To highlight the possibility of misplacement of electrodes during cochlear implantation surgery, to stress the importance of routine neural response telemetry, and also to emphasise the value of conventional radiography in confirming electrode positioning in the immediate post-operative period.

A two-year-old boy presented with bilateral, profound, sensorineural hearing loss and underwent conventional cochlear implantation surgery. During insertion of the implant, there was doubt regarding the direction of passage of the electrode array. Instead of the usual smooth passage of the electrode, some resistance was felt. Neural response telemetry, performed at the end of the procedure, showed absent responses. A confirmatory X-ray in Stenver's view confirmed the extra-cochlear positioning of the electrodes in the superior semicircular canal. The wound was reopened, the electrode array removed and the cochleostomy was positioned a little more antero-inferiorly on the promontory with respect to the round window. Correct insertion of the electrode was then performed without difficulty.

The misplacement of electrodes during cochlear implantation surgery is rare but can occur. Neural response telemetry and conventional radiography are invaluable in assessing the placement of the electrode intra-operatively. Conventional radiographs are very cost-effective and aid in confirming the position of the electrode array.

We present the first reported case of persistent, posterior triangle lymphadenopathy in a child, caused by Castleman's disease.

A seven-year-old boy presented with a painless swelling in the posterior triangle of his left neck, with no compression of the surrounding structures. A histological diagnosis of Castleman's disease was made. Eventual treatment was by complete excision. At six-month follow up, there were no signs of recurrence.

The causes of persistent cervical lymphadenopathy in children are many. Most are not significant, but some are life-threatening. Castleman's disease should be considered as a possible diagnosis in persistent childhood lymphadenopathy.

We report the unique case of a 16-year-old man presenting with sudden and profound left-sided hearing loss following application of a Halo vest.

Case report and review of the world literature concerning spinal realignment procedures, spinal manipulation and Halo vest application.

A 16-year-old man presented to the ENT clinic with sudden and profound left-sided hearing loss after undergoing posterior release of a fixed flexion extension deformity of the cervical spine and Halo vest application. The hearing loss slowly improved until the patient disrupted the Halo vest while boarding a bus. Regular audiometry documented the progress of the patient's hearing loss.

Procedures that significantly alter the established bony anatomy of the neck can be associated with profound audiological deficit through disturbance of the vertebrobasilar arterial system. Such a phenomenon may be associated with application or disruption of a Halo vest.

To demonstrate the importance of detailed clinical analysis in the differential diagnosis of a cyst in the floor of the mouth, and to provide an update on current knowledge and treatment of sublingual hydatid cyst.

A 23-year-old man presented complaining of a swelling in the midline of the sublingual region, present for four months and progressively increasing in size. Ultrasonography of the neck revealed a well defined, hypoechoic lesion in the sublingual region, containing a calcific focus. Fine needle aspiration cytology showed numerous round to oval structures resembling brood capsules, with scolices and occasional hooklets. T1- and T2-weighted, multiplanar magnetic resonance imaging scans showed a well defined, multiloculated lesion in the sublingual region.

Hydatid disease may present as a slow-growing cyst in the sublingual region. Aspiration cytology should preferably be avoided until radiological imaging studies are complete. A high index of suspicion is necessary to diagnose hydatid disease in an unusual location.

Accurate assessment of the features of tympanic membrane perforation, especially size, site, duration and aetiology, is important, as it enables optimum management.

To describe a simple, cheap and effective method of quantitatively analysing tympanic membrane perforations.

The system described comprises a video-otoscope (capable of generating still and video images of the tympanic membrane), adapted via a universal serial bus box to a computer screen, with images analysed using the Image J geometrical analysis software package. The reproducibility of results and their correlation with conventional otoscopic methods of estimation were tested statistically with the paired t-test and correlational tests, using the Statistical Package for the Social Sciences version 11 software.

The following equation was generated: P/T × 100 per cent = percentage perforation, where P is the area (in pixels2) of the tympanic membrane perforation and T is the total area (in pixels2) for the entire tympanic membrane (including the perforation). Illustrations are shown. Comparison of blinded data on tympanic membrane perforation area obtained independently from assessments by two trained otologists, of comparative years of experience, using the video-otoscopy system described, showed similar findings, with strong correlations devoid of inter-observer error (p = 0.000, r = 1). Comparison with conventional otoscopic assessment also indicated significant correlation, comparing results for two trained otologists, but some inter-observer variation was present (p = 0.000, r = 0.896). Correlation between the two methods for each of the otologists was also highly significant (p = 0.000).

A computer-adapted video-otoscope, with images analysed by Image J software, represents a cheap, reliable, technology-driven, clinical method of quantitative analysis of tympanic membrane perforations and injuries.

The paranasal sinuses, comprising the frontal, maxillary, ethmoid and sphenoid sinuses, have caused consternation and debate over their true function over the course of nearly two millennia. This review aims to define the current evidence for the role of the paranasal sinuses, and to attempt to propose an answer to the question ‘why do we have paranasal sinuses?’

A literature review was conducted, searching Medline (1966–2007), Embase (1988–2007), the Cochrane Library and Ovid (1966–2007). Combinations of the following search terms were used: ‘paranasal sinuses’, ‘physiology’, ‘anatomy’, ‘function’, ‘evolution’ and ‘rhinology’. Any relevant references were cascaded to increase detection of pertinent information. The current, tenable theories identified in the literature review are discussed and the evidence for them critically analysed.

The current, tenable theories are described.

The paranasal sinuses may act simply to improve nasal function; certainly, it has been demonstrated that they may act as an adjunct in the production of nitric oxide and in aiding the immune defences of the nasal cavity. However, there is a distinction between utility and evolutionary origin. It may still be that the sinuses arose as an aid to facial growth and architecture, or persist as residual remnants of an evolutionary structure with an as yet unknown purpose, and in doing so have found an additional role as an adjunct to the nasal cavity.

Ménière's disease is not uncommon, with an incidence in Caucasians of about one in 2000. The incidence peaks in the fifth decade. Cases are usually isolated or sporadic, but in perhaps five per cent other family members are affected. We report here the clinical and genetic characteristics of a comprehensive set of familial Ménière's disease cases from the UK.

Forty-six affected families were studied. All cases were diagnosed using the American Academy of Otolaryngology–Head and Neck Surgery committee on hearing and equilibrium 1995, or more stringent, criteria.

Autosomal dominant inheritance with reduced penetrance was the most likely mode of inheritance overall. Apparent genetic anticipation was observed, but may also be a result of ascertainment bias given the collection strategy. There was also a slight tendency for cases to result from maternal transmission within the families in this set. The family pedigrees are presented, and the authors have also set up a website at which all the pedigrees may be viewed in greater detail.

For various medico-legal and financial reasons, some patients may clinically demonstrate an exaggerated hearing loss that varies in degree, nature and laterality. The purpose of this study was to evaluate whether multi-channel auditory steady-state response measurement can be used as an objective test of auditory thresholds in adults with sensorineural hearing loss.

This was a prospective, comparative, experimental research design study conducted in an academic medical centre. From January to June 2007, 142 subjects (284 ears) with varying degrees of sensorineural hearing loss were included. Four commonly used frequencies (500, 1000, 2000 and 4000 Hz) were evaluated. Both pure tone thresholds and multi-channel auditory steady-state response thresholds were obtained for each ear in all subjects. The correlation of auditory steady-state response thresholds and pure tone thresholds was assessed. The time taken for multi-channel auditory steady-state response testing was also recorded.

Results for multi-channel auditory steady-state response thresholds and pure tone thresholds were compared for each test frequency. A difference of less than 15 dB was found in 71 per cent of patients, while a difference of less than 20 dB was found in 83 per cent. Correlation between auditory steady-state response thresholds and pure tone thresholds, expressed as the correlation coefficient (r), was 0.89, 0.95, 0.96 and 0.97 at 500, 1000, 2000 and 4000 Hz, respectively. The strength of the relationship between auditory steady-state response thresholds and pure tone thresholds increased with increasing frequency and increasing degree of hearing loss. The recorded auditory steady-state response thresholds were used to calculate regression lines predicting pure tone threshold results. The mean estimated pure tone thresholds calculated from these regression lines were all within 10 dB of the actual recorded pure tone thresholds. The average multi-channel auditory steady-state response test duration was 42 minutes per patient.

Measurement of multi-channel auditory steady-state response could be a powerful, convenient electro-physiological examination with which to objectively certify clinical hearing impairment in adults.

To assess the long term outcome of gentamicin inner-ear perfusion using the Silverstein MicroWick™ in the treatment of Ménière's disease.

Retrospective questionnaire survey of patients and review of medical records.

A district general hospital.

All 15 patients who completed a minimum follow up of at least 24 months were included.

Subjective symptoms, change in hearing thresholds and Glasgow benefit inventory scores.

Based on the American Association of Otolaryngology-Head and Neck Surgery (1995) guidelines for reporting, 80 per cent of respondents obtained class A vertigo control and 20 per cent obtained class B control. Respondents' functional level improved from pre-operative levels of between three and six to post-operative levels of between one and three. Three respondents had pre-operative ‘dead ears’ and one developed the condition post-operatively. Hearing deteriorated further in three respondents, improved in two and remained unchanged in the rest. Respondents with class A control demonstrated improved quality of life, with a mean Glasgow benefit inventory total score of +34.

Transtympanic gentamicin therapy via the Silverstein MicroWick results in good vertigo control. Patients should however be made fully aware of the risk of hearing deterioration.

This study aimed to investigate the outcomes of autologous ossiculoplasty following temporal bone fracture.

We analysed 10 patients who underwent autologous ossiculoplasty following temporal bone fracture from 1993 to 2006. Average results for air conduction, bone conduction and air–bone gap were calculated, using both a three- and a four-frequency average, in order to evaluate the effect of the operation.

The average follow-up time was 24.4 months. Dislocation of the incus was the most common operative finding. The average three- and four-frequency post-operative air–bone gaps were 12.0 dB (standard deviation 8.3) and 13.8 dB (standard deviation 7.7), respectively. The average air–bone gap improvements were 24.5 dB (standard deviation 13.8) and 24.4 dB (standard deviation 12.1), respectively. Eighty per cent (eight of 10) of the patients had socially acceptable hearing in the operated ear. However, only 50 per cent achieved closure of the air–bone gap to within 10 dB.

Methods of maximising the stability of the reconstructed ossicular chain should be further studied.

To investigate the safety and efficacy of ozone therapy in adult patients with sudden sensorineural hearing loss.

Prospective, randomised, double-blinded, placebo-controlled, parallel group, clinical trial.

Forty-five adult patients presented with sudden sensorineural hearing loss, and were randomly allocated to receive either placebo (15 patients) or ozone therapy (auto-haemotherapy; 30 patients). For the latter treatment, 100 ml of the patient's blood was treated immediately with a 1:1 volume, gaseous mixture of oxygen and ozone (from an ozone generator) and re-injected into the patient by intravenous infusion. Treatments were administered twice weekly for 10 sessions. The following data were recorded: pre- and post-treatment mean hearing gains; air and bone pure tone averages; speech reception thresholds; speech discrimination scores; and subjective recovery rates.

Significant recovery was observed in 23 patients (77 per cent) receiving ozone treatment, compared with six (40 per cent) patients receiving placebo (p < 0.05). Mean hearing gains, pure tone averages, speech reception thresholds and subjective recovery rates were significantly better in ozone-treated patients compared with placebo-treated patients (p < 0.05).

Ozone therapy is a significant modality for treatment of sudden sensorineural hearing loss; no complications were observed.

The treatment of children with ‘glue ear’ often presents surgeons with the question of whether or not to insert a grommet when myringotomy reveals no fluid in the middle ear. We present a study designed to assess which factors contribute to the presence of a ‘dry tap’.

We prospectively gathered data from a cohort of 280 children (504 myringotomies). The cohort included two subgroups, one received halothane and nitrous oxide anaesthesia, and the other received enflurane anaesthesia.

The ENT department of a district general hospital.

Children (aged less than 17 years) requiring myringotomy.

The presence of a ‘glue’ or dry tap at myringotomy was documented. We also recorded data on the following: pre- and post-induction tympanometry; age; season; anaesthetic type; and the delay from listing to actual operation.

A non type B pre-induction tympanogram and delay to operation were strong indications of finding a dry tap at surgery.

In our study population, the proportion of dry taps at myringotomy was 18 per cent. The presence of a dry tap was rarely due to the induction of anaesthesia. Multivariate analysis revealed that the combination of factors most likely to predict a dry tap were non type B tympanogram and delay to operation.

To assess the long-term efficacy of Epley's manoeuvre performed to treat benign paroxysmal positional vertigo.

Two hundred and sixty-nine patients suffering benign paroxysmal positional vertigo were offered Epley's manoeuvre. After five years, follow up was arranged. One hundred and three patients attended for follow up (58 women and 45 men; age range 19–65 years). As mentioned 269 patients were offered the EM and 103 of them were available for follow up. Prior to initial Epley's manoeuvre treatment, these patients' duration of benign paroxysmal positional vertigo had ranged from four to 96 weeks.

Five years after treatment of benign paroxysmal positional vertigo with Epley's manoeuvre, 65 per cent of patients reported no further attacks. Kaplan–Meier testing showed that the time to recurrence was significantly longer in patients aged less than 40 years, those with a duration of attacks of less than three years prior to initial Epley's manoeuvre treatment, and those suffering less than six exacerbations prior to initial Epley's manoeuvre treatment. Gender had no effect on time to recurrence. Duration of illness before receiving Epley's manoeuvre was the only independent predictor of recurrence.

Epley's manoeuvre remains an effective modality for treatment of benign paroxysmal positional vertigo. A patient age of less than 40 years and duration of attacks of less than three years are good prognostic factors. Exacerbation number and gender do not affect the probability of benign paroxysmal positional vertigo recurrence after five years; however, these factors do affect the duration of time free from the condition.

Passive smoking in the paediatric age group is associated with an increased frequency of a number of childhood respiratory disorders. However, its effect on ciliary regeneration after functional endoscopic sinus surgery for chronic sinusitis has not previously been reported.

We conducted a prospective, nonrandomised cohort study on 38 paediatric patients with chronic sinusitis. We compared two patient groups – passive smokers and those not subjected to passive smoking – as regards ciliary regeneration after functional endoscopic sinus surgery, using objective methodology.

We found passive smoking to have a negative impact on sinus cilia regeneration following functional endoscopic sinus surgery.

To evaluate potential pre-dive parameters in relation to paranasal sinus barotrauma in sports self-contained underwater breathing apparatus divers.

The pre-dive and follow-up records of 46 healthy sports self-contained underwater breathing apparatus divers were analysed.

In the routine pre-dive examination of diving candidates with no symptoms of rhino-sinus disease, rhinoscopy, sinus radiography and nasal endoscopy indicated no signs of rhinitis and/or sinusitis. Any signs of paranasal sinus barotrauma were noted, and several parameters were evaluated in relation to occurrence of barotrauma.

Of the studied parameters, a history of sinusitis and of middle-ear barotrauma was significantly more frequent in divers in the barotrauma group (p < 0.05).

In divers undergoing a routine pre-dive examination, paranasal sinus barotrauma was not related to sex, alcohol consumption, smoking, decongestant use, mild nasal septal deviation, or inability to perform the Valsalva or Toynbee manoeuvres. However, divers with a history of sinusitis or middle-ear barotrauma may be more prone to paranasal sinus barotrauma. A more detailed pre-dive examination may be useful for such individuals.

A variety of topical preparations are used for symptomatic relief following nasal surgery. The aim of this study was to compare the effect of two commonly used products on patient symptom scores following nasal surgery.

Randomised, single-blinded, comparative clinical trial.

A single, secondary otorhinolaryngology centre.

One hundred and twenty patients undergoing septoplasty or functional endoscopic sinus surgery as an isolated procedure between November 2003 and January 2006. Patients undergoing additional nasal procedures were excluded, as were those requiring additional post-operative medications other than standardised analgesia.

Following nasal surgery, patients were randomised to receive either xylometazoline hydrochloride 0.1 per cent nasal spray or a sterile physiological saline aerosol.

Visual analogue scale symptom scores for nasal obstruction, rhinorrhoea, pain, loss of sense of smell and bleeding were assessed at day 10 post-operatively.

Post-operative symptom scores were compared between treatment groups. Overall, median pain scores were significantly higher in the xylometazoline group (p = 0.03, chi-square test). When analysed by procedure, median pain scores were significantly higher in septoplasty patients using xylometazoline (p = 0.019, chi-square test).

There is no evidence to support the use of xylometazoline hydrochloride 0.1 per cent nasal spray over aerosolised physiological saline alone, following nasal surgery. Furthermore, there may be more pain associated with the post-operative use of xylometazoline.