Gold eyelid implantation is widely considered the procedure of choice to reanimate the upper eyelid in paralytic lagophthalmos. Commercially supplied implants are not readily available in all places and are sometimes cumbersome to import.

Titanium has been shown to be a highly biocompatible material and recently interest has been raised by its use as a prosthetic material in the ear. Our objective was to prospectively assess the early results of titanium partial and total ossicular replacement prostheses in chronic ear disease. Thirty-three consecutive patients (20 titanium partials and 13 total ossicular replacement prostheses) were analysed and data from pre and post-operative pure tone audiograms were collected and compared at six months over a four frequency range (0.5–4 kHz) as well as using the American Academy of Otolaryngology–Head and Neck Surgery criteria (0.5–3 kHz). Closure of the air-bone gap and improvement in air conduction at six months was also calculated. 69% of patients obtained an air-bone gap of ≤20 dB, with titanium partial ossicular replacement prostheses (85 per cent) doing better than total ossicular replacement prostheses (46 per cent). There have been no cases of sensorineural hearing loss or extrusion. In conclusion, titanium prostheses are easy to use, allow good visibility and have shown good short-term results in our hands.

We studied the transmission of heat to the vestibule during revision stapes surgery with a piston in situ, using a CO2 laser, in an in vitro model. A type K thermocouple was placed around the medial end of stainless steel and fluoroplastic wire pistons in a ‘vestibule’ filled with saline. The effect of laser hits on fluoroplastic wire and stainless steel stapes prostheses was investigated. The effect of introducing a vein graft to seal the stapedotomy was also examined. Greater temperature rises occurred with stainless steel than with fluoroplastic wire pistons. The addition of the vein graft reduced heat transmission.

Application of the CO2 laser to fluoroplastic wire pistons, using the power settings suggested by the manufacturer, is not likely to damage the inner-ear structures. Application of 6 W laser energy to stainless steel pistons can potentially disturb the inner-ear function.

We investigated the motion of the single ossicle found in the middle ears of four different species of birds. In the avian middle ear, the off centre attachment of the extracolumella to the tympanic membrane and the flexion of the joint between the extracolumella and columella results in rocking of the footplate rather than direct excursion in and out of the vestibule. We postulate that this is a protective mechanism to avoid excessive displacement of the footplate into the vestibule during changes in middle-ear pressure and that it is analogous to the ossicular ‘decoupling’ observed in the human middle ear in the same circumstances.

Introduction: Avoidance of infection at the implant site is a crucial element to the success of bone-anchored hearing aid (BAHA) implantation. However, little evidence exists to suggest the best post-operative wound dressing to use.

Material and methods: We report our experience with 160 consecutive BAHA patients, using four types of post-operative BAHA wound dressing (Tri-adcortyl®, Mepitel®, Allevyn®, and Acticoat 7® with Allevyn). Patients were reviewed at week one and week two post-operatively. Infection was defined as a positive wound swab culture or evidence of cellulitis at the BAHA site.

Results: Post-operative BAHA infection rates were 16 per cent, 50 per cent, 10 per cent and 5 per cent, for each of the four dressings respectively, and the mean number of additional visits to wound care clinic were 1.5, 3.7, one and 0.4, respectively.

Discussion: Acticoat 7 with Allevyn produced the lowest infection rate and thus became the dressing of choice for our BAHA programme.

Objective: To compare the estimated effects of conservative surgery to those of a mandibular advancement splint (MAS) in the treatment of habitual snoring.

Method: Prospective, observational, non-randomized cohort study.

Results: Adequate follow-up data were available for 88 participants (23 following coblation, 65 after provision of an MAS). The mean reduction in snoring symptoms inventory (SSI) score for the 23 subjects undergoing coblation was 9.83 (± standard deviation 11.43). Reported pain duration was greatest with uvula amputation, but uvula coblation did not always adequately reduce its bulk. Of the 65 MAS patients, 39 (60 per cent) used the device regularly, with a mean fall in SSI of 12 (±16.4, p = 0.001). Approximately one in four patients in both groups achieved a significant fall in SSI (>15 points), and the measured effect sizes were close to 0.75 for both treatments.

Conclusions: Mandibular advancement splints and coblation have similar efficacies. However, their efficacy does not match that of radical surgery.

Objectives: The authors present their experience of a new intralaryngeal silicone prosthesis used to manage laryngotracheal pathologies associated with severe deglutition and respiratory disorders.

Study design: This retrospective study, conducted in the head and neck surgery department of the Strasbourg University Hospital, France, included 10 patients (12 prostheses inserted) and was conducted from November 2000 to November 2003.

Methods: A pre-operative clinical examination and a computed tomography and/or magnetic resonance scan assessed patients' laryngeal function. Two different semirigid laryngotracheal prostheses were used, inserted under general anaesthetic into the region from the supraglottic area to the first tracheal cartilages including the vocal folds and the ventricles. In group one (n = 5), patients presented with laryngeal stenosis with preserved deglutition function, and patent prostheses were used to restore laryngeal patency. In group two (n = 5), patients suffered from severe deglutition disorders and were in poor general condition and so required a cuffed tracheostomy tube, therefore obstructed prostheses were inserted to stop aspirations and to suppress the cuff of the tracheostomy tube. The study was performed under the authorization of the Biomedical Research Patients' Protection Committee of Alsace I, France.

Results: The mean implantation duration was six months. The prosthesis used in the first group restored laryngeal patency without further complications such as aspiration or prosthesis (mucous) obstruction. The prosthesis used in group two prevented aspiration and allowed to change a cuff by an uncuffed tracheostomy tube.

Conclusions: The intralaryngeal prosthesis used in group one constituted a reversible and effective method of treating laryngotracheal stenoses. The intralaryngeal prosthesis used in group two constituted an alternative to classical larynx exclusion techniques. The insertion is performed in few minutes under general anaesthetic through an endoscopic procedure. This reversible technique aimed to treat patients rapidly to reduce complications and post-operative morbidity.

Objectives: To report the clinical results of a bone-anchored hearing aid (BAHA) programme in a district general hospital, compared with those in an established, large, university teaching hospital centre.

Design: A retrospective postal questionnaire sent to BAHA patients, with two month waiting time and one reminder, combined with case note analysis. Results compared by appropriate statistical tests with published outcomes data from the largest UK series.

Setting: Public sector (National Health Service) district general hospital, England. Catchment population: 300 000 (mixed rural and small towns).

Participants: Case note analysis of sixty-three patients implanted between 1994 and 2003 (age range, six to 88 years). The commonest indication was chronic otitis media, with inability to wear a conventional hearing aid. Otitis externa, otosclerosis and sensorineural hearing loss were other indications. The questionnaire was sent to 59 patients who had worn their aid for at least six months; it was returned by 41 (69 per cent).

Main outcome measures: Glasgow benefit inventory (GBI, change in health status following otolaryngological intervention); incidence of complications.

Results: Bone-anchored hearing aid implantation significantly improved quality of life as measured by the GBI (p < 0.001). The degree of improvement was similar to that achieved in Birmingham by Proops et al. (p > 0.05, chi-squared test). Minor temporary skin infection was common (33 per cent). Thickening of the skin around the implant occurred in 17 per cent. One implant (2 per cent) failed. There were no serious complications.

Conclusion: The BAHA is a safe, reliable and effective treatment for selected patients. A successful BAHA programme can be run in a district general hospital.

This study assessed the effect on the upper airway during sleep nasendoscopy of mimicking the action of a mandibular advancement splint. Twenty-seven subjects with a diagnosis of sleep-disordered breathing were referred for mandibular advancement splint therapy following sleep nasendoscopy. Sleep nasendoscopy was repeated for all subjects with, and without, the appliance in situ. Follow-up sleep studies with a mandibular advancement splint in situ were undertaken for 19 individuals with significant obstructive sleep apnoea.

With the mandibular advancement splint, subjective snoring levels and airway patency improved as predicted in all but one individual. Residual palatal flutter was predicted for five subjects and occurred in eight individuals. Follow-up sleep studies showed highly statistically significant reductions in median apnoea-hypopnoea index (from 28.1 to 6.1, p < 0.001).

Mimicking the action of a mandibular advancement splint during sleep nasendoscopy helps considerably in the patient selection process for this form of treatment.

Packing of the nose with a suitable material remains a popular method of treating epistaxis. The authors report a serious complication of a new design of nasal pack; Rapid Rhino®, which was swallowed during the treatment of a patient with epistaxis, resulting in bowel perforation.

This paper describes the Mills sleeve technique of ossicular reconstructionfor defects of the incus long process and reviews the results of 27 procedures. A retrospectivereview of operations was performed by eight otologists. The results are compared with those from three other reconstruction techniques (cortical bone graft, cortical bone sleeve and incus autograft).

Prostheses were supplied to surgeons who expressed an interest. Pre- and post-operative audiological data forms were analysed for each case along with a questionnaire about use of the prosthesis. The mean post-operative air bone gap (ABG) was compared with results from cortical bone sleeve, incus autograft and simple cortical bone graft reconstruction cases previously performedby the senior author.

Twenty-seven procedures were performed. Closure of the ABG to within 10dB was achieved for 44.4 per cent of Mills sleeve cases compared with 44.7 per cent for the cortical bone sleeve, 52.9 per cent for ossicular and 26.9 per cent for cortical bone grafts. The responses to a questionnaire sent to participating surgeons are discussed.

For the current follow-up period (three months to three years) the Mills sleeve prosthesis appears to be safe and easy to use with audiological results at least as good as other reconstructive techniques.