Sudden sensorineural hearing loss is a true audiological emergency, and its management is much discussed. Currently, no single therapy has been proven effective according to evidence criteria. Recently, intratympanic application of steroids has been increasingly used in refractory cases; however, it has only rarely been reported as first-line therapy.

Twenty consecutive patients with sudden sensorineural hearing loss treated between July 2008 and January 2010 were enrolled in this prospective, case–control study. Ten patients were treated with intratympanic steroids and 10 with systemic ‘shotgun’ therapy (including steroids, pentoxifylline, low molecular weight heparin and vitamin E). The two groups were homogeneous in all respects. Pure tone averages were assessed before and after treatment for both groups.

There were no statistically significant differences between the two groups.

Intratympanic steroids seem to offer a valid alternative to systemic therapy, with few risks, in sudden sensorineural hearing loss patients, and we recommend their use as first-line therapy.

In order to safely explore the medial wall of the attic, a working knowledge of the anatomy of the anterior supralabyrinthine air cell tract is required.

To clarify the surgically relevant anatomical relationships that comprise the anterior supralabyrinthine air cell tract.

Surgical dissection of 10 fresh cadaveric temporal bones was undertaken, including measurement of distances between the key anterior supralabyrinthine anatomical landmarks.

The following mean distances were calculated: the labyrinthine segment between the geniculate ganglion and the ampullated end of the superior semicircular canal, 2.33 mm (range 1.75–2.75); the tympanic segment between the anterior margin of the oval window niche and the geniculate ganglion, 3.58 mm (range 3.25–4); and from the tympanic segment adjacent to the anterior margin of the oval window niche to the labyrinthine segment adjacent to the superior semicircular canal, 3.48 mm (range 3–4.25).

The key anatomical landmarks of the anterior supralabyrinthine air cell tract define a distinct triangular segment of bone, knowledge of which is helpful in surgical dissection.

Post-auricular incisions are performed for a range of otological procedures. Anecdotally, many patients suffer some numbness of the pinna or post-auricular skin post-operatively, but for most this appears to reduce with time. This study aimed to investigate this phenomenon.

A single centre, questionnaire-based study was undertaken, assessing the presence of numbness beyond eight months post-surgery, its location, how it changed, and its impact on the patient. Patients whose numbness had resolved provided details of any temporary deficit. Data were acquired for 35 primary and 16 revision procedures.

Sixty-nine per cent of patients undergoing primary surgery experienced post-operative numbness. Twenty-six per cent had continued numbness after at least eight months' recovery, but only 3 per cent were constantly aware of the deficit. Of those with an ongoing deficit, 78 per cent felt there had been a reduction in the severity, and 67 per cent in the area size, over time. Recovery appeared to be slightly worse in revision cases.

We believe the currently accepted indications for frontal osteoma surgery are inappropriate. We propose a new osteoma classification system, below, in order to standardise surgical decisions.

Osteomas were classified based on: relationship of tumour mass to sinus size; tumour proximity to the infundibulum, destruction of sinus walls, and complications. Forty-five osteoma cases were thus classified (1971–2007), 29 of which underwent surgery (64.44 per cent).

Three stages were thus derived: I, tumour/air fraction less than one-third, tumour distant from the infundibulum, no sinusitis, and no complications (18 patients (40 per cent)); II, tumour/air fraction one-third to one-half, no infundibular obstruction, no bone destruction, no sinusitis, and no complications (six (13.33 per cent)); and III, tumour/air fraction more than one-half, partial or total infundibular obstruction, sinusitis, bone destruction, and/or complications (21 (46.67 per cent)).

Study findings suggest the following surgical indications: stage I, no surgery required, implement monitoring protocol; stage II, implement monitoring protocol, surgery may be required depending on tumour severity and general patient condition; and stage III, surgery always required. This system provides a method of standardising osteoma surgical decisions.

To evaluate symptom scores and nasal smear cytology findings in seasonal allergic rhinitis patients, before and after treatment.

Twenty-nine consecutive adult patients with seasonal allergic rhinitis were evaluated prospectively. They received mometasone furoate nasal spray and cetirizine for 21 days. Nasal and ocular symptom scores were recorded before and after treatment. Nasal cytology was also assessed as a means of determining treatment.

The combined use of an intranasal corticosteroid and an oral antihistamine caused a significant improvement in nasal and ocular symptom scores. Cytological evaluation revealed significant reduction in nasal eosinophil, neutrophil and goblet cell counts after three weeks' treatment.

Symptom scoring systems are widely used for the evaluation of drug efficacy in allergic rhinitis treatment. When investigating the disease and evaluating treatment efficacy, objective as well as subjective methods are needed. Nasal cytological assessment is a simple, objective method which provides valuable information about the nasal mucosa.

Tumours of nasal skin or mucosa are common, and can usually be treated with limited surgical excision or radiotherapy. This paper highlights a subset of high risk tumours which require rhinectomy for complete oncological clearance.

Retrospective case note review of 14 patients undergoing rhinectomy for nasal tumours. Clinical and histological findings, treatment and outcome are reviewed and discussed.

Forty-three per cent of patients had recurrent disease and underwent rhinectomy as a salvage procedure following previous surgery or radiotherapy. Most tumours (79 per cent) were basal cell carcinoma or squamous cell carcinoma. After a mean follow up of 30.1 months (range, zero to 96 months), seven patients (50 per cent) were alive and disease-free. Reconstruction was most commonly with a prosthesis.

Rhinectomy is an oncologically sound procedure for the management of high risk nasal malignancies. Prosthetic rehabilitation can be an excellent alternative to surgery, particularly in those patients unsuitable for major reconstruction.

To determine the negative predictive value of normal nasal endoscopy in assessing paranasal sinus disease as the cause of isolated facial pain in the sinus regions.

The study group comprised 42 consecutive adult patients presenting with the isolated symptom of facial pain, and a negative nasal endoscopy. Patients underwent sinus computed tomography to determine whether radiographic findings indicated a sinugenic aetiology.

Patients comprised 27 women and 15 men, with a median age of 38 years. Twenty patients had unilateral pain, 33 per cent had sinus radiographic findings that might explain their facial pain, and 10 per cent had imaging demonstrating mucosal disease in one or more sinuses correlating with the location of the facial pain. Thirty-one per cent had anatomical radiographic findings that could potentially obstruct the osteomeatal unit.

Normal nasal endoscopy had a negative predictive value of 67 per cent in excluding a sinugenic cause of isolated facial pain, if radiographically determined anatomical factors and mucosal disease were both included as positive findings; this rose to more than 90 per cent if only those patients with mucosal sinus disease were considered as true positive patients.

Peroxisome proliferator activated receptor gamma is a ligand-dependent transcription factor with an important role in insulin resistance and obesity. We investigated the associations between the Pro12Ala polymorphism of this receptor, obstructive sleep apnoea hypopnoea syndrome and hyperlipidaemia risk factors, in a Chinese cohort.

We recruited 420 obstructive sleep apnoea hypopnoea syndrome patients and 190 healthy controls. Genetic analysis was conducted by restriction fragment length polymorphism. The hyperlipidaemia risk in both the study and control groups was analysed.

Comparison of genotype and allele frequencies revealed no significant differences between patients and controls (p > 0.05). In patients, there was no correlation between genotype and clinical parameters (p > 0.05), apart from a significant association between the Ala12 allele and hyperlipidaemia (odds ratio = 2.181; p = 0.017; 95 per cent confidence interval = 1.133–4.198).

In this Chinese cohort, the Pro12Ala polymorphism of peroxisome proliferator activated receptor gamma was not associated with obstructive sleep apnoea hypopnoea syndrome, but was associated with increased hyperlipidaemia risk.

To audit a protocol for elective, day-case, paediatric ENT surgery, previously reported as enabling an overall post-operative nausea and vomiting rate of 2 per cent and a discharge rate of 100 per cent on the day of surgery.

The audit included 91 children (45 boys and 46 girls) aged three to 14 years. Forty-seven children underwent tonsillectomy, 36 adenotonsillectomy and eight tonsillectomy with postnasal space examination; indications included recurrent tonsillitis, tonsillitis and nasal block, upper airway obstruction, and a combination of upper airway obstruction and recurrent tonsillitis.

No post-operative nausea or vomiting was recorded in any of the children on the day of surgery, and no discharges were delayed. The reactionary haemorrhage rate was 1 per cent and the secondary haemorrhage rate 3.3 per cent.

These findings have implications for the safe same-day discharge of children following tonsillectomy.

To illustrate the morphological characteristics and pathological significance of arachnoid cysts confined to the internal auditory canal or facial nerve canal.

Retrospective case series.

Three patients' cases were reviewed, and temporal bone sections examined histologically.

In this series, three intracanalicular arachnoid cysts were found in the internal auditory canal and one in the facial nerve canal. All lesions consisted of distinct, space-occupying cysts with a sharp boundary with surrounding tissues. They were thin-walled and compressed the surrounding nerve trunks to a variable degree. However, there was no indication that patients suffered meatal nerve dysfunction.

Arachnoid cysts can develop within the internal auditory canal or facial nerve canal. In our series, they were asymptomatic, which is quite different from most intracanalicular arachnoid cysts encountered in clinical practice.

To report an extremely rare case of dark pigmentation on the tympanic membrane due to alkaptonuria, and to discuss the probable association between this condition and hearing loss.

A 58-year-old man with alkaptonuria was admitted with tinnitus and hearing loss in both ears. Physical examination showed bluish-black pigmentation on the helixes of both ears and both sclerae. Otoscopic examination revealed dark discolouration of both tympanic membranes. Audiological evaluation revealed mixed high frequency hearing loss in both ears. Tympanometric examination revealed type A tympanograms bilaterally, and absence of acoustic reflexes both ipsilaterally and contralaterally. Computed tomography of the temporal bones revealed no abnormality.

Clinicians should consider alkaptonuria in the differential diagnosis of patients with abnormal tympanic membrane pigmentation and hearing loss.

To present a case of, and to review the literature concerning, osteoblastoma of the nasal cavity, and to demonstrate the importance of considering this rare entity when assessing patients presenting with a nasal septum lesion.

Benign osteoblastoma is a rare tumour, constituting 1 per cent of all bone tumours. Most cases occur in the long bones. Osteoblastoma involving the nasal cavity is rare, with only 10 reported cases in the English-language literature. Most nasal cavity cases originate from the ethmoid sinus and spread to involve the nasal cavity. There are only four reported cases of osteoblastoma originating from the bones of the nasal cavity. We report a case of osteoblastoma originating from the bony nasal septum in a 45-year-old man with a history of recurrent, right-sided epistaxis and nasal obstruction.

This is the second report in the English-language literature of osteoblastoma originating from the bony nasal septum.

We report a rare case of fibro-hyaline anterior extensions of the bony nasal pyramid.

The clinical, radiological, intra-operative and histological findings are presented.

A 34-year-old man presented with bilateral nasal obstruction due to enlarged lateral walls of the nasal vestibule. Radiology showed normal bony structures. Surgery revealed three histologically identical, non-malignant, fibrous masses, one in the nasal septum and one in each of the vestibular walls. The latter were attached to the bony pyramid, protruding anteriorly and converging medially.

The location and symmetry of the fibro-hyaline projections indicated that they constituted a malformation mimicking congenital bony nasal pyriform aperture stenosis. Histological analysis showed that the masses were not neoplastic.

We report a rare case of epistaxis resulting from a ruptured internal carotid artery aneurysm, and present a successful treatment method.

A 72-year-old woman was admitted following recurrent massive epistaxis. There was no history of trauma or surgery. Radiographic imaging demonstrated a large internal carotid artery aneurysm. An attempt was made to occlude the aneurysm with endovascular coils. Despite this, the patient went on to have further epistaxis. Endovascular ablation of the feeding internal carotid artery led to complete resolution.

This case demonstrates that spontaneous epistaxis from intra-cavernous carotid artery aneurysms can be managed using endovascular techniques. To our knowledge, we report the first use of interventional radiological techniques to assess the collateral circulation to the brain and subsequently undertake endovascular ablation of the internal carotid artery.

The authors discuss a case of conjunctival irritation and epiphora in a patient who had undergone dacryocystorhinostomy three years earlier.

Case report, and a review of the world literature concerning lacrimal canalicular air regurgitation after dacryocystorhinostomy.

A 70-year-old woman, who used continuous positive airway pressure therapy during sleep, complained of epiphora and conjunctival irritation. She had undergone dacryocystorhinostomy three years earlier. Her right eye had an augmented tear meniscus, with a predominantly medial conjunctival irritation. Conjunctival irritation from lacrimal canalicular air regurgitation was diagnosed. White petrolatum and mineral oil ophthalmic ointment was prescribed, applied topically before sleeping. After one month of treatment, complete relief of symptoms was obtained.

There is little current information on managing such patients. It is imperative to discuss this potential complication when considering nasolacrimal surgery in patients using continuous positive airway pressure therapy.

Neonates are obligate nasal breathers, and nasal obstruction may have serious implications. We present an extremely rare cause of neonatal nasal obstruction, and its management.

An eight-day-old neonate was referred for upper airway obstruction. Initial investigations had identified no obvious cause. Rigid airway endoscopy revealed a large, cystic lesion appearing to arise from the roof of the posterior nasal space. Computed tomography and magnetic resonance imaging indicated a basal cephalocoele projecting inferiorly into the oropharynx, with an intracranial connection to the pituitary fossa. Histology showed fibrovascular tissue lined on one aspect by respiratory type epithelium, with mucous glands present. The tissue contained multiple cystic spaces lined by choroid plexus epithelium, with glial tissue present in the walls of the mass. A transpalatal excision of the nasopharyngeal cephalocoele, with closure of the intracranial connection, palatal repair and lumbar drain placement was undertaken. Post-operative recovery was uneventful, with no evidence of cerebrospinal fluid leakage or palatal dysfunction.

This surgical approach gave excellent access whilst avoiding the obvious morbidity associated with an intracranial approach. Nasal masses should be considered in the differential diagnosis of neonatal respiratory distress due to nasal obstruction.

We report a rare case of tuberculosis presenting with bilateral vocal fold palsy.

Case report and discussion of ENT manifestations of tuberculosis.

A 39-year-old man presented with stridor and bilateral vocal fold palsies, and underwent an emergency tracheostomy. Intra-operatively, a mass was identified overlying the thyroid cartilage. Fine needle aspiration cytology of this mass showed well formed granulomas but negative Ziehl–Nielsen staining. Computed tomography showed the mass to be surrounding the thyroid cartilage, causing airway occlusion; pulmonary infiltrates were also seen. The patient was commenced on tuberculosis treatment. Subsequent sputum samples from the tracheostomy confirmed the diagnosis. The patient responded very well to treatment, and was successfully decannulated after one week.

The incidence of tuberculosis in the UK is increasing, particularly in urban areas. The otolaryngologist may encounter a wide variety of presentations. Diagnosis requires a high index of clinical suspicion.

We present an extremely rare case of isolated angiokeratoma of the tongue.

Case report and review of related literature.

An 18-year-old, male adolescent presented with a fleshy, intermittently bleeding mass in the posterior third and base of the tongue. The lesion was initially suspected to be a lingual thyroid or haemangioma, but histopathological features were consistent with angiokeratoma. Magnetic resonance imaging revealed that the lesion extended up to the vallecula and involved the lamina propria and superficial tongue musculature. No similar lesions were found elsewhere in the body. No metabolic derangements were identified in the patient or his family. The 2.6 × 1.5 × 0.5 cm mass was excised under general anaesthesia.

We present the 1st case of isolated lingual angiokeratoma in a male, the 4th such case overally, the largest ever documented. The lesion was situated in the posterior third and base of the tongue, a position not previously described.

We report an extremely rare case of giant fibrovascular polyp of the hypopharynx.

We present a 49-year-old man who had increasing difficulty swallowing, advanced respiratory distress and weight loss, as well as a hypopharyngeal mass protruding from his mouth.

Diagnosis was confirmed by endoscopic examination and computed tomography. A tracheostomy was required due to laryngeal obstruction by the regurgitated mass. The giant polyp was removed via per-oral endoscopic excision under general anaesthesia.

Fibrovascular polyps occur most commonly in the cervical oesophagus, and are extremely rare in the hypopharynx. They can grow to a very large size over several years. We discuss the symptoms, diagnosis and surgical treatment techniques for upper aerodigestive tract fibrovascular polyps, in the light of the literature.