To assess the efficacy of dynamic slow motion video endoscopy as a test of eustachian tube function based on its correlation with the eustachian tube swallow test.

The eustachian tube swallow test and dynamic slow motion video endoscopy were performed on 100 clinically normal middle ears of adults undergoing rigid nasal endoscopy for various indications. The dynamic slow motion video endoscopy findings were interpreted by three observers who were blind to the results of the eustachian tube swallow test, and the findings of both techniques were compared.

There was a statistically significant correlation between the dynamic slow motion video endoscopy and eustachian tube swallow test results for some of the more lenient criteria. Five of the 100 eustachian tubes had a floppy medial cartilaginous lamina which appeared to contribute to the eustachian tube dysfunction.

Dynamic slow motion video endoscopy appeared to over-diagnose eustachian tube dysfunction when used as a standalone test of eustachian tube function. However, when used in combination with other tests of eustachian tube function, it can provide valuable information regarding the structural and functional status of the pharyngeal end of the eustachian tube.

This study aimed to validate the use of the Adelaide Disease Severity Score for the assessment of chronic rhinosinusitis.

A prospective cohort study supplying level 2b evidence.

Forty-eight patients, scheduled for endoscopic sinus surgery for failed management of chronic rhinosinusitis, completed the Sino-Nasal Outcome Test 22 and the Adelaide Disease Severity Score tool (the latter assessing symptoms (i.e. nasal obstruction, rhinorrhoea, post-nasal drip, headache or facial pain, and olfaction) and quality of life). Lund–Mackay computed tomography scores and Lund–Kennedy endoscopic scores were also recorded. The Adelaide Disease Severity Score results were then compared with those of the other three tools to assess correlation.

Mean scores (95 per cent confidence intervals) were 22.31 (21.47–24.15) for the Adelaide Disease Severity Score and 30.6 (27.15–34.05) for the Sino-Nasal Outcome Test 22; there was a statistically significant correlation (Spearman coefficient = 0.45; p = 0.0015). A statistically significant correlation was also noted with the Lund–Mackay score (p = 0.04) and with the Lund–Kennedy score (p = 0.03).

The Adelaide Disease Severity Score is a simple, valid tool for clinical assessment of chronic rhinosinusitis, which correlates well with the Sino-Nasal Outcome Test 22, Lund–Mackay and Lund–Kennedy tools.

This study aimed to investigate the prevalence of otomycosis and aetiological agents in Khouzestan province, south-west Iran.

This cross-sectional study examined and cultured 881 swabs from suspected external otitis cases, collected from throughout Khouzestan province. Fungal agents were identified by slide culture and complementary tests when necessary.

The mean patient age was 37 years. The 20–39 year age group had the highest prevalence of otomycosis: 293 cases, comprising 162 (55.3 per cent) women and 131 (44.7 per cent) men. The seasonal distribution of cases was: summer, 44.7 per cent; autumn, 28.7 per cent; winter, 14.7 per cent; and spring, 11.9 per cent. The fungal agents isolated were Aspergillus niger (67.2 per cent), Aspergillus flavus (13 per cent), Candida albicans (11.6 per cent), Aspergillus fumigatus (6.2 per cent) and penicillium species (2 per cent).

Fungal otomycosis is still one of the most important external ear diseases. In this study in south-west Iran, Aspergillus niger was the predominant aetiological agent. However, clinicians should be cautious of candidal otomycosis, which has a lower rate of incidence but is more prevalent among 20–39 year olds.

In the general surgical and anaesthetic literature, there has been a decline in research output originating from the UK. This study analysed the 10 globally leading and 2 UK leading otorhinolaryngology journals to determine whether this trend was also reflected within otorhinolaryngology.

Citable research output was analysed from 4 individual years, over a 10-year period (2000–2010), to determine absolute output, geographical mix and article type.

The proportion of research output from the UK and Ireland grew 22.8 per cent among the leading global otorhinolaryngology journals, but fell 28.6 per cent among the leading two UK otorhinolaryngology journals. The converse trend was true for the USA and Canada. Output from European and the rest of the world grew among both sets of journals, while Japanese output fell. ‘Research’ articles remained the most prevalent type.

These results are encouraging as they refute the fall in UK research output observed by other authors. In the face of growing challenges, it is important to maintain published output so that the fate that has befallen other specialties is not mirrored within UK otorhinolaryngology.

‘Dead ear’ is a rare and serious complication of ear surgery. This paper presents an audit of this complication.

Over 6 years, data for all 617 middle-ear operations performed under the care of a single consultant were recorded for the International Otology Audit. All cases of dead ear were identified and assessed.

A post-operative dead ear occurred in 6 cases (approximately 1 per cent). No cases of post-operative dead ear occurred following the 83 otosclerosis operations and the 62 children's procedures. Amongst 187 adult patients undergoing mastoid surgery for cholesteatoma, there were 5 cases of post-operative dead ear (2.7 per cent of cases).

The occurrence of dead ear after cholesteatoma surgery in adults is less rare than previously thought. This has implications for the surgical consenting process. The current series suggests that, whilst dead ear is often avoidable, it is sometimes inevitable.

To investigate hepatitis B virus DNA in the cerumen of hepatitis B virus infected patients.

This study comprised 30 confirmed cases of chronic hepatitis B. Patients' serum samples were examined for hepatitis B surface antigen and antibodies using enzyme immunoassay systems. The presence of hepatitis B virus DNA in cerumen was investigated using a polymerase chain reaction test.

All of the samples were positive for hepatitis B surface antigen and negative for hepatitis B surface antibodies. Hepatitis virus DNA was detected in two cerumen samples (6.6 per cent of patients).

Cerumen can be a potential source of transmission of hepatitis B virus.

This retrospective, comparative study aimed to assess anatomical and functional results in a group of adults undergoing type I tympanoplasty for subtotal tympanic membrane perforation, using two different types of graft.

The study included 106 patients affected by chronic otitis media, who underwent underlay type I tympanoplasty, 53 using an autologous chondro-perichondral tragal graft and 53 using temporalis fascia. Anatomical and functional outcomes were evaluated over time.

Audiometric results comparing the cartilage and fascia groups at six months and one year after surgery showed no statistically significant differences. Assessment of anatomical outcomes indicated a greater number of complications in the fascia group.

Functional results indicate the validity of the cartilage tympanoplasty, while anatomical results indicate a slightly better outcome in terms of graft re-perforation and retraction, compared with temporalis fascia at one-year follow up. These results suggest that the cartilage technique is preferable for type I tympanoplasty.

To assess the clinical and radiological characteristics of the posterior prolongation of the cartilaginous nasal septum, an under-utilised source of autologous cartilage for nasal reconstruction.

Consecutive patients undergoing primary, external approach rhinoplasty were included. The septal cartilage was assessed intra-operatively prior to routine harvest. Cartilage use was recorded and post-operative cosmesis noted. Computed tomography scans from a separate patient group, with no septal surgery, were used to assess septal cartilage dimensions.

Of the 25 rhinoplasty patients studied, 24 had harvestable septal cartilage, with a posterior prolongation mean length ± standard deviation of 24.3 ± 8.40 mm, mean height of 4.33 ± 0.34 mm and mean width of 1.1 ± 0.35 mm. The mean post-operative cosmesis score was +2.41 ± 0.71 at a mean follow up of 45 ± 8.7 weeks. All 25 radiology patients had visible posterior prolongations on computed tomography (mean length, 18.1 ± 5.1 mm; mean height, 4.2 ± 1.1 mm; mean width 1.5 ± 0.63 mm).

Harvesting of the posterior prolongation would increase by 25 per cent the cartilage area available for autologous grafts. Endoscopic guidance aids this process. Cartilage is most commonly used for overlay grafts, with good cosmesis. The posterior prolongation is demonstrated on computed tomography, although dimensions may be underestimated.

There are many well-known aetiological mechanisms of presbyacusis, and free radicals have been shown to play an important role. This study aimed to evaluate the effect of antioxidant agents on the hearing threshold of patients with presbyacusis.

One hundred and twenty individuals were divided into four groups and received one of the following treatment schemes: ginkgo biloba dry extract, α-lipoic acid plus vitamin C, papaverine chlorhydrate plus vitamin E, or placebo. All participants were evaluated at recruitment and after six months, using pure tone audiometry (at isolated and average frequencies), speech recognition threshold and percentage index of speech recognition.

The various treatments had no effect on any of the evaluated measures of hearing, either between groups or over time.

There was no statistically significant change in the hearing threshold after treatment with any of the tested drugs, during the study period.

To describe the clinical features of external auditory canal cholesteatoma, and to assess the outcome following bony meatoplasty with tragal cartilage and perichondrium graft repair.

A retrospective review was carried out, comprising all patients with external auditory canal cholesteatoma who presented between January 2007 and December 2011. Patients underwent pre-operative audiometry and computed tomography imaging of the temporal bones, before undergoing bony meatoplasty via a postauricular incision. Pre- and post-operative comparisons were made of patients' otological symptoms and the otoscopic appearance of the external ear canal.

Eight patients were included in the analyses. The median age of patients was 46.5 years (range 14–68 years), with a male to female ratio of 1:1. The median length of follow up was 16 months. The most common presenting features were unilateral otalgia and purulent otorrhoea. All patients had relatively advanced disease at presentation, with erosion of the temporal bone. All patients underwent bony meatoplasty via a postauricular approach to eradicate the disease. Bony meatoplasty was successful in the definitive management of external ear canal cholesteatoma.

Adult patients with obstructive sleep apnoea can be a therapeutic surgical challenge if other treatments fail or are rejected. We report the outcomes of a series of 17 patients for whom standard device-based treatments failed or could not be used. These patients were considered unsuitable for a lesser operation and therefore underwent multilevel upper airway reconstruction.

Data from 17 consecutive patients were collected prospectively. This included pre- and post-surgery findings for clinical assessments, body mass index, sleep questionnaires, and laboratory polysomnograms. Patients underwent a combination of modified uvulopalatopharyngoplasty, transpalatal advancement and various tongue reduction procedures.

Analyses revealed statistically and clinically significant reductions in: mean apnoea-hypopnoea index scores (from 36.3 pre-operatively to 14.5 post-operatively, p < 0.001), mean Epworth sleepiness scale scores (from 11.3 to 5.3, p < 0.001) and mean snoring severity scores (from 6.9 to 1.3, p < 0.001). Body mass index remained unchanged.

Multilevel upper airway reconstructive surgery was associated with large reductions in both objective and patient-centred subjective measures of obstructive sleep apnoea severity.

There is a considerable scarcity of reliable population-based data on the prevalence of preventable ear disorders in developing countries. This study was conducted to determine the prevalence of preventable ear disorders in primary school children (aged 5 to 12 years) in northern India.

A pro forma questionnaire was used to screen 15 718 primary school children in New Delhi for ear disorders. Ear examinations were conducted using otoscopy and impedance audiometry.

Impacted cerumen was prevalent in 7.93 per cent of schoolchildren, 4.79 per cent suffered from chronic otitis media and 3.06 per cent suffered from otitis media with effusion. Acute otitis media was detected in 0.65 per cent and foreign bodies were found in 0.34 per cent of the children.

Preventable ear diseases posed a significant health problem among children at primary school level. Regular screening of children during this stage would ensure that their school lives were not affected by hearing impairments or preventable ear disorders. Information gathered in this study will help in effective treatment prioritisation of ear disorders, planning and resource allocation.

Chronic sinusitis is one of the most common otolaryngological diagnoses. Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis can easily be misdiagnosed and treated as chronic sinusitis, causing continuing harm.

To better identify and characterise these two subgroups of patients, who may suffer from a systemic disease requiring multidisciplinary treatment and prolonged follow up.

A retrospective, longitudinal study of all patients diagnosed with allergic fungal sinusitis or eosinophilic mucin rhinosinusitis within one otolaryngology department over a 15-year period.

Thirty-four patients were identified, 26 with eosinophilic mucin rhinosinusitis and 8 with allergic fungal sinusitis. Orbital involvement at diagnosis was commoner in allergic fungal sinusitis patients (50 per cent) than eosinophilic mucin rhinosinusitis patients (7.7 per cent; p < 0.05). Asthma was diagnosed in 73 per cent of eosinophilic mucin rhinosinusitis patients and 37 per cent of allergic fungal sinusitis patients.

Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis have the same clinical presentation but different clinical courses. The role of fungus and the ability to confirm its presence are still problematic issues, and additional studies are required.

The purpose of this study was to evaluate the effect of lengthening of voice onset time and burst duration of selected speech stimuli on perception by individuals with auditory dys-synchrony. This is the second of a series of articles reporting the effect of signal enhancing strategies on speech perception by such individuals.

Two experiments were conducted: (1) assessment of the ‘just-noticeable difference' for voice onset time and burst duration of speech sounds; and (2) assessment of speech identification scores when speech sounds were modified by lengthening the voice onset time and the burst duration in units of one just-noticeable difference, both in isolation and in combination with each other plus transition duration modification.

Lengthening of voice onset time as well as burst duration improved perception of voicing. However, the effect of voice onset time modification was greater than that of burst duration modification. Although combined lengthening of voice onset time, burst duration and transition duration resulted in improved speech perception, the improvement was less than that due to lengthening of transition duration alone.

These results suggest that innovative speech processing strategies that enhance temporal cues may benefit individuals with auditory dys-synchrony.

We aimed to determine: (1) whether mean platelet volume was elevated in patients with sudden sensorineural hearing loss, compared with healthy controls; and (2) whether mean platelet volume level was related to hearing loss severity.

The study included 31 patients with sudden sensorineural hearing loss and 31 age- and sex-matched, healthy controls. Peripheral venous blood samples were taken from subjects and mean platelet volume and levels of glucose, total cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride were measured.

Mean platelet volume was significantly greater in the sudden sensorineural hearing loss group compared with the control group. However, there was no significant correlation between mean platelet volume level and hearing loss severity.

Mean platelet volume, a determinant of platelet activation, is elevated in patients with sudden sensorineural hearing loss. To our knowledge, this is the first report investigating mean platelet volume levels in such patients. Our findings indirectly support the hypothesis of vascular impairment as a pathogenetic factor in sudden sensorineural hearing loss.

Lesions arising in the external auditory canal that require surgical excision are uncommon. They are associated with a range of pathologies, including bony abnormalities, infections, benign and malignant neoplasms, and epithelial disorders.

This paper describes a 10-year personal case series of external auditory canal lesions with chart, imaging and histopathology review.

In total, 48 lesions required surgical management, consisting of: 13 bony lesions; 14 infective lesions; 14 neoplasms with 11 histological types (including ceruminous adenoma and the extremely rare cavernous haemangioma); 3 epithelial abnormalities; and 4 other benign lesions. The surgical management is described.

This study emphasises the diagnostic differences between exostoses and osteomas, and between external auditory canal cholesteatoma and keratosis obturans. It also discusses the management of aural polyps, and highlights the need to excise external auditory canal masses for histology in order to guide subsequent treatment.

To investigate what kinds of stimuli are effective in detaching otoconia from the cupula in three experimental models of cupulolithiasis.

Three experimental models of cupulolithiasis were prepared using bullfrog labyrinths. Three kinds of stimuli were applied to the experimental models. In experiment one (gravity), the labyrinth preparation was placed so that the cupula-to-crista axis was in the horizontal plane with the canal side in the downward position. In experiment two (sinusoidal oscillation), the labyrinth preparation was placed 3 cm from the rotational centre of a turntable, which was sinusoidally rotated with a rotational cycle of 1 Hz and a rotational angle of 30°. In experiment three (vibration), mechanical vibration was applied to the surface of the bony capsule around the labyrinth using a surgical drill.

In experiments one, two and three, the otoconial mass was respectively detached in 2 out of 10 labyrinth preparations, none of the labyrinth preparations, and all of the labyrinth preparations.

Vibration was the most effective stimulus for detaching the otoconia from the cupula in these experimental models of cupulolithiasis.

This study aimed to evaluate the feasibility and efficacy of the recently described chondroperichondrial clip myringoplasty technique, and make comparisons with conventional myringoplasty techniques.

The study comprised a select group of patients with chronic otitis media (mucosal disease only), with central tympanic membrane perforations affecting less than 50 per cent of the pars tensa, and an air–bone gap below 35 dB. A modified custom-made cartilage perichondrial graft was placed using the recently described ‘clip’ technique.

The graft success rate was 91.3 per cent. Post-operatively, the air–bone gap was within 10 dB in 52 per cent of cases and within 10–20 dB in 48 per cent of cases. There were few minor complications.

Chondroperichondrial clip myringoplasty can be considered as an alternative minimally invasive technique for the repair of select cases of tympanic membrane perforations. This technique, which showed impressive results, was associated with minimum morbidity and reduced operative time.

To determine whether the administration of mitomycin C prevents propylene glycol exposure from inducing middle-ear cholesteatoma and otitis media, in a rat model.

Twenty-four Wistar rats underwent intratympanic injections on days 1, 8 and 15, via the tympanic membrane pars tensa, in both the right and left ears. The right ear injection solution contained 50 per cent propylene glycol, gentamicin and saline (0.9 per cent), while the left ear solution contained 50 per cent propylene glycol, gentamicin and mitomycin C. Animals were sacrificed and examined.

There were statistically significant differences between the control and experimental groups for tympanic bulla mucosal thickness (p = 0.004) but not for tympanic membrane thickness (p = 0.371), otomicroscopic findings (p = 0.262), or the presence of exudate (p = 0.125), fibrosis (p = 1.000) or cholesteatoma (p = 0.687).

Intratympanic mitomycin C was ineffective in preventing middle-ear cholesteatoma and otitis media in this rat model.

Nasal polyposis is characterised by opacification of the nasal cavities, paranasal sinuses and ostiomeatal complexes on computed tomography scanning. Sinonasal bony changes have been reported as disease sequelae.

To assess the prevalence of sinonasal bone expansion, erosion and thickening in patients with nasal polyposis, and to correlate disease severity with the prevalence of bony changes.

A retrospective radiological study was conducted comprising pre-operative computed tomography scans of 104 patients with nasal polyposis and scans of 44 age- and gender-matched individuals (control group) without sinonasal disease. Lund–Mackay scores and bony changes were quantified.

Ninety-three per cent of the study group scans showed sinonasal bony change, with no changes in the control group. Radiological severity of nasal polyposis correlated positively with the prevalence of bony changes (rs = 0.31; p < 0.01).

Sinonasal bony changes were common in the study group. This highlights the importance of pre- and intra-operative imaging, which can help to prevent intra-operative complications. As bony changes may mimic invasive disease, the importance of histological assessment of polyps is emphasised.