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.

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.

To assess the feasibility of temporal bone magnetic resonance imaging for evaluating the severity and prognosis of idiopathic acute facial nerve palsy.

Forty-four patients with idiopathic acute facial nerve palsy who had undergone gadolinium-enhanced magnetic resonance imaging were selected retrospectively. The degree of radiological facial nerve enhancement was determined using quantitative analysis (with region-of-interest measurements for separate facial nerve segments) and using subjective visual analysis. The clinical severity of facial nerve palsy was then correlated with the degree of facial nerve enhancement.

The visually determined degree of facial nerve enhancement did not correlate significantly with the House–Brackmann grade at either the early or late stages (p > 0.05). Results using the region-of-interest system were similar (p > 0.05).

Temporal bone magnetic resonance imaging is not essential for patients with acute facial nerve palsy.

To explain a clinical observation: a notch in the stimulus spectrum during transient evoked otoacoustic emission measurement in ears with secretory otitis media.

The effects of tympanic under-pressure were investigated using a pressure chamber. A model of the ear canal was also studied.

Tympanic membrane reflectance increased as a consequence of increased stiffness, causing a notch in the stimulus spectrum. In an adult, the notch could be clearly distinguished at an under-pressure of approximately −185 daPa. The sound frequency of the notch corresponded to a wavelength four times the ear canal length. The ear canal of infants was too short to cause a notch within the displayed frequency range. The notch was demonstrated using both Otodynamics and Madsen equipment.

A notch in the otoacoustic emission stimulus spectrum can be caused by increased stiffness of the tympanic membrane, raising suspicion of low middle-ear pressure or secretory otitis media. This finding is not applicable to infants.

Earlier studies have shown that individuals with thalidomide embryopathy can have skeletal deformities, ear and eye aberrations, and facial palsy. This study aimed to survey the frequency and characteristics of facial palsy in this group of individuals.

Thirty-one individuals with thalidomide embryopathy (age range, 45–47 years) and 25 healthy adults (age range, 41–56 years; mean age ± standard deviation, 49 ± 4.2 years).

Voluntary facial movements, lip force and three-dimensional lip motion analysis.

Four of the thalidomide embryopathy individuals (13 per cent) had congenital facial palsy. All four had eye aberrations, three had ear anomalies and one had a limb anomaly. Individuals with thalidomide embryopathy without a clinical diagnosis of facial impairment had significantly weaker lips and more restricted lip mobility than healthy controls. This study contributes to the overall knowledge of thalidomide embryopathy by adding a description of how facial expression can be affected in this condition.

To determine anatomical variations in the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle, and to propose a rational approach for the preservation of the nerve in thyroid surgery based on anatomical principles.

A cadaveric dissection study of the anatomy of the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle was conducted. Twenty-nine formalin-fixed cadavers of both sexes (age 50–70 years), with normal necks, were examined.

In relation to the Friedman classification, three anatomical variations of the external branch of the superior laryngeal nerve were found. Type 1 variation was found in 57.1 per cent of cases, type 2 in 26.8 per cent and type 3 in 16 per cent.

The prevalence of type 3 variation of the external branch of the superior laryngeal nerve suggests that the nerve will not be encountered in a certain percentage of individuals as it lies under the cover of the inferior constrictor. Therefore, there is no justification for attempting to identify the nerve in all cases.

We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.

Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.

All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.

In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

To report a case of first branchial arch abnormality and the problems associated with misdiagnosis. A succinct literature review is included.

Teaching hospital in Scotland.

A 10-year-old girl presented with localised erythema and swelling in the left parotid region. This was treated with antibiotics and incision and drainage. She re-presented four years later with a history of recurrent discharge. A first branchial arch abnormality was suspected and a magnetic resonance imaging scan arranged.

Imaging showed a fluid-filled sinus tract originating adjacent to the anterior wall of the cartilaginous left external auditory canal. The sinus tract was seen to extend anteriorly and inferiorly through the superficial lobe of the left parotid, and to open onto the left cheek lateral to the left masseter. The tract was explored and excised under general anaesthesia, via two separate incisions, with preservation of the facial nerve.

The diagnosis of a first branchial arch abnormality is generally based on a high index of clinical suspicion, when a neck swelling is noted in a child. Magnetic resonance imaging is a useful modality for investigation, and helps to delineate the position of the tract and its relationship to the facial nerve.

We report an interesting case of a right temporal pre-auricular arteriovenous fistula (cirsoid aneurysm) causing intractable tinnitus successfully managed by transarterial n-butyl cyanoacrylate glue embolisation.

A 52-year-old female presented with a one-year history of tinnitus and pulsatile swelling in the right pre-auricular region. A colour Doppler ultrasound test and magnetic resonance angiography revealed a high-flow scalp arteriovenous fistula with a feeder vessel from the distal superficial temporal artery, which drained into the corresponding, dilated, tortuous vein. The patient underwent diagnostic digital subtraction angiography. This was followed by transarterial embolisation of the fistula using a 50 per cent mixture of n-butyl cyanoacrylate glue and Lipiodol®, with manual distal venous occlusion. A successful outcome was achieved with instant relief of symptoms.

Cirsoid aneurysms of the facial region, an uncommon cause of tinnitus, can be effectively managed by endovascular embolisation. This treatment obviates the need for surgery, which is associated with an increased risk of complications such as scarring, deformity and bleeding.

We report a rare case of posterior semicircular canal dehiscence caused by a jugular diverticulum, and we describe its surgical treatment using a dehiscence resurfacing manoeuvre.

The clinical findings, surgical procedure and outcomes are presented.

A 66-year-old man presented with disequilibrium, sound-induced vertigo, a reduced ocular vestibular evoked myogenic potential threshold, and pressure-induced vertical and torsional nystagmus. Computed tomography revealed a right posterior semicircular canal dehiscence caused by a diverticulum of the jugular bulb. The defect in the posterior semicircular canal was localised and resurfaced with bone paté, temporalis muscle fascia and conchal cartilage, under direct visualisation. Post-operatively, the patient's symptoms disappeared and his ocular vestibular evoked myogenic potential threshold normalised.

This case illustrates that posterior semicircular canal dehiscence can be surgically managed by resurfacing the defect site via a transmastoid approach.

We report a unique case of traumatic tympanic membrane perforation caused by a needlefish beak. We describe the mechanism of injury, the clinical findings and the treatment.

An 11-year-old boy presented with otorrhoea and hearing loss secondary to a traumatic tympanic membrane perforation by a needlefish. The perforation was repaired by performing a myringoplasty, with satisfactory post-operative audiological results.

To our knowledge, this is the first reported case of its kind. It is recommended that careful examination of the middle-ear space should always be carried out prior to and during myringoplasty if there is a possibility of a foreign body.

To report a case of multifocal fibrosclerosis with a nine-year follow up, and to discuss this disease's radiological appearance and management. The disease is a rare systemic disorder of unknown cause characterised by fibrous proliferation involving multiple anatomical sites.

A 50-year-old woman presented with histological findings characterised by similar inflammatory processes involving the meninges, pituitary gland, peritoneum, retroperitoneum and orbits, prompting a search for a common pathophysiology. A diagnosis of multifocal fibrosclerosis was postulated. Symptom improvement was noted after treatment with prednisone and azathioprine.

This is the first documented case of involvement of the cochleovestibular nerve in a patient with multifocal fibrosclerosis. The rare association between fibrotic diseases and masses showing various clinical patterns should be kept in mind by otolaryngologists, and imaging performed to investigate for multifocal fibrosclerosis. However, diagnosis can only be confirmed with tissue biopsy and histopathological examination.

Foreign bodies in the transnasal ethmoido-sphenoidal sinus are uncommon. We present a case of unilateral rhinorrhoea caused by a foreign body which had been lodged in the ethmoido-sphenoidal sinus for 38 years.

A 40-year-old woman presented with unilateral rhinorrhoea. Computed tomography showed a foreign body located in the right ethmoido-sphenoidal sinus, with a defect of the lamina papyracea and the ethmoid roof. The endonasal approach did not permit extraction of the foreign body. A combined approach allowed the extraction of a pen cap, and the defect of the ethmoid roof was rebuilt.

Despite its limitations, the endonasal approach remains the treatment of first choice for osteo-meningeal defects, because of its minimal invasiveness and high success rate. However, in the presented case a combined approach was needed.

Unless the orbital contents are supported, the insertion of nasal packing material during endoscopic endonasal surgery may cause serious intracranial complications such as cerebrospinal fluid leakage.

Case report and literature review.

We report a patient with iatrogenic cerebrospinal fluid rhinorrhoea caused by intracranial entry of a Silastic sheet inserted into the nasal cavity. This skull defect and the surrounding skull base were successfully reconstructed in a multilayer fashion via an endoscopic endonasal approach.

This case highlights the need for caution when inserting nasal packing material. During endoscopic endonasal reduction of blowout fractures, great care must be taken to support the orbital contents, in order to avoid serious intracranial complications such as cerebrospinal fluid leakage.

Organised haematoma of the maxillary sinus may be present in chronic renal failure patients, because these patients are at high risk of haemorrhage.

We present two cases of organised haematoma of the maxillary sinus in patients with chronic renal failure.

A diagnosis of organised haematoma of the maxillary sinus should be considered when a patient with a history of chronic renal failure develops unilateral, recurrent epistaxis and nasal obstruction.

We describe a case of bilateral congenital choanal atresia in the oldest patient reported with this condition in the recent English language literature.

Case report and a review of the relevant English language literature, presenting the embryopathogenesis, diagnostic methods and treatment options for this condition.

A 53-year-old woman having difficulty with nasal breathing, and with a continuous nasal discharge, was admitted to our clinic. Bilateral congenital choanal atresia was diagnosed by endoscopic examination and paranasal sinus computed tomography. Surgical treatment used an endoscopic transnasal approach. The follow-up examination a year later revealed adequate choanal openings bilaterally.

To our knowledge, this is the oldest patient with bilateral congenital choanal atresia to be reported in the recent literature. This condition is rarely encountered in adulthood but should be considered as a possible differential diagnosis of persistent nasal obstruction.

Intranasal teeth are uncommon. Causes include trauma, infection, anatomical malformations and genetic factors. They present mainly in children, and many are asymptomatic.

This report describes the finding of a tooth that had been displaced into the nasal cavity in a six-year-old girl. The history, clinical examination, findings and operative treatment are described.

The child presented with nasal symptoms. Examination revealed a tooth in the right nasal cavity, confirmed by a lateral cephalogram radiograph. It was extracted under general anaesthesia. At follow up, the child was asymptomatic.

This is an unusual case of a child presenting with an intranasal tooth and nasal symptoms following trauma a number of years earlier. The child underwent extraction of the tooth, and recovered well without any complications.

To demonstrate the usefulness of pre-operative selective embolisation of the thyroid arteries in an unusual case with a large, vascular thyroid tumour.

A 29-year-old man presented with a large papillary carcinoma of the thyroid (weighing approximately 300 g on palpation) with extension to the mediastinum and compression of the trachea. A computed tomography scan of the neck and thorax revealed a large tumour the solid part of which was enhanced after contrast medium application, indicating a substantial vascular supply. Pre-operative selective embolisation of both superior thyroid arteries and one inferior thyroid artery, using gelatin sponge particles, was performed 4 days before surgery, under conventional angiography. After selective embolisation of these thyroid arteries, the patient experienced mild anterior neck pain and mild fever. This procedure allowed a significant reduction in blood perfusion to the tumour, which facilitated its surgical removal without blood transfusion.

Pre-operative selective embolisation of both superior thyroid arteries and one inferior thyroid artery may be an effective, minimally invasive procedure for patients with a large, vascular thyroid tumour.

We report a case of hypopharyngeal swelling secondary to a spontaneous thyroid cyst haemorrhage. Haemorrhage is a known complication of thyroid cysts, and usually presents as external swelling and localised pain.

A 93-year-old woman developed hypopharyngeal swelling, dysphagia and odynophagia. A computed tomography scan was consistent with thyroid cyst haemorrhage. The patient was treated with needle aspiration and intravenous steroid injections, with full recovery at thyroid clinic review.

To our best knowledge, there has been no previous report of a hypopharyngeal swelling occurring secondary to spontaneous thyroid cyst haemorrhage. Our case is unusual because of the risk of airway compromise at the level of the hypopharynx, secondary to thyroid cyst haemorrhage.