To gather and analyse information concerning the aetiology and pathology of otitis media with effusion in adults.

A review of the English language literature from 1970 to the present was conducted.

The available evidence suggests that otitis media with effusion in adult life is best viewed as a syndrome with a number of causes, including: infiltration of the eustachian tube by nasopharyngeal carcinoma and other local malignancies; changes in the middle ear and eustachian tube induced by radiotherapy; and systemic disease.

There is now a body of evidence specifically related to the aetiology and pathology of otitis media with effusion in adult life. However, further research is required to fill in the gaps in our knowledge and understanding of this condition.

To investigate the evidence for balloon dilatation of the eustachian tube using a transtympanic approach.

A systematic search of several databases was conducted (using the search terms ‘dilation’ or ‘dilatation’, and ‘balloon’ and ‘eustachian tube’). Only studies that used a transtympanic approach for the procedure were included. These studies were then assessed for risk of bias.

Three studies were included. Each of these studies was a limited case series, with two performed on human subjects and one on human cadavers. Results of safety and efficacy are conflicting. There is a high risk of bias overall.

At present, there is a very narrow evidence base for transtympanic balloon dilatation of the eustachian tube. There are a number of advantages and disadvantages of the technique. Previously identified and theoretical safety concerns will need to be addressed thoroughly in future studies prior to wider clinical use.

There have been recent advances in our appreciation of the functional complementarity of the upper and lower airways. The unified airway begins at the nose: rather than acting merely as a conduit for air to the lungs, the nose and nasal cavity perform an important role in filtering, humidification and immune surveillance.

The physiological and pathological responses of the nasal cavity to exercise and regular training are examined in this narrative review, with specific reference to the relation of nasal health to quality of life, lower airway health and upper respiratory tract infections. Relevant literature is examined and placed in clinical context.

There is considerable published evidence to support nasal dysfunction associated with exercise, and a link to lower airway dysfunction. Evidence also supports the role of upper and lower airway dysfunction in the development of upper respiratory tract infection symptoms.

Nasal dysfunction in exercise may be a source of considerable morbidity to the regular exerciser, and further research into exercise-induced rhinitis is recommended.

Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy.

A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy.

Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment.

Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.

To investigate the use of systemic N-acetylcysteine and vitamin A in the prevention of gentamicin ototoxicity in rats.

Forty-two Wistar rats were divided into four groups according to treatment: intratympanic saline, intratympanic gentamicin, intraperitoneal vitamin A after intratympanic gentamicin, and intraperitoneal N-acetylcysteine after intratympanic gentamicin. Signal-to-noise ratio and distortion product otoacoustic emissions were evaluated in all groups.

N-acetylcysteine had a significant protective effect at 1.5, 2, 3, 4, 6 and 8 kHz, whilst vitamin A had a significant protective effect at 2, 3, 4 and 6 kHz, as determined by the distortion product otoacoustic emission measurements. According to the signal-to-noise measurements, N-acetylcysteine had a significant protective effect at 1.5, 2, 3, 4, 6 and 8 kHz, whilst vitamin A had a significant protective effect at 3, 6 and 8 kHz.

Gentamicin-induced hearing loss in rats may be prevented by the concomitant use of vitamin A and N-acetylcysteine. Specifically, N-acetylcysteine appeared to have a more protective effect than vitamin A for a greater range of noise frequencies.

To investigate a novel oxidative stress marker, thiol/disulphide literature homeostasis, in patients with idiopathic sudden sensorineural hearing loss, and to compare the results with healthy controls for the first time.

Thirty-two patients with idiopathic sudden sensorineural hearing loss and 30 healthy individuals were included in the study. Serum native thiol, total thiol and disulphide levels were measured, and disulphide/native thiol and disulphide/total thiol ratios were determined in all subjects.

Serum native thiol and total thiol levels were significantly lower in patients with sudden sensorineural hearing loss compared with controls (p < 0.05). Of the 32 patients, 25 had lower native thiol levels than controls (333.2 ± 73.9 vs 381.8 ± 35.6 μmol/l, p = 0.002) and 24 had lower total thiol levels (375.1 ± 74.3 vs 426.1 ± 39.3 μmol/l, p = 0.002).

The changes in oxidative markers evident in a significant number of patients may be associated with oxidative stress, which may, in turn, have caused sudden sensorineural hearing loss in those patients.

Olfactory dysfunction is a possible side effect of chemo-radiotherapy performed in patients affected by nasopharyngeal carcinoma. Self-rating measurements and olfactory event-related potentials were used and compared in order to evaluate the impact of this treatment on the olfactory system.

Nine patients underwent subjective evaluation of olfactory function (using visual analogue scales for olfactory symptoms and quality of life, and a six-item Hyposmia Rating Scale), and a quantitative and objective measurement (olfactory event-related potentials).

Spearman's rank correlation analyses highlighted significant relationships between the clinical scales and olfactory event-related potentials. Inter-group analyses showed significant differences in the latency and in the amplitude of olfactory event-related potentials between patients and controls.

Taking into account the small sample size and the lack of pre-treatment assessment, olfactory event-related potentials seemed to allow a more objective diagnosis of unilateral and bilateral olfactory loss. Moreover, olfactory event-related potentials and subjective scales results were concordant.

Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.

Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.

The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).

These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.

The present study was conducted to determine the rate of level IV lymph node involvement among node-negative (N0) necks in patients with squamous cell carcinoma of the tongue.

The study comprised 32 patients with squamous cell carcinoma of the tongue, with tumour–node–metastasis staging of T1–3N0M0, who were admitted to the Otolaryngology Department at Tehran University of Medical Sciences from March 2012 to March 2014. After a complete diagnostic evaluation, wide primary tumour excision (with 1.5–2 cm margins) and extended supraomohyoid neck dissection (levels I–IV) were accomplished.

Occult metastasis was found in 28 per cent of the patients. Level I, II and III metastases were the most common (18.75, 18.75 and 15.62 per cent, respectively). Level IV metastasis was found in 6.25 per cent of patients.

Supraomohyoid neck dissection appears to be an appropriate treatment for N0 tongue squamous cell carcinoma and there is no need for level IV lymph node dissection in a N0 patient.

Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients.

Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma.

Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology).

Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).

To investigate the assessment and management of paediatric snoring and obstructive sleep apnoea in UK otolaryngology departments.

A telephone questionnaire survey of UK otolaryngology departments was conducted over a 16-week period.

The response rate was 61 per cent (85 out of 139 trusts). Use of pre-operative pulse oximetry was reported by 84 per cent of respondents, mainly to diagnose obstructive sleep apnoea (73 per cent) or stratify post-operative risk (46 per cent). Thirty-one per cent of respondents reported using post-operative pulse oximetry. Twenty-five per cent of respondents have a dedicated management protocol for paediatric obstructive sleep apnoea and snoring. Thirty-four per cent require prior clinical commissioning group approval before performing surgery. Fifty-eight per cent of respondents reported following up their obstructive sleep apnoea patients after surgery. The mean follow-up period (±standard deviation) was 6.8 ± 1.2 weeks.

There is variation in the assessment and management of paediatric snoring and obstructive sleep apnoea across the UK, particularly in the use of pre- and post-operative pulse oximetry monitoring, and further guidelines regarding this are necessary.

Surgeons are exposed to a variety of occupational risks, including work-related musculoskeletal disorders. This study investigated the prevalence of these latter disorders amongst UK ENT surgeons and compared this with the existing literature.

A survey containing questions on work-related musculoskeletal disorders was distributed to the entire membership of ENT-UK electronically, with the assistance of its Survey Guardian. A literature review on the subject was then performed.

A total of 323 completed questionnaires were received (a 24 per cent response rate). Work-related musculoskeletal disorders had been experienced by 47.4 per cent of respondents. There were no statistical differences between the occurrence of work-related musculoskeletal disorders and: grade, length of time spent in the specialty or the subspecialty of respondents. Eighty-five per cent of affected surgeons sought treatment, with 22.9 per cent taking time off work and six surgeons retiring early. The literature review only identified five related studies.

Despite the scarcity of studies, work-related musculoskeletal disorders are common amongst ENT surgeons in the UK. Such disparity highlights the need for more research and appropriate ergonomic intervention within the specialty.

Chronic otorrhoea after canal wall down mastoidectomy can be a clinical challenge. Basic principles for canal wall down surgery include establishing a large meatus. Several meatoplasty techniques have been reported. This paper describes this new indication for Todd's meatoplasty with surgical improvements.

Retrospective review.

Academic tertiary referral centre.

Modifications of transposition postauricular flap meatoplasty are reported. This technique was applied in a series of patients with chronic otorrhoea after a canal wall down mastoidectomy.

In general, a dry radical cavity was successfully created within six weeks and follow-up visits at the out-patient clinic were reduced. Only minor complications occurred, which are all reported.

The postauricular flap meatoplasty is a valuable tool in the management of chronic otorrhoea after an open cavity approach for cholesteatoma.

A foreign body is a rare cause of parotid gland obstructive sialadenitis; intra-oral penetration via Stensen's duct is unusual. The relatively recent introduction of interventional sialendoscopy to treat obstructive sialadenitis has allowed surgeons to adopt a gland-sparing approach by means of miniaturised endoscopes and instruments. However, unusual anatomy or pathological conditions can give rise to a risk of intraductal rupture that may lead to a subsequent iatrogenic foreign body.

This paper describes the case of a patient with a 4 mm stone engaged by a broken wire basket stuck in a secondary branch of Stensen's duct.

The iatrogenic foreign body was successfully retrieved by means of sialendoscopy-assisted transfacial surgery.

This is the first reported case of an intraductal rupture of a miniaturised device during interventional sialendoscopy successfully resolved by means of combined endoscopy and external surgery. This proved to be an effective method of rescuing a foreign body stuck in Stensen's duct.