These data suggest that PA may improve QOL following treatment for HNC. We believe that further studies are warranted.

Objective The Control of Noise at Work Regulations came into force in Great Britain in 2005, requiring all work environments to be monitored for potentially harmful noise exposure levels. This study evaluated the effectiveness of a number of iPhone phone applications (apps) (Apple, Cupertino, CA) to accurately measure noise exposure, which may prove effective when a specialist‐calibrated sound level meter is not readily available. Methods Suitable apps were identified using the search terms noise and decibel through the App Store (Apple). Apps that were free to download and had at least one rating were included. Apps were evaluated using a calibrated pure tone sound field and a soundproof testing booth. A 3‐frequency audiogram (1000 Hz, 2000 Hz, and 4000 Hz) was used at 25 dB, 40 dB, 55 dB, 70 dB, and 85 dB. Linear regression was carried out to assess accuracy. Results Nine apps were tested in total, with four out of nine providing a goodness‐of‐fit coefficient (R2 value) over 0.9. The most effective app was found to be the NIOSH (National Institute for Occupational Safety and Health) Sound Level Meter (EA LAB, Slovenia) with an R2 of 0.97. The least effective app was the Decibel Meter With Recorder (Jianhua Ming, China) with an R2 of 0.62. Conclusion This study has shown significant variation in the ability of iPhone apps (Apple) to accurately predict environmental dB levels. However, if the correct app is used, an iPhone represents a relatively reliable means of measuring noise exposure levels when a specialist calibrated sound level meter is not readily available. Level of Evidence NA Laryngoscope, 131:E59–E62, 2021

Objectives: There are no hearing protection regulations in place for passengers using public transport, such as the London Underground. In light of this, we sought to examine sound pressure levels experienced by regular users of the London Underground. Methods: Sound pressure levels (A-weighted decibels: dBA) were taken on moving London Underground carriages between Euston and South Wimbledon on the Northern Line, and between Euston and Vauxhall on the Victoria Line, during 2006 and 2018. In addition, carriage sound pressure levels travelling within Zone 1 of the London Underground were tested in 2019. Three experimental and three technical repeats were undertaken using a hand-held calibrated multi-function sound level meter. Results: Passengers are routinely and consistently subjected to sound pressure levels exceeding 80 dBA, with levels sometimes reaching over 100 dBA. Conclusion: This study is unique within the literature, with no published studies outlining exposure levels for London Underground passengers. It provides evidence of elevated noise exposure to passengers, consistently along large stretches of the London Underground, over a prolonged study period (2006-2019).

The Southampton experience 1 | INTRODUC TI ON Percutaneous drains are frequently used in head and neck surgery cases. However, although effective at preventing post-operative haematoma formation their use can also be associated with significant complications, including infection, fistulae, pain, psychosocial implications and most notably prolongation of hospital stay. 1 As

Globally estimates suggest 25 million people may identify themselves as transgender, but the literature is scarce regarding the optimal perioperative care of patients who identify as transgender. We discuss the medico-legal issues which were considered during a hospital admission for a 44-year-old transgender patient having day surgery. The issues that arose from this case included whether this patient should be allocated to a male or female postoperative bed, and whom is entitled to make this decision. Pertinent literature and discussions with the patient and health care staff were collated to provide a holistic analysis of the legal and ethical considerations when organizing perioperative care for transgender patients.

Objective This study investigated the risk of contamination of lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution after modification of the application technique. Methods This paper reports a prospective basic sciences study involving 22 study samples and 1 control sample of the lidocaine hydrochloride and phenylephrine hydrochloride topical anaesthetic spray. The samples were assessed for microbiological contamination after a single use on patients using a modified application technique. The modification involves keeping the nozzle (actuator) pressed down whilst withdrawing the spray to at least 30 cm (1 ft) from the patient, before releasing the nozzle (actuator) and subsequently reapplying the spray. Results Three of the 23 samples confirmed bacterial growth in the bottle contents, but there was no growth in any of the samples from the pump. These bacteria are considered to be contaminants. Conclusion There is a potential to use the lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution as a multi-use spray by changing the actuator between patients. This would have significant beneficial cost implications without the attendant infection control risk.

Patients with a difficult airway provide a challenge for both anaesthetists and surgeons during laryngeal surgery. We describe a novel technique in the anaesthetic management of a 58-year-old male with a known difficult airway who required tubeless anaesthesia for laryngeal surgery. By utilising an airway exchange catheter as an adjunct during tubeless anaesthesia, we were able to safely manage the airway and ventilation in addition to providing a tubeless surgical field. Our experience has prompted us to consider its use more frequently during laryngeal surgery where a difficult airway is anticipated or encountered.

Laryngectomy surgery is a highly aerosolizing procedure, and we document the key steps, including the addition of a novel Perspex shield, which can be enacted during the COVID‐19 pandemic to reduce risk to the patient and healthcare professional.