The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis.

OBJECTIVES: To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs. DESIGN: This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach. SETTING: Secondary or tertiary care centres that undertook management of DNSIs. PARTICIPANTS: All adult patients with a DNSI. MAIN OUTCOME MEASURES: The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs. RESULTS: Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI. CONCLUSIONS: There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.

Otolaryngology education and training in the COVID-19 and post-COVID-19 digital era: a developing world perspective.

PURPOSE OF REVIEW: This article reviews the literature on the challenges to Otolaryngology training in the developing world, the solutions that have been implemented thus far and the role of technology in first the Digital, and now the Covid era. RECENT FINDINGS: There is an increasing prevalence of Otolaryngological pathology in the developing world. Efforts to treat this are hampered by multiple factors including appropriate medical training. A number of solutions have been implemented for this both in terms of face-to-face as well as virtual training. SUMMARY: The Covid era has created new challenges for Otolaryngology training in the developed world, sparking a huge shift in the delivery of education. Traditional forms of training have disadvantaged colleagues in the developing world and so this change in training modalities may benefit the developing world.

Patients' perspectives on the short- and long-term outcomes following surgery for benign parotid neoplasms.

Surgery for benign parotid gland salivary neoplasms is associated with sequelae: scar and divot defect and complications, facial nerve paresis/paralysis and Frey's syndrome. These potential sequelae and complications are discussed with all patients prior to operation. We contacted 212 patients who had undergone surgery for benign parotid disease during 1988-1997, by postal questionnaire. We enquired about their perception and recollection of the information they had received pre-operatively and to document and comment upon what problems they had experienced in the early and late post-operative period. The usable return rate was 75.5 per cent (173/212). Most patients (90 per cent) were satisfied with the information they had received pre-operatively. The complication and/or sequelae rates for facial nerve palsy (temporary 26.3 per cent, permanent 1.9 per cent), Frey's syndrome (12.5 per cent) and sensory deficit about the cheek and ear (30.6 per cent), are comparable to other published studies.

Multiple primary tumors in patients diagnosed with hypopharyngeal cancer.

OBJECTIVE: There have been few series to report on the incidence of multiple primary tumors associated with hypopharyngeal cancer. A unique consecutive patient group in a closed community who were treated by a single surgeon was available. The incidence and effect of multiple primary tumors were unknown. STUDY DESIGN: We sought to assess (1) the incidence of multiple primary tumors among patients with hypopharyngeal cancer who were treated at a tertiary center, (2) the incidence of synchronous and metachronous tumors, and (3) the location of these multiple primary tumors and their effect on patient survival. METHODS: We conducted a retrospective study of case notes of 150 consecutive patients with hypopharyngeal malignancy treated by a single surgeon between 1983 and 1998. Information was compiled from the patients' medical records and death data from the Family Health Services Authority. RESULTS: Thirty-four patients had multiple primary tumors (22.6%). There were 22 men and 12 women; piriform fossa tumor was seen in 21 men and 6 women, and postcricoid space tumor was seen in 6 women and 1 man. Second primary tumors were synchronous in 7 patients, subsequent to hypopharyngeal tumor in 5 patients, and antecedent to hypopharyngeal tumor in 14 patients. Eight patients had 2 primary tumors, of which 4 were synchronous, 4 were subsequent, and 8 were antecedent to hypopharyngeal malignancy. On the last review (2001), 3 patients were alive, and 31 had died: 17 had died from primary malignancy, 11 from another malignancy, and 3 from unrelated causes. CONCLUSION: The presence of second primary tumors in hypopharyngeal cancer is higher than previously reported, and their presence had a significant effect on the patients' survival.