To examine the reasons for discharging mastoid cavities, the operative findings during revision surgery, and the medium-term outcome.

One hundred and forty revision mastoidectomies in 131 patients were studied. Post-operatively, patients were followed up at three, six and 12 months and then yearly.

A variety of techniques were performed. Over 80 per cent of ears were treated with mastoid obliteration. Concomitant hearing restorative procedures were carried out in one-third of the ears.

The mastoid cavities were troublesome because of large cavity size, bony overhang, residual infected mastoid cells, the presence of cholesteatoma or perforations, and/or inadequate meatoplasty. One year after revision mastoidectomy, over 95 per cent of the ears had become completely ‘dry’ and water-resistant. Overall, 50.9 per cent of the ears had a 12-month post-operative air–bone gap of 20 dB or less.

Revision mastoidectomy has a high success rate in converting troublesome mastoid cavities into dry, water-resistant ears.

To describe our experience of a new multidisciplinary balance clinic for the management of patients with vestibular disorders, run as a pilot project for 12 months.

Retrospective review of the outcomes of 194 patients.

All patients were first evaluated at the balance assessment clinic. Subsequently, each case was discussed at the multidisciplinary balance clinic weekly review meeting, and management decisions made.

The mean waiting time for the balance assessment clinic was 12 weeks (standard deviation six weeks). In total, 74 per cent of patients underwent rehabilitation, 26 per cent were seen in the balance specialist clinic, 15 per cent underwent additional testing, 6 per cent were followed up in adult otology clinics and one patient was listed for surgery. The waiting time for vestibular rehabilitation was reduced from 21 to 15 weeks. Patient satisfaction with the service was encouraging, and no adverse outcomes were recorded.

This multidisciplinary balance clinic, run by allied health professionals, represents an alternative model for the management of patients with balance disorders.

The direct activity of antimicrobial peptides against microbes is thought to be an essential first line of defence in the skin; however, little is known about antimicrobial peptide secretion in the skin of the external auditory canal. Evidence suggests that mast cells contribute to the secretion of antimicrobial peptides. This study aimed to examine the distribution of mast cells and antimicrobial peptides, including human β-defensin-1 and -2 and LL-37, in the external auditory canal skin.

External auditory canal skin samples from 12 patients undergoing middle-ear surgery with canaloplasty were immunohistochemically stained to detect expression of mast cell markers (tryptase and chymase) and antimicrobial peptides (human β-defensin-1 and -2 and LL-37).

Mast cells and human β-defensin-1 were present in the ceruminous glands but not in the sebaceous glands. The increased presence of mast cells, human β-defensin-1 and LL-37 in ceruminous glands suggests that mast cells may participate in the secretion of antimicrobial peptides from ceruminous glands.

These findings suggest that mast cells contribute to the secretion of antimicrobial peptides in the ceruminous glands of the external auditory canal skin.

A biofilm is a community of micro-organisms encased within a self-produced, extracellular, polymeric substance. The role of biofilms as a major pathological aetiology in chronic rhinosinusitis would help explain the clinical manifestation of the disease.

To examine the current evidence, and to discuss possible future research directions, in relation to biofilms and chronic rhinosinusitis.

Systematic literature review.

Two assessors independently undertook critical appraisal of the studies identified by the literature search. Significant findings were incorporated into this review. The primary outcome assessed was the presence of biofilm in human mucosal biopsy samples taken from patients with chronic rhinosinusitis, and from healthy controls.

We identified 11 studies examining biofilm formation in human mucosal biopsy samples taken from patients with chronic rhinosinusitis.

It is unlikely that biofilms occur in every case of chronic rhinosinusitis; consequently, the significance of ‘biofilm detection’ in some series should be considered carefully. Several authors have argued strongly for the use of confocal scanning laser microscopy with fluorescent in situ hybridisation probes as the ‘gold standard’ for biofilm imaging. This imaging modality should be combined with further investigation of the microbiology of chronic rhinosinusitis, and of the efficacy of traditional culture techniques used for pathogen identification.

Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition.

A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis.

Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy.

Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.

This study aimed to use a new otological technique, malleus relocation, to solve the problems of ossicular reconstruction undertaken during revision stapes surgery for incus necrosis.

Prospective study of 12 patients undergoing revision stapedectomy for incus necrosis, in the otolaryngology department of Mansoura University, Egypt.

Twelve patients underwent ossiculoplasty between June 2004 and June 2007, as part of revision surgery for otosclerosis with incus necrosis. All patients underwent ossiculoplasty using the malleus relocation technique. Ossiculoplasty used the patient's own, necrosed incus between the relocated malleus and the footplate.

Post-operative air–bone gap closure to within 10 dB was achieved in seven patients (58.3 per cent). An air–bone gap of less than 20 dB was obtained in 10 patients (83.3 per cent). Deterioration of bone conduction by 10 dB occurred in one case. No patients were left with a ‘dead ear’. Patients’ hearing was stable throughout the follow-up period (range six to 40 months; mean ± standard deviation 23.5 ± 12.8 months).

These findings indicate that malleus relocation, performed during revision stapes surgery, is a safe and efficient technique for the treatment of incus necrosis.

Tinnitus is a disturbing symptom and is often the main reason for otology referral. It is usually associated with hearing loss of varying aetiology, and is thought to begin in the cochlea, with later abnormal central activity. We hypothesise that tinnitus without hearing loss may be caused by central and subcortical abnormalities and altered outer hair cell function.

To compare the auditory brainstem responses, middle latency responses and otoacoustic emissions in normal-hearing individuals with and without tinnitus.

The audiological test results of 25 normal hearing subjects with tinnitus (age 18–45 years) were determined, and compared with those of a control group.

A statistically significant difference was found between study group tinnitus ears vs control group ears, as regards wave I latency prolongation, shortening of wave V and absolute I–III and I–V interpeak latency, enlargement of wave Na and Pa amplitude, and distortion product and transient evoked otoacoustic emission signal-to-noise ratios. There was no statistically significant difference between unilateral vs bilateral tinnitus ears.

The pathogenesis and optimum management of tinnitus are still unclear. It often occurs with primary ear disease, usually associated with hearing loss, but may occur in patients with normal hearing. Observed changes in auditory brainstem and middle latency responses indicate central auditory alterations. Tinnitus involves both peripheral and central activity, and complete audiological and neurophysiological investigation is required. Management should be based on both audiological and neurophysiological findings.

To investigate whether artificial perilymph can induce neural stem cells, derived from the hippocampus of newborn guinea pigs, to differentiate into inner ear hair cells, in vitro.

Primary neural stem cells derived from the hippocampus of newborn guinea pigs were incubated in medium containing either 10 per cent fetal bovine serum or 5, 10 or 15 per cent artificial perilymph, for three weeks. Differentiated cells were identified using immunofluorescence, Western blot and scanning electron microscopy.

Both fetal bovine serum and artificial perilymph induced the neural stem cells to differentiate into cells with hair-cell-specific antibodies.

Neural stem cells can survive in both fetal bovine serum and artificial perilymph, and within these media can differentiate into cells with hair-cell-specific antibodies. This provides an experimental basis for transplantation of neural stem cells into the inner ear.

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.

The chorda tympani is at risk of iatrogenic injury throughout its course. This paper reviews the clinical anatomy of the nerve in adults.

Systematic literature review.

Relevant English-language articles were identified using five electronic databases and one search engine. Data from approximately 70 scientific papers were supplemented with information from selected reference texts.

The anatomy of the chorda tympani differs from standard descriptions, particularly regarding its exit from the middle ear and area of lingual innervation. Whilst it is known to convey taste sensation from the anterior two-thirds of the tongue and parasympathetic innervation to the submandibular and sublingual salivary glands, the chorda tympani probably has additional sensory and secretomotor functions.

A detailed understanding of the anatomy of the chorda tympani may help to reduce the risk of iatrogenic injury during head, neck and middle-ear surgery, and to explain the variable consequences of such injury.

The E-lefENT programme is a collaborative e-learning project developed by the Department of Health and ENTUK. Prior to its introduction, we aimed to assess current use of and attitudes towards e-learning amongst UK otolaryngology trainees.

A web-based questionnaire was distributed to UK otolaryngology trainees via regional programme directors.

A total of 117 responses was received (35 per cent response rate). Most trainees reported increasing exposure to e-learning throughout their training and rated their current computer literacy skills highly, although satisfaction with current e-learning resources was found to vary widely for a variety of reasons.

Meeting the educational needs of otolaryngology trainees in the current era continues to be a challenge. Most trainees are already familiar with e-learning, although the quality and delivery of available websites is currently variable. The majority of trainees who responded seemed receptive to the implementation of a free, otolaryngology-specific e-learning resource.

To review the aetiopathogenesis, clinical characteristics, immunohistochemical profile, prognosis and treatment options for primary thyroid squamous cell carcinoma, and to compare it with squamous cell carcinoma metastatic to the thyroid, thus providing the reader with a framework for differentiating primary and secondary disease.

Review of English language literature from the past 25 years.

A search of the Medline, Embase and Cochrane databases (April 1984 to April 2009) was undertaken to enable a comprehensive review.

After applying strict criteria for the diagnosis of primary thyroid squamous cell carcinoma, 28 articles were identified reporting 84 cases. When reviewing secondary thyroid squamous cell carcinoma, we only analysed cases of squamous cell carcinoma metastatic to the thyroid gland, and found 28 articles reporting 78 cases.

It is possible to differentiate between primary and secondary thyroid squamous cell carcinoma, on the basis of combined evidence from clinical examination and endoscopic, pathological and radiological evaluation. Such differentiation is important, as the prognosis for primary squamous cell carcinoma is uniformly poor irrespective of treatment, and the most suitable option may be supportive therapy. Treatment for secondary squamous cell carcinoma of the thyroid varies with the site and extent of spread of the primary tumour.