Although many clinical investigations have found a relationship between hearing loss and diabetes mellitus, the pathophysiology of this effect remains controversial. To date, the mechanisms of hearing loss in diabetic patients have been explained in terms of microangiopathy, neuropathy and encephalopathy. However, many reports indicate that some diabetic complications are associated with oxidative stress related to the diabetes itself. In the present study, we hypothesised that oxidative stress may be a cause of hearing loss in diabetic patients.

The study group comprised non-insulin dependent diabetic patients with no signs of microangiopathy or peripheral neuropathy. The control group comprised sex-, age- and body weight matched, non-diabetic subjects. Auditory function was evaluated using pure tone audiometry and tympanometry. Subjects with normal hearing and sensorineural hearing loss were included in the study, whereas subjects with conductive hearing loss were excluded. Both the study group (n = 63) and the control group (n = 37) were divided into subgroups based on the presence and absence of hearing loss. Oxidative stress was evaluated by measuring serum indicators of protein oxidation and lipid peroxidation, serum levels of nitric oxide and various non-enzymatic antioxidants, and the activity of various enzymatic antioxidants.

The non-insulin dependent diabetic patients had significantly higher serum levels of protein oxidation products, nitric oxide, enzymatic antioxidant activity (i.e. glutathione peroxidase and superoxide dismutase), compared with the control group (p < 0.05). When we compared the groups in relation to the presence of hearing loss, the nitric oxide level was significantly increased in the diabetic group with good hearing, compared with diabetic patients with hearing loss (p = 0.014). In the diabetic group, a clear, negative correlation was observed between serum levels of nitric oxide and vitamins C and E, and hearing impairment (r = −0.395, r = −0.318, r = −0.500, respectively). There was also a positive correlation between serum vitamin C concentrations and hearing levels in the control group (r = 0.417).

These results suggest that oxidative stress may play an important role in hearing impairment in diabetic patients. In this process, increased protein oxidation appears to be more important than lipid peroxidation. Nitric oxide may have a protective effect on hearing, as may some nonenzymatic antioxidants such as vitamin C and E.

This study aimed to ascertain the usefulness of the bone-anchored hearing aid and its impact on the quality of life of patients fitted in Glasgow between 1996 and 2006.

The Entific Medical Systems questionnaire and the Glasgow Benefit Inventory were posted to patients in order to assess their satisfaction and quality of life changes.

Sixty adult patients were identified, with a questionnaire response rate of 63 per cent. Thirty-two respondents (85 per cent) reported using their bone-anchored hearing aid for more than eight hours per day. Twenty-nine respondents (75 per cent) found their bone-anchored hearing aid to be generally better than their previous, conventional aid. Twenty-seven respondents (71 per cent) reported that their bone-anchored hearing aid improved their quality of life. The median total Glasgow Benefit Inventory score was +33.3.

Bone-anchored hearing aid usage rates and satisfaction levels were high amongst patients in Glasgow. Glasgow Benefit Inventory indices were comparable to published findings from other centres. Despite this, bone-anchored hearing aid funding is still not universally available within the National Health Service in Scotland.

To obtain information on the success rate of tympanoplasty with concomitant myringosclerosis.

The medical records of 40 children with myringosclerosis (23 girls, 17 boys; age range six to 16 years, mean age 9.85 years) who had undergone primary tympanoplasty were retrospectively studied. Surgical success was defined as the perforation remaining closed 12 months post-operatively.

Sclerotic plaques occupied whole remnant eardrums in 17 patients, and were located in various parts of the eardrum in 23. Tympanosclerosis associated with myringosclerosis was present in six patients. The success rate of primary tympanoplasty was 92.5 per cent. All three surgical failures were observed in girls with marginal perforations. These children underwent successful revision procedures for their residual perforations, variously at four, eight and 10 months after the initial surgery.

Appropriate freshening of the perforation edges, with removal of sclerotic plaques, can result in a high rate of successful closure of perforated tympanic membrane with coexisting myringosclerosis.

To investigate the impact of perforation size and other variables on the success of myringoplasty, and also to determine audiological gain following successful closure of tympanic membrane perforations of various sizes.

Retrospective analysis of 130 case notes.

(1) Successful closure of tympanic membrane following myringoplasty, in relation to recorded variables (i.e. perforation size, grade of surgeon, surgical technique, graft material, previous myringoplasty and smoking history). (2) Mean, four-frequency, air conduction audiometric gain following successful myringoplasty for various, pre-operatively categorised tympanic membrane perforation sizes.

The collective myringoplasty success rate was 80.8 per cent (105/130); for successful patients, the mean air conduction audiometric gain was −6.8 dB (t = 5.29, p < 0.0001). Neither perforation size nor any other assessed variable was a statistically significant determinant factor for successful myringoplasty. Air conduction audiometric gains following successful myringoplasty were directly correlated with pre-operative perforation size (−4.0 dB for 0–20 per cent perforations, −5.0 dB for 21–40 per cent, −9.1 dB for 41–60 per cent, −10.8 dB for 61–80 per cent and −13.3 dB for 81–100 per cent).

To determine the causative pathogens of otomycosis, and to evaluate the in vitro activity of antifungal agents against these pathogens.

A total of 96 fungal isolate were taken from 92 patients suspected of otomycosis. The in vitro activity of fluconazole, itraconazole and voriconazole against otomycotic pathogens was tested using the E-test method.

The most common pathogen was Aspergillus fumigatus (40.6 per cent), followed by A niger (35.4 per cent), A flavus (12.5 per cent) and Candida albicans (11.5 per cent). All Aspergillus species were found to be resistant to fluconazole (minimum inhibitory concentration ≥256 µg/ml). The mean minimum inhibitory concentrations of voriconazole for A fumigatus, A niger, A flavus and C albicans were significantly lower than those of itraconazole for the same pathogens.

This study found that the most common otomycotic fungal pathogen was A fumigatus, and that voriconazole had more potent in vitro activity than itraconazole against all Aspergillus species as well as against C albicans.

The Avon Area Health Authority was a first-phase site for introduction of universal newborn screening in the UK. The aims of this study were: to review the programme's results to date; to assess the impact screening would have on other services (e.g. the cochlear implant programme); and to assess the longer term outcome for children identified by the screening programme.

All children identified by the Avon universal newborn hearing screening programme between April 2002 and July 2006.

Fifty-four children with a bilateral hearing impairment of worse than 40 dBHL were identified from a screened population of approximately 44 000. Nine of these children were put forward for cochlear implantation, and seven had been implanted at the time of writing. Thirteen of these children were identified with possible auditory neuropathy or dys-synchrony. All the newborn hearing screening programme criteria assessed were met.

The screening programme was effective. Some areas may need review in order to optimise patient care.

Rhabdomyosarcoma is the commonest malignant tumour of the nose and paranasal sinuses in the paediatric population. Due to its rarity and largely unknown biological behaviour, the treatment of this tumour is complex and controversial. We present the results of multimodality treatment of paediatric sinonasal rhabdomyosarcoma, and we explore the role of surgery in the management of this malignancy.

We retrospectively reviewed the records of 14 patients (median age 7.5 years) with sinonasal rhabdomyosarcoma. Six patients underwent major surgery with post-operative chemoradiation. Eight patients received multi-agent chemotherapy and radiotherapy. The mean follow-up time was 58 months (range seven to 276 months).

The five-year overall survival rates for all patients and for the surgery group were 53.9 and 83.3 per cent, respectively. All patients with alveolar rhabdomyosarcoma had a poor prognosis, with a median survival time of 17 months. Intracranial extension and an age greater than 10 years were also associated with an unfavourable outcome. Non- or partial responders to initial chemoradiation died within a year of diagnosis.

Management of paediatric rhabdomyosarcoma requires a combination of chemotherapy, radiotherapy and surgery. Primary chemoradiotherapy is the established treatment approach for advanced tumours. Early stage tumours with favourable histology can be treated successfully with radical surgery, provided that function and cosmetic appearance are preserved.

Multiple surgical procedures have been advocated for the management of problematic drooling in neurologically impaired children. Parotid duct ligation is a quick and simple operation conducted via an intra-oral approach and usually performed simultaneously with other procedures. In this study, we aimed to evaluate the effectiveness of parotid duct ligation as a discrete procedure.

All children who underwent bilateral parotid duct ligation as the solitary operative intervention at that time, between February 2003 and September 2006, were included in the study.

Ten children were studied. Surgery was successful in 80 per cent of cases. One patient (10 per cent) had a post-operative wound infection.

Bilateral parotid duct ligation is an effective yet conservative operation for drooling in neurologically impaired children. It requires minimal surgical dissection and has a low morbidity rate. It should be considered as a potential first-line procedure in children who aspirate, and as a further surgical option in anterior droolers or those who continue to drool unacceptably following prior surgical intervention.

To ascertain the sensitivity and specificity of clinical diagnosis of obstructive sleep apnoea in children, and to determine if a published clinical algorithm identifies those at high risk of post-adenotonsillectomy complications.

Sixty-seven children aged three to eight years underwent clinical assessment and overnight polysomnography.

Polysomnography detected a significant apnoea–hypopnoea index (i.e. ≥5, indicating significant obstructive sleep apnoea) in 13 (43 per cent) children with a clinical diagnosis of obstructive sleep apnoea and in six (19 per cent) children with no such diagnosis. The sensitivity of clinical assessment was 68.4 per cent and the specificity 59.5 per cent. The post-operative risk algorithm failed to identify any high risk children, although in actuality seven had severe obstructive sleep apnoea confirmed by polysomnography.

This study of two English centres confirms that the clinical diagnostic process for obstructive sleep apnoea is reasonably insensitive and has low specificity. The studied algorithm discriminated poorly between children with and without severe obstructive sleep apnoea. Realistic diagnostic screening guidelines for paediatric sleep apnoea are overdue in the UK, where access to polysomnography is limited.

To assess the quality of life of adult patients with recurrent tonsillitis after tonsillectomy, and to determine predictive factors for patient satisfaction.

In a prospective cohort study, a Glasgow benefit inventory questionnaire was posted to 70 adult patients six months after tonsillectomy for recurrent tonsillitis. Data were obtained on patient characteristics, risk factors, tonsillitis history, and clinical and operative findings. The patients were also assessed using self-completed diary data collection regarding acute symptoms (i.e. fever, throat pain, cough and rhinitis), tonsillitis episodes and visits to a doctor, either three to six months before tonsillectomy or six months after tonsillectomy. Predictive factors were sought for inclusion in the worst 30th percentile of patients (i.e. Glasgow benefit inventory score under 18), regarding post-operative change in quality of life.

Sixty-two patients (40 females, 22 males; age range 15–46 years) returned the questionnaire (response rate 89 per cent). The mean total Glasgow benefit inventory score after tonsillectomy was +26 (standard deviation 14). The mean scores for Glasgow benefit inventory subscales were: general health +25 (standard deviation 18), social functioning +5 (standard deviation 14) and physical functioning +55 (standard deviation 23). The only factors associated with low patient satisfaction were a small number of tonsillitis episodes (diary-based data) and days with fever before tonsillectomy.

Adult patients with recurrent tonsillitis seemed to be generally pleased with their tonsillectomy. The more symptoms they had prior to surgery, the greater was their improvement in quality of life. No other patient- or disease-related factors were associated with patient satisfaction.

To investigate the differing opinions of patients and medical practitioners regarding the relative priorities of pain relief versus bleeding prevention following tonsillectomy.

Questionnaires were mailed out to adult patients, paediatric patients' parents, general practitioners and ENT surgeons.

A total of 72/112 (64.3 per cent) questionnaires were returned. Adult patients, paediatric patients' parents, general practitioners and ENT surgeons all ranked bleeding as the most important factor when assessing risks related to tonsillectomy. Most adult patients indicated that they would accept a bleeding risk of 2 per cent; however, parents indicated that they would accept a higher bleeding risk (3 per cent) for their children in exchange for better pain control.

Adult patients, paediatric patients' parents and doctors were slightly more inclined to ‘trade-off’ an increased post-tonsillectomy bleeding risk in exchange for better post-tonsillectomy pain control, although concerns about post-operative haemorrhage remained the main priority for all groups.

S-phase kinase-associated protein 2 is required for the degradation of p27 protein, which is a negative regulator of cyclin E/cyclin-dependent kinase 2 complex. The present study examined the expression of cyclin E, S-phase kinase-associated protein 2 and p27 protein in nasopharyngeal carcinoma.

Tissue from 35 cases of nasopharyngeal carcinoma and 10 normal nasopharyngeal tissue samples underwent reverse polymerase chain reaction to detect messenger ribonucleic acid. Immunohistochemical analysis was performed on 29 nasopharyngeal tissue samples in order to detect protein expression.

Messenger ribonucleic acid expression in the nasopharyngeal carcinoma tissue samples analysed indicated a 1.75-fold change in the amount of S-phase kinase-associated protein 2, a 0.34-fold change in the amount of cyclin E and a 0.31-fold change in the amount of p27 protein, compared with positive controls. High levels of cyclin E significantly correlated with late-stage nasopharyngeal carcinoma (p = 0.009) and a poor overall survival (p = 0.010). Immunohistochemical analysis indicated positive expression of S-phase kinase-associated protein 2 in 16/29 nasopharyngeal tissue samples (55 per cent), of cyclin E in 13/29 samples (45 per cent) and of p27 protein in 17/29 (59 per cent) samples.

Overexpression of cyclin E messenger ribonucleic acid showed an adverse prognostic significance, correlating with an advanced stage of nasopharyngeal carcinoma and a low overall survival rate.

To introduce the use of optical coherence tomography with an operating microscope for intra-operative evaluation of the human larynx.

A specially equipped operating microscope with integrated spectral domain optical coherence tomography apparatus was used during microlaryngoscopy.

Technical improvements in optical coherence tomography equipment (e.g. pilot beam, variable focal distance, improved image quality and integration into an operating microscope) have enabled greater sensitivity and imaging speed and a non-contact approach. Spectral domain optical coherence tomography now enables a better correlation between optical coherence tomography images and histological findings. With this new technology, the precision of biopsy can be improved during microlaryngoscopy.

Use of this new optical coherence tomography technology, integrated into an operating microscope, enables the surgeon to define the biopsy site location and resection plane precisely, while the optical zoom of the operating microscope can be used over the complete range.

The anatomy and function of the oropharynx and larynx during deglutition can be assessed using the flexible endoscope, but this evaluation does not provide information on the oesophagus. Guided observation of oesophageal swallowing enables extended dysphagia evaluation.

To assess the diagnostic utility of guided observation of oesophageal swallowing in the evaluation of dysphagia.

Retrospective case series.

Procedures for guided observation of oesophageal swallowing were reviewed for oesophageal findings and compared with fluoroscopy and manometry.

Twenty-one patients underwent guided observation of oesophageal swallowing and concurrent videofluoroscopy and/or manometry. No complications of the former procedure occurred. The results of guided observation of oesophageal swallowing concurred with those of fluoroscopy in 15/21 cases (71 per cent) and with those of manometry in five of six (83 per cent) cases. Guided observation of oesophageal swallowing revealed anatomic pathology contributing to dysphagia in 15/21 (71 per cent) patients. The procedure identified pathology not detected by fluoroscopy and manometry in 13/21 (62 per cent) patients.

Guided observation of oesophageal swallowing appears to be a safe diagnostic tool with which to evaluate the oesophageal phase of deglutition.

Bone-anchored hearing aids are well established, implanted devices. We present two patients who suffered mixed hearing loss and who underwent titanium implant placement in the temporal bone to enable attachment of bone-anchored hearing aids. Osseointegration is necessary for such implants to function. We report these two cases to highlight how such osseointegration may be disrupted.

Attached tissue from the explanted or removed titanium implants was examined by transmission electron microscopy and histopathological analysis.

Attached tissue from both implants showed the presence of keratinocytes at the titanium implant and living bone interface. This was confirmed by histopathological analysis. In one case, there was frank keratinocyte proliferation, which had led to osseointegration failure; in the other case, such proliferation was present but not so advanced.

These findings suggest that, in the cases reported, keratinocytes implanted between the titanium and the living bone, leading to disruption of osseointegration.

A case of tracheopathia chondro-osteoplastica causing sub-glottic stenosis is described.

Case report and literature review.

A 37-year-old man presented with a 15-year history of gradually worsening dyspnoea and stridor due to sub-glottic stenosis. His medical and radiographic records were reviewed. This patient's presentation, histopathological findings and radiology images are presented and discussed.

Histopathological evaluation of microlaryngoscopy biopsy specimens, taken during laser debulking of the stenosis, confirmed the presence of tracheopathia chondro-osteoplastica.

This is the first reported case of sub-glottic stenosis caused by tracheopathia chondro-osteoplastica which required an urgent tracheostomy.

We present an unusual case of a 12-year-old child with state-dependent laryngomalacia presenting after anaesthesia with a laryngeal mask airway.

Current literature on state-dependent laryngomalacia and injury following laryngeal mask use is reviewed.

A child who had previously suffered with laryngomalacia as an infant presented with disturbed breathing at night and during exercise. After anaesthesia using a laryngeal mask airway, these symptoms became more pronounced. Microlaryngoscopy revealed laryngomalacic type movement of the larynx.

Our case seems to support a more complex, multifactorial aetiology for laryngomalacia, including both the neurological control of the larynx as well as its structure.