Intratympanic steroids offer direct access to the inner ear with high concentration and without systemic effects. In this study, the efficacy of intratympanic methylprednisolone acetate (IT-MPA) was evaluated in a guinea-pig model of drill-induced inner ear trauma.

Twenty-five guinea pigs were divided into a control group to document the baseline distortion product otoacoustic emissions (DPOAEs) and the normal scanning electron microscopic (SEM) morphology of the inner ear. The animals in the study group were subdivided into a steroid-only group (S), a trauma-only group(T), a trauma-plus-time group (TT), and a trauma-plus-steroid (TS) group.

IT-MPA was found to have no damaging effect on the inner ear. Twelve days after trauma, there was spontaneous although incomplete recovery of the DPOAEs amplitudes and SEM morphology with scar tissue replacing lost outer hair cells. Statistically higher DPOAEs amplitudes (p < 0.05) were recorded in the TS group that had nearly normal SEM morphology compared to the TT group. The authors conclude that IT-MPA significantly improves drill-induced sensorineural hearing loss and inner ear morphological changes in guinea pigs.

Nodular fasciitis is an unusual benign reactive process affecting superficial and deep fascia. Its rapid growth, rich cellularity, high mitotic activity and poorly circumscribed nature result in it being easily misdiagnosed as a sarcomatous lesion. Three cases of nodular fasciitis presenting as neck lumps are reported. They were successfully treated with local excision, with no signs of recurrence following two years of follow up. This paper describes the clinical presentation and microscopic features of this rare benign lesion and it emphasizes the need for accurate histopathology and clinical suspicion, if inappropriate aggressive management is to be avoided.

The aim of this study was to identify the common features in a study group of patients with spontaneous cerebrospinal fluid (CSF) rhinorrhoea, to develop a hypothesis to explain the cause of this condition and to investigate the outcome of surgical techniques adopted to repair the leak. In this retrospective study the authors have reviewed all the cases of spontaneous CSF leaks attending and receiving treatment from the otolaryngology department of Queen Elizabeth Hospital, Birmingham, from 1992 to 2002.

Of 34 patients with CSF leaks, 15 were spontaneous in nature and formed the study group. Of these 15 patients, 14 were female; with ages ranging from 37 to 70 years and a median age of 50 years. All the female patients were overweight with a body mass index (BMI) >24.9 and, of these, nine were considered obese with a BMI >30. It was attempted to identify common factors in the study group and it was evident that female sex, obesity and age played a key role in this condition.

The follow-up period ranged from two to 98 months. Thirteen patients were asymptomatic but two patients remained symptomatic, one of these despite repeated surgical intervention.

Thirty-two members of staff from the Ear, Nose and Throat Department at Warrington General Hospital were asked to estimate blood loss in commonly encountered epistaxis scenarios. Results showed that once the measured volume was above 100 ml, visual estimation became grossly inaccurate. Comparison of medical and non-medical staff showed under-estimation was more marked in the non-medical group. Comparison of doctors versus nurses showed no difference in estimation, and no difference was found between grades of staff.

The medico-legal issues surrounding informed consent are highly topical and contentious. Current attitudes to consent emphasize the high level of ’good medical practice’ expected by a ’reasonable patient/parent’. The authors’ objectives were to assess the levels of knowledge and information expected by patients and parents, prior to signing consent forms for a surgical procedure. Each patient or parent was asked a series of questions prior to signing a consent form. Answers were recorded on a standard questionnaire. More than 80 per cent of respondents were happy with the information provided in out-patients, however, over half of these could not list even one complication of their operation. Two-thirds of those surveyed sought information elsewhere, while over half expected to be informed of all known complications, even if the rate of complications was less than one per cent. In conclusion, the information provided by surgeons might not meet the expectations of today’s informed patients.

Extensive functional endoscopic sinus surgery (FESS) was assessed retrospectively from the viewpoint of out-patients on the basis of their responses to a postal questionnaire, particularly in the Tokyo metropolitan area. Seventeen patients were included in this study (six females and11 males) with an age range of 22–70 years. All the patients had at least ethmoid sinusitis. Additionally, some patients had maxillary or sphenoid sinusitis or polyps obstructing the nasal cavities. The average operation time and blood loss were 36 minutes and 31 ml, respectively. Four patients had to travel more than one hour to reach home. All of them used the train for travelling to and from the hospital. ’Doctors’ advice’ was the most common reason for the decision to undergo this ambulatory surgery. Nine (53 per cent) had some unexpected problems post-operatively. The establishment of a care pathway may improve the outcome of extensive FESS on an out-patient basis.

Most of the previous treatment methods for auricular haematoma are inconvenient for both patients and doctors because they are time-consuming and complex and must be performed under sterile conditions. The purpose of this study was to evaluate the effectiveness of a simple compressive method using a dental (silicone) impression material and comparing it with other methods for treatment of auricular haematomas. The authors aspirated a haematoma and then placed a mixed base and catalyst of silicone putty material on the anterior and posterior surfaces of the auricle in the shape of an inverted U for seven days.

From the 24 cases managed with this method, 23 cases (95.8 per cent) were successfully healed. Eight patients were treated with a collodion-cotton wool cast and 16 of 19 patients were successfully treated with dental cotton-wool rolls. The average number of those visiting the hospital was 2.7 for the collodion-cotton wool cast, 6.9 for the dental cotton-wool roll, and 3.1 for dental silicone. The mean treatment durations were 8.1 days for the collodion-cotton wool cast, 13.8 days for the dental cotton-wool roll, and 8.6 days for dental silicone. The authors believe that this compressive method using dental silicone material is simple and appropriate for the treatment of auricular haematoma.

Access to the anterior tympanic cavity is often restricted by the handle of the malleus. The aim of this paper is to describe a surgical malleus osteotomy that allows the malleus handle to swing superiorly. The authors have found few problems related to this technique, especially with regard to restoration of normal post-operative hearing.

Adenoidectomy Is A Surgical Procedure Frequently Carried Out In Otolaryngological Practice, Traditionally Undertaken Blindly With Curettage Using An Adenotome Following Palpation Of The Adenoid Bed. While A Number Of Alternative Methods Have Been Described For Surgical Removal Of The Adenoid Pad (Power-Assisted/Microdebrider, Transnasal Adenoid Ablation, Suction Coagulation And Liquefaction/Aspiration) None Has Become The Definitive Procedure. Suction Diathermy Adenoidectomy Has Been Known And Used For Some Time; It Has Gained In Popularity Over Recent Years And Is Established As An Alternative To Conventional Curettage, Particularly In Children.

We Describe Several Techniques Which Improve The View Of The Surgical Field While Performing Suction Diathermy Adenoid Ablation.

Ventilation tube insertion plays an important role in the management of otitis media with effusion. In selected cases, repeated grommet insertion due to persistent eustachian tube dysfunction necessitates the need for longer-term ventilation. Insertion of such tubes can however occasionally be more difficult than insertion of standard grommets. One such long-term ventilation tube is the Shah permavent grommet. This paper describes a simple modification of the technique that is less time-consuming and less traumatic.

Epistaxsis and crustation are common problems associated with long-term use of oxygen through nasal prongs in patients suffering from chronic obstructive pulmonary disease. The nasal prong can cause direct trauma to the septal mucosa. We describe a simple solution to this problem with use of the disposable ear tip used in tympanometry

Venous thromboembolic disease has an estimated annual incidence of one in 1000 people. However, thrombosis of the superior mediastinum and neck veins is less frequent and it is usually due to direct trauma to the neck by intravenous catheters, drug abusers or neck dissection surgery. Local or distant malignancy (Trousseau’s syndrome) is also an important cause.

Thrombosis of the superior mediastinal and internal jugular veins is rarely a cause of primary referral to the otolaryngologist. On these rare occasions, it can present as a painful neck mass, but may also present with stridor, dysphonia or dysphagia. The four patients presented here illustrate different ways of presentation. Different imaging techniques such as ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) and venogram, will produce a diagnosis of thrombosis, occasionally with a mass, but only a biopsy will confirm or rule-out malignancy.

Spontaneous thrombophlebitis can be the first manifestation of an occult neoplasm and any investigation into venous thrombosis must include a thorough general examination and follow up.

Alendronate is a bisphosphonate used in treating osteoporosis. Its recognized side-effects include oesophageal irritation and ulceration. The authors describe a case of laryngitis induced by transient contact of this medication with the laryngeal mucosa. Successful management of this case is also detailed.

Although rare, ototoxicity from the use of aminoglycoside drops is well recognized. Ototoxicity has not been described with the use of combination aminoglycoside-steroid-antifungal creams or ointments. We present the case of a 60-year-old man with a perforated tympanic membrane who suffered a total hearing loss after the instillation of cream containing triamcinolone, neomycin, gramicidin and nystatin (Tri-Adcortyl™ cream) into his ear canal. On balance, we believe that a number of potentially ototoxic constituents in this cream were responsible. Other possible causes of sensorineural hearing loss and the possible mechanisms of ototoxicity of this cream are discussed. The reasons why such creams may be particularly ototoxic, compared with drops, are also considered. The authors caution against the use of such creams or ointments in the ear if there is any suspicion of a tympanic membrane perforation.

Spontaneous perforation of the oesophagus is an uncommon condition that almost invariably affects the thoracic oesophagus. We present an unusual case of perforation of the cervical oesophagus, in which an unsuspected ingested foreign body was ultimately found to be responsible.

Tuberculosis affecting the thyroid gland is a rare condition. We present the case of a 30-year-old man with thyroid tuberculosis whose presenting complaints were dyspnoea and hoarseness. There was a cystic mass in the posterosuperior right thyroid lobe extending into the paraglottic space. There was also recurrent laryngeal nerve involvement. We performed surgery and administered post-operative antituberculous treatment

We report the cases of two laryngectomy patients who were diagnosed with de novo nasal polyposis, more than 15 years after their laryngectomies. This phenomenon has not previously been reported in the literature. We discuss the changes in nasal physiology of the laryngectomy patient, with regards to the aetiology of polyp formation, and highlight the importance of examining the nose in such patients.

Canalicular adenomas are a rare form of benign tumour that occur in salivary glands, occurring mainly in the upper lip and minor salivary glands of the buccal mucosa. The authors report the fifth case and the first in the otorhinolaryngological literature of a canalicular adenoma of the parotid gland. Its specific histological features are difficult to detect on fine needle aspiration and its multifocal nature can lead to recurrence and this must be considered in the clinical management.

Malignant (invasive) otitis externa (MOE) is an infection involving the external auditory meatus (EAM), most often found in elderly diabetics, which carries a high morbidity and mortality. In advanced cases it may give rise to osteomyelitis and cranial neuropathies. This is a case of MOE, which invaded the posterior wall of the right temporomandibular joint (TMJ), resulting in severe trismus and pain. Subsequently, this required treatment by replacement of the glenoid fossa with a Silastic® prosthesis.