Background: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common form of cancer worldwide, with approximately 630,000 new cases diagnosed each year. The development of low-cost and non-invasive tools for the detection of HNSCC using volatile organic compounds (VOCs) in the breath could potentially improve patient care. The aim of this study was to investigate the feasibility of selected ion flow tube mass spectrometry (SIFT-MS) technology to identify breath VOCs for the detection of HNSCC. Materials and Methods: Breath samples were obtained from HNSCC patients (N = 23) and healthy volunteers (N = 21). Exhaled alveolar breath samples were collected into FlexFoil® PLUS (SKC Limited, Dorset, UK) sampling bags from newly diagnosed, histologically confirmed, untreated patients with HNSCC and from non-cancer participants. Breath samples were analyzed by Selected Ion Flow Tube-Mass Spectrometry (SIFT-MS) (Syft Technologies, Christchurch, New Zealand) using Selective Ion Mode (SIM) scans that probed for 91 specific VOCs that had been previously reported as breath biomarkers of HNSCC and other malignancies. Results: Of the 91 compounds analyzed, the median concentration of hydrogen cyanide (HCN) was significantly higher in the HNSCC group (2.5 ppb, 1.6–4.4) compared to the non-cancer group (1.1 ppb, 0.9–1.3; Benjamini–Hochberg adjusted p < 0.05). A receiver operating curve (ROC) analysis showed an area under the curve (AUC) of 0.801 (95% CI, 0.65952–0.94296), suggesting moderate accuracy of HCN in distinguishing HNSCC from non-cancer individuals. There were no statistically significant differences in the concentrations of the other compounds of interest that were analyzed. Conclusions: This pilot study demonstrated the feasibility of SIFT-MS technology to identify VOCs for the detection of HNSCC.

Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

Injection laryngoplasties performed under general anaesthesia and local anaesthesia offer similar voice outcomes, with comparable complication rates. Hence, development of a management algorithm for injection laryngoplasties performed under local anaesthesia is recommended.

Background: Secondary post tonsillectomy haemorrhage (sPTH) is a significant complication in Otolaryngology. Most studies have focussed on different risk factors associated with sPTH. However, few studies have reported on the outcomes of sPTH after presentation to a tertiary public hospital. We sought to present our experience with the management of sPTH. Methods: A retrospective review of all patients (n=145) presenting with a sPTH to Flinders Medical Centre (FMC) was analysed over a two-year period. The Stammberger grade for sPTH was applied and recorded in the case notes at presentation of all patients. Results: 59% of these patients were adults. Overall, 79% of patients were conservatively treated and discharged safely without returning to the operating theatre. Adults were marginally more likely to return to theatre (RTT) with a relative risk (RR) of 1.07 (CI 0.5-2.3). Patients who had coblation (COB) tonsillectomy had a higher RR of RTT (RR =1.45) compared to cold steel (CS) tonsillectomy. Patients who had a COB tonsillectomy (16.6%) were also more likely represent with a second bleeding episode compared to CS tonsillectomy (9.8%). The length of stay (LOS) was significantly longer (13 hours) in adults with Stammberger grade C sPTH (P<0.05) compared to grade A1 sPTH, with other factors having no significant effect on LOS. Conclusions: The overall risk of a second bleeding episode is low in patients with sPTH, and conservative management in the first instance is safe. Patients with a COB tonsillectomy are likely to present with multiple episodes of sPTH if initial management was conservative. Stammberger grade at initial sPTH presentation is not predictive of subsequent presentations.

Background: Flexible nasendoscopy is an important part of the diagnostic process in Otorhinolaryngology. Flexible nasendoscopies come in close contact with mucous membranes of the upper aerodigestive tract. Therefore, appropriate and effective disinfection is vital to prevent iatrogenic infection and cross contamination. The lack of official national reprocessing guidelines has led to varying and inconsistent practice amongst ENT centres in Australia. Methods: A questionnaire was sent to 14 Queensland ENT outpatient departments to establish current practice. Results: In total, 50% (N=7) of hospitals used manual disinfection and 50% (N=7) used automated endoscope reprocessors (AEMs). Manual disinfection with Tristel was used in most (N=6) departments and Cidex was used in one hospital. The same disinfection technique was used after hours and in high risk patients (HIV, hepatitis B, hepatitis C, pulmonary tuberculosis) in all hospitals. The efficacy and time to reprocess were the main factors that influenced the disinfection techniques used. The majority (64.3%) of centres cleaned nasendoscopies in the ENT outpatient department and remaining hospitals (35.7%) did so in the Central Sterile Services Department (CSSD). A permanent record of nasendoscopy maintenance, reprocessing and patient tracking system was used in all departments. Conclusions: The disinfection techniques and disinfectant agents vary considerably across ENT outpatient departments in Queensland. Hence, a state wide disinfection guideline would be beneficial to ensure that reprocessing of nasendoscopies is standardised regardless of the technique used across the state.