(1) To identify newly diagnosed cases of methicillin-resistant Staphylococcus aureus ear infection in our local population; (2) to determine the risk factors involved in these patients' clinical courses, and (3) to type the bacterial strains isolated and thus identify whether they were hospital- or community-acquired.

Retrospective review of case notes, together with laboratory-based molecular studies in the departments of otolaryngology and medical microbiology in a university teaching hospital in Scotland, UK.

Over a two-year period, 35 patients were identified with ear swabs positive for methicillin-resistant Staphylococcus aureus infection. These cases came from both hospital and community settings.

(1) Identification of primary methicillin-resistant Staphylococcus aureus otorrhoea in patients with no previously documented colonisation; and (2) molecular typing of the strains isolated, using spa technology, to identify whether they were hospital- or community-acquired.

Of the 35 positive patients, 27 were previously known carriers of methicillin-resistant Staphylococcus aureus. The eight patients with newly diagnosed methicillin-resistant Staphylococcus aureus otorrhoea presented initially in the community. All of these patients had had contact with hospital staff (as in-patients or out-patients) in the weeks preceding development of their ear infection. Using the spa technique for molecular typing, we identified hospital-acquired (‘epidemic’) methicillin-resistant Staphylococcus aureus type 15 in all eight patients' isolates. All were sensitive to topical gentamicin.

In our cohort, hospital-acquired methicillin-resistant Staphylococcus aureus type 15 was the commonest cause of methicillin-resistant Staphylococcus aureus otorrhoea, despite the fact that these patients all first presented in the community. We believe that contact with hospital staff or health care workers is a risk factor for acquiring methicillin-resistant Staphylococcus aureus otorrhoea in the community.

Computer-based medical simulation has recently been adopted as a new method of medical education. This paper reviews the uses of medical simulation within the ENT specialty, and reports how such simulation is used in Al-Ahsa College of Medicine, Saudi Arabia.

We review our use of a simulation laboratory in ENT training. Students are taught ENT anatomy using physical models, ear diseases using physical models, and ENT examination by watching video recordings, and are taught the principles of common ENT surgery using a computerised mannequin (for laryngoscopy and bronchoscopy). A haptic temporal bone surgery simulator is used for mastoidectomy and functional endoscopic sinus surgery training, and a mannequin for cricothyrotomy and tracheotomy training.

The use of such simulation methods has greatly improved our students' perception and comprehension.

Disorders of balance often pose a diagnostic conundrum for clinicians, and a multitude of investigations have emerged over the years. Vestibular evoked myogenic potential testing is a diagnostic tool which can be used to assess vestibular function. Over recent years, extensive study has begun to establish a broader clinical role for vestibular evoked myogenic potential testing.

To provide an overview of vestibular evoked myogenic potential testing, and to present the evidence for its clinical application.

Structured literature search according to evidence-based medicine guidelines, performed between November 2008 and April 2009. No restrictions were applied to the dates searched.

The benefits of vestibular evoked myogenic potential testing have already been established as regards the diagnosis and monitoring of several clinical conditions. Researchers continue to delve deeper into potential new clinical applications, with early results suggesting promising future developments.

Recent advances in electronic nose technology, and successful clinical applications, are facilitating the development of new methods for rapid, bedside diagnosis of disease. There is a real clinical need for such new diagnostic tools in otolaryngology.

We present a critical review of recent advances in electronic nose technology and current applications in otolaryngology.

The literature reports evidence of accurate diagnosis of common otolaryngological conditions such as sinusitis (acute and chronic), chronic suppurative otitis media, otitis externa and nasal vestibulitis. A significant recent development is the successful identification of biofilm-producing versus non-biofilm-producing pseudomonas and staphylococcus species.

Electronic nose technology holds significant potential for enabling rapid, non-invasive, bedside diagnosis of otolaryngological disease.

To observe the long-term effect of laser occlusion of the posterior semicircular canal for benign paroxysmal positional vertigo.

Case report and review of the relevant world literature.

We treated a patient with refractory benign paroxysmal positional vertigo using laser occlusion of the posterior semicircular canal, and achieved satisfactory results. Three months after the operation, the patient was able to lead a normal life. There was no recurrence over five years of follow up.

To our knowledge, this is the first report in the world literature of a patient with refractory benign paroxysmal positional vertigo being treated with laser occlusion of the posterior semicircular canal. This method had long-term effectiveness, and may be one of the most effective methods of treating patients with refractory benign paroxysmal positional vertigo.

Sinonasal inverted papilloma is a benign condition with the potential for recurrence and malignant change. Over the past few decades, numerous studies and reviews have addressed different aspects of this condition.

To amalgamate the current literature on inverted papilloma, in order to review the evidence and consider the gaps in current knowledge.

Retrospective, narrative review.

The reported incidence of inverted papilloma varies between centres and is affected by selection bias. The exact aetiology of inverted papilloma is not fully understood. Currently, there is no reliable histological or biological marker to predict the probability of recurrence or malignant transformation. There is no universally accepted staging system available for sinonasal inverted papilloma. Complete surgical removal of the tumour is the mainstay of treatment, but the method of choice depends on the extent of the disease, the skill of the surgeon and the technology available.

In order to compare different studies and to enable meta-analysis of the literature, there should be a universally accepted staging and classification system for sinonasal inverted papilloma. Further research on the aetiology of sinonasal inverted papilloma, and on biological markers for its recurrence and malignant transformation, is required. To enable meaningful future research, we would encourage multicentre participation with a consensus on management.

The management of sudden sensorineural hearing loss has not yet been standardised. Hyperbaric oxygen therapy influences recovery from sudden sensorineural hearing loss, but the underlying mechanism is unknown and the appropriate indications and protocols undetermined.

Nineteen patients affected by sudden sensorineural hearing loss were treated after unsuccessful medical therapy, either in an acute or chronic setting. Pure oxygen inhalation at 2.5 atmospheres absolute pressure was administered for 90 minutes, for 30 sessions. Frequency-specific and average pure tone hearing thresholds were determined before and after hyperbaric oxygen therapy. The number of hyperbaric oxygen therapy sessions, the patient's age and any therapeutic delay were considered as quantitative variables possibly influencing outcome. Stepwise multivariate analysis was performed.

Salvage hyperbaric oxygen therapy appeared to improve patients' pure tone hearing thresholds, particularly at low frequencies. Positive results were more likely with increased patient age and reduced delay in receiving hyperbaric oxygen therapy.

Hyperbaric oxygen therapy has a strong scientific rationale, and improves pure tone hearing thresholds in cases of sudden sensorineural hearing loss unresponsive to medical therapy. Further research may be able to identify those patients with sudden sensorineural hearing loss for whom hyperbaric oxygen therapy would be most cost-effective.

To demonstrate the technique and clinical application of vibroplasty in which the floating mass transducer component of the Vibrant Soundbridge implant is coupled directly to the oval window niche, in patients with a mobile stapes footplate but a malformed or destroyed stapes suprastructure.

The underlying concept was to create a soft tissue casing for the floating mass transducer, while also firmly connecting the transducer to a small, solid cartilage ‘plunger’ attached to the stapes footplate. This was realised by removing almost all the cartilage from a larger piece of cartilage–perichondrium, leaving only a tiny cartilage island about half a millimetre in diameter, attached to a much wider ‘blanket’ of perichondrium.

By coupling the floating mass transducer directly to the oval window niche, patients' speech understanding was improved. Post-operative aided thresholds of 30–40 dB HL were achieved by all patients.

In patients with mixed hearing loss combined with a destroyed stapes suprastructure but a mobile stapes footplate, we describe the coupling of the floating mass transducer component of a Vibrant Soundbridge to the stapes footplate, as an alternative to coupling to the round window.

To review the current literature on the use of sodium fluoride in the treatment of otosclerosis.

A literature review was conducted, searching the Medline and PubMed database from 1966 to 2009, using the terms ‘otosclerosis’ and ‘fluoride’. Article abstracts were reviewed and relevant full articles acquired.

There has been only one double-blind, placebo-controlled trial of the use of sodium fluoride in otosclerosis patients, and this found a reduced incidence of deterioration in hearing after two years in the treatment group. Several case–control series have described a hearing benefit in the sodium fluoride treated group. Treatment doses vary greatly, and there is no evidence regarding the optimum duration of treatment.

There is low quality evidence suggesting that sodium fluoride may be of benefit to preserve hearing and reduce vestibular symptoms in patients with otosclerosis.

An understanding of the management of chronic facial palsy is vital for otolaryngologists, due to its common presentation to ENT surgeons. There is currently a lack of consensus on the optimum management of this condition. This article reviews the existing literature and offers a perspective on current management, as well as an insight into future treatments.

A literature search was performed, using the Medline, Embase and Cochrane databases from 1966 to the present, using the keywords listed below. Articles were reviewed. Selection was limited to English language articles on human subjects.

A tailored, multidisciplinary approach using combinatorial therapy should be used for reanimation of the face following facial palsy. Advances in surgical and non-surgical techniques, and the exchange of information from centres of excellence via global databases, will enable objective appraisal of results and the development of an evidence-based approach to facial reanimation.

In Australia, the current guidelines for evaluation of noise-induced hearing loss suggest that, in cases of asymmetrical loss, ‘the worse ear be equated to the better ear’ for purposes of compensation. This study aimed to establish that such a method was prejudicial to the worker (i.e. the plaintiff). In consideration of the legal duty ‘to co-construct the ideas of truth and the ideas of justice in the context of legal proceedings’, our study objectives were (1) to document the incidence of asymmetrical hearing loss in compensation cases seen in our practice, and (2) to provide a reasoned argument for inclusion of the same for compensation considerations.

Open, retrospective, clinical study.

Australian plaintiffs with asymmetrical hearing loss (who comprise a significant percentage of industrial hearing loss legal cases) may be excluded from full consideration of their hearing loss as a result of the current guidelines. In contrast to the process of medical diagnosis and treatment, it appeared that the application of accepted probability standards within the legal process may permit inclusion of such clients' hearing loss in compensation considerations.

This study included 208 consecutive clients referred by legal practitioners for assessment of hearing loss for compensation purposes.

A total of 22.6 per cent of clients (47 of 208) had asymmetrical hearing loss, with the left side having the greater loss in 60 per cent of cases. We believe that asymmetrical hearing loss should be included in compensation considerations, both on medical and legal grounds.

Obstructive sleep apnoea has long been recognised as a clinical syndrome; however, high quality evidence on the effects of surgery for this condition is still missing. Despite this, a consensus seems to be evolving, albeit based on limited evidence, that surgery should be offered as a second line treatment to suitable patients with obstructive sleep apnoea.

This article aims to assess the different methods of investigating upper airway obstruction in patients with obstructive sleep apnoea, in respect to these methods' relevance to surgical treatment, via a systematic review of the literature.

The Cochrane Controlled Trials Register, Medline and EMBASE were searched from 1966 onwards. The search was performed in August 2008. A total of 2001 citations were retrieved.

There is not yet a generally accepted way to assess surgical candidacy based on the level of obstruction. Better organised clinical studies with well defined endpoints are needed. In the meanwhile, it appears that sleep nasendoscopy, acoustic reflectometry and pressure catheters can all provide useful information, and their use may be decided upon based on the experience and resources available in individual departments.

Paragangliomas are rare tumours arising from the paraganglia of the autonomic nervous system.

We present a case of a paraganglioma arising from the hypoglossal nerve and producing an unusual clinical picture at presentation.

We supply radiological evidence of a paraganglioma originating from the hypoglossal nerve, and thus extend the evidence base for this rare site of origin. Our patient presented as an emergency with long tract neurological symptoms and progressive brainstem involvement. This presentation is not characteristic of paragangliomas in general, which usually have an indolent growth pattern and often demonstrate benign symptoms for a number of years prior to diagnosis. The location of a hypoglossal paraganglioma differs significantly from more common paragangliomas described in the neck and skull base, and this should inform the surgical approach undertaken.