OBJECTIVES:Extra-cochlear electrodes (EEs) are a frequent complication in cochlear implant (CI) surgery, potentially leading to reduced speech-perception outcomes. Standard intraoperative tools such as contact impedances and electrically evoked compound action potentials often fail to detect these misplaced electrodes. Stimulation Current-Induced Non-Stimulating Electrode Voltages (SCINSEVs), or electrical field imaging (EFI) in the advanced bionics device, are presented here as a faster and more accurate intraoperative measure for identifying EE. Adopting this method clinically could reduce reliance on intraoperative or postoperative imaging and allow EE identification in the critical window of surgery, when immediate correction can occur. DESIGN:This prospective intraoperative study tested adult CI candidates or users undergoing new or revision surgery at a single institution. EFI measurements were recorded during electrode insertion, where the surgeon was asked to hold a randomly selected number of 1 to 6 electrodes outside of the cochlea before full insertion. Visual confirmation of the number of EE electrode positions was achieved with the surgical microscope. Recordings were taken simulating postoperative conditions (with EE surrounded by blood or fascia). Three expert reviewers blinded to surgical outcomes reviewed EFI data to identify the number of EEs. Agreement between reviewers and surgeons was analyzed using correlations, receiver operating characteristic plots, and sensitivity and specificity calculations. RESULTS:General linear models revealed significant effects of the number of EEs not inserted by the surgeon (0 to 6 EEs) and the reviewer (1 to 3) on the EE ranking error, and no effects of the surgery type (revision or first-time cochlear implantation), nor of the material used (blood or fascia). A correlation was observed between the number of not-inserted EEs and EEs ranked based on the EFIs (r = 0.63, p < 0.0001). For identification of the presence or absence of EEs based on visual inspection of SCINSEVs, an overall sensitivity of 95.9% and a specificity of 40.7% were achieved (97.9% and 65.7% with ±2 EE reviewer-surgeon agreement tolerance). CONCLUSIONS:SCINSEVs are a rapid, reliable tool for intraoperative EE detection. With high sensitivity and moderate specificity, they offer a non-radiative alternative to postoperative computerized tomography, with results available during the surgical procedure. Use of this tool may improve CI outcomes through immediate surgical correction. The authors recommend training of relevant clinical staff to record and interpret these measurements for use within clinical practice.

Eustachian tube (ET) dysfunction exists along a spectrum from obstructive to patulous phenotypes, yet no single gold-standard diagnostic test exists. This review examines current methods for assessing ET function alongside evolving therapeutic interventions. Clinical assessment and patient-reported outcome measures alone have limited diagnostic power. Objective tests, including tympanometry, advanced manometric techniques, and sonotubometry, each offer distinct strengths and limitations. Evidence shows that individual tests demonstrate variable sensitivity and specificity and perform best when combined. An integrated diagnostic approach that incorporates clinical history within a curated pathway of complementary objective measures is advocated to improve diagnostic accuracy and guide intervention selection.

Randomised Controlled Trials (RCTs) are the gold standard for evaluating the efficacy of interventions; yet, traditional methods involving multiple recruitment sites often involve significant logistical and financial challenges. The DEFINE trial demonstrates the feasibility of a decentralised approach to RCTs by comparing smartphone-delivered self-guided tinnitus therapy against one-to-one therapist-facilitated treatment for tinnitus. This trial was conducted entirely remotely, leveraging digital technologies for remote recruitment, data collection, and intervention delivery. A total of 210 participants were recruited through social media platforms over a five-month period. Participants were screened and enrolled by a central trial team remotely, who utilised hearing test smartphone applications and electronic consent forms. Baseline and follow-up assessments were conducted using electronic data capture (EDC) platforms, with high retention rates observed at each time point. The trial successfully recruited and retained participants, demonstrating the efficiency and cost-effectiveness of remotely managed trials. Key findings include a high engagement rate from social media ads, with 151,978 impressions leading to 4,997 clicks (3.3%), with a direct advertising spend of £880. 912 individuals self-screened for eligibility online. The median age of participants was 58.3 years, in line with comparable traditionally-recruiting tinnitus studies, with good geographical distribution across the UK. The trial's adaptability allowed for protocol adjustments, and real-time monitoring of data quality and completeness. The DEFINE trial demonstrates that decentralised RCTs can offer a viable alternative to traditional RCTs for some hearing and tinnitus research, potentially increasing participant diversity and reducing the burden of research on participants, while maintaining rigorous standards of data collection and participant safety. Increasing clinical use of remote audiological assessment, and hearing implant programming provide increasing opportunities for the adoption of entirely remote or hybrid studies in hearing and tinnitus conditions.

OBJECTIVE:To determine if a break from cochlear-implant (CI) stimulation reduces auditory electrical stimulation levels, to manage secondary facial nerve stimulation (FNS). STUDY DESIGN:Retrospective case review. SETTING:Multidisciplinary clinic within a CI tertiary-care center. PATIENTS:Four adult CI users exhibiting FNS at stimulation levels needed for auditory perception. INTERVENTION:Taking a break from CI stimulation (temporary nonuse) to test the hypothesis that FNS arose from increasing auditory stimulation. An increase in auditory stimulation levels may stem from a decrease in auditory-nerve excitability due to overstimulation. A break would allow recovery of excitability, leading to lower current use and less cross-stimulation of the facial nerve. Break duration ranged between 1 week to several months. MAIN OUTCOME MEASURES:Lower and upper electrical stimulation levels required for hearing (N=3), reported or observed FNS (N=4), and FNS thresholds (N=1) before and after the break. RESULTS:In all cases for whom stimulation levels for hearing were measured both before and after a break ( Patients 1 to 3 ), these decreased after the break. In 2 of these cases, the decreased stimulation levels helped to manage persistent FNS. In one other case ( Patient 4 ), FNS thresholds decreased slightly or remained unchanged after the break and the stimulation of most electrodes continued to lead to FNS with no change in auditory perception. CONCLUSIONS:A break from CI stimulation could be considered to manage persistent FNS when auditory stimulation levels increase over time. In some cases, a break may reduce the stimulation levels required for hearing, minimizing or eliminating the occurrence of FNS. Further research is needed to determine the biological mechanisms involved, optimize the duration of the break, as well as determine its long-term effectiveness.

The World Health Organization (WHO) estimate that by 2050 approximately 2 billion people worldwide will have a degree of hearing impairment, and more than 700,000,000 will require hearing rehabilitation. The presentation and aetiology of patients with hearing loss changes with age, and this can be a useful starting point for an assessment. Another important discriminator in the approach to patients with hearing loss is the timing of onset, which will differentiate those needing urgent management from the more routine. Hearing loss may be ‘conductive’, due to blockage of sound passage to the inner ear, which is often reversible, or ‘sensorineural’, due to damage to the inner ear or auditory nerve such as seen in age-associated hearing loss (also known as presbycusis), which is usually permanent. This article aims to provide a systematic framework for assessing these patients in primary care and a guide to indicate when referrals to secondary care are necessary.

Introduction: Gastrointestinal (GI) symptoms are some of the most common non-motor symptoms in Parkinson's. Weight is a nutritional metric and can be affected by dysfunction of the gastrointestinal (GI) tract. This study aims to explore the change in trajectory of body mass index (BMI) in individuals with Parkinson's over the course of the disease including the prodromal and post-diagnostic periods. Methods: This was a retrospective longitudinal study of data from participants from the PRIME Parkinson UK cross-sectional study. Participants were included if they had had one or more weights and height recorded in the primary care electronic health record. Results: 287 patients were initially included but only 234 could be included in the analysis of BMI trajectory. Using a piecewise linear mixed model, we determined that there was a 'change point' in BMI trajectory. This occurred on average 3.73 years after diagnosis, when the mean BMI was 26.4 kg/m2. Prior to this change point, the estimated mean rate of change in BMI was -0.09 kg/m2 (95 % credible interval -0.20,0.00 kg/m2) per year. However, after the change point, we observed a more accelerated decline in BMI, with an estimated mean rate of change of -0.34 kg/m2 (95 % credible interval -0.70,-0.07 kg/m2) per year. Conclusion: There was a modest weight loss trajectory in the pre-diagnostic period consistent with clinically stable weight. However, after several years, post-diagnosis BMI loss became more marked. In clinical practice interventions could be targeted at this time point to optimize and maintain nutritional intake.

INTRODUCTION:Remote healthcare has demonstrated benefits in providing high quality care, improving patient access, and reducing morbidity. In ear, nose, and throat surgery, there has been a recent surge in remote care driven by advancements including endoscopic otoscopy and boothless audiometry, as well as the coronavirus pandemic, but uncertainty exists regarding the minimum data needed for accurate remote diagnosis. METHODS:A panel of otology, audiology, general practice, and audiovestibular physicians was invited, and a literature review was undertaken to populate candidate dataset items for Round 1 of the Delphi process using the web-based software, Welphi. This was followed by two further Rounds, with controlled anonymised item-rating and qualitative feedback between rounds. Finally, a consensus meeting analysed and organised the results for dissemination of the final consensus outcomes. RESULTS:Seventy studies were used to populate the questionnaire in Round 1. Thirty-four multi-disciplinary expert panellists determined the final data items across the 3 Delphi Rounds. Experts worked at over 16 different centres across the United Kingdom. There was an average response rate of 94% across all rounds. DISCUSSION:This study highlights a multidisciplinary team's consensus essential dataset for effective remote ear assessment. With NHS waiting lists at an all-time high, remote assessment capacity could alleviate strain and enhance patient care. This initiative will facilitate novel service and pathway redesign with the aim of ensuring all patients have access to high-quality ear assessments, regardless of location. We are also hopeful that this standardised dataset will also facilitate research and audit of remote ear services.

BACKGROUND:Eustachian tube dysfunction (ETD) causes symptoms and signs of pressure dysregulation in the middle ear, and is associated with tympanic membrane retraction, otitis media with effusion, and chronic otitis media. Interventions aiming to improve symptoms can be non-surgical or surgical, including balloon dilatation of the Eustachian tube, also known as balloon eustachian tuboplasty (BET) for obstructive ETD. However, existing published evidence for the effectiveness and safety of BET remains unclear. OBJECTIVES:To evaluate the effects of balloon dilatation of the Eustachian tube in adults with obstructive Eustachian tube dysfunction. SEARCH METHODS:The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid M>DLINE; Ovid Embase; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The final search was updated on 18th January 2024. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA:Randomised controlled trials were included if they allocated adult participants with chronic obstructive ETD to treatment randomly and compared BET with non-surgical treatment, no treatment, or other surgical treatment. Studies with other designs were excluded. DATA COLLECTION AND ANALYSIS:At least two review authors independently selected trials using predetermined inclusion criteria, assessed the risk of bias, extracted data, and rated the certainty of evidence (CoE) according to GRADEpro. Statistical analyses were performed using a random-effects model and interpreted according to the most recent version of the Cochrane Handbook. Predefined primary outcomes were obstructive ETD symptoms, Eustachian tube function (objective or semi-objective tests), or serious adverse events. Secondary outcomes were hearing, tympanic membrane abnormalities, quality of life, and other adverse events. MAIN RESULTS:Nine trials were identified with 684 randomised participants across three comparisons: BET versus non-surgical treatment (five trials, 422 participants), BET versus no treatment (sham surgery; one trial, 17 participants), and BET versus other surgery (four trials, 275 participants). None of the studies were rated with an overall low risk of bias. Comparing BET to non-surgical treatment up to three months, there is low-certainty evidence showing that BET may reduce patient-reported ETD symptoms (change in ETDQ-7: mean difference (MD) -1.66 (95% CI -2.16 to -1.16; I2 = 63%; 4 RCTs, 362 participants)). There is very low-certainty evidence that BET may improve ETD as assessed by objective or semi-objective measures (improvement in tympanometry: RR 2.51 (95% CI 1.82 to 3.48; I2 = 0%; 3 RCTs, 369 participants). Between three and 12 months, the evidence is very uncertain whether BET reduces ETDQ-7: MD -0.55 (-1.31 to 0.21; 1 RCT, 24 participants). The evidence is very uncertain whether BET improves ETD as assessed by objective or semi-objective measures (improvement in tympanometry: RR 2.54 (95% CI 0.91 to 7.12)). Evidence was downgraded for risk of bias, imprecision, indirectness, or a combination of these. Comparing BET to no treatment (sham surgery trial) up to three months, there is very low-certainty evidence that BET improves ETD as assessed by patient-reported ETD symptoms (change in ETDQ-7: MD -0.54 (95% CI -2.55 to 1.47; 1 RCT, 17 participants)). Between three and 12 months, the evidence is very uncertain whether BET improves ETD as assessed by ETDQ-7 (MD 0.16 (95% CI -0.75 to 1.07; 1 RCT, 17 participants)). Evidence was downgraded for indirectness and twice for imprecision. Although there were no serious adverse events reported, these studies were underpowered to detect adverse events and were performed by highly trained and experienced investigators under strict study protocols. This could underestimate the true risk of adverse events by less experienced clinicians in everyday clinical practice. Evidence was rated as very low certainty, downgraded for risk of bias, imprecision, and indirectness. AUTHORS' CONCLUSIONS:BET may lead to a clinically meaningful improvement in ETD symptoms compared to non-surgical or no treatment (in the form of sham surgery) at up to three months. The effects of BET on ETD compared to non-surgical treatment are very uncertain beyond three months. However, the certainty of evidence ranged from low to very low, with the studies being underpowered to detect adverse events. The findings of this review should help to inform further BET research and guidelines. Future research should focus on longer-term outcomes and the incidence of adverse events or complications in real-world practice settings.

Hearing loss is a significant health burden across all stages of life. One in 5 people suffer hearing loss, with 5% of the world's population experiencing disabling hearing loss. A large proportion of this loss is the consequence of damage or loss of neurosensory structures, termed "sensorineural" hearing loss. A recent advance in the treatment of sensorineural hearing loss has occurred, with the advent of inner ear stem cell therapy. Focus has pivoted from augmenting existing neural structures to regenerating neural frameworks. To date, stem cell therapy is limited by the host immune system and rejection of donor cells. A better understanding of immunity in the inner is ear required to progress stem cell therapy for hearing loss. This review outlines a contemporary understanding of the inner ear immune system. We discuss concepts of immune dysregulation that may lead to common inner ear pathologies, and, in doing so, review the efficacy of current pharmacotherapies that mitigate end organ damage through a process of immunosuppression. Current literature is appraised through a systematic review exploring two areas of focus; immunosuppression therapies for the treatment of inner ear pathology associated immune dysregulation, and, subsequently, the efficacy of immunosuppressive agents in translational models of inner ear stem cell therapy. Through greater understanding of these concepts, and systematic appraisal of the literature, this review summarises the literature for contemporary immunosuppressive regimes that may facilitate stem cell accommodation in the cochlea and auditory nerve.

Background Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. Methods and findings A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. Conclusions The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.

Objective: This case series describes the outcomes of airway management, including airway reconstruction, in 6 patients with campomelic dysplasia and tracheostomy/ventilator dependence secondary to multilevel airway obstruction. Methods: Case series and clinical guidelines are provided for the airway management of patients with campomelic dysplasia. Results: Average age of individuals is 19.4 years. Mean follow-up was 12.2 years. Four individuals underwent open airway reconstruction and achieved decannulation. One patient underwent airway reconstruction with improvement of a complete subglottic stenosis but remains ventilator dependent due to severe scoliosis. The remaining 2 patients did not require additional airway reconstruction, have been liberated from ventilator support, and are under evaluation for tracheostomy tube decannulation. Conclusion: Although campomelic dysplasia was historically considered a lethal form of congenital skeletal dysplasia, with many patients succumbing to respiratory failure due to tracheobronchomalacia in the neonatal period, airway reconstruction and long-term survivorship is feasible in children with campomelic dysplasia and significant airway disease.

AbstractObjectivesTo establish audiological and other outcomes following cochlear implantation in humans and animals with eluting electrodes.MethodsSystematic review and narrative synthesis. Databases searched (April 2023): MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and Web of Science. Studies reporting outcomes in either humans or animals following cochlear implantation with a drug‐eluting electrode were included. No limits were placed on language or year of publication. Risk of bias assessment was performed on all included studies using either the Brazzelli or Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) assessment tools. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 statement.ResultsSearches identified 146 abstracts and 108 full texts. Of these, 18 studies met the inclusion criteria, reporting outcomes in 523 animals (17 studies) and 24 humans (1 study). Eluting electrodes included dexamethasone (16 studies), aracytine (1 study), nicotinamide adenine dinucleotide (1 study), the growth factors insulin‐like growth factor 1 (IGF1) and hepatocyte growth factor (HGF) (1 study), and neurotrophin‐3 (1 study). All included studies compare outcomes following implantation with an eluting electrode with a control non‐eluting electrode. In the majority of studies, audiological outcomes (e.g., auditory brainstem response threshold) were superior following implantation with an eluting electrode compared with a standard electrode. Most studies which investigated post‐implantation impedance reported lower impedance following implantation with an eluting electrode. The influence of eluting electrodes on other reported outcomes (including post‐implantation cochlear fibrosis and the survival of hair cells and spiral ganglion neurons) was more varied across the included studies.ConclusionsEluting electrodes have shown promise in animal studies in preserving residual hearing following cochlear implantation and in reducing impedance, though data from human studies remain lacking. Further in‐human studies will be required to determine the clinical usefulness of drug‐eluting cochlear implants as a future treatment for sensorineural hearing loss.

OBJECTIVES:This systematic review and meta-analysis aimed to estimate the rate of taste disturbance following cochlear implantation. METHODS:The review was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies psychophysically measured taste. DerSimonian and Laird random-effects models were used. An overall mean from studies reporting a single mean of taste strip performance was calculated using inverse variance method for pooling. RESULTS:Of 380 studies identified, 9 were included across which 55 cases of postoperative taste disturbance were reported in 498 patients. Taste was tested at variable timepoints, from <1 week to ≥6 months postoperatively. The overall rate of postoperative taste disturbance was 13.5% (95% CI, 7.6-20.7%) with high heterogeneity between studies (I2 = 62%). DISCUSSION:13.5% might indicate a higher prevalence of taste disturbance following cochlear implantation compared to the general population. However, the confidence we can assign to our calculated rate is limited by significant heterogeneity and potential publication bias. Studies reporting mean taste strip scores generally found reduced taste function on the side of the tongue ipsilateral to implantation, but this reduction wasn't statistically significant. CONCLUSION:Further research, employing more robust and standardised methodologies, is necessary to accurately ascertain the rate and nature of taste disturbance following cochlear implantation.

Tinnitus is a common health condition, affecting approximately 15% of the UK population. The tinnitus treatment with the strongest evidence base is Cognitive Behavioural Therapy (CBT), with standard tinnitus therapy typically augmented with education, relaxation and other techniques. Availability of CBT and conventional tinnitus therapy more broadly is limited for tinnitus sufferers. The DEFINE trial aims to assess whether smartphone-delivered tinnitus therapy, the Oto app, is as effective as current standard care, one-to-one therapist-delivered tinnitus treatment for the treatment of tinnitus in adults. The trial is registered in the ISRCTN Registry: ISRCTN99577932 . DEFINE is an open-label, non-inferiority, prospective, parallel design, randomised-controlled trial. Recruitment, interventions and assessments will be remote, enabling UK-wide participant involvement. 198 participants aged 18 years or more will be recruited via social media advertisement or via primary care physicians. A screening process will identify those with tinnitus that impacts health-related quality of life, and following consent smartphone-based audiometry will be performed. Randomisation 1:1 to the Oto app or one-to-one therapist-led tinnitus therapy will be performed centrally by computer, matching groups for age, sex and hearing level. Following participant allocation, the Oto app will be provided for immediate use, or a one-to-one remote therapy appointment booked to occur within approximately 1 week, with up to 6 sessions delivered. Participant outcomes will be collected at 4,12, 26 and 52 weeks via questionnaire and phone call. The primary outcome is the change in Tinnitus Functional Index (TFI) total score measured at 26 weeks following allocation. Adverse events will be recorded. A health economic evaluation in the form of a cost-utility analysis will be performed using data from participant submitted EuroQol 5D-5L and Health Utilities Index Mark 3 scores and resource use data. Trial results will be made publicly available, including a plain English summary.

Background Pharmacologic immunosuppression regimes are commonly employed in stem cell clinical trials to mitigate host immune rejection and promote survival and viability of transplanted cells. Immunosuppression and cell survival has been extensively studied in retinal and spinal tissues. The applicability of stem cell therapy is rapidly expanding to other sensory organs such as the ear and hearing. As regenerative therapy is directed to new areas, a greater understanding of immunosuppression strategies and their efficacy is required to facilitate translation to organ-specific biologic microenvironments. Objective This systematic review appraises the current literature regarding immunosuppression strategies employed in stem cell trials of retinal and neural cells. Methods This systematic review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included studies presenting data on neural or retinal cells as part of an in-human clinical trial that detailed the immunosuppression regime used. Exclusion criteria included non-English language studies, animal studies, review articles, case reports, editorials, and letters. The databases Medline, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to February 2024. Risk of bias was evaluated using the ROBINS-I tool. Results Eighteen articles fit the inclusion criteria. Nine articles concerned retinal cells, 5 concerned spinal cord injury, and 4 concerned amyotrophic lateral sclerosis. A multi-drug and short-term immunosuppression regime were commonly employed in the identified studies. Detected immune responses in treated patients were rare. Common immunosuppression paradigms included tacrolimus, mycophenolate mofetil and tapering doses of steroids. Local immunosuppression with steroids was employed in some studies concerning retinal diseases. Discussion A short-term course of systemic immunosuppression seemed efficacious for most included studies, with some showing grafted cells viable months to years after immunosuppression had stopped. Longer-term follow-up is required to see if this remains the case. Side effects related to immunosuppression were uncommon.

Objective The UK Medical Licensing Assessment curriculum represents a consensus on core content, including ENT-related content for newly qualified doctors. No similar consensus exists as to how ENT content should be taught at medical school. Method A virtual consensus forum was held at the 2nd East of England ENT Conference in April 2021. A syllabus of ENT-related items was divided into ‘Presentations’, ‘Conditions’ and ‘Practical procedures’. Twenty-seven students, 11 foundation doctors and 7 other junior doctors voted via anonymous polling for the best three of nine methods for teaching each syllabus item. Results For ‘Presentations’ and ‘Conditions’, work-based or clinical-based learning and small-group seminars were more popular than other teaching methods. For ‘Practical procedures’, practical teaching methods were more popular than theoretical methods. Conclusion Students and junior doctors expressed a clear preference for clinical-based teaching and small-group seminars when learning ENT content. E-learning was poorly favoured despite its increasing use.