40% of presentations.

What the blogosphere has to say about adult tonsillectomy.

OBJECTIVES: Tonsillectomy has generated extensive comment on the internet, but this content has not been examined in a scientific manner. This study aimed to determine what the blogosphere has to say about adult tonsillectomy and to report whether this information can be used to improve post-surgical care. METHODS: The internet was searched to find personal blogs relating to tonsillectomy. A retrospective review of data collected on these blogs was carried out and the blogs were conceptually analysed by the authors. RESULTS: Fifty blogs were included. Seventy per cent of patients had read blogs prior to their procedure. The average pain score where available was 7.2. Complications occurred in 10 per cent of patients. Only 1 patient (2 per cent) regretted having a tonsillectomy. CONCLUSION: It is important for otolaryngologists to stay in tune with the blogosphere as this unregulated and easily accessible source of information is both friend and foe but will ultimately help in pre-operative counselling and post-operative management.

The changing nature of paediatric otomycosis in the mid-west of Ireland.

BACKGROUND: Fungal otitis externa is prevalent in tropical and sub-tropical climates; however, over the past two decades, there has been a reported increase in the prevalence of otomycosis in paediatric patients from more temperate climates. This study aimed to review the children diagnosed with otomycosis at the University Hospital Limerick with reference to frequency, causative organism, predisposing factors and management. METHODS: A retrospective review was conducted of paediatric patients from 2001 to 2015. Patients with positive fungal ear swabs and a diagnosis of otomycosis were identified. RESULTS: Ninety-three patients were positive for candida (mean age, 5.8 years), 10 patients were positive for aspergillus (mean age, 9.1 years) and 1 patient had mixed fungal infection containing both fungi. There was a positive correlation between a diagnosis of otomycosis and prior treatment with topical fluoroquinolones (r = 0.8; p < 0.01). CONCLUSION: The incidence of otomycosis has been increasing since 2001, which correlates with an increase in the use of topical fluoroquinolones. Previous studies identify aspergillus as the commonest causative fungi; however, this study found that candida was the commonest isolated fungi in the paediatric population.

Never say never: circumventing a contraindication to control apnoea-induced epileptic events with a mandibular advancement device.

BACKGROUND: The benefit of mandibular advancement devices in patients with sleep-disordered breathing and as a potential option for obstructive sleep apnoea syndrome is well recognised. Their use in the setting of epilepsy or other seizure disorders is typically contraindicated.Case reportA 48-year-old patient with a history of poorly controlled epilepsy and obstructive sleep apnoea syndrome was referred for ENT review for possible tracheostomy. The patient was wheelchair-bound with 24-hour continuous positive airway pressure, but sleep studies demonstrated persistent, severe episodes of apnoea and notable sleep disturbance. Sleep nasendoscopy demonstrated marked improvement on capnography with the laryngeal mask airway in situ, and this was maintained with mandibular advancement using jaw thrust following removal of the laryngeal mask airway. A mandibular advancement device was subsequently trialled; this had no subjective benefit for the patient, but the seizures resolved and control of apnoea was achieved with the combination of a mandibular advancement device and continuous positive airway pressure. CONCLUSION: This paper highlights a novel application of mandibular advancement devices, used in combination with continuous positive airway pressure, which resulted in complete resolution of sleep deprivation and apnoea-induced epileptic events.

Case report classics in otolaryngology - head and neck surgery: citation analysis.

OBJECTIVES: To analyse publication and citations trends of case reports within otolaryngology - head and neck surgery literature, with specific attention to the most-cited reports.Study designDatabase query. METHODS: Web of Science was searched for article type 'case reports' published in the leading otolaryngology - head and neck surgery journals since 1945. Variables including publication dates, citation dates and numbers, author, author number, and others were recorded and analysed for trends. The reports with the most citations (classics) were further studied. RESULTS: Of nearly 67 000 published articles in leading otolaryngology - head and neck surgery journals, the overall number of case reports as a percentage of the total has substantially decreased over time. A total of 110 case report classics were identified for which citations have increased. CONCLUSION: Although the case report may not be worthy of its tarnished record, declining trends in publication suggest a limited future for this valuable research and educational resource.

Polyps, grommets and eosinophilic granulomatosis with polyangiitis.

OBJECTIVE: To explore the link between nasal polyposis, refractory otitis media with effusion and eosinophilic granulomatosis with polyangiitis. METHODS: A retrospective observational study was carried out of patients diagnosed with refractory otitis media with effusion necessitating grommet insertion and who had nasal polyps. Patients were evaluated to determine if they fulfilled the diagnostic criteria of eosinophilic granulomatosis with polyangiitis. RESULTS: Sixteen patients (10 males and 6 females) were identified. The mean age of grommet insertion was 45.4 years. The mean number of grommets inserted per patient was 1.6. The mean number of nasal polypectomies was 1.7. All 16 patients had paranasal sinus abnormalities and otitis media with effusion, 14 had asthma, 9 had serological eosinophilia and 7 had extravascular eosinophilia. Nine patients met the diagnostic criteria for eosinophilic granulomatosis with polyangiitis. CONCLUSION: The co-presence of nasal polyps and resistant otitis media with effusion should raise the possibility of eosinophilic granulomatosis with polyangiitis.

Detecting internet search activity for mouth cancer in Ireland.

Mouth Cancer Awareness Day in Ireland was launched in September 2010 by survivors of the disease to promote public awareness of suspicious signs of oral cancer and to provide free dental examinations. To find out whether its introduction had increased public interest in the disease, we used Google Trends to find out how often users in Ireland had searched for "oral cancer" and "mouth cancer" across all Google domains between January 2005 and December 2013. The number of internet searches for these cancers has increased significantly (p <0.001) and has peaked each September since the awareness day was launched in 2010. More people searched for "mouth cancer" than for "oral cancer". These findings may have valuable clinical implications, as an increase in public awareness of mouth cancer could result in earlier presentation and better prognosis.

Citation analysis of otorhinolaryngology journals: follow-up study.

OBJECTIVE: This study aimed to evaluate the changes in impact factors of otorhinolaryngology journals over the past 15 years. METHOD: Using the online edition of Journal Citation Reports, standard (2-year) and 5-year impact factors were calculated for the leading 15 journals. RESULTS: The results were compared with the impact factors for 1998. The average standard impact factor and 5-year impact factor increased by 2.72 and 2.05 fold respectively when compared with 1998. The average 2012 standard impact factor and 5-year impact factor were 1.82 and 1.99 respectively, reflecting a 9.3 per cent difference. The average 1998 standard impact factor and 5-year impact factor were 0.67 and 0.97 respectively, reflecting a 44.8 per cent difference. The Journal of the Association for Research in Otolaryngology had the highest standard and five-year impact factors. CONCLUSION: These data may indicate changing clinical and research interests within our field, as well as increased speed and ease with which the internet has allowed citation. As a result, five-year intervals may no longer be necessary to adequately gauge journal impact.

What is the role of 'the letter to the editor'?

The letter to the editor plays a dual role in the literature. It serves a corrective critical function but also has the capacity to spread and share knowledge. We sought to identify the role and theme of letters to the editor published in four leading otorhinolaryngology journals, to elicit how well this form of communication is being utilised. All letters to the editor published in; Clinical Otolaryngology, The Laryngoscope, The European Archives of Otorhinolarygnology and The Journal of Laryngology and Otology, for the year 2012, were examined and the individual journal guidelines for submission of letters were noted. Seventeen different countries produced a total of 92 letters for the year 2012. The majority of letters originated from Otolaryngology/Head and Neck departments (78 %). Clinical Otolaryngology contributed to 58 % of total letters, of which 55 % were unrelated to original journal material (n = 29). The Laryngoscope published letters solely in response to original journal material. The Journal of Laryngology and Otology was the only journal to index letters with their corresponding article. More letters agreeing (49 %) than disagreeing (32 %) were published, with the remaining letters either clarifying or ignoring issues raised. Letters to the editor serve two main purposes; post-publication peer review and sharing experiences with fellow readers. Both are equally important in maintaining journals' high standards. Indexing needs to be improved otherwise valuable comment does not endure while the original manuscript's message lives on.

The reporting of research ethics committee approval and informed consent in otolaryngology journals.

OBJECTIVES: Medical research involving human subjects must follow ethical standards as outlined in the Declaration of Helsinki of the World Medical Association. The aim of this study was to assess the frequency of reporting of informed consent and regional ethical committee (REC) approval in all reports of trials published in the major European Otolaryngology journals. DESIGN: Review of all clinical research articles published online in the calendar year 2012. SETTING: Three leading European Otolaryngology journals. PARTICIPANTS: Clinical Otolaryngology, The Journal of Laryngology and Otology and The European Achieves of Oto-Rhino-Laryngology. MAIN OUTCOME MEASURES: Evaluate the incidence of reporting of REC approval and informed consent. RESULTS: Of the 767 articles reviewed, 401 met the inclusion criteria (manuscripts reporting human subjects, human tissue or identifiable personal data research which require ethical approval). 49.9% lacked a statement of REC approval and 42.9% lacked disclosure of informed consent. Articles that did not state REC approval were associated with not stating informed consent (P < 0.05). CONCLUSION: Articles that lack explicit statements of REC approval and informed consent are frequent and continue to be published in major otolaryngology journals.

Effect of metronidazole versus standard care on length of stay of patients admitted with severe infectious mononucleosis: a randomized controlled trial.

Metronidazole may be of use in the treatment of infectious mononucleosis (IM). Our aim is to show that metronidazole shortens hospital stay for patients with severe IM. A single-centre randomized controlled trial was undertaken in patients admitted with severe IM, who were with a similar group treated by the standard care. Patients were blinded to which treatment arm they were in. Forty-two of these patients were enrolled in the trial. The primary endpoint was the difference in length of stay. This was significantly less in the metronidazole group (3.67 days v 4.67) (p 0.032). This study demonstrates that metronidazole has a role to play in severe infectious mononucleosis.

Alternatives to the impact factor.

OBJECTIVE: To explore alternative bibliometric markers to the well-established journal impact factor. The bibliometric evolution of a leading ENT journal over a six year period is discussed with critical analysis of a predetermined set of bibliometric alternatives to the journal impact factor. DESIGN: Retrospective review of the bibliometric performance of Clinical Otolaryngology over a six year period. RESULTS: The results of the study reveal that Clinical Otolaryngology has made steady bibliometric progress when the impact factor (IF) is considered with a gradual increase in impact factor from 1.098 in 2006 to a peak of 2.393 in 2011. Self-citation rates reported by the Journal Citation Report (JCR) demonstrated a significant decline during 2007 with a reported self-citation rate of 0%. The SCImago Journal Rank (SJR) database however recorded a self-citation rate of 67. Independent evaluation demonstrated a 56 self-citations during this period. The percentage of review articles published remained stable during the period in question. A lagged association between the number of review manuscripts and the IF failed to demonstrate any significant correlation (r = -0.19). Comparison between the IF and the Eigen factor (EF) as well as the SJR yielded negative correlation (r = -0.46) and (r = -0.35) respectively. The Article Influence score (AIS) and Source Normalised Impact per Paper (SNIP) were the only bibliometric alternatives to demonstrate a positive correlation when compared to the IF (r = 0.94) and (r = 0.66) respectively. CONCLUSIONS: The necessity of bibliometric markers cannot be called into question however the most widely employed of these, the journal impact factor has come under increased scrutiny of late. Despite some of the advantages offered by novel bibliometric markers, these do not necessarily compare favourably to the IF with regards to bibliometric performance. The only two markers to demonstrate a positive correlation when compared to the IF were the AI score and SNIP which would suggest that these are potential alternatives to the IF and have the added advantage that they are open access.

The otological manifestations associated with autistic spectrum disorders.

OBJECTIVES: To elucidate the otological manifestations found in this increasingly commonly diagnosed condition. This paper will discuss the diagnosis, aetiology, pathogenesis, management and the outcomes of treatment. STUDY DESIGN: Systematic literature review. MATERIALS AND METHODS: The following databases were searched for articles pertaining to the otological manifestations of autistic spectrum disorders: MEDLINE, EMBASE, CURRENT CONTENTS, PSYCHLIT, CINAHL and HEALTHSTAR. Articles from 1965 to June 2012 were extracted. Relevant articles from the literature were selected and reviewed by two independent authors. Each paper was assessed as to its level of evidence and validity. The relevant results are presented and discussed in order to present a practical approach to the management of these patients. RESULTS: Patients with ASD have an increased incidence of peripheral and central otological pathology. This pathology plays a key role in the behavioural, communication, and social aspects of the disease. ASD patients have a higher incidence of profound sensorineural hearing loss, middle ear infections, and abnormalities of the cochlear nerve and brainstem auditory pathways. There are cortical and brainstem neurodevelopmental abnormalities in the way auditory information is interpreted and processed in the ASD patient. CONCLUSIONS: The otolaryngologist plays a key role in the multidisciplinary management of individuals with ASD due to the high prevalence of otological pathology amongst these patients. Early diagnosis and expedient treatment focusing on normalisation of auditory input and development can maximise developmental outcomes.

The otolaryngology, head and neck training appraisal questionnaire: a national general practice perspective.

BACKGROUND: Diseases of the Ear, Nose and Throat (ENT) make up a considerable proportion of the everyday workload of general practitioners (GPs). It is recognized that ENT makes up a very small part of the undergraduate curriculum, but some post-graduate training schemes are now offering placements in Otolaryngology. AIM: The aim of the study was to examine a perceived knowledge 'gap' of GPs in the area of Otolaryngology. METHOD: A postal questionnaire was sent to 1,000 GPs distributed evenly throughout the country. RESULTS: There was a 47.3 % response rate; 72 % of GPs felt that they would see at least three or more children with a relevant ENT problem each day. Almost 70 % of GPs had less than a month exposure to ENT in medical school and 84 % of GPs felt that further emphasis was required at the undergraduate level. Twenty-one per cent of GPs surveyed had spent some time in Postgraduate ENT training. Ninety-one per cent of GPs agreed that further emphasis on ENT training was required at the Postgraduate level. CONCLUSION: General Practitioners feel that increased importance should be placed on the study of Otolaryngology at both undergraduate and Postgraduate level.

A longer stay for the kissing disease: epidemiology of bacterial tonsillitis and infectious mononucleosis over a 20-year period.

INTRODUCTION: Anecdotally, infectious mononucleosis is considered a more severe infection than bacterial tonsillitis, requiring a longer hospital stay. However, there is little in the literature comparing the epidemiology of the two conditions. This study aimed to compare the epidemiology of bacterial tonsillitis and infectious mononucleosis, in particular any differences in the length of in-patient stay. METHODOLOGY: The hospital in-patient enquiry system was used to analyse patients admitted with bacterial tonsillitis and infectious mononucleosis between 1990 and 2009 inclusive. RESULTS: There was a total of 3435 cases over the 20 years: 3064 with bacterial tonsillitis and 371 with infectious mononucleosis. The mean length of stay was 3.22 days for bacterial tonsillitis and 4.37 days for infectious mononucleosis. The median length of stay for each condition was compared using the Mann-Whitney U non-parametric test, and a significant difference detected (p < 0.001). CONCLUSION: Patients with infectious mononucleosis have a significantly longer stay in hospital than those with bacterial tonsillitis.