This study evaluated a nasal surgical questionnaire designed for monitoring surgical outcomes and comparing different techniques.

Eighty-three healthy volunteers answered the same questionnaire twice with a minimum interval of five weeks. Three visual analogue scale items were used to assess nasal obstruction during the day, at night and during exercise. Respondents rated nasal obstruction severity by marking on a 10 cm line, with scores ranging from 0 to 100 (measured in millimetres). Other nasal symptoms, considered secondary outcomes, were graded using four-point Likert scales.

Mean visual analogue scale scores for nasal obstruction severity experienced during the day, at night and during exercise at initial assessment were 9.99, 12.95 and 11.67, respectively. Thirty-eight per cent of scores indicated no obstruction (scores of 0), 47 per cent indicated mild obstruction (scores 1–30), 13 per cent indicated moderate obstruction (scores 31–70) and 2 per cent indicated severe obstruction (scores 71–100). Males had higher scores than females. The scores for the first and second assessment did not differ, except at night for obstruction in allergic individuals which was considered clinically unimportant.

The questionnaire reliably assesses nasal symptoms and may be useful for prospective studies of nasal surgery.

To study the biomechanical properties of glass ionomer cement used for incudostapedial rebridging.

Two groups were established based on the size of the gap between the incus and stapes (1.0 mm in group 1 and 2.0 mm in group 2). Glass ionomer cement was applied to the gaps, and compression tests were performed. Maximum force was measured at the fracture point, and was divided by the cross-sectional area to obtain the maximum compressive strength.

No significant difference was found in the maximum force for the two groups (p = 0.312). The glass ionomer cement diameter was significantly higher in group 2 than in group 1 (p = 0.006). The maximum compressive strength was significantly higher in group 1 than in group 2 (p = 0.042).

The fragility of bone cement used in this study was 25.5 per cent higher for a 2 mm gap than for a 1 mm gap. We speculate that the use of bone cement may be safer for the repair of smaller incudostapedial defects.

To demonstrate that the elevated prevalence of migraine in patients with vertigo disorders is due to enhanced sensitivity to dizziness, which could cause migraineurs to seek more, or earlier, medical care for vertigo disorders, confounding the ability to show causation.

This case–control study investigated whether migraineurs perceive dizziness more intensely than non-migraineurs by comparing caloric responses in migraineurs, non-migraineurs and possible migraineurs. The summed caloric responses in the best responding ear were reviewed.

The migraine group had higher caloric response values, with a mean of 37.97 degrees per second, which was statistically significant when compared to the values for the possible migraine group (30.74 degrees per second (p < 0.05)) and the non-migraine group (30.70 degrees per second (p < 0.001)).

The findings suggest that migraineurs experience vestibular stimuli more intensely compared to non-migraineurs, which might explain the association of migraine with vestibular disorders in general.

To determine the outcome of myringoplasty as undertaken by ENT surgeons in the UK, and to assess the current systems available for providing national outcome data.

A prospective national multicentre audit was conducted involving multiple hospitals throughout the UK. Participants consisted of ENT surgeons practising in the UK.

Data were prospectively collected over a three-year period between 1 March 2006 and 1 March 2009 using the web-based Common Otology Database. In total, 33 surgeons provided valid and complete data for 495 procedures. The overall closure rate for myringoplasty was 89.5 per cent. The average hearing gain for successful primary myringoplasties was 9.14 dB (standard deviation = 10.62). The Common Otology Database provided an effective platform for capturing outcome data.

Myringoplasty is a safe and effective procedure in the UK. With the introduction of revalidation by the General Medical Council, participation in national audits will be mandatory in the future. This study demonstrates that a web-based audit tool would be suitable for performing such audits.

Despite extensive soft tissue reduction, the most common complications associated with bone-anchored hearing aid systems, also known as bone-anchored hearing implants, are related to adverse skin reactions around the abutment. The necessary soft tissue reduction also adds complexity to the surgical procedure. This study aimed to evaluate the surgical and audiological outcomes of a new connective interface of the Cochlear™ Baha® BA400 device implanted using the one-stage surgical technique.

A multicentre, retrospective case series is presented, including data collected from three tertiary care institutions.

In total, 16 patients who had undergone bone-anchored hearing aid surgery over a 10- to 12-month period were assessed for hearing performance, implant stability and surgical complications.

This case series indicates that new abutments with a hydroxyapatite coating can be implanted percutaneously without soft tissue reduction. Furthermore, device implantation using this surgical technique may have some advantages compared with a conventional device and procedure combination over 12- to 16-months of follow up.

To investigate whether thymoquinone has any eliminative effects against inner-ear damage caused by acoustic trauma.

Thirty-two male rats were divided into four groups. Group 1 was only exposed to acoustic trauma. Group 2 was given thymoquinone 24 hours before acoustic trauma and continued to receive it for 10 days after the trauma. Group 3 was only treated with thymoquinone, for 10 days. Group 4, the control group, suffered no trauma and received saline instead of thymoquinone. Groups 1 and 2 were exposed to acoustic trauma using 105 dB SPL white noise for 4 hours.

There was a significant decrease in distortion product otoacoustic emission values and an increase in auditory brainstem response thresholds in group 1 on days 1, 5 and 10, compared with baseline measurements. In group 2, a decrease in distortion product otoacoustic emission values and an increase in auditory brainstem response threshold were observed on day 1 after acoustic trauma, but measurements were comparable to baseline values on days 5 and 10. In group 3, thymoquinone had no detrimental effects on hearing. Similarly, the control group showed stable results.

Thymoquinone was demonstrated to be a reparative rather than preventive treatment that could be used to relieve acoustic trauma.

This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre.

A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits.

In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups.

Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

Litigation is a rising financial burden on the National Health Service. This study aims to show if litigation is increasing in rhinology and which procedures lead to the most claims.

Ten years of data were obtained from the National Health Service Litigation Authority. Rhinology claims were examined for cost, injury, diagnosis and operation type.

Of the 123 rhinology claims identified, 52 per cent were successful. There was a 56 per cent increase in the average annual number of claims between the first half of the study period and the second (p = 0.0451). The commonest reasons for a claim were poor cosmesis (15.6 per cent) and lack of informed consent (14 per cent).

The number of claims in rhinology increased over the study period. Most claims resulted from poor cosmetic outcome, lack of consent or recognised complications. It is suggested that enhanced communication and management of patient expectations could reduce litigation and improve patient satisfaction.

This study compared the results of nasal Staphylococcus aureus carriage and nasal cytology in men with and without a moustache.

The study group comprised 118 adult men with a moustache, and the control group consisted of 123 adult men without a moustache. Samples were taken from the participants' right nasal cavity for cytology and from the left nasal cavity for microbiology.

The results for S aureus were positive in 19.5 per cent (n = 23) of participants with a moustache and in 20.3 per cent (n = 25) of men without a moustache. This difference was not significant (p > 0.05). However, nasal cytology revealed rich eosinophil clusters in participants with a moustache.

The presence or absence of a moustache had no effect on nasal S aureus colonisation. However, further research is needed to understand whether the presence of a moustache increases the risk of allergic or non-allergic rhinitis.

The role played by Mycoplasma pneumoniae and Chlamydophila pneumoniae in the pathogenesis of chronic rhinosinusitis with nasal polyps has been the object of ongoing debate. We used real-time polymerase chain reaction to investigate the prevalence of both microorganisms in the nasal tissue samples of patients and controls.

We extracted DNA from nasal polyp samples obtained during functional endoscopic sinus surgery and the inferior turbinate samples of controls undergoing septoplasty. We used the highly sensitive real-time polymerase chain reaction to detect the presence of M pneumoniae and C pneumoniae DNA.

Patients with chronic rhinosinusitis with nasal polyps consisted of 62 individuals (39 men; mean age 51 years); the control group consisted of 24 individuals (13 men; mean age 45 years). All samples from both groups were negative for M pneumoniae and C pneumoniae DNA.

We have demonstrated that the likelihood of M pneumoniae and C pneumoniae acting as an ongoing inflammatory stimulus in chronic rhinosinusitis with nasal polyps is slim.

To investigate whether the aetiology for hearing impairment in neonates with unilateral auditory neuropathy spectrum disorder could be explained by structural abnormalities such as cochlear nerve aplasia, a cerebellopontine angle tumour or another identifiable lesion.

In this prospective case series, 17 neonates were diagnosed with unilateral auditory neuropathy spectrum disorder on electrophysiological testing. Diagnostic audiology testing, including auditory brainstem response testing, was supplemented with computed tomography and/or magnetic resonance imaging.

Ten of the neonates (59 per cent) showed evidence for cochlear nerve aplasia. Of the remaining seven, four were shown to have another abnormality of the temporal bone on imaging. Only three neonates (18 per cent) were not diagnosed with cochlear nerve aplasia or another lesion. Three computed tomography scans were reported as normal, but subsequent magnetic resonance imaging revealed cochlear nerve aplasia.

Auditory neuropathy spectrum disorder as a unilateral condition mandates further investigation for a definitive diagnosis. This series demonstrates that most neonates with unilateral auditory neuropathy spectrum disorder had pathology as visualised on computed tomography and/or magnetic resonance imaging scans. Magnetic resonance imaging is an appropriate first-line imaging modality.

Although human paranasal sinuses are critical organs for nitric oxide production, little information is available regarding the role of arginase in alterations of arginine metabolism and nasal nitric oxide levels that may be informative for classifying chronic rhinosinusitis subtypes.

The expression and localisation of arginase and nitric oxide synthase isoforms in paranasal sinus mucosa were examined, and the fractional exhaled nitric oxide was measured in chronic rhinosinusitis without nasal polyps (n=18) and chronic rhinosinusitis with nasal polyps (n = 27) patients.

Increased arginase-2 activities in chronic rhinosinusitis without nasal polyps patients were associated with significantly lower levels of nasal fractional exhaled nitric oxide. Chronic rhinosinusitis with nasal polyps patients showed significant NOS2 messenger RNA upregulation with concomitant higher levels of oral and nasal fractional exhaled nitric oxide.

These results indicate that fractional exhaled nitric oxide is a valid marker for differentiating chronic rhinosinusitis phenotypes based on a delicate balance between arginase and nitric oxide synthase activities in nitric oxide production.

To assess nasal morbidity resulting from nasoseptal flap use in the repair of skull base defects in endoscopic anterior skull base surgery.

Thirty-six patients awaiting endoscopic anterior skull base surgery were prospectively recruited. A nasoseptal flap was used for reconstruction in all cases. Patients were assessed pre-operatively and 90 days post-operatively via the Sino-Nasal Outcome Test 20 questionnaire and visual analogue scales for nasal obstruction, pain, secretions and smell; endoscopic examination findings and mucociliary clearance times were also recorded.

Sino-Nasal Outcome Test 20 questionnaire data and visual analogue scale scores for pain, smell and secretions showed no significant differences between pre- and post-operative outcomes, with visual analogue scale scores for nasal obstruction actually showing a significant improvement (p = 0.0007). A significant deterioration for both flap and non-flap sides was demonstrated post-operatively on endoscopic examination (p = 0.002 and p = 0.02 respectively).

Whilst elevation of a nasoseptal flap in endoscopic surgery of the anterior skull base engendered significant clinical deterioration on examination post-operatively, quality of life outcomes showed that no such deterioration was subjectively experienced by the patient. In fact, there was significant nasal airway improvement following nasoseptal flap reconstruction.

There are many reports of operations performed to successfully close ear drum perforations. Hearing deterioration after myringoplasty is not a widely published topic. This paper presents an audit of this complication.

A six-year retrospective analysis of a series of myringoplasty operations was performed using electronic patient records. Patients with post-operative hearing loss were identified and those with hearing loss greater than 10 dB were further scrutinised.

Out of 187 patients who underwent myringoplasty procedures, 44 (23.53 per cent) experienced a reduction in hearing thresholds. In seven cases (3.74 per cent), the hearing loss was greater than 10 dB. A case note review revealed no obvious predictive factors, although posterior perforations and the possibility of ossicular chain manipulation were considered.

Hearing loss following myringoplasty is not rare, and this may alter the consent process for this procedure.

To evaluate the survival outcomes of patients who underwent lateral temporal bone resection as treatment for metastatic skin cancers.

A single-institute, retrospective chart review was carried out on patients who underwent lateral temporal bone resection between January 2000 and December 2012. Overall survival and disease-free survival rates were calculated.

Forty-seven patients underwent temporal bone resection for primary (n = 21) or recurrent (n = 26) malignancies. The majority of patients (95.4 per cent) had advanced disease (stage III or IV). Average patient follow-up duration was 45 months. The 5-year and 10-year overall survival rates were 40 per cent and 23 per cent respectively. The five-year disease-free survival rate was 28 per cent.

Aggressive initial surgical resection is warranted in the treatment of these tumours.

Good outcomes have been reported regarding the use of cochlear implants for mumps deafness. The mumps virus induces meningitis and/or encephalitis, which can cause central nervous system damage resulting in retrolabyrinthine hearing loss, for which a cochlear implant would be less effective.

We installed a cochlear implant in two patients with bilateral mumps deafness; one achieved a good result with the cochlear implant, but the other did not. We discuss two possible reasons for the different outcomes. Case 1 was a three-year-old girl with bilateral parotid swelling, vomiting and walking disorder. One year after cochlear implant insertion, speech perception did not develop despite of good pure tone thresholds. Case 2 was an eight-year-old girl with bilateral parotid swelling. A cochlear implant enabled her to improve hearing perception.

Although cochlear implants have been reported to be helpful for mumps deafness, cases that involve central nervous system damage may not achieve good results.

This study aimed to investigate the diagnostic value of wideband acoustic absorbance testing in otitis media with effusion.

This prospective study compared middle-ear wideband acoustic absorbance rates in three paediatric patient groups: a healthy group of 34 volunteers; 48 patients diagnosed with otitis media with effusion; and 28 patients with chronic effusion but no sign of effusion during myringotomy. The diagnostic value of absorbance testing was analysed with the receiver operating characteristic test.

The wideband acoustic absorbance rate was significantly lower in the otitis media with effusion group than in both the otitis media and healthy groups at the 0.375–2 kHz averaged mean absorbance (p < 0.017 and p < 0.001, respectively). Receiver operating characteristic analysis showed the highest diagnostic value for the 0.375–2 kHz averaged mean (area under the curve 0.984), followed by those at 1 and 1.5 kHz (area under the curve: 0.973 and 0.967, respectively).

The wideband acoustic absorbance test is more accurate for detecting middle-ear effusion compared with conventional 226-Hz tympanometry. Its practicality and objectivity suggest that the wideband acoustic absorbance test may be a better alternative for diagnosing otitis media with effusion.

This study aimed to explore adenoid regrowth after transoral power-assisted adenoidectomy down to the pharyngobasilar fascial surface.

Transoral adenoidectomy down to the pharyngobasilar fascia surface was performed on 39 patients under endoscopic guidance, using a power-assisted system. The operation time, amount of blood loss and iatrogenic injury, presence of complications, and success and regrowth rates were recorded to assess the feasibility, safety and effectiveness of our surgical technique.

In this adenoidectomy procedure, the pharyngobasilar fascia was left intact. The estimated blood loss was 5–50 ml (mean 15 ml), and the success rate was 97.3 per cent. Early complications occurred in 2.3 per cent of patients, while no long-term complications occurred in the cohort. No regrowth was found in the follow-up assessments, which were performed for 18–36 months after surgery.

Adenoid regrowth was rare after adenoidectomy down to the pharyngobasilar fascial surface. The pharyngobasilar fascia can therefore be considered a surgical boundary for adenoidectomy.

Postural sway can be assessed clinically using the Romberg test, or quantified using dynamic posturography. We assessed the potential use of a novel iPhone application as a method of quantifying sway.

Fifty healthy volunteers performed the Romberg and tandem Romberg tests on a hard floor and on foam in soundproofed and normal clinic rooms. Postural sway was recorded using the D+R Balance application and data were compared using paired t-tests.

Significantly more postural sway was noted in participants when standing with their eyes closed and feet in the ‘tandem’ position vs feet together; standing with their eyes closed on foam vs on the floor; and standing with their eyes closed on foam with feet in the tandem position vs on the floor with feet together.

This feasibility study suggests that the iPhone D+R Balance application deserves further investigation as a means of assessing postural sway and may provide an alternative to current dynamic posturography systems.

To establish the prevalence of external auditory canal exostosis (‘surfer's ear’) in Cornish surfers and investigate the potential impact on healthcare.

A total of 105 surfers were interviewed and otologically assessed on popular Cornish beaches. The degree of exostosis was graded as mild, moderate or severe.

The prevalence of external auditory canal exostosis was 63.81 per cent (33.33 per cent mild, 18.10 per cent moderate and 12.38 per cent severe). The degree of exostosis showed a significant correlation with absolute cold-water exposure time. However, there was individual variation in susceptibility to external auditory canal exostosis; 12 per cent of surfers with excessive cold-water exposure showed no exostosis. Regression analysis of surgical operations performed at the Royal Cornwall Hospital for exostosis over the last 13 years revealed an average increase of 1.23 operations per year, with an average of 13 cases per year over the last 9 years.

Exostosis of the external auditory canal is common in Cornish surfers. There appears to be individual variation in terms of susceptibility to this condition. The possible reasons for this are discussed. The increase in the technically difficult surgical operations performed for exostosis is likely to have implications for health resources in the future.