Sleep disordered breathing in children causes disturbance in behaviour and also in cardiorespiratory and neurocognitive function. Subtotal tonsillectomy (‘tonsillotomy’) has been performed to treat sleep disordered breathing, with outcomes comparable to established therapies such as total tonsillectomy or adenoidectomy. This review critically assesses the role of subtotal tonsillectomy in a paediatric setting.

The Medline database (1966 to October 2012) was electronically searched using key terms including subtotal or intracapsular tonsillectomy, tonsillotomy, tonsillectomy, paediatrics, and sleep disordered breathing.

Eighteen papers were identified and reviewed. Subtotal tonsillectomy would appear to have an efficacy equal to that of total tonsillectomy for the treatment of sleep disordered breathing, and has significant benefits in reducing post-operative pain and analgesia use. Subtotal tonsillectomy patients appear to have less frequent post-operative haemorrhage compared with total tonsillectomy patients.

In children, subtotal tonsillectomy is associated with fewer post-operative complications whilst having a comparable effect in improving sleep disordered breathing, compared with total tonsillectomy.

Unilateral and bilateral sudden sensorineural hearing loss represent different disease entities. The unilateral condition is more common and predominantly idiopathic, and up to 65 per cent of patients spontaneously recover hearing. Conversely, the bilateral condition is rare, mostly associated with serious systemic conditions, and has a higher prevalence of morbidity and mortality.

A literature search using the PubMed database was conducted using the MeSH terms ‘sudden’, ‘bilateral’ and ‘sensorineural hearing loss’.

One hundred and three reported cases of bilateral sudden sensorineural hearing loss were identified. The condition is most often associated with toxic, autoimmune, neoplastic and vascular conditions. A younger age of onset, with a bimodal age distribution, was seen for bilateral sudden sensorineural hearing loss, compared with the unilateral condition. Patients with the bilateral condition had more profound hearing loss, with poorer recovery and a 35 per cent mortality rate. Vestibular symptoms were also less common than in the unilateral condition.

The presentation of bilateral sudden onset sensorineural hearing loss is a medical emergency requiring thorough and urgent investigation to exclude life-threatening and reversible conditions.

Otitis media represents a major health concern in Australian Indigenous children (‘Indigenous children’), which has persisted, despite public health measures, for over 30 years.

Global searches were performed to retrieve peer-reviewed and ‘grey’ literature investigating the epidemiology of and risk factors for otitis media in Indigenous children, published between 1985 and 2012.

In Indigenous children, the prevalence of otitis media subtypes is 7.1–12.8 per cent for acute otitis media, 10.5–30.3 per cent for active chronic otitis media and 31–50 per cent for tympanic membrane perforation. The initial onset of otitis media in Indigenous children occurs earlier and persists for longer after the first year of life, compared with non-Indigenous children. Indigenous children are colonised by otopathogens more frequently, at younger ages and with a higher bacterial load. Poor community and domestic infrastructure, overcrowding and exposure to tobacco smoke increase the risk of otitis media in Indigenous children; however, the availability of swimming pools plays no role in the prevention or management of otitis media.

Despite awareness of the epidemiological burden of otitis media and its risk factors in Indigenous children, studies undertaken since 1985 demonstrate that otitis media remains a significant public health concern in this population.

Intranasal steroids are the first line of treatment for chronic rhinosinusitis. Although contamination of adjunctive devices (e.g. irrigation bottles) has been much investigated, little is known about nasal contamination of the metered-dose spray bottles used to deliver intranasal steroids, and the potential influence on disease chronicity.

Twenty-five prospectively recruited patients with stable chronic rhinosinusitis underwent microbiological analysis of their nasal vestibule and middle meatus and also of their steroid bottle tip and contents. Additionally, bottle tips were inoculated in vitro with Staphylococcus aureus and various sterilisation techniques tested.

For 18 of the 25 (72 per cent) patients, both nasal and bottle tip swabs grew either Staphylococcus aureus or coagulase-negative staphylococci. Staphylococcus aureus was cultured from 7 of the 25 (28 per cent) patients, and 5 of these 7 had concomitant bacterial growth from both nose and steroid bottle. Thus, the cross-contamination rate was 71 per cent for Staphylococcus aureus infected patients and 20 per cent overall. Sterilisation was effective with boiling water, ethanol wipes and microwaving, but not with cold water or dishwashing liquid.

Nasal steroid spray bottle tips can become contaminated with sinonasal cavity bacteria. Simple sterilisation methods can eliminate this contamination. Patient education on this matter should be emphasised.

Correlating patient perception of nasal obstruction sidedness to causative anatomy is important in surgical planning. The accuracy of patient-perceived asymmetry of nasal obstruction, as regards objective measures, is described.

Cross-sectional study of patients undergoing nasal airflow assessment. Unilateral obstruction was assessed using visual analogue scale scores and anterior rhinomanometry, without decongestion. Subjective obstruction asymmetry was defined using either the absolute score difference (right vs left) or the minimal clinically important difference, derived statistically. Correlation between subjective and objective obstruction measures was assessed.

In 145 patients (mean age ± standard deviation, 42.8 ± 16.6 years; 54.5 per cent female), objective obstruction was right-sided in 32.4 per cent, left-sided in 36.6 per cent and symmetrical in 31.0 per cent. Subjective perception of obstruction sidedness had a sensitivity and specificity of 86.9 and 41.1 per cent, respectively, using the minimal clinically important difference. Positive predictive value was 59.4 per cent using absolute score difference and 53.7 per cent using minimal clinically important difference. Receiver operator characteristic curve analysis indicated correlation between subjective and objective measures (p < 0.001).

Subjective perception of nasal obstruction asymmetry has limited accuracy. Corroboration with objective airway assessment may be helpful in patients whose symptoms are incongruous with clinical findings.

Nasal saline lavage forms a cornerstone of chronic rhinosinusitis management. A number of saline lavage recipes and products are currently available but little is known of their relative physical characteristics.

To determine the osmolarity and pH of nasal lavage solutions, both commercial preparations and home-made recipes, and to determine the reproducibility of saline solution preparation.

Five home-made recipes and two commercial products were prepared in triplicate and analysed. Eight consecutive clinic patients prepared a commercial product and 11 prepared a home-made recipe, and the osmolarity and pH were measured.

The osmolarity of the solutions varied widely, from 140 to 788 mmol/l and the pH varied from 7.88 to 8.50. The commercial and home-made solutions had similar reproducibility when prepared by patients.

Some recipes were markedly hypo-osmolar and some were hyper-osmolar. All were slightly alkaline. The home-made recipes had similar physical characteristics and reproducibility to commercial preparations.

Frey's syndrome and cosmesis are important considerations in parotid surgery. Placement of an interpositional barrier can prevent these complications; however, surgical technique and efficacy remain controversial.

A prospective case series was collected comprising all patients undergoing primary superficial parotidectomy for benign pathology with abdominal free fat grafting between June 2007 and December 2010, performed by a single surgeon. A survey was also distributed to otorhinolaryngology consultants across Australia to assess current practice.

Twenty-eight patients were included. No patient had clinical symptoms of Frey's syndrome. Seventy-five per cent of patients were completely satisfied with their aesthetic outcome, 18 per cent scored 4/5 and the remaining 7 per cent (2 patients) scored 3/5. The survey revealed that 79 per cent of respondents did not use interpositional grafts.

Abdominal free fat is ideal for grafting as it is an effective, safe, simple, accessible, fast and inexpensive method of providing an interpositional graft.

We report the first use in Australia of hyperbaric oxygen therapy for sudden hearing loss following head trauma in a child with large vestibular aqueduct syndrome.

A 12-year-old boy with large vestibular aqueduct syndrome presented with significant hearing loss following head trauma. He was treated with steroids and hyperbaric oxygen therapy, with good improvement of hearing thresholds on audiography. This case represents the first reported use of hyperbaric oxygen therapy for this indication in Australia, following a few previous reports of patients in Japan. We review the literature on management of acute sensorineural hearing loss in large vestibular aqueduct syndrome. The reported case demonstrates a potentially beneficial therapy for a rare condition that usually results in an inevitable decline in hearing.

Hyperbaric oxygen therapy can be tolerated well by children, and may represent a potential treatment for sudden sensorineural hearing loss in patients with large vestibular aqueduct syndrome.

We report the case of an unusual late presentation of congenital tracheal stenosis in a 13-year-old boy. He was treated with minimally invasive Coblation resection of the stenotic segment, avoiding a major open tracheal resection and reconstruction. This case report is the first to document the use of an ultra-fine Coblation wand in the treatment of congenital tracheal stenosis.

The case proceeded well, without any complications. The patient had a fully healed and patent trachea at 12-week post-operative review.

Complex cases of congenital stenosis should be managed with a multidisciplinary approach. Different and novel treatment options should be explored to find one that suits the individual patient. Minimally invasive Coblation technology can offer less invasive treatment with quicker recovery and shorter hospitalisation.