No abstract

Obstructive sleep apnoea (OSA) is increasingly prevalent, particularly in the context of the obesity epidemic, and is associated with a significant social, health and economic impact. The gold standard of treatment for moderate to severe OSA is continuous positive airway pressure (CPAP). However compliance rates can be low. Methodology to improve patient tolerance to CPAP alongside with alternative, non-surgical and surgical, management strategies are discussed. All patients that fail CPAP therapy would benefit from formal upper airway evaluation by the otolaryngologist to identify any obvious causes and consider site-specific surgical therapies. Patient selection is integral to ensuring successful outcomes. A multidisciplinary team is needed to manage these patients.

Objectives: Thyroid conditions are common and their incidence is increasing. Surgery is the mainstay treatment for many thyroid conditions, and understanding its utilisation trends and morbidity are central to improving patient care. Accepted ArticleThis article is protected by copyright. All rights reserved. Results: Mean age at surgery was 49±30 and a female predominance (82%) was observed.Most patients underwent hemithyroidectomy (51%) or total thyroidectomy (32%). Patients underwent surgery for benign (52.5%), benign inflammatory (21%), and malignant (17%) thyroid diseases. Thyroid surgery grew by 2.9% a year and increased in specialization.Increased surgeon volume significantly reduced lengths of stay: the proportion of length of stay outliers fell from 11.8% for patients of occasional thyroidectomists (<5 per year) to 2.8% for patients of high-volume surgeons (>50 thyroidectomies a year). Post-discharge vocal palsy and hypocalcaemia occurred in 1.87% and 1.58% of cases respectively. High-volume surgeons had a reduced incidence of vocal palsy and volumes >30 were consistently protective.Conclusions: Thyroid surgery is increasingly specialised. High-volume surgeons achieve lower complications rates, including lower vocal palsy rates, and length of stay.

Tracheal cancer is under-recognized and under-treated. Early diagnosis, access to interventional bronchoscopy, and surgical treatment in specialist units may improve the survival of patients with this condition.

This systematic review indicates that imaging has a useful role in both the diagnosis and management of otosclerosis, supported principally by Level III/IV evidence.