It has been suggested that there is considerable unmet need in respect of hearing loss amongst the elderly population, but no routine screening test is currently used in general practice to identify these patients. The aim of this study was to determine whether routine questionnaire screening of the over-65s is a feasible way to identify elderly patients with hearing loss in primary care and whether patients so identified would benefit from hearing aid fitting. A cohort of patients consisting of a sample of 234 individuals aged between 65 and 74, attending a doctor’s surgery over a specified period, received a scored questionnaire to complete based on the Hearing Handicap Inventory for the Elderly Screening test. Hearing aid owners and those with a hearing handicap were identified, and non-aid wearers with handicap offered examination and referral. Those patients who were fitted with aids were assessed after six months for aid usage and persisting handicap. Twenty-five per cent of the patient sample reported a previously undiagnosed hearing handicap. Six months after aid fitting, a reduction in hearing handicap was reported in 79 per cent of these cases and overall aid usage in the population sample had increased from nine per cent to 20 per cent. Routine questionnaire screening in general practice may be worthwhile since it is easy to carry out and the resulting intervention significantly reduces reported hearing handicap.

The effect on the taste pores of denervation of the chorda tympani nerve in the middle-ear cavity was studied comparing confocal laser microscopy with lingual nerve resection. Taste pore cells were stained for actin with rhodamine-phalloidin and positive fluorescence was observed as a ring shape at the transverse cross sections. Within three days after chorda tympani nerve resection the ring reaction disappeared, although the pore morphology remained intact as seen by scanning electron microscopy. On the other hand, lingual nerve resection did not induce such rapid disappearance of the ring reaction. These results suggest that the chorda tympani nerve plays a predominant role in the maintenance of actin filaments in taste pore cells.

The technique of onlay sandwich grafting of tympanic membrane perforations fashioned by the use of pedicle flap raised from the posterior deep meatal skin and autologous temporalis fascia is described. The results of a series of 124 ears operated between 1987 and 1999 are the basis of this report. Of these 106 patients had myringoplasty for the first time. The operation was successful in 102 (96.23 per cent) patients. Eighteen patients had revision myringoplasty, with a successful result in 14 (77.78 per cent). None of the patients developed complications usually associated with onlay grafting. A preliminary report of this work was presented at the XVI World Congress of Otolaryngology Head and Neck Surgery at Sydney in 1997.

A knowledge of the microanatomy of the cochlear nucleus complex and its variations is essential for successful implantation and for the design of stimulation devices. One hundred cerebellopontine angle specimens were dissected under surgical conditions using the Zeiss NC31 surgical microscope. The topographical anatomy of the exit of the vestibulocochlear nerve, the cochlear nucleus and the surface of the medulla and their relation to the surrounding structures was recorded and measured. The mean distances between the exits of the VIIth and VIIIth cranial nerves were 4.7 ± 0.9 mm, between the VIIth and IXth 6.3 ± 1.2 mm and between the VIIIth and IXth 5.5 ± 1.0 mm. The visible area of the cochlear nucleus covered a square of 10.0 ± 2.9 by 3.3 ± 1.0 mm. A major AICA-loop had to be re-routed in 17 per cent of specimens. The taenia of the choroid plexus was present in 92 per cent and had to be cut in 51 per cent in order to enter the foramen of Luschka, that had a mean size of 3.5 by 2.0.mm. It was wide open in 24 per cent , open only after incision of the arachnoid in 53 per cent, functionally closed but opened by extensive dissection in 18 per cent and anatomically occluded in five per cent of the specimens. The typical straight vein at the cochlear nucleus leading to the entrance of the foramen of Luschka was found in 76 per cent of specimens. Constant anatomical landmarks are very helpful for finding the cochlear nucleus, but variations may endanger dissection and implantation in a remarkable number of cases.

The surfactant system of the nose was examined biochemically in control cases and compared to cases of primary atrophic rhinitis. The study group included 25 cases with primary atrophic rhinitis compared to 10 normal volunteers. Biochemical analysis of the nasal aspirate in these cases revealed the presence of phospholipids constituting surfactant with phosphatidylcholine constituting 75.35 per cent of the total phospholipids. Biochemical analysis of the nasal aspirate in cases with primary atrophic rhinitis revealed a significant decrease in the total phospholipids compared to normal cases and also a significant change in the phospholipid profile. Thus significant biochemical changes in the surfactant system of the nose is an evident and early finding in cases of primary atrophic rhinitis. This suggests a possible role for surfactant deficiency in the aetiopathogenesis of cases of primary atrophic rhinitis.

We report a case of schwannoma of the chorda tympani. This is a very rare benign tumour and only five other cases have been found in the literature. This is the first case to mimic a cholesteatoma presenting as a pearly tumour in the postero-superior segment of the drum with aural discharge and conductive deafness. Diagnosis is usually by biopsy and treatment is surgical with preservation of facial and auditory function. A summary of the other presentations of this tumour together with a review of the histopathology of the disease is presented.

The aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990–1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezold’s abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.

The two commonly employed methods for tonsillectomy at present are electrodissection and ligature dissection. This study was carried out on 70 patients as a randomized prospective double blind trial to compare the post-operative morbidity of these methods with special reference to pain. The post-operative pain appears to be much less for the ligation dissection technique compared to the electrodissection method except during the first post-operative day. Irrespective of the technique employed for tonsillectomy, the worst pain was experienced on the fifth and sixth post-operative day by almost all of the patients.

Otoendoscopy is a new technique in otological surgery. The traditional surgery for otitis media with effusion (OME) is myringotomy and tube insertion using an operating microscope. In 45 children and five adults presenting to our department with otitis media with effusion, rigid endoscopic myringotomy and grommet tube insertion were performed using 2.7 mm diameter and 0 and 30 angle telescopes under general anaesthesia for children and local anaesthesia for adults. The use of rigid endoscopes provides a large field of view, that is of excellent resolution and fidelity of colour as well as giving good side views. It can be performed in the out-patient clinic with little inconvenience to the patient and minimal risks.

A description is given of some aspects of the normal human auricle. The physiognomy of the auricle is different for every individual which leads to the possibility of identifying people based on their auricles. Indeed this has even led to the reading of earprints similar to fingerprints, a fact not generally known amongst ENT-specialists. This highly specialized knowledge has been developed within a special branch of forensic medicine and criminology, called ‘earology’ or ‘otomorphology’. Two illustrative case histories are presented.

In the last few years, the main thrust of research into cochlear implantation has centred around the development of advanced multi-channel implants. A new area of development is now concentrating on maximizing the potential of each individual electrode in order to improve the quality of hearing. This study involved the medialization of the cochlear implant electrode array using a silastic positioner in five patients. Two parameters were measured, namely current units needed to produce a stapedial reflex, and impedance levels between the electrode and modiolus. On insertion of the cochlear implant, readings were taken before the insertion of the positioner, immediately afterwards and at two months.

Following informed parental consent 93 children underwent bilateral grommet insertion. Tympanometry was performed pre-operatively, and immediately prior to myringotomy. A standardized anaesthetic was used. At myringotomy the presence or absence of fluid was recorded, as well as the time since induction of the general anaesthetic.

A pre-operative type B tympanogram predicted a middle-ear effusion at myringotomy in 92 per cent of patients. A pre-operative type C2 tympanogram predicted a middle-ear effusion at myringotomy in 39 per cent of patients. Sixty tympanograms (30 per cent) changed following a general anaesthetic. Fourteen type B tympanograms changed to type A and eight of these had effusions. The duration of the general anaesthetic did not influence the probability of a middle-ear effusion being present at myringotomy. A pre-operative type B tympanogram is a good predictor of middle-ear fluid. The duration of the general anaesthetic is not significant in predicting the presence of a middle-ear effusion.

This was a study of the history of the technological development of air conduction hearing aids, and a review of international literature on the subject. The technological evolution of amplification devices, from their origin to the present day, can be divided into seven distinct periods: the period of sound collectors, the period of hearing devices constructed from carbon, the period of vacuum tubes, the transistor period, the period of integrated circuits, the microprocessor period and the period of digital hearing instruments. Throughout these different stages, hearing instruments have progressively developed reaching their present state.

The current era is itself undergoing constant development and change. With the introduction of new technologies, we expect that the rate of change will increase rapidly in the future.

Twenty-six adult cystic fibrosis patients were studied to compare nasal disease with their laboratory correlates including skin testing, immunoglobulin and Aspergillus fumigatus precipitin levels, saccharin testing and sputum cultures. Six patients were asymptomatic and all of these had negative skin tests, normal IgE levels and negative Aspergillus fumigatus precipitins. Thirteen patients had rhinitis, 12 had positive skin-testing for common allergens, 10 elevated IgE levels and nine positive Aspergillus fumigatus precipitins. Seven patients had polyps, all had normal IgE levels and negative Aspergillus fumigatus precipitins, six had positive skin testing for common allergens. There also appeared to be a relationship between Pseudomonas spp. colonization and positive skin testing.

In patients with reduced auditory nerve function, for example due to tumour removal or an accident, hearing rehabilitation can be elicited by an auditory brainstem implant (ABI). The electrode array of the ABI manufactured by Cochlear Ltd., Sydney, consists of 21 circled contacts in a silicon carrier. This is inserted in the lateral recess of the fourth ventricle. Since 1996, in Hannover eight patients have been implanted with a cochlear ABI Nucleus 21 + 1. All of them were profoundly deaf on both sides due to neurofibromatosis type 2 (NF2). To find the optimal electrode position during surgery, a multimodal monitoring by auditory evoked potentials (AEP), electromyography (EMG) and somatosensory evoked potentials (SEP) was performed. When monitoring AEPs, the function of the implant can be checked first by the stimulus artefact. By analysing the AEPs in more detail, the optimal positioning of the electrode on the cochlear nucleus can be found. If systems other than the auditory system are stimulated this will be revealed in one or more of the AEP, EMG and SEP recordings. According to the literature, AEPs stimulated by an ABI consist of three vertex positive peaks with latencies shorter than 4 ms. Typical AEPs are correlated with good postoperative hearing sensation. Comparing these AEPs with AEPs stimulated acoustically or electrically at different sites of the auditory system, it can be assumed that the first peak corresponds to J3, the second to J4 and the last to J5. From this comparison it can also be concluded that no potentials should occur later than 5 ms. This corresponds to our findings. Post-operatively, side-effects occurred when areas of the electrode array were stimulated that showed potentials with latencies longer than 5 ms intra-operatively. Our results indicate that monitoring is an essential aid for the surgeon in finding the optimal electrode position. Positioning solely with reference to anatomical landmarks may not be enough to find the optimal functional position.

The otolaryngologist who requests magnetic resonance imaging (MRI) scans to exclude cerebellopontine angle (CPA) tumours may discover incidental pathologies. We retrospectively reviewed the results of 644 consecutive MRI screening scans with the aim of identifying findings other than CPA tumours. Two hundred and eighty-nine (45 per cent) scans featured one or more anomalies or abnormalities, including CPA tumour (23, four per cent), vascular loop (30, five per cent), basilar artery ectasia (13, two per cent), multiple high signal areas (135, 21 per cent), brain atrophy (52, eight per cent), sinus findings (56, nine per cent), middle ear/mastoid disease (34, five per cent), and a variety of other findings (39, six per cent) including clinically serious lesions (11, two per cent). The significance and management of these incidental findings is discussed. The majority were not clinically significant but the occasional presence of a serious incidental pathology should be borne in mind. Basilar artery ectasia and multiple high signal areas may be responsible for the symptoms investigated by MRI, and screening for cerebrovascular disease risk factors in such patients may be appropriate.

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by osseous fragility, blue sclerae and hearing loss. In order to assess the impact of stapedotomy on improving hearing on OI, a retrospective, one-group, pre-test-post-test design was used to compare the pre-operative and postoperative audiograms of nine OI patients, treated with stapedotomy for their mixed hearing loss. Operative findings included fixation or thickening of the stapes footplate with normal superstructure configuration and hypervascularization of the promontory mucosa. Immediate post-operative results showed a significant improvement (p<0.05) from 250–4000 Hz in air conduction and from 250–2000 Hz in bone conduction. A significant closure of the air-bone gap between 250–2000 Hz was also achieved (p<0.05). The long-term results remained satisfactory with a mean threshold shift of 8 dB HL and an almost unchanged air-bone gap. These satisfactory results and the lack of complications make stapedotomy an appealing method for the management of OI-associated hearing loss.

The recommendation of Anderson and Steele, for the use of ear drops four times a day, has not been changed since 1948. In order to re – evaluate the frequency of using ear drops, we examined the duration of the effectiveness of the antibacterial activity of gentamicin ear drops in external otitis. Seventeen patients (25 ears) with external otitis were studied. We took 18 samples from each ear at 0, 1, 2, 3, 6, 8, 10, 12 and 14 hours and measured the concentration of gentamicin on the wick and in the ear canal. We found that the concentration of gentamicin began to decrease only after 12 hours and a more significant decrease was detected after 14 hours of treatment. We have shown that the antibiotic used on the wick is effective for 12 hours. In conclusion, we recommend using ear drops twice a day on a wick as routine therapy for external otitis.