Normal balance relies on three sensory inputs: vision, proprioception and the peripheral vestibular system. This study assessed hearing change and postural control in normal subjects.

Postural control in 20 normal volunteers was assessed using a Nintendo Wii gaming console and balance board. Each subject was tested standing upright for 30 seconds in a clinic room and a soundproof room with their eyes open, eyes closed, whilst standing on and off foam, and with and without ear defenders.

There was significantly more postural sway in the following subjects: those standing with their eyes closed vs those with eyes open (normal room, p = 0.0002; soundproof room, p = 0.0164); those standing on foam with eyes open vs those standing normally with eyes open (in both rooms; p < 0.05); those standing with eyes open in a soundproof room vs a normal room (p = 0.0164); and those standing on foam in a soundproof room with eyes open and wearing ear defenders vs those in the same circumstances but without ear defenders.

Our results suggest that this method provides a simple, inexpensive tool for assessing static postural control. Whilst it is recognised that visual input and proprioception play a central role in maintaining posture, our findings suggest that ambient sound and hearing may also have a significant influence.

Despite longstanding concern, provision of undergraduate ENT teaching has not improved in response to the aims of the UK General Medical Council's initiative Tomorrow's Doctors. Previous studies have demonstrated poor representation of ENT within the undergraduate curriculum. We aimed to identify current practice in order to establish undergraduate ENT experience across UK medical schools, a timely endeavour in light of the General Medical Council's new 2011–2013 education strategy.

Questionnaires were sent to ENT consultants, medical school deans and students. All schools with a clinical curriculum were anonymously represented. Our outcome measures were the provision of mandatory or optional ENT placements, and their duration and content.

A compulsory ENT placement was available to over half (53 per cent) of the students. Ten of the 26 participating schools did not offer an ENT attachment. The mean mandatory placement was 8 days. Overall, 38 per cent of students reported a satisfactory compulsory ENT placement. Most ENT consultants questioned considered that newly qualified doctors were not proficient in managing common ENT problems that did not require specialist referral.

Little improvement in the provision of undergraduate ENT teaching was demonstrated. An increase in the proportion of students undertaking ENT training is necessary. Time and curriculum constraints on medical schools mean that optimisation of available resources is required.

Cisplatin, an effective therapeutic agent for various human cancers, has dose-limiting side effects of ototoxicity and nephrotoxicity. Cisplatin ototoxicity is thought to result from increased amounts of toxic free radicals or cell membrane changes leading to increased intracellular calcium content. Ginkgo biloba extract prevents lipid peroxidation, decreases intracellular free oxygen radical levels, regulates the cell membrane calcium transport mechanism and prevents cell death. This study aimed to investigate the protective effect of Ginkgo biloba extract against cisplatin-induced ototoxicity in rats.

Twenty Wistar albino rats with normal hearing (confirmed by distortion product otoacoustic emission testing prior to cisplatin application) were randomly allocated to two groups. Both groups received a single intraperitoneal dose of cisplatin (12 mg/kg). Group two also received daily intraperitoneal doses of Ginkgo biloba extract (100 mg/kg) for 10 days. Distortion product otoacoustic emission measurements were repeated on days 10 and 17 and signal-to-noise ratios were compared.

Compared with group one, group two had significantly better distortion product otoacoustic emission results at 3, 4, 6 and 8 kHz on days 10 and 17.

These findings suggest that Ginkgo biloba extract protects the inner ear against cisplatin-induced ototoxicity.

To assess the feasibility of temporal bone magnetic resonance imaging for evaluating the severity and prognosis of idiopathic acute facial nerve palsy.

Forty-four patients with idiopathic acute facial nerve palsy who had undergone gadolinium-enhanced magnetic resonance imaging were selected retrospectively. The degree of radiological facial nerve enhancement was determined using quantitative analysis (with region-of-interest measurements for separate facial nerve segments) and using subjective visual analysis. The clinical severity of facial nerve palsy was then correlated with the degree of facial nerve enhancement.

The visually determined degree of facial nerve enhancement did not correlate significantly with the House–Brackmann grade at either the early or late stages (p > 0.05). Results using the region-of-interest system were similar (p > 0.05).

Temporal bone magnetic resonance imaging is not essential for patients with acute facial nerve palsy.

The Bluetooth wireless headset has been promoted as a ‘hands-free’ device with a low emission of electromagnetic radiation.

To evaluate potential changes in hearing function as a consequence of using Bluetooth devices, by assessing changes in pure tone audiography and distortion production otoacoustic emissions.

Prospective study.

Thirty adult volunteers were exposed to a Bluetooth headset device (1) on ‘standby’ setting for 6 hours and (2) at full power for 10 minutes. Post-exposure hearing was evaluated using pure tone audiography and distortion production otoacoustic emission testing.

There were no statistically significant changes in hearing, as measured above, following either exposure type.

Exposure to the electromagnetic field emitted by a Bluetooth headset, as described above, did not decrease hearing thresholds or alter distortion product otoacoustic emissions.

This retrospective study compared the cochlear implantation outcomes of first- and second-generation deaf children.

The study group consisted of seven deaf, cochlear-implanted children with deaf parents. An equal number of deaf children with normal-hearing parents were selected by matched sampling as a reference group. Participants were matched based on onset and severity of deafness, duration of deafness, age at cochlear implantation, duration of cochlear implantation, gender, and cochlear implant model. We used the Persian Auditory Perception Test for the Hearing Impaired, the Speech Intelligibility Rating scale, and the Sentence Imitation Test, in order to measure participants' speech perception, speech production and language development, respectively.

Both groups of children showed auditory and speech development. However, the second-generation deaf children (i.e. deaf children of deaf parents) exceeded the cochlear implantation performance of the deaf children with hearing parents.

This study confirms that second-generation deaf children exceed deaf children of hearing parents in terms of cochlear implantation performance. Encouraging deaf children to communicate in sign language from a very early age, before cochlear implantation, appears to improve their ability to learn spoken language after cochlear implantation.

(1) To assess hypersensitivity to bismuth iodoform paraffin paste impregnated ribbon gauze following its use in packing canal wall down mastoidectomy cavities; (2) to determine if isolation of the skin and mucosa from the pack, using thin Silastic sheeting and Cortisporin ointment, reduces hypersensitivity reactions, compared with a previous series; and (3) to review the literature and to determine if bismuth iodoform paraffin paste hypersensitivity precludes the consumption of seafood (due to its high iodine content).

All patients undergoing canal wall down mastoidectomy with intra-operative bismuth iodoform paraffin paste packing between 1985 and 2009 were identified and reviewed.

Of 587 patients identified, the overall bismuth iodoform paraffin paste reaction rate was 1 per cent. All reactions were in patients undergoing revision mastoidectomy procedures, giving a reaction rate for revision procedures of 2.4 per cent.

Reactions are an uncommon event following post-operative mastoid cavity packing using bismuth iodoform paraffin paste. Reaction rates may be lowered by preparing the cavity with Silastic sheeting and Cortisporin ointment prior to packing, thus isolating the skin and mucosal surfaces. Development of such a reaction does not preclude the consumption of seafood.

To identify the incidence of vestibular schwannoma amongst patients referred from a direct referral audiology clinic, and also the number of incidental findings, as seen on magnetic resonance imaging or computed tomography scans.

Prospective data collection for patients referred from a direct referral audiology clinic due to audiological evidence of asymmetrical hearing loss. The audiograms, magnetic resonance imaging and computed tomography scans of patients with diagnosed vestibular schwannoma were subsequently reviewed.

A total of 4100 patients were seen during the study period, with 396 scans performed. Six (1.5 per cent) patients had vestibular schwannoma, while 12 (3 per cent) had significant incidental findings.

Patients referred from the direct referral audiology clinic had a low incidence of vestibular schwannoma detection. Their detection rate for significant incidental findings was similar to previous reports. If the current protocol had not been in place, over 300 patients would have been needlessly added to the ENT clinic list. Thus, general practitioner referral to direct referral audiology clinics provides a cost-effective way of managing asymmetrical sensorineural hearing loss in older patients. The number of such clinics could be expanded.

To determine the best clinical method for identifying peripheral vestibular nystagmus, by comparing eye movement examination with optic fixation, and with fixation removed using Frenzel's glasses, infra-red video-Frenzel's goggles or an ophthalmoscope, with results of electronystagmography.

One hundred patients referred for electronystagmography from the audiovestibular medicine clinic at Queen Alexandra Hospital, Portsmouth, were examined immediately before undergoing electronystagmography.

Video-Frenzel's goggles were highly effective at detecting peripheral vestibular nystagmus, with a sensitivity of 85 per cent (95 per cent confidence interval, 62.1–96.8 per cent) and a specificity of 65 per cent (53.5–75.3 per cent), compared with electronystagmography. Ophthalmoscopy had comparable sensitivity to Frenzel's glasses (used in the dark), i.e. 26.3 per cent (9.1–51.2 per cent) compared with 31.6 per cent (12.6–56.6 per cent), respectively. Frenzel's glasses as normally used in ENT clinics (i.e. in dim lighting) were ineffective, with a sensitivity of just 10 per cent (1.2–31.7 per cent).

Video-Frenzel's goggles should be used in all clinics with substantial numbers of balance-impaired patients. Traditional Frenzel's glasses have no place in clinical practice unless formal black-out facilities are available.

We report a case of a remaining hemi-thyroid following laryngectomy, which was misinterpreted as a pseudoaneurysm.

Case report and comment on this understandable error which is easily avoidable.

A 59-year-old man had undergone salvage laryngectomy for recurrent squamous cell carcinoma of the larynx, which had previously been treated with radiotherapy. Three months after his laryngectomy, he presented with a sore neck and subcutaneous collections. Computed tomography revealed a unilateral mass with high signal contrast uptake anterior to the left common carotid artery, which was thought initially to be a carotid pseudoaneurysm. Further investigation, including ultrasonography and a review by the senior head and neck radiologist, demonstrated that this mass was actually the remnant hemi-thyroid preserved at laryngectomy (which is often misshapen compared with a normal hemi-thyroid). The collections were found to be recurrent tumour, and unnecessary further interventions were avoided.

Ultrasonography easily distinguishes between a thyroid remnant and a pseudoaneurysm. Furthermore, the opinion of an experienced head and neck radiologist may be vital when interpreting complex post-surgical head and neck radiology.

To review our experience of cochlear implant failure and subsequent revision surgery, and to illustrate the experience we have gained by presenting a series of lessons learned.

A combined retrospective and prospective study of revision surgery in a UK regional cochlear implant centre.

Of the 746 cochlear implantations undertaken, 33 (4.7 per cent of adults and 4.1 per cent of children) had a registered failure requiring re-implantation. The mean time to device failure was 60 months in adults and 35 months in children. Causes of cochlear implant failure were medical (n = 11), electrode displacement (n = 2), ‘hard device failure’ (n = 15) and ‘soft device failure’ (n = 5). Chronic suppurative otitis media and post-auricular mastoid abscess were the commonest causes of medical failure. There was one case of electrode array displacement as a direct result of skin flap revision surgery. In 80 per cent of cases, audiological performances were stable or improved following re-implantation.

As the number of cochlear implants increase and patients outlive the lifespan of their devices, we will face a growing number of revision procedures. Audiologists and otologists should be competent in diagnosing and managing device failure and medical complications requiring cochlear re-implantation.

The pathogenesis of cholesteatoma remains unclear, despite several theories. Alterations in the density of mast cells positive for cluster of differentiation 117 protein (also known as CD117) can be critical to cholesteatoma formation, due to the effect on keratinocyte growth factor production. This study aimed to investigate the potential role of these mast cells in cholesteatoma pathogenesis.

The number and density of mast cells positive for cluster of differentiation 117 protein were immunohistochemically analysed in 52 patients: 22 with chronic otitis media alone (group one), 25 with chronic otitis media with cholesteatoma (group two) and five controls.

The number of these mast cells was much higher in group two (in cholesteatoma matrix tissue) than in group one (in chronic otitis media granulation tissue) or the controls (in normal post-auricular skin). The density of these mast cells was significantly greater in group two than in group one or the controls (p < 0.05). The number and density of these mast cells was much greater in group one than in controls (p < 0.01).

Mast cells positive for cluster of differentiation 117 protein could play a role in cholesteatoma formation. Further investigation of the role of these mast cells in cholesteatoma may suggest new ways of addressing this disorder, and may enable the development of targeted treatments.

To assess the efficacy of anterior tagging of graft material with respect to graft uptake and hearing results, in type I tympanoplasty.

Prospective, randomised, cohort study.

Sixty patients with chronic otitis media of the mucosal type, with pars tensa perforations, were included in the study. Patients were randomly allocated to two groups: group one underwent type one tympanoplasty with anterior tagging, while group two underwent type one tympanoplasty without anterior tagging. Follow up included evaluation of graft uptake and hearing improvement.

There were 33 patients in group one and 27 patients in group two. The overall incidence of successful graft uptake was 96.96 per cent in group one and 81.5 per cent in group two. Closure of central and posterior perforations was successful in 100 per cent of both groups. Closure of anterior and subtotal perforations was successful in 95.45 per cent of group one and 54.54 per cent of group two.

Type one tympanoplasty with anterior tagging of graft material is a suitable technique for anterior and subtotal perforations.

To establish a new magnetic resonance imaging scoring system for diagnosing endolymphatic hydrops.

A total of 214 ears of 107 patients were categorised into five groups: no symptoms, Ménière's disease, sudden deafness, delayed endolymphatic hydrops and other ear disorders. Gadolinium distribution within the labyrinth was scored separately and quantitatively by two radiologists. Multiple independent-sample non-parametric tests, Bayesian discriminant analysis, multivariate logistic regression and receiver operating characteristic curve analyses were performed.

The derived scoring model was highly accurate for diagnosing Ménière's disease and delayed endolymphatic hydrops. Two magnetic resonance imaging scoring methods for the perilymphatic space were proposed for the diagnosis of endolymphatic hydrops: a pre-1 value (a new variable that predicts individual probability) of more than 0.3982299, or a sum of all labyrinth component scores of less than 14.5.

A convenient method is proposed which offers reliable radiological diagnostic criteria for Ménière's disease and delayed endolymphatic hydrops.

To compare the functional results of type I tympanoplasty performed with either temporalis fascia or a perichondrium and cartilage island flap, in patients with bilateral chronic otitis media.

The study included primary tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least one month and normal middle-ear mucosa, together with contralateral tympanic membrane perforation. Temporalis fascia tympanoplasty was undertaken in 41 patients, and cartilage tympanoplasty in 39 patients.

The graft success rate was 65.9 per cent for the fascia group and 92.3 per cent for the cartilage group. Post-operatively, the mean ± standard deviation air conduction threshold was 28.54 ± 14.20 dB for the fascia group and 22.97 ± 8.37 dB for the cartilage group, while the mean ± standard deviation bone conduction threshold was 11.71 ± 8.50 dB for the fascia group and 7.15 ± 5.56 dB for the cartilage group.

In patients with bilateral chronic otitis media, cartilage tympanoplasty seems to provide better hearing results and graft success rates.

To assess results of malleostapedotomy using a Fisch Storz titanium piston with at least 10 months’ follow up.

Using a prospective database, the indications, surgical technique, and pre- and post-operative audiometric data for 60 patients undergoing malleostapedotomy between 2002 and 2010 were evaluated. Diagnoses and primary and revision surgeries were compared with reference to the literature.

Sixty endaural malleostapedotomies were performed, 28 as a primary intervention and 32 as revision surgery. In 68 per cent, the underlying pathology was otosclerosis. The most common reason for revision surgery (i.e. in 59 per cent) was prosthesis dysfunction. Overall, the mean air–bone gap (0.5–3 kHz) for the primary intervention and revision surgery groups was 9.4 and 11.3 dB, respectively; an air–bone gap of less than 20 dB was obtained in 100 and 81 per cent of patients, respectively. There was no significant audiological difference between the primary and revision surgeries groups, and no deafness.

Malleostapedotomy shows comparable results to standard incus-stapedotomy and may be preferable in the presented situations.

To analyse patients with cholesteatoma undergoing canal wall down mastoidectomy together with ossicular reconstruction with a titanium prosthesis, in order to identify factors associated with hearing outcomes.

Retrospective review of 97 cases undergoing single-stage surgical management.

All patients underwent canal wall down mastoidectomy. Kurz titanium ossicular prostheses were used for ossicular chain reconstruction. Pre-operative and post-operative air conduction and bone conduction hearing thresholds were obtained at 500, 1000, 2000 and 3000 Hz.

The mean pure tone average improved from 46.02 ± 14.54 dB pre-operatively to 29.32 ± 14.64 dB post-operatively, for both total and partial ossicular replacement prosthesis groups combined. The mean air–bone gap improved from 30.38 ± 11.12 dB pre-operatively to 15.62 ± 9.65 dB post-operatively, for both groups combined.

Reconstruction with a titanium prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure.