Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers.

Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted.

These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period.

The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

To assess contralateral suppression of transiently evoked otoacoustic emissions in patients with fibromyalgia syndrome and normal hearing.

Twenty-four female patients with fibromyalgia syndrome and 24 healthy female controls with normal hearing were assessed using pure tone audiometry and transiently evoked otoacoustic emissions.

All patients with fibromyalgia syndrome and all controls had normal hearing on pure tone audiometry. In the patients with fibromyalgia syndrome, the mean transiently evoked otoacoustic emission amplitude was 15.5 ± 4.8 dB. The mean transiently evoked otoacoustic emission amplitudes after contralateral suppression was 15.5 ± 4.9 dB. There was no statistically significant difference between the transiently evoked otoacoustic emission amplitudes measured before and after contralateral suppression (p > 0.05). In the controls, the mean transiently evoked otoacoustic emission amplitude was 12 ± 5 dB. The mean transiently evoked otoacoustic emission amplitudes after contralateral suppression was 11 ± 4.7 dB. There was a statistically significant decrease in transiently evoked otoacoustic emission amplitudes after contralateral suppression (p < 0.01).

The mechanisms related to contralateral suppression of transiently evoked otoacoustic emissions seem dysfunctional in fibromyalgia syndrome. This dysfunction may be at the brain stem level, where the medial superior olivary complex is located, or at the synapses of medial superior olivary complex fibres with the outer hair cells in the cochlea. Demonstration of lack of contralateral suppression of transiently evoked otoacoustic emissions can be used as a diagnostic tool in patients with fibromyalgia syndrome.

The objective of the study was to correlate quantitative changes in the lipid composition of human cerumen with changes in age, sex and menstrual cycle stage.

Cerumen samples were collected from the external ear canal and analysed using sequential, one dimensional, high performance thin layer chromatography.

The following age groups of both sexes were investigated: one to 10 years; 11–18 years; 19–40 years; and 40 years and over. Additionally, cerumen samples from subjects in three stages of the menstrual cycle were compared.

In the cerumen samples, the peak values for wax ester and cholesterol occured between the ages of one and 10 years for both sexes. However, squalene and triglyceride content reached maximum levels at puberty. Men aged 19–40 years had a significantly greater percentage of cerumen lipid squalene content than women from the same age group; however, their cholesterol content was found to be lower. Regarding the various menstrual cycle stages, cerumen samples taken at the follicular stage from women aged 19–40 years had a significantly lower free fatty acids content, and higher cholesterol and squalene levels, compared with samples taken in the luteal or menstrual stages.

The proportions of the lipid constituents of cerumen varied with age, sex and menstrual stage. In cerumen, the main lipid constituent stimulated at puberty appears to be squalene, not wax esters as reported for sebum. The relevance of lipid constituents to cerumen's protective role is discussed.

In most centres in the United Kingdom, endoscopic dacryocystorhinostomy is currently undertaken as a joint operation between ophthalmologists and otolaryngologists. The addition of an extra surgeon, the use of endoscopic equipment and the relatively lower success rate of this procedure made us compare endoscopic dacryocystorhinostomy and external dacryocystorhinostomy with regards to costs and income for our hospital.

All 38 primary endoscopic dacryocystorhinostomy cases performed in our centre in 2001–2003 were retrospectively compared with the 49 external dacryocystorhinostomy cases performed in 1993–2000. Cost–income calculations were made based on: rate of local anaesthesia, success rate, rate of day case admission, hospital reference cost for dacryocystorhinostomy, and the income per case extracted from national tariffs (based on the Health Resources Group). Also, the average number of cases per session was used to calculate the income gained per session for each method.

The following rates between the endoscopic and the external dacryocystorhinostomy were found: local anaesthesia, 29 vs 6 per cent, respectively; day-case operation, 95 vs 12 per cent, respectively; and success rate, 87 vs 94 per cent, respectively. The average number of endoscopic dacryocystorhinostomy cases conducted in a single theatre session was twice that of external dacryocystorhinostomy cases. Endoscopic dacryocystorhinostomy generated approximately twice the income of external dacryocystorhinostomy (£6585 vs £3292, respectively).

Endoscopic dacryocystorhinostomy is more cost-effective than external dacryocystorhinostomy, despite having a lower success rate and greater usage of resources, as the endoscopic procedure generates more income. This is mainly due to the higher number of cases per session and the higher rates of local anaesthesia and day case operations possible.

Repeated exposure to excessive noise will eventually lead to an irreversible increase in hearing thresholds. In theory, the damage reflects both the intensity of the noise and the duration of exposure. This is not linear with respect to duration of exposure; rather, the worker may experience a disproportionate loss in the early years of exposure.

A prospective study surveying workers of the production section (i.e. most noise-exposed area) of a bottling factory was carried out in December 2003 and in December 2005. A self-administered questionnaire was used to extract information about worker's demographic characteristics, drug intake, and medical and occupational history, as well as information on the use of hearing protection devices. Noise mapping of the various departments of the factory was carried out. Otological examination, tympanometry and audiometry were also carried out on selected subjects.

Eighty-four workers, 76 (90.5 per cent) men and eight (9.5 per cent) women, were studied. Their mean age was 33.0 ± 7.6 years in 2003 and 35.0 ± 7.6 years in 2005. The recorded noise levels in the factory production section ranged between 91.5 and 98.7 dBA. The prevalence of sensorineural hearing loss among workers was noted to be 64.9 and 86.9 per cent for test one (2003) and test two (2005), respectively. The degree of hearing deterioration within the two years of this study was 1.0–3.2 dB for the right ear and 1.6–3.4 dB for the left ear. This deterioration was at discrete frequencies. More than half (53.6 per cent) of the workers did not have a hearing protection device. Of the 46.4 per cent who did, only 38.5 per cent claimed to have used it regularly.

These findings showed that there was a high prevalence of mild sensorineural hearing loss and significant hearing deterioration among workers, due to exposure to excessive noise over a two-year period. The study demonstrates the practical importance of serial audiometry for noise-exposed workers as a means of monitoring hearing deterioration. It is necessary to enforce existing occupational health laws in our industries in order to prevent noise-induced hearing loss, since it is eminently preventable.

To demonstrate the importance of a detailed history when assessing patients with a repeated pattern of foreign body ingestion.

A 19-year-old woman presented to our department following accidental ingestion of a teaspoon. On further questioning, she admitted to a habit of binge-eating followed by self-induced vomiting, in order to avoid weight gain; she blamed this behaviour on a stressful relationship with her partner. She also had one previous episode of accidental ingestion of a plastic spoon, which had been removed by oesophagogastroduodenoscopy. The patient underwent an uneventful rigid oesophagoscopy and foreign body removal. During post-operative recovery, she admitted that she had suffered for years with bulimia and anorexia nervosa. She was discharged home after appropriate psychiatric counselling, and follow up was arranged.

Oesophageal foreign bodies are commonly encountered in otolaryngology practice. Such circumstances are often compounded by pre-existing psychiatric problems such as bulimia and/or anorexia nervosa. Patients with bulimia may often present with a very similar pattern of multiple episodes of ingestion of large foreign bodies. Identification of this eating disorder (especially when there is a recurrent history of large, accidentally ingested foreign bodies) and prompt psychiatric referral is essential for efficient long-term management of this condition.

(1) To assess the subjective tinnitus perception of patients with audiologically proven hearing loss presenting to a tinnitus clinic, both before and after hearing aid provision; (2) to investigate subjective tinnitus perception in patients with unilateral and bilateral hearing loss; and (3) to assess the impact on tinnitus perception, if any, of a digital hearing aid programme in patients provided with hearing aids.

Prospective data collection for patients attending a tinnitus clinic over a 25-year period (1980–2004).

University teaching hospital otolaryngology department.

A total of 2153 consecutive patients attending a consultant-delivered specialist tinnitus clinic.

A visual analogue scale was used to assess the degree of tinnitus perception improvement, if any, comparing before versus after unilateral or bilateral aiding (in those with audiometrically proven hearing loss). A further assessment compared the effect of digital hearing aid programme introduction on symptomatic tinnitus perception in patients provided with unilateral or bilateral aids.

A total of 1440 patients were given hearing aids (826 unilateral and 614 bilateral). There was little difference in tinnitus perception, comparing overall aiding results in unilaterally or bilaterally aided patients. Overall, 554 (67 per cent) of unilaterally aided patients and 424 (69 per cent) of bilaterally aided patients reported some improvement in their tinnitus perception following aiding. There was a statistically significant improvement in tinnitus perception, comparing analogue aids with digital hearing aids, following introduction of a digital hearing aid programme in 2000, in both unilaterally (p < 0.001) and bilaterally (p < 0.001) aided patients.

Provision of hearing aids in patients with audiometrically demonstrable hearing loss can play a very important part in tinnitus control. The additional improvement in tinnitus control observed following introduction of programmable digital aids had a summative effect in the management of these patients.

The aims of this study were (1) to explore whether the experience at the Radcliffe Infirmary (Oxford, UK) supported the use of combined approach tympanoplasty for cholesteatoma, by determining the rate of disease at subsequent surgery, and (2) to assess whether this rate differed from findings reported elsewhere in the literature, possibly due to the effect of using an oto-endoscope.

Retrospective case review, with data entered prospectively for operations performed by a single surgeon.

Tertiary referral hospital.

Between January 1998 and December 2004 inclusive, 66 patients underwent 68 primary procedures, with data available for all ‘second looks’.

Diagnostic and therapeutic operations for cholesteatoma were performed.

All patients in this study attended follow up and underwent a second look operation, during which the rate of residual and recurrent cholesteatoma was determined. An oto-endoscope was used at all primary and subsequent surgery.

The mean interval between the first and second combined approach tympanoplasty procedures was 16 months, and that between the second and third such procedures was 19 months (10 patients). One patient underwent a fourth combined approach tympanoplasty procedure, 17 months after a third such procedure. The rate of cholesteatoma at second combined approach tympanoplasty was 20.6 per cent (14/68); this was judged to be residual in 10 ears (14.7 per cent) and to be recurrent, with the redevelopment of retraction pockets, in four ears (5.9 per cent). The rate of cholesteatoma at third combined approach tympanoplasty was 20 per cent (two of 10); of these two, one patient had a small pearl in the middle ear removed with the aid of a potassium titanyl phosphate laser. There was no disease present in one patient at a fourth combined approach tympanoplasty. Only four patients required a modified radical mastoidectomy.

Cholesteatoma remains a disease with significant morbidity. Endoscope-assisted surgery may decrease the morbidity of second look surgery and may improve the clearance of disease in appropriately selected patients.

To determine the decibel sound pressure levels generated during extracorporeal lithotripsy for salivary stones, and if such lithotriptor noise levels have the potential for acoustic trauma.

Minilith SL-1 salivary gland lithotriptor, sound level meter; five patient survey.

Decibel measurements were conducted on the lithotripter-generated sounds, using a sound level meter at specific distances from the active element. In addition, a patient survey was conducted as a cross-reference, to enable comparison of predicted results with actual human perception of sound levels.

Sound levels ranged between 68 and 80 dB during treatment sessions, for both the lithotriptor operator and the patient.

During routine use, no acoustic trauma is incurred by either the lithotriptor operator or the patient.

The aim of this study was to present the management and survival data of patients with squamous cell carcinoma of the temporal bone, and to discuss whether extensive surgery improves survival.

Retrospective, case-series review of 17 patients (18 cases) with temporal bone carcinoma (15 primary and three recurrent tumours), over a period of 20 years.

Tertiary referral centre – university hospital.

Disease-specific and overall five-year survival.

The mean age at presentation was 63 years, with a range of 39 to 75 years. Twelve cases of de novo tumour were managed by surgical resection followed by adjuvant radiotherapy in 10 cases, while three such patients were considered incurable from the outset and were given a combination of radiotherapy and chemotherapy. Of the three patients referred to our unit with recurrent disease, two were treated elsewhere with radical mastoidectomy and one with chemoradiation; all were subsequently managed by subtotal petrosectomy. The disease-specific and overall five-year survival for the entire cohort was 64.17 per cent (mean 89 months; 95 per cent confidence interval, 62–117) and 47.06 per cent (mean 70 months; 95 per cent confidence interval, 43–98), respectively. The disease-specific and overall survival for patients with advanced T3 and T4 tumours was 59 per cent (mean 83 months; 95 per cent confidence interval, 53–113) and 40 per cent (mean 62; 95 per cent confidence interval, 33–91 months), respectively. All but one recurrence developed within 12 months of initiating treatment. No deaths occurred after 26 months of follow up.

A lateral temporal bone resection is adequate treatment for T1 and T2 tumours. Post-operative radiotherapy should probably be offered for large T2 tumours. For T3 and T4 tumours, a subtotal petrosectomy with parotidectomy followed by post-operative radiotherapy is adequate treatment, as it offers a similar outcome to that of more extensive procedures.

To assess the five-year outcome of the use of single-flanged tympanostomy tubes in children, including the time to extrusion, rate of retained tubes and rate of persistent perforation.

The medical records relating to 640 single-flanged tympanostomy tubes intended for short-term use in paediatric patients were retrospectively reviewed.

We found that 36.4 per cent of the tubes had extruded within 12 months and 71.0 per cent within 24 months. Results showed that 14.1 per cent of the tubes had been removed because of prolonged retention, with a mean time to removal of 38.9 months. The time to extrusion was longer and the rate of retained tubes was higher than those reported for several other short-term tubes. We found that 4.5 per cent of tube insertions had resulted in a persistent perforation, a higher percentage than previously reported for other tubes intended for short-term use. Within five years of tube insertion, 70.5 per cent of the tympanic membranes had normalised.

Nasal polyposis is one of the most common inflammatory pathologies of the nasal cavity. The aetiopathogenetic mechanisms of nasal polyp formation are still unclear.

The aim of this study was to investigate the serum leptin levels in patients with nasal polyposis.

A randomised, prospective study was performed of 28 adult patients with nasal polyposis and 22 control subjects of a similar age, sex and body mass index.

Serum leptin levels were 12.10 ± 9.39 ng/ml in the nasal polyposis patients and 6.17 ± 7.68 ng/ml in the controls. A significant difference (p = 0.021) was observed in the mean serum leptin levels between nasal polyposis patients and controls.

Serum leptin levels were found to be significantly higher in patients with nasal polyposis. Leptin, apart from its primary role in the regulation of body weight and energy expenditure, may have a role in the inflammatory response of nasal polyposis.

Recent research has indicated that sphingosine 1-phosphate plays a role in allergy. This study examined the effect of allergen challenge on the expression of sphingosine 1-phosphate receptors on the eosinophils of allergic rhinitis patients, and the effect of steroid treatment on this expression.

A prospective, non-randomised study.

The study had three parts. Firstly, sphingosine 1-phosphate receptor expression on the eosinophils of allergic rhinitis patients and control patients was determined. Secondly, sphingosine 1-phosphate receptor expression was quantified pre- and post-allergen challenge, before and after a short course of fluticasone propionate; all patients underwent symptom scoring and peak nasal inspiratory flow measurement pre- and post-allergen challenge, both before and after steroid or saline treatment. Thirdly, the effect of sphingosine 1-phosphate on eosinophil migration was examined.

The eosinophils of both allergic rhinitis patients and controls expressed sphingosine 1-phosphate1, 3, 4, and 5. Eosinophils from all allergic rhinitis patients demonstrated up-regulation in sphingosine 1-phosphate expression after allergen challenge. These changes were statistically very significant for sphingosine 1-phosphate1, 4, and 5, and moderately significant for sphingosine 1-phosphate3. Sphingosine 1-phosphate receptor expression up-regulation was abolished in the steroid-treated group after allergen challenge; however, the saline-treated group showed no change in sphingosine 1-phosphate receptor expression after allergen challenge. Peak nasal inspiratory flow scores were significantly diminished after allergen challenge prior to treatment, but not after a course of topical nasal steroids. Sphingosine 1-phosphate induced eosinophil chemotaxis was increased following allergen challenge in allergic rhinitis subjects.

Local intranasal steroid therapy acts directly to block allergen-induced up-regulation of sphingosine 1-phosphate receptors on the peripheral eosinophils of allergic rhinitis patients, and this is coincident with post-challenge peak nasal inspiratory flow measurement improvements. These observations support the idea that such an increase in sphingosine 1-phosphate receptor expression is clinically relevant in allergic rhinitis, with potential consequences for eosinophil migration and survival.

To evaluate the vestibular aqueduct in patients with sudden sensorineural hearing loss.

We evaluated 19 patients (12 men and seven women; age range, 22−79 years) with unilateral sudden sensorineural hearing loss, using computed tomography and magnetic resonance imaging. All these patients had unilateral sudden sensorineural hearing loss. We also evaluated 47 control subjects (22 men and 25 women; age range, 22–79 years).

In sensorineural hearing loss affected ears, the width of the vestibular aqueduct at the midpoint and at the operculum was significantly greater than that in contralateral ears or in control ears. The width of the vestibular aqueduct at the midpoint and the operculum did not correlate with the audiometric threshold or the audiogram configuration. Contrast enhancement of the ipsilateral endolymphatic sac was observed in 17 of 19 patients with sudden sensorineural hearing loss (89 per cent). Eleven of these 17 patients also showed enhancement on the contralateral side, but no patient showed enhancement only on the contralateral side. In sensorineural hearing loss affected ears, the width of the vestibular aqueduct did not differ significantly between those patients with and without enhancement.

The vestibular aqueducts of sudden sensorineural hearing loss affected ears are wider than those of controls. Precise imaging and evaluation of the inner ear is essential when investigating the pathological conditions responsible for sudden sensorineural hearing loss.

Deafness is the hidden disability of childhood, and leads to poor educational and employment prospects. There is little published information on deafness in Pakistan. Profound hearing impairment is more prevalent in countries where consanguineous marriages are common, such as Pakistan. This study aimed to assess causes of childhood deafness and association with parental consanguinity, within deaf and hearing children in the Peshawar district of Pukhtoonkhwa Province, Pakistan.

One hundred and forty deaf children were identified from two schools for deaf children within the Peshawar district. These children were assessed via audiology, otoscopic examination, case note review and parental history, in order to attempt to ascertain the cause of their deafness. Two hundred and twenty-one attendees at a local immunisation clinic (taken as representative of the local childhood population) were also screened for hearing impairment. Parents of both groups of children were assessed by interview and questionnaire in order to ascertain the mother and father's family relationship (i.e. whether cousins or unrelated).

Of the 140 deaf school pupils, 92.1 per cent were profoundly hearing impaired and 7.9 per cent were severely hearing impaired. All these children had bilateral sensorineural hearing loss. A possible cause of deafness was identified in only six of these children. Parental consanguinity (i.e. first or second cousins) was established for 86.4 per cent of deaf school pupils and 59.7 per cent of immunisation clinic attendees. None of the control children were identified as having a hearing problem.

The prevalence of parental consanguinity was significantly higher in deaf children compared with non-hearing impaired children. However, the study also confirmed a high rate of consanguinity within the general Peshawar community. In this setting, prevention of consanguineous unions is the only means of reducing levels of congenital hearing impairment. The current levels of hearing disability represent both a prominent public health problem and an important, potentially preventable childhood disability.