Chronic rhinosinusitis (CRS) is a globally prevalent inflammatory disease that seriously impairs quality of life. While advances in monoclonal antibody (mAb) therapies have transformed CRS management, mAbs have failed to induce disease remission with symptom return upon withdrawal of treatment. This pattern suggests that, in addition to inflammatory pathways, alternative mechanisms may contribute to CRS pathogenesis. In 2025, our department published the first benchmarking study for sinus microbiome sequencing, finding that the 16S rRNA methods applied in all prior studies significantly distorted samples, with only metagenomic analysis providing accurate results. Hence, to definitively investigate the role of dysbiosis in CRS, we have conducted the first international sinus microbiome study to integrate paired shotgun metagenomic and 16S rRNA sequencing. Samples were collected by endoscopically guided middle meatal swab from 432 participants (174 controls; 155 CRS with nasal polyps [CRSwNP]; 103 CRS without nasal polyps [CRSsNP]), across 14 centres in 9 countries. Metagenomic libraries were prepared using the ONT native barcoding kit and sequenced on the PromethION platform. Data was analysed using an in-house pipeline and custom database with Sourmash for taxonomic assignment. CRS microbiomes differed significantly from non-CRS controls and between disease phenotypes. Corynebacterium accolens was most strongly associated with health (p=0.001, β=5), followed by D. pigrum (p=0.017, β=2). In contrast, P. aeruginosa, S. pneumoniae, and H. influenzae were significantly enriched in CRS (p<0.05, ß=3;4;4). Staphylococcus aureus was associated with CRSwNP (p=0.033, ß=6), while C. kefirresidentii was selectively enriched in CRSsNP (p=0.008, ß=4). This study provides the first international evidence defining dysbiosis in CRS and linking clinically relevant bacteria to both disease presence and phenotype. These findings recentre the sinonasal microbiome in CRS aetiopathogenesis and support its potential as a source of diagnostic, prognostic, and therapeutic targets.

Aim: Geographic barriers are commonly assumed to contribute to delays in cancer diagnosis and treatment. This study investigates the impact of travel distance on the presentation and survival outcomes in patients with oropharyngeal squamous cell carcinoma (OPSCC). Methodology: A retrospective review was conducted on 180 patients with OPSCC treated at St Vincent’s Hospital Melbourne between 2017 and 2022. Patients were classified as urban or regional based on median distance to hospital (≤31.4 km vs >31.4 km). Outcomes included stage at diagnosis, time from diagnosis to treatment, and overall and disease-specific survival. Statistical analyses included chi-square tests, Kaplan-Meier curves, and Cox proportional hazards regression. Results:No statistically significant differences were observed between urban and regional groups in T stage (p=0.41), N stage (p=0.71), overall stage (p=0.52), p16 status (p=0.55), or smoking status (p=0.40). A clinical trend toward higher staging in regional patients was noted. Median time to treatment was 29 days for urban patients vs. 32.5 days for regional patients (p=0.27). Delays >90 days occurred only in regional patients (5.7%, n=5/88) and there was a trend toward longer treatment delays in regional patients compared with urban patients (p=0.06). Multivariable survival analyses showed no significant differences in overall or disease-specific survival across any timepoint or remoteness classification. Conclusion:While travel distance was not associated with later stage at diagnosis or poorer survival, regional patients were more likely to experience prolonged treatment delays. This suggests that high volume tertiary referral head and neck oncology services help to reduce barriers to head and neck cancer treatment. Treatment timeliness remains a point of vulnerability highlighting the need for targeted support to reduce delays in regional patients, particularly those exceeding 90 days.

Aims Rapid Access Neck Lump Clinics (RANLCs) are designed to streamline the assessment, diagnosis and management of head and neck lumps, facilitating earlier cancer detection and treatment initiation. While established in several international centres, such clinics remains relatively uncommon in the Australian public health system. This study aimed to evaluate the impact of a multidisciplinary RANLC on diagnostic efficiency, waiting times and clinical outcomes over a five-year period. Methodology A consultant-led RANLC was established in a tertiary public hospital, incorporating a head and neck surgeon, radiologist and pathologist to enable comprehensive same-day evaluation. Data were collected prospectively for all patients attending the clinic between February 2018 and February 2023. Key performance metrics included time from referral to specialist review, time to multidisciplinary team (MDT) discussion, and time to treatment commencement. Diagnostic yield and malignancy rates were also analysed. Results A total of 437 consecutive patients were reviewed. The mean time from referral to specialist assessment was 16.1 ± 9.5 days. Ultrasound-guided fine needle aspiration (FNA) was performed in 61% of patients, identifying malignancy in 38.6%. The median time from specialist assessment to MDT discussion was 5 days, and the mean interval from clinic review to initiation of treatment was 39.3 days. These findings reflect significant streamlining of the diagnostic pathway and coordination of multidisciplinary care. Conclusions The introduction of a multidisciplinary rapid access neck lump clinic significantly reduced waiting times for diagnosis and treatment of head and neck cancer. This model demonstrates a feasible and effective approach to improving timely access to care within the Australian public health system, aligning with international best practice.

Introduction: Rates of oropharyngeal squamous cell carcinoma have been on the rise in Australia for several decades.(1) In fact, it is now the most common mucosal head and neck cancer to be diagnosed in Queensland. (2). Definitive radiotherapy (RT) with or without concurrent cisplatin based chemotherapy is the contemporary standard of care in non-surgical, curative intent treatment of locoregionally advanced head and neck SCC.(2) However, RT is associated with significant post-treatment morbidity and mortality, and it is estimated that complications from RT arise in 4 to 37% of all patients. Methods: We conducted a retrospective cohort study of patients treated for oropharyngeal cancer at Fiona Stanley Hospital between January 2015 and December 2025 to determine the occurrence of soft tissue necrosis. Results: In univariate analysis, smoking history and tumour stage were significantly associated with soft tissue necrosis, with current or past smokers having higher odds of the complication. Other factors- including age, radiation dose, chemotherapy, subsite, p16 status, diabetes and anticoagulant use- were not significantly associated, and sparse event counts limited interpretation for some categorical variables. Conclusion: In conclusion, radiation induced soft tissue necrosis in oropharyngeal cancer patients is rare. In this cohort, smoking and advanced tumour stage appear to be associated with higher risk of developing necrosis, emphasising the need for careful monitoring in this group. 1.Fan KM, Sprague S, Zhang P, Ariyawardana A, Johnson NW. Rates of oropharyngeal cancer continue to rise steeply amongst Australian men. Oral Diseases. 2023;29(5):1959–66. 2.Gupta T, Maheshwari G, Gudi S, Chatterjee A, Phurailatpam R, Prabhash K, et al. Radiation necrosis of the bone, cartilage or cervical soft-tissues following definitive high-precision radio(chemo)therapy for head-neck cancer: an uncommon and under-reported phenomenon. The Journal of Laryngology & Otology. 2021;136(5):447–53.

Purpose: Post-tonsillectomy bleeding (PTB) is a common cause of emergency department (ED) presentation and can be life-threatening. Primary PTB is less frequent but often requires urgent intervention. Safe management depends on effective multidisciplinary (MDT) coordination, early haemostatic measures, risk stratification, and timely escalation. Methodology: This presentation draws on two related experiences illustrating MDT approaches to PTB, both published in the International Journal of Pediatric Otorhinolaryngology. The first is the STOP study, which evaluated nebulised tranexamic acid (TXA) as an early haemostatic adjunct for patients presenting to a tertiary paediatric ED with non-severe PTB, assessing feasibility and impact on local practice. The second is a national, multicentre case series of catastrophic primary PTB following intracapsular tonsillectomy, demonstrating escalation pathways for severe haemorrhage, including return to theatre and interventional radiology-guided control. Results:In the STOP study, nebulised TXA was a low-risk, easily administered intervention that assisted early bleeding control and improved visualisation. A key outcome was the development of a simple ED-based PTB severity grading system (Grades 1–4), enabling rapid identification of severe bleeding requiring immediate escalation to theatre. This system remains embedded in ED practice. The case series shows that primary PTB can present as sudden, catastrophic haemorrhage requiring immediate MDT involvement, with successful management relying on airway planning, anaesthetic support, rapid theatre mobilisation, and interventional radiology when required. Conclusion:These experiences demonstrate that effective PTB management extends beyond individual treatments. Early haemostatic adjuncts, simple ED-based risk stratification, and clear MDT escalation pathways involving ENT, anaesthetics, theatre teams, and interventional radiology are central to improving patient safety in both routine and high-risk PTB presentations.

Background: Complication rates in paediatric cochlear implant (CI) surgery have been reported between 4 to 26%. Previous studies, however, have not categorised all aspects of medical, surgical and anaesthetic management (e.g. infections, cochleae/nerve abnormality, gusher, explant) and very few studies have included large numbers of children implanted < 9 months. Objectives: Describe medical/surgical/anaesthetic management for children receiving CIs younger than two years of age in the last 10 years. Methods: From an existing database of 1352 children at a single CI centre, 196 children were identified who received CIs under 2 years (unilateral CI n=37 (18.88%), [n=5 single sided deafness (2.55%)], simultaneous-bilateral CIs n=105 (53.57%) and sequential-bilateral CIs n=54 (27.55%). Thus, 355 ears were derived for subsequent analysis with n=57 CI < 9 months. Detailed anaesthetic records were available for a subset of 91 children. Pre- and post-CI medical/surgical/anaesthetic management was coded from available surgical records and electronic medical files. Results: The mean age at first CI was 1.11 years (N=196; range 0.28 - 1.96 years; SD 0.38). Most CI surgeries were straightforward; 243 of 355 ears (68.45%). No anaesthetic events were reported for any of the 355 ear surgeries in the present cohort. The mean weight at surgery was 10.4kg (n=91; range 7-24 kg; SD 2.32) and mean duration of surgery was 3.13 hours (range 0.95 – 5.23hrs, SD 1.06). The mean American Society of Anaesthesiologists (ASA) score was 1.5 (range 1-3; SD 0.61). Conclusion: CI surgery was straightforward in the majority of cases and there was no higher prevalence of management issues for children implanted < 9 months compared to CIs at 9 to 24 months. These data support the view that CI surgery can be performed safely in infants younger than 9 months.

Background: Subglottic stenosis (SGS) is managed using repeated endoscopic interventions or definitive open airway reconstruction such as cricotracheal resection (CTR). While endoscopic management may reduce short-term morbidity, its impact on patient-reported quality of life compared with CTR remains unclear. This study compared airway-related quality of life and subjective voice and swallowing outcomes between patients undergoing endoscopic management and CTR for SGS. Methodology: A retrospective cohort study was performed comparing patients with SGS managed by endoscopic procedures or CTR by a single surgeon. Patient-reported outcomes were assessed using validated instruments (Dyspnoea Index, Voice Handicap Index-10, Eating Assessment Tool-10, and SGS Survey-6). Total scores were calculated according to published scoring systems and summarised as median (interquartile range). Groups were compared using Mann–Whitney U tests, with categorical comparisons performed using Fisher’s exact test. Results: Of 74 eligible patients, 50 completed outcome surveys (response rate 68%), including 32 managed endoscopically and 18 undergoing CTR. The cohort was predominantly female (CTR 94% vs endoscopic 84%) with similar median age (53.5 [IQR 43–68] vs 53.0 [IQR 47–67] years). Dyspnoea Index scores were significantly lower following CTR compared with endoscopic management (median [IQR] 2 [0–6] vs 21 [18–25], p<0.001), with fewer patients demonstrating clinically significant dyspnoea (41% vs 97%, p<0.001). Voice- and swallowing-related quality-of-life scores did not differ significantly. On SSS-6 analysis, CTR was associated with less exertional breathlessness and activity limitation (all p<0.05). Conclusion: CTR was associated with substantially improved airway-related quality of life compared with endoscopic management for SGS, without compromise in patient-reported voice or swallowing outcomes. These findings support definitive open airway reconstruction in appropriately selected patients

Background: Recurrent respiratory papillomatosis (RRP) is a rare but impactful ENT disease requiring repeated airway surgery and long-term follow up. It is strongly associated with HPV 6 and 11, making it a preventable surgical disease. Aim: Demonstrate the effectiveness of Australia’s HPV vaccination program on RRP rates, drawing light to the lessons that can be learnt when surgery collaborates with public health. Identify transferable lessons for other countries such as Africa, where vaccination is not yet universal. Method: Literature review of RRP epidemiology in Australia and the HPV vaccination roll out. A review of RRP burden in Africa, focusing on Southern Africa and the HPV vaccination program implementation alongside barriers and enablers to propose implementation strategies focusing on patient adherence via health and community collaboration. Key findings: Australia reported a marked decline in juvenile RRP incidence since national HPV vaccination (from 0.16 per 100,000 in 2012 to 0.02 per 100,000 in 2016), supporting the feasibility of near elimination with sustained high coverage. In contrast, Kwazulu-Natal in South Africa reported an incidence of 3.82 per 100,000 in 2022 in the context of inconsistent HPV vaccination access and administration. As of 2023, HPV vaccination programs have been introduced into national immunisation programs in 29 of 54 African countries, however coverage remains heterogeneous. Conclusions: Australia demonstrates that prevention can dramatically reduce a surgical disease, a pristine example of the art and science of collaboration between surgery and public health. It reframes surgeons as integral in prevention, policy and equity for all. It paves the way for a collaboration framework between ENT, immunisation programs, community engagement and government implementation which can be used as an example world-wide.

Purpose: To review the history, clinical presentation and management of laryngeal gout as well as presenting the first reported Australian case of laryngeal gout with the aim of improving awareness and understanding of this disease process. Methodology: A literature review and case presentation on laryngeal gout Results: Laryngeal gout is rare with one study quoting that there have been only 29 reported cases in the literature and no reported cases from Australia (1). Due to its rarity and non-specific symptoms, the awareness on laryngeal gout is lacking which can lead to under/delayed/mis- diagnosis. Delayed diagnosis can cause irreversible cartilage damage or airway sequelae. Macroscopically they may appear as submucosal nodules or in extreme cases cartilage erosion/destruction. They can mimic laryngeal neoplasms. Biopsy and histopathology is the gold standard diagnostic investigation for laryngeal gout. Due to its rarity there are no set management guidelines or data on long term outcomes, hence the management is extrapolated from general gout management with diet and lifestyle modifications, urate-lowering therapy and/or surgical excision in cases where there is impairment of laryngeal function or airway compromise (1,2). Conclusion: Laryngeal gout is rare. Clinicians should keep laryngeal gout in their list of differentials apart from carcinoma, atypical infections, polyps, or granulomas when seeing patients with laryngeal nodules. Increased awareness of laryngeal gout is crucial to aid better clinical recognition, earlier diagnosis and treatment. 1.Fu Q, Jing Y, Liu W, Liu L, Xu H. Massive laryngeal gouty tophus: A case report and comprehensive literature review. Otolaryngology Case Reports. 2025. https://doi.org/10.1016/S2468-5488(25)00021-9 2.Zijian He, Jianli Zhang, Jingjia Li & Weixiong Chen (2025) Gouty tophus in the vocal fold: A rare case report, Acta Oto-Laryngologica Case Reports, 10:1, 75-79, DOI: 10.1080/23772484.2025.2503208

Thyroid surgery has transitioned from the high-morbidity era of Billroth to a modern discipline defined by subspecialist precision. This presentation reviews the historical foundations laid by Theodor Kocher—whose meticulous technique earned the 1909 Nobel Prize—and William Halsted, whose emphasis on delicate tissue handling and haemostasis remains the cornerstone of the Australian open approach. This is contrasted against the rising popularity of minimally invasive, or robotic approaches to thyroid surgery. In terms of modern updates in the management of multinodular goitres (MNG) and malignancies, the emphasis remains on the impact of surgeon volume on complication rates, specifically permanent hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. While the standard open thyroidectomy remains the gold standard in Australia, the integration of surgical adjuncts is interrogated and the utility of intraoperative neuromonitoring and near-infrared fluorescence for parathyroid identification are discussed as essential tools for risk mitigation. Regarding malignancy, we examine the shift toward risk-stratified care. This includes the nuanced role of molecular testing in indeterminate cytology and the 2025 updates on central and lateral neck dissection. The morbidity of prophylactic versus therapeutic clearance in the N0 neck is discussed, providing a contemporary framework for the ENT/Endocrine surgeon to optimize oncological and functional outcomes [1]. [1] Ringel, M. D., Sosa, J. A., Baloch, Z., Bischoff, L., Bloom, G., Brent, G. A., Brock, P. L., Chou, R., Flavell, R. R., Goldner, W., Grubbs, E. G., Haymart, M., Larson, S. M., Leung, A. M., Osborne, J., Ridge, J. A., Robinson, B., Steward, D. L., Tufano, R. P., & Wirth, L. J. (2025). 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid : official journal of the American Thyroid Association, 35(8), 841–985. https://doi.org/10.1177/10507256251363120