To compare mucosal and bony measurements in patients with congenital and traumatic nasal septum deviation and compensatory inferior turbinate hypertrophy.

The study examined 50 patients with nasal septum deviation (25 congenital and 25 traumatic) and compensatory inferior turbinate hypertrophy in the contralateral nasal cavity, confirmed by computed tomography.

The study compared inferior turbinate measurements on the concave and convex sides of the septum, in the congenital and traumatic groups. Measurements comprised: the shortest distance from the median line to the medial border of the conchal bone; the distances from the most medial part of the conchal mucosa and the conchal bone to the lateral line; the projection angle of the inferior turbinate; and the widest parts of the whole inferior turbinate and the inferior turbinate conchal bone. The differences between the concave and convex side measurements were compared in the congenital group versus the traumatic group; for three measurements, the difference between these two groups was statistically significant (p < 0.05).

The present study findings suggest that the conchal bone has a marked influence on nasal patency in patients with congenital septal deviation. These findings supported the decision to excise the inferior turbinate bone at the time of septoplasty, especially when treating congenital septal deviation.

To evaluate the effect of different lipid fractions on auditory brainstem evoked responses in hyperlipidaemia.

We conducted a single institution (medical college), prospective, cross-sectional study of 25 hyperlipidaemic patients and 25 normolipidaemic controls, all with a normal hearing threshold on pure tone audiometry. Brainstem evoked response audiometry results were recorded in both groups. The hyperlipidaemic group were further divided into two subgroups, based on the serum value of each lipid fraction: those with less than and those with greater than the mean serum value. These two subgroups were further compared with the control group.

The hyperlipidaemic and normolipidaemic groups had statistically significant differences for all audiometry waves apart from the wave I and the III–V interpeak latencies. The subgroups had a statistically significant difference in brainstem evoked responses. We found a statistically significant association between low-density lipoproteins and many waveforms in the hyperlipidaemic group.

We found that low-density lipoproteins were significantly associated with many waveforms in hyperlipidaemic patients. Thus, low-density lipoproteins may be important in auditory dysfunction.

Vocal fold paralysis can be an early warning sign of serious extra-laryngeal pathology. Even if imaging investigations show no pathology, there is always concern about the emergence of new pathology in the future. There is currently no consensus on the best follow-up protocol for vocal fold paralysis patients with no abnormalities on investigation.

Systematic review, using an Ovid and Medline database search of papers written in the English language and published in the last 20 years.

Eight relevant studies were identified. Not all of them were directly comparable. A narrative review of the studies is presented and conclusions are drawn.

Current diagnostic modalities are sufficiently reliable and sensitive to diagnose any significant existing extra-laryngeal pathology. Thus, once initial investigation (including computed tomography) has concluded, no further follow up is necessary.

To report the outcome of posterior semicircular canal occlusion surgery for intractable benign positional vertigo, regarding vertigo cure rate and hearing and balance outcomes.

Retrospective review of 53 patients presenting with benign positional vertigo, unresponsive to repositioning manoeuvres, who eventually underwent posterior canal occlusion, over a 20 year period.

From 1991 to 2011, 5364 benign positional vertigo patients were treated in our balance disorders clinic; 53 of those who failed to respond to repositioning underwent posterior canal occlusion. All 53 were cured of their benign positional vertigo. Nine suffered some symptomatic permanent hearing loss (>20 dB at low and >25 dB at high frequencies). Ten patients suffered caloric vestibular function deterioration, with mild but permanent subjective imbalance in five; a further 10 patients with no post-operative caloric test changes also had some permanent imbalance. Benign positional vertigo later developed in the operated ear lateral canal in two patients and in the opposite ear posterior canal in eight patients. Two patients needed bilateral sequential posterior canal occlusion.

Posterior canal occlusion is a highly effective treatment for intractable benign positional vertigo, with what is probably an acceptable risk to hearing and balance: five of six patients will have no hearing problem and nine of 10 no balance problem after surgery.

To determine the effect of the Meniett® low-pressure generator on the subjective symptoms and audiovestibular disease markers of patients with unilateral Menière's disease unresponsive to betahistine treatment.

Randomised, placebo-controlled, double-blinded, clinical trial at a tertiary referral centre. After ventilation tube placement, patients were randomised to the active treatment or placebo group. Monitoring comprised audiometry and air caloric testing and a vertigo diary (enabling calculation of vertigo and activity scores, and the number of vertigo days, vertigo-free days and sick days).

Sixty-eight patients completed the study. For the active treatment versus placebo group, the following pre- and post-treatment values, and significances for treatment effect comparisons, were respectively seen: cumulative vertigo scores, 22.47 and 15.97 vs 20.42 and 19.23 (p = 0.048); vertigo days, 6.5 and 4.08 vs 5.94 and 5.52 (p = 0.102); sick days, 3.08 and 0.78 vs 2.87 and 3.45 (p = 0.041); vertigo-free days, 14.47 and 17.61 vs 15.48 and 17.58 (p = 0.362); activity score, 23.61 and 13.42 vs 24.68 and 20.23 (p = 0.078); low-tone hearing threshold, 49.15 and 53.18 dB nHL vs 41.66 and 46.10 dB nHL (p > 0.05); and slow phase velocity in response to caloric stimulation, 18.86 and 18.72 °/second vs 14.97 and 15.95 °/second, (p > 0.05).

Use of the Meniett® low-pressure generator improved patients' vertigo but not their hearing or vestibular function. This safe, minimally invasive treatment is recommended as second-line treatment for unilateral Menière's disease.

To determine the immediate and long-term taste effects of chorda tympani nerve sacrifice in patients undergoing open cavity mastoidectomy.

A retrospective, questionnaire survey of patients receiving follow up and aural toilet following open cavity mastoidectomy, over a four-month period. The questionnaire assessed taste disturbance, both immediately post-operative and current. Available surgical records were reviewed for chorda tympani references.

Of 57 patients, six had undergone surgery to both ears. Of those who could recall (37/57), 24.3 per cent were aware of taste disturbance immediately after surgery, while 8.7 per cent reported current disturbance (median post-operative interval, 28.5 years; range, one month to 67 years). No bilateral surgery patients were aware of taste disturbance.

Mastoidectomy consent procedure emphasises the risk of hearing loss and facial nerve injury, yet in open cavity surgery chorda tympani division is almost inevitable. Reassuringly, most post-operative taste disturbance resolves, and most patients are not aware of long-term disturbance. However, a small percentage suffer ongoing taste disturbance; this could be significant for professional chefs and wine-tasters. The risk of taste disturbance should be addressed in the consent procedure.

This study aimed to compare the outcomes of turbinoplasty assisted by microdebrider and by diode laser (980 nm wavelength).

Forty patients suffering from bilateral nasal obstruction were randomly divided into two equal groups. One group was managed with microdebrider-assisted turbinoplasty and the other with diode laser assisted turbinoplasty. The patients were followed up for six months post-operatively.

After six months, total success rates were 90 per cent for the microdebrider group and 85 per cent for the diode laser group. There were no significant differences between the two groups regarding success rate, post-operative complications or operative time.

These two techniques are equally safe, reliable, successful and non-invasive.

To assess the feasibility of designing and implementing a speech in noise test in children before and after grommet insertion, and to analyse the results of such a test in a small group of children.

Twelve children aged six to nine years who were scheduled to undergo grommet insertion were identified. They underwent speech in noise testing before and after grommet insertion. This testing used Arthur Boothroyd word lists read at 60 dB in four listening conditions presented in a sound field: firstly in quiet conditions, then in signal to noise ratios of +10 (50 dB background noise), 0 (60 dB) and −10 (70 dB).

Mean phoneme scores were: in quiet conditions, 28.1 pre- and 30 post-operatively (p = 0.04); in 50 dB background noise (signal to noise ratio +10), 24.2 pre- and 29 post-operatively (p < 0.01); in 60 dB background noise (signal to noise ratio 0), 22.6 pre- and 27.5 post-operatively (p = 0.06); and in 70 dB background noise (signal to noise ratio −10), 13.9 pre- and 21 post-operatively (p = 0.05).

This small study suggests that speech in noise testing is feasible in this scenario. Our small group of children demonstrated a significant improvement in speech in noise scores following grommet insertion. This is likely to translate into a significant advantage in the educational environment.

This study aimed to investigate the function of tissue plasminogen activator in the olfactory epithelium of mice following neural injury.

Transmission electron microscopy was used to study the changes in the morphology of the olfactory epithelium 1–7 days after surgical ablation of the olfactory bulb (bulbectomy).

Prior to bulbectomy, a uniformly fine material was observed within some regions of the olfactory epithelium of mice deficient in tissue plasminogen activator. At 2–3 days after bulbectomy, there were degenerative changes in the olfactory epithelium. At 5–7 days after bulbectomy, we noted drastic differences in olfactory epithelium morphology between mice deficient in tissue plasminogen activator and wild-type mice (comparisons were made using findings from a previous study). The microvilli seemed to be normal and olfactory vesicles and receptor neuron dendrites were largely intact in the olfactory epithelium of mice deficient in tissue plasminogen activator.

The tissue plasminogen activator plasmin system may inhibit the regeneration of the olfactory epithelium in the early stages following neural injury.

We investigated gustatory changes in patients with chronic otitis media, before and after middle-ear surgery.

This prospective study included 38 patients with unilateral chronic otitis media. We used taste testing solutions to evaluate each patient's taste function. Intra-operative assessments of the chorda tympani nerve were also compared and analysed.

Patients with chronic otitis media had significantly worse ipsilateral perception of sour, bitter and salty tastes. In patients with good intra-operative preservation of the chorda tympani nerve, there was significant improvement in gustatory function one month post-operatively, compared with the pre-operative baseline. In patients who sustained intra-operative chorda tympani nerve injury, one month post-operative gustatory function was the same as the pre-operative baseline.

Middle-ear surgery for chronic otitis media not only treats the ear but also improves gustatory function in the majority of patients. In patients with intra-operative injury to the chorda tympani nerve, post-operative taste decline is only temporary.

To determine anatomical variations in the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle, and to propose a rational approach for the preservation of the nerve in thyroid surgery based on anatomical principles.

A cadaveric dissection study of the anatomy of the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle was conducted. Twenty-nine formalin-fixed cadavers of both sexes (age 50–70 years), with normal necks, were examined.

In relation to the Friedman classification, three anatomical variations of the external branch of the superior laryngeal nerve were found. Type 1 variation was found in 57.1 per cent of cases, type 2 in 26.8 per cent and type 3 in 16 per cent.

The prevalence of type 3 variation of the external branch of the superior laryngeal nerve suggests that the nerve will not be encountered in a certain percentage of individuals as it lies under the cover of the inferior constrictor. Therefore, there is no justification for attempting to identify the nerve in all cases.

Tympanostomy tube (grommet) insertion is a common procedure, with little guidance in the current literature regarding post-operative surveillance. Our institution implemented a protocol to follow up post-surgical grommet patients via audiology at six weeks.

A retrospective audit of all patients less than 16 years old who had undergone grommet insertion during a three-month period.

A total of 149 patients had grommets inserted. Exclusion criteria left a cohort of 123 individuals; 82 (67 per cent) were followed up by audiology. Of these, 13 (11 per cent) did not attend follow up, and were discharged; 53 (43 per cent) were discharged from audiology with normal thresholds; and 16 (13 per cent) were referred back to a consultant. Therefore, the overall reduction in patients followed up by an otolaryngologist was 54 per cent.

We recommend a six-week follow up with audiology following grommet insertion, allowing for referral back to ENT services in the event of related complications.

To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis.

One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund–Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence.

Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014).

Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.

There is wide variation in UK prescribing practice regarding prophylactic antibiotics for nasal packing in spontaneous epistaxis. There are few published cases of infective complications in such patients.

This prospective study examined 149 consecutive patients admitted to a tertiary otorhinolaryngology centre with spontaneous epistaxis, who underwent nasal packing, over a six-month period. In the first three-month period, 78 patients were routinely prescribed prophylactic antibiotics; in the second three months, 71 patients were not routinely prescribed antibiotics. Exclusion criteria included antibiotics prescribed for unrelated pathology and post-operative epistaxis. Signs and symptoms of acute otitis media, sinusitis and toxic shock syndrome were assessed using clinical examination and a questionnaire.

Fourteen of the 149 patients experienced otalgia, most commonly following posterior nasal packing. No patient in either group had evidence of any infective complication.

We do not recommend the routine prescription of prophylactic antibiotics for patients undergoing nasal packing for spontaneous epistaxis.

During nasal septum surgery, elevation of mucoperichondrium from the anterior nasal septum may be more difficult than from the medial and posterior septum. This study aimed to evaluate any histological structural differences between the anterior and posterior nasal septum cartilage, mucoperichondrium and intervening tissue.

Unilateral mucoperichondrial flap elevation without infiltration was performed, after nasal tip and dorsum decortication, in four patients undergoing open septorhinoplasty. Full-thickness samples, including cartilage and mucoperichondrium, were removed from the anterior and posterior nasal septum and examined under light and electron microscopy.

Light microscopy showed no difference between anterior and posterior septum specimens regarding perichondrial thickness and subperichondrial cell density. Demarcation between cartilage and perichondrium and between perichondrium and lamina propria was more regular in the posterior versus the anterior septum. Electron microscopy showed no difference in chondroblast activity at the two sites.

The observed tissue demarcation irregularities may explain the greater reported difficulty in elevating anterior versus posterior nasal septum mucoperichondrium. Immunohistochemical examination would further elucidate these interstructural connections.

This study aimed to identify the incidence of residual viable neck disease in patients with mucosal squamous cell carcinoma of the upper aero-digestive tract, following primary chemoradiation at a tertiary centre.

Retrospective review.

Retrospective chart review of patients treated with primary chemoradiation for squamous cell carcinoma of the aero-digestive tract between August 2001 and August 2008. Neck status pre- and post-treatment was the primary focus.

Forty-two patients with node-positive disease prior to chemoradiation were included. Thirty-seven (88.1 per cent) achieved complete response to treatment: no patient in this group underwent neck dissection, five died due to recurrence at the primary site or distant metastasis, and none suffered neck recurrence. Five (11.9 per cent) patients achieved partial response to chemoradiation and underwent neck dissection; viable tumour was found in one patient.

Our data support conservative management of the neck in patients with complete response to chemoradiation, and consolidation neck dissection in patients with partial response.

To determine potential prognostic factors for survival in patients with mucosal malignant melanoma of the sinonasal tract.

Patients managed between 1991 and 2008 were assessed retrospectively. The seventh edition Union for International Cancer Control (7th UICC) tumour-node-metastasis classification was used for tumour staging. Kaplan–Meier and log rank tests were used for survival analysis.

Twenty-five patients were studied (six were tumour stage three, eight tumour stage four(a) and 11 tumour stage four(b)). Surgery was performed on 23 patients (92 per cent). Fifteen received post-operative radiotherapy. Mean follow up was 31.3 months (range, two to 99 months). Three-year disease-free survival was improved in patients with stage four tumour arising from the nasal fossa, versus other sites, and in those with stage four tumour treated with surgery plus adjuvant radiotherapy, versus other treatments.

Patients with melanoma of the nasal cavity have very poor survival rates. Treatment is still based on adequate surgical resection with safe margins. In this study, post-operative radiotherapy improved local control only for stage four tumours.

We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.

Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.

All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.

In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

Chronic obliterative otitis externa is a rare cause of conductive hearing loss, characterised by stenosis of the deep ear canal secondary to chronic inflammation. A multitude of canalplasty techniques have been described, with variable success.

Fourteen patients undergoing canalplasty performed by the senior author for refractory obliterative otitis externa, over an 8-year period, were included in the study. All underwent split-skin grafting of the denuded canal and meticulous post-operative aural care. Outcome measures included the Glasgow Benefit Inventory and pure tone audiology.

At 3 months post-operatively, the four-tone average threshold had improved by a mean of 13.9 dB (95 per cent confidence interval –9.9 to 37.8 dB; t < 0.001) in the operated ear. The mean Glasgow Benefit Inventory score was 20 (95 per cent confidence interval −2.3 to 42.1).

Significant improvements in both hearing and quality of life are achievable in patients with end-stage obliterative otitis externa treated surgically. Highly trained and competent aural care practitioners are a prerequisite for the success of the procedure, and a substantial number of patients must be prepared to submit to long-term follow-up care.