Literature indicates that complementary and alternative medicine is used by patients with auditory and vestibular symptoms. This study sought to determine the prevalence of complementary and alternative medicine uptake, and examine attitudes towards complementary and alternative medicine in clinicians working with audiovestibular disorder patients.

The Holistic Complementary and Alternative Medicine Questionnaire and a devised questionnaire about recent and lifetime use of complementary and alternative medicine were used.

Fifty-four individuals, including audiologists, ENT surgeons, nurses and rehabilitationists, completed the questionnaires (67 per cent response rate). Lifetime prevalence of complementary and alternative medicine uptake was 44 per cent, and 12-month prevalence was 22 per cent. Uptake was more common in females, but there was no significant difference in use when comparing age, seniority or profession. Attitudes towards complementary and alternative medicine were mildly adverse, but sizeable standard deviation indicates wide-ranging attitudes.

Clinicians working with patients with audiovestibular disorders have a range of attitudes towards complementary and alternative medicine. Personal uptake of complementary and alternative medicine was lower than that of the general UK population, but remains sizeable.

This study aimed to determine the characteristics of tinnitus and tinnitus-related variables and explore their possible relationship with tinnitus-related handicap.

Eighty-one patients with chronic tinnitus were included. The study protocol measured hearing status, tinnitus pitch, loudness, maskability and loudness discomfort levels. All patients filled in the Tinnitus Sample Case History Questionnaire, the Hyperacusis Questionnaire and the Tinnitus Handicap Inventory. The relationship of each variable with the Tinnitus Handicap Inventory score was evaluated by univariate and multivariate analyses.

Five univariables were associated with the Tinnitus Handicap Inventory score: loudness discomfort level, subjective tinnitus loudness, tinnitus awareness, noise intolerance and Hyperacusis Questionnaire score. Multiple regression analysis showed that the Hyperacusis Questionnaire score and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score.

Hyperacusis and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score. Questionnaires on tinnitus and hyperacusis are especially suited to providing additional insight into tinnitus-related handicap and are therefore useful for evaluating tinnitus patients.

To investigate the use of systemic N-acetylcysteine and vitamin A in the prevention of gentamicin ototoxicity in rats.

Forty-two Wistar rats were divided into four groups according to treatment: intratympanic saline, intratympanic gentamicin, intraperitoneal vitamin A after intratympanic gentamicin, and intraperitoneal N-acetylcysteine after intratympanic gentamicin. Signal-to-noise ratio and distortion product otoacoustic emissions were evaluated in all groups.

N-acetylcysteine had a significant protective effect at 1.5, 2, 3, 4, 6 and 8 kHz, whilst vitamin A had a significant protective effect at 2, 3, 4 and 6 kHz, as determined by the distortion product otoacoustic emission measurements. According to the signal-to-noise measurements, N-acetylcysteine had a significant protective effect at 1.5, 2, 3, 4, 6 and 8 kHz, whilst vitamin A had a significant protective effect at 3, 6 and 8 kHz.

Gentamicin-induced hearing loss in rats may be prevented by the concomitant use of vitamin A and N-acetylcysteine. Specifically, N-acetylcysteine appeared to have a more protective effect than vitamin A for a greater range of noise frequencies.

This study aimed to explore the effects of curcumin on experimental allergic rhinitis in rats.

Twenty-eight male Wistar albino rats were randomly divided into four groups: a control group; a group in which allergic rhinitis was induced and no treatment given; a group in which allergic rhinitis was induced followed by treatment with azelastine hydrochloride on days 21–28; and a group in which allergic rhinitis was induced followed by treatment with curcumin on days 21–28. Allergy symptoms and histopathological features of the nasal mucosa were examined.

The sneezing and nasal congestion scores were higher in the azelastine and curcumin treatment groups than in the control group. Histopathological examination showed focal goblet cell metaplasia on the epithelial surface in the azelastine group. In the curcumin group, there was a decrease in goblet cell metaplasia in the epithelium, decreased inflammatory cell infiltration and vascular proliferation in the lamina propria.

Curcumin is an effective treatment for experimentally induced allergic rhinitis in rats.

To establish the prevalence of stapes obliquity as observed in otosclerosis patients during stapes surgery by a simple method of intra-operative measurement.

Prospective observational study.

Intra-operative measurements showed that the mean distance (± standard deviation) between the horizontal segment of the facial nerve and stapes crura in 10 cases of otosclerosis was 0.74 mm (± 0.21 mm), whereas in 10 cases of non-otosclerosis the same distance was 0.20 mm (± 0.00). There was no gap (0 mm) between the stapes crura and inferior border of the oval window niche in otosclerotic ears, whereas in non-otosclerotic ears the same distance was 0.13 mm (± 0.05 mm). The differences were statistically significant (p < 0.0001).

Obliquity and downward displacement of the stapes occurs in otosclerosis. It has diagnostic value as a new clinical sign in otosclerosis. The findings correlate with late complications and failures in stapes surgery. Methods to avoid these have been suggested.

To evaluate a small cohort of patients who presented with symptoms and signs consistent with acute infective sensorineural hearing loss who were treated with intratympanic steroids.

Seven patients received a 7-day course of oral antibiotics and oral prednisolone followed by 3 intratympanic injections of methylprednisolone and 1 week of topical dexamethasone drops.

Hearing improved in 57 per cent of patients (four out of seven). The mean improvement in this group was 24 dB (range, 10–52 dB). The magnitude of the sensorineural hearing loss at presentation was less in those who responded to intratympanic steroid therapy than in non-responders (mean pure tone average of 30 dB versus 65 dB pre-intratympanic steroids, and 14 dB versus 83 dB post-intratympanic steroids, respectively).

The results of our study suggest that intratympanic steroids provide a valuable contribution to the treatment of acute infective sensorineural hearing loss and may provide additional benefit by virtue of a concentrated local steroid effect in patients who do not respond to antibiotics.

A possible role of the APC/beta-catenin pathway in the pathogenesis of sporadic juvenile nasopharyngeal angiofibroma has been suggested. This paper presents its current status and clinical association in our patients.

A prospective observational study was conducted at King George Medical University and Central Drug Research Institute, in Lucknow, India. Western blot analysis was undertaken in 16 cases to examine beta-catenin expression. The clinical details were recorded along with follow up observations, to determine associations.

Up-regulation of beta-catenin expression was seen in 69 per cent of cases. The clinical variables did not reveal significant differences between patients with extremes of expression (extreme under- vs over-expression). However, absent expression was shown exclusively in young adults aged over 18 years, while enhanced expression was associated with an altered facial profile.

Although a beta-catenin association was seen in a subset of our sporadic juvenile nasopharyngeal angiofibroma cases, its expression was not homogeneous. This is in contrast to the Western literature that suggests a universal (homogenous) enhanced expression in the majority. Hence, further research is required to better define its molecular cascade.

To compare stimulation parameters of peri-modiolar and anti-modiolar electrode arrays using two surgical approaches.

Impedance, stimulation thresholds, comfortably loud current levels, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds were compared between 2 arrays implanted in the same child at 5 time points: surgery, activation/day 1, week 1, and months 1 and 3. The peri-modiolar array was implanted via cochleostomy in all children (n = 64), while the anti-modiolar array was inserted via a cochleostomy in 43 children and via the round window in 21 children.

The anti-modiolar array had significantly lower impedance, but required higher current levels to elicit thresholds, comfort, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds than the peri-modiolar array across all time points, particularly in basal electrodes (p < 0.05). The prevalence of open electrodes was similar in anti-modiolar (n = 5) and peri-modiolar (n = 3) arrays.

Significant but clinically acceptable differences in stimulation parameters between peri-modiolar and anti-modiolar arrays persisted four months after surgery in children using bilateral cochlear implants. The surgical approach used to insert the anti-modiolar array had no overall effect on outcomes.

• All theatre staff should participate in the World Health Organization checklist process. (R)

• Post-operative airway management should be guided by local protocols. (R)

• Patients admitted to post-operative care units with tracheal tubes in place should be monitored with continuous capnography. Removal for tracheal tubes is the responsibility of the anaesthetist. (R)

• Anaesthetists should formally hand over care to an appropriately trained practitioner in the post-operative or intensive care unit. (G)

• Intensive care unit staff looking after post-operative tracheostomies must be clear about which patients are not suitable for bag-mask ventilation and/or oral intubation in the event of emergencies. (R)

The vomeronasal organ is an accessory olfactory organ found in vertebrates that specialises in the chemoreception of pheromones. This study aimed to explore the existence and occurrence of the vomeronasal organ in adult humans.

A total of 966 consecutive video recordings of out-patient nasopharyngolaryngoscopies performed at the St Marina University Hospital, Varna, Bulgaria, were retrospectively reviewed.

Data analysis showed that from the evaluable cases, the organ was evident on the left side of the nasal septum in 14.93 per cent, on the right side in 21.15 per cent and bilaterally in 2.35 per cent of cases. The vomeronasal organ was present in a total of 26.83 per cent of the investigated subjects.

More research should be focused on revealing the incidence and functionality of the organ, and on its preservation in surgical manipulations that affect the nasal septum and other nearby structures.

This study aimed to determine the prevalence of vestibular dysfunction in the Singaporean elderly and its association with presbyacusis, age and other associated risk factors.

A cross-sectional study was undertaken in a tertiary otorhinolaryngology department and the community. Healthy adults aged 40 years and above who participated in the institution's community presbyacusis screening programme were invited to participate. The main outcome measures including pure tone audiometry and vestibular assessment were obtained using a modified Clinical Test of Sensory Interaction on Balance.

The prevalence of vestibular dysfunction and presbyacusis in the study population of 216 participants was 30.1 per cent (95 per cent confidence interval, 24.0 to 36.2 per cent) and 55.6 per cent (95 per cent confidence interval, 49.0 to 62.2 per cent), respectively. The median age was 60 years (range, 40–86 years). The adjusted odds ratio for vestibular dysfunction increased by 6.2 per cent with every year of life (p < 0.05), and by 3.14 times in the presence of presbyacusis (p < 0.05). After adjusting for age and presbyacusis, diabetes (n = 30), hypertension (n = 85), hypercholesteraemia (n = 75), cardiac disease (n = 14), stroke (n = 7) and smoking (n = 55) were associated with an increased odds ratio for vestibular dysfunction which did not reach statistical significance (p > 0.05).

Vestibular dysfunction is independently associated with ageing and presbyacusis. Further research into the benefits of additional screening for vestibular dysfunction in elderly presbyacusis patients is warranted.

To determine the proportion of UK surfers aware of external auditory canal exostosis, to identify surfer characteristics associated with knowledge of the condition and to explore attitudes to earplug use.

An online, cross-sectional survey of UK-based surfers.

Of 375 surfers, 86.1 per cent (n = 323; 95 per cent confidence interval = 82.3–89.3) reported awareness of external auditory canal exostosis. Further investigation revealed that, despite their awareness of the condition, 23.4 per cent of these surfers (88 out of 323; 95 per cent confidence interval = 19.5–28.0) had little or no knowledge about external auditory canal exostosis. Predictors of knowledge included: distance from nearest surfing beach (p = 0.001), surfing standard (ability) (p = 0.008), earplug use (p = 0.024) and positive external auditory canal exostosis diagnosis (p = 0.009).

The findings suggest that a significant minority of UK surfers have no knowledge about this condition. Knowledge of external auditory canal exostosis was significantly associated with earplug use when surfing. Efforts to improve surfers’ knowledge are required to enable surfers to better protect themselves, which could reduce the incidence of external auditory canal exostosis.

Thyroglossal duct cyst recurrence following resection is attributed to anatomical variability and residual thyroglossal ducts. In adults, thyroglossal duct cyst recurrence is extremely rare and a surgical solution is yet to be well explored. This paper describes our approach to the management of recurrent thyroglossal duct cysts and sinuses in adults using a wide anterior neck dissection.

A retrospective review was performed to identify adults who underwent a wide anterior neck dissection for recurrent thyroglossal duct cyst management between 1 January 2009 and 1 January 2015.

Six males and one female were included in the series (mean age, 26.4 ± 10.9 years). Recurrence occurred at a mean of 18 ± 9.8 months following primary surgical management (3 patients underwent cystectomy and 4 had a Sistrunk procedure). All patients subsequently underwent wide anterior neck dissection; there was no further recurrence over the 12-month average follow-up period.

This paper describes a wide anterior neck dissection technique for the management of recurrent thyroglossal duct cysts or sinuses in adults; this approach addresses the variable anatomy of the thyroglossal duct and is associated with minimal morbidity.

To verify the hypothesis that intravenous frusemide reduces endolymphatic hydrops, as evaluated by three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging following intratympanic gadolinium administration.

The study comprised 12 patients (7 females and 5 males, aged 19–74 years) with Ménière's disease. Disease duration ranged from 0.5 to 8 years, with a frequency of 0.5 to 6 vertigo spells per month, as calculated in the last 6 months. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging was performed 24 hours after intratympanic injection of gadobutrol diluted eight-fold. Frusemide 20 mg was given intravenously immediately after imaging. Magnetic resonance imaging was repeated after 1 hour, using the same parameters and sequence.

All patients showed enhancement defects, indicating endolymphatic hydrops of variable degrees. No modifications occurred at the second magnetic resonance imaging performed 1 hour after frusemide administration.

There was no evidence of endolymphatic hydrops modification 1 hour after intravenously administered frusemide. Therefore, loop diuretics in Ménière's disease, which are today used on an empirical basis, must be reconsidered. Implications of these outcomes are discussed and related to the role of endolymphatic hydrops in the development of Ménière's disease.

Parotid gland tumours are complex neoplasms with a broad histological range. The parotid gland is also a common site of face and scalp skin cancer metastases.

Parotidectomies performed by ENT department in the Gold Coast health district from 2006 to 2013.

A total of 158 specimens were examined. Of these, 53.80 per cent were benign and 46.20 per cent were malignant. Pleomorphic adenoma was the most common tumour (29.11 per cent), followed by cutaneous squamous cell carcinoma (23.42 per cent) and Warthin's tumour (12.03 per cent).

Metastatic squamous cell carcinoma accounted for a large proportion of parotid masses in our case series, reflecting the high prevalence of non-melanoma skin cancer in Australia. Primary parotid neoplasms had similar incidence rates to other studies.

To investigate nasal mucociliary clearance in patients with Behçet's disease.

Thirty patients with Behçet's disease, diagnosed on the basis of criteria defined by the International Study Group for Behçet's Disease, and 30 healthy individuals were recruited. In both groups, individuals with conditions that could affect nasal mucociliary clearance were excluded. Nasal mucociliary clearance time was evaluated using saccharin tests. The time between placement of a saccharin tablet and the tasting of the saccharin was measured and recorded as the saccharin clearance time.

The mean nasal mucociliary clearance time was significantly longer in the Behçet's disease patients than in the control subjects (p < 0.001). Furthermore, there was a positive correlation between Behçet's disease duration and nasal mucociliary clearance time (p < 0.001, r = 0.882).

The results suggest that nasal mucociliary clearance time is longer in Behçet's disease patients than in control subjects, and is positively correlated with disease duration.

This study was conducted to explore the potential use of neuromuscular electrical stimulation as an adjunctive treatment for muscle tension dysphonia.

Voice data and ratings of fatigue and soreness were obtained for two experiments. Experiment one examined the vocal effects of neuromuscular electrical stimulation applied to the neck for 15 minutes. Experiment two examined the recovery effect of laryngeal neuromuscular electrical stimulation following a vocal loading task among normophonic women.

No significant differences in vocal function following 15 minutes of laryngeal neuromuscular electrical stimulation were found. Six of 11 participants receiving laryngeal neuromuscular electrical stimulation exhibited improved recovery following the vocal loading task.

A short session of laryngeal neuromuscular electrical stimulation may be beneficial in reducing muscle fatigue for some individuals. Further investigation is warranted to determine the applicability of laryngeal neuromuscular electrical stimulation in voice therapy.

To determine whether patients with hereditary haemorrhagic telangiectasia were being screened according to international guidelines, and to review recent evidence in order to provide up-to-date guidelines for the initial systemic management of hereditary haemorrhagic telangiectasia.

A retrospective case note analysis was conducted, assessing patients in terms of screening for: genetics, cerebral arteriovenous malformations, pulmonary and hepatic arteriovenous malformations, and gastrointestinal telangiectasia. Databases searched included Medline, the Cumulative Index to Nursing and Allied Health Literature, and Embase.

Screening investigations were most frequently performed for hepatic arteriovenous malformations and least frequently for genetics. Recent data suggest avoiding routine genetic and cerebral arteriovenous malformation screening because of treatment morbidities; performing high-resolution chest computed tomography for pulmonary arteriovenous malformation screening; using capsule endoscopy (if possible) to reduce complications from upper gastrointestinal endoscopy; and omitting routine liver enzyme testing in favour of Doppler ultrasound.

Opportunities for systemic arteriovenous malformation screening are frequently overlooked. This review highlights the need for screening and considers the form in which it should be undertaken.

This study aimed to evaluate the results of the video head impulse test and of the caloric and rotatory chair tests in patients with dizziness. Agreement between test results was assessed and the best protocol for detecting peripheral vestibulopathy was identified.

Participants comprised 116 patients, 75 with a peripheral vestibulopathy and 41 with non-peripheral vestibulopathy. The main outcome measures were classified as normal or abnormal according to our laboratory data.

Agreement between tests was low. Vestibulopathy testing that required all three results to be abnormal had a sensitivity of 0.547, a specificity of 0.878, and positive and negative predictive values of 0.891 and 0.514, respectively. Vestibulopathy testing that required just one result to be abnormal had a sensitivity of 0.933, a specificity of 0.292, and positive and negative predictive values of 0.701 and 0.705, respectively.

In peripheral vestibulopathy, there was weak concordance in the assessment of horizontal semicircular canal function among the different tests. However, the video head impulse test had sufficient statistical power to be recommended as the first-line test.