To establish surfers' knowledge of the preventability of external auditory canal exostoses (‘surfer's ear’), and their use of water precautions.

Survey of surfers conducted between December 2009 and March 2010 at beaches in Cornwall, UK.

Ninety-two surfers were included (78 males and 14 females, mean age 27 years, standard deviation 7.9 years). Participants were grouped according to their awareness of the preventability of surfer's ear (55 aware, 37 unaware). These groups were comparable in age, surfing history and gender mix (p > 0.05). Surfers aware of the preventability of exostoses (66 per cent) were more likely to use water precautions than those who were not (38 per cent) (p < 0.01). Two surfers used water precautions regularly and 48 used them occasionally. Sixty-one of the 76 surfers who did not use water precautions (ear plugs) suggested they would consider doing so in the future.

Awareness of the preventability of surfer's ear was associated with greater use of water precautions. Further research should explore reasons for the low uptake of such precautions. Most surfers not already using ear plugs would consider doing so in the future.

Bone-anchored hearing aid recipients experience well documented improvements in their audiometric performance and quality of life. While hearing aid recipients may understate their functional improvement, their partners may be more aware of such improvement. We sought to investigate patients' partners' perceptions of functional improvement following bone-anchored hearing aid fitting.

Surveys were sent to 153 patients who had received a bone-anchored hearing aid through the Nova Scotia bone-anchored hearing aid programme. The validated survey asked patients' partners to give their subjective impression of the bone-anchored hearing aid recipient's functional status.

Surveys were completed by 90 patients (58.8 per cent), of whom 72 reported having a partner. Partners reported a significant improvement in hearing (p ≤ 0.0001). Partners reported improvement in 87.0 per cent of functional scenarios, no change in 12.6 per cent, and a decline in 0.4 per cent. These findings demonstrate a significant improvement in the emotional and social effects of hearing impairment, as perceived by bone-anchored hearing aid recipients' partners.

Performance of middle-ear surgery under local anaesthesia has several advantages, but many patients complain of pain, anxiety and adverse events (e.g. dizziness and nausea). To minimise such problems, we compared sedation with midazolam alone versus midazolam with remifentanil.

We initially observed 19 patients undergoing middle-ear surgery under local anaesthesia, as controls. We then sedated a further 40 patients undergoing such surgery, with either midazolam or midazolam plus remifentanil.

The sedated patients had significantly lower incidences of local anaesthesia injection pain (p < 0.001), intra-operative pain (p < 0.001), intra-operative anxiety (p < 0.001) and adverse events, compared with the control group. Patients sedated with midazolam plus remifentanil reported less intra-operative anxiety (p = 0.010) and greater post-operative satisfaction with sedation (p = 0.007), compared with those sedated with midazolam only.

Patients undergoing middle-ear surgery under local anaesthesia alone frequently report pain, anxiety and adverse events. However, the majority of our patients who were sedated with midazolam satisfactorily overcame pain, anxiety and adverse events. Results were better still when midazolam was accompanied by remifentanil.

To investigate the hypothesis of cochlear and retrocochlear damage in scrub typhus, using evoked response audiometry.

Prospective, randomised, case–control study.

The study included 25 patients with scrub typhus and 25 controls with other febrile illnesses not known to cause hearing loss. Controls were age- and sex-matched. All subjects underwent pure tone audiometry and evoked response audiometry before commencing treatment.

Six patients presented with hearing loss, although a total of 23 patients had evidence of symmetrical high frequency loss on pure tone audiometry. Evoked response audiometry found significant prolongation of absolute latencies of wave I, III, V, and wave I–III interpeak latency. Two cases with normal hearing had increased interpeak latencies. These findings constitute level 3b evidence.

Findings were suggestive of retrocochlear pathology in two cases with normal hearing. In other patients, high frequency hearing loss may have led to altered evoked response results. Although scrub typhus appears to cause middle ear cochlear and retrocochlear damage, the presence of such damage could not be fully confirmed by evoked response audiometry.

We report a prospective, randomised study of 51 patients with benign paroxysmal positional vertigo treated with Epley's manoeuvre alone or Epley's manoeuvre plus labyrinthine sedative, at Sundaram Medical Foundation, Chennai, India.

To compare the efficacy of Epley's manoeuvre versus Epley's manoeuvre plus labyrinthine sedative in the treatment of benign paroxysmal positional vertigo.

Consecutive patients were selected based on history and positive Dix–Hallpike test. Patients were randomised to receive either Epley's manoeuvre alone or Epley's manoeuvre plus labyrinthine sedative for one week. Both groups were followed up for four weeks.

Univariate analysis showed that one- and four-week outcomes were influenced by the number of episodes, symptom duration and treatment type. Multivariate logistic regression analysis showed that the one-week outcome was significantly influenced by symptom duration and treatment type, while the four-week outcome was significantly influenced by symptom duration alone. Patients receiving Epley's manoeuvre alone showed better recovery than those receiving both Epley's manoeuvre and labyrinthine sedative.

Labyrinthine sedatives do not aid recovery from benign paroxysmal positional vertigo when used in addition to Epley's manoeuvre.

To review outcomes following implantation of an 8.5 mm bone-anchored hearing aid abutment, as regards post-operative management of scalp soft tissue overgrowth.

Retrospective chart review of paediatric and adult patients implanted with bone-anchored hearing aids between 2003 and 2008 who subsequently underwent revision surgery for excessive soft tissue growth.

A tertiary referral centre and a private otology and neurotology clinic.

A total of 80 patients underwent bone-anchored hearing aid placement between 2003 and 2008. Of these patients, 14 had significant scalp soft tissue overgrowth unresponsive to first-line, nonsurgical local wound care.

Fourteen patients underwent an average of 2.1 surgical procedures each for soft tissue overgrowth around their bone-anchored hearing aid abutment. The mean time between initial implantation and revision surgery was 13.6 months. Of these 14 patients, 11 were eventually fitted with an 8.5 mm abutment. Following placement of the longer abutment, only one patient required additional surgical reduction of soft tissue overgrowth (mean follow-up time 11.8 months). All patients were able to use their bone-anchored hearing aid.

The 8.5 mm bone-anchored hearing aid abutment is successful in preventing the need for additional surgical intervention in the small but significant number of patients with post-implantation soft tissue overgrowth. Early consideration should be given to this option when first-line soft tissue care is inadequate.

The geometry of the adult human mastoid air cell system has not previously been described over a large range of mastoid air cell volumes.

Twenty subjects with a wide range of mastoid air cell pneumatised areas, as determined by X-ray, underwent computed tomography scanning of the middle ear. Mastoid air cell surface areas and volumes were then reconstructed from serial imaging sections, using Image J software.

Mastoid air cell volumes varied from 0.7 to 21.4 ml, and were linearly related to the pneumatised area. Right and left mastoid air cell volumes and surface areas were highly correlated. The mastoid air cell surface area was a linear function of volume.

The relationship between mastoid air cell surface area and volume is similar over a wide range of volumes. Given that the rate of gas exchange across the mastoid air cell mucosa is related to the mastoid air cell surface area, that rate will thus also be a direct linear function of the mastoid air cell volume.

There is currently no standardised management protocol following functional endoscopic sinus surgery. This study assessed frequent endoscopic cleaning versus minimal intervention in the early post-operative period following such surgery.

Prospective, randomised controlled, single-blinded, within-subject trial involving 24 patients with bilateral chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery.

The primary outcome measure was ethmoid cavity healing, based on endoscopic appearance, graded using a modified Lund–MacKay endoscopic score.

Lund–MacKay symptom score before and after surgery.

There was no overall statistically significant difference between the two groups (p = 0.37). Subgroup analysis revealed a significant effect of regular suction clearance on adhesions at three months (p = 0.048), but not on oedema, polyps, granulation, discharge or crusting.

There is no evidence from this study to support frequent endoscopic cleaning in the early post-operative period after functional endoscopic sinus surgery. Less intensive post-operative management is recommended, resulting in decreased patient morbidity and fewer post-operative follow-up appointments.

To assess the efficacy of an endonasal dacryocystorhinostomy technique using conventional instruments, without the use of any adjunctive techniques.

Prospective, non-randomised, cohort study.

Patients diagnosed with nasolacrimal duct obstruction between January 2006 and December 2008 were included in the study. Seventy-eight endonasal dacryocystorhinostomies (primary or revision) were performed with conventional ‘cold steel’ instruments. The technique involved complete exposure and marsupialisation of the lacrimal sac. No adjunctive procedures were used. Success was defined as complete resolution of epiphora and a patent lacrimal system, evaluated by lacrimal irrigation and endoscopy, one year post-operatively.

Seventy-four of the 78 cases were symptom-free after a minimum follow up of 12 months, giving an overall success rate of 94.9 per cent. The success rates for primary and revision cases were 95.5 and 90.9 per cent, respectively.

Meticulous surgical technique can ensure high success rates with the use of conventional cold steel instruments, without the use of adjunctive procedures, making endonasal dacryocystorhinostomy a cost-effective, reliable procedure.

To assess, in healthy North African subjects, the applicability and reliability of a previously published reference equation and normal values for peak nasal inspiratory flow, and to calculate a peak nasal inspiratory flow reference equation in this population.

Anthropometric data were recorded in 212 volunteers (100 females and 112 males) aged 13–27 years. Peak nasal inspiratory flow was measured several times. Univariate and multiple linear regression analyses were used to determine the reference equation.

The previously published reference equation and normal values did not reliably predict peak nasal inspiratory flow in the study population. In our subjects, the reference equation (r2 = 30 per cent) for peak nasal inspiratory flow (l/min) was 1.4256 × height (m) + 33.0215 × gender (where 0 = female, 1 = male) + 1.4117 × age (years) − 136.6778. The lower limit of normal was calculated by subtracting from the peak nasal inspiratory flow reference value (84 l/min).

This is the first published study to calculate a reference equation for peak nasal inspiratory flow in North African subjects. This equation enables objective evaluation of nasal airway patency in patients of North African origin.

To establish the features of Mycobacterium tuberculosis infection in the head and neck region, and to determine which investigations have the greatest diagnostic accuracy.

Region-based, retrospective cohort study.

The study included 148 patients with tuberculosis of the head and neck treated in the Greater Glasgow and Clyde region between 2000 and 2007.

The following diagnostic sensitivities were calculated: 53 per cent for fine needle aspiration, 95 per cent for core biopsy and 91 per cent for lymph node excision biopsy. There was a statistically significant difference between the sensitivity results for fine needle aspiration versus core biopsy (p = 0.0003) and fine needle aspiration versus excision biopsy (p < 0.0001). There was no statistically significant difference between the sensitivity results for core biopsy and excision biopsy.

Core biopsy has equivalent diagnostic accuracy to excision biopsy in the investigation of head and neck tuberculosis. We suggest that core biopsy should be used in preference to lymph node excision, as it can be performed under local anaesthetic outside the operating theatre. A proposed algorithm for diagnostic management is included.

To evaluate the clinical course and pathological characteristics of basaloid head and neck squamous cell carcinoma.

Retrospective study of 18 cases of basaloid head and neck squamous cell carcinoma. Epidemiological, clinical and histological data were analysed and the Kaplan–Meier test used to estimate survival rates.

The majority of lesions were at an advanced stage. These lesions were primarily localised in the larynx, hypopharynx and oropharynx. Routine pre-therapeutic assessment of squamous cell carcinoma was performed. Pathological diagnosis was difficult, although immunostaining was extremely useful. Positive staining for KL1, MNF 116 and 34βE12 and negative immunostaining for chromogranin and synaptophysin were also important factors in obtaining a definitive diagnosis. In the majority of cases, treatment involved surgery and radiotherapy. The five-year survival rate was 5 per cent.

Basaloid squamous cell carcinoma is an uncommon head and neck lesion, with a challenging histological diagnosis. These lesions must be carefully monitored due to their aggressive course, and require multimodality treatment.

Laryngotracheal stenosis is currently one of the most common complications associated with nasal and orotracheal intubation and tracheotomy. Once established, tracheal stenosis can be a complex and difficult problem to manage.

We retrospectively analysed 2004–2010 data for 12 male patients with postintubation cervical tracheal stenosis (grade III–IV) treated in the otolaryngology department, Mansoura University Hospitals. All patients had a tracheostomy at presentation, and all underwent tracheal resection with primary cricotracheal anastomosis and suprahyoid release.

Grade III stenosis was present in five patients (41.7 per cent) and grade IV stenosis in seven patients (58.3 per cent). The length of trachea resected ranged from 2 to 4 cm, representing one to four tracheal rings. In all 12 patients, the procedure allowed successful tracheotomy decannulation. Minor complications comprised surgical emphysema (n = 2) and wound infection (n = 1), and were managed conservatively. Major complications consisted of restenosis (n = 3), managed in two patients by repeated dilatation; one patient was lost to follow up.

Segmental tracheal resection with cricotracheal anastomosis was successful in 11/12 (92 per cent) patients with severe cervical tracheal stenosis. The strategy for treatment of airway stenosis is now well established and success rates are high, with minimal or no sequelae.

To assess the effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray, used in conjunction with antibiotic treatment, on the intensity of clinical signs and quality of life of patients with group A streptococcal tonsillopharyngitis.

Patients (n = 147) with streptococcal tonsillopharyngitis were recruited and randomly allocated to either the treatment group (penicillin plus chlorhexidine and benzydamine; n = 72) or control group (penicillin plus placebo; n = 75). Blinded assessments were conducted before and after 10 days' treatment, using an intensity rating scale for clinical sign severity, a visual analogue scale for subjective health state, the Short Form 36 Health Questionnaire for quality of life, and a customised questionnaire for side effects.

The treatment group showed a statistically significant reduction in the intensity of clinical signs, compared with the control group. On treatment day 7, there was no significant difference in quality of life between the treatment and control groups. The treatment drugs were well tolerated, and no serious adverse events were observed.

Chlorhexidine gluconate and benzydamine hydrochloride mouth spray, added to standard antibiotic treatment, significantly alleviate the intensity of clinical signs in patients with streptococcal pharyngitis. Further research is needed using larger sample sizes or alternative control groups.

To refine the case selection process for the ‘cucumber’ mounting system for laryngeal biopsies.

We conducted a retrospective audit of cucumber technique specimens taken between January 2002 and December 2008. We analysed the clinical indications for biopsy and the pathological diagnosis, for each specimen, in order to inform our case selection process.

The cucumber technique was used for 125 laryngeal specimens. 60 specimens were taken for diagnostic sampling, 46 were taken during endoscopic laser resection, and 19 for overtly benign pathology. The cucumber technique was most useful for the interpretation of margins in endoscopic laser resection specimens.

The cucumber technique is most useful for endoscopic resection cases in which tumour, dysplasia or suspicious lesions have been excised. Detailed information on resection margins is invaluable during multidisciplinary team discussions on patient management. Detailed photography of mounted specimens enables both laryngologist and pathologist to orientate and interpret specimens accurately.

To report an unusual case of fungal mastoiditis caused by entomophthorales in an immunocompetent patient, and its management.

Case report with a review of the literature.

A 13-year-old girl presented to us with a mastoid abscess. Entomophthoromycotic infection of the mastoid was diagnosed on histopathological examination, and subsequently treated with surgical debridement and amphotericin B injection.

This is the first reported case of mastoid abscess secondary to entomophthoromycosis. Early detection and treatment contributed to this patient's good outcome.

To report a case of fluctuating hearing due to auditory aura, as an unusual presentation of temporal lobe epilepsy.

Case report and review of English language literature on temporal lobe epilepsy and auditory aura.

A 31-year-old man presented with intermittent symptoms of bilateral fullness in the ears associated with deafness. He was subsequently diagnosed with temporal lobe epilepsy. Further enquiry revealed a family history of epilepsy.

Auditory aura as a presentation of temporal lobe epilepsy is rarely encountered in otolaryngological practice. This case highlights the importance of obtaining detailed information on epilepsy, including any family history of epilepsy, as a routine part of history-taking in patients presenting with fluctuating hearing loss.

We report a unique case of a mucocele of a pneumatised uncinate process.

Clinical, radiological and intra-operative findings are presented.

A 43-year-old woman was referred to our ENT department suffering from persistent symptoms of left-sided sinusitis. Although an initial computed tomography scan suggested a lacrimal duct mass, dacrocystography showed free flow through the nasolacrimal duct. The patient underwent surgery, revealing a mucocele within a pneumatised uncinate process.

This patient's clinical, radiological and intra-operative findings illustrate how variations in sinus anatomy can pose a diagnostic challenge.

To present a conservative surgical approach, via the transorbital route, for selected cases of infratemporal fossa involvement or inferolateral orbital tumours extending to the infratemporal fossa.

Case series report.

Department of ENT, CSM Medical University (King George Medical College), Lucknow, India.

One patient.

Operative feasibility, intra-operative access, post-operative morbidity and cosmesis.

This novel and relatively conservative technique provides excellent exposure in selected cases of infratemporal fossa involvement and has minimal post-operative morbidity. Cosmesis is excellent, as osteotomy is not required and scarring is minimal. There is no risk of trismus, Vth or VIIth cranial nerve injury, or cerebrospinal fluid leakage, and haemostasis is easily achieved.

Classical, open approaches to the infratemporal fossa involve considerable morbidity, while conservative approaches have their limitations. Diagnostic uncertainty over a small infratemporal fossa mass (perhaps an extension from an inferolateral orbital tumour) is an uncommon clinical challenge. The transorbital approach described is suited to benign and early malignant tumours, and has excellent results when combined with orbital exenteration (if needed). This paper discusses this approach's technical details and feasibility in different clinical situations, and compares it with other infratemporal fossa approaches.