Emma Stapleton

• FRCS (ORL HNS)
• Consultant ENT Surgeon at Manchester University Hospitals NHS Foundation Trust

Objectives: MRI-compatible cochlear implants have weaker internal magnets than non-MRI-compatible devices. Their suitability for individual patients is limited by skin flap thickness, traditionally measured with a needle in the operating theatre. We aimed to establish the accuracy of imaging modalities to measure skin flap thickness pre-operatively...

Introduction Auditory symptoms in individuals with Autistic Spectrum Disorder (ASD) are well described within the neurodevelopmental literature, yet there is minimal mention of ASD in Otolaryngology literature. This is surprising considering the potential clinical and diagnostic implications of this link, and the potential for ASD to present to Oto...

Introduction: Sudden sensorineural hearing loss is considered idiopathic in up to 90% of cases. We explored the role of blood tests as biomarkers for the diagnosis and prognosis of SSNHL. Methods: This review was pre-registered on the PROSPERO database (CRD42022351478) and conducted according to PRISMA 2020 guidelines. Results: Raised inflamma...

Background: Necrotising otitis externa (NOE) is a serious infection with minimal evidence underpinning its management. This review aims to synthesise published evidence of antimicrobial therapies and their outcomes in NOE. Methods: The review was PROSPERO registered (CRD42022353244) and conducted according to PRISMA guidelines. A robust search str...

Objective Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS). Methods The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COME...

Aim Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies. We conducted the first and robust systematic review and meta-analysis to evaluate outcomes for ultrasonography-guided drainage (USD) versus conventional surgical incision and drainage (I&D). Method The protocol was published a priori (PROSP...

Objective: Translabyrinthine excision of a vestibular schwannoma is associated with acute vestibular failure. Preoperative intratympanic gentamicin (ITG) injections can improve objective balance function after surgery but its clinical benefits remain to be established. Methods: Adult patients undergoing translabyrinthine removal of a vestibular...

Objective To compare ultrasonography-guided drainage (USD) versus conventional surgical incision and drainage (I&D) in deep neck space abscesses. Methods The study was pre-registered on PROSPERO (CRD42023466809) and adhered to PRISMA guidelines. MEDLINE, EMBASE and CENTRAL databases were searched. Primary outcomes were length of hospital stay an...

Purpose: Patient suitability for cochlear implant (CI) devices compatible with magnetic resonance imaging and CI processor configuration is dependent on their retro-auricular skin flap thickness. This is typically measured intra-operatively using a needle and therefore patients are not guaranteed their implant of choice prior to surgery. We aimed...

A case series of 46 cochlear implant patients from two separate UK cochlear implant centres, presenting between 2014-2022 with significant vestibular symptoms and raised, fluctuating impedances after a period of normal implant use.

• The priorities of VS treatment, in order of importance, are to preserve life, facial function, and hearing, and to minimise complications. • Hearing restoration with cochlear implants in VS may be less predictable than in patients without VS. • A meta-analysis reports that 82% of patients with VS and ipsilateral cochlear implant demonstrated im...

Objective: Many patients with cochlear implants (CI) and auditory brainstem implants (ABI) require magnetic resonance imaging (MRI) following implantation. This study explores the patient experience of MRI, identifying factors associated with pain, and the effect of interventions designed to enhance comfort and safety. Methods: A prospective obs...

Objective To establish consensus definitions for necrotising otitis externa (NOE) to facilitate the diagnosis and exclusion of NOE in clinical practice and expedite future high-quality study of this neglected condition. Design The work comprised of a systematic review of the literature, five iterative rounds of consultation via a Delphi process an...

Introduction: Cochlear implantation (CI) under local anaesthesia (LA) is an increasingly accepted technique worldwide, though the literature to date includes only single-surgeon and single-centre experiences. We explored the national experience of UK surgeons using this challenging surgical technique, with the goal of providing consensus recommenda...

Introduction: A key clinical feature of necrotising otitis externa (NOE) is granulation tissue arising from the ear canal, representing epidermal compromise. The aim of this work was to explore the role of epidermal compromise in the aetiology of NOE. Methods: A structured risk factor history was taken from 54 patients diagnosed with NOE 2017-2022...

Objectives: To explore the impact of female sex on the experiences of trainees and surgeons in otolaryngology from LMIC and HIC. Methods: This study includes perspectives of five consultants and two resident physicians from the United States, United Kingdom, Uganda, Kenya and South Africa. Results: Six themes emerged from these interviews. Ove...

Introduction: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition incorporating complex physical and neurological symptoms including complex sensory symptoms. This review explores the interface between ASD and Paediatric ENT. Methods: Using the PRISMA guideline, a robust literature search and review was conducted by two resea...

Background: Mentoring within surgery is increasingly recognised as a powerful development tool, but participant expectations have not previously been explored. We aimed to explore and analyse participant expectations from the UK’s first national Otolaryngology mentorship programme. Methods: Participants completed open-ended questionnaires. Respon...

The term ‘mentor’ is derived from Homer’s Odyssey, in which the goddess Athena, disguised as Mentor, guides and advises Odysseus’s son. Mentoring has become an everyday word, it is a process recommended within the General Medical Council’s ‘Good Medical Practice’, and a concept lauded by The Royal College of Surgeons of England, in their 2021 ‘Kenn...

Aim Patient suitability for cochlear implant (CI) devices compatible with magnetic resonance imaging and CI processor configuration is dependent on their retro-auricular skin flap thickness.1, 2 Current manufacturer guidelines suggest measuring skin flap thickness intra-operatively using a needle.1, 2 Therefore, patients are not guaranteed their im...

Aim There is an increasing body of literature supporting cochlear implantation in elderly and frail patients. Restoration of hearing improves quality of life and contributes to better cognitive and executive function. However, the population of ageing patients, and those with significant comorbidities including cardiac frailty, introduces a logisti...

Aim Current preoperative investigations to measure skin flap thickness prior to cochlear implant surgery mainly include computed tomography1 and magnetic resonance imaging2. The aim of this study was to assess the inter-rater reliability of scalp thickness measured by clinical staff with a portable ultrasound device without having any prior experie...

MED-EL Otoplan software can be used to measure cochlear duct length (CDL) for anatomy-based fitting and selection of optimal electrodes on an individual patient basis using pre-operative imaging. Human cochlear duct length varies from 25-36 millimeters, a 50% difference, therefore tailoring of electrode length based on CDL could be important. Coop...

Aim We present two cases of fluctuating cochlear implant electrode impedances with objective evidence of associated vestibular changes in adult patients who had previously stable mapping, and an otherwise normal implant journey until that point. The changes in impedances required significant and repeated re-mapping, employing increases in pulse wi...

Background Necrotising otitis externa (NOE) is a serious infective condition. Patients are typically frail, diagnostic delay is common and severe pain is a key feature. We aimed to qualitatively analyse patient-centred data to identify key themes in patient experience. Methods Open-ended questionnaires were sent to 28 patients. Responses were qual...

Objective: To review the outcomes of cochlear implants (CI) in patients with neurofibromatosis type 2 (NF2) in a large cohort, and identify factors associated with poor hearing benefit. Study design: Fifteen-year retrospective national observational case series. Setting: United Kingdom regional NF2 multidisciplinary teams. Patients: Consecut...

Objective The aim of this study was to develop a novel live Delphi method to obtain a consensus on the skills and competencies that a new ENT registrar (specialty trainee level 3) should possess. Developing a clear outcome set for core surgical trainees is important so that this phase of training can be directed at specific aims. Method Attendees...

This study explores the natural history of vestibular, trigeminal and lower cranial nerve schwannomas (VS, TS, LCNS) in patients with Neurofibromatosis type 2 (NF2), to understand how pathogenic variants (PVs) of the NF2 gene affect tumour burden and growth rate, via a retrospective analysis of a UK NF2 centre database and imaging. VS, TS and LCNS...

INTRODUCTION Necrotising otitis externa (NOE) is a severe, life-threatening infection. Epidemiological data demonstrates a dramatic rise in reported cases in England 2002-17. Reasons for this remain elusive. METHODS A quantitative descriptive study was undertaken using epidemiological data from the Hospital Episode Statistics database. Cases 2002–...

Introduction: Necrotising otitis externa is an invasive infective condition, with minimal evidence underpinning its diagnosis and management. This work aims to analyse literature from the past decade, to identify emerging themes and important topics for future research. Method: A robust literature search and review was conducted by two researchers...

Introduction: Necrotising otitis externa is an invasive infective condition, with minimal evidence underpinning its diagnosis and management. This work aims to analyse literature from the past decade, to identify emerging themes and important topics for future research. Method: A robust literature search and review was conducted by two researchers...

Objective: To objectively assess the utility of an exoscope during simulated otological surgery. Design: Cohort study. Setting: Tertiary referral otolaryngology centre. Participants: Seven experienced otologists undertook simulated temporal bone surgery on plastic temporal bones using the Zeiss Kinevo microscope with both a microscope and ex...

Objective This study aimed to explore the impact of the coronavirus disease 2019 pandemic and postponement of elective surgical procedures for profoundly deaf patients awaiting cochlear implantation. Method Open-ended questionnaires were sent to all adult patients awaiting cochlear implantation surgery. Qualitative analysis was performed using a g...

Perforation of the pharynx is a rare occurrence but has the potential to cause mediastinitis and has an attendant mortality risk. Though numerous mechanisms have been described, we report a unique case of a young woman who presented with a sore throat, odynophagia and subcutaneous emphysema, a short time after performing fellatio. A contrast swallo...

Background Coronavirus disease 2019 has transformed medical education worldwide. Innovations in ENT teaching for medical students have focused on virtual learning, often replacing history-taking, patient examination and practical procedure observation. This qualitative study aimed to evaluate student experience and the impact of the altered learnin...

Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core...

Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core O...

Objective The study aimed to determine long-term outcomes in patients with intraoperative electrical conduction block in an anatomically intact facial nerve (FN). Patients and Methods Single center retrospective review of prospectively collected database of all vestibular schwannoma surgeries between January 1, 2008 and August 25, 2015. Operative...

Background Limited data exists on the disease course of Neurofibromatosis Type 2 (NF2) to guide clinical trial design. Methods A prospective database of patients meeting NF2 diagnostic criteria, reviewed between 1990–2020, was evaluated. Follow-up to first vestibular schwannoma (VS) intervention and death was assessed by univariate analysis and st...

Objective: The National Institute of Clinical Excellence recommends that adult patients with severe to profound deafness are eligible for simultaneous bilateral cochlear implantation if they are blind or have other disabilities increasing their reliance on auditory stimuli. Cochlear implant (CI) surgery is routinely performed under general anaesthe...

Embryonal rhabdomyosarcoma (ERMS) of the larynx in adults is an extremely rare diagnosis with insidious onset and progression. Only six reports (including this one) have been documented in the literature. Clinical presentation is dependent on the site, size, subtype of ERMS and growth rate. Hoarseness is the usual first symptom, followed by stridor...

Introduction Vestibular schwannomas (VS) are histologically benign tumors arising from cranial nerve VIII. Far from a homogenous proliferation of Schwann cells, mounting evidence has highlighted the complex nature of the inflammatory microenvironment in these tumors. Methods A review of the literature pertaining to inflammation, inflammatory mol...

Objectives Cases of sporadic vestibular schwannoma (sVS) have a low rate of association with germline pathogenic variants. However, some individuals with sVS can represent undetected cases of neurofibromatosis type 2 (NF2) or schwannomatosis. Earlier identification of patients with these syndromes can facilitate more accurate familial risk predicti...

OBJECTIVE Inflammation and angiogenesis may play a role in the growth of sporadic and neurofibromatosis type 2 (NF2)–related vestibular schwannoma (VS). The similarities in microvascular and inflammatory microenvironment have not been investigated. The authors sought to compare the tumor microenvironment (TME) in sporadic and NF2-related VSs using...

INTRODUCTION: NECROTIZING OTITIS EXTERNA (NOE) IS A SEVERE, LIFE THREATENING PROPAGATING OSTEOMYELITIS OF THE SKULL BASE THAT ORIGINATES FROM A SEVERE OTITIS EXTERNA. THIS RARE CONDITION MAY NOT BE AS UNCOMMON AS ONCE UNDERSTOOD. EPIDEMIOLOGIC DATA REVEALS AN UNEXPECTED AND DRASTIC RISE IN THE NUMBER OF REPORTED CASES OVER THE LAST 15 YEARS. USING...

Questionnaires and invasive diagnostic tests are established for diagnosing gastro-esophageal reflux disease (GERD) but shown not to be sensitive or specific for diagnosing laryngopharyngeal reflux (LPR) where vast majority of reflux events are weakly acidic or non-acidic. The research question addressed in the current multicentre study was to dete...

Purpose: To evaluate the incidence of mosaicism in de novo neurofibromatosis 2 (NF2). Methods: Patients fulfilling NF2 criteria, but with no known affected family member from a previous generation (n = 1055), were tested for NF2 variants in lymphocyte DNA and where available tumor DNA. The proportion of individuals with a proven or presumed mosa...

Purpose: We have evaluated deficiencies in existing diagnostic criteria for neurofibromatosis 2 (NF2). Methods: Two large databases of individuals fulfilling NF2 criteria (n = 1361) and those tested for NF2 variants with criteria short of diagnosis (n = 1416) were interrogated. We assessed the proportions meeting each diagnostic criterion with c...

Background: Inflammation is hypothesized to be a key event in the growth of sporadic vestibular schwannoma (VS). In this study we sought to investigate the relationship between inflammation and tumor growth in vivo using the PET tracer 11C-(R)-PK11195 and dynamic contrast enhanced (DCE) MRI derived vascular biomarkers. Methods: Nineteen patients...

Objective: Electrically evoked auditory brainstem responses (eABRs) can be recorded before cochlear implant (CI) surgery to verify auditory nerve function, and is particularly helpful in to assess the function of the auditory nerve in cases of auditory nerve hypoplasia. This is the first study to compare three preimplant eABRs recording techniques...

Objective: To explore the nature of spontaneously regressing vestibular schwannomas (VS) and identify possible predictive factors for such behavior. Study design: Retrospective case control study. Setting: Tertiary referral center, university teaching hospital. Patients: Patients with sporadic VS demonstrating spontaneous regression compared...

Objective: To enhance understanding of the behavior of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS), including the potential for late tumor regrowth, and the need for lifelong radiological and clinical surveillance. Patients: From a total of 540 patients with VS and out of 95 patients receiving SRS for their growing VS, the...

Objective: The natural history of vestibular schwannomas (VS) is unpredictable. Our objective was to determine the rate of spontaneous tumor shrinkage in a cohort of patients with sporadic VS, being managed conservatively. Method: A retrospective analysis of the medical notes of 540 VS managed in a tertiary referral center over a 15-year period was...

Vestibular schwannoma growth after stereotactic radiosurgery - Volume 130 Issue S3 - Emma Stapleton, John Crowther, Georgios Kontorinis

Management of the intact, mobile stapes: a 12 year experience - Volume 130 Issue S3 - Emma Stapleton, Peter Wardrop

Cone beam (CBCT) imaging in cochlear implantation practice - Volume 130 Issue S3 - Emma Stapleton, E Mary Shanks, Agnes Allen, Peter Wardrop

The aim of this project was to analyse the use of Twitter in the discussion of cochlear implants between Jan 2015 and Jan 2016.

The Hunterian Society offers an annual award for an essay and presentation on a subject of relevance to John or William Hunter, or medicine in the 18th Century. This article is based on Emma Stapleton’s 2014 winning essay, which was inspired by a visit to the Hunterian Museums in Glasgow, and was accompanied by a comparative dissection of two human...

Background Kate Granger, a doctor and terminally ill cancer patient, introduced the #hellomynameis Twitter campaign in 2013, as ‘the first rung on the ladder to providing compassionate care’. Her campaign defines a gold standard whereby NHS staff should introduce themselves to every patient they meet. The campaign was included in the Government res...

I'm immensely grateful to The Journal of Laryngology & Otology for supporting my visit to the Department of Otology and Neurotology, Toronto General Hospital (Figure 1), Ontario, Canada, during March and April 2010.

Ménière's disease is a diagnosis requiring expert clinical judgment. There are several differences between the American Academy of Otolaryngology Head and Neck Surgery diagnostic guidelines and Prosper Ménière's original description of the disease. Six hundred and fifty patients attending a specialist balance clinic had their clinical profiles full...

The sacculo-collic reflex is believed to be a short latency, otolith-mediated myogenic response to sound. With the application of air-conducted sound, one would expect an absent response in stapes fixation, as a fixed stapes footplate will not transmit a pressure wave to the saccule. Fifty patients (70 stapes surgery ears, 26 otosclerotic ears and...

A clear and detailed clinical history is essential in the assessment of patients with balance symptoms. The aim of this study was to assess the usefulness of open-ended questionnaires in the specialist balance clinic. Fifty-four consecutive new patients completed an open-ended questionnaire, prior to a consultation in which the clinical history was...

The role of laparoscopic repair for femoral hernia has not been clearly defined, although the advantages of this technique for repair of inguinal hernia are well recognized. The aim of this study was to assess the outcome of laparoscopic total extraperitoneal (TEP) repair of femoral hernia. Case records of patients who had laparoscopic TEP repair o...