Otitis media with effusion is a clinical manifestation characterised by inflammation of middle-ear mucosa. This study investigated the therapeutic effect of erythromycin, clarithromycin, azithromycin and roxithromycin on a histamine-induced animal model of otitis media with effusion.

The animals were divided into five groups, receiving erythromycin, clarithromycin, azithromycin, roxithromycin or saline solution. The guinea pigs in the study groups received erythromycin (40 mg/kg/day), clarithromycin (15 mg/kg/day), azithromycin (10 mg/kg/day) or roxithromycin (10 mg/kg/day) for 3 days by gastric tube. Four hours after the end of the administration, histamine solution was injected into the right middle ear.

The lowest neutrophil density value obtained using stereological techniques was in the azithromycin group (0.86 ± 0.25 × 10−5/μm3), while the highest value was observed in the control group (6.68 ± 3.12 × 10−5/μm3). The anti-inflammatory properties of clarithromycin, azithromycin and roxithromycin were similar to one another, but better than that of erythromycin.

The use of macrolide antibiotics is recommended, as they show antibacterial and anti-inflammatory efficacy in otitis media with effusion.

To search the international literature (any language) for publications reporting outcomes of tracheostomy performed to treat obstructive sleep apnoea in children.

Data sources included: Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, and PubMed/Medline. Four authors searched systematically through to 20 January 2018.

A total of 597 studies were screened; 64 were downloaded and 11 met criteria. A total of 196 patients underwent tracheostomy (mean age, 4.2 years; range, newborn to 18 years); 40 had detailed qualitative data and 6 had detailed quantitative data. Apnoea/hypopnoea index showed a 97 per cent reduction (n = 2) and apnoea index showed a 98 per cent reduction (n = 3). Lowest oxygen saturation showed a 34 oxygen saturation point improvement (n = 3). Several patients demonstrated significant improvement in breathing. All identified patients were syndromic, had significant co-morbidities or had severe obstructive sleep apnoea.

Based on reports of children who have undergone a tracheostomy, for whom there are pre- and post-operative data, tracheostomy appears to be a successful treatment for obstructive sleep apnoea. However, additional research is recommended given the small number of patients in the literature.

Recurrent oropharyngeal squamous cell carcinoma causes great morbidity and mortality. This systematic review analyses survival outcomes following salvage surgery for recurrent oropharyngeal squamous cell carcinoma.

A comprehensive search of various electronic databases was conducted. Studies included patients with recurrent or residual oropharyngeal squamous cell carcinoma treated with salvage surgery. Primary outcomes were survival rates following salvage surgery. Secondary outcomes included time to recurrence, staging at time of recurrence, post-operative complications, and factors associated with mortality and recurrence. Methodological appraisal and data extraction were conducted as per Joanna Briggs Institute methodology.

Eighteen articles were included. The two- and five-year survival rates of the patients were 52 per cent and 30 per cent respectively.

Improvements in treatment modalities for recurrent oropharyngeal squamous cell carcinoma were associated with improvements in two-year overall survival rates, with minimal change to five-year overall survival rates. Various factors were identified as being associated with long-term overall survival, thus assisting clinicians in patient counselling and selection for salvage surgery.

Tracheoesophageal puncture represents the ‘gold standard’ for voice restoration following laryngectomy. Tracheoesophageal puncture can be undertaken primarily during laryngectomy or in a separate secondary procedure. There is no current consensus on which approach is superior. The current evidence comparing primary and secondary tracheoesophageal puncture was assessed.

A systematic review and meta-analysis of articles comparing outcomes for primary and secondary tracheoesophageal puncture after laryngectomy were conducted. Outcome measures were: voice success, overall complication rate and pharyngocutaneous fistula rate.

Eleven case series met the inclusion criteria, two prospective and nine retrospective. Meta-analysis did not demonstrate statistically significant differences in overall complication rate or voice outcomes, though it suggested a significantly increased risk of pharyngocutaneous fistula in primary compared to secondary tracheoesophageal puncture.

Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.

This study aimed to compare the hearing results of two different stapedotomy techniques used in the clinic at different time points.

An endoscopic surgery group (group 1; n = 37) were compared retrospectively with a microscopic surgery group (group 2; n = 57). A small fenestra and Teflon piston technique were used in all patients. Bone cement was used for fixation between the prosthesis and incus in the endoscopic group only. Bone conduction threshold and air–bone gap were used as the comparison parameters.

The pre-operative air–bone gap was 31.26 dB in group 1 and 32.51 dB in group 2. The post-operative air–bone gap was 8.93 dB in group 1 and 14.28 dB in group 2. There was a significant difference between the groups in post-operative air–bone gaps. There was no significant difference between the groups in post-operative bone conduction thresholds.

The endoscopic technique using bone cement fixation was better for closing the air–bone gap.

Epistaxis is a common emergency presentation to ENT. The ‘Epistaxis 2016: national audit of management’ collected prospective data over a 30-day audit window in 113 centres. A 30-day all-cause mortality rate of 3.4 per cent was identified. This study examines in more detail the subgroup of patients who died during the audit period.

There were 985 eligible patients identified. Of these, 33 patients died within the audit period. World Health Organization bleeding score, Modified Early Warning System score, haemostasis time, source of referral, co-morbidities and cause of death were investigated from the dataset.

Patients who died were more likely to come from a ward environment, have co-existing cardiovascular disease, diabetes or a bleeding diathesis, be on antithrombotic medication, or have received a blood transfusion. Patients did not die from exsanguination.

Epistaxis may be seen as a general marker of poor health and a poor prognostic sign.

Necrotising otitis externa is a severe inflammatory process affecting soft tissue and bone, mostly in diabetic patients. Diabetic patients are also at risk of diabetic foot osteomyelitis, another inflammatory condition involving soft tissue and bone. This review aimed to describe the similarities and differences of these entities in an attempt to further advance the management of necrotising otitis externa.

A PubMed search was conducted using the key words ‘otitis externa’, ‘necrotising otitis externa’, ‘malignant otitis externa’, ‘osteomyelitis’ and ‘diabetic foot’.

The similarities regarding patient population and pathophysiology between necrotising otitis externa and diabetic foot osteomyelitis raise basic questions concerning the effects of long-standing diabetes on the external ear. The concordance between local swabs and bone cultures in diabetic foot osteomyelitis is less than 50 per cent. If this holds true also to necrotising otitis externa, the role of deep tissue cultures should be strongly considered. Similar to diabetic foot osteomyelitis, magnetic resonance imaging should be considered in selected necrotising otitis externa subgroups.

To determine the effectiveness of vestibular rehabilitation using the Wii Fit balance platform, in adults with dizziness.

A single-site prospective clinical trial was conducted in a university hospital in the UK. Forty patients with dizziness, who would normally be candidates for vestibular rehabilitation, were identified and considered as potential participants. Participants were randomised into either the treatment group (the Wii Fit group) or the control group (standard customised vestibular rehabilitation protocol). Participants were assessed over a 16-week period using several balance and quality of life questionnaires.

Both exercise regimes resulted in a reduction of dizziness and an improvement in quality of life scores over time, but no statistically significant difference between the two interventions was identified.

This pilot study demonstrated that use of the Wii Fit balance platform resulted in a statistically significant improvement in balance function and quality of life. Furthermore, outcomes were comparable to a similar group of individuals following a standard customised vestibular rehabilitation protocol. The study provides useful information to inform the design and execution of a larger clinical trial.

Otitis externa is a common presentation to secondary care otolaryngology clinics. Despite this, few studies have investigated the microbiology and antimicrobial resistance of otitis externa. This study aimed to examine these issues.

Analysis identified 302 swabs taken from 217 patients (100 male, 117 female), between 1 January 2015 and 30 March 2016, at our rapid access otolaryngology clinic.

In total, 315 organisms were isolated; the most frequent was Pseudomonas aeruginosa (31.1 per cent), followed by candida species (22.9 per cent) and Staphylococcus aureus (11.7 per cent). P aeruginosa was sensitive to ciprofloxacin in 97.7 per cent of cases and to gentamicin in 78.4 per cent.

Compared with studies worldwide, the relative proportions of different organisms causing otitis externa and the patterns of antimicrobial resistance differ. Increasing resistance of P aeruginosa to aminoglycosides demonstrates a changing pattern of antimicrobial resistance that has not been previously reported. Reassuringly, quinolone antibiotics remain highly effective when treating P aeruginosa.

To determine the diagnostic performance of diffusion-weighted magnetic resonance imaging in the assessment of patients with suspected, but not clinically evident, cholesteatoma.

A retrospective analysis of a prospectively collected database of non-echo-planar diffusion-weighted magnetic resonance imaging studies (using a half-Fourier single-shot turbo-spin echo sequence) was conducted. Clinical records were retrospectively reviewed to determine indications for imaging and operative findings. Seventy-eight investigations in 74 patients with suspected cholesteatoma aged 5.7–79.2 years (mean, 41.7 years) were identified. Operative confirmation was available in 44 ears. Diagnostic accuracy of the imaging technique was calculated using operative findings as a ‘gold standard’. Sensitivity of the investigation was examined via comparison with clinically evident cholesteatoma.

The accuracy of diffusion-weighted magnetic resonance imaging in assessment of suspected cholesteatoma was 63.6 per cent. The imaging technique was significantly less accurate in assessment of suspected cholesteatoma than clinically evident disease (p < 0.001).

Computed tomography and diffusion-weighted magnetic resonance imaging may be complementary in assessment of suspected cholesteatoma, but should be used with caution, and clinical judgement is paramount.

A distinct subgroup of patients, presenting with apparently spontaneous onset of vertigo, is described.

Although vestibular evaluation revealed caloric weakness, the proximate cause of vertigo was not labyrinthine dysfunction, but rather the loss of vestibular compensation for an older and previously compensated labyrinthine injury.

Instead of addressing the vestibular weakness, effective management needs to focus on the condition that has caused the loss of compensation.

Studies on the nasal cycle can be limited by time-consuming rhinomanometric measurements. However, quantifiable subjective assessment of nasal airflow has been limited by poor correlation with rhinomanometric data, even when investigating patients with a deviated nasal septum.

Thirty healthy participants attended two study days for rhinomanometric and subjective assessment of nasal airflow (using the subjective ordinal scale). A nasal partitioning ratio was calculated for both measures.

Objective and subjective nasal partitioning ratios were compared; strong correlations were seen, with a correlation coefficient of 0.64 (p < 0.00001) on day 1 and 0.68 (p < 0.00001) on day 2.

The use of the subjective ordinal scale and nasal partitioning ratio provides a sensitive tool for assessing relative nasal airflow, with results that correlate strongly with rhinomanometric data. This finding strongly suggests that this combination could be used for future subjective assessment of the nasal cycle.

High-quality trials have the potential to influence clinical practice.

Ten otolaryngology journals with the highest 2011 impact factors were selected and publications from 2010 were extracted. From all medical journals, the 20 highest impact factor journals were selected, and publications related to otolaryngology for 2010 and 2011 were extracted. For all publications, the reporting quality and risk of bias were assessed.

The impact factor was 1.8–2.8 for otolaryngology journals and 6.0–101.8 for medical journals. Of 1500 otolaryngology journal articles, 262 were therapeutic studies; 94 had a high reporting quality and 5 a low risk of bias. Of 10 967 medical journal articles, 76 were therapeutic studies; 57 had a high reporting quality and 8 a low risk of bias.

Reporting quality was high for 45 per cent of otolaryngology-related publications and 9 per cent met quality standards. General journals had higher impact factors than otolaryngology journals. Reporting quality was higher and risk of bias lower in general journals than in otolaryngology journals. Nevertheless, 76 per cent of articles in high impact factor journals carried a high risk of bias. Better reported and designed studies are the goal, with less risk of bias, especially in otolaryngology journals.

A double-blinded, randomised, placebo-controlled trial was conducted to determine whether routine pre-operative analgesia is beneficial in reducing post-operative ear pain following bilateral myringotomy and tube placement.

Forty-five children (aged 3–15 years) were randomised to receive either pre-operative analgesics (paracetamol and ibuprofen) (n = 21) or placebo (n = 24). All children underwent sevoflurane gas induction with intranasal fentanyl (2 mcg/kg) to reduce the incidence of emergence agitation. Post-operative pain scores were measured using the Wong-Baker Faces Pain Rating Scale. Median pain scores taken 90 minutes post-surgery, and the highest pain score recorded prior to 90 minutes, were analysed.

There were no statistical differences between the median pain scores at 90 minutes or subsequent need for rescue analgesia. Emergence agitation did not occur in any child. Inadvertent ear trauma, use of an intravenous cannula or airway adjunct did not affect pain scores.

Routine pre-operative analgesia does not reduce pain scores in the early post-operative period. Simple analgesics are effective for rescue analgesia in the minority of cases.

To investigate the morphology and dimensions of the vestibular aqueduct on axial, single-oblique and double-oblique computed tomography images.

The computed tomography temporal bone scans of 112 patients were retrospectively evaluated. Midpoint and opercular measurements were performed using axial, single-oblique and double-oblique images. Morphometric analyses were also conducted. The vestibular aqueduct sizes on axial, single-oblique and double-oblique images were compared.

At the midpoint, the mean (± standard deviation) vestibular aqueduct measured 0.61 ± 0.23 mm, 0.74 ± 0.27 mm and 0.82 ± 0.38 mm on axial, single-oblique and double-oblique images, respectively; at the operculum, the vestibular aqueduct measured 0.91 ± 0.30 mm, 1.11 ± 0.45 mm and 1.66 ± 1.07 mm on the respective images. The co-efficients of variation of the vestibular aqueduct measured at the midpoint were 37.4 per cent, 36.5 per cent and 47.5 per cent on axial, single-oblique and double-oblique images, respectively; at the operculum, the measurements were 33.0 per cent, 40.5 per cent and 64.5 per cent. Regarding morphology, the vestibular aqueduct was fissured (33.5 per cent), tubular (64.3 per cent) or invisible (2.2 per cent).

The morphology and dimensions of the vestibular aqueduct were highly variable among axial, single-oblique and double-oblique images.

To assess the feasibility of non-contrast T2-weighted magnetic resonance imaging as compared to T1-weighted post-contrast magnetic resonance imaging for detecting acoustic neuroma growth.

Adult patients with acoustic neuroma who underwent at least three magnetic resonance imaging scans of the internal auditory canals with and without contrast in the past nine years were identified. T1- and T2-weighted images were reviewed by three neuroradiologists, and tumour size was measured. Accuracy of the measurements on T2-weighted images was defined as a difference of less than or equal to 2 mm from the measurement on T1-weighted images.

A total of 107 magnetic resonance imaging scans of 26 patients were reviewed. Measurements on T2-weighted magnetic resonance imaging scans were 88 per cent accurate. Measurements on T2-weighted images differed from measurements on T1-weighted images by an average of 1.27 mm, or 10.4 per cent of the total size. The specificity of T2-weighted images was 88.2 per cent and the sensitivity was 77.8 per cent.

The T2-weighted sequences are fairly accurate in measuring acoustic neuroma size and identifying growth if one keeps in mind the caveats associated with the tumour characteristics or location.

An anatomical study was performed to describe the endoscopic anatomy and variations of the protympanum, including classification of the protiniculum and subtensor recess.

A retrospective review was conducted of video recordings of cadaveric dissections and surgical procedures, which included visualisation of the protympanum, across 4 tertiary university referral centres over a 16-month period. A total of 97 ears were used in the analysis.

A quadrangular conformation of the protympanum was seen in 60 per cent of ears and a triangular conformation in 40 per cent. The protiniculum was type A (ridge) in 58 per cent, type B (bridge) in 23 per cent and type C (absent) in 19 per cent. The subtensor recess was type A (absent) in 30 per cent, type B (shallow) in 48 per cent and type C (deep) in 22 per cent.

The protympanum is an area that has been ignored for many years because of difficulties in visualising it with an operating microscope. However, modern endoscopic equipment has changed this, providing detailed anatomical knowledge fundamental to ensuring the safety of endoscopic surgical procedures in the region.

To observe the effects of magnetic resonance imaging scans in Vibrant Soundbridge 503 implantees at 1.5T in vivo.

In a prospective case study of five Vibrant Soundbridge 503 implantees, 1.5T magnetic resonance imaging scans were performed with and without a headband. The degree of pain was evaluated using a visual analogue scale. Scan-related pure tone audiogram and audio processor fitting changes were assessed.

In all patients, magnetic resonance imaging scans were performed without any degree of pain or change in pure tone audiogram or audio processor fitting, even without a headband.

In this series, 1.5T magnetic resonance imaging scans were performed with the Vibrant Soundbridge 503 without complications. Limitations persist in terms of magnetic artefacts.

To establish the prevalence of hypocalcaemia following laryngectomy and demonstrate that total thyroidectomy is a risk factor.

A retrospective cohort study was conducted that included all patients who underwent total laryngectomy from 1st January 2006 to 1st August 2017. Exclusion criteria were: pre-operative calcium derangement, previous thyroid or parathyroid surgery, concurrent glossectomy, pharyngectomy, or oesophagectomy.

Ninety patients were included. Sixteen patients had early hypocalcaemia (18 per cent), seven had protracted hypocalcaemia (8 per cent) and six had permanent hypocalcaemia (10 per cent). Exact logistic regression values for hypocalcaemia following total thyroidectomy compared to other patients were: early hypocalcaemia, odds ratio = 15.5 (95 per cent confidence interval = 2.2–181.9; model p = 0.002); protracted hypocalcaemia, odds ratio = 13.3 (95 per cent confidence interval = 1.5–117.1; model p = 0.01); and permanent hypocalcaemia, odds ratio = 22.7 (95 per cent confidence interval = 1.9–376.5; model p = 0.005).

This is the largest study to investigate the prevalence of hypocalcaemia following laryngectomy and the first to include follow up of longer than three months. Total thyroidectomy significantly increased the risk of hypocalcaemia at all time frames and independent of other variables.

Computed tomography is the standard pre-operative imaging modality for sinonasal papilloma. The complementary use of magnetic resonance imaging as an additional investigation is debated. This study aimed to establish whether magnetic resonance imaging can accurately detect tumour extent and is a useful adjunct to computed tomography.

A retrospective review was conducted on 19 patients with sinonasal papilloma. The interpretation of computed tomography and magnetic resonance imaging scans, by three clinicians, was conducted by comparing prediction of tumour extent. The perceived necessity of magnetic resonance imaging was compared between clinicians.

The addition of magnetic resonance imaging improved accuracy of pre-operative interpretation; specifically, this finding was significant in cases with frontal sinus involvement. Surgeons were more likely than a radiologist to request magnetic resonance imaging, particularly when computed tomography indicated frontal sinus disease.

Pre-operative combined magnetic resonance imaging and computed tomography helped predict disease in the frontal sinus better than computed tomography alone. A close working relationship between the ENT and radiology departments is important for accurate tumour localisation.