To determine the prevalence of GJB2 mutations among subjects with congenital, non-syndromic, sensorineural hearing loss, within a north Indian population.

This was a case–control study in which the frequencies of the three most prevalent GJB2 mutations (35delG, W24X and 167delT) were studied. Polymerase chain reaction restriction fragment length polymorphism assays were performed to detect these mutations. The entire coding region of the GJB2 gene was sequenced in all patients, and also in any of their family members who showed GJB2 mutations.

The 35delG mutation was found to be the most prevalent mutation (21 per cent), followed by the W24X mutation (7 per cent). This is the first report of the 35delG mutation in an Indian population. One patient was a compound heterozygote for 35delG/W24X. The 167delT mutation was not observed in any patient.

These findings challenge the classical view that the W24X variant of the GJB2 gene represents a single ‘founder’ mutation.

To assess the incidence of vestibular disturbance in patients after cochlear implantation, and to evaluate the quality of vertigo symptoms.

Prospective, observational study.

Cochlear implant centre at a tertiary referral university hospital, Munich, Germany.

Forty-seven adult patients undergoing unilateral cochlear implantation between 2003 and 2007.

Patients were interviewed post-operatively about vertigo symptoms, using a specifically designed questionnaire. Questionnaire data were used to define patient subgroups based on probable vertigo aetiology. Cochlear implantation was performed via a retroauricular, transmastoidal approach. Thirty-six implants were Cochlear Nucleus 24 devices and 11 were MedEl devices.

Twenty-one (45 per cent) patients reported vertigo symptoms following cochlear implantation. The time of onset was directly post-operatively in the majority of patients. In 90 per cent, the symptoms suggested an otogenic origin. The majority of patients reported paroxysmal vertigo with a duration of seconds to minutes. Typical concomitant symptoms were tinnitus, fluctuating hearing loss and vegetative reactions. Serious disablement by vertigo was rare.

Exposing patients to the risk of possible balance disorders associated with cochlear implantation is justified in view of the hearing rehabilitation achieved, even with today's broader indications for cochlear implantation. However, patients should in any case be informed about the possibility and quality of post-operative vertigo symptoms.

To review the management, causative organisms, morbidity and mortality of intracranial abscesses secondary to sinus and ear disease.

Retrospective, case note review of suppurative intracranial complications of ear and sinus disease in patients admitted to a regional neurosurgical centre between 1980 and 2004. These data were compared with published material from the same region from 1950–1979.

There was a marked reduction in the mortality rate and the number of intracranial abscesses secondary to chronic ear disease, comparing the two time periods. However, there was little change in the percentage of sinus-related abscesses treated and in their symptoms, signs, abscess location and long term morbidity. Microbiology results showed that streptococcal species predominated as causative organisms, with a high percentage of anaerobic bacteria in otogenic abscesses.

Despite improved outcomes, a high index of suspicion for intracranial complications of ear or sinus disease should be maintained in the presence of appropriate signs and symptoms.

The literature on delays in vestibular schwannoma diagnosis is from the era before the routine use of magnetic resonance imaging. We evaluated such diagnostic delays and their impact on tumour size and on pre- and post-treatment morbidity, in a relatively recent patient series.

Retrospective review.

A two-centre study was conducted, including 91 consecutive vestibular schwannoma patients diagnosed between 1992 and 2006. Data on the presenting symptom and the initial medical visit were obtained from primary care records completed at the time of the initial visit; data on the tumour and the clinical course were obtained from review of the hospital chart. Data on diagnostic delays were available for 59 patients.

The median patient, professional and total diagnostic delays were three, four and 14 months, respectively. Unilateral hearing loss as the presenting symptom predicted an lengthened total diagnostic delay. Diagnostic delay had no impact on the tumour size at time of diagnosis or on the pre- and post-treatment morbidity.

Delays in the diagnosis of vestibular schwannoma have shortened since the introduction of magnetic resonance imaging. Longer diagnostic delays do not seem to have significant consequences.

To report a cluster of families affected by cholesteatoma in the East Anglia region of the UK.

Otology service for the population of Norfolk and North Suffolk, East Anglia, UK.

Prospective and systematic collection of family history data for patients presenting with cholesteatoma over 10 years.

Several families were identified with affected individuals over several generations.

There is likely to be a genetic propensity for cholesteatoma in some individuals.

A number of authors have suggested that surgery for suspected perilymph fistula is effective in preventing deterioration of hearing and in improving hearing in some cases in the short term. We present long-term hearing outcome data from 35 children who underwent exploration for presumed perilymph fistula at The Children's Hospital, Sydney, Australia, between 1985 and 1992.

The pre-operative audiological data (mean of 500, 1000, 2000 and 4000 Hz results) were compared with the most recently available data (range two to 15 years) and the six-month post-operative data.

The short-term results showed no significant change in hearing at six months, with a subsequent, statistically significant progression of hearing loss in both operated and non-operated ears (Wilcoxon signed rank test: operated ear, p < 0.017; non-operated ear, p < 0.009).

In this case series, exploratory surgery for correction of suspected perilymph fistula did not prevent progression of long-term hearing loss.

The term septal body refers to a thickened area of the nasal septum which is located superior to the inferior turbinate and anterior to the middle turbinate. Despite its important role in changing nasal airflow resistance, it has received little attention. Clinically, a well developed septal body may be misdiagnosed as high septal deviation.

The aim of the present study was to reassess the histological characteristics of the septal body mucosa and the morphometric differences between it and the adjacent septal mucosa. This information was then used to determine the exact location and surface area of the septal body.

The study was performed on 30 cadaveric specimens (60 sides). Serial numbered sections of the whole septal mucosa were stained with haematoxylin and eosin as well as periodic acid Schiff – Alcian blue. Morphometric analysis was performed to determine the histological differences between the septal body mucosa, the anterior septal mucosa and the inferior septal mucosa. The precise boundaries of the septal body area were then defined in a manner similar to the Mohs micrographic surgical technique.

The histological characteristics of the septal body mucosa included thick (more than 60 µm), pseudostratified, ciliated respiratory epithelium with goblet cells, abundant seromucinous glands and many blood sinusoids. Morphometric analysis showed that the septal body mucosa had thicker epithelium and more glandular acini and blood sinusoids than the rest of the septal mucosa. Mapping of the septal body area showed that its anterior end was 2.2 ± 0.3 cm (mean ± standard deviation) behind the caudal edge of the septal cartilage, and its inferior border was 1.1 ± 0.2 cm above the floor of the nose. The mean horizontal diameter of the septal body was 2.0 ± 0.15 cm, and the mean vertical diameter was 1.5 ± 0.11 cm.

The present study determined the morphometric characteristics of the septal body as well as its location and surface area. The intimate relationship of the septal body to the internal nasal valve and the histological characteristics of its mucosa should stimulate research into its potential role in modifying nasal airflow pattern and resistance, and its role in changing the humidity and temperature of the inspiratory air stream.

To determine the efficacy of inferior turbinate coblation for the treatment of nasal obstruction.

Twenty patients awaiting submucosal diathermy to the inferior turbinates were recruited into the study. All underwent inferior turbinate coblation. Pre-operative and post-operative nasal function was investigated using posterior rhinomanometry and subjective symptom scales.

There was no significant increase in nasal conductance two weeks after inferior turbinate coblation (p = 0.159). However, three months after inferior turbinate coblation, median nasal conductance had increased significantly, from 203 to 324 cm3/s (p = 0.004). The median increase in nasal conductance was 73 cm3/s or 43.5 per cent. Post-operative visual analogue patients' reported post-operative visual analogue scales scores for nasal obstruction decreased significantly, both two weeks (p = 0.006) and three months after inferior turbinate coblation (p = 0.001) when compared to Pre-operative values. There was no change in the reported severity of rhinorrhoea, nasal itching or sneezing. There was a significant relationship (ρ = −0.57, p = 0.014) between pre-operative nasal conductance and change in nasal conductance after inferior turbinate coblation.

This study confirms the short-term efficacy of inferior turbinate coblation for the treatment of nasal obstruction. The benefit was greatest in patients with lower pre-operative nasal conductance. Objective measures of nasal obstruction may be important when selecting patients for inferior turbinate coblation.

External dacryocystorhinostomy has been the treatment for nasolacrimal duct obstruction for more than a century. More recently, nasal endoscopy has allowed this procedure to be carried out endonasally.

The aim of this postal questionnaire study was to compare the health status of patients treated for epiphora by external versus endonasal non-laser dacryocystorhinostomy.

The Glasgow benefit inventory questionnaire, along with an additional, department-based symptomatic questionnaire, was distributed to all patients fitting our criteria.

Satisfactorily completed questionnaires were received from 64 out of 90 patients in the external group and from 30 of 41 patients in the endonasal group. Results indicated positive scores for both groups for all four subscales of the Glasgow benefit inventory. There were no statistically significant differences between results for the external and endonasal procedures. The ocular symptomatology questionnaire results indicated better scores for the external procedure, but this difference did not reach statistical significance.

To describe a new endonasal dacryocystorhinostomy technique and to assess its efficacy.

Prospective, non-randomised, interventional case series.

Patients with primary nasolacrimal duct obstruction were included. A prospective series of 226 consecutive endoscopic transnasal dacryocystorhinostomies performed between January 2003 and December 2006 were entered into the study. Patients who had undergone previous lacrimal surgery were excluded. The surgical technique involved the creation of nasal mucosal and large posterior lacrimal flaps at the medial lacrimal sac wall. The two flaps were placed in close apposition. The technique also involved creation of a large bony ostium.

Success was defined as the resolution of symptoms, or unobstructed lacrimal irrigation and endoscopic visualisation of a patent rhinostomy.

A total of 226 consecutive endoscopic transnasal dacryocystorhinostomy procedures performed between January 2003 and December 2006 were reviewed. The main presentation was with epiphora (95 per cent) and/or mucocele (13 per cent). Septoplasty was performed in 36 per cent of cases at the time of surgery. In 18 per cent of cases, endoscopic sinus surgery was also added to the procedure. The follow-up period ranged from six months to two years. Of the 226 patients, eight were lost to follow up and were thus excluded from the series. The procedure achieved a 92 per cent success rate, in terms of symptom relief and anatomical success.

The described technique of endoscopic endonasal dacryocystorhinostomy had a success rate comparable to that of external dacryocystorhinostomy. The procedure is simple and cost-effective because it does not require sophisticated equipment such as lasers, optical fibres, silicone stents or a microdebrider.

To improve case selection for near-total laryngectomy by identifying the causes of poor oncological and functional outcomes.

Analysis of prospectively accrued data for 28 consecutive cases of near-total laryngectomy undertaken between 1996 and 2005 at a tertiary care centre. We analysed the impact of tumour extent and location, patient physiological status, and surgical technique on disease-free survival and on functional outcome.

Patients' average four-year Kaplan–Meier disease-free survival was 74 per cent (95 per cent confidence intervals, 46–89 per cent). Eighty-two per cent of patients had good to excellent functional outcomes. Pre-operative tumour extension to the ipsilateral arytenoid significantly compromised disease-free survival (patients with this development had a two-year survival of 40 per cent; p = 0.001). Internal communicating fistula formation (i.e. a fistula between the neopharynx and myomucosal shunt lumens) occurred in five of 28 cases and was uniformly associated with a poor functional outcome (i.e. lack of phonation with or without aspiration). Fistula formation was significantly more likely in cases with tumour involving the ipsilateral arytenoid and the ipsilateral subglottis.

Significant disparity exists for the functional outcome of near-total laryngectomy in patients who develop post-surgical internal fistula, compared with those with uneventful healing. Tumour involvement of the ipsilateral arytenoid compromises the oncological and functional results. Tumour extension to the subglottis may compromise functional outcome. Near-total laryngectomy should be avoided in cases with ipsilateral arytenoid involvement, and undertaken with caution in cases with subglottic extension.

To determine whether, in a developing world context, early oral feeding after laryngectomy is safe, cost-effective and appropriate.

A prospective study of early oral feeding after laryngectomy, compared with retrospective, historical delayed feeding controls.

Forty patients underwent total laryngectomy for advanced carcinoma of the larynx with or without hypopharyngeal involvement, not requiring tongue base resection or myocutaneous flaps, and were commenced on oral feeding on the second post-operative day. Thirty-nine laryngectomy patients previously managed in the same unit who had received conventional, delayed oral feeding served as controls.

Pharyngocutaneous fistulae developed in 20 per cent of the early feeding patients, compared with 15.4 per cent of the delayed oral feeding controls (p = 0.592). For patients who did not develop fistulae, hospitalisation was shorter in the early oral feeding group (p = 0.007).

Early oral feeding for laryngectomy patients is recommended, both in developed and developing countries.

This retrospective study reviewed the ENT-related cases seen, and the discharge or transfer outcomes, at both a local ‘walk-in centre’ and the respective emergency department, over one year in Norwich.

Of the 7657 ENT cases seen at the walk-in centre, the commonest conditions included tonsillitis or pharyngitis, otalgia, cough, and deafness. In comparison, 1586 patients were seen at the emergency department, and the commonest conditions were epistaxis and throat foreign bodies. Of the ENT cases seen at the walk-in centre, 85.4 per cent were treated and discharged. Of the 14.6 per cent referred to other healthcare providers, 11.1 per cent were to the general practitioner. In comparison, the emergency department discharged 41.2 per cent and referred 58.8 per cent to other healthcare providers.

This study indicates that ENT cases may constitute a large proportion of patients seen in walk-in centres, and that the case types seen may differ from those presenting to emergency departments. It also indicates that walk-in centres may potentially be assessing, treating and discharging 85.4 per cent of ENT patients seen.

An alternative method of reconstruction of a lower lip defect is presented, using a mucosal flap taken from the upper lip. This approach leaves the skin intact and therefore avoids skin scarring, with its associated unpredictable healing. The upper lip mucosal flap applied to reconstruct the lower lip injury was identical to the injured tissue type.

The results were functionally and aesthetically excellent (as illustrated).

This technique represents an excellent alternative to reconstruction of a damaged lip, with the benefits of minimal scar tissue formation and excellent aesthetic result.

We report the second published case of a child with a serious traumatic injury involving the fixture and abutment of their bone-anchored hearing aid.

Case reports and review of the world literature concerning unusual complications following trauma to bone-anchored hearing aids.

A nine-year-old girl with Dubowitz syndrome sustained an intrusion injury of her bone-anchored hearing aid fixture and abutment following a fall. No other injury was sustained, and there was no neurological complication. The patient underwent immediate removal of the implant and subsequently made a full recovery. Such serious and unusual complications are fortunately very rare. On review of the literature, four cases of similar complications were identified. Only one involved a traumatic injury in a child.

Provision of bone-anchored hearing aids involves many clinicians. All clinicians involved in this procedure must be aware of the need to monitor their patients carefully, and to remember that unusual and unexpected complications, although rare, do happen. The patient's need for care continues long after the surgery is complete.

To discuss the management and to review the literature regarding retained knife blades in the head and neck.

We present three cases in which patients presented with retained knife blades in the head and neck region; in two of these, the diagnosis was delayed by more than eight weeks. In all patients, the retained knife blade was removed through the pathway of insertion, without significant sequelae.

The methods of removal, appropriate radiological investigations and patient profiles are discussed.

We propose that radiography be performed on all patients presenting with facial stab injuries which are anything more than superficial. We further suggest that the direct extraction of sharp objects through the pathway of insertion is safe if radiological studies show no risk of vascular injury.

The aim of this study was to describe the successful operative management of a patient with superior semicircular canal dehiscence syndrome, using the transmastoid approach under local anaesthesia.

The transmastoid approach was used to plug the superior semicircular canal.

Post-operatively, the patient experienced significant improvement in his symptoms of sound- and pressure-induced dysequilibrium, autophony and imbalance.

Successful operative management of superior semicircular canal dehiscence can be achieved via the transmastoid approach under local anaesthesia.