To report clinical data from six centres in the US, Western Europe and Asia which have used phase-shift sound wave cancellation for treatment of predominant tone tinnitus, from the first treatment in 2000 to 2009.

Clinical data were obtained from New York City, London, Erie (Pennsylvania, USA), Antwerp, Grottamare (Italy) and Kuala Lumpur, and summarised.

A total of 493 patients were treated. A reduction in tinnitus volume (defined as ≥6 dB) was seen in 49–72 per cent of patients.

Surgery for vestibular schwannoma may reduce patients' quality of life, but the effect of hearing preservation on this process is not fully understood. Our aim was to determine whether hearing preservation makes a difference to patients' quality of life in this clinical setting.

Retrospective questionnaire and cross-sectional survey.

The study included 104 consecutive patients who had undergone surgery for vestibular schwannoma between 1998 and 2004. Surgery was via a middle cranial fossa route in 24 patients and a translabyrinthine route in 79. Quality of life was assessed using the SF-36 questionnaire and the Glasgow Benefit Inventory.

Quality of life was reduced in both patient groups, with a mean Glasgow Benefit Inventory score of −7.5 (confidence interval (CI) −13 to −2.5) in the translabyrinthine patients and −4 (confidence interval −13.5 to 5.5) in the middle fossa patients. The SF-36 scores did not show any statistically significant difference between the two groups, except for social function (p = 0.01).

Surgery for vestibular schwannoma reduces patients' quality of life, and the preservation of hearing, achieved by using a middle fossa surgical approach, does not significantly alter this result.

To determine the degree of association, if any, between benign paroxysmal positional vertigo and osteoporosis, both of which are disorders of impaired calcium carbonate homeostasis.

A retrospective chart review was undertaken in two otology clinics to assess the prevalence of treated osteoporosis in 260 women with and without benign paroxysmal positional vertigo, between the ages of 51 and 80 years.

There was a statistically significant, negative association between benign paroxysmal positional vertigo and treated osteoporosis in women aged 51 to 60 years. We also observed a trend towards a negative association for women in their 60s, and for the group as a whole.

Osteoporosis, or the medication used to treat it, may provide protection against benign paroxysmal positional vertigo.

Tympanoplasty continues to pose a challenge in developing countries, where treatment cost and lack of compliance with second stage surgery are often important factors in determining the surgical strategy. This study aimed to determine the effectiveness of the newly developed, ‘umbrella’ autograft.

In 22 patients suffering chronic suppurative otitis media, in whom the incus and stapes suprastructure were found to be absent during surgery, reconstruction was achieved using cartilage-malleus umbrella graft assembly. Six-month post-operative results were evaluated on the basis of average hearing gain, measured at 0.5, 1, 2 and 3 kHz.

At six months post-operatively, 77.3 per cent of patients showed hearing improvement. Audiography at this time indicated significant improvement (p < 0.001), suggesting that this hearing gain may stand the test of time.

Umbrella graft tympanoplasty appears to be a promising technique in terms of cost-effectiveness and the autologous nature of implant materials.

To evaluate the outcome of mobile ear surgery, in terms of tympanic membrane perforation closure, absence of otorrhoea and hearing threshold improvement.

Descriptive study.

The study enrolled patients with chronic ear disorders requiring surgery who presented to the mobile ear surgery unit at Sakaeo Hospital, Thailand, from 1 to 4 July 2008. The following data were recorded: pre-operative audiogram, post-operative middle-ear and mastoid infection, wound infection, graft condition, any complications, and post-operative audiogram. Patients were followed up at one week, two weeks, four weeks and 24 weeks post-operatively.

For the 31 cases of tympanic membrane perforation, the closure rate was 90.3 per cent. For the 32 patients with otorrhoea, the rate of ear dryness was 87.5 per cent. All 35 patients had impaired hearing initially; the rate of hearing improvement was 74.3 per cent (95 per cent confidence intervals = 56.7–87.5 per cent). Patients' mean hearing improvement was 22.9 dB.

The assessed ear surgery procedures had good results.

To evaluate current concerns about transnasal endoscopic repair of bilateral congenital choanal atresia, regarding technical difficulties, prognostic factors and important controversies.

Ten infants with bilateral congenital choanal atresia, aged from 3 to 27 days (mean, 11.2 days) were included. All cases underwent transnasal endoscopic repair and were clinically and endoscopically monitored.

Of the seven patients treated with stenting, five remained patent and two required minor debridement (with complete patency thereafter). Of the three patients treated without stenting, one remained patent and two required minor debridement (with patency thereafter).

Transnasal endoscopic repair of bilateral congenital choanal atresia is a safe and successful technique. The use of powered instrumentation in neonatal patients requires experience and a correctly sized drill. Stenting with an appropriate nasal tube for a suitable period is favoured, especially in hospitalised patients.

In patients with Wegener’s granulomatosis, subglottic stenosis can develop due to active disease; however, some patients develop subglottic stenosis with no clear evidence of airway inflammation. In some cases of idiopathic subglottic stenosis, an association with gastroesophageal reflux disease has been found. Our study assessed the potential role of gastroesophageal reflux as an aetiological factor in the development of subglottic stenosis in patients with Wegener’s granulomatosis.

We assessed evidence of active reflux disease, using 24-hour pH monitoring and assessment of bile salts in bronchoalveolar lavage fluid.

Ten Wegener’s granulomatosis patients with subglottic stenosis underwent 24-hour pH monitoring and bronchoscopy and lavage of the right middle lobe. A similar number of control patients were included.

There was no statistically significant difference in the occurrence of bronchoalveolar bile salts in patients with subglottic stenosis (n = 2) versus control patients (zero) (p = 0.457). There was good correlation between the detection of reflux by 24-hour pH monitoring and the detection of bronchoalveolar bile salts (κ = 0.769).

In this small study of patients with Wegener’s granulomatosis, there was no evidence of an association between the development of subglottic stenosis and gastroesophageal reflux.

Many patients with allergic rhinitis are reluctant to use daily intranasal steroids for prolonged periods. A self-adjusted regimen which delivers reasonable control of allergic rhinitis may be more acceptable to such patients.

To compare the efficacy of daily use of mometasone furoate nasal spray, versus a self-adjusted regimen, in patients with chronic allergic rhinitis, in terms of symptom control and nasal volume change.

Ambulatory visits in an office setting.

Sixty patients with chronic allergic rhinitis were randomised: 30 were prescribed mometasone furoate nasal spray once daily for six weeks, while 30 were prescribed the same spray daily for one week, every alternate day for one week and then on a self-adjusted regimen for four weeks. Patients kept a symptom diary documenting sneezing, rhinorrhoea, nasal blockage and nasal itching. Acoustic rhinometry was used to measure the total nasal cavity volume at the first visit and at the end of the treatment period.

The total nasal score on treatment days showed an improvement in both groups, compared with baseline measurements. There was no significant difference in total nasal scores between the two groups, except on days 10 (p = 0.043), 20 (p = 0.008), 23 (p = 0.19), 30 (p = 0.008) and 37 (p = 0.000), when the daily group's total nasal score was significantly lower than the self-adjusted group's total nasal score, and on day 8 (p = 0.004), when the self-adjusted group's total nasal score was significantly lower than the daily group's total nasal score. Total nasal cavity volume significantly increased in both groups (p = 0.0001), with no statistically significant difference between the groups.

Self-adjusted dosage of mometasone furoate nasal spray gives reasonable control of allergic rhinitis (albeit with some ‘breakthrough’ symptoms). Patients should learn how to control these symptoms with the least number of steroid doses.

To evaluate the causes, treatment modalities and recovery rate of paediatric facial nerve paralysis.

We analysed 24 cases of paediatric facial nerve paralysis diagnosed in the otolaryngology department of Gachon University Gil Medical Center between January 2001 and June 2006.

The most common cause was idiopathic palsy (16 cases, 66.7 per cent). The most common degree of facial nerve paralysis on first presentation was House–Brackmann grade IV (15 of 24 cases). All cases were treated with steroids. One of the 24 cases was also treated surgically with facial nerve decompression. Twenty-two cases (91.6 per cent) recovered to House–Brackmann grade I or II over the six-month follow-up period.

Facial nerve paralysis in children can generally be successfully treated with conservative measures. However, in cases associated with trauma, radiological investigation is required for further evaluation and treatment.

Recently, the 532 nm pulsed potassium-titanyl-phosphate laser has emerged as an effective angiolytic laser for treating mucosal lesions of the larynx in the operating theatre and clinic. We sought to assess the current impact of potassium-titanyl-phosphate laser on our laryngeal surgery practice.

Retrospective review of 710 patients undergoing endoscopic laryngeal surgery over a one-year period.

Medical records of the endoscopic laryngeal procedures were reviewed; 386/710 had been performed in the clinic and 324/710 in the operating theatre under general anaesthesia. Indications for the procedures were classified by pathology.

Pulsed potassium-titanyl-phosphate laser was used in 209/386 clinic procedures. The indications for these procedures were: dysplasia (114/209 procedures), papillomatosis (89/209), varices or ectasia (three of 209), and ‘other’ (three of 209). Pulsed potassium-titanyl-phosphate laser was used in 178/324 operating theatre endoscopic laryngeal procedures. The indications for these procedures were: cancer (54/178 procedures), dysplasia (52/178), papillomatosis (38/178), varices or ectasia (13/178), polyps (six of 178), nodules (six of 178), stenosis (five of 178), granulation (three of 178), and amyloid (one of 178).

Due to its versatility, the 532 nm pulsed potassium-titanyl-phosphate laser is our most commonly utilised instrument for performing endoscopic laryngeal surgery.

Total laryngectomy affects patients' post-operative speech and swallowing functions. We aimed to assess these outcomes.

Patients' normalcy of diet, ability to eat in public and speech comprehensibility were assessed using the Performance Status Scale for Head and Neck Cancer, in a cross-sectional survey of disease-free laryngectomees.

Seventy-nine laryngectomees (72 men and seven women), with a mean age of 64 years (range 37 to 96), were included. Mean scores were 81.6 (standard deviation 29.2) for normalcy of diet, 77.8 (standard deviation 30.2) for eating in public and 65.2 (standard deviation 23.5) for speech. Normalcy of diet achieved higher scores within six months of laryngectomy and remained stable. There was a statistically significant difference between scores for the speech and public eating domains, comparing patients less and more than six months post-laryngectomy. This trend was maintained beyond 12 months.

In post-laryngectomy patients, Performance Status Scale for Head and Neck Cancer scores improved over time, especially those for the speech and public eating domains, reflecting increasing confidence in social interactions and familiarity with surgical voice restoration.

There is growing evidence to suggest that reflux (both laryngopharyngeal and gastroesophageal) has a role in the development of upper aerodigestive tract squamous cell carcinoma. This study discusses the role of identifying reflux in this patient group, and its prevalence.

Prospective review of patients with head and neck cancer undergoing flexible oesophagogastroscopy as part of their diagnostic investigation.

Forty-five consecutive patients were identified. All patients were found to have evidence of oesophagitis, with 28 having oesophageal erosions and two Barrett's oesophagitis.

Flexible oesophagogastroscopy is a useful test in patients with upper aerodigestive tract squamous cell carcinoma.

To survey antibiotics prescribed for patients admitted with acute tonsillitis and peritonsillar abscess to UK ENT departments.

An anonymous postal questionnaire was sent to UK ENT consultants.

Intravenous benzylpenicillin alone was preferred significantly more often for acute tonsillitis (n = 175) than for peritonsillar abscess (83) (p < 0.001). A combination of benzylpenicillin and metronidazole was preferred significantly more often for peritonsillar abscess (n = 131) than for tonsillitis (62) (p < 0.001).

In this survey, penicillin was the commonest antibiotic choice for tonsillitis; this is in accordance with published guidelines. For cases of peritonsillar abscess, benzylpenicillin with metronidazole was the most common antibiotic combination chosen. However, the high resolution rate of peritonsillar abscess following drainage and treatment with penicillin alone suggests that multiple antibiotics are unnecessary and inappropriate in this setting.

Chronic nasopharyngeal infection is rare. To our knowledge, no effective treatment for this condition has previously been described. This report documents our experience of using suction ablation diathermy in this clinical setting.

We performed a prospective review of four patients aged 23–65 years (two men and two women) who presented with chronic nasopharyngitis. Initial medical management consisted of regular saline irrigation plus a 14-day course of doxycycline 100 mg daily, combined with rifampicin 200 mg twice daily. When this proved unsuccessful, patients subsequently received a four-week course of omeprazole 40 mg daily, also unsuccessfully. Given these treatments' lack of success, surgery was undertaken.

Following suction diathermy ablation, nasopharyngeal crusting took four to six weeks to settle. After this, all patients ceased to cough up crusts or infected mucus.

Chronic nasopharyngitis is uncommon. If medical management fails, suction ablation diathermy is a useful surgical treatment option.

This report describes a novel case in which superior canal dehiscence syndrome was unmasked by successful stapes surgery for otosclerosis.

Case report and literature review regarding superior canal dehiscence syndrome.

Superior canal dehiscence syndrome is a rare but well described condition in which audiovestibular symptoms are caused by noise or straining. A dehiscence of the superior semicircular canal in the floor of the middle cranial fossa is responsible, and acts as a ‘third window’ into the inner ear.

A patient with confirmed otosclerosis underwent second-side stapedotomy, with good audiometric outcomes. Unfortunately, surgery was complicated by immediate post-operative vertigo and persistent auditory symptoms. A diagnosis of superior canal dehiscence syndrome was eventually made, on the basis of low threshold vestibular evoked myogenic potentials and characteristic computed tomography findings. Superior canal resurfacing resulted in complete resolution of symptoms.

The otosclerotic focus in the oval window prevented the development of symptoms from this patient's superior canal dehiscence syndrome. Surgical stapedotomy created a third window and resulted in immediate post-operative imbalance and auditory symptoms.

The diagnosis of superior canal dehiscence syndrome should be considered in patients with persistent audiovestibular symptoms after stapes surgery. High resolution computed tomography of the temporal bone and vestibular evoked myogenic potential testing, if available, are the investigations of choice in confirming the diagnosis.

We present two cases of a hyoid bone fracture identified through careful clinical examination with a Valsalva manoeuvre during nasendoscopy.

Case reports and review of the literature, with emphasis on technique during nasendoscopy.

The first patient had sustained a blow to the neck with a stick, six months prior to presentation with a globus sensation. External examination and standard nasendoscopy were unremarkable. The second patient had been struck across the neck by a wire whilst riding a motorbike at low speed. Endoscopy revealed swelling of the supraglottis. He recovered and was asymptomatic at review one month later. Computed tomography scans on both patients were unremarkable. During nasendoscopy, both patients were asked to forcibly expire with their mouths closed (the so-called nasal Valsalva manoeuvre), and the hyoid bone was seen to swing into view on the side where the first patient complained of symptoms, and in the second case where swelling had been noticed previously.

We would not ordinarily have reached a diagnosis in these patients, as radiography and examination were otherwise unremarkable. The use of the nasal Valsalva manoeuvre during routine nasendoscopic examination is recommended, as unusual pathology may be demonstrated and the need for direct laryngoscopy under general anaesthesia may, in some instances, be avoided.

We present two cases of dental implant migration into the maxillary sinus, with subsequent removal via image-guided, transnasal endoscopy.

Presentation of clinical cases, together with a literature review of alternative surgical techniques, the theories behind implant migration, and the benefits of an image-guided, endoscopic approach.

One patient was asymptomatic, and the other had begun to experience sinogenic symptoms after implant displacement. Both patients presented to the ENT clinic, and both underwent the BrainLab protocol to generate computed tomography images for navigational reconstruction. Transnasal endoscopy was carried out with this guidance, and the implants were removed successfully in both cases. Previously used surgical techniques such as the Caldwell-Luc procedure or extraction through the tooth socket have higher rates of conversion to open procedures, more damage to the nasal sinuses and higher post-operative complication rates compared with the transnasal endoscopic approach.

Both patients underwent successful removal of their migrated dental implants with no complications, and neither required any follow-up intervention.