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  1. Article ; Online: Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition.

    Homer, Jarrod J / Winter, Stuart C

    The Journal of laryngology and otology

    2024  Volume 138, Issue S1, Page(s) S1–S224

    MeSH term(s) Humans ; United Kingdom ; Head and Neck Neoplasms/diagnosis ; Head and Neck Neoplasms/surgery ; Interdisciplinary Communication ; Neoplasm Staging
    Language English
    Publishing date 2024-03-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 218299-3
    ISSN 1748-5460 ; 0022-2151
    ISSN (online) 1748-5460
    ISSN 0022-2151
    DOI 10.1017/S0022215123001615
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  2. Article ; Online: COVID-19 and the return to head and neck outpatient activity in the United Kingdom: what is the new normal?

    Bola, Sumrit / Jaikaransingh, Dominic / Winter, Stuart C

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2020  Volume 278, Issue 7, Page(s) 2641–2648

    Abstract: Purpose: As surgical specialties now begin the graduated return to elective activity and face-to-face clinics, this paper investigates the current head and neck outpatient practices across the United Kingdom.: Methods: A cross-sectional study ... ...

    Abstract Purpose: As surgical specialties now begin the graduated return to elective activity and face-to-face clinics, this paper investigates the current head and neck outpatient practices across the United Kingdom.
    Methods: A cross-sectional study comprised of an online 20-item survey was distributed to members of the British Association of Head & Neck Oncologists (BAHNO). The survey was open on a web-based platform and covered topics including safety measures for patients, protective equipment for healthcare staff and protocols for the use of flexible nasendoscopy in the clinic.
    Results: The survey was completed by 117 participants covering 66 NHS Trusts across the UK. There was a significant reduction in face-to-face Otolaryngology, Maxillofacial and Speech and Language clinic patients when compared to pre-pandemic numbers (p < 0.0001). Risk assessments for flexible nasendoscopy were done for 69% of clinics and 58% had an established protocol. Room downtime after flexible nasendoscopy ranged from 0 to 6 h and there was a significant increase in allocated downtime after a patient had coughed/sneezed (p < 0.001). Natural ventilation existed in 36% of clinics and the majority of responders didn't know the Air Change Per Hour (ACPH) of the clinic room (77%). Where ACPH was known, it often did not match the allocated room downtime.
    Conclusion: There is a wide variation in outpatient activity across the United Kingdom, but adaptations are being made to try and maintain staff and patient safety. However, more can still be done by liaising with allied teams to clarify outpatient protocols.
    MeSH term(s) COVID-19 ; Cross-Sectional Studies ; Humans ; Outpatients ; SARS-CoV-2 ; United Kingdom
    Keywords covid19
    Language English
    Publishing date 2020-11-06
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-020-06458-x
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  3. Article ; Online: Patient and physiotherapist perceptions of the Getting Recovery Right After Neck Dissection (GRRAND) rehabilitation intervention: a qualitative interview study embedded within a feasibility trial.

    Fordham, Beth / Smith, Toby O / Lamb, Sarah / Morris, Alana / Winter, Stuart C

    BMJ open

    2022  Volume 12, Issue 11, Page(s) e064269

    Abstract: Objective: The Getting Recovery Right After Neck Dissection (GRRAND) intervention is a physiotherapy programme for patients with head and neck cancer who have undergone neck dissection. The aim of this qualitative study was to understand if the ... ...

    Abstract Objective: The Getting Recovery Right After Neck Dissection (GRRAND) intervention is a physiotherapy programme for patients with head and neck cancer who have undergone neck dissection. The aim of this qualitative study was to understand if the intervention was useful, acceptable and whether it was feasible to conduct a randomised controlled trial (RCT).
    Design: This qualitative study was embedded within the GRRAND-Feasibility (GRRAND-F) Study.
    Setting: Participants were recruited from four acute National Health Service hospitals in England between 2020 and 2021.
    Participants: We interviewed four usual care and four intervention patient-participants from a single study site (Oxford). Six were male, two were female. All were white British ethnicity. We interviewed two physiotherapists from Oxford who delivered the GRRAND-F intervention, and physiotherapists from Birmingham, Poole and Norwich who were trained to deliver the intervention but were not able to deliver it within the study time frame.
    Results: The analysis identified five themes: (1) Acceptability, (2) Adherence, (3) Outcomes, (4) Feasibility and (5) Stand-alone themes (prehabilitation, video consultations, healthcare use).Patient-participants and physiotherapist-participants agreed that usual care was not meeting patients' rehabilitation needs. The GRRAND intervention provided biopsychosocial support. In comparison to the usual care group, patient-participants who received the intervention were more confident that they could perform rehabilitation exercises and were more motivated to engage in long-term adaptive behaviour change. Physiotherapists felt they needed more administrative support to participate in an RCT.
    Conclusion: Participants felt that usual care was insufficient. GRRAND provided much needed, biopsychosocial support to patients. Participants were supportive that it would be feasible to test GRRAND in an RCT.
    Trial registration number: ISRCTN11979997.
    MeSH term(s) Humans ; Male ; Female ; Feasibility Studies ; Physical Therapists ; Neck Dissection ; Qualitative Research ; Exercise Therapy ; Cost-Benefit Analysis
    Language English
    Publishing date 2022-11-14
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-064269
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  4. Article ; Online: Timing and volume of information produced for the Otolaryngologist during the COVID-19 pandemic in the UK: A review of the volume of online literature.

    Cernei, Cristina / Shrivastava, Manu K / Colquhoun-Flannery, William / Winter, Stuart C

    Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

    2020  Volume 46, Issue 2, Page(s) 318–324

    Abstract: Background: The SARS-CoV-2 was first reported in December 2019 in Wuhan, China and has been declared a pandemic in March 2020. COVID-19 has caused unprecedented and lasting biopsychosocial effects worldwide. All healthcare professionals have faced life- ... ...

    Abstract Background: The SARS-CoV-2 was first reported in December 2019 in Wuhan, China and has been declared a pandemic in March 2020. COVID-19 has caused unprecedented and lasting biopsychosocial effects worldwide. All healthcare professionals have faced life-threatening risks by attending their daily jobs. The daily emergence of advice and guidelines was necessary to ensure the safety of patients and staff. To this effect, all elective services came to a halt to preserve hospitals' capacity for dealing with the sickest. This retrospective, descriptive review aims to assess the volume and timing of the advice released specifically relevant to UK ENT specialists.
    Methods: Two separate searches were performed. One involved online advice published in English by international, national and ENT-specific organisations between January 1 and May 31. The date, title, source, type of advice and link to the advice were recorded in Excel. The resources were analysed per week of publication. A second separate search for peer-reviewed publications was conducted using PubMed Central and Cochrane databases.
    Findings: COVID-19-related guidance was considered, of which 175 were identified. 52/175 (29.7%) articles were published by international organisations. 56/175 (32%) were produced by national organisations, and 67/175 (38.28%) were produced by ENT specific organisations. The peak guidance production took place in the third and fourth week of March (16/03/2020-29/03/2020) with 72/175 publications. Of these, 27/70 came from the international category, 17/70 from national bodies and 26/70 from ENT-specific organisations. 13 863 total publications relating to COVID-19 were found using PubMed and Cochrane search strategies; 76% were relevant to ENT.
    Conclusion: The challenges faced by ENT relate to the unprecedented, sudden and daily changes to clinical practice. Multiple bodies interpreted the guidance, giving an opportunity for confusion and delay in treatments for patients. Implementing a system with clear lines of communication and dissemination of information will improve our response to future pandemic events whilst maintaining a commercial awareness to better use the human and financial resources of an already financially restricted NHS.
    MeSH term(s) Bibliometrics ; COVID-19/epidemiology ; Education, Medical, Continuing ; Humans ; Otolaryngologists/education ; Pandemics ; SARS-CoV-2 ; State Medicine ; United Kingdom/epidemiology
    Language English
    Publishing date 2020-12-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 2205891-6
    ISSN 1749-4486 ; 1749-4478 ; 0307-7772 ; 1365-2273
    ISSN (online) 1749-4486
    ISSN 1749-4478 ; 0307-7772 ; 1365-2273
    DOI 10.1111/coa.13669
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  5. Article: Trans-cutaneous electrical nerve stimulation to treat dry mouth (xerostomia) following radiotherapy for head and neck cancer. A systematic review.

    Salimi, Fatemeh / Saavedra, Francisco / Andrews, Brain / FitzGerald, James / Winter, Stuart C

    Annals of medicine and surgery (2012)

    2021  Volume 63, Page(s) 102146

    Abstract: Background: A dry mouth or xerostomia is one of the most common long-term complications following radiotherapy for head and neck cancer and has a negative impact on quality of life in cancer survivors. Transcutaneous electrical nerve stimulation (TENS) ... ...

    Abstract Background: A dry mouth or xerostomia is one of the most common long-term complications following radiotherapy for head and neck cancer and has a negative impact on quality of life in cancer survivors. Transcutaneous electrical nerve stimulation (TENS) is a novel approach to improving saliva flow in these patients.
    Objective: To perform a systematic review of studies evaluating TENS in the treatment of radiotherapy induced xerostomia in head and neck cancer patients.
    Data collection and analysis: A comprehensive electronic search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted in January 2020. Two review authors assessed all studies identified by the search strategy and carried out data extraction.
    Results: Five studies were included in the systematic review which analysed a total of 280 patients with head and neck cancer. Methodological quality and outcomes were evaluated in every study included. The outcome measure was either subjectively assessed or objectively measured. Three studies used conventional TENS therapy to stimulate parotid glands which produced a significant increase in saliva production following therapy. Two studies used acupunctured TENS type to electrically stimulate acupuncture points scattered in the body and they reported improvement in saliva production at the same level as medical treatment. No reported adverse effect of TENS was identified.
    Conclusions: This systematic review confirms the safety and feasibility of TENS in the treatment of xerostomia. It is established that commencing daily TENS therapy simultaneously with radiotherapy has the most efficacy. Given the nonspecific parameters used in the included studies, further evidence is needed in order to establish optimal settings and parameters of TENS for treatment of xerostomia.
    Language English
    Publishing date 2021-02-03
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2745440-X
    ISSN 2049-0801
    ISSN 2049-0801
    DOI 10.1016/j.amsu.2021.01.094
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  6. Article ; Online: Incidental findings on 18-FDG PET-CT in head and neck cancer. A retrospective case-control study of incidental findings on 18-FDG PET-CT in patients with head and neck cancer.

    Casselden, Elizabeth / Sheerin, Fintan / Winter, Stuart C

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2018  Volume 276, Issue 1, Page(s) 243–247

    Abstract: Purpose: Use of 18-FDG PET-CT is increasing in patients with head and neck cancer, enabling the identification of metastases or synchronous malignancies, but also 'incidental' disease. We aimed to establish the rate of 'incidental' findings resulting ... ...

    Abstract Purpose: Use of 18-FDG PET-CT is increasing in patients with head and neck cancer, enabling the identification of metastases or synchronous malignancies, but also 'incidental' disease. We aimed to establish the rate of 'incidental' findings resulting from 18-FDG PET-specific imaging, that would not have been otherwise identified on other imaging, in patients with head and neck cancer undergoing staging or surveillance of disease.
    Methods: 18-FDG PET-CT was performed for investigation or surveillance. Case notes were reviewed retrospectively. Unexpected findings identifiable on CT imaging alone, or by FDG-PET were recorded. For those only identifiable with FDG-PET, findings were divided into either 'incidental' or 'intentional', and benign or malignant.
    Results: 93 patients underwent 18- FDG PET-CT. 86.0% had new pathology identified. 3.2% had a new malignancy identified. 37.6% had new findings on FDG-PET that would not have been identified on CT alone: 5.4% had 'intentional findings' (metastasis), and 32.3% had 'incidental findings' (synchronous malignancy or benign). 1.1% had a new malignancy on FDG-PET alone.
    Conclusions: Intentional and incidental findings are likely on 18-FDG PET-CT. Whilst important for patient management, there is an associated emotional and financial cost, which needs acknowledgement and further investigation.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Fluorodeoxyglucose F18/pharmacology ; Head and Neck Neoplasms/diagnosis ; Humans ; Incidental Findings ; Male ; Middle Aged ; Positron Emission Tomography Computed Tomography/methods ; Radiopharmaceuticals/pharmacology ; Retrospective Studies
    Chemical Substances Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2018-12-10
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-018-5203-1
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  7. Article ; Online: Functional Outcomes Following Total Laryngectomy and Pharyngolaryngectomy: A 20-Year Single Center Study.

    Layton, Thomas / Thomas, Rachel / Harris, Carol / Holmes, Sam / Fraser, Lisa / Silva, Priy / Winter, Stuart C

    The Annals of otology, rhinology, and laryngology

    2022  Volume 131, Issue 12, Page(s) 1301–1309

    Abstract: Background: Laryngeal cancer accounts for 1% of all cancers in men and 0.3% of all cancers in women. Pharyngolaryngectomy (TPL) and total laryngectomy (TL) are central surgical techniques in the management of advanced laryngeal malignancies but are ... ...

    Abstract Background: Laryngeal cancer accounts for 1% of all cancers in men and 0.3% of all cancers in women. Pharyngolaryngectomy (TPL) and total laryngectomy (TL) are central surgical techniques in the management of advanced laryngeal malignancies but are associated with significant morbidity. In addition, optimal reconstruction following TPL remains an area of active research.
    Methods: Here, we compared speech and swallowing outcomes following circumferential and partial pharyngeal resection alongside total laryngectomy in patients with laryngeal and hypolaryngeal tumors. We performed a systemic analysis of patient demographics, tumor characteristics, treatment modality, and pharyngeal reconstruction technique following TPL and TL, leveraging data collected over a 20-year period at a large tertiary referral center.
    Results: Analyzing 155 patients the results show circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications.
    Conclusion: Pharyngeal resection carries a substantial risk of incurring impaired speech and swallowing in patients. Moreover, our results support poorer functional outcomes with more radical pharyngeal resections and show a clear trend toward worse swallowing outcomes in salvage surgery.
    MeSH term(s) Female ; Humans ; Laryngeal Neoplasms/pathology ; Laryngectomy/methods ; Male ; Pharyngectomy ; Retrospective Studies ; Salvage Therapy
    Language English
    Publishing date 2022-01-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120642-4
    ISSN 1943-572X ; 0003-4894
    ISSN (online) 1943-572X
    ISSN 0003-4894
    DOI 10.1177/00034894211072987
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  8. Article ; Online: Using immersive technology and architectural design to assist head and neck cancer patients' recovery from treatment: A focus group and technology acceptance study.

    Greenway, Kathleen / Frisone, Caterina / Placidi, Andrea / Kumar, Sanjay / Guest, Will / Winter, Stuart C / Shah, Ketan / Henshall, Catherine

    European journal of oncology nursing : the official journal of European Oncology Nursing Society

    2022  Volume 62, Page(s) 102261

    Abstract: Purpose: Head and neck cancer patients can face debilitating treatment related side-effects, resulting in requirement for support and negatively impacting on care outcomes. This study aimed to develop a digital recovery support package and assess its ... ...

    Abstract Purpose: Head and neck cancer patients can face debilitating treatment related side-effects, resulting in requirement for support and negatively impacting on care outcomes. This study aimed to develop a digital recovery support package and assess its acceptability with head and neck cancer patients to support their information needs and assist with their self-management. It provided additional support through development of a WebXR platform 'recovery' package, which allowed patients to live a 'virtual reality' experience, entering and moving inside a 'virtual room', accessing targeted resources and specific learning materials related to their cancer.
    Method: A qualitative intervention development study consisting of three phases. This study followed the COREQ checklist for qualitative research. Phase 1- Focus groups with seven head and neck cancer patients and six healthcare professionals. Phase 2- Development of 'recovery' package based on the focus group data which informed the content and design of the WebXR recovery platform. Phase 3- Technology acceptance study. Once developed, the platform's acceptability of the experience lived inside the virtual room was assessed via qualitative interviews with six different patient participants.
    Results: Most participants felt comfortable using the virtual reality platform, finding it a realistic and useful support for identifying resources and signposting to relevant materials. Participants agreed the WebXR platform was a feasible tool for the head and neck cancer setting and helped reduce anxiety.
    Conclusions: Head and neck cancer patients welcome specific targeted, information and advice to support their ability to self-manage their rehabilitation and thus focus their nursing care. The platform was implemented during the Covid-19 pandemic, demonstrating its versatility and accessibility in providing complementary support to head and neck cancer patients, to empower them to adjust to their 'new' normal as part of their ongoing cancer journeys.
    MeSH term(s) Humans ; Focus Groups ; Pandemics ; COVID-19 ; Head and Neck Neoplasms/therapy ; Qualitative Research
    Language English
    Publishing date 2022-12-22
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2017117-1
    ISSN 1532-2122 ; 1462-3889
    ISSN (online) 1532-2122
    ISSN 1462-3889
    DOI 10.1016/j.ejon.2022.102261
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  9. Article ; Online: Getting Recovery Right After Neck Dissection (GRRAND-F): mixed-methods feasibility study to design a pragmatic randomised controlled trial protocol.

    Gallyer, Victoria / Smith, Toby O / Fordham, Beth / Dutton, Susan / Chester-Jones, Mae / Lamb, Sarah E / Winter, Stuart C

    BMJ open

    2021  Volume 11, Issue 6, Page(s) e045741

    Abstract: Introduction: We will evaluate the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention on pain, function and health-related quality of life following neck dissection (ND) ... ...

    Abstract Introduction: We will evaluate the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention on pain, function and health-related quality of life following neck dissection (ND) after head and neck cancer (HNC).
    Methods and analysis: This is a pragmatic, multicentred, feasibility study. Participants are randomised to usual care (control) or usual care plus an individualised, rehabilitation programme (Getting Recovery Right After Neck Dissection, GRRAND intervention). Adults aged over 18 with HNC for whom ND is part of their care will be recruited from specialist clinics. Participants are randomised in 1:1 ratio using a web-based service. The target sample size is 60 participants. Usual care will be received by all participants during their postoperative inpatient stay consisting standard National Health Service care supplemented with a booklet advising on postoperative self-management strategies. The GRRAND intervention programme consists of usual care plus up to six individual physiotherapy sessions including neck and shoulder range of motion (ROM) and progressive resistance exercises, advice and education. Between sessions participants will be advised to complete a home exercise programme. The primary outcome is to determine recruitment and retention rates from study participants across sites. Outcomes will be measured at 6 and 12 months. Participants and physiotherapists will be invited to an optional qualitative interview at the completion of their involvement in the study. The target qualitative sample size is 15 participants and 12 physiotherapists. Interviews aim to further investigate the feasibility and acceptability of the intervention and to determine wider experiences of the study design and intervention from patient and physiotherapist perspectives.
    Ethics and dissemination: Ethical approval was given on 29 October 2019 (National Research Ethics Committee Number: 19/SC/0457). Results will be reported at conferences and in peer-reviewed publications.
    Trial registration number: ISRCTN11979997.
    Status: Trial recruitment is ongoing and is expected to be completed by 30 August 2021.
    MeSH term(s) Adult ; Cost-Benefit Analysis ; Exercise Therapy ; Feasibility Studies ; Humans ; Neck Dissection ; Quality of Life ; Randomized Controlled Trials as Topic ; State Medicine
    Language English
    Publishing date 2021-06-21
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2020-045741
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  10. Article ; Online: Use of the self-retaining Alexis ring retractor in transoral robotic surgery.

    Perenyei, Miklos / Dobbs, Thomas D / Fraser, Lisa R / Winter, Stuart C

    Head & neck

    2017  Volume 39, Issue 10, Page(s) 2132–2134

    Abstract: Background: Ring retractors, such as the Alexis® wound retractor, are simple devices used in a wide range of surgical settings to provide atraumatic exposure while protecting wound edges.: Methods: Here, we describe the application of the Alexis® to ... ...

    Abstract Background: Ring retractors, such as the Alexis® wound retractor, are simple devices used in a wide range of surgical settings to provide atraumatic exposure while protecting wound edges.
    Methods: Here, we describe the application of the Alexis® to provide access during transoral robotic surgery (TORS).
    Conclusion: Its ease of application and many benefits, including maximization of intraoral space and protection of perioral soft tissues, make this device an excellent adjunct for TORS procedures.
    MeSH term(s) Humans ; Mouth/surgery ; Natural Orifice Endoscopic Surgery/instrumentation ; Natural Orifice Endoscopic Surgery/methods ; Robotic Surgical Procedures/instrumentation ; Robotic Surgical Procedures/methods ; Surgical Instruments
    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article ; Technical Report
    ZDB-ID 645165-2
    ISSN 1097-0347 ; 0148-6403 ; 1043-3074
    ISSN (online) 1097-0347
    ISSN 0148-6403 ; 1043-3074
    DOI 10.1002/hed.24882
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