To report a case series of elective removal of bone-anchored hearing aid implants, and reasons for removal.

Retrospective review of a prospectively collected database.

Two tertiary referral centres in the Manchester area: Manchester Royal Infirmary and Salford Royal University Hospital.

A series of 499 adults and children who had undergone a total of 602 implant insertions (1984–2008).

Implant removal rates, and reasons.

Twenty-seven of the 602 implants (4.5 per cent) required removal. Of these, 12 were due to pain (2.0 per cent), seven to persistent infection (1.2 per cent), three to failure of osseointegration (0.5 per cent), three to trauma (0.5 per cent) and two to other reasons (0.4 per cent).

Chronic implant site pain represents the main reason why implants are removed electively, and affects 2 per cent of all implants. This complication has important medico-legal implications and should be discussed when obtaining informed consent for implantation.

Mutations in the gap junction protein beta-2 gene (‘GJB2’) are known to be responsible for mild to profound congenital and late-onset hearing loss. This study aimed to investigate the molecular basis of progressive hearing loss compared with non-progressive hearing loss.

Following clinical otorhinolaryngological evaluation, a genetic analysis was performed in a cohort of 72 patients with progressive sensorineural hearing loss.

Pathological genotypes were established in 16 patients (22.2 per cent). Six different gap junction protein beta-2 gene mutations were detected in 15 patients, with the c.35delG mutation responsible for 56 per cent of the mutated alleles. A novel gap junction protein beta-6 gene (‘GJB6’) mutation (p.Met203Val) was observed in one patient with mild progressive hearing loss.

Analyses of gap junction protein beta-2 and -6 genes revealed that similar pathological genotypes, occurring with similar frequencies, were responsible for progressive hearing loss, compared with reported genotypes for non-progressive hearing loss patients. Thus, genotype cannot be used to differentiate non-progressive from progressive hearing loss cases; in this study, patients both with and without an established pathological genotype had a similar clinical course.

To conduct a systematic review comparing the effect of three interventions (prophylactic antibiotics, tympanostomy tube insertion and adenoidectomy) on otitis media recurrence, recurrence frequency and total recurrence time.

Literature on recurrent otitis media was identified using the PubMed and Scopus search engines for the period January 1990 to March 2011. A hand search of the reference lists of relevant articles and textbooks was conducted to identify additional studies. Randomised, controlled trials with a minimum of 40 children and follow up of at least 12 months were included.

Eighteen publications were identified. Each was assessed using preset inclusion criteria; seven publications met these criteria.

Prophylactic antibiotics are effective in reducing otitis media recurrence, recurrence frequency and total recurrence time. Tympanostomy tube insertion failed to reduce the prevalence of otitis media recurrence, but reduced the recurrence frequency and total recurrence time. Adenoidectomy reduced otitis media recurrence; results on otitis media recurrence frequency differed but on average there was a reduction; however, the two studies with relevant data on total recurrence time had contradictory results.

To provide an update on the ever-increasing role that embolisation plays in the practice of otolaryngology.

A literature search was performed during November 2008. The Medline, Embase, PubMed and Cochrane databases were searched. This resulted in 285 papers relevant for review.

The role of embolisation has expanded greatly to include the management of refractory epistaxis, pre-operative preparation of vascular tumours, vascular injuries and as an adjunct in skull base surgery.

Acute hearing loss is a distressing albeit rare occurrence in pregnancy. Due to its infrequent presentation, little is known of its cause, and the best management is unclear.

To present a summary of current knowledge regarding sudden hearing loss in pregnancy and its management, by reviewing the published literature.

The following electronic databases: PubMed (MEDLINE), Ovid (MEDLINE), all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE and CCTR) and Embase; plus a hand search of reference lists of retrieved papers.

All papers retrieved using key word searches for ‘sudden hearing loss and pregnancy’ and ‘sudden deafness and pregnancy’ were reviewed. Due to the scarcity of literature, all studies identified were included in this review.

All retrieved papers were reviewed. Sudden hearing loss is a rare occurrence during pregnancy, leading to a dearth of literature due to limited clinical experience. Audiological investigation findings for such patients remain equivocal. Recovery can be spontaneous during the postpartum period. In patients who require medical treatment, a dextran 40 infusion can be employed. There remains scope for further research, in the form of larger studies, to ascertain the best management option for this clinical problem.

Inner ear homeostasis is dependent on the vestibular aqueduct and its content, the endolymphatic duct. Narrow and enlarged vestibular aqueducts have both been associated with hearing loss in Ménière's and large vestibular aqueduct syndromes. This review investigated the correlation between vestibular aqueduct diameter and pure tone average, and the effect of measurement site (i.e. the midpoint or the external aperture).

A systematic review of the literature and meta-analysis of large case series published on the Allied and Complementary Medicine, British Nursing Index, Cumulative Index to Nursing and Allied Health, Embase, Health Business Elite, Health Management Information Consortium, Medline, PsycInfo and PubMed databases. References and personal books were also scrutinised.

A linear relationship between vestibular aqueduct diameter and hearing loss was observed, with a projected increase of 6 dBHL per unit of vestibular aqueduct diameter (95 per cent confidence interval, 2–10; p = 0.003). This relationship was independent of measurement site.

This dose-dependent or linear relationship supports the role of flow and/or pressure change as aetiological factors in the pathogenesis of hearing loss, as per Poiseuille's law. This aetiological association is strengthened by the fact that the observed relationship is independent of measurement site.

To evaluate the management of mastoid subperiosteal abscess using two different surgical approaches: simple mastoidectomy and abscess drainage.

The medical records of 34 children suffering from acute mastoiditis with subperiosteal abscess were retrospectively reviewed. In these cases, the initial surgical approach consisted of either myringotomy plus simple mastoidectomy or myringotomy plus abscess drainage.

Thirteen children were managed with simple mastoidectomy and 21 children were initially managed with abscess drainage. Of the second group, 12 children were cured without further treatment while 9 eventually required mastoidectomy. None of the children developed complications during hospitalisation, or long-term sequelae.

Simple mastoidectomy remains the most effective procedure for the management of mastoid subperiosteal abscess. Drainage of the abscess represents a simple and risk-free, but not always curative, option. It can be safely used as an initial, conservative approach in association with myringotomy and sufficient antibiotic coverage, with simple mastoidectomy reserved for non-responding cases.

To review outcomes following paediatric cholesteatoma surgery performed between 1999 and 2009 in a tertiary paediatric ENT unit.

Retrospective case note review.

A total of 137 mastoid procedures were recorded. Fifty-four per cent of children were observed to have disease involving the entire middle-ear cleft and mastoid complex. The revision rate was 25 per cent. Time to recurrence was one to three years in 17 patients, three to six years in five patients, and six to nine years in three cases. Eight of 25 revision cases demonstrated spontaneous improvement in air conduction thresholds following primary surgery. A high facial ridge and inadequate meatoplasty correlated highly with disease recurrence.

Children tend to present with aggressive disease. Disease extent and ossicular chain involvement are associated with a higher risk of recurrent disease. Spontaneous improvement in hearing thresholds following cholesteatoma surgery should alert the clinician to recurrent disease.

To review the currently available literature on iatrogenic injury of the adult chorda tympani.

Systematic literature review.

Five electronic databases and one search engine were used to access available English language literature on the chorda tympani, focusing on iatrogenic injury.

The chorda tympani is most often injured during middle-ear surgery, after which at least 15–22 per cent of patients experience symptoms, mostly changes in taste and dryness of the mouth. Numerous factors influence whether injury to the chorda tympani causes symptoms, including the extent of injury, type of surgery, age of the patient, anatomical variables and subjective adaptation. Although most patients experience gradual symptomatic recovery, complaints can be persistent and troublesome.

Care should be taken to preserve the chorda tympani during middle-ear surgery, and to warn patients pre-operatively about this potential complication. This is particularly important if surgery is bilateral.

To develop a virtual-reality subtotal tonsillectomy simulation for surgical training.

Computer models of a male patient's head and throat, and the surgical instrument, were created. These models were combined with custom-built simulation software. Recently developed tissue simulation technology that exploits recent developments in programmable graphics processing units was used to model tonsillar tissue in a way that allows surgical interaction whilst providing accurate tactile feedback. Current real-time rendering techniques were used to provide realistic visuals. Iterative refinements were made to the simulation, and in particular the tissue simulation, in consultation with relevantly experienced surgeons.

We have used newly developed tissue simulation technology to developed a novel virtual-reality subtotal tonsillectomy simulation for surgical training, the first of its kind.

Early feedback suggests that this simulator can help surgeons to rapidly acquire subtotal tonsillectomy surgical skills in a risk-free and realistic virtual environment.

Oral antiplatelet drugs are increasingly being encountered in patients scheduled for elective ENT surgery. Their pre-operative cessation can have potentially serious complications in some patients, particularly those with intracoronary stents.

In order to gain an impression of current peri-operative management of patients taking antiplatelet drugs, an online survey was distributed to the Expert Panel of ENT UK, the British Association of Otolaryngologists Head and Neck Surgeons, between 13 January and 15 February 2011.

Three hundred and three members were contacted. The response rate was 55 per cent (167 replies); 78 per cent of respondents were consultants. Results are presented in the main text.

Patients can be categorised as high or low risk, depending on their indication for taking antiplatelet drugs. Recommendations taken from the literature are given on how best to manage these two groups.

This study aimed to contribute to the literature on the prevention and treatment of ototoxicity due to various drugs and chemicals.

This study compared the histological effects of intratympanic dexamethasone, memantine and piracetam on cellular apoptosis due to cisplatin ototoxicity, in 36 rats.

Dexamethasone and memantine had significant effects on the stria vascularis, organ of Corti and spiral ganglion (p < 0.05). Although piracetam decreased the apoptosis rate, this effect was not statistically significant (p > 0.05).

Dexamethasone and memantine were found superior to piracetam in reducing apoptosis due to cisplatin ototoxicity. Further studies of this subject are needed, incorporating electron microscopy and auditory brainstem response testing.

To determine whether procedure-specific brochures improve patients' pre-operative knowledge, to determine the amount of information expected by patients during the consenting process, and to determine whether the recently proposed ‘Request for Treatment’ consenting process is viable on a large scale.

A prospective, questionnaire-based study of 100 patients admitted for selected, elective surgical procedures.

In total, 99 per cent of patients were satisfied with the information received in the out-patient department, regarding the proposed procedure. However, 38 per cent were unable to correctly state the nature of the surgery or specific procedure they were scheduled to undergo. Although the vast majority of patients were able to state the intended benefits to be gained from the procedure, only 54 per cent were able to list at least one potential complication, and 80 per cent indicated that they wished to be informed about all potential complications, even if these occurred in less than 1 per cent of cases.

The introduction of procedure-specific brochures improved patients' pre-operative knowledge. Although the failings of current consenting practice are clear, the Request for Treatment consenting process would not appear to be a viable alternative because of the large number of patients unable to accurately recall the nature of the proposed surgery or potential complications, following consent counselling.

In the management of sensorineural hearing loss, effective therapy for degenerated hair cells, third order neurons, ganglions, dendrites and synaptic areas of the vestibulo-cochleo-cerebral pathway remains an enigma. Transplantation of stem and progenitor cells appears to be an emerging potential solution, and is the focus of this review.

To review recent developments in the management of sensorineural hearing loss in the field of stem cell research.

A systematic review of the English language literature included all experimental and non-experimental studies with a Jadad score of three or more, published between 2000 and 2010 and included in the following databases: Cochrane Library Ear, Nose and Throat Disorders; Medline; Google Scholar; Hinari; and the Online Library of Toronto University.

Of the 455 and 29 600 articles identified from Medline and Google Scholar, respectively, 48 met the inclusion criteria. These were independently reviewed and jointly analysed.

Although there is not yet any evidence from successful human studies, stem cell and ‘alternative stem cell’ technology seems to represent the future of sensorineural hearing loss management.

Despite longstanding concern, provision of undergraduate ENT teaching has not improved in response to the aims of the UK General Medical Council's initiative Tomorrow's Doctors. Previous studies have demonstrated poor representation of ENT within the undergraduate curriculum. We aimed to identify current practice in order to establish undergraduate ENT experience across UK medical schools, a timely endeavour in light of the General Medical Council's new 2011–2013 education strategy.

Questionnaires were sent to ENT consultants, medical school deans and students. All schools with a clinical curriculum were anonymously represented. Our outcome measures were the provision of mandatory or optional ENT placements, and their duration and content.

A compulsory ENT placement was available to over half (53 per cent) of the students. Ten of the 26 participating schools did not offer an ENT attachment. The mean mandatory placement was 8 days. Overall, 38 per cent of students reported a satisfactory compulsory ENT placement. Most ENT consultants questioned considered that newly qualified doctors were not proficient in managing common ENT problems that did not require specialist referral.

Little improvement in the provision of undergraduate ENT teaching was demonstrated. An increase in the proportion of students undertaking ENT training is necessary. Time and curriculum constraints on medical schools mean that optimisation of available resources is required.

Adipose-derived stem cells have been reported as a novel candidate for the repair of cartilage injuries in vivo.

In order to assess their differentiation ability, adipose-derived stem cells isolated from rabbit fat tissue were injected into the midportion of a surgically created rabbit ear auricle cartilage defect. After several months, the auricles were resected, histopathologically assessed and compared with a control group.

Histopathological examination of auricles removed three, four and five months after injection showed islands of new cartilage formation at the site of the surgically induced defect. Six months after injection, we observed well-formed, mature cartilaginous plates that completely filled the defect in the native cartilage. In the control group, there was no significant growth of new cartilage.

The results of this study suggest the great potential of adipose-derived stem cells to repair damaged cartilage tissue in vivo.