Churchill's wartime comment on the Soviet Union (British Broadcasting Corporation broadcast, London, 1st October 1939) could equally be applied to Ménière's disease.Reference Flood and Kenyon¹ The cause of Ménière's disease still remains an enigma, despite some 157 years since Prosper Ménière's original observations in 1861. In this month's issue of The Journal of Laryngology & Otology, Jeremy Hornibrook postulates a saccular otoconial theory for Ménière's disease.Reference Hornibrook^{2, 3} In that article, evidence that Ménière's disease is caused by detached saccular otoconia is presented. It is hoped that as the resolution of inner-ear imaging in human ears advances, further progress will be made in elucidating the exact pathophysiological mechanism of Ménière's disease.Reference Patel, Oberman, Zacharia and Isildak⁴

Also in this month's issue, Puttasiddaiah and Browning describe a novel technique of using piezo surgery to remove external auditory canal exostoses.Reference Puttasiddaiah and Browning⁵ The authors propose that such a technique lessens the risk of injury to surrounding structures. The article follows the use of the ultrasonic bone aspirator for temporal bone dissection, which similarly reduces injury to surrounding structures and can be utilised endoscopically.Reference Gardner, Sappington, Arriaga and Kanotra⁶ If the safety profile of this technique is indeed demonstrated over time, then it offers the potential for simultaneous bilateral surgery to be performed in the future, thereby reducing the recovery time for patients with bilateral exostoses.

A study by Siupsinskiene et al. in this month's issue of The Journal examines the relationship between intranasal Helicobacter pylori infection and nasal polyps.Reference Siupsinskiene, Katutiene, Jonikiene, Janciauskas and Vaitkus⁷ This work follows their previous study published last year, which demonstrated an association between H pylori infection and chronic tonsillitis and laryngopharyngeal reflux.Reference Siupsinskiene, Katutiene, Jonikiene, Janciauskas and Vaitkus⁸ In this latest study, the authors found a higher rate of H pylori carriage in the nasal polyp patients compared with controls (28.9 per cent vs 3.3 per cent; p = 0.005). Further work is required to determine whether H pylori is simply an ‘innocent bystander’ colonising the upper airway preferentially in nasal polyp patients (e.g. chronic inflammation of the sinonasal mucosa may create a more suitable environment for the bacterium to survive), or whether there is indeed a causal relationship between H pylori intranasal colonisation and sinonasal disease.