This review aimed to summarise present knowledge surrounding cochlear implants and neuroplasticity using positron emission tomography.

Cochlear implants are an established device for severe sensorineural hearing loss. However, the outcomes following a cochlear implant are variable and unpredictable. Furthermore, despite increasing numbers of implantations taking place, there are still uncertainties regarding how individuals learn to process speech using an implant. Functional neuroimaging studies using techniques such as positron emission tomography provide an insight into the cortical changes that take place in patients with cochlear implants.

Only when the underlying mechanisms responsible for speech processing in implantees are understood can appropriate rehabilitation for those with poor speech perception be provided and outcomes improved.

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 determine the best clinical method for identifying peripheral vestibular nystagmus, by comparing eye movement examination with optic fixation, and with fixation removed using Frenzel's glasses, infra-red video-Frenzel's goggles or an ophthalmoscope, with results of electronystagmography.

One hundred patients referred for electronystagmography from the audiovestibular medicine clinic at Queen Alexandra Hospital, Portsmouth, were examined immediately before undergoing electronystagmography.

Video-Frenzel's goggles were highly effective at detecting peripheral vestibular nystagmus, with a sensitivity of 85 per cent (95 per cent confidence interval, 62.1–96.8 per cent) and a specificity of 65 per cent (53.5–75.3 per cent), compared with electronystagmography. Ophthalmoscopy had comparable sensitivity to Frenzel's glasses (used in the dark), i.e. 26.3 per cent (9.1–51.2 per cent) compared with 31.6 per cent (12.6–56.6 per cent), respectively. Frenzel's glasses as normally used in ENT clinics (i.e. in dim lighting) were ineffective, with a sensitivity of just 10 per cent (1.2–31.7 per cent).

Video-Frenzel's goggles should be used in all clinics with substantial numbers of balance-impaired patients. Traditional Frenzel's glasses have no place in clinical practice unless formal black-out facilities are available.

To present results for the auditory rehabilitation of patients with Treacher Collins syndrome with bilateral osseous atresia, using middle-ear implantation with a Vibrant Soundbridge.

Three patients underwent vibroplasty for aural atresia with moderate to severe conductive hearing loss. The pre-operative Jahrsdoerfer radiological score was 4 for all patients. Patients underwent active middle-ear implantation of a Vibrant Soundbridge implant (coupling the floating mass transducer to the rudimentary stapes or footplate distally, and positioning it adjacent to the round window membrane proximally), with audiological analysis as follow up.

After implant activation, the mean air conduction threshold ± standard deviation decreased to 22.8 ± 5.5 dB HL, representing a mean functional gain of 44.5 dB. The mean word recognition score (for bisyllabic words at 65 dB SPL) increased from 0 to 97 per cent.

Vibrant Soundbridge implantation is an effective hearing rehabilitation procedure in patients with Treacher Collins syndrome with bilateral osseous atresia. This is a versatile implant which can achieve coupling even in cases of severe middle-ear malformation.

Image guidance surgery is an emerging technology that may allow more efficient treatment of sinus disease. This retrospective study examines National Health Service and military patients who underwent procedures using image guidance surgery during the period 2001–2009.

Medical records were reviewed in terms of indications for surgery, incidence of major complications and need for revision following image guidance surgery. An attempt was also made to determine the cost-effectiveness of purchasing this navigational system.

A total of 132 patients underwent 147 procedures using image guidance surgery over the 8-year period. The indications for surgery ranged from severe nasal polyposis and chronic rhinosinusitis to malignant tumours in the paranasal sinus and skull base region. Average length of follow up was 17.6 months. Four patients had a major complication. Fourteen patients underwent revision surgery. The cost of providing an image guidance surgery service was estimated to be £110,000–120,000 during the study period. The economic model for the subgroup of nineteen military patients (with non-polypoid chronic rhinosinusitis) suggests that use of this technology will reduce overall costs by approximately £70,000 when compared with conventional sinus surgery.

This study provides some evidence that image-guided sinus surgery is cost effective, safe and may decrease surgical revision rates.

This study aimed to compare the outcomes of turbinoplasty assisted by microdebrider and by diode laser (980 nm wavelength).

Forty patients suffering from bilateral nasal obstruction were randomly divided into two equal groups. One group was managed with microdebrider-assisted turbinoplasty and the other with diode laser assisted turbinoplasty. The patients were followed up for six months post-operatively.

After six months, total success rates were 90 per cent for the microdebrider group and 85 per cent for the diode laser group. There were no significant differences between the two groups regarding success rate, post-operative complications or operative time.

These two techniques are equally safe, reliable, successful and non-invasive.

Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery.

To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test.

Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated.

Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps.

The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.

To investigate the effects of adenotonsillectomy on the quality of life of children under three years of age with obstructive sleep apnoea. To our knowledge, there have been no previously published studies on this topic.

Thirty-nine children under three years of age and treated with adenotonsillectomy for obstructive sleep apnoea met the inclusion criteria. A quality of life questionnaire was adapted from the validated, six-item instrument developed by de Serres et al. (2000). The questionnaire assessed improvement in specific domains following adenotonsillectomy. Carers scored each domain on a point scale ranging from ‘none’ (0) to ‘couldn't be more’ (6).

The quality of life of all children improved after surgery. The greatest mean improvement scores were in the domains of care-giver concern, physical suffering and sleep disturbance. The modal questionnaire score was 4 and the overall mean questionnaire score was 4.2.

Adenotonsillectomy provides measurable improvements in quality of life for children under three years of age with obstructive sleep apnoea.

To investigate reasons for prolonged hospitalisation of children with tracheostomies once they are medically fit for discharge.

Retrospective, cross-sectional study of 101 children undergoing tracheostomy between 2000 and 2010.

Of the study patients, 44.6 per cent did not spend any time in hospital once medically fit, 19.8 per cent spent up to two weeks, 12.9 per cent spent between two weeks and one month, and 22.8 per cent spent over one month. Of the 56 cases with delayed discharge, the majority (22 children, 39.3 per cent) were delayed due to time taken obtaining parental competencies in tracheostomy management. A number of external factors were identified in these delays: parental substance abuse; single parenting; concerns about parenting ability, and English not being the parents' first language.

Paediatric tracheostomy may lead to prolonged hospitalisation, but this is often influenced by social factors. Better use of dedicated specialist paediatric tracheostomy nurses may reduce unnecessary hospitalisation.

To evaluate modern diagnostic and therapeutic management of juvenile recurrent parotitis, and to show the benefits of operative sialoendoscopy on the basis of our experience in 14 patients and the results of others.

Ultrasonography is sensitive in detecting the pathological features of juvenile recurrent parotitis. Interventional sialoendoscopy is a safe and effective method of treating the disease. In our case series, after a mean follow-up time of 30 months only 5 patients experienced recurrence of symptoms, with a mean symptom-free period of 20 months.

The use of modern, minimally invasive diagnostic tools such as colour Doppler ultrasonography, magnetic resonance sialography and sialoendoscopy represents a new frontier in the management of juvenile recurrent parotitis. Operative sialoendoscopy also has the important therapeutic benefit of reducing the number of recurrences of acute episodes of parotitis, thus giving patients a better quality of life until puberty.

Tumours with neuroendocrine differentiation frequently express chromogranin A, synaptophysin and somatostatin receptors. The role of neuroendocrine differentiation in head and neck squamous cell carcinoma is not yet clear.

The presence of chromogranin A, synaptophysin and somatostatin receptors was studied immunohistochemically in 78 head and neck squamous cell carcinoma specimens.

Sparse chromogranin A expression was found in 41 per cent, associated with high chromogranin A messenger RNA expression and the presence of dense core granules. Low synaptophysin expression was found in 18 per cent. The highest staining scores were found for somatostatin receptor 5 (82 per cent), followed by somatostatin receptor 1 (69 per cent) and somatostatin receptor 2 (54 per cent), whereas somatostatin receptors 3 and 4 expression was low. Expression was not correlated with tumour stage or survival.

Cells with neuroendocrine differentiation are sparsely scattered in some head and neck squamous cell carcinomas. Their pathophysiological role is elusive. In contrast, somatostatin receptor and particularly somatostatin receptor 5 expression is frequent in head and neck squamous cell carcinoma. Somatostatin receptor expression is not considered to indicate neuroendocrine differentiation in head and neck squamous cell carcinoma.

The proper positioning of the Nerve Integrity Monitoring® endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. This article describes our experience with the GlideScope® and explains how it can facilitate the accurate placement of the Nerve Integrity Monitoring endotracheal tube.

Endotracheal intubation with the Nerve Integrity Monitoring endotracheal tube was performed in 250 patients undergoing thyroidectomies using the GlideScope video laryngoscope. The correct positioning of the tube was determined according to impedance values of less than 5 kohm and an impedance imbalance of less than 1 kohm.

Successful intubation was achieved in all cases. The GlideScope aided the correct placement of the Nerve Integrity Monitoring endotracheal tube in the majority of the cases.

The GlideScope provides an excellent means to ensure the correct positioning of the Nerve Integrity Monitoring tube. It allows both the surgeon and the anaesthesiologist to participate in the intubation process and confirm correct placement of the tube, whilst also allowing gentle intubation with improved visibility.

We report deafness occurring as an extremely rare complication of influenza A caused by the H1N1 virus (‘swine flu’), in two children.

Case reports and review of the literature concerning influenza A (H1N1) and acquired viral infection causing deafness.

Two children with normal hearing developed bilateral deafness following influenza A (H1N1). The diagnosis was confirmed using polymerase chain reaction. Both patients were treated with oseltamivir.

Following a review of the literature, these two patients appear to be the first reported cases of bilateral deafness following influenza A (H1N1).

We report an extremely rare case of primary otoscleroma.

We present a case report and a review of the world literature concerning otoscleroma.

An adult woman presented with chronic suppurative otitis media with tubotympanic disease and conductive hearing loss. On mastoid exploration, dark granulations were seen, which were identified as otoscleroma on histopathological examination. The patient responded well to streptomycin.

To the best of our knowledge, this is the first report of primary otoscleroma in the world literature. This case indicates that Frisch's bacillus can also spread to the middle ear.

We present the first published description of a painful paraganglioma of the external auditory canal. Atypical histopathology made the diagnosis difficult. We discuss the potential pitfalls of clinical diagnosis and treatment of such a case.

A 49-year-old woman presented with left-sided otalgia, hearing loss and tinnitus. Physical examination revealed a firm swelling arising from the superior portion of the left external auditory canal. A clinical diagnosis of otitis externa was made.

There was minimal response to medical treatment. The swelling was aspirated, leading to brisk bleeding. A tumour was suspected from the computed tomography scan, and confirmed by a biopsy. The patient underwent excision of the paraganglioma. The histopathology was atypical, making diagnosis difficult.

Such unusual masses of the external ear should always be borne in mind, especially when dealing with atypical presentations of commonly encountered diseases. Clinicians should have a low threshold for early intervention with imaging and biopsy.

Subclinical infection of the sinuses can result in delayed diagnosis and unusual presenting complications.

This paper describes the case of a 14-year-old boy with a rare combination of periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis following a late presentation of unilateral frontal sinusitis.

Following multiple surgical procedures, and antimicrobial and anticoagulation therapy, the patient made a full recovery.

Serious sinusitis complications still occur, and can do so in unusual combinations with minimal clinical signs. Systemic anticoagulation therapy is considered safe practice in the management of cerebral venous sinus thrombosis and may reduce morbidity and mortality.

We report a rare case of small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses with intracranial extension, and discuss the management of this rare tumour.

Small cell neuroendocrine carcinoma involving the nasal cavity and paranasal sinuses with intracranial extension may be treated successfully with surgery alone, without development of local recurrence.

Small cell neuroendocrine carcinoma is a locally aggressive tumour with a high rate of recurrence. Early and aggressive surgical excision with or without radiotherapy or chemotherapy can improve a patient's outcome and prognosis. Regular follow up is needed to detect any local or distant recurrence.

We report a modified surgical technique for transplanting an ectopic, lingual thyroid to the submandibular space, in order to maintain thyroid function while relieving obstructive symptoms.

A 52-year-old woman complained of progressive dysphagia and dyspnoea. Ectopic lingual thyroid tissue was diagnosed. The ectopic thyroid gland was transplanted into the submandibular region via a lateral pharyngeal approach. A random muscle pedicle was prepared to provide a vascular supply to the transposed gland.

Twelve-month follow up confirmed the survival of the transplanted thyroid gland, with preserved thyroid function.

Surgical transplantation of a lingual thyroid to the submandibular region offers an alternative treatment method for this anomaly, which avoids the need for resection and lifelong thyroxine replacement.

To highlight a rare cause of Horner's syndrome, and to review the management of blunt carotid artery injury.

Literature search via PubMed for related articles.

Horner's syndrome and blunt carotid artery injury are rare phenomena; sexual asphyxia as a cause has not previously been reported. This case is also the first of its kind to have radiological evidence of injury to the external carotid artery but not the internal carotid artery. In Horner's syndrome, additional symptoms of ipsilateral headache or neck pain, tinnitus, or any cerebral ischaemic symptoms should raise suspicion of blunt carotid injury.

Blunt carotid artery injury is a potentially fatal condition and can present without radiological evidence. Early recognition and management with anticoagulants or antiplatelet drugs is crucial to prevent mortality and morbidity.