Foreign bodies are commonly seen by the Ear, Nose and Throat emergency team with cotton wool being the most common aural foreign body seen in the adult population. Most complications secondary to aural foreign bodies described in the literature are minor and rarely require any surgical intervention. Here, we present two cases with impacted cotton wool as aural foreign bodies which resulted in suppurative labyrinthitis and osteomyelitis causing profound sensorineural hearing. These cases highlight the importance of considering aural foreign bodies in the differential diagnosis in those presenting with unilateral symptoms as significant complications, although rare, can occur, particularly in those with delayed diagnosis.

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ObjectivesPalliative self-expandable metallic stent (SEMS) insertion is common in patients not suitable for resection of oesophago-gastric (OG) cancer. Factors which may determine survival however are not clear. The present study examined the relationship between tumour and host factors, including the systemic inflammatory response, and survival of patients undergoing palliative SEMS insertion. MethodsPatients with a diagnosis of OG cancer who were considered suitable for palliative SEMS only without systemic therapy were identified. Patient characteristics including Eastern Cooperative Oncology Group performance status, radiological stage and modified Glasgow were associated with shorter survival. The combination of performance status and mGPS stratified three-month survival of patients without metastatic disease from 88% to 20% (P<0.001) and patients with metastases from 43% to 6% (P=0.059). Similar results were 3 observed when analysis was restricted to patients with oesophageal and junctional cancer (M0: 83% to 20%, P=0.008; M1: 33% to 8%, P=0.082). ConclusionPerformance status, metastatic disease and mGPS are independent predictors of survival in patients with OG cancer undergoing palliative SEMS insertion. These routinely available markers provide a rational system on which to base decisions regarding prognosis and treatment.

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Introduction There is a trend toward more conservative management of solitary micropapillary thyroid carcinomas (mPTC). Incidental findings of multifocal mPTC are a regular subject of discussion at multidisciplinary team (MDT) meetings, however, guidance on its management is limited. Methods All patients discussed at the West of Scotland Thyroid Cancer MDT between November 2008 and July 2020 with multifocal mPTC (10mm or less) on the first surgical pathology specimen were included. Cases with solitary mPTC on the first surgical pathology specimen were excluded, as were any cases with pathology that would alter prognosis e.g. papillary carcinoma &gt;10mm. Results 52 patients were included in the final analysis, representing 6% of the total cases discussed at the Thyroid cancer MDT. The incidence has increased over time. 76.9% (40) of cases were female with a mean age of 48.6. Median follow up was 23.5 months (Range 1–119). 15.4% (8) of cases had pathological lymphadenopathy on pre-operative imaging. Capsular or vascular invasion and extrathyroid extension were common (26.9%, 9.6% and 32.7% of cases respectively). 55.8% (29) of cases underwent additional treatment after the finding of multifocal mPTC. Overall, 1 (1.9%) patient developed recurrence and is still alive at 75 months follow up after salvage treatment. 1 (1.9%) patient died during follow up, not felt to be related to their thyroid disease. Conclusion Multifocal mPTC is an increasingly common MDT discussion. Recurrence rates are low and may respond well to salvage therapy. A more conservative approach may be an appropriate management strategy for this patient cohort.